weightloss

Though she’d been into fitness for most of her life, Gina C., an administrator at a hospital, suddenly found herself putting on unhealthy amounts of weight as she approached her fiftieth birthday. After making every attempt to combat her weight gain in other ways, she finally decided that she would consult the bariatric surgeons at The Valley Hospital, certified as a center of excellence by the American Society of Metabolic and Bariatric Surgery. She arranged for laparoscopic gastric banding surgery with Beth Schrope, MD, Director of the Center for Metabolic and Weight Loss Surgery at The Valley Hospital.

Sleeve Gastrectomy

Sleeve Gastrectomy

It wasn’t until her final consultation with Dr. Schrope, however, that Gina decided to ask about an alternative treatment called sleeve gastrectomy, which involves removing about three-fourths of the stomach. The name “sleeve” comes from the appearance of the stomach afterwards; instead of looking bulb-shaped, the stomach is so much smaller and slimmer that it almost looks like a continuation of the esophagus.

Gina was thrilled to hear that the minimally invasive procedure, though a slightly longer operation, seemed to be just as effective, if not more effective, than laparoscopic adjustable gastric banding — but with a much lower rate of long-term complications (due to the reoperation rate after banding). No reconnecting of the intestines would be necessary, as in a gastric bypass, nor would an artificial device need to be implanted and regularly adjusted, as required by gastric banding. Most importantly — in Gina’s eyes, at least — one of the procedure’s unique effects is to substantially reduce the body’s production of the hormone ghrelin, which is responsible for stimulating hunger. “When I heard that [the sleeve gastrectomy] removes ghrelin, I raised my hand: I’m in!” Gina said. “The removal of ghrelin really needs to be investigated by anybody with an addiction to food — it’s amazing.”

The catch about sleeve gastrectomy, though, is that it’s permanent. A gastric band can be removed, and a gastric bypass undone — but after actually removing a portion of the stomach, as in the gastrectomy, it cannot be put back. As convinced as Gina was that sleeve gastrectomy was the way to go, Dr. Schrope insisted that she take a week to think about whether she wanted to make this irreversible decision. Gina did so. At home, she went to online forums and message boards, chatted with others who had gotten the procedure, and carefully weighed all of her options. She remained convinced that sleeve gastrectomy was the best choice for her.

Healthy Choices

On October 4, 2011, Gina had her operation. It went wonderfully. Even the unexpected presence of a hiatal hernia hardly slowed Dr. Schrope, who easily repaired the hernia as she went. The whole procedure was done laparoscopically, meaning that there was not so much an incision as set of five tiny holes. Only a couple hours after the operation, Gina was walking around. Two days later, she went home.

Since the surgery, Gina, an Italian, has lost the taste for pasta, carbohydrates, and starches; the effects of the lack of ghrelin, she says, are extremely noticeable, and wonderful. More importantly, perhaps, she has been steadily losing weight. She’s already lost 50 pounds — a good 20% of her body weight — and she says that although she’s already very happy with where she is now, it’s quite possible that she’ll continue to lose weight. She’s also been able to stop taking all the medications she’d needed before her surgery (namely, those for fibromyalgia, arthritis, and high blood pressure) because her dramatic weight loss has reduced or eliminated her symptoms.

All in all, Gina is incredibly pleased with the results of her operation: “I’m over the moon about it,” she said, “I’m the cheerleader. My results are fantastic, I’m off all my prescription medications, and I couldn’t be happier.” She’s even bringing exercise back into her life again, and can’t wait to go skating and biking once the weather warms back up in the spring.

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For Lasting Weight Loss, Surgery is Not Enough

by Columbia Surgery on February 3, 2012

Browse the success stories in the weight loss section of the Department of Surgery’s website and you’ll notice a running trend beyond the impressive drops in weight maintained by these patients.

Lisa Pre-Op

Lisa Pre-Op

They are all enjoying new activities, exercising, overhauling their eating habits, and one has even become a personal trainer. These new habits and lifestyles speak to comprehensive changes in their lives, made possible through the Center for Metabolic and Weight Loss Surgery at NewYork-Presbyterian Hospital/Columbia University Medical Center. For sure, bariatric surgery was one of the first and biggest steps in the transformation undergone by every one of these patients, but it wasn’t the surgeon who signed Lynda up for kickboxing classes or turned Lisa into an athlete and personal trainer.

Another trend you’ll notice is how the patients who have been successful in maintaining their new lower weights are still benefiting from the professional staff with whom they have worked since before having surgery. The center integrates a broad spectrum of medical professionals because sustainable weight loss depends on a lasting change in lifestyle. The key is the combination of the talented physicians, surgeons, nurse practitioners, registered dieticians, behavioral therapists, and a host of ancillary support professionals—all dedicated to helping each patient make a smooth transition into a new, healthier set of habits.

Lisa Post-Op

Lisa Post-Op

“Seventy percent of a person’s weight is genetically determined,” says Marc Bessler, MD, Surgical Director, Columbia University Center for Metabolic and Weight Loss Surgery Director of Laparoscopic Surgery, “However, obesity has been increasing in the United States at a much faster rate than genetic changes occur, which tells us that environment also plays a huge role.” The environmental causes of obesity are precisely what make a comprehensive approach to weight loss so crucial. The registered dieticians and behavioral therapists at the center are trained to help patients confront the lifestyle changes that necessarily accompany their significant weight loss.

When a patient like Irina says, “I cannot imagine having these kinds of results without the undying support and unsurpassed care I received, and continue to receive, at the Columbia University Center for Metabolic and Weight Loss Surgery,” it becomes clear that there is a lot more successful weight loss than a date with the surgeon.

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Young, Obese, and In Surgery

by Columbia Surgery on January 13, 2012

“It’s like having a precancerous condition that you can treat rather than waiting till it’s cancer,” says Jeffrey L. Zitsman, Director of the Center for Adolescent Bariatric Surgery at NewYork-Presbyterian/Morgan Stanley Children’s Hospital, in a New York Times article January 8, 2012. Yet despite the prospect of a lifetime of obesity, ostracism, and diseases such as diabetes for such patients, nearly half of pediatricians and family doctors say they would never refer a teenager for obesity surgery.

Full Article: Young, Obese and in Surgery

Prevalence of Obesity Among US Adolescents

Prevalence of Obesity Among US Adolescents, aged 12 - 19, 2007-2008


*Obesity defined as BMI ≥ 95th percentile. Total includes racial and ethnic groups not shown separately. Source: National Health and Nutrition Examination Survey, 2007 – 2008.

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Stories of Hope: Alexander Vasquez

by Columbia Surgery on November 16, 2011

For as long as he could remember, Alexander Vasquez struggled with his weight. His weight rose with the years — 100 pounds in kindergarten, 400 pounds by 9th grade. That trend was briefly reversed each summer, when he spent several months in the Dominican Republic playing outdoors with friends and relatives, only to resume again each fall once he returned to school in New York. He endured the hurtful comments of his peers until he dropped out of high school in his junior year, when he no longer fit into the school’s single chair and desk units.

Alex began the process of researching options for weight loss surgery in his early 20′s. First he tried to arrange for weight loss surgery at St. Luke’s Hospital, but his weight exceeded the hospital’s maximum limit. He tried to lose enough weight to qualify for surgery, but failed. The next year, he went through the same process at Montefiore Hospital, and again, was told he was ineligible for surgery because he was too heavy. He requested surgery at Beth Israel Hospital, and tried losing weight on his own with the help of shedweight.com, to no avail. After these disappointments, Alex said he just stopped trying, and his weight rose to almost 600 pounds. For the next few years, Alex felt resigned to being big forever.

In many respects, thing were going fairly well; Alex was working in a bindery, had a girlfriend, and did not have any other major health issues. But underneath the cheerful facade he portrayed to the world, Alex felt shame and discouragement about his weight. He started having back problems and his knee gave out several times, causing him to fall. Shopping for clothes, he recalls, was impossible in regular stores – the only options were very expensive specialty stores. His fatigue worsened, and he no longer had the strength to keep working. Then one day, he went to drive somewhere with his girlfriend and could not fit behind the steering wheel. He broke down in tears. Admitting that being obese was holding him back in life, Alex made a momentous decision: he did not want to become “a couch person,” as he calls it. “I wanted to grow up and be able to live life.”

With renewed determination, Alex contacted NewYork-Presbyterian/Columbia, where he had been born. The Center for Weight Loss Surgery would be able to do his surgery, he was told. Alex soon began pre-surgical evaluations, educational seminars, and monthly weight-ins at Columbia, and later at the Lawrence Hospital, a Columbia affiliate that was closer to home. And to hear Alex tell it, he couldn’t be any happier. “I love Lawrence Hospital – I love everything about it, from the parking attendants to the security guard to all the nurses and doctors on my team. They are fantastic.”

Since his surgery June 7, 2011, Alex has lost over 160 pounds and is ecstatic. He is well on his way to achieving his goal of a healthy weight (between 215 and 230 pounds for his 6’2” frame) by June of 2013. What’s more, his success has inspired him to reach out to others struggling with their weight: he has been posting a series of videos on YouTube in order to let others know that if they are obese, they can change their lives too. “Before my surgery, I was in denial about my weight. I acted like a regular person, but I didn’t look or act like a regular person because I was so big. Now, I want to encourage others like me to seek help, and for those who have surgery, I want to help them by letting them know what they can expect during this process. I’m open about everything because I hope every obese person will choose to come out of denial and find help.”

On the recommendation of his physicians, Alex chose sleeve gastrectomy, a procedure that decreases the size of the stomach helping patients to feel full after eating smaller amounts of food than before surgery. Patients undergoing this procedure can expect to achieve significant weight loss, comparable to the results achieved by gastric bypass surgery, but in a less complicated manner. Alex’s surgeon, Aaron Roth, MD, FACS, says “Alex is one of the most motivated patients in our practice. Like all weight loss operations, the sleeve procedure is a tool to help patients control their weight. It is perfectly suited for patients like Alex who are at very high risk for surgery, one that best balances risk and opportunity for success.”

The Columbia University Center for Obesity Surgery at Lawrence Hospital has been treating patients since 2003. The program offers the convenience and atmosphere of a smaller community hospital in combination with the world-class clinical expertise and research capability found at New York-Presbyterian Hospital. According to Jane Alexander, NP and Clinical Coordinator of the weight loss surgery program, being a part of Columbia University establishes a link with the main hospital to deliver care that other programs cannot. “We offer patients a personalized approach that takes into consideration their physical health, family, and emotional concerns. Being a community hospital, we’re more available and accessible to our patients, enabling us to create a bond and partnership with them. It is extremely rewarding to work with patients like Alex and see the results of hard work and dedication.” Dr. Roth “All patients with or without high risk are are welcome in our practice and are encouraged to come and discuss surgical options with us.”

To learn more about weight loss surgery at the Lawrence Hospital Center, visit the Center for Advanced Surgery or call 914.787.4000.

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Study Begins to Explain Why Surgery Cures Type 2 Diabetes

by Columbia Surgery on June 9, 2011

Science Translational Medicine

Science Translational Medicine

The April 27, 2011 issue of Science Translational Medicine included a study titled “Differential Metabolic Impact of Gastric Bypass Surgery Versus Dietary Intervention in Obese Diabetic Subjects Despite Identical Weight Loss.

Melissa Bagloo, MD, Assistant Professor of Clinical Surgery at the Center for Metabolic and Weight Loss Surgery, NYP/Columbia, explains the context and importance of this study.

Q: What did this study find?

Dr. Bagloo: For years, surgeons have observed that gastric bypass surgery cures diabetes in over 80% of patients with diabetes. This improvement in blood sugar levels happens almost immediately after surgery, and far before any significant weight loss occurs. What’s more, studies have found that when patients lose the same amount of weight through diet as other patients lose after surgery, those who had surgery experience significantly better improvement in their diabetes than those who lost weight non-surgically. So we know surgery dramatically improves or resolves diabetes, but we do not know why this happens.

This recent study in Science Translational Medicine found an important clue as to why this effect may occur. The researchers found that after gastric bypass surgery, the levels of a certain type of amino acids (branched-chain amino acids) circulating in the blood were significantly reduced. This reduction in amino acids improved patients’ sensitivity to insulin, having the effect of normalizing their blood sugar levels.

Q: Why is this finding important?

Dr. Bagloo: The molecular mechanisms that cause diabetes are still unknown to us. Elevated amino acids have been identified previously in diabetic patients, but this is the first study to compare surgical with non-surgical weight loss. In that context, observing reduced amino acids after surgery clearly adds to our body of knowledge about the role they may play in the mechanisms underlying diabetes.

Q: Do you perform weight loss surgery specifically to treat diabetes?

Dr. Bagloo: The use of weight loss surgery to treat diabetes is called metabolic surgery, and as our knowledge has increased, metabolic surgery has become a very important therapeutic option for patients with morbid obesity and diabetes. The Center for Metabolic and Weight Loss Surgery at NYP/Columbia has been at the forefront of advancing and studying metabolic surgery for about a decade, and the use of metabolic surgery has been well established in diabetic patients with a body mass index (BMI) of 35 or greater. At this time, we are now studying the effect of weight loss surgery among patients with diabetes and BMI between 30-35. Select patients with BMI between 30-35 may be eligible for participation in the Diabetes Surgery Study, which is currently underway.

Visit the NYP/Columbia Center for Metabolic and Weight Loss Surgery or call 212.305.4000 for more information about metabolic surgery or the Diabetes Surgery Study. Read more about the Science Translational Medicine study in NPR’s health blog post, “New Clues To Why Gastric Bypass Surgery Cures Type 2 Diabetes”.

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Teens and Weight Loss Surgery

by Columbia Surgery on September 1, 2010

The spiraling obesity epidemic has become a top concern not only for doctors and weight loss centers, but for the government, schools, and even the food industry. The options to treat obesity are fairly uncomplicated: a healthy diet and more physical activity. Yet these deceptively simple steps remain a formidable challenge, leading increasing numbers of people to choose weight loss surgery to help them regain their health.

According to Marc Bessler, MD, Director of the Center for Metabolic and Weight Loss Surgery, it has been widely proven that a severely overweight adult person, someone who is 100 pounds or more over their ideal weight, may benefit greatly from weight loss surgery. Overall, length of life and quality of life improve greatly. Direct benefits of weight loss include significant reduction or elimination of cardiovascular disease, asthma, obstructive sleep apnea, non-alcoholic fatty liver disease, gastro-esophageal reflux disease (GERD), and other serious health problems. Moreover, gastric bypass surgery, the most popular weight loss procedure in adults, provides an additional benefit: rapid elimination of type 2 diabetes. “Patients who undergo gastric bypass surgery experience significant improvement or elimination of type 2 diabetes within a month after surgery, before significant weight loss even occurs,” says Dr. Bessler. Interestingly, a woman who has had weight loss surgery between pregnancies will provide her second child with a better chance of having a healthier weight, says Dr. Bessler. Yet, with all these benefits, should weight loss surgery be an option for obese teenagers and adolescents?

According to a University of Michigan study of general practitioners and family doctors that was published in May of this year, the verdict as decided by these clinicians is mixed. Forty-eight percent stated that they would never refer an obese adolescent for weight loss surgery, and 46 percent stated that the minimum age at which they refer a patient for weight loss surgery would be 18 years. 1

During the past 15 years, Dr. Bessler has helped many patients to achieve a healthy weight. He explains, “Without a very significant change in lifestyle, a 200 pound 15-year-old will be a 300 pound 18-year-old, and then a 375 pound 21-year-old. By this time, he or she may already be experiencing serious health issues because of the excess weight.” Dr. Bessler has pioneered continuous advancements in minimally invasive surgical techniques, which translate to exceedingly safe procedures and very successful outcomes.

Jeffrey Zitsman, MD, Director of the Adolescent Bariatric Surgery program at NewYork-Presbyterian Morgan Stanley Children’s Hospital/Columbia University Medical Center has been studying laparoscopic gastric banding in teens since for several years now. Although adults may choose among several surgical options for weight loss (gastric bypass, laparoscopic gastric banding, and sleeve gastrectomy), Columbia performs only laparoscopic gastric banding in patients under 18, because it is the least invasive and best studied procedure in teens to date.

Gastric banding involves placing an adjustable, removable silicone band around the upper portion of the stomach. This creates a small upper pocket in the stomach that fills rapidly, creating a feeling of fullness, and causing the patient to eat less. Because it does not surgically alter the intestinal tract, the procedure is less likely to cause nutrient absorption problems than other types of weight loss surgery, and it is fully reversible.

Although gastric bands are not approved for those who are under 18 years of age, doctors at Columbia have been granted approval by the FDA to test the procedure in selected patients, who are then followed for at least five years. Outcomes among adolescents have been excellent, according to Dr. Zitsman, with weight loss in teens comparable to that in adults who undergo gastric banding.

Not every teen will qualify for weight loss surgery, since other factors in addition to obesity, such as compliance to a healthy diet, physical activity and family support, are important factors in weight loss success. Risk of complications of weight loss surgery must be carefully weighed in the context of health risks associated with obesity. Careful screening by Columbia’s multidisciplinary team is essential to provide a patient with the best opportunity for a successful outcome after weight loss surgery. The decision for a teen to undergo weight loss surgery is a personal one. What would you do if this was you or your adolescent family member?

Additional Articles:
Gastric Banding Gives Good Results in Obese Teens
Teen Takes Drastic Measures To Battle Weight
Weight-Loss Surgery for Obese Teens Backed by Study

1 “Bariatric Surgery in Severely Obese Adolescents Debated” on Medscape Today [web site]; available from www.medscape.com/viewarticle/721446 retrieved 18 May 2010.

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According to Dr. Marc Bessler, Director of the Center for Metabolic Weight Loss Surgery at NewYork-Presbyterian Hospital/Columbia University Medical Center, “Minimally invasive surgery is all about making improvements to current procedures by using the newest tools and most recent research. Minimally invasive practices can be transferred between specialty areas such as endoscopy and surgery. Weight loss surgery has benefited from this.”

The TOGa procedure, in which surgery is performed completely through the mouth, or endoscopically, is one example. The benefits of an endoscopic approach are less pain, quicker recovery, shortened hospital stay and decreased complications, as well as a lack of scarring

Dr. Marc Bessler in Operating Room

Dr. Marc Bessler in Operating Room1

Transoral Gastroplasty for the Treatment of Morbid Obesity

NewYork-Presbyterian/Columbia is one of the few U.S. medical centers participating in the research of one of the newest minimally invasive weight loss procedure, transoral gastroplasty for the treatment of morbid obesity, or TOGa. To perform this, a specialized surgical device is inserted into the stomach through the mouth. The device staples the sides of the stomach into a pouch, that slows down the entry of food into the digestive system. This makes the patient feel fuller faster.2

Once the clinical trial process is complete—completion is anticipated for October of 2010—TOGa may become an option for patients who are unable or unwilling to undergo more invasive surgery.

With the help of endoscopy, the number of weight loss surgeries are increasing, what are your thoughts on this? Are they being used to excess or are they providing a lifeline to people who may not be able to lose weight by any other means? As you think of this, please watch for our upcoming post on weight loss surgery in teens.

For more information on weight loss surgery please visit the Center for Metabolic and Weight Loss Surgery web site.

1Photo taken by Jada Fabrizio

2“TOGa US Clinical Trial,” on Satiety, Inc [web site]; available from http://ous.satietyinc.com/toga-procedure/overview; retrieved 11 May 2010.

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