Khashayar Vaziri, MD, discusses the two types of weight-loss surgery offered by GW Hospital (laparoscopic gastric bypass and laparoscopic sleeve gastrectomy). Both procedures are minimally invasive and allow patients a quick and less painful recovery than past surgical techniques.
Dr. Vaziri also explains the pre- and post-operative protocols, chronic health conditions that can be alleviated by undergoing the procedure (diabetes, high blood pressure, sleep apnea, reflux, arthritis), and which individuals are ideal candidates for bariatric surgery.
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Understanding Weight-Loss Surgery
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Learn more about Khashayar Vaziri, MD
Khashayar Vaziri, MD
Khashayar Vaziri, MD is board-certified in General Surgery and a member of the medical staff at The George Washington University Medical Center and is affiliated with The George Washington University Hospital and GW Medical Faculty Associates. He specializes in advanced laparoscopic and gastrointestinal surgery. He also serves as the director of surgical clerkship as well as an associate professor at The George Washington University School of Medicine & Health Sciences. His areas of interest include laparoscopic surgery for gastroesophageal reflux, achalasia, hiatal hernias, bariatric surgery and laparoscopic surgery for the stomach, colon, pancreas, spleen and adrenal glands.Learn more about Khashayar Vaziri, MD
Transcription:
Dr. Michael Smith (Host): Welcome to GW Healthcast. I'm Dr. Mike Smith. The topic today is understanding weight loss surgery. My guest is Dr. K Vaziri. Dr. Vaziri is board certified in general surgery and specializes in advanced laparoscopic and gastrointestinal surgery and is a member of the medical staff at the George Washington University Hospital and is affiliated with The George Washington University Hospital and GW Medical Faculty Associates. Welcome to the show. Let’s start off with who is a good candidate for weight loss surgery and what are some of the things that you look into to see if somebody meets those criteria?
Dr. Khashayar Vaziri, MD (Guest): That’s a great question. Weight loss surgery and bariatric surgery is not just solely for weight. The purpose of the surgery and the purpose of the process is not only to reduce someone’s weight, but also to get rid of many of the other medical problems that are worse with weight, or comorbidities as we call them, and some of these are diabetes and high blood pressure and obstructive sleep apnea. It’s not just the fact that a patient may be morbidly obese, but these other medical problems can also be ameliorated or cured with this weight loss program.
Dr. Smith: That’s interesting. What that may mean then is let’s say you have two people and they're the same weight, they're overweight, somebody has diabetes and some of those consequences of being overweight, but the other person doesn't. Maybe that other person you wouldn’t suggest surgery for, but the one with the comorbidities you would. Does it work like that a little bit?
Dr. Vaziri: Yes, it does. In general, when we look at overall weight, and it's not just the weight that we look at in kilograms, it's something called the body mass index. That is a ratio of the height and the weight and that will give you a certain number and there are many online calculators for that. In general, a body mass index of 40 or greater would qualify someone as a potential candidate for bariatric surgery. With respect to the other medical problems, a body mass index of 35 and greater along with one of those medical comorbidities would qualify a patient for bariatric surgery.
Dr. Smith: At the top of this interview, I mentioned that we’re going to try to understand weight loss surgery, but you just said something interesting there. You called it bariatric surgery. Can you help us to understand what that word means, “bariatric”?
Dr. Vaziri: Bariatric surgery is just another way of saying weight loss surgery. It is surgery and the process involved in order to decrease one’s overall weight and at the same time give them a healthier life by getting rid of many of those other medical problems that are made worse with weight. For example, diabetes is much easier to control after bariatric or weight loss surgery, high blood pressure, sleep apnea, reflux, arthritis – these are all medical problems and diseases that are made worse or come hand in hand with being significantly obese or overweight. With the weight loss, those medical problems are either easy to treat and at many times actually are resolved with the weight loss.
Dr. Smith: What are some of the specific procedures that GW Hospital offers?
Dr. Vaziri: We offer all the bariatric procedures here. We offer them the gastric bypass procedure, which we do laparoscopically here, and the laparoscopic sleeve gastrectomy. Those are the two most common operations done for weight loss in the United States and those are the two that we offer here, both through a minimally invasive approach using a tiny little scope and small incisions with a much faster recovery and much less postoperative pain.
Dr. Smith: Of course, that’s part of the workup, understanding what might be the best procedure for somebody. It’s individualized. It’s based on somebody’s current condition. How do you make some of those decisions of what procedure to actually do?
Dr. Vaziri: That’s a great question. That we’ll do is when patients come to our bariatric weight loss center, they're seen by a surgeon and it is that initial consultation with the surgeon where we ask specific questions individualized to the patient, what they have tried in the past, what has been successful for the patient in the past, what other medical problems they may have such as diabetes or high blood pressure or sleep apnea, and where they think they actually need help in this process to have successful, long-term durable weight loss. Everyone is a little bit different, everyone has different eating habits, everyone has different areas where they need help, and so the decision for which procedure to do for a patient really is individualized based upon what's been successful for the patient in the past, what other medical problems they have and where the procedure would fit into their overall goals.
Dr. Smith: I understand that it takes about six months between that first session, that orientation session, and the actual procedure. Why is that the case and what happens during the six months?
Dr. Vaziri: There are multiple requirements and it can be anywhere between two and six months. It’s not always six months, but there are multiple requirements that need to be fulfilled prior to having an operation, and those requirements, many of them are set forth by insurance companies. For us, we also require a medical weight loss program. That is required by insurance companies nationwide and depending upon how long a patient needs to be involved preoperatively with nutrition and physicians and dietitians in the medical aspect of their weight loss, that can span two to six months. Many of those requirements are set forth by insurance companies. For example, some insurance companies require six months of documented medical weight loss prior to qualifying for a bariatric or weight loss surgery. Some insurances require only two months, but all insurances and our center require some type of medical weight loss management preoperatively. The duration is really dependent upon the insurance.
Dr. Smith: When you think of the two most common procedures, what can somebody expect from those procedures and what type of recovery time are we talking about?
Dr. Vaziri: The operations that we do, the two most common that we do, are the laparoscopic gastric bypass and the laparoscopic sleeve gastrectomy. Both of these operations are done in a minimally invasive fashion. What the patient should expect is that the night before surgery, they have to fast after midnight, they come in the morning of surgery, they have their operation, they're roughly in the hospital for one and a half to two days. They go home after two days and they will recover at home for a few weeks after surgery. In general, when patients leave the hospital and they go home after two nights, they are up and working around, they will be on a specific postoperative diet, which at the beginning starts with a liquid and protein shake diet in order to allow their new anatomy and their surgical site to heal – that's only for the very first week postoperatively – then they would slowly get advanced to soft pureed foods, soft foods and then back to regular foods. Patients, when they leave the hospitals, are ambulatory. They're walking on their own, they'll be on a little bit of pain medication, they feel great, they don't have any tubes, drains or lines sticking out of them. The first few weeks after surgery really has to do with increasing the diet to get patients back to a regular diet. At the end of the day, the purpose of the weight loss surgery is not to have patients doing nothing but drinking protein shakes the rest of their life. The purpose of the weight loss surgery is to get patients back to eating regular food, but with better choices and better portions. The surgery is designed as a tool to help patients do that.
Dr. Smith: This may be a tough question because obviously individual results vary, but when you look at those two common procedures, what type of outcomes have you experienced?
Dr. Vaziri: Personally, and also from partnership, we’ve experienced great outcomes and that really has to do with all the hard work that our patients put in. It is really understanding that the surgery is just a tool, and like any other tool, if it’s used appropriately and their proper environment, it can be a very powerful tool. In general, what patients should expect at one year postoperatively is a loss of at least 50% to 70% of their excess weight. We measure success at 50% to 70% excess weight loss at one year and the data will show that for patients who have changed their lifestyle and used the surgery as a tool, they can keep that weight off 20-25 years.
Dr. Smith: I like the way you said that too. This is a tool. There are no magic bullets out there. This is a procedure that can help when we make those dedicated better choices to diet and exercise. In summary, what would you like people to know about weight loss surgery?
Dr. Vaziri: I think weight loss surgery is tried, it's true, it's safe in the right hand and if the patients are committed and they use this tool appropriately, the outcomes are very good, they have healthier lives, they could lose a significant amount of weight, and the unrealized gain is that they're actually adding years to their life.
Dr. Smith: Thank you so much for the work that you are doing and thank you for coming on the show today. You're listening to the GW Healthcast. Please visit GWDocs.com to get connected with Dr. Vaziri or another provider, or call 1-888-4GW-DOCS to schedule an in-person or virtual appointment. This is Dr. Mike Smith. Thanks for listening.
Dr. Michael Smith (Host): Welcome to GW Healthcast. I'm Dr. Mike Smith. The topic today is understanding weight loss surgery. My guest is Dr. K Vaziri. Dr. Vaziri is board certified in general surgery and specializes in advanced laparoscopic and gastrointestinal surgery and is a member of the medical staff at the George Washington University Hospital and is affiliated with The George Washington University Hospital and GW Medical Faculty Associates. Welcome to the show. Let’s start off with who is a good candidate for weight loss surgery and what are some of the things that you look into to see if somebody meets those criteria?
Dr. Khashayar Vaziri, MD (Guest): That’s a great question. Weight loss surgery and bariatric surgery is not just solely for weight. The purpose of the surgery and the purpose of the process is not only to reduce someone’s weight, but also to get rid of many of the other medical problems that are worse with weight, or comorbidities as we call them, and some of these are diabetes and high blood pressure and obstructive sleep apnea. It’s not just the fact that a patient may be morbidly obese, but these other medical problems can also be ameliorated or cured with this weight loss program.
Dr. Smith: That’s interesting. What that may mean then is let’s say you have two people and they're the same weight, they're overweight, somebody has diabetes and some of those consequences of being overweight, but the other person doesn't. Maybe that other person you wouldn’t suggest surgery for, but the one with the comorbidities you would. Does it work like that a little bit?
Dr. Vaziri: Yes, it does. In general, when we look at overall weight, and it's not just the weight that we look at in kilograms, it's something called the body mass index. That is a ratio of the height and the weight and that will give you a certain number and there are many online calculators for that. In general, a body mass index of 40 or greater would qualify someone as a potential candidate for bariatric surgery. With respect to the other medical problems, a body mass index of 35 and greater along with one of those medical comorbidities would qualify a patient for bariatric surgery.
Dr. Smith: At the top of this interview, I mentioned that we’re going to try to understand weight loss surgery, but you just said something interesting there. You called it bariatric surgery. Can you help us to understand what that word means, “bariatric”?
Dr. Vaziri: Bariatric surgery is just another way of saying weight loss surgery. It is surgery and the process involved in order to decrease one’s overall weight and at the same time give them a healthier life by getting rid of many of those other medical problems that are made worse with weight. For example, diabetes is much easier to control after bariatric or weight loss surgery, high blood pressure, sleep apnea, reflux, arthritis – these are all medical problems and diseases that are made worse or come hand in hand with being significantly obese or overweight. With the weight loss, those medical problems are either easy to treat and at many times actually are resolved with the weight loss.
Dr. Smith: What are some of the specific procedures that GW Hospital offers?
Dr. Vaziri: We offer all the bariatric procedures here. We offer them the gastric bypass procedure, which we do laparoscopically here, and the laparoscopic sleeve gastrectomy. Those are the two most common operations done for weight loss in the United States and those are the two that we offer here, both through a minimally invasive approach using a tiny little scope and small incisions with a much faster recovery and much less postoperative pain.
Dr. Smith: Of course, that’s part of the workup, understanding what might be the best procedure for somebody. It’s individualized. It’s based on somebody’s current condition. How do you make some of those decisions of what procedure to actually do?
Dr. Vaziri: That’s a great question. That we’ll do is when patients come to our bariatric weight loss center, they're seen by a surgeon and it is that initial consultation with the surgeon where we ask specific questions individualized to the patient, what they have tried in the past, what has been successful for the patient in the past, what other medical problems they may have such as diabetes or high blood pressure or sleep apnea, and where they think they actually need help in this process to have successful, long-term durable weight loss. Everyone is a little bit different, everyone has different eating habits, everyone has different areas where they need help, and so the decision for which procedure to do for a patient really is individualized based upon what's been successful for the patient in the past, what other medical problems they have and where the procedure would fit into their overall goals.
Dr. Smith: I understand that it takes about six months between that first session, that orientation session, and the actual procedure. Why is that the case and what happens during the six months?
Dr. Vaziri: There are multiple requirements and it can be anywhere between two and six months. It’s not always six months, but there are multiple requirements that need to be fulfilled prior to having an operation, and those requirements, many of them are set forth by insurance companies. For us, we also require a medical weight loss program. That is required by insurance companies nationwide and depending upon how long a patient needs to be involved preoperatively with nutrition and physicians and dietitians in the medical aspect of their weight loss, that can span two to six months. Many of those requirements are set forth by insurance companies. For example, some insurance companies require six months of documented medical weight loss prior to qualifying for a bariatric or weight loss surgery. Some insurances require only two months, but all insurances and our center require some type of medical weight loss management preoperatively. The duration is really dependent upon the insurance.
Dr. Smith: When you think of the two most common procedures, what can somebody expect from those procedures and what type of recovery time are we talking about?
Dr. Vaziri: The operations that we do, the two most common that we do, are the laparoscopic gastric bypass and the laparoscopic sleeve gastrectomy. Both of these operations are done in a minimally invasive fashion. What the patient should expect is that the night before surgery, they have to fast after midnight, they come in the morning of surgery, they have their operation, they're roughly in the hospital for one and a half to two days. They go home after two days and they will recover at home for a few weeks after surgery. In general, when patients leave the hospital and they go home after two nights, they are up and working around, they will be on a specific postoperative diet, which at the beginning starts with a liquid and protein shake diet in order to allow their new anatomy and their surgical site to heal – that's only for the very first week postoperatively – then they would slowly get advanced to soft pureed foods, soft foods and then back to regular foods. Patients, when they leave the hospitals, are ambulatory. They're walking on their own, they'll be on a little bit of pain medication, they feel great, they don't have any tubes, drains or lines sticking out of them. The first few weeks after surgery really has to do with increasing the diet to get patients back to a regular diet. At the end of the day, the purpose of the weight loss surgery is not to have patients doing nothing but drinking protein shakes the rest of their life. The purpose of the weight loss surgery is to get patients back to eating regular food, but with better choices and better portions. The surgery is designed as a tool to help patients do that.
Dr. Smith: This may be a tough question because obviously individual results vary, but when you look at those two common procedures, what type of outcomes have you experienced?
Dr. Vaziri: Personally, and also from partnership, we’ve experienced great outcomes and that really has to do with all the hard work that our patients put in. It is really understanding that the surgery is just a tool, and like any other tool, if it’s used appropriately and their proper environment, it can be a very powerful tool. In general, what patients should expect at one year postoperatively is a loss of at least 50% to 70% of their excess weight. We measure success at 50% to 70% excess weight loss at one year and the data will show that for patients who have changed their lifestyle and used the surgery as a tool, they can keep that weight off 20-25 years.
Dr. Smith: I like the way you said that too. This is a tool. There are no magic bullets out there. This is a procedure that can help when we make those dedicated better choices to diet and exercise. In summary, what would you like people to know about weight loss surgery?
Dr. Vaziri: I think weight loss surgery is tried, it's true, it's safe in the right hand and if the patients are committed and they use this tool appropriately, the outcomes are very good, they have healthier lives, they could lose a significant amount of weight, and the unrealized gain is that they're actually adding years to their life.
Dr. Smith: Thank you so much for the work that you are doing and thank you for coming on the show today. You're listening to the GW Healthcast. Please visit GWDocs.com to get connected with Dr. Vaziri or another provider, or call 1-888-4GW-DOCS to schedule an in-person or virtual appointment. This is Dr. Mike Smith. Thanks for listening.