Obesity is a serious chronic medical problem that has increased at an alarming rate. Morbid obesity is associated with numerous health-related problems. One of the treatment options for severe obesity is weight loss surgery. Our multidisciplinary team approach is advocated for persons with medically significant obesity. We are here to offer help for a healthier future. The success of weight loss surgery is dependent upon long-term changes in diet, behavior and exercise. Success begins with setting realistic goals. Problems may arise after surgery that can require re-operation. As with any surgery, there are possible associated operative and long-term complications. Make certain you are well informed as this surgery will be one of the most important decisions you make in your life.

For people who are morbidly obese (persons approximately 100 pounds overweight) or people who have serious health problems as a result of their weight, weight loss surgery is a potential choice for weight loss. People who have made other attempts to lose weight and meet additional criteria may want to consider the option of weight loss surgery.

Facts About Obesity
"During the past 20 years there has been a dramatic increase in obesity in the United States. Currently, more than half of all U.S. adults is considered overweight (defined as a BMI 25 to 29.9) or obese (defined as a BMI 30 or higher). Body Mass Index (BMI) is defined as a measure of an adult ’s weight in relation to his or her height, specifically the adult’s weight in kilograms divided by the square of his or her height in meters." The Centers for Disease Control

The obesity epidemic is spreading across the United States to such a degree that the Surgeon General has identified the need to take action to prevent and decrease overweight and obesity as one of the 15 national priorities for immediate action. The increase in being overweight and obese crosses all age, racial and ethnic groups for males and females.

How do I know if I qualify for weight loss surgery?

You must have a body mass index of 35 with weight-related health problems or a body mass index of 40 with no weight-related health problems to be considered for this surgery. (calculate your body mass index). You must have documentation of other weight loss efforts that you have unsuccessfully tried in the past. You must have approval from your medical doctor or health care provider to undergo this surgery. You must complete a psychological evaluation (purpose of the psychological evaluation). You need to be healthy enough to undergo major abdominal surgery. In addition, you need to be evaluated by a dietitian. A surgical evaluation will be performed to determine if you are a candidate for gastric bypass surgery.

• The surgery that is performed is called ROUX EN Y GASTRIC BYPASS. This is a laparoscopical procedure that is not easily reversible. Patients must be properly selected and must meet the criteria to have this surgery. This is not a cosmetic procedure.
• Gastric Bypass Surgery will promote weight loss but it cannot do so alone. The operation reduces the size of the stomach so that eating a few bites makes one full. You must be motivated to choose healthier food, not overeat and to set realistic goals, including being well informed and committed to long-term medical follow-up with your physician and support staff. Patients need to participate in physical activities as part of their exercise plan. Expected weight loss, gastric bypass diet, nutritional complications, activity.
• The interdisciplinary team at Palmetto Health Baptist is comprised of a number of health care professionals: surgeons, nurses, medical case management, physical therapist, respiratory therapist, psychologist, dietitian, peri-operative services, resource center personnel, and a gastric bypass patient. Together, they plan and improve programs to help you lose weight and pursue a healthier life style.
• Body Mass Index (BMI) is a guideline to determine if one is at risk for health problems related to weight. Individuals with BMIs between 25-30 are considered overweight and those with BMIs above 30 are considered obese. (click here to calculate your BMI)
• The surgeons who perform weight loss surgery at Palmetto Health Baptist are Dr. Dalton C. Prickett and Dr. J. Benjamin Tribble of Surgical Associates of South Carolina, PA. They may be contacted by calling 803-256-3400 or http://www.surgicalassociatesofsc.com
• Bari Buddies Support Group—This support group is for people who have undergone gastric bypass surgery. It meets the second and fourth Tuesday of each month at 1501 Sumter St. at Palmetto Health Baptist. The support group is free. Sharing experiences and concerns with others who are struggling with similar health concerns can be a powerful source of encouragement and direction. Various members of the interdisciplinary health care team are present for feedback and advice. You may call 803-376-5982 for additional information.
• Informational Gastric Bypass Surgery Seminar—This two-hour seminar is free and open to the public. Topics include discussion of Roux en Y gastric bypass surgery, risks/complications, benefits, the gastric bypass diet and insurance information. Speakers include health professionals from Surgical Associates of South Carolina and support staff from Palmetto Health Baptist. One of the speakers has undergone gastric bypass surgery and will share her experiences. The seminar meets in the auditorium of 1501 Sumter St. Breast Health Center on the third Tuesday of each month from 6-8 p.m. Call 803-376-5982 for additional information. Free parking is available in the 1501 Sumter St. garage.

The following websites may be helpful:

• Surgical Associates of South Carolina
• Association for Morbid Obesity Support
• American Society for Bariatric Surgery
• National Heart, Lung, and Blood Institute Obesity Education Initiative
• Overeaters Anonymous

If you do not have a physician or primary care provider, you may contact Palmetto Health's physician referral service, Care Call, by calling 803-296-2273 or by e-mail.

• Calendar for support group dates
• Calendar for seminar dates
• Driving directions/map to Palmetto Health Baptist

Learning about the surgery

(Diagrams 1&2) Areas where small intestine is separated prior to being reconnected to newly created gastric pouch and also to stomach.

(Diagram 3) Incision into stomach to begin creation of gastric pouch.

(Diagram 4) Completed gastric pouch with intestine and stomach reattached. Stomach is sutured so that food enters gastric pouch, thereby bypassing the stomach into the small intestine.

This surgical procedure is one method to achieving long-term weight control. It is not a cosmetic surgery. The name of the gastric bypass surgery is Roux en Y. The surgery reduces the size of the stomach to a small pouch formed in the upper portion of the stomach. This part of the stomach will receive food. The lower part of the stomach is bypassed, as is the first part of the small intestine (the duodenum, which is the first section of the small intestine and the jejunum, which is the second portion of the small intestine). Although food does not go through this bypassed segment, it still functions. The lower part of the small intestine is brought up and connected to the small stomach pouch. Food will pass through the small opening into the stomach pouch and then into the small intestine.

After the surgery eat small amounts of food slowly and must chew their food very well. Patients lose weight because they eat less. They feel full after eating a small amount of food and also absorb fewer calories. Before surgery your stomach is about the size of a football and after gastric bypass surgery the small stomach pouch is about the size of an egg.

When the surgery is performed laparoscopically, most people have shorter recovery times, a shorter hospital stay, and fewer post-operative complications. Not every patient is a candidate for laparoscopic surgery. Weight loss is about the same whether you have the laparoscopic surgery or the open method using a long abdominal incision.

Expected hospital stay after gastric bypass surgery—If you have been medically approved for gastric bypass surgery and your insurance company has approved weight loss surgery for you, the surgeons will set a date for your surgery. A person who elects weight loss surgery must be well informed, motivated, and have acceptable operative risks. Any serious health problems need to be stabilized prior to surgery. That person also must consent to long-term follow-up care.

The surgery usually is performed laparoscopically. If the surgery is performed laparoscopically and no complications occur, most people are discharged from the hospital two to three days after surgery. Your surgeon will decide if a longer hospitalization is needed.

Benefits
Weight loss improves health-related weight problems. Blood pressure, blood glucose levels, and cholesterol are significantly improved with modest weight loss. There usually is less pain associated with weight bearing joints. Weight loss may improve your mood and psychosocial function. It also may improve your ability to work and perform activities of daily living.

Other weight-related health problems such as obstructive sleep apnea may be improved or even eliminated. Some research studies have shown that weight loss surgery improves quality of life through improved support from others and easier social adjustment. Many people report improvement in their self-esteem, body image, and in increased energy levels, as weight is lost.

Risks/Complications of the Roux ey Y gastric bypass procedure
Roux en Y gastric bypass is a major surgical procedure. There are potential risks and complications associated with this procedure and with general anesthesia. The risk of death is about one percent (1 in 100). Other complications include the risk of leakage at the connections between the stomach and the small intestine. Blood clots can develop in the legs and/or break off and travel to the lungs. Other complications include pneumonia, infections, bleeding, injury to the spleen, narrowing where the stomach pouch is connected to the small intestine, breathing problems that require a breathing tube, esophageal spasm, diarrhea, malnutrition, and failure to lose weight.

Expected Weight Loss
The exact amount of weight loss depends on compliance with the dietary guidelines and exercise. Most weight is lost during the first six months following surgery. Not everyone will reach their ideal body weight, but most can reach a healthier weight.

Gastric Bypass Diet
The surgery helps one limit the amount of food they can eat. A specific meal plan must be followed so that the new stomach pouch can heal and the weight loss process can begin. Meals plans vary from person to person because no two people are the same. Introducing food too soon can cause potential problems such as blockages.

There are several stages in the diet. The surgeon will decide when it is time for the diet to advance to the next stage.

• Stage One: Low sugar, non-carbonated clear liquids
• Stage Two: Low sugar, non-carbonated full liquids
• Stage Three: Pureed/blenderized foods that are the consistency of baby food
• Stage Four: Soft diet
• Stage Five: Regular

In the beginning, patients take very small sips of liquids. When no longer on the liquid stage of the diet, they stop intake of liquids 30-60 minutes before and after eating. After advancing beyond Stage Three, food must be chewed until it is the consistency of baby food. If eating meat products, meat must be cut to the size of a pencil eraser and chewed until it is the consistency of baby food. Food must be chewed well to avoid blockage of the stomach pouch. It may take 30-40 minutes to eat a meal. Eat slowly and savor the taste of the food. There is no need to rush.

The staged dietary process may continue for several months. Diet advancement and adjustments depend upon an individual’s progress as evaluated by the surgeon. A dietitian is available to assist with meal planning and to answer nutrition questions. The above are general guidelines. Your doctor will discuss what is best for you. The surgeon will recommend vitamin and mineral supplements that are required to supplement your diet.

The newly created stomach pouch is a tool to assist with weight control. However, people need to make appropriate food choices and behavior changes for this tool to be effective. Patients are encouraged to eat three meals a day. Frequent overeating at meals can slow weight loss and may even promote stretching of the stomach pouch. High fat foods (fried foods, fast foods, high fat meats such as sausage and hot dogs, pastries, ice cream, etc.) and high sugar foods (cakes, candy, pies, etc) should be avoided. Awareness of the caloric content of food and reading food labels helps people make appropriate choices.

Possible Nutritional Complications
The stomach pouch is small—about the size of an egg. Following gastric bypass surgery, patients will eat much smaller portions of food. Overeating may result in becoming extremely uncomfortable or cause vomiting.

Read labels and select nutritious foods that are low in calories. If high calorie foods (food high in sugar and/or fat) are selected, they may interfere with efforts to lose weight.

Potential nutritional complications include:

• Dehydration—The size of the new stomach pouch limits the amount of fluids that can be drunk at one time. However, patients will need the same amount of fluid after surgery as they did before surgery. Following surgery, the stomach pouch holds one-to-two ounces at a time. As a result, people who have had gastric bypass surgery must drink small amounts of non-carbonated, low sugar beverages throughout the day to meet their fluid needs. Water is an excellent choice.
• Protein deficiency—Proteins serve as the building blocks for growth and repair of tissues. Following gastric bypass surgery, excess hair loss, swollen ankles, or feelings of being overly tired may be early signs of adequate protein intake. This may be avoided by eating high protein foods and/or protein supplements. A dietitian is available to help plan meals and supplements to prevent protein deficiency.
• Dumping Syndrome—This occurs when the stomach is not able to regulate the rate at which food passes into the intestine. As a result, food gets “dumped” into the intestine and patients may experience cramping, rapid heart rate, cold sweats, diarrhea, weakness, and/or nausea. Drinking too soon after eating a meal also may cause dumping. Avoidance of sweets or foods with high sugar content helps to prevent this problem.
• Vitamin and Mineral Deficiencies—Because this surgery bypasses the part of the small intestine where many nutrients are absorbed, vitamin and mineral supplements are required. The doctor will order blood work and bone studies to make certain that adequate amounts of vitamins and minerals are consumed. This is one of the reasons follow-up medical care is so important.
• Food as a coping skill—A person, who uses food to cope with stress or handle emotional challenges, needs to develop other outlets for this. Attending the gastric bypass support group may help this important process (gastric bypass support group)
• Dieting—Gastric bypass surgery is not a cure-all for dieting. People can find ways to eat more than the recommended amounts following surgery. After gastric bypass surgery, patients need to remain conscious about the foods they put into their mouths.
• Lactose Intolerance—This problem that may develop after gastric bypass surgery. Symptoms include cramping, bloating, gas and diarrhea, which can occur whenever dairy products are eaten.

Nutritional problems may occur after gastric bypass surgery, but they are manageable. By following the guidelines, the new stomach pouch "tool" should have a positive impact on one’s health.

Click here if you have a question for our resident dietitian.

Activity
Exercise is most helpful in the maintenance of lower body weight. Increased physical activity also can reduce cardiovascular risk. However, for many people who are overweight, exercise can be a challenge. For many of these people, walking may be the best exercise.

Exercise is an important part of a healthy lifestyle and is necessary to maintain weight loss in the obese population. Although physical activity and exercise are key factors in successful weight reduction programs, unrealistic expectations of weight loss may lead to disappointment and discontinuation of exercise.

Maintenance of weight loss is aided by regular exercise. With the approval of the patient’s physician, our team of physical therapists can suggest an appropriately designed exercise program in which even the most obese patient may be able to participate.

Purpose of the Psychological Evaluation
The American Society for Bariatric Surgery offers guidelines for the gastric bypass procedure and recommends psychological consultation prior to having this surgery. Many insurance companies also require this examination prior to authorizing coverage for gastric bypass surgery.

There are several psychologists who perform this function and the surgeon and his staff will assist in making referrals. The psychologist asks questions about personal history, particularly any serious life crises, and any treatment previously received for emotional or personal difficulties. The psychologist is likely to conduct a brief psychological test or inventory that assesses one’s current adjustment and capacity to cope with the demands of surgery and the resulting lifestyle changes.

The psychological evaluation should accomplish these goals:

1. Identify any serious adjustment problems that might interfere with the capacity to recognize or handle the requirements and demands associated with surgery and recovery.
2. Determine the strengths, coping skills, and support resources that will aid in adapting to a healthier lifestyle including nutrition, exercise, and a positive outlook.
3. Consider alternative, healthier ways for replacing any dependence on food as a means of coping with stress and meeting basic security needs.
4. Clarify expectations regarding gastric bypass surgery and verify the presence of proper purpose and motivation for proceeding with this major decision The psychologist will forward the results of the interview and test profile to the surgeon you have selected. The surgeon will then review and discuss any concerns with the patient to help him/her prepare for surgery and future health maintenance. Participation in a gastric bypass support group or other methods of assistance in support of a transition to a healthier lifestyle may be recommended.

Support & Additional Information

Upcoming seminars
Surgeons and staff with Surgical Associates of South Carolina together with Palmetto Health Baptist health professionals will be in attendance to provide information and answer any questions you may have regarding gastric bypass surgery.

The free seminars are held The Breast Health Center. Free parking is available in the garage. For additional information, call 803-376-5982.

Bari Buddies Surgery Support Group Meetings
This support group meets at The Breast Health Center on the second and fourth Tuesday of each month from 6:30 to 8 p.m. Free parking is available in the attached garage.

Please call 803-376-5982 for additional information.

ON THE MOVE
ON THE MOVE is a physical activity program for patients who have undergone gastric bypass surgery. This is a collaborative program between the University of South Carolina and Palmetto Health Baptist. It is a great way to learn the importance that physical activity has with health and weight loss. To learn more about ON THE MOVE, contact us at 803-376-5282.

Contact Us
For more information about the Gastric Bypass Program at Palmetto Health or to sign up for upcoming seminars, please complete the following:

Click here if you have a question for our resident dietitian.

Palmetto Health Baptist Weight Management Center
1850 Laurel Street, Suite 1-A
Columbia, SC 29201
Phone: 803-376-5982 — Fax: 803-376-5987