Ivanesa Pardo, MD, Bariatric Surgeon

With bariatric surgery and the widespread adoption of GLP-1 RA medications, such as Ozempic and Mounjaro, there are now more effective options to treat obesity than ever before. And for some patients, the best route is a combination of treatments.  The first step to treating obesity is for patients and providers to recognize it as a medical condition with effective available treatments. Obesity is a complex, chronic disease defined by an increase in the size and number of fat cells in the body. It has many causes, including genetics and family history, medications, and behaviors. People with obesity have a higher risk for other serious health conditions, including: Asthma Cancer Depression and anxiety Gallstones and gallbladder disease High blood pressure High cholesterol Heart disease Osteoarthritis Type 2 diabetes Sleep apnea Stroke According to the latest statistics, about 42% of people in the U.S. have obesity. Research finds that by 2030 almost half of the nation will have a body mass index (BMI) greater than 30, the threshold for obesity.  While discussing weight can be uncomfortable, the sooner patients and providers begin talking about treatment, the earlier we can intervene to improve their health. And with so many effective tools available, now is an excellent time to consider making a change.  As with other chronic medical conditions, the best treatment for obesity may be a combination of methods tailored to each patient’s condition, goals, and lifestyle. One of the most recent advances in weight loss treatment are medications called glucagon-like peptide-1 receptor agonists, or GLP-1 RA. You’ve probably heard about brand names like Trulicity (dulaglutide), Victoza (liraglutide), Ozempic (semaglutide), and Mounjaro (tirzepatide).  Some GLP-1 RA are approved for treating type 2 diabetes, some for weight loss, and others for both. These drugs mimic the action of the GLP-1 hormone to help control blood sugar, reduce appetite, and encourage weight loss by slowing down food’s movement from the stomach to the small intestine, so you feel full longer.  These medicines are taken either in pill form or, more commonly, by injection. They can help patients lose 10-20% of their bodyweight in six to 12 months when they make lifestyle changes, such as eating healthy foods and exercising.  Like any medication, GLP-1 RA drugs can have side effects, especially in the gastrointestinal tract. These can include nausea, vomiting, diarrhea, constipation, and bloating. Headaches, injection site reactions, and dizziness are also possible side effects of GLP-1 medications. Public insurance carriers, such as Medicaid and Medicare, may not cover the cost of these drugs for weight loss alone if you don’t have diabetes. While these drugs offer a convenient option for many patients, we don’t yet have long-term data about side effects or what happens when patients stop taking them. Some early studies have suggested that once the drug is stopped, weight tends to return—time and research will tell whether the same could be true for high blood pressure or diabetes. For some patients, bariatric surgery provides more effective, long lasting weight loss. Studies have shown it is better  than GLP-1 drugs for patients with chronic kidney disease, and it’s covered by many insurance plans.  Many patients can lose more weight following bariatric surgery than with medications, in part because the surgery makes an anatomical change. When we make the stomach smaller or bypass the intestine, it’s harder to regain weight.  While GLP-1 medications are sometimes prescribed without much support, patients in MedStar Health’s unique bariatric program participate in three important steps: Preoperative weight management: A medically supervised weight loss program for three to six months before surgery. Surgery Follow up: Our experts continue to work with patients throughout their life to help them monitor their weight loss and stay healthy.  Not everyone is a candidate for bariatric surgery. As an Accredited Center for Metabolic and Bariatric Surgery, at MedStar Health we follow national guidelines for eligibility. Criteria to proceed with surgery include: Commitment to a major lifestyle change. A BMI of 35 or more with an obesity-related condition or a BMI of 40 or more with no obesity-related condition. Healthy enough to have surgery. No unstable psychiatric issues. No alcohol, tobacco, or substance use. We perform three primary types of bariatric surgery procedures: Lap-band system: The least extreme surgical option, laparoscopic gastric banding involves placing an adjustable band around the upper part of the stomach to make it smaller. Sleeve gastrectomy: This procedure reduces the size of the stomach by about 85% by making the stomach a thin sleeve that holds much less food. Roux-en-Y bypass: This most significant surgery divides the stomach to make a small pouch that is attached to the intestine, bypassing most of the stomach and the first part of the small intestine. Most bariatric surgeries my colleagues and I perform are minimally invasive. With a few small incisions in the abdomen, we insert delicate instruments that allow us to complete surgeries with very little disruption to the nearby tissues. This makes recovery much faster. Many bariatric surgeries now require just one night in the hospital.  Minimally invasive bariatric procedures have a low risk of complications. The most common side effects are nausea, fatigue, and vomiting in the first few days after surgery. Patients who choose surgery or GLP-1 RA medications to treat obesity should also commit to lifestyle modifications for the best chance of success. For some patients, lifestyle modifications such as these are the best treatment plan: Healthy eating: Consume a variety of fresh, minimally processed foods, such as fruits, vegetables, lean meats, low-fat dairy, and whole grains. Activity: Get at least the recommended amount of 150-300 minutes per week of moderate-intensity physical activity.  Counseling: Work with nutrition and mental health professionals to help address emotional issues related to eating and build new strategies to support nutritional and exercise goals.  Other modifications: Get enough sleep, limit screen time, and manage stress to make a big difference in your overall health. Related reading: Weighing Your Options: 4 Tools to Break the Cycle of Obesity.   Bariatric surgery and GLP-1 medications aren’t an either-or choice. For many patients, it’s a combination of these tools that can help them get healthier by losing weight.  With any obesity treatment, our goal is more than just a number on a scale. It’s about improving health, so patients can better their quality of life and live longer, fuller lives. I have had patients who were able to stop taking diabetes or high blood pressure medications after surgery. These are the outcomes we’re working toward. There is still too much shame associated with obesity, and more stigma than most medical conditions. While we are making progress, too many patients still tell me, “My doctor never said I had a problem.” Neither bariatric surgery nor GLP-1 RA medications are an “easy way” to lose weight. My patients can tell you that getting healthier is hard, but it’s worth it. They often tell me with a smile, “I can walk to your office without stopping,” or “I can play with my grandkids again.” If you have obesity, don’t wait until you develop other medical conditions to seek treatment. We have so many tools that can help—talk with your primary care doctor or an obesity specialist about an evaluation.  

Counting calories. Slimming down. Watching weight. No matter what you call your personal journey, society has lots of names and options for achieving your weight-loss goals—and some that are no help at all.  With so many products and services available today that claim a quick weight-loss fix, it’s important to understand that obesity is recognized by the American Medical Association as a chronic disease. Your body mass index (BMI) is a calculation using your weight and height. A BMI of 30 or higher indicates obesity. This diagnosis can mean different things: Obesity is more than a simple result of lifestyle choices. It’s a medical condition sometimes tied to metabolic changes that can benefit from treatment. Obesity is a lifelong condition to keep an eye on. Losing weight today doesn’t mean you’re not at risk for gaining it back tomorrow. In fact, fewer than 5% of people who achieve their weight-loss goal with lifestyle changes only maintain it. Talking with your doctor is a great first step to learn the best ways to help manage your weight. While you prepare for that conversation, here are four weight-loss tools to think about. A mindful diet of nutritious foods and appropriate exercise go together to play a crucial role in helping you lose weight and maintain your goal weight when you get there. There are different healthy-eating lifestyles to consider, such as: Heart-healthy choices like the Mediterranean or Dietary Approaches to Stop Hypertension (DASH) diets Intermittent fasting Sugar-conscious options like low carb and keto Your primary care provider can help you decide if these options might be right for you. As a bariatric surgeon, I tend to encourage patients in our bariatric program at MedStar Washington Hospital Center to focus on portion size and moderation and less on restrictive diets. We discuss the value of paying close attention to nutrition labels to avoid trans fats and high sugar foods.  I also caution against too many liquid calories like diet shakes and nutritional smoothies—these can sometimes contain up to three times the amount of nutrients that would have been consumed in solid food. The right portions of healthy fats, and low sugar, high protein foods like leafy green vegetables and lean meats can help avoid the frustrating yo-yo dieting effect that some restrictive plans can cause.  When it comes to exercise, recommendations vary. The Centers for Disease Control and Prevention suggests moderate-intense activity at least 30 minutes per day, five days per week. The Journal of Applied Physiology suggests 60 or more minutes of moderate-intense activity per day to maintain weight, a challenging commitment for people with time-consuming work or family responsibilities. I usually recommend my bariatric surgery patients strive for 60 minutes of activity three days per week to start. It’s an easier exercise target to hit for a busy lifestyle and for obese patients with activity-limiting conditions like painful arthritis or respiratory illnesses.  Zapped energy, breathing problems, and aching joints caused by carrying extra pounds can make it difficult to achieve the level of activity needed to lose weight, trapping patients with obesity in a cycle of trying and failing, starting and stopping. In those cases, diet and exercise alone might not be enough to break out of obesity. Related reading: Is Your Diet SAD? See How Going Mediterranean Supports Heart Health. Drug store products like gummies, liquids, and patches that advertise a special formula for weight loss without a prescription sound too good to be true because they are.  Think of it this way: Obesity isn’t usually caused by one thing alone, so one key ingredient probably isn’t going to be a miracle fix. None of the over-the-counter products are going to work like you might hope. You’ll probably end up wasting money on a gimmick. Weight-loss medications that do work are evidence-backed, and doctor-prescribed. For example, GLP-1 receptor agonists injections, such as Ozempic® or Wegovy® help people lose weight by regulating blood sugars and appetite.  For people with a BMI in the overweight range of 25 to 30 with other conditions such as high cholesterol or diabetes, GLP-1 medication management may help stop obesity before it starts. On average, some people experience as much as 10% weight loss in six months with help from GLP-1 injections, making this a good option to explore for those who aren’t interested in surgery or for those with a BMI of 30+ who fall into a bariatric surgery qualification gap. There are some downsides to consider, though: GLP-1 treatments are relatively new, so there isn’t data yet on long-term effects or how well weight loss is maintained post-medication.  Some people can experience side effects like diarrhea or nausea—prescription weight loss might not be right for everyone. GLP-1 injections are often expensive, the American Pharmacists Association says sometimes they can cost as much as $1,200 per month for one dose with limited insurance coverage. If you decide GLP-1 medication is the way to go after talking with your doctor, be sure to keep your diet and exercise routine on point along the way. Related Reading: How GLP-1 RA Medications Can Help Manage Diabetes and Weight Loss. For some people with a BMI of 40+ or a BMI of 35+ with medical challenges related to obesity, such as sleep apnea, high blood pressure, and diabetes, bariatric surgery may be a successful choice for managing obesity and its chronic health conditions.  Unlike a diet plan or medication, committing to any type of bariatric surgery—whether a lap-band, sleeve or gastric bypass—means altering the stomach and being ready for positive, and permanent, changes.  That level of commitment can feel a bit overwhelming sometimes. You’ll want to be sure you talk to your doctor about any concerns and remember that undergoing any kind of surgical procedure always comes with the possibility of risks.  It’s also important to understand that bariatric surgical processes and procedures have advanced tremendously, especially during the last 20 years. Bariatric surgeons must undergo an extra year of surgical training for this specialty. Bariatric surgery is often as safe or safer than a knee replacement or gallbladder surgery per the American Society for Metabolic and Bariatric Surgery. Most insurance will cover bariatric surgery for those who qualify. Reputable programs should be accredited, follow quality guidelines, and adhere to regulations that boost patient safety.  For those who are comfortable with the idea of surgery, it might seem as though bariatric procedures are an easy fix for obesity. However, patients put in a lot of work both before and after their procedure, from lab tests to learning a new way of eating and exercising.   Every bariatric program has a safety profile with a BMI limitation, meaning people with severe obesity can’t safely undergo surgery until they’re able to lower their BMI. This is when diet, exercise, and weight-loss medication may join forces to help a person lose weight. The safety profile for our bariatric program at MedStar Washington Hospital Center includes a BMI of 80+. We put a multi-modal plan in place for those patients using a combination of diet, exercise and weight-loss medication management to help lower their BMI to the safe zone for surgery. Then, we implement strategies to continue treating their obesity after surgery as they continue to work toward their goal. At the end of the day, bariatric surgery is a tool to help people live healthier, longer lives. And it’s possible that access to this treatment may soon be available for more people.  The American Society for Metabolic and Bariatric Surgery recently proposed new BMI guidelines that would help patients qualify for surgery sooner. That means more people would have the potential to avoid severe obesity and reverse chronic conditions like diabetes. Advocates are championing these new recommendations for Medicare approval, and physicians like me are hopeful they’ll be in place sooner rather than later. Related reading: 5 Reasons to Consider Bariatric Weight Loss Surgery. Non-surgical endoscopic procedures are on the horizon. They’re not covered by insurance today and are still being studied. In the future, they may offer less invasive opportunities to lower BMI or become another tool to help bridge any gaps in treatment. Examples of these procedures include: Gastric balloon: This procedure implants a temporary balloon inside the stomach to simulate the feeling of fullness, giving the patient time to implement diet and exercise changes. Sleeve gastroplasty: This procedure uses stitching to reduce the stomach’s volume, limiting how much it can hold and how long it takes to empty. No matter which weight-loss tools you and your doctor decide would be the right ones, a healthy diet and exercise lifestyle are sure to be part of it. Obesity is a chronic disease with the potential to sneak back into your life without careful management. Our experts are here to support you on your journey to a healthy weight.

By 2030, an estimated 50% of U.S. adults will be obese—a sharp increase from the approximately 33% who are obese in 2022. With obesity rates on the rise, there’s no better time to bring awareness to the health risks of obesity and the proven benefits of bariatric surgery. Obesity has been directly associated with serious health conditions that take away decades of active, enjoyable life. Among the most frequently diagnosed are: Blood clots Bone degeneration Cancer Heart disease Stroke Type 2 diabetes People with obesity are more likely to be hospitalized or die from COVID-19. For many patients considering weight loss solutions, the harsh realities of the pandemic were a wake-up call. We’ve seen an increase in patients who are ready to take on the challenges—and reap the long-term benefits of—bariatric surgery. MedStar Health is a national leader in the full range of weight loss surgery options, notably gastric bypass, sleeve gastrectomy, and revision surgery. In each option, a surgeon will adjust the size of your stomach, to reduce the amount of food it can hold, and for a few options, the intestines may be rerouted. Over time—in concert with making healthy lifestyle choices—the change can lead to long-term weight loss. From better mental health to a longer lifespan, bariatric surgery offers several benefits beyond weight loss. But fewer than 20% of patients who qualify for bariatric surgery go through with it—often due to misconceptions about the preparation, procedure, and ongoing maintenance.  If you are on the fence about bariatric surgery, talk with your doctor about your short- and long-term health risks.  And consider these five benefits of bariatric surgery. The vast majority of our patients say choosing to have a weight loss procedure was one of the best health decisions they ever made.  Related reading: Bariatric Surgery: More Than Weight Loss   Click to Tweet A thorough study published on JAMA Network examined the years of life lost to obesity in Black and White populations. Researchers found that obesity reduces life expectancy in all adults, and especially in young adults. For example: A 20-year-old Black woman with a body mass index (BMI) over 45 has an estimated 8.9% reduction in remaining years of life. A 20-year-old Black or White man with a BMI over 45 has an estimated 22% reduction in remaining years of life. A 20-year-old White woman with a BMI over 45 has an estimated 13% reduction in remaining years of life. Other studies have shown that the risk of death from any health cause is 40% lower after bariatric surgery. The sooner we treat patients with obesity, the longer they’ll live. If you are 18 or older and have obesity, get an evaluation for bariatric surgery before other medical conditions develop. A common myth about bariatric surgery is that you’ll gain back all the weight you lost—or more. The truth is, over 90% of patients sustain long-term weight loss after their procedure. A successful bariatric surgery results in a loss of more than 50% of your excess weight. When we say “excess weight,” we mean anything above your ideal weight based on your age, gender, height, and overall health.  For example, if your ideal weight is 200 pounds and you currently weigh 300 pounds, you have 100 pounds of excess weight. You could expect to lose 50-75 pounds within a year just from surgery, and more from following your long-term maintenance plan. After surgery, you’ll be exercising more and eating healthier—behaviors we’ll help you develop and improve before surgery. And you’ll have regular follow-up appointments with us so we can help you stay on track. Related reading: The Inside Scoop on Bariatric Surgery After bariatric surgery, Type 2 diabetes goes away completely in 85% of patients who had the disease prior to their procedure. For the rest, weight loss surgery can drastically reduce the reliance on diabetes medication. This is due to the metabolic changes that occur during surgery—studies have shown that medication alone cannot produce these benefits. Sleep apnea, a common condition linked to obesity, also usually goes away. Patients with sleep apnea stop breathing many times during sleep, and in patients with obesity, its often because excess tissues in the neck block their airway. High blood pressure also improves after bariatric surgery—most patients who had one or both of these conditions prior to surgery no longer did 3-6 months after their procedure.  Bariatric surgery can also, amongst many benefits: Reduce cholesterol Delay joint degeneration and replacements Resolve nonalcoholic fatty liver disease Improve polycystic ovarian syndrome symptoms Living with obesity is hard. From traveling to job hunting to clothes shopping, patients often feel judged, which can affect their stress levels and mental health over time. Patients with obesity often have depression or anxiety. Research shows that these conditions typically improve after bariatric surgery, especially in patients with low self-esteem or body image frustrations. Obesity also can cause chronic fatigue that keeps patients from participating in activities they enjoy. After healing from bariatric surgery, patients can move more and breathe better. And when they start feeling better physically, their mental health improves.  Every patient interested in bariatric surgery at MedStar Health undergoes a mental health evaluation before surgery. While beneficial, having bariatric surgery is a major life change that can trigger more stress and anxiety. By identifying patients who might struggle with the change, we can closely monitor their symptoms and provide support as their mental health improves. One of the best parts of my job as a bariatric surgeon is seeing how happy patients are after surgery. It feels good to take fewer medications, to play sports you’ve been longing to try, to bike, run, or play with kids and grandkids. To achieve a higher quality of life, patients put in a lot of work. Bariatric surgery is not an “easy way out.” It requires significant behavioral changes before and after surgery that patients must work to maintain every day.  However, this doesn’t mean you will live off green smoothies for the rest of your life. You’ll still be able to enjoy an occasional rich meal or slice of cake—just in smaller portions and less often than you might have eaten treats before surgery. Bariatric surgery is safe and effective. For those struggling with obesity, the procedure can be life-changing—and lifesaving.

The muscles of the abdominal wall —the core muscles— wrap in strong layers around the body’s midsection. These vital muscles support the upper body, enable bending and twisting, and help power the arms and legs. They also serve to structurally contain the internal organs. A hole —or hernia— can occur at or near natural weak points in these core muscles. When a hole forms in the muscle mass, fatty tissue or a portion of an organ may begin to push through that gap, migrating between the abdominal wall and skin and often creating a visible bulge. A hernia may appear suddenly or gradually over time. Some types are: Inguinal hernia, which occurs within the muscles of the groin Umbilical hernia, occurring near the navel Hiatal hernia, developing within the diaphragm Incisional hernia, which can appear at the site of a prior surgery Depending on size and location, hernias may cause varying levels of discomfort. A small opening that allows some fatty tissue to penetrate may cause no symptoms at all. A larger hole may permit a more substantial portion of internal organ—for example, part of the small or large intestines, bladder, or ovaries—to migrate, triggering pain and other medical issues. In extreme cases, as an organ is forced through the gap, it can become strangulated—its blood supply so restricted that the organ may begin to die. Most serious cases of hernia warrant medical attention well before they reach this life-threatening stage. The biggest risk factor for a hernia is simply age. Over decades, it’s normal for muscle tone to diminish and for weakened areas to become increasingly prone to herniation. In addition, certain medical conditions can encourage hernia development. For example, a serious respiratory condition that causes chronic coughing, such as COPD, can cause recurring force within the belly that results in herniation. Strenuous activity is also a risk factor—particularly in extreme athletic endeavors, or among weight lifters, or warehouse and construction workers, who routinely lift heavy loads. Men can be especially susceptible to inguinal hernias due to a small hole that exists naturally within their groin muscles, allowing blood vessels to reach the testicles. The abdominal wall within the inguinal area can weaken with age, also creating the potential for hernia. As a result of the strain placed on a woman’s abdomen, pregnancy may also create a tear in the abdominal wall; however, the developing baby typically provides a somewhat protective barrier between the tear and a woman’s internal organs. Among these other risk factors, obesity can also increase the likelihood of hernia, and of its recurrence post-surgery. For this reason, weight loss is often recommended prior to a hernia procedure. Hernia symptoms can vary, depending on where the hernia is located. For example: An abdominal hernia typically appears as a visible bulge that may or may not be painful for the patient. In the case of inguinal hernia, one patient may complain of a mass in the groin area that doesn’t hurt at all, while another may experience pain with no visible cause. Occurring within the chest, a hiatal hernia often presents as a digestive issue like reflux or as dysphagia—difficulty or discomfort swallowing. Hiatal hernia may decrease respiratory capacity as well. In order to make a clear and accurate diagnosis of hernia, we conduct a physical examination and review the patient’s medical history, including reports of pain, bulging, or discomfort. If hernia is suspected but is possibly too minimal to detect easily, or if a patient’s abdomen is very large, an ultrasound or CT scan can help confirm the diagnosis. Once confirmed, surgical treatment of hernia is generally the best course of treatment. This approach has evolved considerably from the days when surgical repair required very large incisions and a complicated healing process. Beginning in the 1980s, laparoscopic—or “belly button”—surgery launched the age of minimally invasive procedures, with reduced incision size making same-day surgery and speedier healing possible. Today, the game-changer in hernia repair is robotic surgery. Like laparoscopic procedures, robotic hernia surgery utilizes thin instruments passed into the body via very small incisions, as tiny on-board cameras and lights provide clear views of the area to be repaired. But robotic surgery offers additional advantages over traditional laparoscopy: The instruments used for robotic hernia surgery are smaller and even more maneuverable, reducing tissue damage and blood loss and promoting faster recovery. For many patients, smaller incisions mean less post-surgical pain as well. The robotic system’s dual cameras deliver a true 3D view, allowing more comprehensive examination of the damaged area. As a natural extension of arm and hand movement, surgeons find the robotics console quite intuitive to use. As a pianist, I compare operating the console to playing the piano—it feels instinctive. Minimally invasive robotics can be used to manage even severe or complex repairs that would have required open surgery just a few years ago. With these tools, we can confidently and effectively repair hernia damage, and tailor and apply a superior grade of supportive mesh to strengthen the affected area. The vast majority of hernia surgeries are very successful. In just two to three percent of repair procedures, hernia may recur. This may be due to insufficient time allowed for healing or to the patient’s overall health—hernia can sometimes return for smokers (who do not heal as well as non-smokers) and for obese patients. Most patients return home the same day as their hernia surgery. They may experience some soreness for a few days; medication is prescribed when needed, but patients often find that over-the-counter pain relievers are enough to manage their temporary discomfort. The most critical element of a strong recovery is time allowed for thorough healing. Most surgical patients can begin a return to light activity within a week or so, when residual soreness from their procedure subsides. Intense core exercises and heavy lifting must be avoided for at least six weeks; however, with their surgeon’s approval, patients can generally take walks, cycle without resistance, and even jog lightly during the six-week recovery period. Protecting the surgical repair and giving it time to heal, as well as carefully managing weight and tobacco usage, can give the hernia patient their best chance for a complete and healthy recovery.

Obesity is quickly becoming a worldwide health crisis. One recent study suggests that it may soon surpass world hunger as a leading catalyst for serious medical conditions globally. In the U.S. today, more than 1 in 3 adults are obese, compared to about 1 in 7 in 1980. The rise in obesity and resulting health problems threatens to reverse the steadily increasing lifespan that Americans have been experiencing in recent decades.    Although these numbers can be alarming, there is an effective health intervention that can help reverse these trends: bariatric surgery, a procedure to change the size and position of a patient’s stomach and small intestines. Benefits of this minimally invasive surgery can extend well beyond weight loss for obese patients—including near-immediate resolution of several chronic conditions, a reduced need for medications, improved quality of life and increased longevity. Over time, most obese patients have lost weight repeatedly. The pounds can continually return as the body reacts to weight loss by dramatically lowering the patient’s metabolic rate. But this setback doesn’t occur with bariatric surgery. In fact, with bariatric surgery techniques in use today, we see significant metabolic improvements in our patients, often before any post-surgical weight loss occurs. For instance, there appear to be immediate changes in how the gut signals satiety and hunger to the brain. Other hormonal changes improve how the body metabolizes carbohydrates and fat. Even changes in gut bacteria following bariatric surgery may play a beneficial role. What’s clear is that bariatric surgery can deliver significant positive health benefits to the body, beyond weight loss alone. Here are some common obesity-related conditions that improve with bariatric surgery: Type 2 Diabetes: Resolved Over 80% of obese patients experience complete remission of their type 2 diabetes immediately following bariatric surgery. That means patients actually leave the hospital with normalized blood glucose and no longer need medication to control it. As a result, they also have a much lower risk of life-threatening damage to the heart and blood vessels from ongoing diabetes. I’ve seen a number of great outcomes for patients here at MedStar Washington Hospital Center. A five-year research study known as the STAMPEDE trial showed that these dramatic benefits can’t be achieved with diabetes medication alone. When researchers compared obese patients taking intensive medication to control their diabetes with those who also underwent bariatric surgery, only the surgical patients were able to maintain glucose control without medications. They also experienced unmatched improvement in their blood lipid levels and their reported quality of life. Hypertension & High Cholesterol: Reduced Bariatric surgery also offers important cardiovascular health benefits. Between 52% and 92% of obese patients quickly return to healthy blood pressure levels following surgery, depending on how long they’ve had hypertension and how many medications they’ve been taking. Some leave the hospital no longer requiring blood pressure-lowering medicines. Others are able to decrease to a single medication and improve control from there as they lose excess weight. In addition, patients reduce their overall risk for cardiovascular disease, especially heart attacks and strokes, by 82% following surgery. Some of this is related to the weight loss, and some to metabolic and other changes in the body post-surgery. For about 63% of obese patients, cholesterol levels return to normal following bariatric surgery as well. (Success rates for resolving this condition are a little lower than for others, primarily because it’s not always weight-related. If your high cholesterol levels are a family trait, you may have a genetic predisposition that bariatric surgery won’t reverse.) Obstructive Sleep Apnea: Cured Nearly 90% of obese patients suffer from this serious sleep disorder, which involves the occasional collapse of throat tissue during sleep, temporarily cutting off breathing. Untreated, sleep apnea increases your risk for a multitude of health problems—from hypertension and heart rhythm irregularities to heart attacks and stroke. While CPAP machines can be a highly effective treatment, they can be inconvenient and difficult to use regularly and reap the full benefit. With bariatric surgery, 80% to 85% of patients experience complete remission of their sleep apnea in the first few months as they lose weight. Many patients find they no longer need the CPAP machine to maintain normal breathing at night. Nonalcoholic Fatty Liver Disease (NAFLD): Resolved As obesity has increased, so have cases of this chronic liver condition, characterized by too much fat stored in the liver cells. About one in four adults in the U.S. has this form of liver disease today, which is often silent and can lead to inflammation, scarring and even liver failure, similar to damage caused by alcohol abuse. About 90% of NAFLD cases resolve with bariatric surgery. As a result, we’re seeing more obese patients being referred to us by liver specialists, who recognize the benefits of bariatric surgery for preventing liver failure in these patients. Polycystic Ovarian Syndrome (PCOS) Symptoms: Improved This hormonal imbalance and metabolic problem affects about one in ten women of childbearing age. One risk factor is obesity. Belly fat tends to be very metabolically active, affecting your body’s insulin and producing extra testosterone that can affect the ovaries and trigger the irregular menstrual cycles we see with PCOS. After bariatric surgery, our patients typically have a 100% resolution of most PCOS symptoms and a 79% resolution of the excessive facial and body hair (hirsutism) that typically comes with it. More Benefits By their two-week follow-up appointment after bariatric surgery, most of my patients have lost 10 to 20 pounds. Besides the immediate health benefits, weight-related headaches, reflux and urinary incontinence go away very quickly as well following surgery. Quality of life increases dramatically for my patients, as social stigma about their weight goes away and they can more comfortably enjoy travel, work opportunities and physical activities with loved ones. Within 12 to 18 months, most of my patients have lost 75% of their excess weight and 90 to 95% of bariatric surgery patients maintain that weight loss long-term. This enables a wide range of benefits, from healthier pregnancies, to safer organ transplants and joint replacement surgeries, to the possibility of aging with less disease and dementia. Perhaps most importantly, statistics show that treated patients typically enjoy more years of life as well, with an 89% lower risk of death within five years of their bariatric surgery. Truly life changing. In 2013, the American Medical Association categorized obesity as a treatable disease, rather than a lifestyle choice. That announcement, along with the well-documented safety and effectiveness of bariatric surgery, has prompted more health insurers (private and government) to cover the procedure in recent years. Coverage is still mostly reserved for people whose obesity is severe (a body mass index of 40 or more) or who have a BMI of 35–39 along with a weight-related health condition, like Type 2 diabetes. But it is hoped that bariatric surgery will soon be covered more broadly, as many more people could benefit from it before their health problems become advanced. If you’re considering surgery, be careful to choose a highly experienced medical center and team. At MedStar Washington Hospital Center, our program is recognized as a Comprehensive Center with the highest level of accreditations from the American Society for Metabolic and Bariatric Surgery. Our connected, multi-disciplinary care team works with you before, during and after your surgery to ensure your care and well-being. Attend our free online information session, a great way to ask questions and learn more. Then, schedule an appointment to get information about potential insurance coverage and to meet with a bariatric surgeon who can review options with you. Today, most of these visits can be done via telehealth. Don’t wait to learn more about bariatric surgery. Earlier treatment can bring you a healthier, happier and longer life.

Some people still think of bariatric surgery solely as weight-loss surgery. But the benefits extend far beyond a leaner body. For people with obesity-related diseases, like diabetes, for example, bariatric surgery can immediately eliminate or improve them. Bariatric surgery can dramatically reduce the risk of developing a life-threatening illness, such as cancer or heart disease. It can also extend people’s lifespans. Given the safety of today’s surgical techniques and the well-proven long-term health benefits to be gained, I tell patients who are considering it not to wait. Find out all you can. Today, there are a variety of options for you to consider and some additional options on the horizon. At MedStar Washington Hospital Center, these surgeries are done with minimally invasive techniques—meaning laparoscopically or robotically—to speed recovery and maximize safety for patients. And our team offers in-depth support before, during, and after surgery to help ensure that patients experience enduring health benefits. Today, the gastric sleeve procedure is the most popular bariatric surgery technique nationwide and is selected by three out of four patients at MedStar Washington Hospital Center. It involves sectioning off about 80% of the stomach with a stapling device, removing it, and creating a smaller, vertical “sleeve” of stomach shaped like a banana. Not only does this reduce the amount of food you can ingest at any given time, it also decreases the level of hunger-signaling hormone that the stomach sends to the brain—so you have less of an appetite, amongst other metabolic changes. Patients often choose this surgical option, as it offers some metabolic improvements and sustained weight loss via a procedure that changes only the stomach. This second most popular technique, also called Roux-en-Y (ROO-en-why) gastric bypass, involves changing both the stomach and the intestines. Those additional changes to the body can offer extra health benefits. With this technique, we use a stapling device to section off a small egg-size pouch of stomach; the rest of the stomach remains. Then, part of the small intestine is rerouted and connected to the stomach pouch. As a result, the food you eat goes into the small stomach pouch, then directly into the connected lower section of small intestine, bypassing most of your stomach and the top portion of the small intestine. This works like the gastric sleeve to reduce the amount of food you eat and the release of hormones that send hunger signals to your brain. In addition, the rerouted intestine limits the absorption of food nutrients and calories. It also causes an even more drastic metabolic impact on your body. Gastric bypass tends to be a little better than the sleeve procedure for creating more weight loss and resolving more weight-related health issues like diabetes, high blood pressure, and sleep apnea. It’s also a very good option for people with severe acid reflux as this procedure improves that condition. These healthy changes also tend to persist longer-term because the absorption in the intestine is changed. But on the flip side, patients have a slightly higher risk of malnutrition long-term. Typically, this can be managed with vitamins and supplements. Today, this is a relatively safe procedure. I tell patients the risks of this versus the gastric sleeve after surgery are about the same, and the potential for greater health benefits may be worth considering. Like gastric bypass, this technique involves making the stomach smaller and rerouting the intestine to reduce food absorption. The difference is that the reduced-size stomach is more similar to the gastric sleeve; in other words, it is larger than the gastric bypass pouch and patients are able to eat a little more. In addition, much more of the intestine is bypassed, starting at the duodenum (hence the name). So absorption of food, especially fat, is reduced even further, by more than 70%. While the weight loss is highest and most long-lasting, and the metabolic benefits are more profound with duodenal switch, the long-term risk for malnutrition is especially high. Close monitoring for vitamin, mineral, and protein deficiencies is a must. Also known as the adjustable Lap Band, this was the most popular bariatric surgery option more than a decade ago. It involves placing a flexible silicone band around the top part of the stomach and tightening it to create a narrowed passageway. It’s meant to limit how much food you can eat at any given time. While it’s the least invasive approach, and completely reversible, it also doesn’t work very well for many people and has decreased in popularity. Patients tend to lose weight much more slowly and often regain it. And the gastric band doesn’t offer the metabolic health benefits that the other surgical options do. Also, more than 30% of people develop complications from the gastric band, such as heartburn or swallowing issues. While this option is still available, it’s not typically recommended, as newer techniques offer greater, more reliable health benefits. Several new alternatives are currently being evaluated. These include some endoscopic bariatric therapies, performed through a flexible tube inserted through a patient’s mouth rather than via abdominal incisions like traditional bariatric surgeries. Currently, the most well-known approach is the intragastric balloon, by which a fluid- or gas-filled balloon is placed in the stomach.  It makes you feel full faster and slows down stomach emptying so you may feel full longer. Some centers also offer endoscopic sleeve gastroplasty, which is similar in some ways to a gastric sleeve surgery. Part of the stomach is closed off with sutures, which are placed using the endoscopic tube inserted through the patient’s mouth and down into the stomach. Although there are no long-term data on their effects, these less-invasive approaches may be worthwhile for patients who are not safe candidates for traditional surgery. At this time, severely obese patients have excellent options to consider. If you’re considering surgery, sign up for an information session. These free sessions are typically offered online or in person, and they provide an excellent overview of the pros and cons of each surgical option the medical center offers. It’s a great opportunity to learn more and ask questions. From there, you can make an appointment with a bariatric surgeon to further discuss your options. Find an information session here. You should also choose an experienced hospital and medical team. At MedStar Washington Hospital Center, our program has been recognized as an American Society for Metabolic and Bariatric Surgery Center of Excellence and is fully accredited by the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program. Our board-certified and fellowship-trained surgeons utilize the most current minimally invasive techniques, which can offer shorter hospital stays, less pain, and faster recovery. In addition, our surgeons are supported by a complete care team, including a gastroenterologist, nurse coordinator, psychologist, dietitian, and exercise physiologist to help ensure your needs are met and you are set up for long-term success. As a team, we also collaborate with your primary care physician. We typically start by evaluating your medical and weight history, diet and exercise habits, and the stomach itself. Then, we explain your options in detail and share the latest research findings to help you decide what’s right for you. Each patient ultimately chooses what they’re comfortable with, and we support them every step of the way. As I mentioned earlier, I urge people who’ve thought about bariatric surgery not to put off learning more about it. Don’t wait until obesity makes you sick if you aren’t already. In many cases, the earlier this surgery is done, the better the outcomes in terms of your health, your productivity, and your overall length and quality of life in the years ahead. It’s never too early for that.

Men or women can develop hernias. When they do, an organ or tissue can squeeze through a weak spot in a muscle wall. When surgery is called for, several options are available. A hernia is a weak spot, defect, or hole in the muscle layers of the abdomen, through which a part of an organ or piece of fatty tissue can poke. Hernias most often occur in the groin or at the umbilicus (belly button). But they can also occur elsewhere, such as the sites of previous surgical incisions. The belly button, for instance, is where our umbilical cord attached us to our mother when we were in her womb. After birth and the cord’s cutting, the hole usually will close itself. But some people have a persistent opening that eventually can enlarge to become a hernia. People sometimes develop an “inguinal hernia” in the groin. This can happen with strenuous activity, or sometimes after birth, a baby’s inguinal canal does not close behind them, leaving a weak spot, which eventually can become a hernia. Other hernias can occur at weak spots like old incisions, from strenuous activities or incomplete healing. https://ct1.medstarhealth.org/content/uploads/sites/6/2017/10/medstar_washington-mwc020.mp3 Physical activity, especially strenuous and high-intensity exercise, can exacerbate or even cause a hernia. There are definitely some stories about people who exercise a lot and do a lot of heavy lifting, and they suddenly feel a “pop” and have a hernia. Those are acute cases; however, there is no need to put strict limits on how much someone should exercise, rather to be smart about it. When lifting heavy things or exercising, everyone should know -- and observe -- their limits. Anyone with signs of a hernia should be careful when straining or lifting, because the hernia can become “symptomatic,” which means it requires medical attention. An “incarceration” occurs when something – such as a piece of intestine or fatty tissue – gets stuck in an opening (hernia) and can’t be pushed back in. A more serious situation is “strangulation.” That’s when the stuck piece of tissue or organ is losing its blood supply and starting to die. That requires emergency surgery. Pay attention if you feel a lump that gets larger, or more tender, when you sneeze, cough or strain. If this occurs, see your primary care physician, or a specialist, for a diagnosis. I recommend elective surgery when the defect (hernia) is large enough that, even if it’s reducible, a segment of intestine could get stuck, which could lead to incarceration or strangulation. We can repair hernias in several ways. There’s the old-fashioned “open repair” approach, which involves a larger incision. Then, there are more modern “minimally invasive” repairs. They can be laparoscopic or robotic. Their appropriateness will depend on the particular patient, the availability of the medical facility in question, and the skills of the surgeon. Request an Appointment Most hernia repairs today involve implanting a mesh. This is a screen that is made of synthetic material that reinforces the muscle layers where the defect, or hernia, is. The advent of the mesh has reduced the chances of a hernia coming back after it’s been repaired. You should talk with your surgeon about whether you need a repair, and whether mesh is appropriate.

The headlines may sound alarming: “Weight loss surgery tied to lasting digestive issues.” “After gastric bypass surgery, many experience eating difficulties.”   The stories were in response to a December 2016 study published in the British Journal of Surgery that followed 249 patients who had laparoscopic Roux-en-Y gastric bypass. It found that two years after surgery, gastric bypass patients were far more likely to suffer from digestive problems, such as indigestion, diarrhea and flatulence, as well as an inability to tolerate certain foods than the control group, which did not have the surgery.   However, these results aren’t that surprising. They simply highlight what we bariatric surgeons already know. Gastric bypass changes the way your body absorbs and processes food. Before surgery, patients spend months learning about the diet and lifestyle changes to which they must commit after surgery to mitigate the effects of how their bodies will change during surgery.   When you have gastric bypass, the surgeon reduces the size of the stomach and reconnects the small intestine to the new stomach, bypassing the original stomach and several feet of the small intestine. This will make you feel full sooner, meaning you’ll eat less, but it also affects how food is processed and the amount of nutrients including vitamins and minerals that your body absorbs.   Our patients are usually excited to follow their dietary recommendations to the letter before and immediately after the surgery. However, as they heal and time goes on, some of them fall off the wagon a little. They pay less attention to what they eat or try to push their diet a little further than they should. That’s usually when we begin to see gastrointestinal (GI) problems surface.   This is one of the most common complications patients face after bariatric surgery. Dumping syndrome occurs when food, especially sugar, moves too rapidly from the stomach into the small intestine. This can result in diarrhea, nausea and abdominal cramps.   Dumping syndrome can be avoided by eating smaller meals and limiting foods high in sugar, as well as not rushing through your meal. We educate our patients about this syndrome, so they can recognize it. Patients often tell us that after it happens once, they learn pretty quickly what triggered it so it doesn’t happen again.   Everyone has a certain amount of bacteria living in their intestines. However, in rare cases, gastric bypass can cause bacteria to grow unchecked. This excess bacteria may eat up the nutrients your body needs and can cause bloating, cramping, gas and diarrhea.   In severe cases, small bowel bacteria overgrowth can inhibit the body from properly absorbing nutrients, leading to malnutrition and vitamin and electrolyte deficiencies, such as anemia.   Small bowel bacteria overgrowth usually can be successfully treated with antibiotics.   The study found that 71 percent of gastric bypass patients developed intolerance for fried foods, pastries and carbonated drinks. However, only 14 percent of those people said the intolerance was very bothersome.   We stress to our patients the importance of avoiding and cutting back on foods high in fat and sugar because the body just doesn’t process them as well after surgery. You’ll still be able to eat these foods, just not as often and in moderation. This is good advice for anyone, not just people who have had weight loss surgery!   We also see some patients who “develop” lactose intolerance after surgery. They most likely were mildly lactose intolerant before surgery, but the surgical changes caused it to surge. When they switch to lactose-free products, the problems go away.     In rare cases, complications from gastric bypass, such as small bowel bacteria overgrowth, can result in GI problems. But these problems usually are related to diet.   Our patients go through on average six months of education before surgery to learn about the diet and lifestyle changes they’ll need to make. In the weeks and months after surgery, they go through a diet progression: from liquids only, to thicker liquids, to soft food, then to solid food.   The most important thing you can do to prevent gastrointestinal problems is to follow the dietary guidelines. They may seem overwhelming at first, but you’ll likely find they become a part of your daily routine. And don’t rush to advance your diet or experiment with new foods before your dietitian gives you the OK.   A few general tips: Eat small portions. Eat slowly and chew food thoroughly. Limit foods high in sugar and fat. Keep a journal documenting food and portions. Drink water between meals to avoid dehydration.  Click to Tweet We’ll test your vitamin and mineral levels six months after surgery, at a year, then yearly after that. This helps us catch potential nutritional deficiencies early and address them before they become a serious problem.   If you experience persistent gastrointestinal or eating difficulties, see a doctor. We can check for surgical complications and discuss your dietary habits. This is where a food journal can come in handy. By examining what you’re eating and how much, we usually can pinpoint the culprit and solve the problem. Even if you do experience GI symptoms at some point, for the majority of my patients, the overall benefits of the surgery outweigh them.   Bariatric surgery is not just about weight loss. It’s about improving your overall health and reducing the risks of life-threatening conditions caused by obesity, such as diabetes, hypertension and high cholesterol. By sticking to a healthy diet and lifestyle, you can reap the many health benefits of weight loss surgery and prevent or reduce potential complications.

It’s difficult to pin down the exact number of people who travel abroad to access medical services, but the Centers for Disease Control and Prevention (CDC) estimates that thousands of U.S. residents do so each year. And Patients Beyond Borders, a consumer source of information about medical tourism, says weight loss surgery is among the most-sought specialties, along with cosmetic surgery, dental work and cancer and heart treatments. There are a number of reasons people travel to get these procedures, but two of the most common are: Lower costs: Surgical procedures in some countries can cost up to 80 percent less than in the U.S. Broader eligibility criteria than in the United States: We follow National Institutes for Health guidelines to determine who is eligible for bariatric surgery. It’s not done purely for cosmetic reasons. This isn’t the case in some countries, so people who might not qualify in the U.S. may be eligible elsewhere. Not everyone who travels for medical care crosses the U.S. border. When a procedure or treatment isn’t available locally, some patients may need to go to a distant city or state to get it. I’ve never had a patient ask me for advice before going abroad for bariatric surgery, but I have seen patients over the years seeking follow-up care or treatment for complications. Before you travel to get a procedure, such as gastric bypass or sleeve gastrectomy take these precautions. Each country has its own standards that healthcare providers and facilities must meet, and these can be very different from the United States. Check the qualifications of your doctor and facility and learn how they compare to those in the U.S. You also can check with international accrediting organizations, which require facilities to meet a list of standards to be certified. The CDC recommends ensuring your facility is accredited by the Joint Commission International,  DNV GL - International Healthcare Accreditation or the International Society for Quality in Health Care. Ask about your doctor’s experience. How many surgeries have they performed and what are their success rates? Get in writing the specific treatment, supplies and care covered in the costs. You don’t want to be surprised when you arrive or get the bill. Bariatric surgery doesn’t start and end in the operating room. It’s not just an anatomical change; it changes how you’ll live the rest of your life. This type of change requires support–before and after surgery. Procedures, such as gastric bypass, change how your body processes and absorbs food. They require major lifestyle and dietary changes. If you don’t understand what you can eat, when you can eat it, and how much of it you can eat, you can suffer from digestive problems or vitamin deficiencies. Pre-surgery education and long-term follow-up care are essential components to a successful bariatric surgery outcome. Weight loss surgery patients in the United States go through, on average, six months of preparation and education by dietitians and other healthcare providers. After surgery, we recommend ongoing dietary supervision and regular appointments the first year and then yearly afterward, to monitor for nutritional deficiencies and other complications. If you travel for surgery, it’s likely not feasible—or even an option—to spend months before and after surgery in that destination for education and follow-up care. Form a relationship with a local bariatric surgery program to receive pre- and post-surgery education and care. Remember to check with your insurance company. If you’re having surgery outside the country, this care may not be covered by your plan. But as I said, this support is crucial to achieving your goal of long-term weight loss. TWEET THIS! If you receive care in a country where you do not speak the language fluently, determine how you will communicate with your doctor and care team. While foreign language interpreters may be commonplace in U.S. healthcare facilities, don’t expect every place to have them. It’s vital that you are able to effectively communicate with your team, so there are no misunderstandings about your care. Complications can arise, and you must be prepared for them. For instance, you may need to stay longer than anticipated to recover. If the problem is severe, you may need to return to the U.S. for more advanced care. If you or a loved one has to be transferred from one hospital to another, you know how involved that move can be–even within the same city. Now think about the difficulty involved in transferring a patient to another country. Keep in mind that flying after surgery has its own risks, including deep venous thrombosis (blood clots) and pulmonary embolism (blockage of an artery in the lung). To help prevent these complications during your flight: Get up and walk around every two hours Move your legs while sitting Stay hydrated Wear compression stockings Bariatric surgery can be a lifesaver for people who struggle with severe obesity and the complications that can accompany it, such as diabetes and hypertension. But it’s more than surgery; it’s a set of lifestyle changes that requires education and continuous support. When possible, it’s best to get this care close to home. But if you must travel, whether to the next town or overseas, make the preparations necessary to optimize for a successful outcome. Schedule an appointment to talk with our bariatric surgery team about pre- or post-surgery support.

Bariatric surgery has been available in the U.S. for more than 50 years, and surgeons are doing more every year. In fact, our team performed 336 of these procedures in 2016, compared with 257 in 2013. Still, bariatric surgery is still not well understood, and many people have questions about it. I’ve heard many. Two of the most frequent ones I get are, “Is bariatric surgery safe?” and “Will I be left with a lot of flabby skin?” Bariatric surgery, such as gastric bypass or sleeve gastrectomy, can be a lifesaver for people struggling with obesity and its side effects. So let’s get to the truth of some of the most common questions. https://ct1.medstarhealth.org/content/uploads/sites/6/2017/04/medstar_washington-mwc021.mp3 Patients often tell me that friends and family worry they will die during bariatric surgery and try to discourage them from getting a procedure. I suspect this fear is a holdover from when the surgery was new. As with any surgical procedure, the risks from bariatric surgery were much greater when it was first developed. But with the advent of minimally invasive techniques, such as laparoscopic and robotic surgery, which come with fewer complications, the procedures’ safety has dramatically improved. In fact, the latest data show that bariatric surgery is safer than having your gallbladder removed. The mortality rate for bariatric surgery is 0.25 percent compared with 0.7 percent for gallbladder removal. And don’t forget that obesity also is dangerous, increasing the risk of life-threatening conditions, such as diabetes and hypertension, and even decreasing lifespan. Click to Tweet This is a complex issue and it’s specific to every individual. The bigger you are and the more weight you lose, the more excess skin you’ll have. But most patients find they have less excess skin than they expected.The best advice I can give to avoid excess skin is to maintain and increase muscle mass, giving the skin lean tissue to contract over. I’m not saying you need to become a body builder or look like a star athlete. But developing a fitness routine that promotes healthy muscle tone will help reduce excess skin.If you do have sagging skin that bothers you, you can explore body contouring, which is an umbrella term for procedures, such as tummy tucks and lifts to the upper arms, midsection, back, thighs, buttocks and hips.Everyone seems to knows someone who had bariatric surgery and gained all the weight back. But in reality, that’s pretty rare. A 2016 study found that only 3 percent of study participants who had gastric bypass regained most or all of the weight they lost after 10 years.Weight loss after bariatric surgery occurs on a curve. Weight drops rapidly right after surgery and continues for 18 months to two years. A little weight gain is expected after that, but then it should plateau. This is normal, and we’re talking about a few pounds, not a massive amount of weight (usually about 5 percent).When a patient does regain a considerable amount of weight, we first try to determine whether there was a problem with the surgery. For example, in gastric bypass, the surgeon reduces the size of the stomach and reconnects the small intestine to the new stomach, bypassing the original stomach and several feet of the small intestine. One rare complication of this surgery is gastrogastric fistula, in which food goes into the old stomach instead of the new stomach pouch, causing weight gain.Most weight gain can be traced back to dietary habits. People don’t come back for after-care appointments or follow diet recommendations, or they simply fall back into old habits. And while someone might go through all the pre-surgery education, their psychological relationship with food may not change post-surgery.Regaining all the weight can happen, but it’s rare. We’ll work with you and a dietitian to help you get back on track before you regain too much of the weight you worked so hard to lose.I’m amazed that in this day and age some people still think of surgery as the easy way out. There is nothing easy about bariatric surgery. People who have these procedures prepare for six months on average and then must change their lifestyle and diet after surgery. It’s a lot of work. The National Institutes of Health recognizes bariatric surgery as the only effective way to treat severe obesity and maintain long-term weight loss. Attend Our Online Seminar Losing weight through diet and exercise can be extremely difficult. Many people experience the yo-yo effect, in which they lose and gain weight multiple times. This can wreak havoc with a person’s metabolism, making losing weight even more difficult. In fact, less than 5 percent of people who lose weight by diet and exercise are able to maintain long-term weight loss.And weight loss medications come with their own problems. Along with potential side effects, they only work as long as you take them. There’s no long-term weight loss effect.Vitamin deficiencies are a real concern after bariatric surgery. Your body will not be able to absorb them, as well as it used to. However, taking a daily multivitamin and following your dietary recommendations should ward off potential problems.Severe vitamin deficiencies don’t develop overnight, and we have processes in place to catch them early. We check your vitamin levels six months after surgery, at a year, then yearly after that. If your levels are low, we’ll work on it before it becomes a problem.Yes. Because your body will process and absorb foods differently after surgery, we recommend that you not eat foods high in sugar and fat immediately after surgery or drink alcohol for two years. But after a while, you can have a piece of cake at a wedding or a glass of wine for your anniversary. You’ll need to eat and drink these items in moderation, but you can have them for special occasions. This is also a good guideline for people who just want to live a healthier lifestyle.If you have heard something fishy about bariatric surgery, don’t hesitate to ask your doctor. We’ve heard it all, and we won’t think your question is silly. If you’re considering bariatric surgery, it’s your right—and our job—to make sure you understand the ins and outs before you commit to preparing for and maintaining a healthier weight.Sign up to get more health insights and wellness tips sent directly to your inbox.