Questions and Answers about Weight Loss Surgery

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When it comes to shedding unwanted pounds, it’s a good idea to weigh your options. Many consider weight loss surgery, also known as bariatric surgery, a great way to meet their health goals.

We recently sat down with Brown & Toland physician and board-certified surgeon, Ryan Macht, MD, to learn more about his background and the bariatric surgery program he leads at Dignity Health Medical Group – Sequoia. Like any medical procedure, there are common questions asked before the process. Dr. Macht provided some of the answers you’ll need as you consider your options.

1. What drew you to being a surgeon, and to bariatric surgery in particular?

I went to medical school unsure of what specialty I wanted to pursue, but I never thought I would be interested in surgery. However, I fell in love with it during my third year surgery rotation. I enjoyed the technical aspect of being in the operating room and seeing the immediate results of fixing such a broad range of surgical issues. But more important, I liked helping patients through a challenging time in their lives. Seeing bariatric surgery patients during my student rotation was actually one of the main reasons I became interested in pursuing general surgery. I was amazed at how the operation could transform people’s lives and improve their health so significantly. I was so impressed and intrigued, that I got involved with a research project shortly after looking at improvements in pulmonary function after bariatric surgery.

2. What is rewarding about practicing bariatrics?

The most rewarding part is seeing my patients after surgery and hearing them talk about how much their quality of life has improved. Many of their health problems, like diabetes and high blood pressure, are improved or even completely cured after surgery. I also enjoy the long-term relationships that I develop with them, guiding them through the preoperative process and then following up with them each year after surgery. It’s one of the few areas within general surgery where this long-term patient relationship is possible and I think that makes it very worthwhile.

3. Are there specific qualifications for becoming a candidate for surgery?

In general, patients must have a body mass index (BMI) greater than 40 or BMI greater than 35 with obesity-related health issues. Prior to surgery, all patients undergo a mental health evaluation, dietitian counseling and participate in education with support groups to prepare them for surgery, and an individualized medical workup as needed. Different insurance plans will often also have other requirements for insurance approval.

4. Please describe the different types of bariatric surgery.

Currently, the most common bariatric surgery performed in the United States is the sleeve gastrectomy. In this operation, about two-thirds of the stomach is removed and the remaining narrow stomach is about the size and shape of a banana. The gastric bypass is slightly more involved and a small stomach pouch is created with the small intestines rearranged to connect to this pouch. Both operations lead to great outcomes, but there are some differences between them and I work with patients to help them choose which is best for them. The lap band is an operation in which an adjustable band is placed around the stomach. It previously was performed quite commonly, but has now fallen out of favor due to less weight loss and more long-term complications.

5. Tell me about some of the latest breakthroughs in bariatric surgery.

One of the great things about surgeons is that we are constantly striving to improve peri-operative care to make things safer and more effective for patients. Sometimes this involves changing the technique of operations and finding ways to perform surgery less invasively, like with robotic surgery. However, one of the biggest changes more recently is incorporating Enhanced Recovery After Surgery (ERAS) protocols for bariatric surgery. This is a multidisciplinary effort to standardize care with the goal of decreasing complications and having patients recover and leave the hospital in less time. We have incorporated these ERAS pathways at Sequoia Hospital with many different methods to decrease pain and nausea after the operation and decrease the likelihood of rare complications like blood clots, readmissions to the hospital and respiratory issues.

6. Can you debunk any common myths about weight-loss surgery?

There are unfortunately many misconceptions about weight loss surgery but once patients learn more about it, a lot of their concerns are relieved. First, people often think it’s very invasive and unsafe. While there are risks to any surgery, the safety of bariatric surgery has dramatically improved over the last 20 years and the risk of serious complications or death are similar to other more common operations like appendix or gallbladder removal. Another myth is that most people gain all of the weight back over time. While weight regain can be an issue for some, the majority of patients are able to sustain their weight loss and health improvements in the long term. Finally, many people think that weight loss surgery is only for extreme cases or as a last resort after many years of suffering from obesity-related comorbidities. In actuality, doing bariatric surgery sooner leads to a higher rate of remission of comorbidities like diabetes and can prevent other serious health issues from developing.

To learn more about the bariatric surgery program at Sequoia Hospital, please visit their webpage .  To join Dr. Macht for an informational seminar to learn if bariatric surgery is right for you, register here.