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Weight Loss Surgery
Weight Loss Surgery
Methodist Specialty Transplant Hospital
A Campus of Methodist Hospital
Health For Life Center
The Methodist Health for Life Center offers a comprehensive multidisciplinary program involving a physiological, psychological, psychosocial and nutritional approach, which is designed to target underlying causes of obesity to ensure maximum success for our patients as they embark on their weight loss journey. We are staffed by qualified nurses and support staff with expertise in caring of the surgical weight loss patient. Methodist Specialty and Transplant Hospital has been designated as an American Society for Metabolic Surgery (ASMBS) Bariatric Surgery Center of Excellence® (BSCOE). To register for a free seminar or to learn more about the Health for Life Center at Methodist Specialty and Transplant Center visit www.HealthForLifeCenter.com
Methodist Texsan Hospital
A Campus of Methodist Hospital
Health for Life Center
Methodist Texsan Hospital’s boutique-style surgical weight loss center offers personalized customer service. When you arrive at Methodist Texsan Hospital, you will be greeted by our friendly concierge staff. The concierge staff is a resource for our patients as well as their families. Not only will the concierge staff give you directions, they are there to provide updates to your family during surgery. During surgery, you and your surgeon will benefit from our operating rooms supported by advanced clinical technologies. We have highly skilled surgical nurses and techs sensitive to the issues surrounding obesity. After surgery, you will be moved to one of our private rooms. Each room is equipped with a sleeper chair, as we encourage one overnight visitor. Our Bariatric Services Director will be with you through your stay. Methodist Texsan Hospital has been designated as an American Society for Metabolic Surgery (ASMBS) Bariatric Surgery Center of Excellence® (BSCOE). To attend a free surgical weight loss seminar, call 877-777-7756 or 210-575-0525.
For more information, please visit Methodist Texsan Hospital's Health for Life Center website.
Metropolitan Methodist Hospital
A Campus of Methodist Hospital
Health For Life Center
Metropolitan Methodist Hospital has a new 9-bed bariatric surgery unit specifically designed for patient who undergo surgical weight-loss procedures. The new unit features private rooms, internet access, waiting room for families and friends with TV and coffee. The unit is designed and furnished with beds and chairs that will comfortably accommodate the larger patient. Specialized nursing care and monitoring are provided in the unit. Our nurses work closely with our surgeons and promote relationship based care with patients and their loved ones. Metropolitan Hospital, Health for Life Center, and the Bariatric Unit is committed to extending lives, improving quality of life, and maximizing independence through a variety of interventions with weight loss. We welcome you to our hospital and hope you have a wonderful experience in our Bariatric Unit. Metropolitan Methodist Hospital has been designated as an American Society for Metabolic Surgery (ASMBS) Bariatric Surgery Center of Excellence® (BSCOE). To register for a free seminar or to learn more about the Health for Life Center at Methodist Specialty and Transplant Center visit www.HealthForLifeCenter.com.
Our facilities host FREE seminars for those interested in surgical weight loss. These informative seminars are held at our hospital and are hosted by one of our bariatric surgeons and usually last two to three hours. During this time the surgeon will discuss the different types of bariatric surgery, the rationale for surgery and the expected outcomes. After the surgeon lecture, attendees will have the opportunity to participate in a question-answer session with the surgeon. We encourage anyone interested in weight loss surgery to bring friends and family to the seminar for support and to share in the experience.
What is Obesity?
Obesity is an excess proportion of total body fat (weighing 20% or more than normal weight). Obesity is most commonly measured by body mass index or BMI. A person with a BMI of 30 or above is considered obese. A BMI 40 and above suggests morbid obesity.
|18.6 – 24.9||Normal|
|25.0 – 29.9||Overweight|
|30.0 – 39.9||Obese|
|40 and above||Morbidly Obese|
The Health Effects of Obesity
Morbid obesity is a disease that can cause a severe decline in health and a shortened life span. Weight loss surgery is not done for cosmetic reasons; it is done to treat and prevent serious medical problems associated with severe obesity.
Nearly all body systems are affected by morbid obesity (also called severe obesity and defined as 80 - 100% over ideal body weight). Some common and significant medical problems caused by morbid obesity include:
- High Blood Pressure
- Obstructive Sleep Apnea, Breathing Failure
- Degeneration of Weight-Bearing Joints (Hips, Knees, Ankles and Feet)
- GERD (Reflux Disease)
People who undergo surgery for obesity do tend to lose substantial amounts of weight after surgery (50-200+ pounds), and they have a very good chance of maintaining their lower weight for life. Many medical problems improve as the medical stress caused by weight is reduced. A few of the most important medical improvements that are seen after bariatric surgery are:
- Diabetes – 85% resolved after Gastric Bypass
- GERD – 95% resolved after Gastric Bypass
- High Blood Pressure – 60% resolved after Gastric Bypass
- Cancer (all types together) – risk reduced by about 50%
Bariatric surgery also saves lives. It has now been statistically demonstrated in several research papers that, for a person who is morbidly obese, the chance of being alive 5 years from now is at least 40% better with bariatric surgery than without. Note that this outline of benefits is not complete unless it is balanced against the risks of the chosen surgical procedure.
Most people who suffer from obesity know that the weight is causing lots of problems with lifestyle and function. Here is a partial list of lifestyle factors that can reasonably be expected to improve as weight comes down:
- Ability to do normal personal hygiene
- Increased energy level
- Regularly get a good night’s sleep
- Greater confidence
- Improved job or career prospects
- Ability to cross legs
- Better ability to travel (mobility, airline seats)
Am I a Candidate?
One of the first questions people ask about surgical weight loss is, “Am I a Candidate?” While this question sounds simple, the answer is more complex. Think of this question as a two part question.
- Do I meet the medical criteria to qualify for surgical weight loss?
- Am I mentally prepared for surgical weight loss?
To medically qualify for surgical weight loss a person must:
- Have a Body Mass Index (BMI) greater than 40, OR
- Have a BMI greater than 35 with at least one co-morbidity exacerbated by weight. These co-morbidities include, but are not limited to:
- Diabetes (Type 2, or insulin resistant)
- High Blood Pressure
- Obstructive Sleep Apnea
- GERD, or Gastroesophageal reflux disease
- High Cholesterol
- Degeneration of the knees or other weight –bearing joints
The second question, “Am I mentally prepared for surgical weight loss?” can only be answered by the individual. It is important to realize that surgical weight loss is not a quick fix. It is a tool that can assist you in your weight loss journey. It is a lifelong commitment that requires permanent changes in your eating habits.
Surgical Weight Loss
Almost every patient achieves a substantially lower weight for life after bariatric surgery. Surgical weight loss is dramatically greater than any medication or non-surgical program. If all types of bariatric surgery are lumped together in the long run, then about 2/3 of patients will keep off more than half of their excess weight, meaning that they will be 70 – 150 pounds lighter than they started.
Lower weight leads to resolution or improvement of many medical problems. On average, patients experience dramatically better health after surgery than they had before – this is the core outcome of bariatric surgery. Read more about this on our page describing health improvements
Weight loss after Bariatric Surgery
Our goal is to help each patient lose a lot of weight, and to maintain the lower weight with better health for the rest of their life. That’s pretty obvious, right? Some of you are asking, “Ok, but what’s the number? How many pounds should I lose? What BMI should I get to?” Let’s take a moment to discuss appropriate weight goals following bariatric surgery.
The first point is that the “Ideal Body Weight” is NOT a proper goal for a person who is currently considering bariatric surgery. This is because the body of a morbidly obese person takes on a lot of extra structure to carry/support the excess weight (bone, heart muscle, skin, etc.) and the body is not able to shed all that structure in a healthy way. In other words, patients who go from a BMI of 48 to a BMI of 24 are medically too skinny; they have low energy, feel weak, look ill and are probably not at the optimal weight for health. Most patients are at their “best” weight (best health and sense of well-being) at a BMI or 26-29.
Are all of our patients going to get that low weight level? Unfortunately not – only about 35% of our patients will get to this “best” weight. (Check out the factors affecting weight loss below). Does that mean patients have failed if they end up at a BMI of 37 or so? Heck no, most patients have still lost substantial weight and they are healthier as a result.
This brings us to the second point: the key goal of bariatric surgery is to make a patient healthier. Sometimes surgery is worthwhile to bring diabetes under control, or to allow better heart function or better lung function, even if a patient only loses 30 pounds.
The fact is that there is a lot of variation in weight loss results after bariatric surgery, so it is necessary to talk about some factors causing greater and lesser weight loss after bariatric surgery:
- Which procedure is done (see more about this factor below)
- Starting weight – heavier patients tend to lose more pounds, but they are not as likely to get below a BMI of 30
- Age of patient – younger patients tend to lose more
- Diabetes – diabetics tend to lose less
- Overall health and ability to exercise – more active patients lose more
- Compliance with diet and exercise plans following surgery
- Family support and other support systems
Types of Surgeries
Gastric Bypass Weight Loss
The Gastric Bypass helps patients achieve rapid and reliable weight loss.
In the first few months after surgery, the surgical trauma that is naturally created on the stomach “stuns” the nerves of hunger, so that patients tend to experience a profound freedom from hunger over a sustained time period. During the first 3 months after surgery, most patients lose weight rapidly. Depending on the starting point, patients can lose anywhere from 40 up to 100 pounds in the first 3 months. As healing of the stomach pouch progresses, hunger and calorie intake naturally return so that weight loss slows. Weight loss is usually steady during months 3-6, and the in the 6-8 month time period a patient begins to experience “plateaus” where the weight is stable for a week or so before continuing to drop.
For most Gastric Bypass patients, the lowest weight level is reached 10-16 months after surgery. There is a strong tendency to regain 10-15 pounds during the second year after surgery, and the weight that a patient has at the two year point after Gastric Bypass is usually one they will maintain (with an appropriate level of effort and intention) for the rest of their life.
The total weight loss depends on the other factors listed above, and it varies from a minimum of about 70 pounds lost, up to 250+ pounds lost.
Sleeve Gastrectomy Weight Loss
The Gastric Sleeve causes profound suppression of hunger in a way that appears similar to the Gastric Bypass. It seems that the long tubular stomach recovers a bit more quickly than after Gastric Bypass, so that average weight loss is not as dramatic as for Gastric Bypass patients. On the other hand, the reservoir section of the stomach that is removed seems to be the source of some hunger-related hormones such as ghrelin, so that removal of that stomach may help create sustained suppression of hunger.
Available literature suggests that total weight loss will be somewhat less than for Gastric Bypass, but in the same range. There is not yet any data on the weight maintenance at 5 years or more after Gastric Sleeve.
Adjustable Gastric Band Weight Loss
The Band helps create weight loss that is slower and more prolonged, sometimes continuing for three years after surgery.
In the first few weeks after Band surgery, most patients experience a freedom from hunger caused by the minor trauma to the nerves of the stomach. Since the trauma to the tissues is less than with the Gastric Bypass, and since the Band is placed with fluid (wide open) on the day of surgery, hunger usually returns with the first few weeks.
During the first month, a Band patient may lose from 5-30 pounds. Weight loss will slow down as hunger and intake return, but if the patient is working with the surgical team to adjust the Band (usually filling it to make it steadily tighter until it is properly “tuned”) then the hunger will be controlled.
When a patient’s Band is working well and the patient is following the team’s diet and exercise recommendations, patient usually lose 1-2 pounds per week. It is usually possible to sustain some steady/slow weight loss for at least a year.
The total weight loss after Band surgery may bring the patient all the way down to their “best” weight in some cases. In our experience, about 30% of Band patients will lose less than 40 pounds but will have achieved better health with that modest weight loss.
Most people know someone who had a bariatric surgical procedure years ago, lost a lot of weight, and then “gained it all back”. There is no getting around the fact that some patients do regain substantial weight after bariatric surgery. Searching into the causes of weight regain almost always turns up one of these factors behind the problem:
- The person underwent an older surgical procedure that is prone to long term weight regain. The most common example is the Vertical Banded Gastroplasty (VBG), which was done very commonly in the 1980’s and early 90’s.
- The person has stopped visiting the surgical program in follow-up. There needs to be an understanding that obesity is a lifetime disease that requires lifetime management and support. Normal people need reminders of the proper diet and activity patterns, as well as support in sticking with the life changes that keep these patterns in place.
Of the bariatric procedures that are currently most commonly performed, adjustable gastric banding apperars most likely to be associated with long term weight regain.
Glossary of Terms
Bariatrics – The branch of medicine that deals with the causes, prevention, and treatment of obesity. This includes the discipline of Bariatric Surgery, which is also called Weight Loss Surgery.
Arthritis – Inflammation of a joint, usually accompanied by pain, swelling, and stiffness. Most patients with morbid obesity have degenerative arthritis, which is the erosion of the joint lining from excess pressure caused by weight. The damage from degenerative arthritis cannot be reversed, but if excess weight is removed then further damage can be prevented.
Congestive Heart Failure (CHF) – A condition where there is ineffective pumping of the heart, leading to an accumulation of fluid in the lungs. Typical symptoms include shortness of breath with exertion, difficulty breathing when lying flat and leg or ankle swelling. Causes include chronic hypertension, cardiomyopathy and myocardial infarction. Most patients with morbid obesity actually have normal heart function, but the load caused by the excess weight is too much for the heart to keep up with so they become easily short of breath.
Diabetes – tendency for blood sugar levels to be elevated, sometimes to a dangerous degree. Steady elevation of the blood sugar above normal causes ongoing damage to the nerves and blood vessels, and a higher chance of infection from any minor injury. A common result of advanced diabetes is foot infection that requires leg amputation. Other common complications of diabetes are loss of eyesight or loss of kidney function. Most people who have diabetes with obesity have plenty of insulin (the hormone that controls blood sugar) but the fat tissues do no react normally to the insulin – this is called Type 2 Diabetes. Gastric Bypass puts diabetes into permanent remission most of the time. Also see the section on results of bariatric surgery.
Dumping Syndrome – is likely to be induced by the intake of simple carbohydrates, such as sugar and some starches. The syndrome is characterized by palpitations (fast heart rate), a clammy feeling, queasiness and nausea, and sometimes vomiting or diarrhea. Usually the patient feels weak, and must lie down for an hour or so. Dumping syndrome is not dangerous, but it feels awful. All bariatric surgical patients are strongly advised to avoid sugary junk food, sugar and other carbohydrates. Experiencing the strong negative effects of dumping syndrome can serve as a useful deterrent to keep patients away from these types of foods.
Dysmenorrhea (menstrual irregularity, infertility) - any abnormality of a woman’s menstrual cycle, such as absence of menses, heavy bleeding, or irregular menses. In women with morbid obesity, it turns out that the fat cells (which secrete a tiny amount of hormone from each cell) put out enough hormones to throw the entire system out of balance. Many of our surgical patients who were infertile prior to surgery can safely carry a child after surgery (once weight is stabilized – it is VERY IMPORTANT to avoid pregnancy while the patient is still losing weight).
Edema – retaining excess fluid in tissues. Patients with morbid obesity often have edema of the legs, which they experience as leg swelling. This is usually caused by abdominal pressure that impairs blood flow out of the legs, though in advanced (severe) cases the swelling might also be caused by heart failure.
Gastroesophageal reflux disease (GERD) – the stomach contents regurgitate and back up (reflux) into the esophagus. Normally, the food in the stomach is partially digested by stomach acid and enzymes. The partially digested material in the stomach is delivered by the stomach muscle down into the small intestine for further digestion. With esophageal reflux, stomach acid and other digestive fluids reflux back up into the esophagus and occasionally all the way back into the breathing passages. In the esophagus the acid causes inflammation and damage to the esophagus.If the acid and digestive juices get into the lungs they cause damage that shows up as bronchitis, asthma, pneumonia, or a chronic cough. Morbidly obese patients experience much more reflux and heartburn then the normal weight population, because the increased abdominal pressure associated with obesity literally pushes fluids back up the esophagus. Almost all GERD improves significantly with weight loss. If a patient has really severe GERD or damage of the esophagus so that it does not “pump” properly, then a Gastric Bypass is probably preferred over an Adjustable Gastric Band.
Hernia (abdominal wall) – an abdominal hernia is a weak area in the strong muscle layer that is supposed to contain the soft internal organs such as the intestine. Hernias are quite common in morbidly obese people, mostly arising from some prior surgical incision. The increased abdominal pressure associated with obesity interferes with the healing and “knitting” process that is needed for long term strength of the muscle layer after it has been cut for surgery. This gap in the muscle layer allows a bulge of the soft tissues, which shows up as pain and a focal swelling. If the hernia is not treated (surgical repair) then the soft internal tissues such as intestine can become trapped in the hernia. It is quite common for our patients to come into surgery with an abdominal wall hernia – our surgeons will try to treat the hernia during the bariatric surgery but it may also be necessary to plan a second stage repair once the weight and pressure are much less.
Hiatal Hernia – a weakness and looseness of the muscle ring that holds the junction of the esophagus and stomach in the right place. If one has a hiatal hernia, then usually the upper part of the stomach protrudes upward through the esophageal cleft in the diaphragm, sometimes causing a backflow of acid stomach contents into the esophagus. Our surgeons will repair a hiatal hernia at the time of the bariatric surgical procedures if it is technically reasonable to do so.
Hibernation Syndrome – this is discussed on the page about side effects of bariatric surgery.
High Blood Pressure or Hypertension – abnormally elevated blood pressure. Very common in morbid obesity. This leads to higher stress on the heart, with a higher chance of heart attack and also a stroke. High blood pressure almost always improves and frequently resolves after weight loss.
Hypercholesterolemia, Hypertriglyceridemia - Condition of elevated cholesterol or triglyceride concentration in the blood. It has been linked to higher risk of heart disease and arteriosclerosis. Elevated cholesterol and lipids are more common and more sever in morbidly obese patients, though elevation may also be caused by genetic factors in the absence of obesity. This condition almost always improves with weight loss, but about half of patients who are on lipid meds prior to bariatric surgery will still need the meds in the long run (note that lots of skinny people have high cholesterol, too).
Metabolic Syndrome (also called “Syndrome X”) – a cluster of metabolic abnormalities that result from the primary disorder of insulin resistance (insulin resistance is the cause of Type 2 diabetes in morbidly obese patients). All the metabolic abnormalities associated with Syndrome X can lead to cardiovascular disorders – when present as a group, the risk for cardiovascular disease and premature death are very high.
The characteristic disorders present in Metabolic Syndrome X include:
- insulin resistance
- hypertension (high blood pressure)
- abnormalities of blood clotting
- low HDL and high LDL cholesterol levels
- high triglyceride levels
Most patients with Syndrome X are morbidly obese. In most cases the features of Syndrome X will resolve after gastric bypass.
Obstructive Sleep Apnea (OSA) – People with sleep apnea literally stop breathing repeatedly during their sleep, often for a minute or longer and as many as hundreds of times during a single night. Sleep apnea can be caused by either complete obstruction of the airway (obstructive apnea) or partial obstruction (obstructive hypopnea – hypopnea is slow, shallow breathing), both of which case oxygen levels to drop below normal and cause loss of restful sleep. Patients feel chronically tired, have daytime drowsiness and don’t feel rested when the alarm clock goes off. Someone in the family is usually complaining about snoring. This is a very under diagnosed disorder - it is usually present in 85% of morbidly obese patients. This almost always improves with substantial weight loss.
PCOS (Polycystic Ovarian Syndrome) – an endocrine (hormonal) disorder found in women. Most often, symptoms appear around the start of menstruation. However, some women do not develop symptoms until their early to mid-20’s. It affects women of all races and nationalities. No two women have exactly the same symptoms. The following characteristics are very often assocated with PCOS, but not all are seen in every women:
- Hirsutism (excessive hair growth on face, chest, abdomen, etc.)
- Hair loss (androgenic alopecia, in a class “male baldness” pattern)
- Polycystic ovaries
- Infertility or reduced fertility
In addition, women with PCOS appear to be at increased risk of developing the following health problems during their lives:
- Insulin resistance
- Lipid abnormalities
- Cardiovascular disease
- Endometrial carcinoma (cancer)
- Morbid obesity is a frequent underlying cause for PCOS, though not in all cases. In situation where morbid obesity and PCOS go together, significant weight reduction will usually result in resolution of the PCOS as well.
Urinary Incontinence – The involuntary release of urine. It often occurs during coughing or other forceful stresses. In many cases the leaking of urine is caused or worsened by the continuous pressure that obesity places on the bladder. In these cases we would expect weight loss to allow better bladder control.
Find a Physician
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155 E Sonterra Blvd
San Antonio, TX 78258
General Surgical Associates
8042 Wurzbach Rd, Ste 310
Physicians Plaza II
San Antonio, TX 78229
Rene G Jaso, MD
1303 McCullough Ave
San Antonio, TX 78212
8550 Datapoint Suite 250
San Antonio, TX 78229