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New Study Finds Weight Loss Surgery Extends Lives

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anatomy of gastric sleeve procedure

by Dr. Trace Curry, Cincinnati, Ohio

I remember when I did my first laparoscopic gastric bypass in 2003 at Wayne Hospital in Greenville, Ohio.  I was a general surgeon then, and I wanted to branch out and challenge myself with more advanced procedures.  Those were the very early days of laparoscopic weight loss surgery, and we were still fighting the bad rap of years of high complication rates from the same exact procedure being done with a huge 12 inch incision.  Originally, I had planned on weight loss surgery being just a small part of my general surgery practice, but when I saw how these procedures totally transformed my patients’ health with just a few tiny incisions, I quickly decided to dedicate my entire practice to this exciting field.  I could see a patient’s life expectancy improve right before my very eyes – in fact I once had a patient who was so obese and had such severe sleep apnea that he had to have a tracheostomy done (this was long before Thousand Pound Sisters).  When he came in for his 1 year post op check after his gastric bypass procedure, he proudly rode his bike right into my office, his trach tube long removed!

As a weight loss surgeon, the fact that weight loss surgery increases life expectancy is something that has been plainly obvious to me for the last 20 years.  Now, however, we have new data from a study spanning 40 years and including nearly 22,000 people that confirms this as fact!

These results were just published last Wednesday in the journal Obesity. It was a retrospective study out of Utah, meaning the researchers looked back at data from patients over past years. They looked at patients with and without weight loss surgery and matched patients for things such as age, sex, and BMI so they were comparing apples to apples. There were 21,837 matched surgery and non-surgery pairs and the follow up was up to a very impressive 40 years.  This study is important not only because of the large number of patients including such a large time span, but also because it involves data on American patients which may be more applicable to patients in my practice than if the data were taken from, say patients in Sweden or Africa.

Four procedures were examined (listed from most common to least common):

  • gastric bypass
  • gastric sleeve
  • gastric band
  • duodenal switch

The researchers found that patients who underwent one of these procedures were 16% less likely to die from any cause, 29% less likely to die from cardiovascular disease, 43% less likely to die from various cancers, and incredibly–72% less likely to die from diabetes!

There have been other large studies that support the data seen here, so I feel like it’s about time to shout it from the rooftops!  In the U.S., it’s estimated that only 2% of patients who qualify actually end up having weight loss surgery.  Some of this is related to lack of insurance coverage, and some to patients’ reluctance to seek out weight loss surgery.  Many patients are not even aware that, when they choose an insurance plan, it may exclude access to a surgical weight loss procedure which they qualify for medically.  Not because they don’t need it, but because language is written into their policy that says it’s not going to be covered, no matter how badly they need it.

Regardless of the reason, considering modern techniques, the complication rate for bariatric surgery procedures such as gastric bypass, gastric sleeve, Lap Band, and duodenal switch are miniscule compared to what they used to be 30 years ago.  This, given with the data we see from this study and others, should compel more insurance companies to provide coverage for these life-saving procedures and more patients to consider taking this step to be rid of the disease of obesity.

Trace Curry M.D.

 

Dr. Trace Curry is the medical director of JourneyLite Physicians and JourneyLite Surgery Center in Cincinnati, Ohio.  JourneyLite is a multi-specialty center that focuses on advanced outpatient laparoscopic weight loss surgery and incisionless weight loss procedures.  He has done over 7000 weight loss procedures in his career and is a key opinion leader in the field of surgical and incisionless weight loss.

Gastric Sleeve

vertical sleeve gastrectomy

Gastric Bypass

gastric bypass anatomy

SIPS

loop duodenal switch

Lap Band

lap band photo

Pre-op Weight Loss

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scale

Pre-op weight loss can be essential to reducing the risk of bariatric surgery.  Therefore we set some goals for most patients at your initial consultation.  These goals are higher in patients with a higher body mass index.

Below you can see our typical pre-op weight loss goals to see where you will likely fall.  However in some cases there will be custom goals that are set that can differ from these guidelines.

BMI

30-45

Primary Weight Loss Goal

  • Maintain initial consult weight until pre-op/consent visit.

Secondary/Pre-op Diet Weight Loss Goal

  • Lose some weight.
45.1-50
  • Lose 5 pounds from initial consult weight to pre-op/consent visit.
  • Appetite suppressant optional.
  • Lose 5% of TBW from initial consult weight to surgery.
  • Appetite suppressant optional.
50.1-55
  • Lose 10 pounds from initial consult weight to pre-op/consent visit.
  • Appetite suppressant recommended.
  • Lose 8% of TBW from initial consult weight to surgery.
  • Appetite suppressant recommended.
55.1-60
  • Lose 5% of TBW from initial consult weight prior to scheduling a surgery date.
  • Appetite suppressant recommended.
  • Male: Lose 10% of TBW from initial consult weight to surgery or achieve a BMI of 55, whichever is the lower weight.
  • Female: Lose 10% of TBW from initial consult weight to surgery.
  • Appetite suppressant recommended.
60.1-65
  • Lose 5% of TBW from initial consult weight prior to scheduling a surgery date.
  • Appetite suppressant recommended.
  • Male: Lose 10% of TBW from initial consult weight to surgery, or achieve a BMI of 55 to qualify for surgery at JourneyLite.
  • Female: Lose 10% of TBW from initial consult weight to surgery or achieve a BMI of 55, whichever is lower weight.
  • Appetite suppressant recommended.
65.1+
  • Lose 10% of TBW from initial consult weight prior to scheduling a surgery date.
  • Appetite suppressant recommended.
  • Custom goal will be set.
  • Appetite suppressant recommended.

TBW = total body weight

5% of TBW: For example, in a 200 lb patient, 5% of 200 lb = 10 lbs

10% of TBW: For example, in a 300 lb patient, 10% of 300 = 30 lbs

Crushing Medications After Weight Loss Surgery-Should I or Shouldn’t I?

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As a rule we recommend against crushing medications after weight loss surgery.  There are some larger pills, however, that can be difficult to get down in the early days when there is still some swelling present.  There are many medications, however, that should NOT be crushed under any circumstances.  Generally speaking, these are extended release medications that have a special coating to cause the drug to be released slowly over a period of time.  Probably the most common medication like this is Prilosec.  If you crush it, the coating is destroyed and the medication will be absorbed all at once.  In the case of Prilosec, this would likely cause little harm, however this is not the case with all medications and in some instances life-threatening side effects could occur.

We always recommend checking with your pharmacist, however you can also refer to this fairly comprehensive list of medications that should not be crushed under any circumstance!

Do Not Crush These Meds!

weight loss medications

Incisional Pain After Gastric Bypass Surgery

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pain

Pain after surgery is expected, particularly with the gastric bypass. This is a bigger, more involved surgery than the sleeve! Setting realistic expectations after surgery is important–you should expect to have some pain after surgery. 

 

We always inject local anesthetic in each incision, however the effect of this is only temporary. This can make it seem like your pain is getting worse, but it’s actually just the numbing medicine wearing off.  

 

Most of the discomfort in the gastric bypass there is one incision on the far left side of your abdomen.  This will commonly cause complaints such as: sharp or intense pain, dull cramping pain, burning, tugging, and pulling sensations. These are sometimes worsened by movements, or certain positions and the pain is not always felt directly underneath this incision.   These types of symptoms are normal and expected after bypass surgery. 

 

This incision is necessary in order to safely complete the surgery. Because of the size and depth of this incision, a suture is placed through the deep muscle layers to help prevent a hernia. This suture is almost always the cause of the symptoms described above. This pain will commonly last for 3-6 weeks and perhaps longer in some situations. 

 

We always do our best to minimize the discomfort associated with this incision, but we cannot completely eliminate this pain all together. Patients will be prescribed a narcotic pain medication, a muscle relaxer, and a pill which helps with neuropathic (nerve) pain. In addition to the medications, we recommend using ice packs over the incisions, 20 minutes on and 20 minutes off several times per day. This will help with the inflammation. After 2-3 days you may get better relief with a heating pad as the pain becomes more muscular in nature. 

 

This same far left incision can also be prone to infection, as at the end of the procedure we pull a little piece of small intestine out through it.  This can sometimes contain bacteria which can lead to infection, despite the fact that we place it in a sterile pouch before pulling it out.  Some of the first signs of infection are: fever, swelling at the incision site, redness around the incision, or drainage at the incision )particularly yellow thick foul smelling drainage).  Occasionally a clear or pale-red drainage will be present–this does not necessarily mean there is an infection. If you have concerns with your incisions, please contact us to have your incisions evaluated by our staff! 

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How To Achieve Success After Weight Loss Surgery-The Three “M’s”

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By Dr. Trace Curry

Patients always want to know what they need to do to be successful after weight loss surgery, it’s one of the most common questions I’m asked.  In my experience treating thousands of patients over the past 20 years, it all boils down to the three M’s:

  • Motivation
  • Menu
  • Movement

Motivation

I listed motivation first as it is the key.  If you are not motivated to lose weight and improve your health, even the most powerful weight loss procedure will not work in the long run.  Weight loss surgery can be life saving, by reducing or eliminating current or future medical issues such as diabetes, heart disease, high blood pressure, and high cholesterol.  You must have the motivation to make permanent lifestyle changes that include the changes listed below.  It’s worth the effort!

If you feel like you motivation is fading, even if you are 10 years out from surgery, reach out to us so that we can bring you in to meet with the team and formulate a plan to get you back on track.

Menu

Menu is the second item in the list because if you are not eating the right types of foods, you simply cannot move enough to burn off the excess calories.   First off, you need to “get the white out” of your diet!  White food refers to foods that are white in color, meaning that they have been processed and refined.  Things includes things like table sugar, flour, pasta, rice, bread, crackers, and cereal.  Secondly, eliminate liquid calories from your diet.  Everything you drink after surgery, with rare exception, should be zero (or very low) calorie.

Keep in touch with our expert registered dietitians for suggestions on healthy substitutions for these items in your diet.

Movement

It’s very difficult to be sedentary and maintain your weight loss in the long run.  These operations frequently have enough power to provide significant short-term weight loss without exercising at all.  However, once you reach your nadir (your lowest weight achieved after surgery) if you are not active AND exercising you will regain weight.  In some cases you could regain all your weight, especially if your motivation and menus are lacking.  No matter what your physical condition is, you must start somewhere!  Everyone’s definition of exercise is a little different, so just pick something you can do and build on it from there.  I highly recommend getting a good fitness tracker so that you can make sure you are reaching your move goals and modifying them as your health improves.  I’m partial to the Apple Watch as it does a good job not only to encourage you to exercise, but also not to be sitting for the rest of the day!

If your mobility is significantly limited, check out these low-impact exercise options for overweight patients.

overweight person exercising

If you keep the 3 M’s in mind, you will be successful in your weight loss journey.  The sky is the limit!

Other Posts From Dr. Curry

  • anatomy of gastric sleeve procedure

    New Study Finds Weight Loss Surgery Extends Lives

    by Dr. Trace Curry, Cincinnati, Ohio I remember when I did my first laparoscopic gastric bypass in 2003 at Wayne Hospital in Greenville, Ohio.  I was a general surgeon then, and I wanted to branch out and challenge myself with more advanced procedures.  Those were the very early days of laparoscopic weight loss surgery, and [...]
  • scale

    Office Follow-up Schedule After Weight Loss Surgery

    JourneyLite Physicians Post-Surgical Follow-Up Protocol   JourneyLite is committed to patient success. As a best practice, JourneyLite Physicians follows the Metabolic and Bariatric Surgery and Quality Improvement Program (MBSAQIP) follow up protocol, and exceeds the MBSAQIP standards to ensure the highest quality care and long-term success for our patients. First year follow up consists of [...]
  • scale

    Pre-op Weight Loss

    Pre-op weight loss can be essential to reducing the risk of bariatric surgery.  Therefore we set some goals for most patients at your initial consultation.  These goals are higher in patients with a higher body mass index. Below you can see our typical pre-op weight loss goals to see where you will likely fall.  However [...]
  • Transcarent, Inc home page screenshot

    JourneyLite and Transcarent, Inc Partner to Provide Lower Cost Weight Loss Surgery

    JourneyLite Surgery Center is pleased to announce that, effective October 1, 2022, we will be the regional provider for bariatric surgery services for Transcarent, Inc. Transcarent describes their organization as “a health care experience company that makes it easy to get the high-quality, affordable health and care that everyone deserves. Transcarent puts consumers back in [...]
  • weight loss medications

    Crushing Medications After Weight Loss Surgery-Should I or Shouldn’t I?

    As a rule we recommend against crushing medications after weight loss surgery.  There are some larger pills, however, that can be difficult to get down in the early days when there is still some swelling present.  There are many medications, however, that should NOT be crushed under any circumstances.  Generally speaking, these are extended release [...]

Gastric Sleeve

vertical sleeve gastrectomy

Gastric Bypass

gastric bypass anatomy

Low-Impact Exercise For Overweight Patients

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Movement is one of the critical keys to success after weight loss surgery. For some of our patients though, exercise (or even walking) can be a challenge.  Once the weight starts coming off however, patients will see a dramatic improvement in weight-bearing joint pain.  Even so, it’s important to start some form of exercise as soon as possible after surgery.  The definition of exercise can vary from patient to patient.  For some just walking out to get the mail and back can be very challenging.  Below are some very low-impact exercise routines that nearly any patient can do.  Just start off slow and start building your tolerance, even before surgery!

All of these workout routines require no special equipment and can be done at home!

Low Impact Exercise Routines For Overweight Patients

Also check out Joyn – it’s a free site with all sorts of options for patients with any kind of mobility issue. There is even have a section for chair exercises!

joyn icon

Breaking A Plateau After Weight Loss Surgery

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scaleBreaking a Weight Loss Plateau

Weight loss is a journey, and with that journey will come many struggles! A common discussion we have with patients is overcoming a stall or “plateau” in weight loss. Below are some tips to help break out of a weight loss plateau.

  • First of all, consider how far you have come!
    • Before you hit your plateau, you were most likely experiencing successful weight loss for quite some time.
    • Remember your non-scale victories! This can include feeling better, having more energy, clothes fitting better, being able to do things you haven’t been able to in a while, and feeling more confident! Success is not always measured by the amount of weight that you lose!
  • Work with a dietitian to reassess caloric needs.
    • Based on the amount of weight you have lost so far, your calorie needs may have changed and will need to be adjusted. This can include changing the amounts of protein, carbohydrates, and fat in the diet as well, which all contribute to calories in the diet.
    • Sometimes the timing of your meals will need to be adjusted rather than the amount of calories.
    • Adding variety into your diet can help add different nutrients into your diet and ramp up weight loss.
    • If you aren’t tracking food already, get back into it to see if any extra calories are sneaking into your diet somewhere.  Ideally, use our Healthtrac app so that our team has access to your data!
  • Ramp up your workout routine.
    • Increasing the amount or intensity of your workouts could help you break out of a weight loss plateau because it can:
      • Help you burn more calories.
      • Make you feel better mentally and physically.
      • Bring more structure into your day.
  • Weight loss isn’t only related to what you eat. Consider if there are other factors in your life affecting your ability to lose weight.
    • Lack of sleep, excessive stress, and mental health issues can cause the body to produce more cortisol, which can tell the body to store more fat.
    • Seek medical advice if these things are affecting your life.

We hope these tips help you to explore the cause of a weight loss plateau and find ways to remedy it. Remember: You are NOT a failure for falling into a stall with weight loss, you are doing the best you can!

“When you feel like quitting, think about why you started” ~ Anonymous

Diabetes, weight loss surgery, and SGLT2 inhibitors

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SGLT2 Inhibitors

Diabetes management is a rapidly-changing field.  It seems like every few days there is a new medication being advertised.  If you are a diabetic, it’s important to understand how to manage your medications before and after surgery.

SGLT2 (sodium-glucose transport protein 2) inhibitors are a new class of medications used to treat type 2 diabetes.  They are also known as “gliflozins.”  If you are on a medication and the generic name of it ends in “flozin” you are likely on an SGLT2 inhibitor.  They work by preventing the reabsorption of glucose from the blood that gets filtered by your kidneys, causing excess glucose to flow out in the urine.

It is recommended that these medications be stopped 5 days prior to surgery, and not to be resumed until a reasonable amount of calories are consumed on a daily basis.  This would typically be around 4 weeks post-operatively (unless instructed otherwise).

Current medications in this class include:

  • Invokana (canagliflozin)
  • Invokamet (canagliflozin and metformin)
  • Farxiga (dapagliflozin)
  • Xigduo XR (dapagliflozin and metformin)
  • Jardiance (empagliflozin)
  • Glyxambi (empagliflozin and linagliptin)
  • Steglatro (ertugliflozin)

If you are on one of these medications, please make sure you formulate a plan with your provider at your pre-op visit!

Spatz Adjustable Gastric Balloon

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spatz 3 adjustable gastric balloon

The Spatz 3 adjustable gastric balloon was approved by the FDA in the United States in 2021.  It is indicated for patients with a body mass index (BMI) of 35-40, or a BMI of 30-35 with an obesity related medical issue.  Spatz 3 has been available outside the US for some time, and over 100,000 have been implanted.

 

What makes the Spatz unique is that it is the only adjustable balloon system.  This is important for several reasons:

  • One of the most common complications for traditional saline-filled balloons is balloon interolerance.  This means that a small percentage of patients will not tolerate their balloon and will have ongoing issues with vomiting and discomfort.  In the past, if these issues persisted beyond a week or so then the balloon was typically removed early.  With the Spatz however, some saline can be removed from the balloon which will usually cause these issues to resolve without balloon removal.  This does require a repeat endoscopy, however.
  • Another issue with saline balloons in the past is that some patients will only lose weight for the first few months.  These patients will either have a weight loss plateau or even weight gain.  If this occurs with a Spatz, some additional saline can be added to the balloon which will usually lead to additional weight loss.  This also requires a repeat endoscopy.

An additional benefit of the Spatz is that it can be left in the stomach for 8 months, as opposed to a maximum of 6 months for other saline gastric balloons that have been approved in the US.

These advantages have resulted in significantly better weight loss and long-term success for the Spatz balloon in their FDA trial than for any other gastric balloon, whether saline or gas-filled.

Spatz balloon results

As can be seen in the above table comparing all gastric balloons with which we have experience, the Spatz has not only the best weight loss, but also the highest success rate.

Currently, only patients who are able to participate in the Spatz FDA Post-approval Study can have one of these balloons implanted.  Click here if you’re interested to find out if you may be eligible!

How the Spatz Adjustable Gastric Balloon Teaches You to Eat Less!

Weight Loss Surgery And Hair Loss

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hair loss

A frequent question we get from surgical patients is “Will I lose a lot of hair?” This is a common concern, as some patients have heard isolated reports that they will experience hair loss after bariatric surgery. Although it can occur after surgery, maximizing your protein intake and taking the appropriate supplements can minimize this issue.

When hair loss does occur after weight loss surgery, it is typically a result of the body experiencing some degree of malnutrition as well as a stress reaction. Rapid weight loss plus major surgery both put stress on the body, and obviously bariatric procedures limit food intake by design and if the patient isn’t eating right, mild malnutrition can occur.

Protein intake is our primary focus after surgery for many reasons.  One such reason is that adequate intake of protein is the best way to avoid significant post-op hair loss. Vitamin supplementation is important as well, to ensure proper nutrition to support all of the body’s functions, including hair health.

Biotin supplementation stimulates the regrowth of hair in some individuals. However, biotin will not prevent the actual loss so patients will still experience hair falling out without overall adequate nutrition.

Keeping all of your follow up appointments is key to maintaining good health and minimizing issues such as hair loss. Our providers and Registered Dietitians will monitor nutritional intake as well as lab values. Our team uses that information to help us to tailor a supplementation regimen appropriate for each patient!  

Nutrients to Help Minimize/Prevent Hair Loss and Promote Hair Regrowth

Maintaining an adequate daily amount of protein (>80-100 grams), hydrolyzed collagen (2.5-15 gms), and fluid (>80 oz) may promote optimal hair regrowth and minimize hair loss. In addition, there are many vitamins and minerals, when consumed in a routine diet or taken in a daily supplement, which may also promote hair regrowth and may help reduce hair loss. These include: 

 

Vitamin E (15 mg) – can block the erosion of your scalp tissues

Zinc (8-11 mg) – helps promote hair tissue growth and repair

Magnesium (320-420 mg) – helps to release hair follicles clogged by calcium

Vitamin C (65-90 mg) – helps build collagen

Vitamin A (700-900 mcg) –  moisturizes the scalp

Vitamin B5 (5 mg) – helps by strengthening and nourishing hair follicle to promote healthy hair growth

Vitamin B12 (2.8 mcg) – promotes healthy hair growth by assisting in the production of oxygen-rich red blood cells which feed hair follicles

Biotin (30 mcg) – stimulates keratin production in hair and can increase the rate of follicle growth

Iron (18 mg) – prevents iron deficiency, which can cause anemia (a major cause of hair loss)

Vitamin D (600 IU) – stimulates hair follicles to grow

 

Maintaining a diet rich in eggs, seafood, leafy green vegetables, fruits, grains, nuts and seeds, as well as taking a comprehensive multivitamin will promote the opportunity to provide the necessary vitamins and minerals as outlined.