Tag Archives: sleeve gastrectomy outcomes

Weight Loss Surgery Options

Posted on October 15, 2019 by CFWLS

Let’s talk about the problem of obesity and what you can do about it. I will preview the operative procedures and the risks of having surgery, as well as the results. I’ll give you my opinion. For most people I think the sleeve gastrectomy is the better option! I see all the nutritional problems that arise and abnormal anatomy problems with the bypass. And I see the device problems with the adjustable bands. There’s relatively poor weight loss with the bands. The sleeve gastrectomy is a fairly low risk procedure. It’s a quick recovery and we see really good weight loss with it. And, you keep your anatomy normal. I’ve become convinced over the years that keeping the anatomy normal is probably a good thing.

Weight loss is hard. Surgery is an extension of an overall medical weight loss plan. Weight doesn’t magically fall off just because you have surgery. It’s still diet, exercise, and behavior modification. Surgery is a “tool” to assist you with weight loss. That’s all it is. A tool can either be used correctly, or it can be used incorrectly. If used correctly it can be very powerful. If used incorrectly it doesn’t work well and you can get into some real problems. Long term weight control is still very hard. Some people think they’ve had the surgery and lost the weight so they don’t have to worry about it anymore. YES YOU DO! You can regain your weight. It doesn’t matter what operation we’re talking about. You need to do the right thing. You have to know what the right things to do are. Then, how do you implement those things? Sometimes the concepts are really straight forward but you have to know what they are. Implementing the concepts is the hard thing. We have the expertise and support here. We can help you with how you do this in your life. Sometimes life tends to get in the way. Surgery combined with a Medical Weight Loss program gives you the best chance for long term success. It’s not that we’re doing better or different operations but we see better weight loss than other places. We see better weight loss because it’s the education and support side of this whole thing that really gets people optimizing weight loss and then keeping that weight off long term. That’s absolutely key.

Lots of different medical problems go along with weight. Every single one I’ve listed on the slide is directly related to weight. When weight goes up, they get worse. As weight comes down, they get better. Some of them completely go away with weight loss. If they don’t go away, at least they get under control. Some of them are very significant: diabetes, high blood pressure, heart disease, and more. These things can potentially be life threatening. Weight loss treats them all. If I could boil it down to the biggest problem it’s the risk of dying. It goes way up. For someone who is 75-100 pounds overweight, on average, you’re going to die about 10-15 years before someone who’s not overweight. That’s the issue. We want you to live a long, healthy life and die of old age. Last thing you want is that premature death. By treating the weight, we can treat all those other problems.

To learn more about your weight loss surgery options, check out our informative webinar: Weight Loss Surgery Webinar

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What is Life Like After Weight Loss Surgery?

Posted on April 30, 2018 by CFWLS

Your feelings regarding life after surgery will likely vary depending upon how far out you are from surgery, your level of preparation prior to surgery, your ability to manage change and your overall attitude/mindset. Rest assured, there is often not a dry eye in the office as goals are met/exceeded throughout the first year after surgery and beyond. It’s extremely rewarding for you and everyone involved and you hear more often than not “I wish I would have done this sooner”. As a generalization, at the Center for Weight Loss Success, we have found that most people go through a few expected phases and the timeframe for each varies:

Phase 1: What have I done?
Phase 2: I can do this.
Phase 3: I am glad I did this.
Phase 4: I wish I would have done this sooner!
Phase 5: I need to stay on track (especially if necessary long term success habits throughout the first year after surgery weren’t developed)

At the time of this publication, the primary surgery performed by Dr. Clark at the Center for Weight Loss Success is the sleeve gastrectomy. In fact, most of these patients go home the same day of surgery since you generally recover better in your own home environment. You go through a thorough pre-operative program and your post-operative program begins right away.

When you first go home from the hospital, here are some general guidelines for what to expect. Of course, each surgeon has their own particular orders so be sure to follow whatever he/she recommends.

With regards to your diet, you will want to make sure you are staying hydrated by sipping all day. You will usually continue with a liquid diet until you are seen by your surgeon 10-14 days after surgery. You should not have any carbonated beverages – refer to your the liquid diet instructions set forth by your surgeon. You need to stay hydrated and do your best to try to get about 80-100 grams of protein in per day with high quality protein shakes (again, follow your surgeons specific orders).
You will want to be up and walking as tolerated and rest when you are tired. You are usually permitted to shower. Common sense comes into play here. If anything is hurting you then you probably should not be doing it yet. At the Center for Weight Loss Success, we restrict lifting to no more than 20 pounds for the first two weeks and restrict driving for 3-4 days after surgery as long as you are off of your pain medication. Getting up and moving is a good thing. Not only for your body but for your emotional state as well.
Your surgeon will have specific instructions for wound care and medications. Follow these as instructed.
It is not unusual for you to question “What did I do?” the first days after surgery. It is a big adjustment and although you won’t likely feel hungry, just drinking liquids is a big change and can be difficult to get used to. The first few days tend to be the worst and then you get used to it. It helps to focus on your goals. This will all be worth it.
Make sure you go to all of your scheduled follow-up appointments and call your surgeon if you have any questions/concerns.

After the first two weeks, you will generally be able to begin “mushy” foods. At the Center for Weight Loss Success, we have a thorough educational program that guides you through exactly what to do/eat which is beyond the scope of this book. Your experienced bariatric surgeon/center will likely have similar resources for you.

At approximately one month after surgery, you will begin eating more regular foods. You will want to focus on getting in an adequate amount of quality protein (at least 90 grams), staying hydrated (sometimes thirst is mistaken for hunger) and easing into a regular exercise regimen. Your experienced bariatric surgeon/center will have an entire plan set to help guide you through each phase after surgery. Remember, it is never too early to begin your habits for success. As a general rule, these include:

Eating – Don’t skip meals. Food choices should be low fat and low sugar. Think “Protein First”. Eating should be approached as “how little can I eat and be satisfied”, NOT “how much can I fit into my new smaller stomach”. You will want to cut your food up into small pieces, use a smaller plate, put your fork/spoon down in between bites and chew slowly. It is best to eat at a table and not “on the run” so you will avoid eating too fast, overfilling your pouch and end up with unnecessary pain or difficulty.

Drinking – Try to avoid drinking with your meals since it “washes” the food through quicker and decreases your ability to stay fuller longer. Beverages should be non-caloric and non-carbonated. Drinking 8 glasses of water each day is a good idea with any weight loss plan. Avoid alcoholic beverages.

Vitamins – Multivitamins should be taken daily – Forever. Other vitamins and/or supplements may be needed depending upon individual needs.

Sleeping – Make sure you are well rested. You will be most successful if you sleep an average of 7 hours each night.

Exercise – Regular exercise is extremely important and should be done at least 3-4 times per week for at least 30-40 minutes.

Personal Responsibility – Successful patients take personal responsibility for weight loss/weight control. It’s up to you!! No one else can lose the weight for you. The surgery is only a “tool”. You have to use this tool appropriately.

Every person recovers at a different rate. It is important to take it one day, one week, and one month at a time. Be involved in your pre-operative and post-operative educational program and try to attend a support group once a month. Being around others who are experiencing the same thing or who have a long-term success story to share is very helpful. When you get to that point, be sure to share your success as well. Celebrate your accomplishments along the way and reward yourself with something non-food related such as a massage, manicure, pedicure, golf club, fitness center membership, new piece of exercise equipment or a great piece of clothing. You will not want to invest a large amount of money in clothing because of rapid weight loss. Joining a clothing exchange with other weight loss surgery patients is helpful too.

Finally, surround yourself with like-minded successful people who support you and your goals. There are plenty of saboteurs in this world – they may even be your closest family or friends. This is a topic we could write an entire book about! In short, ask them for their support and explain the changes you want and need to make (use “I” statements and own your goals). If they continue to be unsupportive, you may need to limit your time with them. I know this is easier said than done but it is ok for you to be selfish – this is your time to shine! Go for it!

Is Weight Loss Surgery Right for Me?

Posted on March 12, 2018 by CFWLS

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).⁵In 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 CFWLS

If 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:

BMI	Classification	Health Risk
Under 18.5	Underweight	Minimal
18.5-24.9	Normal Weight	Minimal
25-29.9	Overweight	Increased
30-34.9	Obese	High
35-39.9	Severely Obese	Very High
40 and Over	Morbidly Obese	Extremely 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 CFWLS

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:

The 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:

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

The sleeve gastrectomy was originally developed as the 1^st 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.

Laparoscopic 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:

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

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

Thanks to Dr. Clark...

General Guidelines for Weight Loss Surgery Candidates3:

Sleeve Gastrectomy:

Advantages:

Risks:

Typical Results and Outcomes:

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

Advantages:

Risks:

Typical Results and Outcomes:

Laparoscopic Gastric Bypass Surgery

Risks:

Typical Results and Outcomes:

General Guidelines for Weight Loss Surgery Candidates³: