With Dr. Ramsey Dallal, Director, Einstein Bariatrics, Einstein Healthcare Network
What are the surgical options to treat obesity?
“Two procedures in the United States account for the vast majority of weight loss operations performed,” explains Dr. Ramsey Dallal, director of Einstein Bariatrics. “The procedure most commonly performed is the gastric bypass. In that procedure, we cut the stomach and reshape it into the size of an egg or smaller. Then, we cut part of the small intestine and reattach it to that smaller stomach, creating a bypass and a rerouting of where the food will go.
“The second procedure is the sleeve gastrectomy. In that, we cut the stomach and reshape it into the shape of a tube and the size of a pencil,” Dallal says. “Both these procedures substantially decrease the hunger drive by changing the signaling to the brain. Also, people feel full quickly after eating.
“The Adjustable Band is a third option,” Dallal says, “but the long-term weight loss results have proven to be unpredictable while complications, although not life-threatening, are too common. Very few lap band procedures are done today.”
Who is a candidate for bariatric surgery?
“The national threshold — and that of insurance companies — is a of BMI 40, but can be dropped to 35 if people have a severe medical condition,” Dallal says. “These procedures are for people who are 100 lbs. over their ideal body weight.”
From consultation to recovery, what are the steps of bariatric procedures?
“First, the patient meets with me or another bariatric surgeon to review the options and risks, and have their questions answered,” Dallal says. “Next, they meet with our dietician to talk about their current diet and the diet they will be on after the procedure. They also are evaluated by a psychologist to assist with behavioral modification and transitioning to a new lifestyle. Then, we order labs, X-rays, an EKG and a few other preliminary tests. If all that goes well, we get approval from the insurance company and set the date for surgery.
“The surgery takes me about one hour to complete,” Dallal explains. “The patient stays in the hospital for one or two nights and generally goes back to work in 1-2 weeks. We have a vested interest to ensure the long-term health and success of our patients and plan life-long follow-up visits.”
What is the No. 1 misconception about bariatric surgery?
“The biggest misconception is held by people who are not obese,” Dallal says. “They think these are procedures for people who are vain. The procedures are offered due to a medical illness — obesity — that severely impairs quality of life, overall health and life expectancy. I also hear, ‘Why don’t they just exercise and diet?’ Only 5 percent of people are successful at maintaining substantial weight loss after a diet and exercise program.* The vast majority of people need more help.
“The patients who come to me know the toll that obesity takes,” Dallal says. “They are in chronic pain. They are in pain getting into their cars, going to the mall and sitting on airplanes. They have problems with their backs, knees and feet. Most have sleep apnea, so they are sleep deprived.
“Then, there is the psychological pain of obesity,” Dallal says. “Their quality of life has severely deteriorated. They can’t play with their kids or even go for a walk. They are socially isolated. By the time patients come to see me, it is to the point that they can’t take it anymore. Every moment of every day, they feel badly about themselves and their life. People underestimate what it is like to live with obesity. The obese get no sympathy, only judgment. Obesity is seen as a character flaw. It’s not. It is a disease.”
* According to American Psychologist, Vol. 62(3), April 2007