Most of us take the little things for granted. Things like taking a walk in the park. Or buying a new shirt off the rack from a local store. But for individuals who are obese, these simple acts are challenging if not impossible.

Today, the morbidly obese have access to bariatric surgical procedures, medical techniques that can help them lose weight and improve quality of life. But does losing pounds and inches really change lives?

For Curt Shelvey and Jeff Rogers, the answer is a resounding yes.

Curt Shelvey’s story
Curt Shelvey’s daughter, Trinity, is 4 years old and the apple of her daddy’s eye. His love for her has been lifealtering.

Now 46, Shelvey had struggled with obesity since he was 10. He had tried exercise and diets and, unsure of what his next step should be, had attended an informational meeting about bariatric surgery. Still he was hesitant to undergo the complex procedure— until he saw the future reflected in his daughter’s eyes.

“I was a borderline diabetic,” Shelvey says. “I had high blood pressure, sleep apnea and was always fatigued. My knees, hips and feet hurt all the time. I practically ate Tylenol like candy to take the edge off.”

Because Shelvey was so overweight, his open gastric bypass surgery was especially complicated. Recovery was not easy. For six weeks, he received nutrition through a tube as his body adjusted to the change.

But, he says, the results have been worth the effort.

The Italian chef who once weighed more than 400 pounds is now 200 pounds lighter. “I dropped from a 64-inch waist to a 38,” he says. “I wore a 6X shirt, and now I can wear an XL. Before the surgery, I was taking five medications. Today, I am prescription-free.”

Best of all, Shelvey now has the energy to enjoy life. “I used to watch from the sidelines. Now, my wife Stacie and Trinity have a hard time keeping up with me.”

Jeff Rogers’ LAP band surgery
A teacher by profession, Jeff Rogers recognizes the value of education. Two years after his LAP band surgery, he is an advocate for those who may be on the fence.

Go to an informational session, he advises. Read everything you can, and ask questions.

“I was tired of getting out of breath and breaking a sweat just tying my shoes,” Rogers says. “I knew I needed to do something about my weight. Diets hadn’t helped. I saw an advertisement for an educational session, and I went. After about six months of preparation, I had the procedure. I would do it again tomorrow.”

Rogers, who has lost 123 pounds and counting, is overjoyed with the results. “I am off all prescription medications,” he says. “I have more energy. My joints don’t hurt. I was using a cane; now, most of time, I can stay balanced without it.”

He also goes to the gym six days a week. “It’s a pleasure not having to shop in the Big and Tall section of clothing stores anymore,” he says, “because I have lost eight pant sizes and three shirt sizes.”

“Bariatric surgery is a tool,” says bariatric surgeon Raymond Washington, M.D., of Pinehurst Surgical. “It is used in combination with changes in diet and exercise to improve health. It is a life-changing event. A lot of these patients are either intentionally or unintentionally discriminated against, and there are a lot of things they can’t do. By having the surgery and losing the weight, they are often able to get off their medications. They can exercise and lose more weight. They get a new outlook on life.” Bariatric surgery involves several procedures designed to help the excessively obese live healthier lives. It can be a safe and effective method for promoting weight loss and treating sleep apnea, diabetes, high blood pressure, joint pain and various other illness associated with morbid obesity. However, experts caution that it is not a quick fix. Achieving success through bariatric surgery requires lifestyle change. The procedures are complex, and serious complications can result if patients are not 100 percent committed.

Recognized as a Center of Excellence by the American Society of Metabolic and Bariatric Surgery, the Bariatric Center at FirstHealth Moore Regional Hospital offers Roux-en Y divided gastric bypass surgery, the adjustable gastric band and revisional bariatric surgery.

Performed by way of either a traditional “open” incision or a laparoscopic (minimally invasive) approach, the Roux-en Y procedure reduces the stomach to a small pouch that holds about an ounce of food. The pouch is connected to the small intestine so it can empty.

Limiting the amount of food a patient can eat and the number of calories that the patient’s body is able to absorb promotes dramatic weight loss while often controlling type 2 diabetes, high blood pressure, sleep apnea and other health problems. Patients who have gastric bypass must remain in the hospital for a few days and have

During this procedure, surgeons typically use laparoscopic techniques to implant an inflatable silicone band into the abdomen. Like a wristwatch, the band is fastened around the upper stomach to create a tiny new stomach pouch that limits and controls the amount of food that is eaten. It also creates a small outlet that slows the emptying process into the stomach and small intestine. As a result, patients are satisfied with smaller amounts of food.

Gastric band surgery is reversible, and the band can be tightened or loosened as necessary. Most patients will experience an overnight stay in the hospital after surgery and are able to resume work and other normal activities within two to four weeks

Revisional bariatric surgery alters or repairs a previous operation for treatment of morbid obesity. There are two reasons for revisional bariatric surgery: poor weight loss or weight regain, and complications of the original procedure.

Surgeons at Moore Regional also perform gastric sleeve resection procedures—often as a Roux-en Y staging procedure for certain highrisk patients. During a sleeve procedure, a large portion of the stomach is removed and the remainder is converted into a tube that restricts food intake.

“Although patient preference does factor into the decision, we carefully evaluate every individual and make recommendations on what is best for their specific situation,” says bariatric surgeon C. Kenneth Mitchell Jr., M.D., also of Pinehurst Surgical. “The methods we use to prepare our patients set us apart from other hospitals and surgeons. We approach each case individually and customize the care for the patient. Our goal is to help each one achieve his or her desired results. In essence, the procedure is just one ingredient in an overall new recipe for life.”

Raymond Washington, M.D. (standing) and Kenneth Mitchell Jr., M.D., perform bariatric surgeries at FirstHealth Moore Regional Hospital.

Media attention is at an all-time high. Patients are evaluating their bariatric surgical options now more than ever, and the number of surgeons performing bariatric surgery continues to increase. The choices for obese patients have never been more plentiful. Some would say they have never been more difficult. Bariatric surgery was once a club, if you will, of dedicated surgeons who had great interest in the treatment of the morbidly obese. Over the last 10 years, bariatric surgery has developed into a society and, more recently by necessity, has evolved into an industry. With more and more surgeons claiming their “bariatric expertise,” patients now have more choices regarding bariatric surgeons.

How does the patient choose a bariatric surgeon? Here are some questions to consider:

1) What are my surgeon’s credentials regarding bariatric surgery? This is one of the most basic questions you should ask yourself and your surgeon. In this time of new technology and innovative techniques, almost anyone can claim to be a bariatric surgeon. So know how your surgeon became interested in bariatric surgery, and ask what proportion of his practice is involved with bariatric surgery. I feel a dedicated bariatric surgeon should devote at least 50 percent of his practice to bariatric procedures to be considered a specialist by his peers.

Did my surgeon receive special training in bariatric surgery within his residency program? Did my surgeon complete a bariatric fellowship? Is my surgeon board eligible/board certified? All of these questions are important, and should be asked early on.

2) What is my surgeon’s reputation in the medical community? This will tell you a lot about your surgeon, because one physician cannot do it all. Bariatric surgeons should work closely with other physicians in their community when caring for bariatric patients. What does your family doctor think of your bariatric surgeon? Your cardiologist?

Any inside information from the medical community could be very helpful.

3) Are other patients satisfied with my surgeon? Any Internet chat room can help you with this process, but beware. Not everyone who is obese is a candidate for bariatric surgery. Be on the lookout for the disgruntled patient who had a bad experience with a particular surgeon and spends his/her free time trying to trash that surgeon or that surgeon’s office and staff. Pay most attention to the majority, not the exceptions. Attend a support group meeting and ask other patients their opinion of their surgeon.

4) What are my surgeon’s complication and mortality rates? This can be difficult information to obtain, but the best way is to ask. Any respectable bariatric surgeon will be honest and open with you regarding these issues. Remember, some bariatric patients are quite ill prior to surgery, in essence making them great candidates for bariatric surgery. With pre-existing co-morbidities comes increased risk. However, this is not a license for higher complication rates or high mortality rates. The accepted mortality rate (chance a patient will die within 30 days of surgery) is roughly 1 percent. The accepted morbidity rate (chance a patient will experience a complication in the immediate post-operative period) is roughly 15 percent.

5) What is my surgeon’s office like? This is a very important observation that all patients make. Start with the waiting room. Are there chairs that you can sit in comfortably? Is the waiting room cramped? Are the examination tables big enough for large patients? Are there scales for weighing patients in excess of 500 pounds? Does the surgeon have a bariatric coordinator who can be contacted easily?

6) Is my surgeon offering an operation or a program? Some bariatric surgeons pride themselves on the ability to operate, and measure the success of their patients by the immediate post-operative course. Once a patient recovers from his surgery, the bariatric surgeon may dismiss him to follow up with his family doctor. This leaves the patient with little surgical follow-up in the weeks, months and years to come. Most dedicated bariatric surgeons spend most of their practice in bariatric surgery educating their patients before and after surgery. Most of their operating time is spent performing bariatric surgery, not just doing a gastric bypass or LapBand if there are too few hernia repairs or gallbladder excisions to do. Truly dedicated bariatric surgeons see this specialty as demanding of their time and resources. Their program starts with education and evaluation prior to surgery and leads to lifelong follow-up after surgery.

7) What does my surgeon expect of me before and after surgery? This is tied into the operation vs. program question. My feeling about bariatric surgery is that the operation itself is about 10 percent of the entire package, but a very important 10 percent. Information sessions are a great way to learn about the options for bariatric patients, and some surgeons require prospective patients to attend a free information session prior to an office consultation. This gives the patient, and the patient’s family or loved ones, a chance to learn about this exciting opportunity at no cost and in a non-threatening environment.

What about post-op? Long-term follow-up is necessary and, in most elite bariatric practices, mandatory. In my experience, the success of a post-op bariatric patient depends on four major points:

• Completing a successful bariatric procedure

• Taking daily supplements for the rest of your life

• Adherence to an exercise regime with a strengthtraining element

• Compliance with a strict post-operative diet and commitment to long-term follow-up and support group participation

If one of these elements is missing, the post-op patient’s level of success will be limited.

8) Is the hospital specially equipped for the bariatric patient? This assessment begins in the admissions department. Don’t be afraid to ask questions; without questions, you won’t get answers. Are there special wheelchairs, stretchers and hospital beds? What about reinforced toilets or extra-large bedside commodes? Is there specialized equipment in the operating room, specifically an operating room bed that can accommodate a person greater than 500 pounds? Is the anesthesia department specially trained to care for the bariatric patient?

9) Is my surgeon a member of the American Society of Bariatric Surgeons? This is the most important question you should ask of your bariatric surgeon. Involvement in this society is considered mandatory for the true bariatric specialist. Members evaluate current research, discuss new techniques and set standards for the society to follow. If you had a bad heart, would you seek the consultation of a cardiologist who was not a member of the American Heart Association? I rest my case.

These are just some suggestions. Consider them and remember: Choose a surgeon and a program you feel comfortable with, even if you have to drive an hour or two out of you way. It’s your choice, and you are the customer.

C. Kenneth Mitchell Jr., M.D., is a general and bariatric surgeon with Pinehurst Surgical and medical director of the bariatric surgery program at FirstHealth Moore Regional Hospital. For more information on the bariatric program at FirstHealth Moore Regional Hospital, call (800) 213-3284.