ACCORDING TO THE CENTERS FOR Disease Control and Prevention (CDC), more than one-third (36.5 percent) of American adults are obese. In addition, the U.S. National Health and Nutrition Examination Survey estimates that medical care costs associated with this disease are more than $147 billion per year and rising,
as obesity increases the risk of costly, chronic conditions such as diabetes, heart disease, stroke, arthritis and some cancers.
Since surgical procedures to treat obesity are delivering some promising outcomes for patients, COMMERCE asked doctors from New Jersey’s top hospitals to discuss the options that are available and key considerations for anyone considering one of these procedures. The following experts weighed in on these questions:
Chilton Medical Center Medical Director of Bariatric Surgery Vadim Gritsus, M.D.;
● Community Medical Center Bariatric Surgeon James V. Pasquariello, M.D., FACS;
● Englewood Hospital and Medical Center Chief of Surgery and Surgical Services James McGinty, M.D.;
● Hackensack Meridian Health Medical Director of the Center for Bariatric Surgery Karl Strom, M.D., FACS;
● Hackensack University Medical Center Division of Bariatric Surgery Chief Hans J. Schmidt, M.D., FACS:
● Holy Name Medical Center Medical Director of Bariatric Services Stefanie Vaimakis, M.D.;
● Kennedy Health Medical Director of Center for Surgical Weight Loss Marc A. Neff, M.D., FACS;
●Overlook Medical Center Bariatric Surgery Program Director Ajay Goyal, M.D., FACS;
● Robert Wood Johnson University Hospital Rahway, RWJ Surgical Weight-Loss Program Medical Director Anish Nihalani, M.D.;
● The Valley Hospital Center for Bariatric Surgery and Weight-Loss Management Medical Director Melissa Bagloo, M.D.;
● Woodbury Medical Center Director of Bariatrics By Alexander Knijnikov, M.D.
Additional insights are provided by Trinitas Regional Medical Center Director of Physical Medicine and Rehabilitation James Dunleavy, Ph.D. (joint replacement) and Rutgers Medical School’s David Bleich, M.D. (diabetes).
Chilton Medical Center, Atlantic Health System
By Vadim Gritsus, M.D., Medical Director of Bariatric Surgery
Bariatric surgery provides many benefits besides the most obvious one—weight loss. Patient experience improvement in diabetes, high blood pressure and high cholesterol and are frequently able to get rid of medications they take for these illnesses. In addition, patients experience resolution of their sleep apnea and, as a result, they have more energy and feel less tired. Patients also benefit tremendously from improved
mobility due to improvement of arthritis. One of the other positive side effects of weight-loss surgery is improved self-image, confidence and self-esteem. First and foremost, to be a candidate for bariatric surgery, patients will have to be comfortable with their ability
to make a long-term change in their lifestyle and diet. Patients will qualify for bariatric surgery if they are about 80 to 100 pounds over their ideal weight, although this number varies dependent on patient’s height. There are three main options in bariatric surgery: gastric sleeve, gastric bypass and laparoscopic gastric band. In addition, there is gastric
balloon—a non-surgical weight-loss option that is also gaining popularity. Patients are advised to research their surgical weight-loss options to choose the best procedure for them.
Community Medical Center, RWJBarnabas Health
By James V. Pasquariello, M.D., FACS, Bariatric Surgeon, Center for Bariatrics
In addition to weight loss, bariatric surgery can reverse the effects of the associated comorbidities, such as hypertension, diabetes and sleep apnea to name a few. Bariatric surgery can also reduce the incidence of developing such conditions in the future. Patients may no longer need to take medications to control diabetes, high blood pressure, high cholesterol or need to use a CPAP machine for sleep apnea after weight-loss surgery. Once a significant amount of weight is lost, your joints will benefit
too; this will help patients lead a more active way of life. We give patients tools to maintain a long-term, healthy lifestyle. There are a few ways to qualify for surgery. Candidates for weight-loss surgery are patients that have a body mass index or BMI of 40 or greater, or are 100 pounds overweight. A patient can also qualify for surgery with a BMI of 35-39.9 that has comorbidities, such as high blood pressure, type 2 diabetes and sleep apnea. Candidates should be dedicated to lifestyle changes, taking advantage of the included monthly support group sessions and lifelong follow-up appointments to achieve success. Surgical options for weight loss typically include the sleeve gastrectomy and the gastric bypass. Both procedures are done laparoscopically through small incisions, which help speed your recovery, are less painful and reduce the complications associated with the large incisions of open surgery.
Englewood Hospital and Medical Center
By James McGinty, M.D., Chief of Surgery and Surgical Services, Bariatric and General Surgeon
Studies show that bariatric (weight-loss) surgery can lead to a longer and healthier life because the sustained weight loss after surgery can prevent, improve or resolve obesity-related diseases such as heart disease, cancer and type 2 diabetes. It is also known to improve quality of life for those suffering from lower back or joint diseases,
asthma, and gastroesophageal reflux. The most common types of bariatric surgery are laparoscopic sleeve gastrectomy and laparoscopic gastric bypass. Laparoscopic, or minimally invasive, surgery allows the surgeon to perform the procedure through a few small holes in the abdomen, leading to faster recovery and lower risk of complications.
For people who are 80 pounds or more over their ideal body weight, weight-loss surgery is the best method to lose a significant amount of weight and keep it off. To be eligible for bariatric surgery, a patient must have shown an inability to maintain a healthy weight for a sustained period of time with prior weight-loss efforts. The person must also have a body mass index (BMI) equal to or greater than 40 or be 100 pounds overweight, or have a BMI equal to or greater than 35, along with one or more obesity-related disorders.
Hackensack Meridian Health, Raritan Bay Medical Center-Perth Amboy, Bayshore
Medical Center, Moutainside Medical Center and Southern Ocean Medical Center
By Karl Strom, M.D., FACS, Medical Director of the Center for Bariatric Surgery
The medical outcome of bariatric surgery is a significant decrease in excess weight as well as improvement of weight-related health conditions, such as diabetes, hypertension, sleep apnea, and joint and back pain. Within two years of surgery, type 2 diabetes is resolved in 80 percent of patients, and nearly all patients with sleep apnea
experience improvement. Being a candidate for weight-loss surgery is dependent on a patient’s body mass index or BMI. A BMI of 35 with a weight-related comorbidity such as sleep apnea, diabetes or hypertension, qualifies a patient for surgery. If a patient’s BMI is greater than 40, they qualify based on weight alone without a health issue. Our patients are at least 18 years old, and there is no upper age limit as long as they receive appropriate medical clearances. Three common procedures are gastric band (LapBand), sleeve gastrectomy, and gastric bypass. The band places a device around the upper portion of the stomach to limit the amount of food patients are able to consume. The sleeve procedure removes a portion of the stomach to make it resemble a banana; this also limits the amount of food patients can eat. Sleeve patients typically lose four pounds to six pounds per week. The bypass is a movement involved
procedure that reroutes the patient’s intestines to limit the amount of food and calories the body absorbs. Bypass is usually reserved for the very morbid obese or severe diabetics. Most patients opt for the sleeve gastrectomy.
Hackensack University Medical Center, Hackensack Meridian Health
By Hans J. Schmidt, M.D., FACS, Chief, Division of Bariatric Surgery, Director,
Center for Bariatric Medicine and Surgery, Department of Surgery
The Center for Bariatric Medicine and Surgery at Hackensack University Medical Center is one of the highest volume weight-loss surgery centers in the United States. Since performing the first laparoscopic gastric bypass in New Jersey in 1999, we have performed more than 10,000 bariatric procedures. One of the most severe sequelae of
obesity is diabetes mellitus, a life-threatening disease of which the incidence has risen 30 percent in the last 10 years. After bariatric surgery, more than 80 percent of diabetic patients have full remission of their diabetes. The American Diabetes Association recommends bariatric surgery as an effective option for obese patients suffering from diabetes. Hackensack University Medical Center is an American College of Surgeons Center of Excellence, which qualifies doctors to perform all surgical options available. In addition to the commonly performed laparoscopic gastric bypass, vertical sleeve gastrectomy and gastric banding, we offer cutting-edge endoscopic and neuromodulatory procedures. Our surgical program is combined with a multidisciplinary medical program to provide patients with comprehensive care before and after surgery. By partnering with the HackensackUMC Fitness and Wellness Center, patients have a complete program to achieve their health and fitness goals. A recent initiative allows us to identify all inpatients meeting the criteria of morbid obesity via our electronic medical record system. Our team can reach out to them during their hospital stay to begin the weight loss dialogue.
Holy Name Medical Center
By Stefanie Vaimakis, M.D., Medical Director of Bariatric Services
As a designated American Society for Metabolic and Bariatric Surgery Comprehensive Center, Holy Name Medical Center’s Bariatric Services provide comprehensive stateof-
the-art surgical and non-surgical weight-loss treatment options, nutrition counseling, and psychosocial support for adolescent and adult patients. Bariatric surgery can be curative for type 2 diabetes, high blood pressure, sleep apnea, high cholesterol, migraines and urinary incontinence. Weight-loss surgery can also reduce the incidence of joint pain, asthma symptoms, migraines and gastroesophageal reflux, and reduce the need for medications to treat these conditions. Our board-certified bariatric surgeons use minimally invasive laparoscopic techniques to perform sleeve gastrectomy surgery, gastric bypass surgery and adjustable gastric banding for patients with a body mass index (BMI) of 35 with a medical condition or a BMI of 40 without one. An innovative non-surgical option is the endoscopic gastric balloon procedure for patients with a BMI of 30 to 40, during which a saline-filled balloon is placed inside the stomach for six months to slow digestion and help patients control food portions. An exciting, new nonsurgical gastric balloon option is Obalon, the first and only FDA-approved swallowable weight-loss device, which is inflated once it reaches the stomach. When combined with a lifetime commitment to diet, exercise and lifestyle changes, these treatment options can result in long-term weight loss.
By Marc A. Neff, M.D., FACS, Medical Director, Center for Surgical Weight Loss
There are more than 65 medical conditions and 15 different cancers linked to obesity. It has been described by many as the leading health crisis of our times. Patients can expect an improvement in nearly all medical conditions related to obesity, and in certain
circumstances—such as diabetes, hypertension and sleep apnea—potential cures. Patients must have failed all non-operative attempts at weight loss. Patients must have a body mass index greater than 35 with a serious medical condition related to obesity, such as heart disease, moderate to severe sleep apnea, hypertension requiring multiple medications to control or diabetes. The most successful candidates are those committed to the lifestyle change and lifelong follow-up. The most popular surgical options today are the gastric sleeve, and the gastric bypass. The gastric sleeve removes the redundant part of the stomach and achieves permanent portion control and appetite control. The gastric bypass limits portion size and reroutes the path of digested food so that only about 80 percent of the food that is able to be ingested is absorbed.
Overlook Medical Center, Atlantic Health System
By Ajay Goyal, M.D., FACS, Director, Bariatric Surgery Program
Bariatric Surgery is really the best course of treatment for improving or resolving the common illnesses that are associated with obesity, including type 2 diabetes, sleep apnea and joint pain. Too many people don’t realize that obesity raises your risk
of other diseases, such as cancer and PCOS, so by losing between 50 percent and 80 percent of excess body weight, patients live much healthier lives. Individuals must have a BMI over 40 or a BMI over 35 with a comorbidity. However, those whose BMI is below
35 with an obesity-related illness may qualify for an investigational study. Perhaps the most important qualification is that individuals must be committed to lifestyle changes, such as healthy eating and exercise, because their long-term success will depend on it. Options for bariatric surgery include the gastric sleeve and gastric bypas; both of
these reduce the size of the stomach to help control portions, but there is also a hormonal component that helps patients feel less hungry.
Robert Wood Johnson University Hospital Rahway, RWJBarnabas Health
By Anish Nihalani, M.D., Medical Director, RWJ Surgical Weight-Loss Program
Weight-loss surgery is not a cosmetic procedure. For many, it’s medically necessary to improve overall health. It is a covered benefit under most insurance plans, including Medicare. Bariatric surgery can improve or eliminates diabetes, hypertension and sleep apnea. It can reduce or eliminate joint pain. Some of the criteria for weight-loss surgery
are determined by the insurer. You may be a candidate for surgical weight loss if you are 100 pounds over ideal body weight or have a body mass index of 35 or greater with other obesity-related conditions such as diabetes, high blood pressure, high cholesterol or severe sleep apnea. Weight-loss surgery options include laparoscopic sleeve gastrectomy, which is when the stomach is surgically reduced to nearly a quarter of its original size; laparoscopic gastric banding, which uses an adjustable band at the top of the stomach to create a small pouch that limits food intake; and laparoscopic gastric bypass, which routes food past most of the stomach and the first part of the small intestine. Surgery gives patients a tool to assist with weight loss, but it’s the mental and emotional changes that need to be made post-surgery that ensure success. We provide a comprehensive program that includes the necessary nutritional and lifestyle support
to maintain a healthy weight.
The Valley Hospital
By Melissa Bagloo, M.D., Medical Director, Center for Bariatric Surgery and
Valley’s Center for Bariatric Surgery and Weight-Loss Management offers
patients an individualized and comprehensive approach to weight loss. We
believe bariatric surgery is a life-changing, and potentially life-saving, option
for our patients. We offer consultations with a surgeon to identify the best weight-loss modality for each patient. Surgical options include adjustable gastric banding, sleeve gastrectomy, Rouxeny gastric bypass; and the duodenal switch—all of which are performed through several small incisions to minimize post-operative pain and enhance
recovery. Our staff nutritionist provides nutritional education, diet recommendations and guidance for operative preparation and recovery. We also offer medical weight-loss options for those patients who do not wish to pursue surgery. While we see successful weight loss with all of our treatment options, the gastric sleeve, gastric bypass and duodenal switch have shown the greatest weight loss and improvement in associated medical conditions in the long term. We place a strong emphasis on long-term follow up to ensure a patient’s nutritional health. With successful and sustained weight loss, ourpatients see marked improvement of their weight-related medical conditions, such as hypertension, hyperlipidemia, diabetes and sleep apnea. Most importantly, our patients experience a significant improvement in their quality of their life.
Woodbury Medical Center, Inspira Health Network
By Alexander Knijnikov, M.D., Director of Bariatrics
Shown to be the most effective treatment for obesity, bariatric surgery can be a safe option for many individuals suffering from excess weight—particularly with obesity affecting more than one-third of U.S. adults. In addition to weight loss, medical comorbidities—including hypertension, diabetes, heart disease and sleep apnea—significantly improve or completely resolve as a result of bariatric surgery. To qualify, a candidate’s body mass index (BMI), the ratio of height to weight, must be over 40, or over 35 with a medical condition related to obesity. Inspira is committed to investing
in the latest technology and innovation, such as robotics and advanced laparoscopic
equipment, to deliver superior quality of care for our bariatric patients. The three primary bariatric surgery options—all offered at Inspira Health Network—include laparoscopic sleeve gastrectomy, the most frequently performed bariatric surgery; laparoscopic Roux-en-Y gastric bypass, the classic gold standard weight loss operation; and laparoscopic adjustable band, LapBand. Many studies have shown that all three surgeries result in significantly higher weight loss than non-surgical programs, and their safety has been proven. The Cleveland Clinic’s Bariatric and Metabolic Institute found
that gastric bypass is as safe as commonly performed surgeries, including gallbladder surgery or an appendectomy.
Obesity “Epidemic” Leading to More Total Joint Replacements
According to the American Academy of Orthopedic Surgeons, more than 500,000 total knee replacements and 300,000 total hip replacements are performed each year.
These numbers represent a three-fold increase in frequency since 1993. A study appearing in the Journal of Bone and Joint Surgery found that an increase in
the prevalence of overweight people and obesity in the United States accounted
for 95 percent of the higher demand for knee replacements, with younger patients the most affected.
“Joint replacement technology has improved, leading more people to consent to surgery, but there is a definite cause and effect with weight gain and joint problems,” explains James Dunleavy, Ph.D., director of Physical Medicine and Rehabilitation at Trinitas Regional Medical Center. People who carry additional body weight increase
the pressure on their hip and knee joints, which often leads to the need for total joint replacements, he adds.
“Obesity also impacts the ability of total joint replacement patients to achieve all the potential functional gains that the procedure can provide, while it affects patients’ ability to heal properly after surgery as well,” explains Dr. Dunleavy. “At Trinitas, we screen
patients using body mass index and other measures to determine their risk and the expected outcomes of our care.”
Treating Patients with Diabetes
By David Bleich, M.D., Rutgers Medical School
I became interested in diabetes when I was an intern at Maimonides Medical Center in Brooklyn and took care of a young woman who developed type 1 diabetes; we did not
have many tools in the early ‘80’s to treat patients. I worked with my patient to try tocontrol her blood sugar, but my lack of knowledge, limited resources, and antiquated tools for testing blood sugar led to her developing eye and kidney disease in a very short period of time. I was devastated by my inability to help this woman, and became determined to work with patients to control this disease. While we’re still far away from having cellular therapy to “cure” the disease, new devices to deliver insulin are a tremendous benefit. For example, the artificial pancreas will benefit a select number of individuals with type 1 diabetes, but I shudder to think of the cost. My guess is probably $10,000 to $15,000 per year. Some of the new drugs that have come through the pipeline also offer improved glucose control. When you develop diabetes, you the patient, are the one who has to do all the “un-fun” activities to control your blood sugar: checking blood sugar, watching carbohydrate consumption and taking medications on a schedule. You do not get a vacation from the disease.
Private Practices and Personalized Patient Care Remain Popular Among U.S. Dentists
By John Joseph Parker Contributing Editor
Research shows patients still prefer time-tested, personalized relationships with their dentists who are friendly, trustworthy, possess good communications skills and are supportive. These types of high-quality relationships are typically cultivated in private
practice, where dentists have more opportunity to get to know their patients through repeated contact over time, according to Adrian LaTrace, CEO of Boyd Industries, a dental equipment manufacturer and supplier.
“Patients want a dentist they know and trust to provide the best care possible instead of a corporate-model, one size- fits-all treatment approach,” explains LaTrace. “Even though many younger dentists initially start out in a group practice, it’s not the way they
would prefer to work. Millennial dentists understand the importance of authentic relationships, and they want to be able to provide the best care possible to a patient pool they carefully develop over time.”
Today, 42 percent of working dentists are age 55 or older, and this means many of them will soon start to sell their private practices to younger dentists who want to build their own practices. Like older generations, younger dentists want the freedom, clinical autonomy and growth potential that comes with private practice ownership, instead of
becoming an employee in a corporate dental practice.
“Even as Millennial dentists work in corporate practices to pay down their student loans, they’re keeping their eye on their end goal—private practice ownership,” says LaTrace. “For these dentists, it’s about doing what they need to do initially to ensure a successful
future as practice owners who have the flexibility to care for patients.”