As they introduce themselves around the table, they speak openly about why they have had or will have weight loss surgery.
“I needed the surgery. I had spine fusion and gained 60 pounds that I couldn’t lose,” says one.
“I was depressed trying to lose all this weight and I couldn’t do it myself,” says another.
“I’m here for my health,” says a third. “My blood pressure is high and my doctor said it would go away with surgery.”
Numbering nearly 20, they’ve come to St. Barnabas Hospital for the monthly bariatric surgery support group. The sessions are led by Rebecca Koch, the registered dietitian at the Center for Bariatric Surgery at SBH.
“We want you to talk about your experiences if you’ve had surgery, and your concerns whether you have or you haven’t,” she tells them. “Dr. (Nissin) Nahmias (the medical director of the center) is not here tonight because of ‘white coat syndrome,’ where people might not want to talk when their doctor is within listening distance.”
That certainly doesn’t seem to be the case here, as the participants seem generally fond of Dr. Nahmias, a genial sort, who is bilingual and keeps an electric guitar in his office that, as the interest in the program grows, gives him less chance to play.
The sessions feature a presentation from an outside speaker. Tonight,
a representative from Celebrate, an Ohio-based manufacturer of nutritional supplements, discusses the importance of vitamin and mineral supplements for pre-operative deficiencies, but most importantly for patients following weight loss surgery. This becomes part of any bariatric patient’s daily routine, as their needs for supplements to replace vitamins A, D, C and E, and such minerals as Thiamine, Folic Acid, Selenium and Magnesium increase due to a combination of decreased nutrient absorption and decreased food intake. Reducing the size of the stomach to a banana-like shape, as with the sleeve gastrectomy, or bypassing the duodenum as well as the stomach, as with gastric bypass surgery, causes malabsorption. “Calcium requires vitamin D for absorption, and vitamin C increases absorption of iron,” she says. “And iron and calcium don’t mix.”
The nutritional supplement representative uses different colored puppets, each representing one of the aforementioned vitamins and minerals, to drive home this point. She further discusses how her company offers meal replacements in flavors that truly cover the taste gamut from deep chocolate to, well, chicken soup.
Upcoming support groups will hear presentations from a social worker on the importance of self-care, and a plastic surgeon for patients interested in combining the health benefits of losing 100 or more pounds with the cosmetic improvements of eliminating excess skin.
To date, Dr. Nahmias has performed the sleeve or bypass surgery on about 60 patients in the year-old program, with another 200+ patients working their way through the multi-step process needed to obtain medical clearance. Although the steps may vary depending on their insurance requirements for authorization, most patients undergo a cardiology evaluation, a pulmonary evaluation (which may include a sleep study), a GI evaluation (which often includes an endoscopy) and a mental health evaluation. This is in addition to a medically-supervised weight management program which requires following up with the nutritionist for monthly counseling. Patients who smoke need to quit and demonstrate a negative nicotine test. If they have diabetes, their hemoglobin A1C must register below 8.5.
Vicki, who had bypass surgery in May, says she has more energy now than she has experienced in years. She’s lost 80 pounds and is able to wear more stylish clothing. She acknowledges that she still has work to do to get to her desired weight of 145 pounds (having previously weighed more than twice that much).
Joanna had the sleeve procedure performed two months ago. “It was not nearly as painful as I thought it would be,” she says. She finds that her tastes have changed since the procedure.“I don’t like sweets anymore,” she says. Her diet consists mostly now of fish, eggs, shredded chicken, crab, turkey and various vegetables (like peppers, onions, and green beans), but she admits to missing her old favorites: pizza and pasta. “I loved bacon, but I haven’t been able to eat it,” she says. She’s a little impatient about her weight loss – 30 pounds and counting – but she feels her decision to have surgery was the right one.
Alicia hasn’t had the surgery yet and is scheduled for early next year. She’s become well educated on weight loss surgery, and is planning on the bypass surgery. “I tried to lose weight after giving birth to my last child, but I couldn’t,” she says. She says she’s pre-diabetic and doesn’t want to end up like her mother, who has diabetes. Her goal is to lose about 100 pounds.
The surgery, she says without hesitation, “is something that I’m doing for me.”