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:
• HackensackUMC’s Hans J. Schmidt, M.D., FACS;
• Holy Name Medical Center’s Stefanie Vaimakis, M.D.;
• Morristown Medical Center’s Michael Nusbaum, M.D.;
• Overlook Medical Center Ajay Goyal, M.D.;
• Prime Surgicare’s Seun Sowemimo, M.D., FACS, FASMBS;
• Robert Wood Johnson University Hospital New Brunswick’s Ragui Sadek, M.D., FACS, SOEMBS;
• Saint Barnabas Medical Center’s Michael Bilof, M.D.;
• The Valley Hospital’s Melissa Bagloo, M.D.;
• University Medical Center of Princeton’s Lisa Dobruskin, M.D., FACS.
By Hans J. Schmidt, M.D., FACS, Chief, Division of Bariatric Surgery, Director, Center for Bariatric Medicine and Surgery, Dept. of Surger
The Center for Bariatric Medicine and Surgery at HackensackUMC is one of the highest-volume weight loss surgery centers in the United States. Having performed the first laparoscopic gastric bypass in New Jersey in 1999, we have performed more than 10,000 bariatric procedures. More than 20 million Americans suffer from morbid obesity, making it one of the leading medical problems facing the country today. Medical options for weight loss are routinely prescribed, but are only successful in about one in 20 patients (5 percent). HackensackUMC is an American College of Surgeons Center of Excellence, which qualifies doctors to perform all surgical options that are 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 the hospital stay to begin the weight loss dialogue.
Holy Name Medical Center
By Stefanie Vaimakis, M.D., Medical Director of Bariatric Services
As a Surgical Review Corporation Center of Excellence, Holy Name Medical Center’s Bariatric Services provide comprehensive state-of-the-art surgical and non-surgical weight-loss treatment options, nutrition counseling, and psychosocial support for adolescent and adult patients. Bariatric surgery is still 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.
Morristown Medical Center, Atlantic Health System
By Michael Nusbaum, M.D., Chief of Bariatric Surgery
We are using multiple surgical techniques including invasive and noninvasive techniques to improve the health of patients who are suffering from the disease of obesity. Using bariatric surgery, we’re able to vastly improve the health of our patients and help resolve other conditions like diabetes type 2, sleep apnea, and obesity related hypertension. At Morristown
Medical Center, we perform laparoscopic Roux-En-Y bypass, sleeve gastrectomies, gastric banding and gastric balloon surgery. Just going to a hospital and having surgery isn’t enough, and that’s a misconception. In many instances, patients experience plateaus in weight loss, or even weight regain after bariatric surgery. All of the procedures are tools to help people lose weight, but the only way to be successful in the long term is to have a comprehensive program and team that includes a surgeon, metabolic specialist, dietician and nutritionist, and exercise physiologist.
Overlook Medical Center, Atlantic Health System
By Ajay Goyal, M.D., Director of Bariatric
Obesity impacts every part of a person’s life. It causes serious health issues, such as
type 2 diabetes and hypertension. Bariatric surgery is remarkable because not only does it produce sustainable weight loss, but patients also see substantial improvements in their health. It resolves diabetes in more than 80 percent of patients and often cures or improves a host of other conditions. At Overlook Medical Center, which is an American Society of Bariatric Surgery Center of Excellence, our surgeons talk with patients about their goals and their health to determine the best procedure for them. The most popular procedure now is the Sleeve Gastrectomy, which removes about two-thirds of the stomach. Patients eat less and feel less hungry because it also reduces hunger hormones. It works so well that many of my patients say they wished they’d done it sooner. So while our patients come to us because they want to lose weight, it’s the health and quality-of-life improvements that make a difference in their daily lives. I get no greater joy than hearing from a patient who has found happiness by simply being able to keep up with their kids on the playground or ride a rollercoaster.
Prime Surgicare, CentraState Medical Center (On Staff)
By Seun Sowemimo, M.D., FACS, FASMBS
We’re helping very overweight people in two key ways to overcome the debilitating effects of metabolic disease (obesity). First, for people battling chronic medical conditions related to excess weight, (particularly diabetes, heart disease, high cholesterol, sleep apnea, chronic pain and depression), a bariatric weight loss solution can resolve, or significantly lessen symptoms from these conditions and the need for ongoing medication use. For the obese population at large (BMI 35+) a bariatric weight loss solution can improve the overall quality of life by lengthening lifespan, improving career opportunities, increasing social engagement and allowing the person to participate more actively in everyday life with family and friends. I perform gastric bypass, the procedure which is clinically proven to offer the highest volume of sustained weight loss, sleeve gastrectomy and revision bariatric surgery for patients who have not achieved their intended weight loss goal after a bariatric procedure. Our bariatric program also includes a comprehensive menu of additional support services to help patients before and after their operation: postop bariatric patient fitness program, onsite lab services, support group meetings, appointments with a bariatric dietitian specialist and monthly group exercise programs (led by me) held at the Henry Hudson Trail in Freehold.
Robert Wood Johnson University Hospital, New Brunswick
By Ragui Sadek, M.D., FACS, SOEMBS, Medical Director, Adult & Adolescent Bariatric Surgery
When diet and exercise alone are not enough to reverse obesity, and associated conditions such as asthma, sleep apnea and high blood pressure are present, adults and teens can be considered for one of four bariatric procedures currently offered at Robert Wood Johnson University Hospital. A sleeve gastrectomy reduces the stomach into a small, banana-shaped pouch to reduce the capacity of the stomach and controls hunger by regulating hormones. Gastric banding, also known as “the band,” places an inflatable band around the top of the stomach to create a small pouch. Gastric bypass provides the least complications by bypassing the stomach to create a small pouch through a laparoscopic procedure. We also offer the ORBERA™ Managed Weight Loss System. Currently only available for adults, this is a non-surgical procedure that inflates a small balloon inside the stomach to reinforce portion control.
There are several health benefits associated with weight loss surgery in general that often occur over time. These benefits potentially include lower blood pressure, improvement of type 2 diabetes, lower cholesterol, relief of sleep apnea and acid reflux, better mobility and improved mood with higher self-esteem.
Saint Barnabas Medical Center, a RWJBarnabas Health Facility
By Michael Bilof, M.D., Section Chief, Bariatric Surgery, President, New Jersey Chapter, American Society of Metabolic and Bariatric Surgery
The New Jersey Bariatric and Metabolic Institute at Saint Barnabas Medical Center strives to improve the overall health of our patients utilizing several treatment options for overweight patients, such as lifestyle intervention and behavioral modification, medical management and surgical intervention. We find that weight loss or metabolic surgery is the best option for long-term treatment of obesity. Our patients not only experience significant weight loss, but have improvements or resolution of co-morbidities associated with obesity, such as diabetes, hypertension and sleep apnea. Our research tells us that weight loss can be achieved through commercial diets and medications; however, long-term maintenance of that weight loss is problematic.
We find that our patients lose more weight with the surgery than with other weight loss methods and are successful at maintaining the weight loss, which leads to healthier and happier outcomes. Our patients tell us: “I was off all my diabetes medications after the surgery!” “Now I am able to play at the park with my children.” “I’m no longer afraid I won’t fit into an airplane seat.” We offer three weight loss or metabolic surgeries at Saint Barnabas: the sleeve gastrectomy, the gastric bypass and the duodenal switch. We suggest you attend one of our free, monthly information sessions to learn more about the surgeries.
The Valley Hospital
By Melissa Bagloo, M.D., Director, Center for Metabolic Surgery and Weight Loss Management
Valley’s Center for Metabolic Surgery and Weight Loss Management offers patients an individualized and comprehensive approach to weight loss. We promote bariatric surgery as a life changing, as well as potentially lifesaving, option for all of our qualified patients. Patients can choose from four surgical procedures, including gastric banding, sleeve gastrectomy, gastric bypass and the duodenal switch. The gastric sleeve, gastric bypass and duodenal switch are the best surgical options for long-term outcomes. To further promote patient success and long-term weight loss, we have a nutritionist in the office who provides nutritional counseling to patients both pre- and post-surgery. In addition, we place a strong emphasis on maintaining a longterm relationship with our patients. This relationship includes annual checkups and regular bloodwork to monitor the patient’s post-surgical health and weight.
University Medical Center of Princeton
By Lisa Dobruskin, M.D., FACS, Medical Director of the Center for Bariatric Surgery & Metabolic Medicine
Bariatric surgery has proven to be the most effective treatment for obesity and its many related health concerns, including diabetes, hypertension, obstructive sleep apnea and infertility.
To achieve the best results, surgery must be combined with long-term lifestyle changes, especially healthy eating and physical activity. At University Medical Center of Princeton, our Center for Bariatric Surgery & Metabolic Medicine provides patients with the education and support they need—beginning before surgery and continuing throughout their lives—to achieve and maintain optimal weight loss. Patients have access to experienced and caring bariatric surgeons, dietitians, behavioral health specialists and a nurse navigator to guide their journey. We offer three commonly performed, successful weightloss procedures:
sleeve gastrectomy; gastric bypass; and LAP-BAND®. Each procedure is different, yet they all promote weight loss by limiting the amount of food individuals can eat.
The procedures are typically performed laparoscopically—through keyhole-sized incisions—which reduces post-operative pain and allows for a faster and easier recovery. Patients typically lose 60 to 100 pounds in the first year post-surgery. No procedure is right for everyone. Our surgeons have indepth conversations with patients about their priorities and expectations to help determine which surgery is best for them.