Understanding Bariatric Surgery and Who is a Candidate

By Dr. Julio Rivera, bariatric surgeon and physician on the medical staff at Texas Health HEB. 

Let’s be honest — summertime in the sweltering North Texas heat can be really uncomfortable, especially if you’re feeling held back by your weight. Maybe you want to ride a roller coaster at Six Flags, go down a waterslide with your child or have the stamina to take a long walk with your family, but right now you just can’t do it. Fortunately, there is hope.

For patients who meet the National Institutes of Health guidelines, which recommend either a body mass index (BMI) of 40+ or a BMI of 35 with serious accompanying health issues, such as hypertension, heart disease, sleep apnea or Type 2 diabetes, bariatric surgery may be an option.

I currently perform the gastric sleeve and gastric bypass procedures, both of which can lead to significant weight loss. The gastric sleeve procedure restricts the amount of food a patient can eat, while the gastric bypass procedure works by restriction and malabsorption or by limiting the number of calories and nutrients a patient’s body will absorb.

At the Texas Health HEB Bariatric Surgery Program, we work with each patient on a case-by-case basis to determine which procedure is right for him or her before we move forward. For example, patients with esophageal issues probably won’t do well with a sleeve procedure. Some procedures are considered “reversible,” while others are more permanent, so that’s something to think about. Additionally, the advantages and disadvantages of malabsorption need to be considered carefully.

Patients often come to a consultation with a preference because of family members or co-workers who have had good or bad experiences with procedures, while others research online. There’s a significant amount of information out there about bariatric surgery, but not all of it is credible, and some of it is even dangerous. There are many things to consider, and we’ll look at the whole picture — your medical history, your personal preference and the possible drawbacks of one procedure over another — before we decide on a course of action.

We generally do not recommend bariatric surgery for patients under the age of 18 or over 65, and any potential patient must have the mental capacity to understand the implications of surgery. Sixty percent of our patients’ procedures are covered by insurance, but when they’re  not, cash options are available. We work with patients every day to find out what coverage their insurance offers and how we can help them achieve their weight loss goals.

To ensure the best outcomes, our patients become part of a comprehensive program that offers support services from dietitians, physical therapists and Texas Health Springwood mental health professionals. We know there are many places to have bariatric surgery in the DFW area, but we believe a patient’s success is directly tied to support, before and after surgery. We’ve worked hard to create a warm environment where patients find personalized attention and they know we’re invested in their long-term health.

The field of bariatric surgery has progressed by leaps and bounds since I started working with patients in 2007. It’s safer than ever, and there are more options due to the improvements in technology. In addition, everything is more standardized than it used to be, and there’s a big push toward shortening the length of each patient’s stay after surgery while also reducing complications.

Bariatric surgery has the potential not only to extend life expectancy but also to dramatically improve the quality of a patient’s life. I’ve had patients with type 2 diabetes reduce or eliminate the need for insulin altogether after surgery. Early on in my career I had a young patient, not even 40 years old, who had been told she needed knee replacement surgery. After her gastric bypass, she lost 100 pounds and no longer needed the surgery. Another patient had always dreamed of becoming a flight attendant but was too overweight for the job. After surgery, she was able to lose more than 100 pounds and landed that dream job.

Bariatric surgery isn’t right for everyone; however, for patients who fit the criteria, go forward with a procedure and follow the recommended post-surgery lifestyle changes, I believe we can help them reach their weight loss goals, experience healthier and longer lives, and ride every roller coaster at Six Flags — twice.

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