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.
Atlantic Health System, Overlook Medical Center
By Ajay Goyal, M.D., FACS, Director of Bariatric Surgery; Associate Director of Minimally Invasive Surgery
Weight loss surgery—gastric sleeve and gastric bypass—is recognized by the National Institutes of Health as the most effective long-term solution for people struggling with obesity and looking to take control of their health. I discuss with my patients that weight loss surgery success goes beyond seeing a smaller number when you step on the scale. It’s about resolving chronic health conditions, as well as victories as simple as walking without shortness of breath to as remarkable as completing a 5k race. One of my patients, who had a family medical history of cardiovascular disease and obesity, knew he wanted to break the cycle of poor eating habits, the constant struggle to lose weight and increasing health concerns—his high blood pressure and severe acid reflux. He had gastric sleeve surgery, lost 65 pounds and says he feels like his life is back on track. His blood pressure is normal, and his acid reflux problems are gone. With more energy, he has an avid interest in staying active and continues to train for his next 5K race.
East Orange General Hospital
By Naveen Ballem, M.D., FACS, Bariatric Surgery
There are multiple options for surgical weight loss, including the gastric balloon, lap band, lap sleeve gastrectomy and the lap gastric bypass. The choice of procedures is tailored to the needs of each patient and their medical issues. With these bariatric procedures, patients not only lose weight, but also their medical comorbidities, such as type 2 diabetes, hypertension, cholesterol and sleep apnea. We use a multidisciplinary approach utilizing dietitians, psychologists and personal trainers to ensure each patient reaches their weight loss goals. The most commonly performed bariatric procedure in the United States is the lap sleeve gastrectomy; the average weight loss seen is about 70 percent of one’s excess weight, which typically occurs within 12 months to 18 months. The hormonal effects of this operation help reduce the amount of hunger hormones stomachs produce (ghrelin and leptin), which helps patients lose weight and maintain it long term. The strongest effect of weight loss surgery is with the improvement of type 2 diabetes, which occurs more than 90 percent of the time. The results—patients that were once 100 pounds overweight are now running marathons, competing in triathlons and climbing mountains.
By James McGinty, M.D., Chief of Surgery and Surgical Services
Obesity is not a moral failing, or something within patients’ control—it’s a disease that has a major impact on health. Patients start the process six months before surgery, meeting with not only our expert weight loss surgeons, but also our primary care physicians, registered dietitians, exercise physiologists, psychologists and support groups to prepare them nutritionally, medically and emotionally for the operation. 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 at Englewood Health, a fact that has significantly decreased surgical complications and mortality rate, while shortening recovery times and decreasing postsurgical pain. When I was in training, the accepted mortality rate was 2 percent to 3 percent, and now it’s less than 1 percent. After surgery, patients are carefully monitored for the rest of their lives to be certain they maintain their new weight successfully and safely.
Hackensack Meridian Health, JFK Medical Center
By Alexander Abkin, M.D., Medical Director
Lifestyle changes are the key to permanent weight loss, and bariatric surgery can help address the comorbid conditions associated with obesity, such as type 2 diabetes, high blood pressure, high cholesterol and sleep apnea. Sleeve gastrectomy is a restrictive procedure which reduces the amount of food you can eat at one time. The outer portion of the stomach is removed leaving a sleeve of stomach roughly the size of a banana. After the “sleeve” is created, the leftover part of the stomach is removed. By reducing the size of the stomach, sleeve gastrectomy allows the patient to feel full after eating less and taking in fewer calories. On average, patients can expect approximately 50 percent to 60 percent excess weight loss. With gastric band surgery, the surgeon creates a stomach pouch that makes the stomach a lot smaller, reducing the amount of food it can hold. The stomach pouch is then surgically attached to the middle of the small intestine. This limits the number of calories that are absorbed and sends messages to your brain that you are full. Patients can expect approximately 60 percent to 80 percent excess weight loss.
Hackensack Meridian Health, Southern Ocean Medical Center
By Karl W. Strom, M.D., FACS, Bariatric Surgery Program
The sleeve gastrectomy is currently the most common procedure performed. This procedure reduces the size of the stomach, allowing patients to feel satisfied with less food. It also helps with satiety by removing the hunger hormones in the stomach. A gastric band is a device that, when inserted around the upper portion of the patient’s stomach, creates a small pouch, which also allows the patient to feel satisfied while restricting the amount of food they consume. The band is both adjustable and removable if necessary. Gastric bypass is another option for patients struggling with their weight. Being the most invasive procedure, this option is reserved for patients who have significant weight to lose or have diabetes that is not well controlled. Gastric bypass involves changing a patient’s anatomy to decrease the number of calories consumed. All three procedures are performed laparoscopically, with little incisions and are minimally invasive. Obesity is a disease that is often the cause of several other serious health conditions, such as diabetes, high blood pressure and sleep apnea. There are several weight loss surgery procedures that can alleviate these conditions by helping patients lose their excess weight and improve or even cure their weight-related comorbidities and enhance their quality of life and overall health.
Holy Name Medical Center
By Stefanie Vaimakis, M.D., Medical Director of Bariatric Services
Our Bariatric Services provide adult and adolescent patients with state-of-the-art surgical and non-surgical weight-loss treatment options, nutrition counseling and psychosocial support. We also offer specialized services that respect patients’ dignity and comfort, including a dedicated inpatient unit, nurses with expertise in caring for bariatric patients, sensitivity training for all staff, and equipment and furnishings for larger patients. Bariatric surgery is the best long-term solution and often is curative for type 2 diabetes, high blood pressure, sleep apnea, high cholesterol and urinary incontinence. Weight-loss surgery can also reduce the incidence of joint pain, asthma symptoms, migraines and gastroesophageal reflux. Our board-certified bariatric surgeons use minimally invasive laparoscopic techniques to perform sleeve gastrectomy surgery, gastric bypass surgery and adjustable gastric banding. An innovative non-surgical option is the endoscopic gastric balloon procedure for patients with a body mass index (BMI) of 27 or above, who are not candidates for bariatric surgery or are not interested in surgery. We also offer a medically supervised weight-loss program to help patients lose pounds and maintain a healthy weight. When combined with a lifetime commitment to following guidelines for diet, exercise, and lifestyle changes, all of these treatment options can result in long-term weight loss.
By Louis Balsama, D.O., FACS, Bariatric Surgeon
Weight loss surgery has evolved over the past 50 years to treat morbid obesity, as well as to reduce medical issues related with a patient’s weight. The most useful procedures are those which offer the best weight loss with the least amount of complications and weight regain. Currently, the most popular procedures are the laparoscopic sleeve gastrectomy and laparoscopic gastric bypass, although others are still being used in modern surgery with good results. Weight loss, in itself, may improve or resolve many medical issues, including diabetes, hypertension, sleep apnea, arthritis, and high cholesterol. As a bariatric surgeon, I have seen great success in my patients. One of my notable patients lost more than 400 pounds and kept it off, over six years and counting! He also reduced his medications from more than 10 pills a day to one single multivitamin. It is very satisfying, as a surgeon, to see such results. Weight loss surgery simply extends and improves lives. It is not only an important modality of treatment for many medical problems, it is really the most effective long-term treatment for morbid obesity.
New Bridge Medical Center
By Gian Varbaro, M.D., Chief Medical Officer
There are a wide range of options for bariatric surgery. These procedures range from minimally invasive endoscopy, where balloon-like objects are placed in the stomach, to smaller surgeries, such as the gastric sleeve, to more extensive surgeries like the traditional gastric bypass. The best procedure for a patient varies depending on many factors, such as the patient’s starting weight, other medical problems, and socioeconomic factors and situations. Bariatric procedures can help with a patient’s diabetes, obstructive sleep apnea, high blood pressure, high cholesterol and heart disease, among other medical issues. I can personally attest to the efficacy of these procedures as I lost more than 100 pounds after a gastric sleeve procedure with no complications at all and I have significantly increased energy since my procedure.
RWJBarnabas Health, Clara Maass Medical Center
By Harvey Rainville, M.D., FACS, Medical Director of Robotic Surgery
There are many options available to help patients lose weight. However, patients who are currently obese or morbidly obese will see the greatest long-term results with surgical weight loss. The most common weight loss procedures available include the gastric balloon, gastric band, sleeve gastrectomy and the gastric bypass. The choice of procedure is tailored to the needs of each patient. With bariatric surgery patients not only lose significant weight but also many of their medical problems, such as diabetes, hypertension, high cholesterol and sleep apnea. We use a multidisciplinary approach utilizing dietitians, psychologists, and personal trainers to ensure each patient reaches their weight loss goals. The most commonly performed procedure is the sleeve gastrectomy. It has a greater than 90 percent success rate of getting patients to their goal weight, which typically occurs within 12 months to 18 months. The hormonal effects of this operation help reduce the amount of hunger signals stomachs produce (ghrelin and leptin), and this helps patients lose weight and maintain it long-term. We are fortunate to see on a daily basis the positive impact these procedures have on our patients’ lives.
Saint Peter’s University Hospital
By Carlos A. Macias, M.D., General Surgery
Gastric bypass surgery for weight loss is performed under general anesthesia. A surgeon divides the stomach into a small upper section and a larger bottom section. The top section of the stomach is where food eaten goes and, since it is connected to the small intestine, the stomach, the duodenum and first portion of the jejunum are bypassed and thus cannot absorb nutrients as they usually do. This procedure is both restrictive because the stomach is made smaller and malabsorptive because the bypassed segment of the gastrointestinal tract cannot absorb any nutrients. Patients feel sated although they are eating and absorbing less food. Patients must take vitamins and other nutrients. Gastric sleeve surgery, or vertical sleeve gastrectomy, is the most common option nowadays. The procedure is performed under general anesthesia. During the procedure, the surgeon narrows the stomach into a thin vertical sleeve, about the size and shape of a banana. The remainder of the stomach is removed. This is a restrictive operation. The patient’s smaller stomach gets full quickly after eating smaller portions of food, so the patient is satisfied after consuming less calories. Digestion and absorption of nutrients is not impaired, and the patient seldom needs any dietary supplements.
Valley Medical Group
By Melissa Bagloo, M.D., Medical Director, Center for Bariatric Surgery and Weight-Loss Management
Bariatric surgery has been shown to be the most effective long-term treatment for the disease of obesity. The most common operations performed today are the sleeve gastrectomy and Roux-en-Y gastric bypass. Less commonly performed are the laparoscopic adjustable gastric band and duodenal switch operations. Patients can expect to lose an average of 60 percent to 70 percent of their excess weight after surgery. More importantly, patients see significant improvements in their associated medical conditions, such as diabetes, high blood pressure, sleep apnea, joint pain and high cholesterol. In fact, patients with diabetes are often discharged home off all of their diabetes medications immediately after surgery. Overall, patients experience an increased quality of life and are able to enjoy activities that they otherwise have not been able to participate in. All of the bariatric operations are able to be performed through minimally invasive techniques using small incisions across the upper abdomen, thereby making recovery much faster and decreasing pain after surgery. The overwhelming majority of patients who have undergone bariatric surgery are happy with their progress and feel that they are living healthier, more enjoyable lives.
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.”