Obesity and Bariatric Surgery

When Your "Make-Over" Requires Weight Loss Surgery

             

Tammy tells her story of Weight Loss VIDEO                          Tim tells his story of Weight Loss READ IT

            Watch a Lap-Band Procedure                                           Watch a Gastric Sleeve Procedure

 

Obesity is an epidemic in America. It is estimated that approximately 2 out of every three Americans is over-weight and nearly 10% are morbidly obese. To be classified as morbidly obese a person generally must weigh at least 100 pounds more than his or her ideal weight. Typically this translates into a BMI of 40 kg/m2  or more. Body Mass Index (BMI) is a calculation used to assess relative obesity and is calculated by taking the person’s weight in kilograms, divided by their height in meters (kg/m2). It is much easier to just look it up on a BMI chart. 

What’s your BMI?

Listen to Dr. Sewell and other experts discuss Weight Loss Surgery on BlogTalkRadio program "Wellness for the Real World - with Dr. Veronica". Recorded 12-13-2011. The read his summary blog post that will help you decide "Is Weight Loss Surgery Right For You?"

Obesity-Related Health Problems

The National Institutes of Health reports that morbid obesity reduces life expectancy and is associated with an increased risk of developing a variety of other health conditions such as:

  • Type 2 Diabetes
  • Hypertension (High Blood Pressure)
  • Back and Joint Problems
  • Sleep Apnea
  • Some Types of Cancer
  • Coronary Artery Disease
  • Respiratory Problems

Together these conditions are often referred to as Metabolic Syndrome. Obviousl, each of these conditions is often treated as a separate problem, but if the underlying obesity can be successfully addressed, these secondary problems often improve dramatically as well.

Weight Loss Options

There are many weight-loss options available to obese patient, including both surgical and non-surgical approaches. In general, any overweight individual should try non-surgical efforts first. Diets and exercise programs easy to find; sticking to it can be a bit more of a challenge. For the severely overweight person bariatric surgery may be the best option. While the idea of surgery to promote weight loss sounds frightening, in recent years this option has become increasingly safe and effective. But, for anyone considering weight loss surgery, it's important to recognize that surgery alone may not solve the problem. For optimal results it is necessary to employ a comprehensive approach to bring about permanent lifestyle changes.

Minimally Invasive Surgery Options

Top notch!  Dr. Sewell is the best.  

                            ~ Dale A.

There are a number of proven surgical procedures that can aid patients in their weight loss efforts. The two safest options are the Adjustable Gastric Band (also known as the Lap-Band®) and the Gastric Sleeve (also known as a Vertical Sleeve Gastrectomy). Both procedures are routinely performed using laparoscopic surgical techniques, and typically require only an overnight hospital stay. The decision as to which one is best for any given patient depends on a number of factors. Prospective patients undergo an individual assessment by the surgeon, a dietitian, an exercise specialist and a clinical psychologist,to help determine not only the appropriate procedure, but also to develop a long-range plan for success.

Gastric Sleeve

The Gastric Sleeve, also known as the Sleeve Gastrectomy, is a weight loss operation that restricts the amount of food you can eat and significantly reduces hunger in most patients. It is a purely a restrictive procedure, meaning there is no rerouting of the GI tract that can interfere with the absorption of nutrients and, unlike the Adjustable Gastric Band, the Gastric Sleeve does not involve implanting any foreign object into the body. The procedure simply reduces the size of the stomach by removing approximately 3/4 of its volume.

Following the Gastric Sleeve procedure you will be unable to eat very much at a time, so to maintain appropriate nutrition, you must choose high quality foods, eat more slowly, take smaller bites, and chew everything very well. In other words, you stop "living to eat" to start "eating to live."  Check out the After Surgery Do's and Don't's.

Who is a Candidate?

If you need to lose anywhere from 75 to 250 pounds the Gastric Sleeve may provide a good option. If you have diabetes or high blood pressure or other obesity related health problems you may also be candidate even if you are not technically classified as morbidly obese.  Increasing clinical evidence suggests that weight loss procedures may provide significant benefit for diabetic patients even if they only need to lose 50 to 75 pounds. In these situations the Gastric Sleeve may offer considerable benefit with manageable risk. Patients who need to lose a very large amount of weight (more than 300 pounds) may still benefit from the Gastric Sleeve since it can be combined with other procedures later on to address persistent weight problems.  Do you know your BMI? 

Minimally Invasive Surgical Options

It was a positive experience, from beginning to end. 
                           ~Linda K.

The Gastric Sleeve is performed under general anesthesia, and most patients spend only one night in the hospital.  The operation is performed using laparoscopic techniques, which means quicker recovery and minimal pain in most cases. (Watch a video of the Gastric Sleeve procedure) Following the procedure, you will be on a liquid diet for the first couple of weeks or so with solid foods gradually reintroduced back into your diet over the first month following surgery. Eventually Gastric Sleeve patients are able to eat most foods they chose without much difficulty.

Results & Risks

Perhaps the biggest benefit of the Gastric Sleeve is a significant reduction in your sense of hunger. Most patients tell me they just aren't hungry. When they do get a little hungry they eat a couple of bites and are satified. By physically removing a large part of the stomach there are fewer signals being sent to the brain, which create that feeling of hunger. While the sleeve is a great tool, and most patient lose weight fairly quickly, to maximize success it should be combined with a comprehensive weight management program, including regular follow-up visits with the surgeon and dietitian along with regular exercise.

The risk of the Gastric Sleeve is relatively low, but cannot be ignored. Part of the stomach is removed using a stapling device which seals-off both sides of the stomach with overlapping rows of staples then cuts the tissue between the rows of staples. It is possible for a leak to occur through the staple line, which could be a serious problem requiring additional surgery to repair. To help reduce this risk, Gastric Sleeve patients are maintained on a liquid diet for the first couple of weeks to minimize the stress on the staple-line. After that the risk of a leak is very small.

Dilation of the Gastric Sleeve can occur over time due to persistent over-eating. This could result in gradual weight gain if you return to your old eating habits. This is why it is important to combine weight loss surgery with dietary counseling, behavior modification and regular exercise to achieve optimal long-term success.

 

 

 

 

It is extremely important for any potential patient to recognize that obesity is a complex disease and the Gastric Sleeve alone will not cure this problem. The procedure should be viewed as a tool that is most effective when combined with a comprehensive weight management program. Only by combining weight loss surgery with dietary counseling, behavior modification training and regular exercise is it possible to achieve optimal success.

Gastric Banding

When it Comes to the Lap Band® Dr. Sewell Wrote THE Book 

Dr. Sewell's book includes everything you need to know to make an informed decision about Lap Band or any other weight loss surgery. It contains more than 20 patient stories, both those who were successful and those who were not. It is written in easy to understand language that speaks directly to patients. Check out what others have to say about this valuable resource at Amazon.com.

 

   

The Adjustable Gastric Band

The Adjustable Gastric Band (AGB), also known as the Lap Band® promotes weight loss by restricting the amount of food you can eat. When the band is properly adjusted the upper stomach pouch will only hold only a couple of ounces of food. If you continues to eat, food will back up into the esophagus making you very uncomfortable followed by regurgitating or spitting up. For patients to be successful with the band you must choose good quality, nutritious foods, high in protein and learn to eat more slowly, taking small bites, and chewing everything very well. You also need to avoid drinking with your meals. This sounds easy enough, but changing a lifetime of eating habits requires commitment and perseverance, as well as regular follow-up by a team of trained professionals.

Who is a Candidate?

Patients who need to lose anywhere from 75 to 100 pounds may be good candidates for the AGB. Others who havediabetes or high blood pressure may also be candidates even if they are not technically classified as morbidly obese.  Increasing clinical evidence suggests that weight loss procedures may provide significant benefit for diabetic patients who only need to lose 50 to 75 pounds. In these situations the AGB may offer significant benefit with high risk. But patients who need to lose a very large amount of weight (more than 100 pounds) may be better served with a different procedure, such as the Gastric Sleeve.  Find your BMI here.

The AGB operation is performed under general anesthesia, and most patients spend only one night in the hospital.  It is routinely performed using laparoscopic techniques, which means quick recovery and minimal pain in most cases. When first placed, the band is relatively loose around the top of the stomach, so it the needs to be tightened by adding saline into a small injection port under the skin. The adjustment process is typically started about 6 weeks after the surgery, and normally it takes several adjustments over the first few months to customize the tightness of the band to meet the individual patient’s specific needs.

Results & Risks

Sustained weight loss requires regular exercise and a new overall healthier lifestyle.  Repeated adjustments to the tightness of the band are not a substitute for making those difficult lifestyle changes. 
Dr. Sewell is one of the nicest, kindest, most reassuring and pleasant doctors I have ever known.  I have the utmost confidence in him and his abilities. ~Rosemary L.

The AGB is widely recognized as the weight loss operation with the lowest surgical risk, but there are problems that may occur weeks, months or even years after the surgery. If the band is adjusted too tightly, over time the result may be a stretching of the esophagus, which can cause chest pain, trouble swallowing and even regurgitation of food or fluid into the lungs. The band can also "slip" down on the stomach due to excessive retching and vomiting, or persistent overeating. The symptoms of a slipped band include:
  • heartburn
  • chest pain
  • regurgitation
  • failure to lose weight

It is also possible for the band to erode through the wall of the stomach causing an infection of the band and the surrounding area. The diagnosis of an eroded band is confirmed either by an upper GI X-ray or an endoscopic examination of the inside of the stomach. If an erosion occurs it is mandatory that the band be removed.

In rare cases the patient may simply be intolerant of the restriction the band creates, which may necessitate removal of the Lap Band® with conversion to a Gastric Sleeve. SEE REVISIONS & CONVERSION

It is extremely important for any potential patient to recognize that obesity is a complex disease and the AGB alone will not cure this problem. The procedure should be viewed as a tool that is most effective when combined with a comprehensive weight management program. Only by combining weight loss surgery with dietary counseling, behavior modification training and regular exercise is it possible to achieve optimal success. 

Revisions and Conversions

Problems can arise months or even years after an Adjustable Gastric Band (AGB) or Lap-Band®. It may be possible to reposition or replace the band, and in some cases the appropriate option may be to simply remove the band. But for many patients the best way to manage problems with a Lap-Band® is to convert to an entirely different weight loss procedure. BAND TO SLEEVE CONVERSION VIDEO These procedures can usually be performed with the same laparoscopic techniques used to place the band initially. Here what our patients say about Conversion from Band to Sleeve.

Who is a Candidate?

If you have developed a complication or intolerance to the Lap-Band® you may be a candidate for a conversion procedure. One common complication is known as a slipped band. If the band slides down on the stomach it creates a larger than normal upper pouch. Symptoms may include heartburn, weight gain, frequent regurgitation and chest pain. 

The best way to show the actual position of the band before determining the best course of action is an Upper GI X-ray. The band can be repositioned, but it may slip again in the future, so in most cases it is preferable to remove the band and convert to an entirely different procedure, such as the Gastric Sleeve. 

For other patients their AGB seems to work very well up to a point, then they just seem to stop losing weight. The reason for this plateau effect is unknown, but on average it occurs when the patient has lost about half of their excess body weight. This may be very acceptable for someone who only needed to lose 75 to 100 pounds, but for those who started out 150 to 200 pounds or more overweight this 50% loss is generally not an adequate result. Band patients who have reached a plateau and are still morbidly obese often seek another solution. Removal of the band with conversion to another weight loss procedure such as the Gastric Sleeve may be exactly what it takes to get them started losing weight again. (Watch a video of Lap Band Conversion to Gastric Sleeve)

Results & Risks

For many patients a revision or conversion of their Gastric Band can provide a new start toward achieving their ultimate goal. However, one thing must be made very clear: if the underlying problem is a failure to change long-standing behaviors, it will not matter what procedure is done. So any revision procedure should include a comprehensive weight management program to help ensure the best possible result.

In general, revision procedures carry a higher risk for complications than the original surgery. This is particularly true for revisions of the Gastric Band. The dissection and identification of the stomach and surrounding organs is more difficult because of the scar tissue that invariably surrounds the band. So, if revision surgery is required, there is no substitute for an experienced laparoscopic surgeon and a team of dedicated support personnel.

Nutrition Corner

Sandi Graham is a Licensed and Registered Dietitian who works closely with all our bariatric surgery patients. She has extensive experience in not only helping patients lose weight, but also provides important nutritional guidance that ensures patients maintain a healthy diet.

A major part of the Master Center Weight Loss program is getting our patients actively involved in setting their own realistic goals and creating strategies to acheive them. Sandi works with each patient to help keep them on track and focused on restoring their health through good nutrition.

Exercise Corner

Getting regular exercise is an extremely part of any weight loss program and we are excited to have Stacie Sauber on our team.

Stacie is an exercise and fitness expert who performs an initial assessment of each patient's physical fitness prior to surgery, She then offes support all along the way.providing our patients with helpful tips for creating their own exercise routine that will keep them moving toward their healthier lifestyle goals. Stacie offers individual and small group work-out sessions at her small private facility in Southlake, Purely for Fitness.

Stacie participates in our Monthly Forum where she offers a variety of ideas that help keep exercise both fun and productive. She has suggested the resources below to assist each patient in assessing their ability to participate in regular exercise routines.

1. The American College of Sports Medicine Risk Stratification Categories will help you determine where to start.

2. Check out How to Determine Your Heart Rate Max based on your age.

3. Learn about the Groups of Cardiorespiratory Endurance Activities.

 

Monthly Forum

Our Bariatric Support program is a one hour live forum that is held in our office the 3rd Thursday of every month from 7:30 to 8:30PM. Dr. Sewell's patient are invited to attend in personwith us here in the office or participate LIVE On-Line to hear what fellow patients have to say about their experiences. Sandi Graham, our dietitian, offers her perspective on nutrition and making better food choices. Stacie Sauber, our exercise guru, presents a variety of ideas to improve fitness and maximize weight loss. Dr. Sewell concludes the hour with his "video blog" on healthcare topics of interest to everyone. It's a fun and informative hour, designed to keep you motivated a help you succeed in achieving your weight loss goals. 

Contact the office at 817-748-0200 or by e-mail at info@robertsewellmd.com to reserve your spot since space is limited.

To watch on-line just click here to watch the most recent epissode of the Master Center Forum. You can also watch live or go back and catch any previous Forum session.

Monthly Newsletter

Our Monthly Newsletter is designed to inform and inspire our weight loss patients as they continue to strive toward their goals. The content more or less mirrors the support offered through our monthly Master Center Forum, which is available as an online video program. So whether you are into reading or watching, our aim is to keep you on track.

Read the December 2011 Newsletter

Archives of previous Newsletters