COMPILED BY MILES Z. EPSTEIN, EDITOR, COMMERCE
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.
Atlantic Health System, Morristown Medical Center By Ashish Padnani, M.D., Chair, Bariatric Surgery
Effective medical and surgical options to help patients achieve long-term weight loss begin with understanding the science behind obesity, and why diets and medications fail. Our multidisciplinary team—metabolic physicians, registered dietitians, psychologists and gastroenterologists—works together to understand each patient to develop a personal treatment strategy. This multidisciplinary approach helps achieve the most efficacious weight loss and improvement in weight-related comorbid conditions such as high blood pressure, diabetes, high cholesterol and others. If a more aggressive weight-loss strategy like surgery is warranted, our dedicated and specially-trained bariatric surgery health care team—surgeons, anesthesiologists, nurses, technicians and facilitators—works with the patient and his/her support network to determine the most appropriate next step, which could include laparoscopic vertical sleeve gastrectomy, laparoscopic Roux-en-Y gastric bypass, revisional bariatric surgery and more. I recently performed a laparoscopic sleeve gastrectomy on a 31-year-old who had gained weight after the birth of her child and busy, inactive lifestyle. After five months, she lost 87 pounds and frequently shares photos of her new physique on social media. Many photos are of her doing active things such as hiking with her young son, which really shows me how much the surgery changed her lifestyle, not just her body.
Englewood Health By James McGinty, M.D., Chief of Surgery and Surgical Services
Patients who undergo weight-loss surgery start the process six months prior, meeting with not only our expert weight-loss surgeons, but also our primary care physicians, registered dietitians, exercise physiologists, psychologists and support groups. Two of the most widely performed weight-loss surgeries are the vertical sleeve gastrectomy and gastric bypass. These procedures alter intestinal hormones that influence metabolism and weight loss, leading to a longer, more fulfilling life by preventing, improving or resolving obesity-related conditions such as heart disease, cancer, diabetes, hypertension and sleep apnea, as well as lower back or joint diseases, asthma, and gastroesophageal reflux. Both procedures are performed laparoscopically, significantly decreasing surgical complications and the mortality rate, while shortening recovery times and decreasing postsurgical pain. And with the addition of a new robotic system, more surgeries are now being performed robotically, allowing for better range of motion and precision. After surgery, patients are carefully monitored—most report having more energy and being able to do activities their weight previously held them back from. In addition, this year our bariatric program received reaccreditation as a distinguished three-year Comprehensive Center under the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program.
Hackensack Meridian Health, Hackensack University Medical Center By Hans J. Schmidt, M.D., Director of the Center for Bariatric Medicine and Surgery
Like many married couples, Len and Vinnie DiPiazza have shared a lifetime of wonderful experiences. But there’s one experience in particular, most others probably have not—laparoscopic bariatric surgery. After years of being overweight, Len developed type 2 diabetes. Vinnie, who struggled with her weight since her pregnancies, was having digestive issues. The weight was taking a toll on both of them. Laparoscopic bariatric surgery, which reduces the size of the stomach, is an excellent option for people who are severely overweight and suffering from significant medical problems. I performed the one-hour procedure on Len first. Over the course of a year, he went from 318 pounds to 194, resolving the diabetes. Vinnie was next, dropping from a size 20 to a size 6, in six months. With this procedure and our dietary counseling, this wonderful couple was able to reach their target weight together.
Hackensack Meridian Health, JFK Medical Center By Alexander D. Abkin, M.D., FACS, Medical Director, JFK for Life Bariatric Surgery Program
After losing her sister who was only 53 and a diagnosis of her own heart condition at age 47, Wendy Florczak contacted me about weight loss surgery. After consultations, she decided to undergo a laparoscopic sleeve gastrectomy. This involves the removal of about 80 percent of the stomach. The smaller stomach limits the amount of food that is eaten at one time by producing a full sensation. The majority of my patients—about 80 percent—request a sleeve gastrectomy when other attempts to lose weight through dieting fail. For Wendy, this made all the difference. She weighed 305 pounds before the sleeve gastrectomy and was on 13 different medications for diabetes, high cholesterol, high blood pressure and other conditions. Wendy lost 80 pounds in 15 months and is still losing weight and down to only four medications. As she continues to become healthier, Wendy appreciates small changes that other people might take for granted. “I’m no longer huffing and puffing as I walk; I can touch my toes; and I climbed a ladder to clean out the gutters,” she says. “I have a great outlook on life.”
Hackensack Meridian Health, Southern Ocean Medical Center By Jonathan Reich, M.D., FACS, Center for Bariatrics
The best option for weight loss surgery in this day and age is the sleeve gastrectomy procedure. This procedure highlights the desired combination of feeling full after a small portion size and decreased overall hunger and cravings. It is highly successful over the long term. The sleeve is performed by reshaping the stomach into a smaller size. This reduces the stomach’s capacity, as well as reducing the overall secretion of appetite hormone. The result is a nutritionally sound weight-loss procedure. Average weight loss range is between 20 and 30 pounds within the first month following the procedure and continues along in the range of 8 to 10 pounds per month until the patient is out of the body mass index (BMI) obesity category.
Holy Name Medical Center By Stefanie Vaimakis, M.D., Medical Director of Bariatric Services
Our bariatric services provide adult and adolescent patients with a comprehensive program that includes a state-of-the-art surgical weight-loss treatment option combined with nutrition, fitness and psychosocial support services. Our bariatric surgeons perform all weight-loss surgeries using the da Vinci® robot, which not only provides greater precision, but also leads to smaller incisions, minimal scarring, a quicker recovery and just one overnight stay for patients. By far, one of the most important benefits is that patients often only need over-the-counter pain relief medication, rather than narcotic pain medication. In the morning after surgery, patients are often sitting up and ready to go home, with minimal discomfort. Surgical options include gastric sleeve surgery and gastric bypass surgery. Bariatric surgery is the best long-term solution for obesity, and can potentially put type 2 diabetes into remission, reduce high blood pressure and high cholesterol, ease asthma and sleep apnea, lessen joint pain, and relieve stress urinary incontinence. As a designated Center of Excellence by the American Society for Metabolic and Bariatric Surgery, Holy Name ensures patients’ dignity and comfort with a dedicated inpatient unit, nurses with expertise in caring for bariatric patients, sensitivity training for all staff, and equipment and furnishings designed for larger patients.
Jefferson Health New Jersey By Marc Neff, M.D., FACS, FASMBS, Director, Center for Surgical Weight Loss
More than 6 million Americans are currently 100 lbs. over their ideal body weight, significantly putting their health in jeopardy. Today, we can offer patients multiple surgical options that usually fall into one of three broad categories: restrictive, malabsorptive or hormonal. A restrictive option, like the Lap-Band®, limits the patient’s eating habits. A malabsorptive option, such as gastric bypass surgery, changes the patient’s eating habits, and also changes the absorption of calories and nutrients by bypassing the stomach. Options like sleeve gastrectomy change a patient’s eating habits, but more significantly, change the hormonal response to food eaten. Choosing the proper procedure is a decision made by the patient, in collaboration with their doctor and dietitian. Here’s a success story: a 54-year-old patient—who is more than 150 lbs. over his ideal body weight—has already had bilateral knee replacements and has medical conditions including diabetes, elevated cholesterol, and severe sleep apnea. After his gastric bypass surgery, which was performed two years ago, his medical conditions are gone—his only pills are his vitamins.
RWJBarnabas Health, Newark Beth Israel Medical Center By Alan A. Saber, M.D., MS, FACS, FASMBS, Director of the Bariatricand Metabolic Surgery Program
When I came to Newark Beth Israel Medical Center in early 2018 to start the Bariatric and Metabolic Surgery Program, I was drawn to Newark Beth Israel due to its long-standing commitment to reducing obesity in the communities served. My goal was to provide patients struggling to lose weight with surgical options that can help them reach their weight loss goals.
We currently offer minimally invasive procedures called laparoscopic sleeve gastrectomy, laparoscopic Roux-en-Y gastric bypass, and laparoscopic revisional procedures. These procedures often are more commonly referred to as “sleeve,” “bypass,” and “revision.” I have seen many patients with multiple medical problems prior to surgery. After surgery, often many of their related health issues, like type 2 diabetes, hypertension, asthma, sleep apnea and heart disease risk decrease or often resolve. Patients also tell me they feel more energetic and are again able to do things they were unable to do prior to surgery. Our multidisciplinary team is never more than a phone call away, both before and after surgery. We encourage our patients to reach out at any point if they have questions, to speak to any member of the team.
RWJBarnabas Health, Robert Wood Johnson University Hospital Somerset By David Ward, M.D., Bariatric Surgeon
There are two main types of weight loss surgical procedures: gastric bypass surgery and gastric sleeve surgery. Gastric bypass surgery divides the stomach and uses the small intestine to create a bypass for food so fewer calories and nutrients are absorbed by the body. Gastric sleeve surgery involves removing about 75 percent of the stomach to leave a narrow tube or sleeve, limiting the amount of food you eat. Patients typically lose at least half of their excess weight within two years of surgery as well as note health improvements such as reduced sleep apnea, improved blood glucose levels and lower blood pressure. Over the past 20 years, I have seen many success stories. It is particularly rewarding to see the long-term impact weight loss surgery has had on individuals’ quality of life, including allowing them to do more activities that they enjoy, be more active with their children and grandchildren and achieve professional success due to their improved confidence and self-esteem. Many are able to get off of their diabetes and blood pressure medications and reduce their risk for serious health issues, such as heart attack and stroke.
Saint Peter’s Healthcare System By Carlos Aitor Macias, M.D., Surgical Director, Saint Peter’s Bariatric Center
Bariatric surgery can be grouped into two categories based on how the body works following surgery. The most common bariatric procedure performed nowadays—sleeve gastrectomy—results in patients being able to eat less than they did before the surgery because the size of their stomach is surgically reduced. This effect is called restriction and results in early satiety. Patients are satisfied after eating less amounts of food. With gastric bypass, regardless of the amount of food ingested, patients cannot absorb nutrients as they did prior to surgery. This effect happens as some segments of the bowel are bypassed when shortcuts or new connections are created by the surgeon to reroute food as it travels through the bowels. A patient referred to Saint Peter’s Bariatric Center was morbidly obese and in constant pain due to severe bilateral hip osteoarthritis. Weighing 280 pounds, she had to use a wheelchair to get around and taking analgesics around the clock with no relief from pain. She worked with our team to lose 20 pounds, soon becoming a good candidate for bariatric surgery and had a laparoscopic sleeve gastrectomy six months ago. She has since lost about 70 pounds, half of her excess weight, and continues to lose weight. Because of the significant weight loss, she became a candidate for orthopedic surgery. She had her hips replaced recently, her pain has subsided, and now she is able to walk again.
The Valley Hospital Center for Bariatric Surgery and Weight-Loss Management By Melissa Bagloo, M.D., Medical Director
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, Roux-en-Y 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, our patients 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 quality of life.