Bariatric Surgery
Should I have surgery to lose weight?
Recent research indicates many patients are unable to achieve and maintain large amounts of weight loss without the assistance of weight loss surgery.
Along with the burden of obesity, often times these patients are plagued with diseases associated with excess weight. These diseases are referred to as co-morbidities and include:
- hypertension
- diabetes
- sleep apnea
- GERD
- joint pain
Co-morbidities may be reduced or eliminated by weight loss.
The goal of the bariatric program is to provide assistance to patients who may benefit from significant weight loss and have had little success with more conservative treatment methods.
Retirees and dependents who meet specified criteria are eligible for the bariatric surgery program.
What surgeries are available?
The bariatric procedures currently being performed in the program are laparoscopic gastric banding, laparoscopic sleeve gastrectomy, and open or laparoscopic gastric bypass.
All procedures are very effective but differ in surgical technique, dietary modifications, lifestyle changes, medical monitoring, and risk to the patient.
Each patient is unique and will consult with the bariatric surgeon to determine the best surgical procedure.
Laparoscopic Gastric Banding is the least invasive but effective weight loss procedure. It is the safest procedure. In this procedure, an inflatable silicone band is placed around the upper portion of the stomach. The band is tightened around the stomach by injecting saline into the adjustable band. The tightened band creates a small pouch of the upper stomach which restricts the amount of food the stomach can hold, resulting in weight loss.
Laparoscopic Sleeve Gastrectomy is another very effective surgical weight loss procedure in which the stomach is stapled and part of the stomach is removed. The remaining portion of the stomach is called a sleeve. The sleeve remains attached to the small bowel and digestion occurs normally. The small stomach fills quickly allowing the patient a feeling of fullness, reducing the food intake, resulting in weight loss.
Gastric Bypass is the most invasive and most effective weight loss surgery. In this procedure the stomach size is reduced to a pouch, and the upper portion of the small bowel is bypassed. Weight loss occurs by reducing the amount of food intake into the smaller stomach and by the GI tracts reduced ability to absorb calories and nutrients. Following bypass surgery, the patient will require lifetime medical monitoring for nutritional deficiencies and supplemental vitamins and minerals.
Handouts
Forms
Do I qualify for the Surgical Weight Loss Program?
The eligibility criteria for a consultation with one of our bariatric surgeons are as follows:
- BMI of 35 or greater with co-morbidities, or BMI of 40 or greater without co-morbidities. BMI is a method of classifying body mass into categories used to predict morbidity and mortality. BMI is calculated by weight in kilograms divided by height in meters squared. We do not perform surgery on patients with a BMI of 50+ or >400 lbs.
- Retired military
- Dependents of active duty or retired military
- 18-64 years old
- TRICARE Prime beneficiary
- Not pregnant or lactating
- No multiple serious medical complications related or unrelated to weight
Note for Active Duty Service Members: Bariatric surgery represents a major and permanent change in your digestive system that requires strict adherence to a specific dietary regimen that may interfere with operational deployment. A history of bariatric surgery is a bar to military service and receiving bariatric surgery while on active duty may be grounds for separation. Active duty personnel cannot have weight loss surgery as mandated by DOD, and are not eligible for the Surgical Weight Loss Program.
How do I begin the process?
The road to weight loss surgery begins with an appointment with your Primary Care Manager (PCM). Your PCM is going to play a vital role should weight loss surgery be the best choice for you. You must keep in close contact with your PCM throughout the process. Your health maintenance needs to be up-to-date with optimization of current medical problems. If you have had a diagnosis of H. pylori in the past, you must have documentation that it was treated.
If you meet the criteria listed in the previous section and have been unsuccessful with other methods of weight management, have your PCM enter a consult to the General Surgery Clinic entering “bariatric surgery” as the reason for consult. In that referral, your doctor will need to include your actual weight at the time of visit, highest weight, height, BMI, and co-morbidities (other conditions caused by obesity).
Bariatric studies to be ordered by your PCM after your acceptance into the Surgical Weight Loss Program and you have attended the Bariatric Seminar:
| PCM to coordinate: |
Time Frame Test Valid |
| Contraception |
Contraception should not be taken within 4 weeks prior to surgery |
| CBC |
Labs Baseline Nutritional Status Valid within 1 yr |
| Complete Metabolic Panel |
Valid within 1 yr; if no active problems |
| Lipid Panel |
Valid within 1 yr |
| Vit D(calcidiol/25-hydroxy Vit D |
Valid within 1 yr |
| HB A1c if diabetic ; must be < 8.5 |
Valid within 1 yr; if no active problems |
| Vit B12/Folate |
Valid within 1 yr |
| Serum Thiamine |
Valid within 1 yr |
| Iron studies |
Valid within 1 yr; if no active problems |
| Serum ferritin |
Valid within 1 yr |
| TSH |
Valid within 1 yr; if no active problems |
| PTH |
Valid within 1 yr |
| Colonoscopy beginning at age 50 |
Valid within 2 yrs; current with recommended screenings |
| Mammogram-females beginning at age 40 |
Annual; current with recommended screenings |
| Cervical Pap beginning at age 18 |
Valid within 2 yrs; current with recommended screenings |
| PSA- Prostate Specific Antigen-beginning at age 50 |
Annual |
| Ultrasound of Right Upper Quadrant of Abdomen if gallbladder present |
Valid within 1 yr. |
| H Pylori |
Valid within 2 yrs; if + must be treated |
| EKG-males beginning at age 40: females beginning at age 50 |
Valid within 6 mo. of surgery date |
| Cardiac Risk Stratification e.g.echo? |
Valid within 6 mo. documentation of surgical clearance required |
| Sleep Study |
Valid with 2 yrs |
| CPAP/Bi PAP |
If indicated in report |
| Dietician NCA approved Only |
3 pre-op bariatric visits and explicit recommendation for surgery |
| Exercise Therapist |
Within 1 yr. |
| Support Group-NCA only while actively in program |
2 support pre-op and life long participation |
| Studies coordinated by Bariatric Surgery |
|
| GI-endoscopy and PH/Mannometry |
Within in 2 yrs |
| Psychiatry |
Within 1 yr |
TRICARE Coverage
Please visit the TRICARE website for coverage information.
Exercise Physiology and Physical Therapy (WRNMMC)
301-295-4065
Required Consults: Exercise Physiology and Physical Therapy
Our Exercise Physiologist and Physical Therapist are members of the multidisciplinary team caring for you in the Surgical Weight Loss Program. Their expertise lies in evaluating muscle response to activity and maximizing its positive effect on the body. This enables them to formulate exercise programs for professional athletes as well as patients suffering from cardiac conditions, asthma, chronic obstructive pulmonary disease, or bariatric patients with various limitations in their ability to exercise in the normal sense.
In collaboration with your surgeon and other team members, they will develop a customized exercise program for you. Their program will assist you in developing techniques and movements to improve your mobility and body strength. Exercise, as a requirement of the weight loss program, is a key element in achieving and maintaining long term success in managing a healthy weight. This program will help you incorporate exercise into your lifestyle. Please call (301) 295-4065 for an appointment or more information.