What is Obesity?
Obesity results from the excessive accumulation of fat that exceeds the body's skeletal and physical standards. According to the National Institutes of Health (NIH), an increase in 20 percent or more above your ideal body weight is the point at which excess weight becomes a health risk.
Today 97 million Americans, more than one-third of the adult population, are overweight or obese. An estimated 5 to 10 million of those are considered morbidly obese.
Obesity becomes “morbid” when it reaches the point of significantly increasing the risk of one or more obesity-related health conditions or serious diseases (also known as co-morbidities) that result either in significant physical disability or even death. As you read about morbid obesity you may also see the term “clinically severe obesity” used. Both are descriptions of the same condition and can be used interchangeably.
Morbid obesity is typically defined as being 100 lbs. or more over ideal body weight or having a Body Mass Index of 40 or higher. According to the National Institutes of Health Consensus Report, morbid obesity is a serious disease and must be treated as such. It is a chronic disease, meaning that its symptoms build slowly over an extended period of time.
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Causes of Morbid Obesity
The reasons for obesity are multiple and complex. Despite conventional wisdom, it is not simply a result of overeating. Research has shown that in many cases a significant, underlying cause of morbid obesity is genetic. Studies have demonstrated that once the problem is established, efforts such as dieting and exercise programs have a limited ability to provide effective long-term relief.
Science continues to search for answers. But until the disease is better understood, the control of excess weight is something patients must work at for their entire lives. That is why it is very important to understand that all current medical interventions, including weight loss surgery, should not be considered medical cures. Rather they are attempts to reduce the effects of excessive weight and alleviate the serious physical, emotional and social consequences of the disease.
Contributing Factors
The underlying causes of severe obesity are not known. There are many factors that contribute to the development of obesity including genetic, hereditary, environmental, metabolic and eating disorders. There are also certain medical conditions that may result in obesity like intake of steroids and hypothyroidism.
Genetic Factors
Numerous scientific studies have established that your genes play an important role in your tendency to gain excess weight.
- The body weight of adopted children shows no correlation with the body weight of their adoptive parents, who feed them and teach them how to eat. Their weight does have an 80 percent correlation with their genetic parents, whom they have never met.
- Identical twins, with the same genes, show a much higher similarity of body weights than do fraternal twins, who have different genes.
- Certain groups of people, such as the Pima Indian tribe in Arizona, have a very high incidence of severe obesity. They also have significantly higher rates of diabetes and heart disease than other ethnic groups.
We probably have a number of genes directly related to weight. Just as some genes determine eye color or height, others affect our appetite, our ability to feel full or satisfied, our metabolism, our fat-storing ability, and even our natural activity levels.
The Pima Paradox
The Pima Indians are known in scientific circles as one of the heaviest groups of people in the world. In fact, National Institutes of Health researchers have been studying them for more than 35 years. Some adults weigh more than 500 pounds, and many obese teenagers are suffering from diabetes, the disease most frequently associated with obesity.
But here’s a really interesting fact – a group of Pima Indians living in Sierra Madre, Mexico, does not have a problem with obesity and its related diseases. Why not?
The leading theory states that after many generations of living in the desert, often confronting famine, the most successful Pima were those with genes that helped them store as much fat as possible during times when food was available. Now those fat-storing genes work against them.
Though both populations consume a similar number of calories each day, the Mexican Pima still live much like their ancestors did. They put in 23 hours of physical labor each week and eat a traditional diet that’s very low in fat. The Arizona Pima live like most other modern Americans, eating a diet consisting of around 40 percent fat and engaging in physical activity for only two hours a week.
The Pima apparently have a genetic predisposition to gain weight. And the environment in which they live – the environment in which most of us live – makes it nearly impossible for the Arizona Pima to maintain a normal, healthy body weight.
Environmental Factors
Environmental and genetic factors are obviously closely intertwined.
If you have a genetic predisposition toward obesity, then the modern American lifestyle and environment may make controlling weight more difficult.
Fast food, long days sitting at a desk, and suburban neighborhoods that require cars all magnify hereditary factors such as metabolism and efficient fat storage.
For those suffering from morbid obesity, anything less than a total change in environment usually results in failure to reach and maintain a healthy body weight.
Metabolism
We used to think of weight gain or loss as only a function of calories ingested and then burned. Take in more calories than you burn, gain weight; burn more calories than you ingest, lose weight. But now we know the equation isn’t that simple.
Obesity researchers now talk about a theory called the “set point,” a sort
of thermostat in the brain that makes people resistant to either weight gain or loss. If you try to override the set point by drastically cutting your calorie intake, your brain responds by lowering metabolism and slowing activity. You then gain back any weight you lost.
Eating Disorders & Medical Conditions
Weight loss surgery is not a cure for eating disorders. And there are medical conditions, such as hypothyroidism, that can also cause weight gain. That’s why it’s important that you work with your doctor to make sure you do not have a condition that should be treated with medication and counseling.
Options for Treatment
For anyone who has considered a weight loss program, there is certainly no shortage of choices. In fact, to qualify for insurance coverage of weight loss surgery, many insurers require patients to have a history of medically supervised weight loss efforts.
Most non-surgical weight loss programs are based on some combination of diet/behavior modification and regular exercise. Unfortunately, even the most effective interventions have proven to be effective for only a small percentage of patients. It is estimated that less than 5% of individuals who participate in non-surgical weight loss programs will lose a significant amount of weight and maintain that loss for a long period of time.
According to the National Institutes of Health, more than 90% of all people in these programs regain their weight within one year. Sustained weight loss for patients who are morbidly obese is even harder to achieve. Serious health risks have been identified for people who move from diet to diet, subjecting their bodies to a severe and continuing cycle of weight loss and gain known as “yo-yo dieting.”
The fact remains that morbid obesity is a complex, multifactorial chronic disease.
For many patients, the risk of death from not having the surgery is greater than the risks from the possible complications of having the procedure.
That is the key reason that in 2000, approximately 40,000 weight loss surgical procedures were performed and why the American Society for Bariatric Surgery estimates that 50,000 weight loss surgical procedures will be performed in 2001. Patients who have had the procedure and are benefiting from its results report improvements in their quality of life, social interactions, psychological well-being, employment opportunities and economic condition.
In clinical studies, candidates for the procedure who had multiple obesity-related health conditions questioned whether they could safely have the surgery. These studies show that selection of surgical candidates is based on very strict criteria and surgery is an option for the majority of patients.
Weight Loss Surgery
Weight loss surgery is major surgery. Its growing use to treat morbid obesity is the result of three factors:
- Our current knowledge of the significant health risks of morbid obesity
- The relatively low risk and complications of the procedures versus not having the surgery
- The ineffectiveness of current non-surgical approaches to produce sustained weight loss
Surgery should be viewed first and foremost as a method for alleviating debilitating, chronic disease. In most cases, the minimum qualification for consideration as a candidate for the procedure is 100 pounds above ideal body weight or those with a Body Mass Index (BMI) of 40 or greater. Occasionally a procedure will be considered for someone with a BMI of 35 or higher if the patient’s physician determines that obesity-related health conditions have resulted in a medical need for weight reduction and, in the doctor’s opinion, surgery appears to be the only way to accomplish the targeted weight loss.
In many cases, patients are required to show proof that their attempts at dietary weight loss have been ineffective before surgery will be approved. More important, however, is the commitment on the part of the patient to required, long-term follow-up care. Most surgeons require patients to demonstrate serious motivation and a clear understanding of the extensive dietary, exercise and medical guidelines that must be followed for the remainder of their lives after having weight loss surgery (see Life After Surgery).
Diet & Behavior Modification
There are literally hundreds of diets available. Moving from diet to diet in a cycle of weight gain and loss – yo-yo dieting – that stresses the heart, kidneys and other organs can also be a health risk.
Doctors who prescribe and supervise diets for their patients usually create a customized program with the goal of greatly restricting calorie intake while maintaining nutrition. These diets fall into two basic categories:
- Low Calorie Diets (LCDs) are individually planned so that the patient takes in 500 to 1,000 fewer calories a day than he or she burns.
- Very Low Calorie Diets (VLCDs) typically limit caloric intake to 400 to 800 a day and feature high-protein, low-fat liquids.
Many patients on Very Low Calorie Diets lose significant amounts of weight. However, after returning to a normal diet, most regain the lost weight in under a year. Ninety percent of people participating in all diet programs will regain the weight they’ve lost within two years.
Behavior modification uses therapy to help patients change their eating and exercise habits. Like low-calorie diets, behavior modification, in most patients, results in short-term success that tends to diminish after the first year.
If diet and behavior modifications have failed you and surgery is your next option, it is important to understand that diet and behavior modification will be instrumental to sustained weight loss after your surgery. The surgery itself is only a tool to get your body started losing weight – complying with diet and behavior modifications required by most surgeons would determine your ultimate success.
Exercise
Starting an exercise program can be especially intimidating for someone suffering from morbid obesity. Your health condition may make any level of physical exertion next to impossible. The benefits of exercise are clear, however. And there are ways to get started.
A National Institutes of Health survey of 13 studies concludes that physical activity:
- results in modest weight loss in overweight and obese individuals
- increases cardiovascular fitness, even when there is no weight loss
- can help maintain weight loss
New theories focusing on the body’s set point (the weight range in which your body is programmed to weigh and will fight to maintain that weight) highlight the importance of exercise. When you reduce the number of calories you take in, the body simply reacts by slowing metabolism to burn fewer calories. Daily physical activity can help speed up your metabolism, effectively bringing your set point down to a lower natural weight. So when following a diet to attempt to lose weight, exercise increases your chances of long-term success.
Examples to get you started:
- Park at the far end of parking lots and walk
- Take the stairs instead of the elevator
- Cut down on television
- Swim or participate in low-impact water aerobics
- Ride an exercise bike
Overall, walking is one of the best forms of exercise. Start out slowly and build up. Your doctor, or people in a support group, can offer encouragement and advice. Incorporating exercise into your daily activities will improve your overall health and is important for any long-term weight management program, including weight loss surgery. Diet and exercise play a key role in successful weight loss after surgery.
Over-the-Counter & Prescription Drugs
New over-the-counter and prescription weight loss medications have been introduced. Some people have found them effective in helping to curb their appetite. The results of most studies show that patients on drug therapy lose around 10 percent of their excess weight and that the weight loss plateaus after six to eight months. As patients stop taking the medication, weight gain usually occurs.
Weight loss drugs can have serious side effects. Still, medications are an important step in the morbid obesity treatment process. Before insurance companies will reimburse/pay for weight loss surgery, you must follow a well-documented treatment path.
“Since many people cannot lose much weight no matter how hard they try, and promptly regain whatever they do lose, the vast amount of money spent on diet clubs, special foods and over-the-counter remedies, estimated to be on the order of $30 billion to $50 billion yearly, is wasted.” (New England Journal of Medicine)
Non-Surgical Weight Loss Program
This program will be open to anyone over the age of 16 who is interested in losing weight.
The program will not only provide participants with a dietary plan for weight loss but will also provide tools for effective psychological behavior modification.
Requirements
Before the participant can enter the weight loss program, medical clearance needs to be obtained either from the participant’s own Primary Care Physician (PCP) or the program's PCP. The "Weight Loss Medical Evaluation and Clearance" form must be completed by the participant’s own PCP and reviewed by the program's PCP before the participant can schedule the initial appointment with the psychologist and dietitian.
If Cleveland Clinic in Florida accepts participant’s insurance, the program's PCP's visit for clearance can be billed through the insurance.
Length of Program
The program will run for 9 weeks. The appointment will be done one-on-one on Wednesday with the dietitian (60 minutes) and the psychologist (75 minutes). These will be scheduled back-to-back.
Appointments 2 through 9 will be in a group setting and will meet on Monday for 60 minutes with the nutritionist and for 60 minutes with the psychologist. These group appointments will also be back-to-back. Participants will register at desk 23/24 to get weighed in by the dietitian. The groups will be held in a David Jagelman Center conference room.
Cost of Program
The fee will be $590 for all 9 weeks of both services payable at the first visit. This program will not be covered by insurance.
For additional information, please call:
Gina Sweat MS, RD, LD/N
954.659.5874
Download the form, have your primary care physician sign and fax it directly to Gina Sweat at 954-659-5256.
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Obesity-Related Health Conditions
Obesity-related health conditions are health conditions that, whether alone or in combination, can significantly reduce your life expectancy. A partial list of some of the more common conditions follows. Your doctor can provide you with a more detailed and complete list.
Type 2 Diabetes
Obese individuals develop a resistance to insulin, which regulates blood sugar levels. Over time, the resulting high blood sugar can cause serious damage to the body.
High blood pressure/Heart disease
Excess body weight strains the ability of the heart to function properly. The resulting hypertension (high blood pressure) can result in strokes, as well as inflict significant heart and kidney damage.
Osteoarthritis of weight-bearing joints
The additional weight placed on joints, particularly knees and hips, results in rapid wear and tear, along with pain caused by inflammation. Similarly, bones and muscles of the back are constantly strained, resulting in disk problems, pain and decreased mobility.
Sleep apnea/Respiratory problems
Fat deposits in the tongue and neck can cause intermittent obstruction of the air passage. Because the obstruction is increased when sleeping on your back, you may find yourself waking frequently to reposition yourself. The resulting loss of sleep often results in daytime drowsiness and headaches.
Gastroesophageal reflux/Heartburn
Acid belongs in the stomach and seldom causes any problem when it stays there. When acid escapes into the esophagus through a weak or overloaded valve at the top of the stomach, the result is called gastroesophageal reflux, and “heartburn” and acid indigestion are common symptoms. Approximately 10-15% of patients with even mild sporadic symptoms of heartburn will develop a condition called Barrett’s esophagus, which is a pre-malignant change in the lining membrane of the esophagus, a cause of esophageal cancer.
For more information on heartburn, its causes and possible cures, visit http://www.heartburnhelp.com/.
Depression
Seriously overweight persons face constant challenges to their emotions: repeated failure with dieting, disapproval from family and friends, sneers and remarks from strangers. They often experience discrimination at work, cannot fit comfortably in theatre seats, or ride in a bus or plane.
Infertility
The inability or diminished ability to produce offspring.
Urinary stress incontinence
A large, heavy abdomen and relaxation of the pelvic muscles, especially associated with the effects of childbirth, may cause the valve on the urinary bladder to be weakened, leading to leakage of urine with coughing, sneezing, or laughing.
Menstrual irregularities
Morbidly obese women often experience disruptions of the menstrual cycle, including interruption of the menstrual cycle, abnormal menstrual flow and increased pain associated with the menstrual cycle.
Weight Loss Surgery Options
- Restrictive procedures that decrease food intake.
- Malabsorptive procedures that alter digestion, thus causing the food to be poorly digested and incompletely absorbed so that it is eliminated in the stool.
Gastric Restrictive Procedure – Vertical Banded Gastroplasty
Vertical Banded Gastroplasty (VBG) is a purely restrictive procedure. In this procedure the upper stomach near the esophagus is stapled vertically for about 2-1/2 inches (6 cm) to create a smaller stomach pouch. The outlet from the pouch is restricted by a band or ring that slows the emptying of the food and thus creates the feeling of fullness.
Advantages
- The primary advantage of this restrictive procedure is that a reduced amount of well-chewed food enters and passes through the digestive tract in the usual order. That allows the nutrients and vitamins (as well as the calories) to be fully absorbed into the body.
- After 10 years, studies show that patients can maintain 50% of targeted excess weight loss.
- For more information, please go to Lap-Band® System website.
Risks
- Postoperatively, stapling of the stomach carries with it the risk of staple-line disruption that can result in leakage and/or serious infection. This may require prolonged hospitalization with antibiotic treatment and/or additional operations.
- Staple-line disruption may also, in the long-term, lead to weight gain. For these reasons, some surgeons divide the staple-line wall of the pouch from the rest of the stomach to reduce the risk of long-term staple-line disruption.
- The band or ring applied may lead to complications of obstruction or perforation, requiring surgical intervention.
- Characteristically, these procedures, while creating a sense of fullness, do not provide the necessary feeling of satisfaction that one has had “enough” to eat.
- Because restrictive procedures rely solely on a small stomach pouch to reduce food intake, there is the risk of the pouch stretching or of the restricting band or ring at the pouch outlet breaking or migrating, thus allowing patients to eat too much.
- Around 40% of patients undergoing these procedures have lost less than half their excess body weight.
- As is the case with all weight loss surgeries, readmission to a hospital may be required for fluid replacement or nutritional support if there is excessive vomiting and adequate food intake cannot be maintained.
Malabsorptive Procedures – Biliopancreatic Diversion
While these operations also reduce the size of the stomach, the stomach pouch created is much larger than with other procedures. The goal is to restrict the amount of food consumed and alter the normal digestive process, but to a much greater degree. The anatomy of the small intestine is changed to divert the bile and pancreatic juices so they meet the ingested food closer to the middle or the end of the small intestine. With the three approaches discussed below, absorption of nutrients and calories is also reduced, but to a much greater degree than with previously discussed procedures. Each of the three differs in how and when the digestive juices (i.e., bile) come into contact with the food.
Since food bypasses the duodenum, all the risk considerations discussed in the gastric bypass section regarding the malabsorption of some minerals and vitamins also apply to these techniques, only to a greater degree.
Biliopancreatic Diversion (BPD)
BPD removes approximately 3/4 of the stomach to produce both restriction of food intake and reduction of acid output. Leaving enough upper stomach is important to maintain proper nutrition. The small intestine is then divided with one end attached to the stomach pouch to create what is called an “alimentary limb.” All the food moves through this segment, however, not much is absorbed. The bile and pancreatic juices move through the “biliopancreatic limb,” which is connected to the side of the intestine close to the end. This supplies digestive juices in the section of the intestine now called the “common limb.” The surgeon is able to vary the length of the common limb to regulate the amount of absorption of protein, fat and fat-soluble vitamins.
Extended (Distal) Roux-en-Y Gastric Bypass (RYGBP-E)
RYGBP-E is an alternative means of achieving malabsorption by creating a stapled or divided small gastric pouch, leaving the remainder of stomach in place. A long limb of the small intestine is attached to the stomach to divert the bile and pancreatic juices. This procedure carries with it fewer operative risks by avoiding removal of the lower 3/4 of the stomach. Gastric pouch size and the length of the bypassed intestine determine the risks for ulcers, malnutrition and other effects.
Biliopancreatic Diversion with “Duodenal Switch”
This procedure is a variation of BPD in which stomach removal is restricted to the outer margin, leaving a sleeve of stomach with the pylorus and the beginning of the duodenum at its end. The duodenum, the first portion of the small intestine, is divided so that pancreatic and bile drainage is bypassed. The near end of the “alimentary limb” is then attached to the beginning of the duodenum, while the “common limb” is created in the same way as described above.
Advantages
- These operations often result in a high degree of patient satisfaction because patients are able to eat larger meals than with a purely restrictive or standard Roux-en-Y gastric bypass procedure.
- These procedures can produce the greatest excess weight loss because they provide the highest levels of malabsorption.
- In one study of 125 patients, excess weight loss of 74% at one year, 78% at two years, 81% at three years, 84% at four years, and 91% at five years was achieved.
- Long-term maintenance of excess body weight loss can be successful if the patient adapts and adheres to a straightforward dietary, supplement, exercise and behavioral regimen.
Risks
- For all malabsorption procedures there is a period of intestinal adaptation when bowel movements can be very liquid and frequent. This condition may lessen over time, but may be a permanent lifelong occurrence.
- Abdominal bloating and malodorous stool or gas may occur.
- Close lifelong monitoring for protein malnutrition, anemia and bone disease is recommended. As well, lifelong vitamin supplementing is required. It has been generally observed that if eating and vitamin supplement instructions are not rigorously followed, at least 25% of patients will develop problems that require treatment.
- Changes to the intestinal structure can result in the increased risk of gallstone formation and the need for removal of the gallbladder.
- Re-routing of bile, pancreatic and other digestive juices beyond the stomach can cause intestinal irritation and ulcers.
Combined Restrictive & Malabsorptive Procedure – Gastric Bypass Roux-en-Y
In recent years, better clinical understanding of procedures combining restrictive and malabsorptive approaches has increased the choices of effective weight loss surgery for thousands of patients. By adding malabsorption, food is delayed in mixing with bile and pancreatic juices that aid in the absorption of nutrients. The result is an early sense of fullness, combined with a sense of satisfaction that reduces the desire to eat.
According to the American Society for Bariatric Surgery and the National Institutes of Health, Roux-en-Y gastric bypass is the current gold standard procedure for weight loss surgery. It is one of the most frequently performed weight loss procedures in the United States. In this procedure, stapling creates a small (15 to 20cc) stomach pouch. The remainder of the stomach is not removed, but is completely stapled shut and divided from the stomach pouch. The outlet from this newly formed pouch empties directly into the lower portion of the jejunum, thus bypassing calorie absorption. This is done by dividing the small intestine just beyond the duodenum for the purpose of bringing it up and constructing a connection with the newly formed stomach pouch. The other end is connected into the side of the Roux limb of the intestine creating the “Y” shape that gives the technique its name. The length of either segment of the intestine can be increased to produce lower or higher levels of malabsorption.
Advantages
- The average excess weight loss after the Roux-en-Y procedure is generally higher in a compliant patient than with purely restrictive procedures.
- One year after surgery, weight loss can average 77% of excess body weight.
- Studies show that after 10 to 14 years, 50-60% of excess body weight loss has been maintained by some patients.
- A 2000 study of 500 patients showed that 96% of certain associated health conditions studied (back pain, sleep apnea, high blood pressure, diabetes and depression) were improved or resolved.
Risks
- Because the duodenum is bypassed, poor absorption of iron and calcium can result in the lowering of total body iron and a predisposition to iron deficiency anemia. This is a particular concern for patients who experience chronic blood loss during excessive menstrual flow or bleeding hemorrhoids. Women, already at risk for osteoporosis that can occur after menopause, should be aware of the potential for heightened bone calcium loss.
- Bypassing the duodenum has caused metabolic bone disease in some patients, resulting in bone pain, loss of height, humped back and fractures of the ribs and hip bones. All of the deficiencies mentioned above, however, can be managed through proper diet and vitamin supplements.
- A chronic anemia due to Vitamin B12 deficiency may occur. The problem can usually be managed with Vitamin B12 pills or injections.
- A condition known as “dumping syndrome” can occur as the result of rapid emptying of stomach contents into the small intestine. This is sometimes triggered when too much sugar or large amounts of food are consumed. While generally not considered to be a serious risk to your health, the results can be extremely unpleasant and can include nausea, weakness, sweating, faintness and, on occasion, diarrhea after eating. Some patients are unable to eat any form of sweets after surgery.
- In some cases, the effectiveness of the procedure may be reduced if the stomach pouch is stretched and/or if it is initially left larger than 15-30cc.
- The bypassed portion of the stomach, duodenum and segments of the small intestine cannot be easily visualized using X-ray or endoscopy if problems such as ulcers, bleeding or malignancy should occur.
Laparoscopic or Minimally Invasive Surgery
For the last decade, laparoscopic procedures have been used in a variety of general surgeries. Many people mistakenly believe that these techniques are still “experimental.” In fact, laparoscopy has become the predominant technique in some areas of surgery and has been used for weight loss surgery for several years. Although few bariatric surgeons perform laparoscopic weight loss surgeries, more are offering patients this less invasive surgical option whenever possible.
When a laparoscopic operation is performed, a small video camera is inserted into the abdomen. The surgeon views the procedure on a separate video monitor. Most laparoscopic surgeons believe this gives them better visualization and access to key anatomical structures.
The camera and surgical instruments are inserted through small incisions made in the abdominal wall. This approach is considered less invasive because it replaces the need for one long incision to open the abdomen. A recent study shows that patients having had laparoscopic weight loss surgery experience less pain after surgery resulting in easier breathing and lung function and higher overall oxygen levels. Other realized benefits with laparoscopy have been fewer wound complications such as infection or hernia, and patients returning more quickly to pre-surgical levels of activity.
Laparoscopic procedures for weight loss surgery employ the same principles as their “open” counterparts and produce similar excess weight loss. Not all patients are candidates for this approach, just as all bariatric surgeons are not trained in the advanced techniques required to perform this less invasive method. The American Society for Bariatric Surgery recommends that laparoscopic weight loss surgery should only be performed by surgeons who are experienced in both laparoscopic and open bariatric procedures.
Non-Surgical Weight Loss Program
This program will be open to anyone over the age of 16 who is interested in losing weight.
The program will not only provide participants with a dietary plan for weight loss but will also provide tools for effective psychological behavior modification.
Requirements
Before the participant can enter the weight loss program, medical clearance needs to be obtained either from the participant’s own Primary Care Physician (PCP) or the program's PCP. The "Weight Loss Medical Evaluation and Clearance" form must be completed by the participant’s own PCP and reviewed by the program's PCP before the participant can schedule the initial appointment with the psychologist and dietitian.
If Cleveland Clinic in Florida accepts participant’s insurance, the program's PCP's visit for clearance can be billed through the insurance.
Length of Program
The program will run for 9 weeks. The appointment will be done one-on-one on Wednesday with the dietitian (60 minutes) and the psychologist (75 minutes). These will be scheduled back-to-back.
Appointments 2 through 9 will be in a group setting and will meet on Monday for 60 minutes with the nutritionist and for 60 minutes with the psychologist. These group appointments will also be back-to-back. Participants will register at desk 23/24 to get weighed in by the dietitian. The groups will be held in a David Jagelman Center conference room.
Cost of Program
The fee will be $590 for all 9 weeks of both services payable at the first visit. This program will not be covered by insurance.
For additional information, please call:
Gina Sweat MS, RD, LD/N
954.659.5874
Download the form, have your primary care physician sign and fax it directly to Gina Sweat at 954-659-5256.
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Choosing Surgery
Weight loss surgery is major surgery. Although most patients enjoy an improvement in obesity-related health conditions (such as mobility, self-image and self-esteem) after the successful results of weight loss surgery, these results should not be the overriding motivation for having the procedure. The goal is to live better, healthier and longer.
That is why you should make the decision to have weight loss surgery only after careful consideration and consultation with an experienced bariatric surgeon or a knowledgeable family physician. A qualified surgeon should answer your questions clearly and explain the exact details of the procedure, the extent of the recovery period and the reality of the follow-up care that will be required.
They may, as part of routine evaluation for weight loss surgery, require that you consult with a dietician/nutritionist and a psychiatrist/therapist. This is to help establish a clear understanding of the post-operative changes in behavior that are essential for long-term success.
It is important to remember that there are no ironclad guarantees in any kind of medicine or surgery. There can be unexpected outcomes in even the simplest procedures. What can be said, however, is that weight loss surgery will only succeed when the patient makes a lifelong commitment.
Some of the challenges facing a person after weight loss surgery can be unexpected. Lifestyle changes can strain relationships within families and between married couples. To help patients achieve their goals and deal with the changes surgery and weight loss can bring, most bariatric surgeons offer follow-up care that includes support groups, dieticians and other forms of continuing education.
Ultimately, the decision to have the procedure is entirely up to you. After having heard all the information, you must decide if the benefits outweigh the side effects and potential complications. This surgery is only a tool. Your ultimate success depends on strict adherence to the recommended dietary, exercise and lifestyle changes.
Bariatric Surgery Center Network
This designation means that the Bariatric and Metabolic Institute’s program has met the essential criteria that ensure it is fully capable of supporting a bariatric surgery care program and that its institutional performance meets the requirements outlined by the ACS BSCN Accreditation Program.
Established by the American College of Surgeons in 2005 in an effort to extend established quality improvement practices to all disciplines of surgical care, the ACS BSCN Accreditation Program provides confirmation that a bariatric surgery center has demonstrated its commitment to providing the highest quality care for its bariatric surgery patients. Accredited bariatric surgery centers provide not only the hospital resources necessary for optimal care of morbidly obese patients, but also the support and resources that are necessary to address the entire spectrum of care and needs of bariatric patients, from the pre-hospital phase through the post-operative care and treatment process.
The American College of Surgeons is a scientific and educational association of surgeons that was founded in 1913 to raise the standards of surgical education and practice and to improve the care of the surgical patient. Its achievements have placed it at the forefront of American surgery and have made the College an important advocate for all surgical patients. The College has more than 69,000 members and is the largest organization of surgeons in the world.
Life After Surgery
The following identifies areas that will be important for patients to follow after weight loss surgery.
Diet
The modifications made to your gastrointestinal tract will require permanent changes in your eating habits that must be adhered to for successful weight loss. Post-surgery dietary guidelines will vary by surgeon. You may hear of other patients who are given different guidelines following their weight loss surgery. It is important to remember that every surgeon does not perform the exact same weight loss surgery procedure and that the dietary guidelines will be different for each surgeon and each type of procedure. What is most important is that you adhere strictly to your surgeon’s recommended guidelines.
The following are some of the generally accepted dietary guidelines a weight loss surgery patient may encounter:
- When you start eating solid food it is essential that you chew thoroughly. You will not be able to eat steaks or other chunks of meat if they are not ground or chewed thoroughly.
- Don’t drink fluids while eating. They will make you feel full before you have consumed enough food.
- Omit desserts and other items with sugar listed as one of the first three ingredients.
- Omit carbonated drinks, high-calorie nutritional supplements, milk shakes, high-fat foods and foods with high fiber content.
- Avoid alcohol.
- Limit snacking between meals.
Going Back to Work
Your ability to resume pre-surgery levels of activity will vary according to your physical condition, the nature of the activity and the type of weight loss surgery you had. Many patients return to full pre-surgery levels of activity within six weeks of their procedure. Patients who have had a minimally invasive laparoscopic procedure may be able to return to these activities within a few weeks.
Birth Control & Pregnancy
It is strongly advised that women of childbearing age use the most effective forms of birth control during the first 16 to 24 months after weight loss surgery. The added demands pregnancy places on your body and the potential for fetal damage make this a most important requirement.
Long-Term Follow-Up
Although the short-term effects of weight loss surgery are well understood, there are still questions to be answered about the long-term effects on nutrition and body systems. Nutritional deficiencies that occur over the course of many years will need to be studied. Over time, you will need periodic checks for anemia (low red blood cell count) and Vitamin B12, folate and iron levels. Follow-up tests will initially be conducted every three to six months or as needed, and then every one to two years.
Support Groups
The widespread use of support groups has provided weight loss surgery patients an excellent opportunity to discuss their various personal and professional issues. Most learn, for example, that weight loss surgery will not immediately resolve existing emotional issues or heal the years of damage that morbid obesity might have inflicted on their emotional well-being.
Most surgeons have support groups in place to assist you with short-term and long-term questions and needs. Most bariatric surgeons who frequently perform weight loss surgery will tell you that ongoing post-surgical support helps produce the greatest level of success for their patients.
Calendar of Events
The Bariatric Institute of Cleveland Clinic in Florida strives to educate the public on weight loss surgery options. We recognize the need for continued support as you adapt to a new lifestyle. All our support groups are a free service provided by Cleveland Clinic in Florida and are held at the David G. Jagelman Conference Center, Room 1 & 2. Please check monitor for confirmation of room number.
Meeting dates may be subject to change. You may contact the office for additional information 954.659.5239.
Information Sessions
Open to all interested in learning about surgical options for weight loss at Cleveland Clinic in Florida. Opportunity to meet with the surgeon, program coordinator, and insurance authorization specialist and to view videos on weight loss surgery procedures performed at Cleveland Clinic in Florida.
All new patients should attend an orientation prior to their office consultation. Pre-registration is not necessary. Please note, if you are traveling a distance greater than one hour travel time to attend the information session, you may schedule your consultation with the doctor for the same day.
Patient Education Webcast
View a free patient education webcast to learn about the risks of gastric bypass surgery. A certificate of completion will be provided at the end of webcast. This does not replace attendance to the Baritric Orientation Seminar at Cleveland Clinic in Florida.
Morning Sessions
- Weekly Tuesday with Dr. R. Rosenthal at 8 a.m. in Room 1 of the David G. Jagelman Conference Center. A video will be shown from 10 a.m. – 10:30 a.m. (optional).
- Weekly Thursday with Dr. S. Szomstein at 8 a.m. in Room 1 of the David G. Jagelman Conference Center.
- SPANISH ORIENTATION FROM 7:30 a.m. to 8:00 a.m. THURSDAY MORNINGS. This is ONLY offered on the last Thursday of the month. (Orientación ofrecido en Español en el jueves de 7:30 a 8 de la mañana).
Evening Sessions
English evening orientation will be available on the fourth Tuesday of every month from 5 p.m. to 7 with Dr. Rosenthal in room 1 of the David G. Jagelman Conference Center.
*The evening orientation on December 28th from 4:30 p.m. - 8 p.m. is canceled.
General Obesity Support Group Meetings
Obesity Support Group Meetings for all will be held the last Monday of each month at: David G. Jagelman Conference Center, Room 1 & 2, 6 p.m. to 7 p.m. Features a Guest Speaker with topic of interest for the group.
Cleveland Clinic Chat Group
5 p.m. to 6 p.m., preceding the General Support Group Meetings.
This is an opportunity for the post-operative patients to meet, share experiences and support each other.
Nutrition Support Group Meetings
Second Monday of each month, David G. Jagelman Conference Center, Room 1, at 9 a.m.
First Tuesday of the month from 5 p.m. – 7 p.m. in the Jagelman Conference Center.
For post-op patients only. Nutrition topic to be presented monthly by a registered dietician.
Sharon Katz
Procedure: Gastric Sleeve
Before Weight: 312 lbs.
After Weight: 140 lbs.
“I chose Cleveland Clinic Florida because of its reputation as the best bariatric program in South Florida...I cannot say enough about the incredible support I received…”
I went on my first diet in the fourth grade. For the next 30 years, I lost and then gained back hundreds of pounds. After my uncle passed away from complications related to morbid obesity, I decided to look into weight loss surgery. I chose Cleveland Clinic Florida because of its reputation as the best bariatric program in South Florida. The most appropriate procedure for my condition was gastric sleeve surgery, which was performed in January, 2009 by Dr. Szomstein. By February, 2010, I had lost a total of 162 pounds and met my goals! I cannot say enough about the incredible support I received and continue to receive from my team at Cleveland Clinic Florida. I spoke with nutritionist, Lillian-Craggs Dino, at least once a week throughout the year and had frequent email contact with Dr. Szomstein. I regularly attended support groups and was inspired by other patients who had maintained their weight loss for 5-10 years. I eat healthfully, work with a trainer, and exercise a minimum of 5 times a week. I look forward to maintaining my healthy weight and becoming in inspiration to other patients in the coming years.
Ralph Moccia
Procedure: Gastric Bypass
Before Weight: 340 lbs.
After Weight: 210 lbs.
“Cleveland Clinic Florida has a world class bariatric team, from the docs to the nurses and nutritionists. They have the tools to make it work…”
My weight loss success is credited to going to support and nutrition meetings. The dedication of the Cleveland Clinic staff is what has kept my weight off for over four years. I would do the surgery again in a heartbeat and I am a 1 million percent supporter of Cleveland Clinic Florida and Dr. Rosenthal.
I was always a big boy. However, I really put on some weight within two years of being diagnosed with Fibromyalgia. Due to high blood pressure, diabetes, sleep apnea and the lack of mobility, I gained 125 pounds. At that point, I needed to find a solution and sought help at the Bariatric and Metabolic Institute at Cleveland Clinic Florida. After consulting with Dr. Rosenthal, I decided to undergo the Roux-en-Y Gastric Bypass. In February, I celebrated my four year anniversary of the surgery. I have lost 130 lbs. and maintained a weight within five pounds of my lowest weight.
Cleveland Clinic Florida has a world class bariatric team, from the docs to the nurses and nutritionists. They have the tools to make it work, such as physiological and nutrition counseling, as well as a mentor group of former bariatric patients. This support is the key success factor - the rest is up to the patient to make changes in their behavior.
Michele C. Knowles
Procedure: Gastric Bypass
Before Weight: 245 lbs.
After Weight: 129 lbs.
“They provide a fabulous network of support for all patients - outstanding nutritionists, a psychologist and support group meetings - which is essential and vital for a gastric bypass patient...”
As I compose these words, many will read it and say, "this is me!" I have battled weight gain my entire life. I have tried this diet and that diet. I have lost and gained the same weight over and over again through the years. Then the weight loss stopped and I was only gaining. A red light went off in my head.
I did extensive research and talked to a lot of people before considering gastric bypass surgery. The decision to undergo gastric bypass wasn't made hastily. I visited several doctors for consultations and advice before choosing a doctor. Finally, I chose Dr. Raul Rosenthal at the Cleveland Clinic Florida in Weston. Not only is he a fantastic surgeon who made me feel comfortable and secure, but his entire staff is outstanding. They provide a fabulous network of support for all patients, such as outstanding nutritionists, psychologist, and support group meetings. This support is vital for a gastric bypass patient before and after the surgery.
I am very happy to say that I have lost 116 lbs. so far, and I must thank the entire staff at the Bariatric and Metabolic Institute. If you are struggling with weight and it has reached a point where you can no longer control it, do not hesitate to contact Cleveland Clinic Florida. You will not regret it.
