Sometimes it seems like everyone is on a diet. More than half of Americans report that they want to lose weight – and yet an estimated 160 million Americans are either overweight or obese. One key reason that so many efforts fail? Many weight loss programs focus on aesthetics and fail to tackle the problems of disease prevention or treatment for diabetes, high blood pressure, heart disease, and other ailments associated with obesity. There is a true gap between where medicine and bariatrics meet, and many patients get caught up in programs that do not take an individualized approach to their weight loss goal.
Each of us has a unique set of factors – among them are metabolism, hormone balance, nutritional status, and genetic makeup – and lifestyle factors such as diet, exercise, self-care, sleeping habits and stress management that can all interact with those variables.
Back in 2003, Easton Hospital realized that a truly successful weight loss program could not be developed with a one-size-fits-all approach. For the last 15 years, they have offered an intensive, multi-component behavioral intervention program that combines the medical division for the bariatric journey with the surgical division for operative and post-operative care.
“This was the first comprehensive program for bariatric surgery in the Valley. Since then, we’ve treated more than 2,000 patients. And while Easton Hospital is a relatively small hospital, there is a lot of stress on one-on-one patient care and one-on-one patient interaction with the surgeons,” says Vinay Singhal, MD, Medical Director of Bariatric Surgery at Easton Hospital, who oversees the program along with Artun Aksade, MD. “It’s very much a family-oriented approach and a friendly approach with one-to-one care, which is relatively different from some other programs.”
The weight loss journey
Successful weight management takes a true lifetime commitment in order to have long-term, lasting effects on your overall health. With each patient having individual needs and different influences, Easton Hospital’s weight loss professionals work with patients to discover the right method and mode of weight management that best suits them.
It all starts the day that they walk in the door to see their doctor – and the aim from day one is not to discuss surgery. Instead, the conversation begins by talking about life events that led to the weight gain. Circumstances often include pregnancy, divorce, depression, stress, addiction or substance abuse, or other behavioral changes.
“The aim is to recognize – not just to do surgery and get on with it. The aim is also to find out what problems this person is having due to their excess weight,” says Dr. Singhal. “There are some people who may carry excess weight and don’t have any problems. But if they have uncontrolled diabetes or blood pressure, or if they are having difficulty breathing or aren’t getting a good night’s sleep, what is the root cause? We talk about what things will get better if they lose weight.”
Another goal is to educate the patient that just losing weight is not enough, and that their journey is about making a true lifestyle change. If a patient comes in who smokes or drinks too much, making sure they are rehabilitated prior to beginning the program is important. Like any other specialty, the job of Easton Hospital’s bariatric doctors is to make the patient healthy – and helping them lose weight surgically is only one of the modalities that they use.
There is also the issue of how the patient’s mental health plays a role in their weight loss journey. Patients must be emotionally prepared to go through the process and commit to remaining in the system even if they choose not to have surgery or are not a candidate for surgery. To that end, there are support groups that patients are encouraged to attend to share their experience with others who have taken the same path.
“We make sure that they have full access to a dietician and an exercise physiologist who, on a day-to- day basis, can advise them and keep them on track,” says Dr. Singhal. “The emotional and social aspect gets taken care of more in a program like ours.”
Once patients are enrolled in the program, they see Dr. Singhal or Dr. Aksade every couple of months. In the meantime, they have the opportunity to attend classes at the hospital that teach them everything from how to count calories to how to decipher food labels and what healthier foods they can shop for. They are also taught how to prepare healthier meals. With any questions that arise, they have a member of the bariatric team ready to help them remain committed to their goals.
Program success, says Dr. Singhal, is measured by the time and effort the patient is willing to put in.
“The successful patient is somebody who is never missing classes, somebody who is always making it to their appointments even during bad weather, somebody who calls to reschedule to make it to an afternoon or evening appointment because they missed the morning appointment. Those are the people I see doing better. Commitment doesn’t come in one fell swoop – it’s those little things which incrementally add up that really makes it work.”
Those successful patients also discover a newfound confidence and a world opens up to them that they may have thought was lost.
“I have a patient who used to sing professionally onstage. I never knew that until she was halfway through the program. Some people don’t like to share many details about their lives until they’re comfortable with their physician,” shares Dr. Singhal. “She started telling me how she used to sing and she didn’t want to be onstage because she was so conscious of her weight. She had surgery and started losing weight, and you can see the change in her demeanor. The back straightens up and the shoulders straighten up. She is about three years post-surgery, and now she’s back onstage singing again.”
Lehigh Valley Weight Loss
Thousands of people across the Lehigh Valley have already discovered Lehigh Valley Weight Loss, which is the largest medical and surgical weight loss program in the area. Still, it might be safe to say that for many others, it’s the area’s best-kept healthcare secret.
John Scaffidi, MD, FABOM, FACOG and Maneesh Ailawadi, MD, FSSO were the first to perform outpatient bariatric surgery in the state, and have realized the importance of becoming what they call the “primary caregiver” for patients’ weight loss journeys. Scaffidi, who has three decades of experience in obstetrics and gynecology, consistently saw patients come into his practice who either didn’t qualify for weight loss surgery, or didn’t want it. The goal for him became providing his patients with a way to get the medical component of weight loss taken care of before surgery could even be an option.
Enter Dr. Ailawadi, who had opened his own private practice performing bariatric surgery, general surgery, and surgical oncology. Four years ago, the two physicians began working together to provide a truly unique full-service center that presents patients with a multidisciplinary approach to weight loss. Their collaborative effort also brings patients into the fold of Easton’s weight loss program for the surgical component.
“It kind of came around a little backward from the way that most programs are built up. The hospital provides the bariatric surgery, but I created the program in the beginning because it was for people who didn’t want the surgery or didn’t qualify,” explains Dr. Scaffidi. “It then became so busy that I started to have one or two percent of people who needed surgery or wanted it. Then it was five or six percent, and pretty soon I had patients asking me daily, ‘Where can I go?’ I knew of Dr. Ailawadi’s expertise, and together we put the two services together.”
The two used the paradigm of the multidisciplinary approaches to other areas of medicine – such as cancer care and cardiac care teams – and applied it to weight loss. The most important issue became that the impact of not treating obesity far outweighed the risks of treating it.
“That is true for all surgical weight loss. The risk of heart attack, stroke, diabetes and the long-term downstream of those are a thousand times more risky than the small risk of [weight loss] surgery,” confirms Dr. Ailawadi. “We want to make sure their heart is in good shape, their lungs are in good shape, and that they have no blood clotting disorders. That’s the standard procedure we go through for any operation. We go through that checklist and we make the operation as safe as possible by making sure of that.”
While there are multiple types of weight loss surgery, that one that they use most often is the laparoscopic sleeve (LGS) procedure, which is the most popular and safest form of bariatric surgery. It is done by making several small incisions in the abdomen, having a surgical camera (laparoscope) and special surgical tools inserted through them, and then having a portion of the stomach cut away to limit the amount of food that can fit in it. The new, banana-like shape goes from the esophagus to the small intestines.
The operation takes about 45 minutes to an hour, and patients go home the next day. The program has less than a one percent readmission rate.
“With the post-op phase, we switch our gears a little bit on the medical division because we want to make sure that nutritionally, the patient is getting adequate vitamins and minerals as well as overall nutrition – and that weight loss is neither too rapid nor too little,” explains Dr. Scaffidi. “And this is really where the art of medicine comes in. Each patient is going to be treated differently. We just go hand in hand with the patient through the rest of that post-op phase, which is usually a longer phase. Our medical team never lets go of that patient.”
About 90 percent of the patients continue on in the program and show amazing success.
“We haven’t been stumped yet,” says Dr. Scaffidi. “There hasn’t been anybody we’ve seen where we can say, ‘I don’t know what to do for you because you’re not losing weight. That just hasn’t happened.”