Could This Be the Path to a Trimmer You?
Weight-Loss Surgery is Right for Some; for Others, Diet and Exercise Suffice. Either Way, TriHealth Can Help
Many of us battle with our waistlines, striving to lose those few extra pounds. But if you’re seriously overweight, you’re putting your health at risk.
Being overweight or obese is linked to type 2 diabetes, heart disease and cancer. But the good news is that losing weight can help—sometimes, for example, it can cure diabetes or high blood pressure completely.
Losing weight is tough, but TriHealth can help. For some, surgery is the answer; for others, a supervised program of exercise and dieting can do the job.
In recent years, bariatric (weight-loss) surgery has become a safe and effective treatment for those who have tried hard but failed to lose weight through lifestyle changes such as diet and exercise. But surgery is not for everyone. Indeed, surgery for any condition is always the last resort. And in the case of weight loss, it’s only allowed for patients who meet strict requirements set by national medical groups such as the American Society for Metabolic and Bariatric Surgery. The Good Samaritan Hospital Weight Management Center was the first in Cincinnati to be recognized as a Center of Excellence for Bariatric Surgery, and it continues to be a center accredited by the Metabolic and Bariatric Surgery
Accreditation and Quality Improvement Program (MBSAQIP).
Patients who qualify for surgery must have a body mass index (BMI)—a ratio of weight to height—that is 35 or higher if there are coexisting conditions such as high blood pressure, type 2 diabetes and sleep apnea, or a BMI of 40 or higher if these conditions aren’t present, says Kevin Tymitz MD, a bariatric surgeon with TriHealth.
He and his partner, George Kerlakian MD, medical director of the bariatric program, “offer the full gamut of bariatric procedures,” he says, almost all of them done with a minimally invasive approach that uses laparoscopic instruments inserted through small openings in the belly. These techniques allow for faster healing, less blood loss and pain and shorter hospital stays than with open surgery, he says, noting that “our patients typically go home the day after surgery.”
The two most common procedures are Roux-en-Y gastric bypass and sleeve gastrectomy. In the former, the surgeon creates a small pouch in the stomach and then connects that to a lower part of the intestine, in order to limit the amount of food eaten and digested. Sleeve gastrectomy involves removing two-thirds of the stomach, leaving a “sleeve” that also reduces the amount of food the patient can eat, but does not bypass part of the intestine.
In a third procedure, called lap band surgery, an adjustable band is placed around the top portion of the stomach. But this option has fallen out of favor with bariatric surgeons. “It’s a trend across the country,” says Dr. Tymitz. “Lap band rates are way down for several good reasons. It’s the least effective surgery, patients tend to regain weight more readily, and it also has the highest complication rates.”
Dr. Tymitz recommends gastric bypass surgery for those with higher BMI and with diabetes or other conditions because "with that method they tend to lose more weight and lost it more quickly. In addition, changes in gut hormones that result from the procedure can in some cases, effectively cure diabetes in the days and weeks after surgery, he says. Sleeve gastrectomy produces more gradual weight loss and a lower eradication of diabetes.
“I tell gastric bypass patients they can expect peak weight loss at 12 months and they will lose between 60 and 80 percent of their excess body weight,” says the doctor. “With sleeve gastrectomy, the peak is at 18 months, and they lose between 50 and 70 percent of excess weight.”
Surgery, however, is just the beginning. “The surgery is the easy part of the journey, and the least important,” Dr. Tymitz stresses. “The most vital part is following up with our dieticians and getting into a regular exercise regimen. Patients can easily regain weight if they fall back into old eating habits and don’t exercise.”
For those who stay the course, the results can be dramatic. “These patients can achieve a lifesaving change,” the doctor says. “To see their transition as the weight comes off, to see them come back to the office off their blood pressure medications or insulin—it’s an amazing thing to see people change before your eyes.”
Learning to Eat Healthy
When patients don’t meet the surgical requirements or simply wish to avoid surgery, TriHealth offers special programs to help them lose weight. The first, called LifeSteps, is a comprehensive 12-week program that teaches people how to eat healthy, increase their physical activity and make successful behavior changes. It includes an individual nutrition consultation as well as weekly exercise sessions with a personal trainer.
Also, a recently added program called HealthOne provides a low-calorie diet product for individuals with a BMI of at least 27. The HealthOne program runs 36 weeks and combines a food replacement with the diet and exercise education provided by LifeSteps.
Both programs include a full complimentary membership in the TriHealth Fitness & Health Pavilion. Registered dieticians Gina Feldkamp and A. Jo Schenkel supervise patients’ participation. “Our classes teach how the environment and your friends and family can help you, how to deal with eating out and at special occasions, supplements you need to take, how to find time for exercise, how to keep food records and how to be more accountable for your eating and drinking,” Feldkamp says. The programs also include healthy cooking classes, talks given by TriHealth physicians, health screenings and more.
Whether you choose to lose weight with or without surgery, working with TriHealth’s team at the TriHealth Weight Management is critical for sustained weight loss. Each patient meets with a bariatric surgeon (if they’ve had surgery), a bariatric nurse coordinator, a dietician and an exercise physiologist. “Our team is awesome,” Dr. Tymitz says. “They are vital to the success of the program and our patients. Without them we would not see the success we have seen.”