Anisa’s experience as a gastric bypass patient and her work with patients today reflect the overall evolution of bariatric care. Memorial Health Surgical & Bariatric Care’s approach to bariatric treatment is one that supports its patients throughout their weight loss journey, whether they choose surgery or another means.
Oliver Whipple, MD, FACS, medical director of robotics and bariatrics at Memorial Health in Savannah, Georgia and associate professor of surgery at Mercer University School of Medicine in Savannah, Georgia, is a leader in the field. He’d like more people to understand that the surgery is safe and that it truly works.
Dr. Whipple developed a comprehensive program based on his own evidence-based research for those who do choose to undergo surgery. This work is also helping HCA Healthcare streamline and standardize the way that bariatric patients are treated. Surgery is a useful tool when it comes to weight loss, and the holistic care of patients includes lifelong changes to maintain their weight.
Patients also have nonsurgical options, including medically supervised weight loss and new medications. Just 2% of people who qualify for surgery follow through with it. Most people try losing weight through self-directed diets, says Dr. Brengman. Recently, more patients are choosing medications — especially injectable medicines — due to their success rate of a 10% to 15% total body weight loss.
Advances in how surgeries are performed have greatly changed the field. Options include endoscopic sleeve gastroplasty, where a surgeon shrinks and reshapes the stomach by sewing it from the inside; gastric band, in which a device is implanted to give an earlier sense of fullness; and sleeve gastrectomy, which is currently the most popular procedure. It requires removing about 80% of the stomach and reshaping it into a narrow tube. This gives patients an earlier sense of feeling full and decreases the hunger hormone in the stomach. Gastric bypass, which shrinks the stomach and reroutes the digestive process to suppress hunger, is the second-most popular procedure. These are just a few of several approaches to bariatric surgery.
One significant milestone in bariatrics is the transition from open surgery, in which incisions were larger and hospital stays longer, to laparoscopic surgery, where patients can go home the next day. The use of robotics also makes surgery safer for patients and easier for surgeons, allowing them to perform a greater variety of procedures. In time, it could help improve access to bariatric surgery, Dr. Whipple says.
“In my state chapter, we went from one year with nobody really doing robotics, to the next year where 80% of us are doing almost everything robotically,” he adds.
With so many opportunities available to patients, clinicians – including Dr. Whipple – typically oppose bariatric procedures outside the country, which is a driving factor for medical tourism. Mexico is among the top countries receiving patients from abroad, according to the National Center for Biotechnology Information.
“The biggest problem with medical tourism is that these patients are denied the support that they need after surgery,” Dr. Whipple says. “Bariatric surgery is most successful when the patient is actively involved with a multidisciplinary program after surgery. Bariatric medical tourism denies them this key piece of the puzzle.”