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Surgeons
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Contents:
What do
Primary Care Physicians Need to Know?
by David Diaz, M.D.
Changing Your Lifestyle...
Forever
by Keith Kim, M.D.
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By David Diaz, M.D.
Most primary care physicians are well aware
of the benefits of gastric bypass surgery.
Many of our patients are referred to us by
their doctors because the co-morbidities, or
diseases associated with obesity, are often
difficult to control by conventional means.
Physicians understand that until the obesity
is resolved, problems such as diabetes, high
blood pressure and sleep apnea, just to name
a few, will not go away.
In the past there have been many surgical
approaches to weight loss. Unfortunately,
some of the initial surgical designs were
fraught with problems and complications.
This created the perception that all
operations for obesity management were to be
avoided – so much so that many institutions
avoided bariatric procedures until only
recently. Many primary care physicians still
have recollections of the problems their
patients faced when they underwent early,
ill-conceived operations for weight loss.
Due to this past experience with poorly
designed operations, it is understandable
that there are still physicians who are
hesitant to refer their patients for
bariatric procedures. They truly believe
they are acting in the best interests of
their patients.
The Roux-en-Y gastric bypass has evolved as
the premier operation for the surgical
treatment of morbid obesity in the United
States. This operation has a 30-year track
record of safety and efficacy, and accounts
for approximately 90% of the bariatric
procedures performed in the U.S. today. This
is the operation that we offer our patients
at U.S. Bariatric. After 3500 procedures,
85% of our patients have lost at least 75%
of their excess weight, and 95% have lost at
least 50% of their excess weight. The
combined weight loss of all our patients is
approximately 500,000 pounds.
A comprehensive, integrated,
multi-disciplinary, surgical weight-loss
program like U.S. Bariatric is critical for
patient success. The decision to proceed
with surgery needs to be a combined effort,
to include the patient, primary care
physician, pulmonary specialist,
cardiologist, endocrinologist, psychologist,
surgeon and any other individuals involved
in the patient’s care. Just because a
surgeon is willing to do a weight-loss
procedure will not assure success unless
there is a comprehensive program in place to
guide the patient through the period of
recovery and readjustment. We are proud of
our success at U.S. Bariatric and welcome
the opportunity to discuss questions
regarding your care with any of your other
physicians.
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By Keith Kim, M.D.
Certainly the first year after weight loss
surgery provides different experiences for
different people, but one thing is for
certain – it is a period of change. The
changes are drastic and involve eating
patterns, attention to nutrition, weight,
and even interpersonal relationships, just
to name a few. However, the changes slowly
become less intrusive and become a new daily
routine. Life and weight again assume a more
stable posture.
If only it were that easy. I often ask
patients who admit to not taking their
multivitamins regularly why they brush their
teeth every morning. The response is
usually, “I don’t know, I just do it. I
don’t even think about it.” This is what
surgeons want to hear from patients when
other people ask them how they refrain from
eating certain foods, how they take
multivitamins everyday, how they refrain
from drinking with their meals, etc.
The problem with obesity has not been so
much how to lose the weight, but more how to
keep the weight off. Many people know that
this is the downfall of diets and behavior
modifications without surgical intervention,
but this issue is also a concern after
weight loss surgery. Understanding the
problem is relatively simple. The body has
an incredible capacity for adaptation and
tends to resist drastic changes. Surgery
causes a dramatic reduction in caloric and
nutritional intake, whether by restriction
or a combination of restriction and
malabsorption. This obviously results in
weight loss. The body adapts by slowing down
the basal metabolic rate and by increasing
the efficiency of absorption of nutrients in
the small intestine. Eventually a balance is
again achieved and the weight loss stops and
a plateau is reached. The important point
here is the idea of balance. The same
efforts that it took to reach that point
need to be maintained in order to preserve
this balance.
It is much easier for patients to be
compliant in the first year because the
initial rapid weight loss rewards the
efforts. It is during this period that it is
critical to establish good habits. This
means doing the right things everyday so
that a routine can be established. Once the
weight loss stops, no matter how much more
active patients are or how much better they
feel than before surgery, the everyday
problems and challenges of life must be
addressed. With the excitement of constant
rewards and compliments gone, it is hard to
do the right things everyday. The ultimate
success of the surgery, however, hinges on
just that - doing the right things every
single day. Cheating here and there in the
first year or so after surgery easily leads
to cheating routinely in the years after
surgery.
A good friend, a bariatric chef, and a
patient himself told me that he saw the
period of weight loss as a dress rehearsal.
The maintenance of the weight loss he
pointed out was the performance, a
performance that lasts a lifetime. I think
this is the perfect way to look at the
process. The first year after surgery is a
period of practice and a period of
developing tools. This is the period in
which routines and habits must be developed.
Remember that achieving goal weight is not
the end of the journey, but merely the
beginning. A balance has been reached and
maintaining that balance is the real
challenge in the journey.
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