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Health Matters 8/9: Bariatric surgery for weight loss 

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By Wai-Yip Chau, M.D. 

Obesity is a chronic, progressive disease affecting millions of Americans and increasing the risk for serious health complications, such as diabetes and heart disease. 

Often people try diets and other weight loss solutions to overcome obesity, but in many cases, they are not enough. 

For these patients, bariatric surgery may be an option. 

The Center for Bariatric Surgery & Metabolic Medicine at Penn Medicine Princeton Medical Center offers a number of safe and effective bariatric surgery options, performed by board certified surgeons and a skilled care team. 

About Bariatric Surgery 

Bariatric surgery can change the way food is digested or limit what patients can eat, helping them achieve their weight loss goals, improve their health and feel better about their overall appearance. 

The American Society for Metabolic and Bariatric surgery reports that bariatric surgery is the most effective and long-lasting treatment for severe obesity, resulting in significant weight loss and leading to the improvement, prevention or resolution of many related diseases, including type 2 diabetes, heart disease, hypertension, sleep apnea and certain cancers. 

From 2011-17, more than 1.3 million people underwent bariatric surgery, according to the society. 

In addition, studies show that many people who have bariatric surgery lose about 40-85% of excess weight. 

Types of Bariatric Surgery 

The most common type of bariatric surgery is sleeve gastrectomy, which results in patients feeling full after eating small portions. During the procedure, about 70% of the stomach is removed, reducing the amount someone can eat by 80-90%. In addition, sleeve gastrectomy causes a drop in the levels of ghrelin – the hunger hormone – so your appetite is reduced. 

Sleeve gastrectomies accounted for 59% of bariatric surgical procedures in 2017, according to the American Society of Metabolic and Bariatric Surgery. 

Another common type of weight loss surgery is gastric bypass surgery, a procedure where a small stomach pouch is created. The small intestine is rearranged so that the lower part of the small intestine is connected to the new stomach pouch. Patients feel full after a smaller portion of food and also absorb fewer calories.

Less common today is adjustable gastric banding, a procedure in which the stomach is encircled with a silicone band that restricts food intake. The band is adjustable and reversible.

Advanced Techniques 

Bariatric surgery is normally performed laparoscopically, using minimally invasive techniques, including advanced robotic-assisted surgical equipment. This approach uses a few tiny incisions rather than one large incision. It can reduce surgical discomfort and scarring and can lead to earlier discharge from the hospital. 

During robotic-assisted surgery, your surgeon sits at a console next to you and operates using tiny instruments through the small incisions. A camera provides a high-definition, 3D magnified view inside your body. Every hand movement your surgeon makes is translated by the system in real-time to bend and rotate the instruments with precision. 

Criteria 

Patients with a Body Mass Index (BMI) of over 40 or over 35 with other health conditions are considered ideal candidates for bariatric surgery. Additionally, adjustable gastric banding is FDA approved for patients with a BMI of 30 or greater with comorbidities. 

Patients who have failed to lose weight after at least two supervised attempts at weight loss may also be candidates for bariatric surgery.

The surgeons at the Center for Bariatric Surgery & Metabolic Medicine participate in most insurance plans and Medicare. If your health insurance doesn’t cover your weight loss surgery with your surgeon of choice or fails to approve you for the procedure (or if you don’t have health insurance), other payment options are available.

While bariatric surgery can help patients with obesity achieve weight loss goals, it is not a quick fix. Maintaining a healthy weight also requires a commitment to eat healthier, exercise more and stay connected to your bariatric team after surgery. 

Learn More 

Penn Medicine Princeton Health will air a pre-recorded UStream video with me about bariatric surgical options on Wednesday, Aug. 14 ,at noon on its Princeton Health On Demand UStream channel at http://www.ustream.tv/princetonhealth. 

After the episode premieres, it will remain available for on-demand viewing on the Princeton Health UStream channel. 

For more information about Center for Bariatric Surgery & Metabolic Medicine at Penn Medicine Princeton Medical Center or to find a bariatric surgeon affiliated with Penn Medicine Princeton Health call 609-785-5870 or visit www.princetonhcs.org.

Wai-Yip Chau, M.D., is board certified in general surgery and specializes in bariatric and metabolic surgery. He is a member of the medical staff at Penn Medicine Princeton Health. 

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