When the standard diet and exercise don’t seem to be working, it can be hard not to become discouraged. Luckily, for those who have gained a substantial amount of weight and struggle with weight loss and health, there are lower-risk, surgical options. Dr. Joon Shim of Wright State Physicians spoke with HealthScene Ohio on what to know, how to prepare, who’s eligible and just how low-risk bariatric surgery can be.
HealthScene Ohio: What don’t patients know about bariatric surgery, and what do you wish they knew?
Dr. Joon Shim: Some patients think that to lose weight and maintain weight loss is simple as long as one goes on a diet and exercise program. It is not that simple. Bariatric surgery provides a surgical tool for the selected patients to have a jump start into a lifelong commitment to health and lifestyle change.
HSO: What are some common concerns patients have about bariatric surgery, and how do you put them at ease?
JS: Having any surgery is risky. But the risks with bariatric surgery are low and uncommon. The primary reasons for improved safety include the increased use of laparoscopy, robotics and advancements in surgical techniques. Bariatric programs are accredited by the American Society for Metabolic and Bariatric Surgery and the American College of Surgeons. Overall, the mortality rate is about 0.1 percent, which is less than gall bladder surgery (0.7 percent) and hip replacement (0.93 percent).
HSO: Are there any pre-existing conditions that limit a patient’s options with bariatric surgery? What other options does the patient have?
JS: The psychosocial evaluation identifies potential risks to surgical intervention, such as substance abuse or poorly controlled psychiatric illness, and identifies interventions that can enhance long-term weight management.
Obesity is a risk factor for certain malignancies such as endometrial, renal, gall bladder, breast, colon, pancreatic and esophageal, and therefore prompts age- and risk-appropriate cancer screening before bariatric surgery.
There may be potential non-surgical endobariatric options for those patients.
HSO: Are there concerns for a patient’s mental health after surgery? Is depression ever an issue? What can be done to combat this?
JS: Among the psychological disorders, depression is the most studied. It should be noted that there is some overlap between symptoms of major depression and the physical consequences of obesity, such as fatigue, increased appetite and poor sleep, which may lead to over-diagnosis of depression in this population. You must differentiate symptoms that truly reflect depression from symptoms that are secondary to obesity itself. Continued follow-up with behavioral health providers is integral to the success of the bariatric patient population, preoperatively and postoperatively.
HSO: What are some healthy habits patients need to pick up post-surgery? What food and drink should a patient emphasize?
JS: Regular post-surgery dietary counseling by a registered dietitian is critical. Dietary counseling groups report greater improvements in eating behavior. A gym membership is not a requirement, but exercise should be part of the lifestyle change, and soda brings no benefit to the body.
Recommendations for protein intake are variable, but studies suggest higher protein levels (80-90 grams a day) are associated with reduced loss of lean body mass. Diet recommendations after surgery vary depending on your individual situation.
A gastric bypass diet typically follows a staged approach to help you ease back into eating solid foods as you recover. How quickly you move from one step to the next depends on how fast your body heals and adjusts to the change in eating patterns.
HSO: What are some risks that come along with bariatric surgery, and what is done to combat these risks?
JS: As with any major surgery, weight loss surgeries pose potential health risks, both in the short term and long term. Risks associated with the surgical procedure can include leaks, bleeding, infection, blood clots, reactions to anesthesia, lung or breathing problems, and death, albeit rare.
All these risks are low and the surgical team – including the surgeons, anesthesiologists and nurses – do everything possible in the operating room to prevent this from occurring. But patients need to be aware of these risks before consenting to weight loss surgery.
HSO: What are the latest developments in bariatrics, and how have they affected what you do? How have these developments affected patients?
JS: Recent advances in laparoscopic/metabolic surgery have made this minimally invasive surgery more than 10 times safer than a decade ago. The safety profile of laparoscopic/metabolic surgery is compatible with that of laparoscopic gall bladder surgery. For example, laparoscopic sleeve gastrectomy is becoming the leading bariatric surgery because of its simplicity and efficacy.
HSO: What are some of the best ways a patient can prepare for bariatric surgery? What are some common missteps leading up to the surgery and how can they be prevented?
JS: Education, education, education. Patients need to advocate for themselves and learn all the nuances of weight loss surgery, including pre-surgery and post-surgery. Patients who realize that weight loss surgery is a “surgical kick-start” and a tool do better than those who convince themselves that the surgery will do it all alone. Complete transparency and expectations between patient and all team members (including a surgeon, bariatric nurse coordinator, dietitian, behavioral health specialist, primary care physician, cardiologist, pulmonologists and endocrinologists) will guide and assist the patient for lifelong success.
HSO: What factors determine whether or not a patient is eligible for surgery?
JS: Qualifications for bariatric surgery in most areas include a body mass index greater than 40, or more than 100 pounds overweight, or a body mass index greater than 35 and at least two obesity-related co-morbidities, such as type two diabetes, hypertension, sleep apnea and other respiratory disorders, non-alcoholic fatty liver disease, osteoarthritis, lipid abnormalities, gastrointestinal disorders, or heart disease. Another factor would be the inability to achieve a healthy weight loss sustained for a period of time with prior weight loss efforts.
HSO: What is the recovery period like, and what are followup appointments like? How can a patient self-motivate post-surgery?
JS: When a patient commits to weight loss surgery, our program is committed to the patient and it is lifelong. We are your team members for the rest of your life. With that said, each program is different. We see our patients every few months to make sure they are recovering well and they are on the right path for success. Motivation comes with oneself. If a patient is committed to success, I think the motivation follows.
Hannah Bealer is a contributing writer. Feedback welcome at feedback@cityscenemediagroup.com.
Dr. Joon Shim
Dr. Joon Shim is a fellowship-trained, minimally invasive and bariatric surgeon with Wright State Physicians. Shim specializes in general surgery, bariatric surgery, minimally invasive surgery, robotic surgery, reflux, hiatal hernia and endoscopy. She also teaches as an assistant professor of surgery at the Wright State University Boonshoft School of Medicine.
Hannah Bealer is an editor. Feedback welcome at hbealer@cityscenecolumbus.com.
