| Dr. Donald J Waldrep is a Member of the American Society of Metabolic and Bariatric Surgery. Here the Doctor has answered some of the common questions Bizymoms visitors have about Bariatric Surgery.
Q. After the surgery, what support will a patient receive in adjusting to new daily habits?
A. Patients are given significant preparation through evaluations by multiple specialists prior to the operation. There are many ways to optimize the success of the procedure. The foremost is allowing the patient the most reasonable understanding of the goals of the procedure, the techniques used in the surgery, and establishing realistic goals; as in most important life events, "preparation is the key to success". Patients maintain a regular schedule of assessments to ensure they maintain their health. We enjoy providing support for patients through a variety of ways.
Support groups are held monthly and are open to anyone interested in having – or who has already had - a weight wellness procedure. Family members and friends of clients often come and provide important insights. This setting allows clients considering surgery to "get a snapshot" of experiences, and have the opportunity to speak to someone who may come from a similar perspective, or sometimes more importantly, a completely different perspective.
I can’t tell you how proud I am of our clients who participate in this Support Group and courageously tell their stories, sometimes funny, sometimes dramatic, but always personal. One unique aspect of our group is that we have always asked clients to attend before the surgery when they are most motivated. Studies show that education and support options greatly enhance the success of the surgery.
One common factor that we see in patients struggling after weight wellness surgery is a lack of personal empowerment. Some patients have a lack of confidence or even a fear of success. I am always surprised how many people feel like they don’t really "deserve" to treat themselves to weight loss, health, or feeling good about themselves. Many women who, every day, perform the highest calling of service to others --- as wives, mothers, and grandmothers --- don’t give themselves the gift of love that they give to others. I mentioned that we like to think that we help clients fall in love with themselves again. One of my dreams that has come to fruition is the creation of a support network to help patients, something that I have co-created with my wife and partner, Lisa Janks Waldrep, who has created a new program directed to clients who want to master their circumstances, and feel in control of their decisions. This is an exciting and unique course.
Q. How long is the recovery period?
A. Patients generally return home the same day they have a Gastric Band placed, and as soon as the next day after Gastric Bypass. The ‘miracle’ of laparoscopy is that people do not have to recuperate from a large incision, so our clients are encouraged to participate in as much normal activity as they feel comfortable performing as soon as possible. Interestingly, the ability to be normal so soon after surgery is one of the hardest things for clients to believe, so they are typically very delighted after a procedure.
Q. What is Roux-en-Y gastric bypass surgery?
A. Gastric Bypass is a weight wellness procedure that separates the stomach into to parts, resulting in a small upper ‘pouch’ about the size of an egg. This pouch allows a much smaller portion of food than the normal stomach, and sends a signal of "feeling full" after eating less food than before. The small intestine is also rearranged in the shape of the letter "Y", with each of the upper arms of the Y connected to the pouch or the other part of the stomach.
Food travels down one arm of the Y and "bypasses" the stomach.
A Gastric Band also creates a pouch by simply constricting the stomach at the top with a circular inflatable balloon. It essentially creates an "hour-glass" effect which slows the passage of food through the top part of the stomach and creates a feeling of "fullness" after eating less food than before surgery.
Q. What types of bariatric surgeries are there?
A. There are surgeries that generally decrease the amount of food that is required to make us feel "full", there are surgeries that divert calories that we eat so fewer calories are actually absorbed, and there are surgeries that do both. Like many things, surgical procedures experience periods of popularity. The most popular procedures now are Roux-en-Y ("roo-n-y") Gastric Bypass and Gastric Banding. There are currently two Bands in the US now: the Lap-BandTM and Realize BandTM. A relatively new procedure is the Gastric Sleeve, which involves creating a long tube by actually removing about 80% of the stomach from the body. A procedure called Duodenal Switch had some popularity a few years ago, but is one of the more radical techniques in terms of amount of gastro-intestinal rearrangement.
New procedures and new applications for established procedures continue to occur. Some patients who were successful after Gastric Bypass achieve additional weight loss with the addition of a Gastric Band ("Band on Bypass").
Our clinic is unique in being able to provide Gastric Band (either Lap-Band or Realize Band) for lower weight patients, who may only be 30 to 50 pounds overweight.
Some outpatient procedures are being designed to be done with through the mouth, but the effectiveness or longevity of these is yet to be seen.
Q. Does Bariatric Surgery Typically Lead to Major Weight Loss?
A. Yes. Clearly, bariatric (weight loss) surgery is the most effective treatment of excess body weight. Typically, surgeries lead to a much higher and longer lasting weight loss when compared to highly supervised diets. In addition, many of the diseases that are brought on by, or made worse by, obesity are eradicated with the effective weight loss provided by surgery. The most inspiring changes, however --- even more than curing diabetes or high blood pressure --- is the exuberance and revitalization clients feel after losing weight. Having patients share this feeling of a "new life" is the best part of the job.
It is very important to remember that, like anything else, surgery is a tool that needs to be understood to be used correctly. But it's a Power Tool. And you can’t build a house without taking the hammer out of the toolbox; and you can’t build a house with just a hammer. Surgery is best combined with education. I am a very big advocate of patient education, so education has always been an integral part of our program; so much so that even those that are not patients can sign up for the free newsletter offering free tips, recipes, and tools to empower their weight loss journey. Anyone can access these by visiting www.RxForRenewal.com, www.SALSA.md.
Q. What is the average level of weight loss of each type of surgery?
A. The weight loss varies among procedures, genders, races, clinics, etc. We describe weight loss as the percentage of excess body weight loss (%EBWL), or basically, how much of the "extra" body weight is lost.
It is very common to study the outcome of weight loss surgeries. Success is harder to define, as this is often related to many subjective and emotional issues that the patient determines. Fortunately, most clients do not expect to --- or even want to --- look like an 18-year old swimsuit model, and they are satisfied to be free of medications and to be moving freely again. Bypass surgery may lead to 60% to 100% of extra weight and 40 to 60% with Banding, but each person is largely in control of the level of success they achieve.
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