There are the numbers: An exhaustive, 10-year study by the National Institute of Health (NIH) determined surgery as the most effective method of weight loss and maintenance for anyone with a Body Mass Index of 40 or higher.

And there is the eyeball test: “The majority of our patients will lose between 60-80 percent of their excess weight,” said Longstreet Clinic bariatric surgeon Robert L. Richard, M.D., FACS.

Many people still have questions about bariatric surgery, however. And Dr. Richard and his colleagues at Longstreet Clinic’s Center for Weight Management, understand this and are always ready to discuss the merits and realities of weight loss procedures.

With that in mind, let’s look at some of the most common questions patients pose to Drs. Richard and fellow bariatric surgeon Eric J. Velazquez, M.D., MBA, FACS, FASMBS – and their responses.

(NOTE: To qualify for bariatric surgery, you must have a Body Mass Index, or BMI, of at least 40. However, patients with a BMI of 35 that also suffer from obesity-related health conditions, such as diabetes, hypertension, cardiovascular disease, etc. – called comorbidities – may also qualify. A patient’s BMI is obtained by dividing their weight in kilograms by the square of their height in meters. A healthy BMI is between 18.5-25; between 25-30 is considered overweight.)

QUESTION: Is it possible to lose too much weight with surgery?

RICHARD: It’s rare that we’ll have a patient that loses too much weight after surgery. For someone to lose too much weight, we’ll have to get them to a normal weight and exceed that to get them to an unhealthy weight. Usually, if a patient gets to that kind of weight, they’ve developed an eating disorder. Some of our more aggressive procedures, like a duodenal switch, which is a malabsorptive procedure, may mean that a patient gets too much malabsorption. If that happens, that patient may need provisional surgery to prevent that excess weight loss. If it’s the former, the patient that has an eating disorder, we really want them to work with our behavioral health team to understand how to properly eat after weight loss surgery. So, the short answer is that it is a rare person that loses too much weight with these types of operations, and it’s completely abnormal and needs to be addressed.

Q: What happens to those patients that initially lose weight from bariatric surgery but then begin to gain some weight back?

RICHARD: That is a tough question, but it’s one that we see every day, because this disease is a chronic, relapsing disease. It’s like any other disease – with breast cancer, if someone gets a mass removed and it comes back, that needs to be addressed. This is a similar kind of condition. If a person has had weight loss surgery and been successful and then, for some reason, they begin to fail at their weight loss, regaining weight, we need to investigate. There are things that we can do to try to get this weight under control, and it’s just as important as before that initial operation. We will evaluate the patient’s anatomy, depending on what procedure they had, and there may be some surgical options on an individual basis to restore the continuity of that operation and to return that patient to weight loss. Revisional bariatric surgery is real and is individualized – no two patients are the same – but it is something that we need to address. Because comorbidities can come back. Diabetes can return and with that the complications that are associated. So, this weight regain needs to be addressed a second, and for some patients, maybe even a third time. But, just like breast cancer, we don’t give up on these patients who experience this.

VELAZQUEZ: It highlights the importance of accepting obesity as a chronic disease. Even when we get it under control with surgery and the weight goes away, it can come back. That’s why it’s so important to have long-term follow-up with bariatric surgeons. And that’s how we shape our care at the Center for Weight Management. We stay with our patients throughout their journey.

Q: Do patients that undergo dramatic weight loss have to worry about loose skin?

VELAZQUEZ: I usually tell them not to worry about it. These surgeries are going to achieve very high weight loss. They’re going to make the patient healthier. And a lot of times, probably 90-95 percent of the patients I’ve operated on in the past 12 years, don’t seek any cosmetic procedures. From that five percent, there are a few of them interested in cosmetic procedures – but that’s because that was part of their journey to begin with. They said, ‘I’m going to lose the weight and that part of the journey is that body transformation.’ But a lot of people are very happy with the end results and don’t feel the need to seek any other cosmetic care. What I recommend is: Keep a balanced diet. Take your vitamins. Take your proteins. You can add some collagen. But, most likely, you’re going to be very happy with the results.

RICHARD: I’m pretty up front with patients. They want to know if they lose weight slower will they have better results (with loose skin), and I say, if you’re going to lose 100 pounds – it doesn’t matter if it’s slow or fast – you’re going to have some loose skin. But I think it’s going to be well worth the journey.

Q: Is exercise possible after bariatric surgery?

VELAZQUEZ: Exercise is such an important component of weight loss. You’re changing your life when you go through this journey and exercise is going to become a big portion of your life. Surgery is not something you do and just forget about everything else. So, yes, I’m pro exercise on the journey.

RICHARD: I absolutely believe in exercise as a part of this journey. But exercise isn’t the only part of this journey. So, when I have a patient that’s not doing well, and they want to say, ‘Well, it’s because I haven’t exercised,’ I want them to understand that exercise is a part of it, and eating is a part of it, and lifestyle change is a part of it, and all of this needs to play a role in their long-term success.

Both doctors emphasize that ultimate weight loss success – with or without bariatric surgery – is based on a lifetime commitment to health. That includes a commitment to diet and exercise, as well as other factors like sleep and stress.

Bariatric surgery is not a magic bullet that does all the work for the patient. It simply kickstarts the weight loss process and allows the patient to take control of their health. That’s why Center for Weight Management providers – which include surgeons, dieticians, and nurses – are focused on a lifelong approach to health, not just weight loss surgery.

It is also why Longstreet clinicians are happy to talk with any patient curious about bariatric surgery or weight loss in general. Because they’ve seen the results, and they’ve helped countless patients complete and maintain a health-giving journey that lasts.

If you are tired of battling obesity and are looking for a lasting meaningful solution, the caring staff at the Center for Weight Management is always eager to discuss your situation and is ready to help. To learn more, please call Longstreet Clinic’s Center for Weight Management today at 770-534-0110 or toll-free at 877-921-0110. Or you can watch our online seminar then fill out our contact form, and our weight loss team will reach out to you.

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