Dr. John Romanelli, medical director of the Weight Loss Surgery Program at Baystate Medical Center, appeared on last night’s new Medical Rounds – a collaboration between Baystate Health and Western Mass News. The weekly Medical Rounds is broadcast in the 5:30 p.m. portion of the Tuesday night news and focuses on family health and wellness and breakthrough technologies. Each session is followed by an interactive live chat. Last night’s discussion focused on weight loss options, including weight loss surgery available at Baystate. A transcription of last night's edition follows.
Q. Many people are dealing with weight issues today. When should someone consider a surgical procedure or other intervention?
A. People should consider weight loss procedures when they have tried multiple attempts at losing weight on their own without success. These should be attempts that last several months and include regular exercise with the diet they are following. When that fails, a person should think about speaking to their doctor about what options are available to help them with their weight loss. This can range from dietary programs to medical weight management programs, as well as medications, exercise programs, and even surgery.
Q. What is the most effective procedure for weight loss management?
A. Gastric bypass is considered the most effective weight loss procedure, although it is no longer the most commonly performed. Today, sleeve gastrectomy is the most performed weight loss surgery in the United States. The sleeve is slightly less effective in terms of weight loss, but it is undeniably safer, which is the main reason why patients who opt for surgery choose it.
Q. How does it work?
A. Sleeve gastrectomy works by limiting the amount of food you can eat in a single meal. To put it simply, you go on a diet – with reduced food volume – and are not hungry at the end of the meal. It also decreases how hungry you get before each meal by limiting how much of the hormone we call ghrelin that your stomach makes – the part that secretes the ghrelin is what gets removed.
Q. What qualifies patients for this procedure?
A. Patients must have a body mass index (BMI) of 40KG/M2, which equates to about 100 pounds over their ideal body weight. Patients with diseases related to obesity, such as high blood pressure or diabetes, may also qualify at a lower weight, but must still have a BMI of 35 KG/M2 to quality. In addition, they must spend a period of time in a weight loss surgery program working with support groups, dietitians, and psychologists, to see if they can make longstanding life interventions that will help them to succeed.
Q. On average, what results do most patients see following the procedure?
A. Patients who undergo gastric bypass lose 55-60% of their excess pounds – their weight minus their ideal body weight. For sleeve gastrectomy, it is about 50-55%. We expect to see a patient hit his or her maximum weight loss at about 18-24 months. With appropriate nutrition and exercise habits, this allows them to improve their overall health, while feeling more confident in their personal lives.