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How do I prepare for weight loss surgery?

Posted on April 16, 2018 by

sands of timeHow to best prepare for weight loss surgery is one of those questions that might not be on the top of your list, but will contribute to your overall level of success.  As you know, weight loss surgery is an important decision.  If you are adequately prepared, your level of anxiety will decrease and you will be better able to manage the changes required of you after surgery.  In addition, with preparation comes confidence.  This is a great trait to have as you embark upon this remarkable journey.

So how do you prepare for weight loss surgery?  You will want to ask questions.  You will want to make sure that your bariatric surgeon/center has a very thorough educational process in place prior to and after surgery that addresses nutrition, behavior modification and fitness.  These three components are critical to long term success.

You may only be thinking short term.  Let’s face it, you are really busy and have many obligations at home, at work, with school and with friends that take precedence over your needs.  It’s easy to tell yourself “I will figure this out” but it is a lot easier if you have a support system in place at home and with your bariatric surgeon/center prior to surgery so that you can better manage any surprises that may come along the way.

If you have already decided to have weight loss surgery, you will want to think about the positive changes you want to accomplish.  Often people view surgery from a number perspective (i.e. how many pounds they would like to lose).  Weight loss surgery is about so much more than that.  It is about enabling yourself to accomplish things that might not have been possible in the past.  It is about having an exciting life.  Life you can experience to the fullest extent.  It is very important to think about (and document) life goals related to your weight loss.  Then you can celebrate the positive changes transforming your life.  Some of the “dreams” that people have shared include:

  • Walking up the stairs or to the corner of their street without getting short of breath
  • Playing with their children or grandchildren
  • Crossing their legs
  • Painting their toenails
  • Stop worrying about being able to fit into a chair at a public place or worrying that it will break when they sit on it
  • Fitting in a bathtub and having water on both sides
  • Shopping in a store for regular sized people
  • Riding a bicycle
  • Returning to a productive lifestyle
  • Stop worrying about going to a restaurant that might only have booths or chairs with arms on them
  • Going to a movie and fitting into the seat

Take some time to identify your “wish list” and document it.  Then spend some time getting your mind and body ready.  In the weeks or days before surgery, you need to consider yourself in training.  Just as athletes prepare for a race, you can prepare yourself to be in top form for surgery.  When you actively get your body and mind ready you likely will:

  • Have fewer complications from anesthesia and surgery
  • Be able to cooperate with necessary treatments
  • Heal faster and feel better quicker
  • Have better control of your pain

There are some very specific things you need to do to be in the best shape possible.  You need to begin these things as soon as possible.  We know that the very worst time to try to learn things is right after surgery when you may feel foggy from anesthesia and uncomfortable from your operation.  Learn and practice these things now so that you will be able to help yourself after surgery.

  • Focus on healthy eating. The better nourished you are, the more quickly your tissues will heal.  Healing is WORK for your body.  Good nutrition helps you tolerate the stresses on your body and to offset limits on food and fluids right after surgery.  Weight loss prior to your surgery can decrease your risk and improve recovery time after surgery.  This is why you should incorporate your new eating plan and individualized weight loss counseling prior to surgery as a part of your overall plan.  Consult your bariatric surgeon for specific options for weight loss prior to surgery.
  • If you are a smoker – QUIT! Even a few weeks of not smoking increases the safety of anesthesia.  You will not be allowed to smoke while hospitalized.  You will need all your oxygen for healing.
  • Build your exercise tolerance. Toning your muscles and building your strength will help you bounce back quicker.  Walking is a perfect exercise for you prior to surgery.  It is normal to feel a little weak after surgery, but you can reduce this by toning up with daily exercise.
  • Exercise your lungs! Practice your deep breathing.  After surgery you will be encouraged to do this.  Expanding your lungs helps your system get rid of anesthesia drugs quickly, helps prevent pneumonia, and speeds oxygen to your tissues to help you heal quickly.  You will also FEEL better.
  • Move your legs to prevent blood clots!!!! After an operation, the best exercise to help your circulation and reduce your chance of blood clots will be walking!  The nurses in the hospital will get you up after a brief recovery period following surgery.  Once you go home, follow the specific discharge instructions set forth  by your surgeon.  In general, you should rest as needed but also get up and walk around as much as tolerated.  You can do these exercises in bed or sitting in a chair during any rest periods.
    • Lying on your back in bed, “walk” your feet toward your body until your knees are fully bent. Tighten your abdominal muscles while you do this.  Now let your legs slide gently back to the flat position and repeat this four more times.
    • Lying in bed or sitting up, point your toes as if you were trying to bend your foot backwards. Hold for the count of five and relax.  You should feel a “pull” on the muscles in the front of your legs.  Next point your heels away from your body, tightening your leg muscles.  Hold for the count of five and relax.  You should feel this pull in the back of your legs.  Repeat the pointing exercises 5-10 times.

If you have decided to have surgery, you also need to focus your mind on a good outcome.  You are the most important player in this team effort, and much will depend on your ability to fully participate.  Your feelings and thoughts will play a very big part in your recovery.  Reassure yourself that the best people, equipment and techniques are supporting you during surgery.

Finally, if you have decided to have surgery, a good way to prepare is to use the power of your relationships to gather a support group.  Enlist family and friends to help you keep your spirits up.  Let friends and neighbors help with chores and meals.  We all do better when we know we are supported by people who care about us and are cheering us on. Don’t underestimate the power of your emotions.  Positive thinking is the biggest help you can give yourself.  Think hopeful, optimistic thoughts about the experience ahead, and start NOW!

If you do all of these things, you will be best prepared for a positive experience and outcome.

We’re ready to help you achieve your dream – view our online Weight Loss Surgery Webinar or schedule the next

 

 

What if my insurance doesn’t cover weight loss surgery?

Posted on April 09, 2018 by

If your insurance doesn’t cover weight loss surgery, you are not alone.  Unfortunately, according to the American Society for Metabolic and Bariatric Surgery, less than 1 percent of those who meet the criteria for surgery actually have surgery5.   A big reason for this is lack of insurance coverage.

If you find you do not have insurance coverage, there are self-pay options available (some more affordable than others).  The self-pay cost of weight loss surgery procedures varies by the type of procedure and geographical area in which it is offered (urban areas tend to have a higher fee).  Generally speaking, the average cost for a gastric bypass ranges from $18,000 to $25,000, while the adjustable gastric banding surgery costs anywhere from $17,000 to $30,000.  The sleeve gastrectomy procedure is newer and a price range is not as readily available.  A ball Park Range is anywhere from $14,000 to $22,000.  The price range is also influenced by the supportive program aspects that may or may not be included, the number of follow-up visits, and for the laparoscopic adjustable banding, whether or not any adjustments are included.

The self-pay cost of weight loss surgery generally includes the cost of anesthesia, the hospital facility fee and the surgeon’s fee.  There may also be additional costs for diet and fitness plans, behavioral modification therapy and nutritional products before and/or after surgery.  However, some fees include these services.  For example, at the Center for Weight Loss Success, our comprehensive weight loss surgery pricing including the costs for anesthesia, the hospital and the surgeon is as follows:

  • Gastric Sleeve – $13,995.00
  • Laparoscopic Adjustable Gastric Band – $16,995.00
  • Gastric Bypass – $18,995

However, in addition, an exclusive comprehensive 12 month program is included with these fees.  It is called Weight Management University for Weight Loss Surgery™ and includes the following:

WMU4WLS

You may be surprised that all of these products/services are included, but it’s the right thing to do for optimal long term results and has resulted in a high degree of patient satisfaction and improved outcomes.  For those that travel for surgery, some services are offered online instead of on-site.  No matter who you choose as your bariatric surgeon, make sure that there is a comprehensive program available and ongoing support prior, during and after surgery.

Also, most experienced bariatric surgeons/centers have financing options available.  You will want to verify this and explore your options.  How much is adding 5-7 years of quality life worth to you?

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Rhonda’s Opinion:  You will find a way to pay for it…I did and I did not make very much money at the time at all.  You are worth it and Dr. Clark’s program is one of the most comprehensive and affordable programs available anywhere. 

 

Self-Pay Weight Loss Surgery is common – we offer the most comprehensive and affordable options on the East Coast!  Learn more at: Self-Pay Surgery

Will My Insurance Cover Weight Loss Surgery?

Posted on April 02, 2018 by

Insurance coverage for weight loss surgery varies by state and by the insurance provider.  While some insurers may cover the entire bill, many public or private insurance companies will pay a percentage (usually around 80%) of what is considered “customary and usual” for the surgery as determined by the insurance company.  The first step if you are considering weight loss surgery is to contact your insurance provider (use the provider number on your insurance card) and ask “Is weight loss surgery a covered benefit under my policy?”  Many policies require that the employer providing the policy purchase a “Ryder” for weight loss surgery.  Thus, you might also want to ask “Do I have the Ryder for weight loss surgery on my policy?”  The employer must purchase this Ryder for everyone that is covered under the plan, not just a select few.  There are a number of factors that play into this decision for employers.  However, generally speaking, employers who understand the value of weight loss and the employee benefits (improved/resolved co-morbidities, lower health care and medication costs, less time missed from work and increased productivity to name a few) are more likely to purchase the weight loss surgery Ryder.

"My insurance didn't cover Weight Loss Surgery, but I didn't let that stop me!" Allen Fabijan,  'Some Guy Named Allen' from 106.1

“My insurance didn’t cover Weight Loss Surgery, but I didn’t let that stop me!”
Allen Fabijan, ‘Some Guy Named Allen’ from 106.1

If your initial attempt to authorize coverage is denied, you can appeal, and you should initiate your appeal immediately.   Your experienced bariatric surgeon/center will assist you with this process.  It makes good fiscal sense for your insurer to foot the bill for your weight loss surgery.   According to the Obesity Action Coalition, the upfront costs of weight loss surgery are paid off in three and a half years, due to hospitalization cost savings.  What’s more, the cost of drugs for people with diabetes and high blood pressure plummet following weight loss surgery.  Many are able to stop taking such medications altogether as their blood sugar and blood pressure return to normal levels after weight loss6.

Medicare, the U.S. government health plan as know today for people 65 years of age or older states it will pay for three types of weight loss surgery for patients who are treated in “high-volume” centers that achieve low mortality rates.  The three types of surgeries as we know it today include:

  • The Roux-en-Y bypass
  • Open and laparoscopic biliopancreatic diversions
  • Laparoscopic adjustable gastric banding

An experienced bariatric surgeon/center can guide you through the Medicare requirements that need to be documented prior to scheduling surgery.  Medicare does not pre-authorize weight loss surgery so you will need to make sure all requirements are met prior to surgery and submitted properly with your claim.  Some private insurers require a letter of medical necessity from a doctor before they will agree to pay for weight loss surgery.  However, Medicare does not require pre-certification and does not pre-authorize weight loss surgery.  As a result, many surgeons may ask Medicare patients to sign a contract stating that they will pay for any costs that Medicare does not cover after processing the claim.  You can find out your specific requirements regarding diet history by contacting your local Medicare provider. However, at the time of this publication, weight loss surgery is an option for Medicare beneficiaries if they have a body mass index (BMI) of 35, with at least one health problem related to obesity such as heart disease or diabetes.  As you are aware, governmental insurance is currently under debate and potential revision.  Thus, you will want to work closely with your experienced bariatric surgeon/center.

6Obesity Action Coalition website. Fact Sheet: Why it makes sense to provide treatment for obesity through bariatric surgery.

Rhonda’s Opinion:  It wasn’t covered by my insurance – that’s ok – just do it and move into the future.  As I said earlier, you should qualify yourself instead of letting a stranger at an insurance company make your health decisions for you.

Dr. Clark and the Center for Weight Loss Success offer the lowest cost options on the East Coast.  Learn more at: Self Pay Surgery

Is Weight Loss Surgery Reversible?

Posted on March 26, 2018 by

chance or choiceIs weight loss surgery reversible? The answer is “yes” and “no” depending upon the type of weight loss surgery procedure that is performed.  Again, the purpose here is not to create confusion, but the bottom line is that you should not go into weight loss surgery with the mindset that it is reversible.  First time (primary) weight loss procedures have risk.  Secondary operations have a much higher risk primarily due to potential scar tissue, potential hernia formation and the fact that your anatomy has already been altered to a certain degree depending upon the type of primary operation performed.

Weight loss surgery may be reversible for the adjustable gastric banding procedure since the device can be removed.  With the gastric bypass, it is anatomically reversible since the parts of the stomach and small intestine can technically be put together again, but it is not recommended and carries a higher degree of risk.  For the sleeve gastrectomy, this procedure is not reversible since the portion of the stomach that is removed in order to create your new “medium banana sized” pouch cannot be replaced.

You have to go back to your need, your desire and your motivation for surgery.  It’s a commitment that can reap benefits beyond your imagination.  Fear is natural and you have to make sure you have done your research and you are as comfortable as possible with your decision.  A certain amount of anxiety is actually desirable.  It usually means that you realize you are making an important decision that will require a behavioral change (which is scary) but if you choose carefully and surround yourself with supportive people and proactively prepare for the potential obstacles, success will follow.

View our free Weight Loss Webinar now – or reserve your spot at our next on-site Weight Loss Seminar!

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Rhonda’s Opinion:  I don’t want to ruin a great thing!

Should Weight Loss Surgery be My Last Resort?

Posted on March 19, 2018 by

MaryYou may think this is a strong statement but…ABSOLUTELY NOT!  However, weight loss surgery shouldn’t be your first option either.  The purpose here is not to create confusion but to reinforce the fact that for people who are morbidly obese and have tried other nutritional, behavioral and fitness programs without success, weight loss surgery can be a great option.

An ideal candidate is someone who is somewhere between 75 and 150 pounds over their ideal body weight.  As your weight increases, generally so does the incidence of other health problems.  With the additional weight and health problems, your risk for weight loss surgery increases significantly as well.   Thus, you take the risks associated with surgery and increase them which is not the most desirable situation for your or your surgeon.

The fear and negative connotations surrounding weight loss surgery has significantly decreased since 1994 when I began my weight loss surgery career.  Thank goodness!  In addition, the procedures have evolved and become safer and more effective.  However, the higher your BMI and co-morbid conditions (other health problems) the higher your surgical risk will be.  In addition, the higher the BMI and co-morbid conditions, the higher the possibility is that you may not be a candidate for weight loss surgery.

CFWLS-Rhonda-09-

 

 

Rhonda’s Opinion:  I should have done surgery a long time ago before I yo-yoed all those years.

 

View our Weight Loss Surgery Webinar now!

Is Weight Loss Surgery Right for Me?

Posted on March 12, 2018 by

kevin

As you have read, weight loss surgery is a decision that requires research (like you are doing here), a risk/benefit comparison, an evaluation by an experienced bariatric surgeon and soul searching on your part to make sure you are committed to long term changes.  These changes can drastically improve your health, your ability to live your life to the fullest and potentially extend your lifespan.  This may seem overwhelming but the important thing for you to know is that you are not alone.

There is a delay with regards to documented statistics, but here are the clear trends:

  • About 15 million adults in the U.S. have morbid obesity which is associated with more than 30 other diseases and conditions including type 2 diabetes, heart disease, sleep apnea, hypertension, asthma, cancer, joint problems and infertility.  The direct and indirect costs to the health care system associated with obesity are about $117 billion annually.5
  • In the United States, the number of people who qualify for weight loss surgery is increasing as the incidence of obesity and morbid obesity is on the rise.
  • In the United States, the number of weight loss procedures performed each year continues to rise with an estimated 177,600 procedures performed in 2006 (an increase from about 16,000 in the early 1990’s).5 In 2008 the number of weight loss procedures was up to 220,000 and remained there in 2009.  Numbers for subsequent years have not been published as of this publication.

5http://asmbs.org/benefits-of-bariatric-surgery/

Telling you that you are not alone and sharing these sobering statistics doesn’t solve the problem for you or the general population.  There has to be a need (and clearly there is a need), there has to be a want (which usually results from the pain endured as a result of being obese or morbidly obese) a viable solution (in this case, surgical weight loss with an experienced bariatric surgeon who is passionate not just about surgery but your long term success).  Sounds like a recipe for success but there is an ingredient that is missing.  You can have a need and a want and a viable solution but if you don’t have the commitment and motivation to follow through and create lasting change for yourself, you may never experience the optimal success you deserve.

If you decide that you have the want, the need and the commitment, you are a great candidate for weight loss surgery.  Now you just need to explore the rest of the questions in this book and get started on your path to success.

View our free Weight Loss Surgery webinar now and then click to schedule your conversation with Cat Williamson, our Surgical Coordinator.

How do I know if I qualify for weight loss surgery?

Posted on March 05, 2018 by

gastric sleeve sleeve gastrectomy GeorgiaIf you are at least 50 pounds over your ideal body weight and have been unsuccessful with other methods of weight loss, you may be a candidate for weight loss surgery.  However, most insurance companies additionally require a BMI of 40 or greater or a BMI of 35-40 with other potentially life threatening health problems such as diabetes, high blood pressure and/or sleep apnea.  Your BMI is your weight in relation to your height.  So how do you calculate your BMI?  You need to take your weight in kilograms and divide by the square of your height (meters).  For example, If your weight is 80 kilograms and your height is 1.8 meters, you would square your height (1.82=3.24) and then divide it into your weight (80 divided by 3.24 = a BMI of 24.69).  Or you can simply enter your information online for quick results with a BMI calculator.4

General BMI classification guidelines include:

BMIClassificationHealth Risk
Under 18.5UnderweightMinimal
18.5-24.9Normal WeightMinimal
25-29.9OverweightIncreased
30-34.9ObeseHigh
35-39.9Severely ObeseVery High
40 and OverMorbidly ObeseExtremely High

The decision as to whether or not weight loss surgery is right for you is ideally made by you and your surgeon after careful consideration of your weight, your past medical/surgical history and your current health problems or co-morbidities.  However, there are general guidelines that most surgeons and insurance companies adhere to when choosing who an appropriate candidate for weight loss surgery is as noted below:

General Guidelines for Weight Loss Surgery Candidates3:

  • BMI of 40 or greater
  • Comorbidity: You have a life-shortening disease process, heart disease, diabetes or obstructive sleep apnea that can be improved by losing weight.
  • For at least two years, you have attempted to lose weight.
  • You have been obese for an extended period of time, at least three to five years.
  • You are able to effectively care for yourself and follow a physician’s instructions.
  • You are motivated to lose weight and maintain a healthful lifestyle.
  • You do not abuse drugs or alcohol.
  • You are a nonsmoker or have quit smoking.
  • You are an adult under the age of 65.

These guidelines vary by insurance carrier and your individual policy.  Your insurance policy is an agreement between you and your insurance provider.  However, if you are working with an experienced bariatric surgeon/center, they can easily help you navigate through your particular insurance requirements and efficiently submit your information for surgery authorization. This topic is covered in Chapter 6 of the book, Less Weight…More Life! Is Weight Loss Surgery Right for You?

As with any general guidelines, there are caveats that cannot be ignored. Some of the ones we find most important include age, motivation and mindset.  With regards to age, you can see by the general guidelines listed previously that it is recommended that an adult be under the age of 65.  At the Center for Weight Loss Success (www.cfwls.com) we do not put a cap on age for good reason.  Age is just a number.  You likely know someone who is over 65 years of age yet physically, emotionally and intellectually they are really more like a 40 year old.  Conversely, you likely know someone around 40 who walks, talks and acts as if they should be 80+ years old.  In terms of lower age restrictions, although there are a few centers in the United States performing weight loss procedures on patients under the age of 18, most surgeons prefer to wait until you are 18 years of age or older and able to better decide and commit to such a life changing procedure.

Of great importance is your motivation and mindset.  If you are considering weight loss surgery, you need to be motivated and an active participant throughout your entire pre-operative and post-operative phases.  This is how you will experience the best results.  Weight loss surgery is something you need to do for yourself, not someone else.  You need to prepare yourself physically and mentally prior to surgery and proactively plan for your post-operative phase.  If you believe surgery is a “quick fix” or the “easy way out” you likely should not pursue weight loss surgery.  With this mindset, you may not fully commit to the lifestyle changes that result in the rewarding outcomes that will transform your life in so many positive ways.  However, if you do commit, get ready for an amazing journey.  Try not to get overwhelmed here.  An experienced bariatric surgeon/center will provide a comprehensive process to help guide you through these considerations.

Finally, it is important to note that some people are actually too obese to qualify for weight loss surgery.  If you are too heavy, you will usually be instructed to lose weight before your surgeon can proceed with weight loss surgery.  Once again, an experienced bariatric surgeon/center will guide you through this process and help you optimize your physical and emotional health prior to surgery and beyond.

3 Bariatric Surgery for Severe Obesity. Consumer Information Sheet. National Institute of Diabetes and Digestive and Kidney Diseases. March 2008. http:// http://win.niddk.nih.gov/publications/gastric.htm

4http://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/english_bmi_calculator/bmi_calculator.html

If you don’t qualify for weight loss surgery under your insurance provider, contact my Surgical Coordinator, Cat Williamson at CFWLS to discuss your options.

What are the best weight loss surgery options available today?

Posted on February 27, 2018 by

Weight loss surgery has certainly evolved…thank goodness!  Don’t get me wrong, it is not without any risk but the procedures available today are much safer and more effective than procedures of the past.

This overview includes the three primary surgical procedures performed within the United States as of the publication of this book along with the advantages, risks and typical results/outcomes for each.  These three procedures are the Sleeve Gastrectomy (also referred to as the Gastric Sleeve), the Laparoscopic Adjustable Gastric Banding (also referred to as LapBand® or Realize Band®) and the Laparoscopic Gastric Bypass. 

Sleeve Gastrectomy:

sleeve GastrectomyThe Sleeve Gastrectomy is a newer laparoscopic weight loss surgical procedure in which a small “sleeve-shaped” stomach is created.  Approximately 75% of the “stretchy” portion of the stomach is removed. This also removes the portion of the stomach that makes the hormone ghrelin. Ghrelin is a hormone which makes you feel hungry. The remaining “sleeve” of the stomach is about the size and shape of a medium banana.   Because anatomy remains normal, this procedure can be considered for people with less weight to lose (50-60 lbs. overweight).

Advantages:

  • The portion of the stomach that produces ghrelin (a hormone that stimulates hunger) is removed.
  • The stomach is reduced in volume, but otherwise tends to function normally.
  • No “Dumping Syndrome” since the pylorus is preserved.
  • No intestine is bypassed so there is little chance of nutritional deficiencies.
  • No implanted device that requires adjusting.
  • Procedure is performed laparoscopically most of the time.
  • Usually done as an outpatient.

This procedure tends to work due to 2 major reasons:

  1. You have a much smaller stomach and will feel full with eating only a small amount.
  2. There is a decrease in the hormone ghrelin so that hunger is much better controlled.

The sleeve gastrectomy was originally developed as the 1st stage of a 2 stage procedure (patients would undergo a conversion of the sleeve gastrectomy to a bypass procedure).  However, it was found to work so well on its own that most patients did not need (or want) to go through with the next stage. This surgery cannot be reversed (i.e. once that part of the stomach is gone…it’s gone).

Risks:

Obesity, age, and other diseases increase your risks from any surgery.  Below are identified risks related to surgery and the sleeve gastrectomy procedure based upon national averages? :

  • Risk of death is 1:500-1,000
  • Leaks (1-2%)
  • Infection (2%)
  • Blood Clot/Pulmonary Embolus (1%)
  • Nausea/vomiting
  • Peptic ulcer disease
  • Formation of gallstones due to rapid weight loss
  • Stricture (1%)

Some of these problems may require further surgical intervention

Typical Results and Outcomes:

Weight loss outcomes are tracked closely at the Center for Weight Loss Success.  We are proud that outcomes here generally out-perform national averages.  The average best weight loss for this procedure is 65-70% of a client’s excess body weight (i.e. if someone is 100 lbs. over their ideal body weight, average weight loss outcomes would be 65-70 lbs.).

A weight loss of only about 40% of excess body weight will often show significant improvement in many other medical problems:

  • Many Type 2 diabetics will get off of their medications
  • Hypertensive clients will have improvement or resolution of their hypertension
  • Sleep apnea almost always improves
  • Cholesterol improvement in most clients
  • Arthritic symptoms improve

Laparoscopic Adjustable Gastric Banding (LapBand® or Realize Band®):

The FDA approved adjustable gastric banding surgery in June, 2001.  However, it was developed in the 1980’s and has been used in Europe since 1993.  In terms of surgical procedures for weight loss, this is the least invasive procedure.

LAP-BANDLaparoscopic adjustable gastric banding involves applying a band around the upper part of the stomach.  As a result, this creates a small gastric pouch at the top of the stomach, with a small opening to the rest of the stomach.  The band is made of an inflatable silastic ring that controls the flow of food from the small pouch to the rest of your digestive system.  With this surgery, there is no cutting or stapling required dividing the stomach.

In addition to the band, a small port is connected by tubing to the inflatable ring around the stomach.

The port is secured just beneath the skin where fluid can be injected or withdrawn to inflate or deflate (adjust) the band.  This results in increasing or decreasing the size of the opening between the upper small gastric pouch and the lower portion of the stomach.  The need for an adjustment is determined by the surgeon based upon weight loss and symptoms related to eating.

Like any tool, it can be used correctly or incorrectly.  Used incorrectly (such as drinking high calorie liquids) you will have relatively poor weight loss or even weight gain.  It is still diet, exercise, and behavior change which produce weight loss.  Thus, following your surgeon’s recommendations is crucial to your overall success.

Advantages:

The advantages cited in the literature are outlined below:

  • Risk of death is approximately 1:1000
  • There is no division or re-routing of intestinal tract
  • Minimal risk of malnutrition
  • The procedure is considered reversible since the Band can be removed with minimally invasive technique if needed

The band is adjustable:

  • Often performed under fluoroscopic guidance
  • May require 4-6 adjustments during the first year (or more)
  • Adjustments need to be checked yearly – forever

The band is effective with the following considerations:

  • Weight loss success is directly related to:
    • close clinical follow-up
    • appropriate adjustments
    • exercise
    • diet and behavior modification

The potential disadvantages of laparoscopic adjustable gastric banding are as follows:

  • Weight loss is typically slower when compared to other weight loss surgeries
  • Adjustments are required throughout your lifetime
  • Problems can develop secondary to the mechanical device (see Risks)

Risks:

Obesity, age, and other diseases increase your risks from any surgery.  Below are identified risks related to surgery and the laparoscopic adjustable gastric banding procedure based upon national averages.

  • Risk of death is 1:1000
  • Infection (<1%)
  • Blood Clot/Pulmonary Embolus (1%)
  • Gastric pouch dilation potentially requiring further surgery (5%)
  • Band slippage or migration often requiring further surgery (5%)
  • Band erosion requiring further surgery for band removal (1%)
  • Access port problem or tubing leak requiring further surgery
  • Nausea/vomiting
  • Peptic ulcer disease
  • Formation of gallstones due to rapid weight loss

Some of these problems may require further surgical intervention

Typical Results and Outcomes:                       

Following are expected results and outcomes based upon national averages:

  • Average weight loss is 45-50% of excess body weight, but with aggressive diet and exercise changes you can lose almost all of your excess weight.
  • A weight loss of only about 40% of excess body weight will often show significant improvement in many other medical problems:
    • Many of Type 2 diabetics will get off of medications
    • Hypertensive clients will have improvement or resolution of their hypertension
    • Sleep apnea almost always improves
    • Cholesterol improvement in most clients
    • Arthritic symptoms improve

 

Laparoscopic Gastric Bypass Surgery

Laparoscopic Roux-en-Y Gastric Bypass was first originated by a group of Bariatric surgeons in California in 1994.  This procedure is considered a combination procedure.  It works by both restricting the amount of food consumed and also by providing some malabsorption.   The surgical outcomes of this procedure seem to indicate that the weight loss results are similar to the traditional “open” procedure as long as the procedures are performed the same way.

The procedure begins by dividing the stomach to create a “pouch” that limits the amount of food that can be eaten.  The pouch is about the size of one’s thumb and can hold about 20cc or 2-3 tablespoons of food.  The larger excluded stomach, known as the gastric remnant, is stapled closed and separated from the pouch.  This portion no longer receives food but has a normal blood supply thereby keeping it healthy.

The second step of the procedure involves taking a portion of the small intestine and creating a “bypass” or “Roux” limb that is connected to the new pouch to provide an outlet for food.  This part of the procedure is what creates a slight malabsorption of nutrients to assist in weight loss.

The malabsorptive portion of the procedure also contributes to weight loss by causing a condition known as “Dumping Syndrome”.  Most sugar consumed is normally absorbed in the first 1-2 feet of small intestine in normal situations.  After the Gastric Bypass procedure sugar passes directly from the pouch into the lower small intestine.  The unabsorbed sugar pulls fluid into the small intestine resulting in distension, increased motility (activity), cramping and a neurologic response that may cause an increase in heart rate, sweating, diarrhea, nausea, and even vomiting.  Most patients will experience this at least once and will learn to avoid foods containing high sugar content, thus improving the chance for long-term weight loss success.

The following is a diagram of the described procedure: gastric bypass

Risks:

  • Possible conversion to an open procedure due to limited access and visibility
  • There may be an increased risk for bowel obstruction in the long term
  • Death (1:500-1,000)
  • Pouch leaks – (1%)
  • Deep venous thrombosis (1-2%)
  • Pulmonary emboli (1%)
  • Abdominal wall hernia (1%)
  • Peptic ulcer disease (3-5%)
  • Stricture (narrowing) at gastric pouch (1-2%)
  • Small bowel obstruction (1-2%)

Typical Results and Outcomes:

The average best weight loss for this procedure is 70% of a person’s excess body weight (i.e. if someone is 100 lbs. over their ideal body weight, average weight loss outcomes would be 70 lbs.).

A weight loss of only about 40% of excess body weight will often show significant improvement in many other medical problems:

  • Many Type 2 diabetics will get off of their medications
  • Hypertensive clients will have improvement or resolution of their hypertension
  • Sleep apnea almost always improves
  • Cholesterol improvement in most clients
  • Arthritic symptoms improve

Determining which procedure is right for you will require an evaluation with your surgeon and discussion about your specific situation.  As you meet with him/her you will want to find out what their opinion is regarding the preferred weight loss procedure based upon your medical history as well as the number of procedures he/she has performed and their individual outcomes.

We invite you to view our Weight Loss Surgery webinar to learn more and decide if weight loss surgery is right for you:  Weight Loss Surgery Webinar

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Rhonda’s Opinion:  The decision has to be yours but I am REALLY happy with the sleeve gastrectomy!

Best of CoVa Contest!

Posted on January 21, 2018 by

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We have to admit it.  We know we have the very best patients around!  We drive to work with smiles on our faces. looking forward to helping our patients improve their health by losing weight.  Your success makes us happy!

If you’d like to let others know about Dr. Clark’s Center for Weight Loss Success, please take a minute and VOTE FOR US in Coastal Virginia Magazine’s Best of Readers’ Choice Awards for 2018!

You will find us under HEALTH and BEAUTY in THREE categories

  • Best Gym/Wellness Center
  • Best Specialty Fitness
  • Best Weight Loss Center

You can also nominate/vote for us in SHOPPING

  • Specialty Foods

You can vote ONCE each DAY through Friday, March 30, 2018

Share the Love!

Walk Your Way Healthy

Posted on October 16, 2017 by

So often people want to exercise, but they don’t know where to start. Walking is a great place to start. Walking is typically easy on the joints, can be done anywhere, and all you need is a comfy pair of shoes.

HOW TO GET 10,000 STEPS A DAYfeet on sidewalk
Everyone knows movement is good for the body. The hardest part is often finding the time, especially if you have an office job. However, 9-5 is a long time to be sitting at a desk. But don’t worry, anything is possible with a little bit of change.

Walking is the best way to start adding movement into your day. Walking is typically easy on the joints, can be added in small time frames, and needs no fancy equipment.

If you have the option, I highly recommend an activity tracker. While pedometers and activity trackers are in no way a necessity, seeing your steps add up can motivate and inspire you to keep moving. Seeing your steps also adds accountability. You may think you are getting an adequate amount of movement, but having a concrete number to track will help you ensure you are hitting your goals.

If you are new to walking try to hit 10,000 steps a day at first. That may seem daunting, but think of reaching 10,000 steps in smaller goals. Set a small goal to hit 250 steps/hour or 100 steps/30 minutes throughout the day. Newer activity trackers can often be set to alert you at different times of the day or a well-placed post-it note can sometimes be all it takes to keep your mind focused on your goal. Also start to recognize what activities equal 100 steps. You’ll be more motivated to continue changing your habits if you can see a concrete benefit that results.

If you are at a desk for the majority of the day there are great ways to sneak in steps throughout your day:

1. First, stepping side-to-side does count! Stand and pace as you read your emails in the morning. Are you brainstorming with colleagues? Don’t be afraid to stand and move as you think. The fun thing about counting steps is every step counts! Even if you’re not walking anywhere.

2. Park in the back of the parking lot. This advice is nothing new. But it still stands as good advice. I bet walking into work in the morning from the last spot in the lot can easily get you 100 steps.

3. Do you take an elevator? Change to taking the stairs. If you are new to stairs don’t feel like you have to conquer them all at once. Simply walk one flight up and then take the elevator the rest of the way. Add in the extra flights as you get stronger. Fitness success is about making a lot of little changes over a long period of time. It’s not about making a lot of changes all at once.

4. Rather than emailing or calling a coworker, walk over to their cubicle.

5. Walk the longest path to the bathroom, printer, scanner, fax, kitchen, water cooler, etc.

6. Take a short walk during your lunch break. Instead of spending your time driving to and from a restaurant, pack your lunch and then squeeze in a short walk with the time you saved.

7. Dress for success! Keep a change of shoes, socks, undershirt, etc. in your car during warmer weather for your longer lunchtime walks. In the winter, keep mittens, hat, and a scarf handy.

8. If it’s still too cold in the winter or too hot in the summer you can head to your nearest mall. Walking end to end one time is sure to add up!

9. Be the one who walks the dog, gets the mail, takes out the trash, and picks up the house before bed

10. Make time with your family count. Take a walk after dinner. Start playing Pokemon Go with your kids. Dance in the kitchen as you cook. Start a new hobby like bird watching, golfing, or hiking. Free time is when you’ll really rack up the steps.

Once you start tracking your steps you’ll be motivated to squeeze in more steps and set new goals. More importantly, you;ll be finding more ways to live a happy and long life. Steps don’t just result in better physical health. Walking will give you more opportunities to de-stress and clear your mind. Innovative ways of hitting your step goals will create new hobbies and create family memories. The more you get moving the more life you’ll have in each step.

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Join the CFWLS Steps for Success and add your daily steps to our group walks!  It’s easy – just log into World Walking and join the group.  It’s fun and a great way to stay inspired.

If you would like more advice on reaching 10,000 steps a day contact a CFWLS personal trainer or lifestyle coach today.

Spring Teller croppedContributed by Spring Teller, CPT, Group Instructor