Bariatrics Team Offers Empathetic Care
for Often-Ignored Patients With Obesity
For many people with severe obesity, deciding to undergo weight-loss surgery can be an emotional and difficult process. The disease of obesity is an underlying cause of many life-threatening diseases and truly robs people of their quality of life.
Despite that, to seek treatment for their disease, those with weight problems have to overcome substantial biases from friends, family, and sometimes even their health care providers, says Ramsey Dallal, MD, chief of bariatric surgery at Einstein Healthcare Network.
The bariatric surgery team at Einstein has a different vision, Dr. Dallal says. “Our vision is to provide the absolute safest, most compassionate, empathetic care to a group of patients who have generally been marginalized and ignored.”
The issue, he says, stems from a failure of the health care system. While, physicians are very good at recognizing the complications of obesity such as diabetes and heart disease, there is very little education about the disease of obesity.
The Einstein bariatrics team recently launched an updated website designed specifically to help fill the gap.
“Our website is part of our plan to bypass the gaps in the medical community,” says Dr. Dallal, “to provide management and treatment for those with obesity.”
One important goal is to make sure that people who are searching online — most patients — have access to reliable information. “There’s a lot of poor, biased, or conflicting information out there,” Dr. Dallal says.
“People who are interested in weight loss surgery have researched it on their own,” he says. “They have done it in private. They have decided over a period of years whether surgery is right for them.
“They have a lot of emotion that goes with it. Excitement and hope, shame and embarrassment. They have conflicts with their family, who say we love you how you are, we don’t want you to have surgery. They have conflicts with themselves.”
The bariatrics website, launched in February, takes people through each stage of the decision process, from first thinking about surgery to choosing a procedure and a program, then adjusting to life afterward, including diet changes.
Bariatric surgery at Einstein includes a choice of two procedures, gastric bypass and sleeve gastrectomy. Both procedures reduce the size of the stomach, though in different ways. Gastric bypass also reroutes the flow of food to skip part of the digestive process.
The procedures are done laparoscopically, meaning that surgeons can operate through small incisions. This reduces pain and recovery time. Most people stay in the hospital just one night. They may be able to return to work within a week.
Einstein Bariatrics was founded in 2005 and now has three full-time surgeons: Dr. Dallal, Dr. Alfred Trang, and Dr. Matthew Hubbard. Einstein Bariatrics is one of the busiest weight-loss surgery programs in the greater Philadelphia region.
The program has won recognition for its high quality and excellent results. The honors include accreditation as a Comprehensive Center by the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program. This is a joint program of the American College of Surgeons and the American Society for Metabolic and Bariatric Surgery.
Studies show that bariatric surgery, sometimes called weight-loss surgery, leads to rapid loss of large amounts of weight. Two years after surgery, 90% of people will have lost between 60% and 95% of their excess weight. Most of that weight loss is lasting. In the long term, people gain back only 10% to 15% of the weight on average.
“The operations that we do drastically improve people’s quality of life, life expectancy, and innumerable medical problems,” Dr. Dallal says.
For example, one large population study found that bariatric surgery reduced deaths linked with diabetes by 90% and deaths from heart disease by 56%. More than half of people with diabetes actually have a remission of the disease after bariatric surgery.
Throughout the years and decades after surgery, Einstein’s bariatric program continues to support patients.
“We’re very proud of the fact that we take full ownership for our patients. We tell them all — and we mean it — that we follow you for life,” Dr. Trang says. “If they have any questions, any issues, five years down the road, 10 years down the road, they know to call us. We want those phone calls because we take care of our patients.”
Follow-up is long term because bariatric surgery is different from other types of surgery, he says. “It’s one of the few surgeries that will affect you for the rest of your life. Because bariatric surgery affects how you eat, how your digestive tract works, your weight loss, your health, all those things for the rest of your life, we feel that if there are any issues with that, we should be the ones managing it.”
Bariatric surgery is not for everyone. Generally, people must be at least 100 pounds over their ideal weight or have a body mass index (BMI) of at least 40. (There are exceptions for some people with severe medical problems related to obesity.) BMI is a measurement of weight in relationship to height. A BMI of 30 or more is classified as obese.
Einstein Bariatrics manages patients of all sizes, risks, and backgrounds, Dr. Dallal says. “We have taken care of those waiting for transplants, those completely immobile, those at the extreme of weight, those who are truly on their last leg.”
But the surgeons emphasize that all degrees of obesity are unhealthy and warrant treatment.
“Some of these patients may be turned down by other programs because they qualify as much higher risk,” Dr. Trang says. “We actually have had other programs unwilling to do surgery on a patient, but then refer to us.”
“We’ve had excellent results” with these patients, he says. “It comes down to perspective. You could look at it as ‘this patient is too sick to have surgery, very high risk.’ The different perspective is that this is the patient who benefits the most from surgery. They are the ones that are probably going to live much longer than if they didn’t have surgery.”
“While it feels good to take care of a 20-year-old who has minimal medical problems and is just trying to chase after a young child and feel comfortable, we’re also excited and enthusiastic to take care of the 60-year-old with heart failure on dialysis who is in a wheelchair and can’t walk, or may need home oxygen,” Dr. Dallal says. “These are individuals whose bodies have been ravaged by obesity for decades and have had terrible complications, people who others may be not inclined to take care of.”
Einstein’s program has the track record to provide a solution for these patients, Dr. Dallal adds. “Being confident in our experience and our ability to provide care safely allows us to operate on those people who are most direly in need.”