UAB Synopsis, Vol. 28, No. 22, June 8, 2009
“Gastric bypass surgery is not just about helping someone wear a different pant size or weigh less on a scale,” says laparoscopic surgeon Ronald H. Clements, MD.
“We can improve patients’ quality of life and health with this surgery,” Dr. Clements says. “We make it crystal clear to every patient that the only reason to have a bariatric operation is to improve overall health by reducing the comorbidities of obesity.”
He directs UAB’s Bariatric Surgery Program, a comprehensive surgical weight-loss program with a proven record of providing the highest-quality care for the most challenging and complex bariatric patients.
The program primarily offers the lapa- roscopic Roux-en-Y gastric bypass procedure, but also provides gastric banding. “We have seen more rapid improvement in health outcomes with the gastric bypass procedure, specifically with regard to resolution of type 2 diabetes. If a patient specifically requests banding, we consider the pros and cons of the procedure for that individual,” Dr. Clements says.
A new surgeon, Jayleen M. Grams, MD, PhD, soon will be working with Dr. Clements in the Bariatric Surgery Program. A graduate of UAB’s Medical Scientist Training Program, Dr. Grams is completing a minimally invasive surgery fellowship at Mount Sinai Medical Center and will join UAB’s faculty in July.
The program is accredited by the American College of Surgeons as a Level 1A Bariatric Center of Excellence — the highest level of certification. “This advanced designation recognizes our large surgical volume, rigorous clinical and data reporting standards, and high level of commitment to safe bariatric surgery,” Dr. Clements says.
Some experts estimate that 15% of Alabama’s population is morbidly obese and at risk for or suffering from adverse health effects, including heart disease, hypertension, diabetes, sleep apnea syndrome, gastroesophageal reflux disease, asthma, gallbladder disease, and other conditions related to obesity.
600,000 Could Benefit
“As many as 600,000 Alabamians could benefit from bariatric surgery, but fewer than 1% are getting the surgery. The message we want to broadcast is that bypass surgery can resolve many obesity-related health problems that medical therapy only keeps at bay,” he says. For example, about 80% of patients’ type type 2 diabetes resolves after gastric bypass. Similarly, sleep apnea resolves for as many as 85% of patients.
Surgeons carefully weigh the risks and benefits of surgery for each individual. Patients first must meet NIH criteria, which dictate that candidates have a body mass index (BMI) of 40. Individuals with a BMI between 35 and 40 may qualify if they have certain comorbidities, such as severe diabetes, cardiopulmonary problems, or other obesity-induced conditions interfering with lifestyle.
“Patients must be physically and psychologically fit to undertake what will be a major, life-changing event,” says Dr. Clements. “They must be motivated to change and committed to long-term follow-up.”
UAB surgeons do their own follow-up, he says, because specific physiologic changes occur after a gastric bypass, such as alteration of vitamin and mineral absorption. “Surgeons are most knowledgeable about these complications. Long-term care is critical. If a patient misses an appointment, we contact them and try to get them in,” he says. The clinic also offers a support group coordinated by Deborah S. Thedford, MSN, CWOCN, who is bariatric surgery coordinator.
For information on the Bariatric Surgery Program, call 205.975.0471 or visit www.uab.edu/obesitysurgery.