December 19, 2022
According to the Centers for Disease Control and Prevention, more than 40% of adults in the United States fit the criteria for obesity, a high-risk condition that leads to progressive health complications and significant personal hardships when left untreated.
Bariatric surgery, commonly known as weight loss surgery, has made outstanding advancements in recent years as an intervention for patients with severe and morbid obesity.
People who have a body mass index (BMI) above 35 and an obesity-related condition — such as heart disease, diabetes or high blood pressure — may be considered suitable candidates for bariatric surgery. Anyone with a BMI above 40 may also explore bariatric surgery when diet and exercise alone cannot shed enough excess weight to stabilize long-term health.
At Penn Medicine, obesity treatment is an area of concerted focus for an experienced multi-specialty team committed to helping patients lead healthier, longer lives.
"Bariatric surgery is the most durable obesity treatment that we currently have," said Colleen Tewksbury, PhD, MPH, RD, CSOWM, LDN, dietician and Bariatric Program Manager at Penn Medicine. "From a surgical standpoint, the earlier we intervene, the better. We talk to our patients about their options and center their decision-making on what will help them reach their health goals in the long-run."
The Penn Medicine Bariatric Surgery program uses a staged approach to guide patients through a decision about surgery.
"From a dietician's standpoint, we have to determine when behavioral intervention and lifestyle changes, like diet and exercise, are not enough in terms of reducing overall risk," Tewksbury said. "As BMI goes higher, the risk of developing more serious conditions substantially increases."
Once patients elect to go forward with surgery, they are fully supported in developing a diet and exercise plan that will position them for success both as they prepare for their operation and as they navigate recovery to achieve long-term weight loss and management.
A significant challenge faced by many patients seeking weight loss surgery is understanding what their individual insurance health plans cover.
"It's a really tough system to navigate," Tewksbury said. "For this reason, we have patient coordinators and administrative support staff to help individuals get through the insurance process."
Dr. Noel Williams has led Penn Medicine’s bariatric surgery program for nearly 25 years, performing thousands of operations at the Hospital of the University of Pennsylvania, and is now operating at the health system’s new state-of-the-art Pavilion. Dr. Williams and the Penn Medicine team now complete more than 1,200 bariatric procedures per year, across the health system's six participating sites in the region.
"We're the most experienced group in this region and we pride ourselves on a very strong, multidisciplinary program," Williams said.
The majority of patients who get bariatric surgery opt for a sleeve gastrectomy, a minimally invasive and straightforward procedure in which the stomach is reduced to about 15% of its original size. The operation takes about two hours to complete and most patients are able to go home the following day. Many return to work within two weeks, but they will remain on a restricted diet for about six weeks as they heal, resume physical activity, follow up with their doctor and adjust to new eating habits.
The other surgical option offered is gastric bypass, which involves creating a small pouch from the stomach and connecting the newly created pouch directly to the small intestine. Gastric bypass is associated with more significant weight loss and higher improvement rates for co-morbidities and related conditions.
Up to 85% of patients across the country who have bariatric surgery achieve the goal of losing up to 70% their excess weight based on BMI.
Penn Medicine's MBSAQIP accreditation in bariatric surgery requires that lifelong follow-up care be provided by the program's team of experts, who will help address any hurdles that patients may encounter.
"There's a lot of preparation and long-term management, so having the allied health team at Penn brings together nurse practitioners, dieticians and psychologists to help patients is paramount," Tewksbury said.
Williams explained that the key to long-term improvement is diligent follow-up with the program's care team. The growing prevalence of bariatric surgery also has made it easier for patients to meet others who share their experience and can provide valuable insights into the process.
"Compared to when I first started doing bariatric surgery, with the explosion of the internet and social media, patients are much more supported. They're on websites and weight-loss community forums telling their stories. They can interact with other people who have had surgery through support groups. The awareness and the knowledge of this is much higher."
Tewksbury stressed that weight bias and internalized social stigma continue to be barriers for people who can benefit from bariatric surgery. At Penn Medicine, patients are empowered to see past harmful stereotypes that may prevent them from seeking help.
"It's a false concept that individuals who carry excess weight somehow have a character deficit," Tewksbury said. "In fact, we know that it is a clinical condition and a severe metabolic disease. We reinforce that individuals are here for treatment and we do our best to help them leave stigma at the door. The hardest step in this entire process is deciding to talk to someone about it."
Williams encourages people with obesity and related health conditions to gather information about bariatric surgery, learn about their options and seek guidance on how best to get treatment if they feel it is right for them.
"This is a safe procedure. This is a life-changing procedure," Williams said. "It's up to us, once the patients come in, to educate them as to the safety and the benefit of it."