The Collaborative Approach to Surgical Weight Loss
By Ryan Moon, MD
What if everything we knew about treating bariatric patients was wrong?
How we currently deal with obese patients remains rooted in the philosophy that weight loss surgery is all that’s needed. The concept that surgery alone cures all is quickly fading in the rear-view mirror. But the most recent approach to treating patients suggests that while surgery is in fact paramount to initiating both a restrictive and metabolic chain of events, we are now realizing the magnitude of difference a collaborative approach makes in the overall success of the bariatric patient.
Much emphasis has been placed on "Bariatric Centers", where a surgeon evaluates and treats morbidly obese patients in conjunction with a collection of key services. Bariatric Nutritionists provide a critical role in educating surgical patients prior to surgery, as studies have demonstrated higher success rates and more lasting weight loss in patients that understand the process, and "buy in" with life style changes. They are also a constant source of postoperative "trouble-shooting", and can make a tremendous difference in the lives of postoperative patients who may be struggling with food choices, timing of meals, or creative menus. Finally, Bariatric dietitians provide expert knowledge in monitoring and treating potential vitamin deficiencies that can occur with surgical weight loss.
Successful bariatric centers often include the presence of bariatric psychologists. Careful screening of a patient's understanding of the surgical process, as well as attempting to predict compliance with their future life-style change, are both critical to the overall success of their experience. The failure to identify and treat eating disorders, a lack of an adequate support system, and other psychological illness, often lead to bariatric failures. A strong bariatric psychological program goes a long way in helping to raise the overall success rates. Patients also appreciate having access to a bariatric psychologist after surgery, to help with issues such as depression, perceived body image, and changes in families' dynamics.
A Medical Weight Loss Program can be a valuable asset in a bariatric center as well. This is typically accomplished by a certified bariatrician who helps to manage the medical needs of the obese patient. Patients who are felt to find more optimization with a surgical approach can be referred to the surgical options. Likewise, patients who may not be safe surgical candidates may be referred to the bariatrician for medical weight loss. The Medical Weight Loss Program can also be utilized to help super morbidly obese patients lose weight prior to surgery, as well as for the patient who wants a little more optimization many years after surgery.
Additionally, with the growing acceptance that surgical weight loss imparts a metabolic change in the patient, more and more endocrinologists are referring diabetic patients to bariatric centers for consideration for surgery. Collaboration with the endocrinologists, as well as with primary care physicians, is critical in the postoperative patient with blood sugar and hypertensive control.
What’s important to understand is that we know if we keep doing what is working for obese patients, they will succeed. Anyone who works with bariatric patients knows this. And that’s the big win—not just to “fix” them with surgery, but to set them up for success on their own. Perhaps this is why the collaborative approach to the care of the chronic disease of obesity is certainly becoming more of a standard of care.