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Weight Loss Surgery: The Basics of Winning Through Losing
Dr. Hope Jackson discusses the evolution of weight-loss surgery and how qualifying patients can use surgery to achieve a healthier lifestyle.
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Learn more about Hope Jackson, MD
Hope Jackson, MD
After medical residency, Hope Jackson, M.D., got an opportunity to work as a medical advisor for Grey’s Anatomy. Aside from the perks of working with an all-star cast and getting to be in several scenes, her experience has had a lasting impact: Her surgical knowledge helped the show be accurate, and the lessons she learned about storytelling influenced how she communicates with patients about their health.Learn more about Hope Jackson, MD
Transcription:
Dr. Mike Smith (Host): Weight loss surgery has proven itself to be pretty effective and safe for helping people to lose weight and maintain a healthier lifestyle, but how do you know if it's right for you? Welcome to The GW Hospital HealthCast. I'm Dr. Mike Smith, and today's topic, Weight Loss Surgery: The Basis of Winning Through Losing. My guest is Dr. Hope Jackson. Dr. Jackson is Assistant Professor of Surgery at The George Washington University School of Medicine and Health Sciences. Dr. Jackson, welcome to the show.
Dr. Hope Jackson (Guest): Thanks so much for having me. It's great to be here.
Host: Well, thank you for coming on. I really appreciate it. And obviously, there's a continued growing interest in weight loss surgery. As you know, unfortunately, overweight and obesity rates continue to climb in this country, but I thought maybe we could start with a little history of weight loss surgery. Where did it start? Where were we? And where are we today?
Dr. Jackson: Sure. Those are great questions. And you're right, patients who have obesity — we lose almost a half a million lives per year from the complications of obesity. It's one of the second leading preventable causes of death after smoking, so it's definitely become a health crisis at this point.
Where we were — really if you look at the history of weight loss surgery over the last say 30 years, our understanding has changed substantially. The primary procedure that was done for weight loss when you look back in the 80s and 90s was the gastric bypass, which I can talk about a little bit later, and varying iterations of the gastric bypass.
What we do now is we still offer the gastric bypass, but there are a few other options that we offer, mainly the gastric sleeve — the sleeve gastrectomy. Those are really the two primary weight loss surgery options that we have now. And really, that's evolved based on an understanding of how we lose weight, why we lose weight, and how to use surgery as a tool to maximize the weight that we lose. The two principles are going to be a restriction, which is decreasing the amount of food that we can eat and malabsorption, meaning changing the amount of food that you eat that you can actually absorb and your body can store in calories.
Host: Yeah.
Dr. Jackson: All of weight loss surgery is based on one or two of those principles. That's pretty much where we are today in thinking about weight loss surgery.
Host: When you think about the two main types there you started with — again, in the 80s and the 90s it was gastric bypass — tell us about that one and why was there a need to develop another one? Tell us how that evolved.
Dr. Jackson: Sure. Great. In terms of the gastric bypass, it really works based on two principles — again restriction, meaning changing the size of the stomach. We are going to make the stomach a lot smaller. It's going to be about the size of the palm of your hand. And then, the second principle is going to be malabsorption, so we're actually going to take a piece of your small intestine, connect it to the small stomach, and bypass a portion of your small intestine so that a segment of your small intestine can't absorb nutrients. Patients lose weight because one, they can't eat as much because their stomach is smaller and then two, they're not able to absorb all of the calories that they're eating. They have potentiated weight loss. What we have found looking at these patients and looking at them over the course of ten years is they began to see patients who for various reasons — whether it was because of their comorbidities and the health problems that they had or their inability to tolerate certain surgeries — we started to do a sleeve gastrectomy, meaning we just cut the size of the stomach. We didn't really change what the body absorbed. We were finding that patients were also losing a significant amount of weight, almost as much as they're losing for a gastric bypass. So then, the sleeve gastrectomy really in the last seven to eight years has really exploded as an option for weight loss surgery because we're finding that patients are also able to lose a significant amount of their excess body weight.
Host: Both of these techniques are effective. I do want to ask you because — I think some of my audience members might think this as well — when you talk about the gastric bypass approach and you talk about maybe not absorbing as many calories, does that mean they're not absorbing as many nutrients either? Was there an issue there?
Dr. Jackson: Yeah, that's a great question. Yes, so what we were finding is in some patients — and there are various versions of the bypass — where we found that some patients were losing — not absorbing as much in the way of nutrients. They were having nutritional deficiencies, which can manifest as hair loss, problems with bones, osteoporosis. We were finding that because patients were having nutritional deficiencies we were having to make sure they were on vitamins for life. Out of that came a way to try to avoid having some of those nutritional deficiencies. There is certainly less potential for nutritional deficiencies with the sleeve gastrectomy. Both are at risk for nutritional deficiencies, but because we're not really rerouting any intestines with the sleeve, we're finding that there really aren't as many nutritional deficiencies. Really, the major one is vitamin D.
Host: Dr. Jackson, in your expert opinion, who should the surgery be for? What type of person should seek this procedure out?
Dr. Jackson: That's a great question. The main reason that we do this procedure is because of what we call obesity health-related risks. Patients who have high blood pressure, heart disease, diabetes, obstructive sleep apnea, all of those medical conditions are going to increase their risk of having some type of comorbid condition or mortality from obesity. Patients who have these health-related risks and patients who have a body mass index — which is a calculation based on your height and weight — that are within a certain range as well as these health risks are typically candidates for weight loss surgery. Typically, we say are there any patients that are struggling with their weight, they're finding that diets and medication are not controlling their weight, and they have these medical conditions they should talk to their primary care physician about being a candidate for weight loss surgery and then being referred to a weight loss center to review their history and see if they are true candidates for the procedures.
Host: Yeah. I like the way you said that. It's not just, "I need to lose the weight." That may be true, but it's also, "I need to improve the health of my heart," or maybe it's diabetes, or whatever. You're really doing this as a way of helping to maybe prevent some of those, as you've said, comorbidities associated with obesity. Can you just maybe walk us through what it's like — maybe what happens before the surgery? Obviously, we're not surgeons, so we're not going to understand the surgery part of it so much. But generally, what is it like before and really, ultimately after? And what kind of outcomes can we expect?
Dr. Jackson: Sure. Before surgery, you'll come to our weight loss center here and you'll meet with us. It's an entire team that's really focused on meeting your weight loss goals. You'll meet with us as surgeons. You'll meet with our nutritionists. You'll meet with our psychiatry team here, and you'll also meet with our team members — our coordinators here that help move you through the process. What we'll do is we'll talk about your goals. We'll examine you, and we'll start you on a nutrition plan. Usually, in order to actually have weight loss surgery, you'll have to complete at least three to six months of a nutrition dietary plan. We'll talk to you, you'll work with our nutritionist, we'll help you with your meal planning. We'll help you understand how to make healthy choices — really changing your relationship and understanding of food. That's a key component, our nutrition program. And that's again, three to six months prior to any surgery.
Once you've completed that we'll also work with your primary care physician to make sure you're cleared from a medical standpoint, and then we'll take you to surgery. And depending on whether or not you're doing a bypass or a sleeve gastrectomy, we'll do one of two things: For the sleeve gastrectomy, we'll cut your stomach, and about more than half of your stomach will be removed and you'll have about a third of your stomach left. And again, that's just to provide restriction, so some feedback — you'll feel full after eating a small amount. If you're getting the bypass surgery, what we'll do is we'll also make your stomach smaller, and then we'll again, reroute your intestines to change how much nutrients your body can absorb.
Following surgery, you'll be in the hospital for 24 to 48 hours, and we'll be working with you, and our physical therapist will be working with you to help get you moving, walking, taking deep breaths. We'll work with you on your new diet plan while you're in the hospital. You'll see us afterward for several visits. You'll see us about two weeks after surgery and six weeks after surgery, three months, six months, nine months, and then a year. At each of those visits, you'll be seeing us as well as our nutritionist and dietician to make sure that you're staying on track with your healthy eating. We'll be watching you to make sure you're meeting your weight loss goals.
In terms of what we expect with your weight loss, we'll calculate some numbers beforehand, and we expect you to lose about 70 to 75% of your excess weight. If you are 100 pounds overweight, we expect you to lose about 70 to 75 pounds by adhering to our nutrition plan and with the surgery. That's it in kind of a two minute — I don't even know if I made it two minutes — a nutshell.
Host: That's great. No, that was great. It helps sometimes just for people to hear the process, right?
Dr. Jackson: Sure.
Host: And that there is some thought that goes into it at the beginning, especially with helping people with the dietary advice, better relationship with food. I think that's important up front. And of course, the effective results down the line. I think, Dr. Jackson, we should end with your take on this whole weight loss surgery process. What would you like people to know about weight loss surgery?
Dr. Jackson: Great question. I think the most important thing to know is that if you're interested in weight loss surgery, it is a total process. The surgery itself is not going to cause weight loss by itself. It's going to be a total effort on our part in terms of doing what we need to do for the surgery, but then also on you to make healthy eating choices and to really change your nutrition plans, which we will help you with before and after surgery. These operations are going to work better with exercise and healthy eating, and they are merely tools to help you with your weight loss and with your healthy eating. They're going to work better when you follow up with us regularly, and they're going to work better when they're combined with increased activity and exercise. That's the key takeaway that I tell all of my patients.
Host: Perfect. That was an awesome summary, Dr. Jackson. I want to thank you for the work that you're doing, and also thank you for coming on the show today. You're listening The GW Hospital HealthCast. For more information, go to GWDocs.com, that's GWDocs.com. I'm Dr. Mike Smith, thanks for listening.
Dr. Mike Smith (Host): Weight loss surgery has proven itself to be pretty effective and safe for helping people to lose weight and maintain a healthier lifestyle, but how do you know if it's right for you? Welcome to The GW Hospital HealthCast. I'm Dr. Mike Smith, and today's topic, Weight Loss Surgery: The Basis of Winning Through Losing. My guest is Dr. Hope Jackson. Dr. Jackson is Assistant Professor of Surgery at The George Washington University School of Medicine and Health Sciences. Dr. Jackson, welcome to the show.
Dr. Hope Jackson (Guest): Thanks so much for having me. It's great to be here.
Host: Well, thank you for coming on. I really appreciate it. And obviously, there's a continued growing interest in weight loss surgery. As you know, unfortunately, overweight and obesity rates continue to climb in this country, but I thought maybe we could start with a little history of weight loss surgery. Where did it start? Where were we? And where are we today?
Dr. Jackson: Sure. Those are great questions. And you're right, patients who have obesity — we lose almost a half a million lives per year from the complications of obesity. It's one of the second leading preventable causes of death after smoking, so it's definitely become a health crisis at this point.
Where we were — really if you look at the history of weight loss surgery over the last say 30 years, our understanding has changed substantially. The primary procedure that was done for weight loss when you look back in the 80s and 90s was the gastric bypass, which I can talk about a little bit later, and varying iterations of the gastric bypass.
What we do now is we still offer the gastric bypass, but there are a few other options that we offer, mainly the gastric sleeve — the sleeve gastrectomy. Those are really the two primary weight loss surgery options that we have now. And really, that's evolved based on an understanding of how we lose weight, why we lose weight, and how to use surgery as a tool to maximize the weight that we lose. The two principles are going to be a restriction, which is decreasing the amount of food that we can eat and malabsorption, meaning changing the amount of food that you eat that you can actually absorb and your body can store in calories.
Host: Yeah.
Dr. Jackson: All of weight loss surgery is based on one or two of those principles. That's pretty much where we are today in thinking about weight loss surgery.
Host: When you think about the two main types there you started with — again, in the 80s and the 90s it was gastric bypass — tell us about that one and why was there a need to develop another one? Tell us how that evolved.
Dr. Jackson: Sure. Great. In terms of the gastric bypass, it really works based on two principles — again restriction, meaning changing the size of the stomach. We are going to make the stomach a lot smaller. It's going to be about the size of the palm of your hand. And then, the second principle is going to be malabsorption, so we're actually going to take a piece of your small intestine, connect it to the small stomach, and bypass a portion of your small intestine so that a segment of your small intestine can't absorb nutrients. Patients lose weight because one, they can't eat as much because their stomach is smaller and then two, they're not able to absorb all of the calories that they're eating. They have potentiated weight loss. What we have found looking at these patients and looking at them over the course of ten years is they began to see patients who for various reasons — whether it was because of their comorbidities and the health problems that they had or their inability to tolerate certain surgeries — we started to do a sleeve gastrectomy, meaning we just cut the size of the stomach. We didn't really change what the body absorbed. We were finding that patients were also losing a significant amount of weight, almost as much as they're losing for a gastric bypass. So then, the sleeve gastrectomy really in the last seven to eight years has really exploded as an option for weight loss surgery because we're finding that patients are also able to lose a significant amount of their excess body weight.
Host: Both of these techniques are effective. I do want to ask you because — I think some of my audience members might think this as well — when you talk about the gastric bypass approach and you talk about maybe not absorbing as many calories, does that mean they're not absorbing as many nutrients either? Was there an issue there?
Dr. Jackson: Yeah, that's a great question. Yes, so what we were finding is in some patients — and there are various versions of the bypass — where we found that some patients were losing — not absorbing as much in the way of nutrients. They were having nutritional deficiencies, which can manifest as hair loss, problems with bones, osteoporosis. We were finding that because patients were having nutritional deficiencies we were having to make sure they were on vitamins for life. Out of that came a way to try to avoid having some of those nutritional deficiencies. There is certainly less potential for nutritional deficiencies with the sleeve gastrectomy. Both are at risk for nutritional deficiencies, but because we're not really rerouting any intestines with the sleeve, we're finding that there really aren't as many nutritional deficiencies. Really, the major one is vitamin D.
Host: Dr. Jackson, in your expert opinion, who should the surgery be for? What type of person should seek this procedure out?
Dr. Jackson: That's a great question. The main reason that we do this procedure is because of what we call obesity health-related risks. Patients who have high blood pressure, heart disease, diabetes, obstructive sleep apnea, all of those medical conditions are going to increase their risk of having some type of comorbid condition or mortality from obesity. Patients who have these health-related risks and patients who have a body mass index — which is a calculation based on your height and weight — that are within a certain range as well as these health risks are typically candidates for weight loss surgery. Typically, we say are there any patients that are struggling with their weight, they're finding that diets and medication are not controlling their weight, and they have these medical conditions they should talk to their primary care physician about being a candidate for weight loss surgery and then being referred to a weight loss center to review their history and see if they are true candidates for the procedures.
Host: Yeah. I like the way you said that. It's not just, "I need to lose the weight." That may be true, but it's also, "I need to improve the health of my heart," or maybe it's diabetes, or whatever. You're really doing this as a way of helping to maybe prevent some of those, as you've said, comorbidities associated with obesity. Can you just maybe walk us through what it's like — maybe what happens before the surgery? Obviously, we're not surgeons, so we're not going to understand the surgery part of it so much. But generally, what is it like before and really, ultimately after? And what kind of outcomes can we expect?
Dr. Jackson: Sure. Before surgery, you'll come to our weight loss center here and you'll meet with us. It's an entire team that's really focused on meeting your weight loss goals. You'll meet with us as surgeons. You'll meet with our nutritionists. You'll meet with our psychiatry team here, and you'll also meet with our team members — our coordinators here that help move you through the process. What we'll do is we'll talk about your goals. We'll examine you, and we'll start you on a nutrition plan. Usually, in order to actually have weight loss surgery, you'll have to complete at least three to six months of a nutrition dietary plan. We'll talk to you, you'll work with our nutritionist, we'll help you with your meal planning. We'll help you understand how to make healthy choices — really changing your relationship and understanding of food. That's a key component, our nutrition program. And that's again, three to six months prior to any surgery.
Once you've completed that we'll also work with your primary care physician to make sure you're cleared from a medical standpoint, and then we'll take you to surgery. And depending on whether or not you're doing a bypass or a sleeve gastrectomy, we'll do one of two things: For the sleeve gastrectomy, we'll cut your stomach, and about more than half of your stomach will be removed and you'll have about a third of your stomach left. And again, that's just to provide restriction, so some feedback — you'll feel full after eating a small amount. If you're getting the bypass surgery, what we'll do is we'll also make your stomach smaller, and then we'll again, reroute your intestines to change how much nutrients your body can absorb.
Following surgery, you'll be in the hospital for 24 to 48 hours, and we'll be working with you, and our physical therapist will be working with you to help get you moving, walking, taking deep breaths. We'll work with you on your new diet plan while you're in the hospital. You'll see us afterward for several visits. You'll see us about two weeks after surgery and six weeks after surgery, three months, six months, nine months, and then a year. At each of those visits, you'll be seeing us as well as our nutritionist and dietician to make sure that you're staying on track with your healthy eating. We'll be watching you to make sure you're meeting your weight loss goals.
In terms of what we expect with your weight loss, we'll calculate some numbers beforehand, and we expect you to lose about 70 to 75% of your excess weight. If you are 100 pounds overweight, we expect you to lose about 70 to 75 pounds by adhering to our nutrition plan and with the surgery. That's it in kind of a two minute — I don't even know if I made it two minutes — a nutshell.
Host: That's great. No, that was great. It helps sometimes just for people to hear the process, right?
Dr. Jackson: Sure.
Host: And that there is some thought that goes into it at the beginning, especially with helping people with the dietary advice, better relationship with food. I think that's important up front. And of course, the effective results down the line. I think, Dr. Jackson, we should end with your take on this whole weight loss surgery process. What would you like people to know about weight loss surgery?
Dr. Jackson: Great question. I think the most important thing to know is that if you're interested in weight loss surgery, it is a total process. The surgery itself is not going to cause weight loss by itself. It's going to be a total effort on our part in terms of doing what we need to do for the surgery, but then also on you to make healthy eating choices and to really change your nutrition plans, which we will help you with before and after surgery. These operations are going to work better with exercise and healthy eating, and they are merely tools to help you with your weight loss and with your healthy eating. They're going to work better when you follow up with us regularly, and they're going to work better when they're combined with increased activity and exercise. That's the key takeaway that I tell all of my patients.
Host: Perfect. That was an awesome summary, Dr. Jackson. I want to thank you for the work that you're doing, and also thank you for coming on the show today. You're listening The GW Hospital HealthCast. For more information, go to GWDocs.com, that's GWDocs.com. I'm Dr. Mike Smith, thanks for listening.