Bariatric Surgery: Proven Success, Life Changing Results

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Featured Speaker:
Steve Weiland

Steven T. Weiland, MD – Bariatric Surgeon
Steven T. Weiland, MD is a native of Wausau. He started practice in 2002 after completing his Medical School at Medical College of Wisconsin, Milwaukee, WI and Residency at University of Wisconsin Hospital & Clinics, Madison, WI.

Special Medical Interests: Minimally Invasive Laproscopy Surgery, Weight Loss Surgery, Hepatic and Pancreatic Surgery.

About This Podcast

Obesity is a serious condition that affects over 78 million adults in the United States. Being obese substantially raises your risk of morbidity from serious health conditions and can stop you from doing the things you want to do in life.

You don’t have to live with being overweight. Weight loss surgery provides a proven and effective way to achieve long-term weight loss to help you make a change for health and for life.

Here to discuss bariatric surgery options available at Aspirus Bariatrics is Steven T. Weiland, MD. He is a Bariatric Surgeon with Aspirus Health System.

Transcription

Melanie Cole (Host): Obesity is a serious condition that affects over 78 million adults in the United States. Being obese substantially raises your risk of morbidity from serious health conditions and it can stop you from doing the things you really want to do in life. My guest today is Dr. Steven Weiland. He is a bariatric surgeon with Aspirus Health System. Welcome to the show Dr. Weiland. So, who is a candidate for weight loss surgery? When does it come to the point when you think somebody should come and see you or visit a bariatric surgeon to find out what the parameters are?

Dr. Steven T Weiland, MD (Guest): Well oftentimes, we use body mass index as a gauge to help us define who would qualify for weight loss surgery and that’s something you can look up quickly on the internet and by adding your height and weight into a calculated calculation that you can find on the internet. In any event, we usually pick patients who have a body mass index over 40 or someone who has a body mass index of 35 but has lots of health problems or comorbidities that are associated with their weight. We are also looking for patients who have tried very hard to lose weight in the past on their own with diet and exercise or with the help of their physician. Weight loss surgery really shouldn’t be your first line approach to try and lose weight. We would like to have people try and lose weight by making healthy choices around eating habits and exercise and trying more conservative approaches prior to jumping right at surgery.

Melanie: So, as a tool to aid in weight loss, which is what I understand that you physicians consider this, it is not the be-all, end-all answer. But it is a tool and something that people have to consider very carefully. What are some of the things you want people to think about in advance and what do they have to do? Is there psychological counseling that they have to do? Do you want them to continue to exercise and try and lose weight?

Dr. Weiland: Well you really hit the nail right on the head. Surgery is not a stand by itself way to treat morbid obesity. Surgery is simply a tool and to use the tool correctly, you have to learn new habits around eating properly, eating healthy, picking good food choices and also exercise. You know the body, I always say is not that complicated. We put calories in and you have to burn calories off every day. And really, it’s a very, very thoughtful way to approach these situations and we give our patients all the help that they need in this area. We have them work with skilled nutritionists, dieticians who help them understand their present eating habits and how we have to morph those into more appropriate eating habits in the future going forward. We also have our patients work with our exercise physiologists, our physical therapists who kind of can specialize in helping these overweight people to exercises that they can tolerate and that their body’s can tolerate because many of them have problems with chronic back pain, or chronic knee pain that can somewhat limit them. But we are able to work with them and teach them exercise habits that they can do, and they can accomplish. But to summarize, I always make it very clear to the patients, surgery is one aspect of their weight loss. Probably the bigger more important aspect is lifestyle change around their eating habits and exercise and it’s a change that has to happen not only right before surgery, in the months leading up to it; but also after. You brought up psychology assessment and every patient goes through a psychological evaluation prior to surgery. Many patients don’t need anything beyond there, but often patients who are morbidly obese struggle with eating habits, poor behaviors around eating, and we have a team of people that can work with those patients to help them understand where they are struggling and help them to change those habits or correct them, so they will have a better outcome after surgery.

Melanie: What does it mean Dr. Weiland, to say that you have been recognized by the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program? What does mean for Aspirus patients considering this type of surgery?

Dr. Weiland: Well, I think what it means is that we have successfully gained that accreditation which speaks to the fact that we follow very specific guidelines and have outcomes that are judged to be in the upper level quality wise. So, I think a patient who goes to a center with that type of accreditation, knows that this is not an organization that just does this as a part-time thing. We are very serious about this and we have been accredited I want to say for at least 10-12 years and we have always maintained our accreditation and we are very proud of that. But it shows that we do a basic number or a threshold number of these procedures on a yearly basis. It also looks at our quality outcome metrics and that we’re meeting those metrics as far as results with the actual weight loss and limiting our complications.

Melanie: So, let’s speak about the types of bariatric surgery that you offer and why don’t you start with the one that people have heard the most about which is gastric bypass?

Dr. Weiland: The Roux-en-Y gastric bypass is really the work horse and has been the workhorse in weight loss surgery. In the last four or five years, there has been larger trend to sleeve gastrectomy which I will get to shortly. The Roux-en-Y gastric bypass however, has really been around for about 30 years. It really kind of gained a lot of growth and enthusiasm which the advent of laparoscopic surgery. That was our ability to do these operations through very small incisions as opposed to one long, lengthy incision going up and down the entire abdomen. But basically, it is a two-pronged approach to get people to lose weight. First there is a restriction component where we divide the stomach up high leaving a small pouch at the base of the esophagus. That’s the restriction. You are limited in how much you can eat and fit into that pouch at any one time. There is also a malabsorptive property and that is the bypass. That is bringing up a loop of intestine and connecting it to that upper pouch which allows the food in that pouch to pass down the bowel away from the secretions from the liver and pancreas that help you digest your food. So, the concept of the Roux-en-Y is we are limiting how much you can eat and what you do eat, you are limited in the amount of calories that you are actually absorbing. And the goal of that operation is to get people to lose about 70% of their excess body weight; the amount of weight that they are over their ideal body weight, 70% of that over the course of 12-18 months.

The sleeve gastrectomy really was developed probably about 15 years ago, and it was actually thought to be perhaps a segue for people that were extremely overweight, severely, severely obese with weights in the 500-600 range. It was felt to be a segue to get them to lose a small amount of weight before moving on to a Roux-en-Y gastric bypass. And what a sleeve gastrectomy is, is actually removing a majority of the stomach by leaving a tube of stomach from the esophagus down to the duodenum, but taking away that capacity of that stomach to hold food. It doesn’t have as much of a malabsorptive property that you have with the Roux-en-Y, but what we found interestingly was that when we did the sleeve; patients really lost similar weight to the Roux-en-Y and what we found is that they didn’t need to go on to secondary procedures to lose weight. This procedure was adequate. And since that time, there has been a lot of trend towards the sleeve gastrectomy because a lot of patients like that idea because it is not retooling your whole insides, your anatomy more or less is the same, we are just removing that area of stomach. But in general, in the last four or five years across the United States, sleeves have now overtaken the Roux-en-Y as being the more common operation that are performed. In our practice, I would say it is 50-50, 50% of our patients choose a Roux-en-Y and 50% chose the sleeve.

Melanie: When you say malabsorption and listeners don’t quite know what that means when you are talking about bypass. Does that mean that for the rest of their life, they must supplement? Are they not getting the nutrients that they need? What do you tell them about what life might be like after either one of these procedures?

Dr. Weiland: Well, after the Roux-en-Y, there is a malabsorptive property and it really, I try to explain it as we are giving less time for your intestines to absorb the calories and the proteins and the nutrition and so forth that you are eating. Most people however, if you are eating a well-balanced diet, we supplement you with a single multivitamin daily with iron and most patients do not develop a significant malnutrition as a result of that. So, I think it is something to understand, but and we spend a lot of time talking to patients about that obviously, but I don’t think that is something to fear.

Melanie: And I know you probably don’t always want people to ask this question, but are either one of these reversible, or should people just not go into this thinking that they are reversible?

Dr. Weiland: Well, the sleeve gastrectomy really is not reversible because once you actually remove the stomach, it’s gone. Again, I’m emphasizing that the whole stomach is not removed, but just a portion of the stomach, we usually throw out a number of like 90% or 85%. But once that’s removed from your body, it can’t be put back in. Theoretically with the Roux-en-Y, it is reversible. There is a way to disassemble it and put it back together in the proper orientation. But I think you really hit the nail right on the head. Patients who are looking at a surgery saying well maybe I’ll try this and if I don’t like it, I can reverse it; those are patients we really shy away from. Reversals are very complex. They are very high risk and they are really only done when patients develop certain complications that make it advantageous for them to have a reversal. But that’s very, very, very uncommon. So, if a patient is ever coming to me and saying I’d like to consider weight loss surgery but I really would like something that is reversible, usually I say that they are – in my opinion, they are not really ready to have weight loss surgery. This is something that they have to be committed to for the rest of their life.

Melanie: So wrap it up for us and how people can get started and what you want the listeners to know when they are considering bariatric surgery if they are morbidly obese and they have some of the parameters that you have discussed. What would you really like them to know Dr. Weiland, and how do you recommend they get started?

Dr. Weiland: Well, I think first of all sometimes it’s very helpful to talk to your primary care doctor. They oftentimes can help you find some pathways to start losing weight around your eating habits, exercise or even some medications. Patients who then gravitate more towards surgery, they usually reach out to us and we have a bariatric coordinator, named Theresa who oftentimes will talk to patients over the phone, give them information. We send them out information, we send them out a big packet. And we are more than happy to start that process. Patients have to understand that the process to actually get to an operation takes five or six months and usually that is more a factor of insurance parameters that require you to do a physician directed diet over the course of six months. We have patients go to support group meetings and obviously, we talked earlier about the aspects of meeting with our nutritionists, our exercise physical therapists and our psychology team. So, once you start this process, though patients usually are very excited. They are very motivated because they can start seeing progress with their weight already, losing some weight as they go through that process and so that’s exciting for them.

Melanie: Thank you so much for such great information and thanks for being with us today. This is Aspirus Health Talk and for more information on Aspirus Bariatrics please visit us at www.aspirus.org , that’s www.aspirus.org. This is Melanie Cole. Thanks so much for listening.