Food should not be a four-letter word. Yet, for the estimated 25 percent of Connecticut residents classified as clinically obese, food is that and more. Their diet and weight increase their risk from obesity- related health issues – among them diabetes, high blood pressure, high cholesterol, fatty liver disease and sleep apnea.
Turning their negative food cycle into a healthy lifestyle is the goal of the Yale New Haven Health System Bariatric Surgery Program staff at Bridgeport Hospital. A goal that patients achieve at a remarkable rate. “After surgery, about 85 percent of our patients keep the weight off long-term,” said Andrew Duffy, MD, director of bariatric and metabolic surgery at Yale New Haven Health System and associate professor of surgery at Yale School of Medicine. “Compare that with the five percent success rate through diets.”
Why such high success? Because bariatric surgery is just the start. “These patients are not giving up food. They are making better lifestyle choices,” he explained. “Surgery helps reinforce these lifestyle changes.” Changes like eating healthier foods, exercising regularly and not smoking.
“In many ways, surgery is the easy part of their journey,” added Saber Ghiassi, MD, site director of bariatric surgery at Bridgeport Hospital, which is why the program also features after-surgery support, essential for long-term success. Patients receive nutrition counseling, lifestyle coaching and attend regularly scheduled support groups led by trained leaders, where they can talk to others who elected surgery.
Not surprisingly, “Those who become involved most succeed most,” noted Jessie Moore, APRN, bariatric surgery program manager.
Bariatric surgery patients are typically 60 - 100 pounds overweight, classified as morbidly obese. That is based on a ratio of weight to height called Body Mass Index (BMI) generally used to determine what degree a person is overweight.
We want to become the regional center for bariatric surgery and help patients statewide.
– Andrew Duffy, MD
“Being 60 to 100 pounds overweight is the threshold,” said Duffy. These patients have a BMI of 35, the low end of the scale. Some patients are even 200 pounds overweight, others 300 - 500 pounds. An individual is considered morbidly obese at a BMI of 40, regardless of any medical conditions; 35 if health problems such as diabetes, high blood pressure or obstructive sleep apnea are also present.
Those who qualify for surgery and commit to the long-term lifestyle changes complete a psychological and medical evaluation before surgery. They also visit with dietitians and receive before- and after-surgery instructions. “In fact, our comprehensive program includes more than what’s required to be certified,” said Dr. Duffy.
Based on the individual’s medical condition, one of three minimally invasive surgeries is recommended: gastric bypass, sleeve gastrectomy or adjustable gastric banding.
“Every operation is laparoscopic,” noted Dr. Ghiassi, a high-tech word for making several very small incisions in the abdomen, so the surgeon can insert a specialized scope or camera to complete the procedure. Of the three procedures, about 65 percent of patients undergo gastric bypass. While banding reduces food intake by wrapping a band around the upper stomach, it needs ongoing adjustments, made in the physician’s office, five or six times the first year, once or twice annually afterward, and weight-loss is half as fast. Sleeve gastrectomy requires removing most of the stomach, but gastric bypass simply creates a smaller stomach from the existing one.
The choice of surgery is often decided by the physician and patient together. “Dr. Duffy discussed all three with me, but I chose the sleeve because I thought it would be the most effective,” said Christopher Hogan, a 49-year-old Seymour resident. “Since I didn’t have any health issues, he agreed that procedure would be fine.” Immediately after surgery, Christopher began to shed weight. “I weighed over 400 pounds, but Dr. Duffy believes that losing 200 pounds is not out of the question,” especially with the recommended diet, nutrition and exercise plan Christopher follows closely. “I can also talk to the nutritionist at any time and I plan on attending some of the available seminars,” he added. Like Christopher, most patients usually go home the next day or two, “And they go home healthier,” added Moore.
One key to their improved health is how bariatric surgery alters a body’s metabolism. “It balances the hormones that tell you when you’re hungry and when you’re full, reducing a person’s appetite,” explained Dr. Duffy. This change also helps the body burn more calories. Neither result is possible by dieting alone.
Every operation is laparoscopic, a high-tech word for making several very small incisions in the abdomen, so the surgeon can insert a specialized scope or camera to complete the procedure.
– Saber Ghiassi, MD
Another benefit of the change in hormones is that it improves or eliminates type 2 diabetes. “We’re still trying to fully understand how this happens,” said Dr. Duffy. But the end-result is normalized blood sugar, which usually occurs immediately after surgery. That was one of several improvements for Marion Rodriguez following her gastric bypass surgery. “I no longer need to take medication for type 2 diabetes or cholesterol,” said the 41-year-old Stratford resident. Instead she relies on recommended vitamins and a healthier diet.
“It’s also easier for me to exercise,” she noted, prompted four to five times a week by an exercise video that promotes a stronger body as she continues losing weight – more than 20 pounds in the first weeks alone.
Improved health also leads to increased life expectancy from a reduced risk of related health issues, such as heart and pulmonary disease, and stroke. There is often a positive impact on family members, as well. “About 80 percent of our patients are women,” noted Dr. Duffy. “When they do well, husbands, children and other family members become interested in the program.”
Most patients overweight by 200 pounds or more lose about 120 pounds the first year after surgery. “While they are still overweight, they are far healthier than before and they can still lose more,” he added. At the one-year stage, bariatric patients often hit a “set point,” where the body slows or stops the weight loss process. “It takes a while to reset this point, but we can help patients adjust and lose more weight,” explained Moore.
Some patients, like Marion, who topped 300 pounds, might have additional health issues like a hernia that also require surgery. “Dr. Duffy performed my gastric bypass surgery and repaired my hiatal hernia at the same time,” noted Marion. Others might need an additional surgery to repair the hernia.
For the hernia operation to succeed, most patients, especially those nearing 400 pounds or more, must lose sufficient weight beforehand, explained Dr. Duffy. So, bariatric surgery is performed first. After the patient reaches the recommended weight, the hernia is repaired. “Every pound they lose makes the additional operation easier to perform and succeed,” said Dr. Duffy.
Bariatric surgeries are performed at Bridgeport and Yale New Haven hospitals, depending on each patient’s needs. And while all surgeons are board-certified, they also have additional fellowship training and experience in bariatric surgery. “That’s what distinguishes our program from others in Connecticut,” explained Dr. Duffy, a difference Christopher and Marion experienced in their results.
“The Bridgeport Hospital staff was really wonderful,” said Marion. “They explained every step of the procedure, so I knew what to expect, before and after. I just can’t say enough about them.”
“The level of care was truly amazing,” added Christopher. “I would gladly recommend the program to anyone.”
As the bariatric program grows and facilities expand in Bridgeport, what will further distinguish the program is reaching its broader goal. “We want to become the regional center for bariatric surgery and help patients statewide,” added Dr. Duffy. For prospective patients, that is serious food for thought.
A golf-ball-sized pouch is made at the top of the stomach and the upper intestine is connected to the new pouch. Less space means small amounts of food make a person feel full. Bypassing the larger stomach portion and rerouting the path to the intestine puts food in contact with digestive juices for a short time, so fewer calories are absorbed. Changes in hormones regulating appetite and blood sugar make a person less hungry and normalize blood sugar levels.
After surgery, about 85 percent of our patients keep the weight off long term . . . These patients are not giving up food. They are making better lifestyle choices.
– Andrew Duffy, MD
About 75 - 80 percent of the stomach is removed, leaving a tube or “sleeve.” This limits the amount a person can eat. It also changes hormone production related to hunger. The small intestine is not changed.
Surgeons implant an inflatable, adjustable silicone band around the upper stomach, creating an egg-size stomach pouch that limits the amount and type of food a person can eat. Food passes through the remaining portion of the stomach and into the small intestine, where it is absorbed. The band can be inflated with a solution through a tube connecting it to a port under the skin. Increasing or decreasing the fluid loosens or tightens the band, changing the passageway size.
The bariatric surgery staff at Bridgeport Hospital includes:
