Dear Bariatric Times Editor:

I noted with interest the article by Cynthia Buffington, PhD, entitled, “Alcohol Use and Health Risks: Survey Results,” which appeared in the March 2007 issue of Bariatric Times.[1] Recent inquiries to the International Bariatric Surgery Registry (IBSR) from patients or family members have been requests for information regarding the incidence of alcoholism following bariatric surgery.

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by Sayeed Ikramuddin, MD; Daniel Leslie, MD; Bryan A. Whitson, MD; and Todd A. Kellogg, MD, PhD

All from the University of Minnesota Medical Center in Minneapolis, Minnesota.

This article serves as an update of an article on the same topic published in Bariatric Times in September, 2005. (Ikramuddin S, Kellogg, TA. Energy Metabolism and Biochemistry of Obesity. Bariatric Times 2005;(2)5:37–9)

Introduction

Obesity, though clearly a result of energy excess in comparison to energy expenditure, has been difficult to establish as a disease. It is true that obesity is now occurring at epidemic proportions. In parallel, efforts to treat obesity are increasing. Currently, surgery is the only proven treatment resulting in sustained weight loss for the morbidly obese.[1] It is important to stress that surgery alone is not effective; however, surgery in a program of behavioral modification and sustained caloric reduction results in sustained weight loss greater than five years.

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by Margaret Houk, RN, BSN

Margi Houk, RN, BSN, is a case manager with Saint Mary’s Health Plans, Reno, Nevada.

My Journey to Surgery

I have struggled with my weight since my birth. It is a family disease; my older brother has also dealt with a lifelong battle against morbid obesity and all of its associated health problems. In the fall of 2002, my brother nearly died while on a hunting trip to Colorado from complications of being at a high altitude. He was in the ICU on a ventilator for seven days and was the forced to be dependent on a supplemental oxygen tank for a full year following the trip. That development was the slap in the face I needed; I suddenly saw myself going down the same path and realized that with my similar health and weight situation, I was staring at an untimely and young death looming on the near horizon.

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TELL US ABOUT THE ROLES AND RESPONSIBILITIES OF THE LEAD STAFF AT YOUR FACILITY.

Western Bariatric Institute is an established, highly experienced, multidisciplinary, surgical weight loss center located in Reno, Nevada. With a long track record of professional care, compassionate service, and outstanding outcomes, we are dedicated to providing our patients with the highest level of care available. Our practice houses four board-certified surgeons, three advanced practice nurses, a registered nurse, two medical assistants, a dietitian, and a whole line of support staff to care for our bariatric patients through every step of the process towards weight loss surgery. In total, we currently have 24 employees who specialize in providing outstanding patient care and service.

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JONES: Laparoscopic vs. Open Roux-en-Y Gastric Bypass: Does the Data Support One Method Over the Other?

Kenneth B. Jones, Jr., MD, FACS, is Clinical Assistant Professor of Surgery, Louisiana State University, Health Sciences Center, Shreveport, Louisiana.

The term “minimally invasive, open Roux-en-Y gastric bypass with a left subcostal incision (RYGBP-LSI)” appears to be an oxymoron. “Open RYGBP” means a xiphoid to umbilical midline incision, but that may not always be the case. Many bariatric surgeons use a much smaller incision, and in over 4,000 bariatric cases (including various gastroplasties earlier on and then RYGBP in the past 20 years), I have used a left subcostal incision exclusively, which levels the laparoscopic versus open playing field, relative to abdominal access.

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by James W. Saxton, JD; Maggie M. Finkelstein, JD;
and Susan Gallagher Camden, RN, MSN, PhD

Both from Stevens & Lee, Lawyers and Consultants

This third installment of our newest Bariatric Times column serves to answer all of your legal, managerial, treatment-related, and universal bariatric questions. Keep in the loop simply by reading your fellow bariatric professionals’ questions and our experts’ answers in the coming issues, or by sending in your own inquiries involving issues in your bariatric practice.

We are really interested in creating a customer-centered practice. Can you give one example of a bariatric surgery program that provides a high level of customer service?

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by Louis J. Aronne, MD, FACP,and Kathy Keenan Isoldi, MS, RD, CDE

Dr. Aronne is Former President of the North American Association for the Study of Obesity and a Fellow of the American College of Physicians. He has authored more than 40 papers and book chapters on obesity, and edited the National Institutes of Health Practical Guide to the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. He is a consultant to the VA Weight Management/ Physical Activity Executive Council. Kathy Keenan Isoldi, MS, RD, CDE, is Coordinator of Nutrition Services at The Comprehensive Weight Control Program, New York, New York. Ms. Isoldi has been counseling adult and pediatric clients seeking weight management for the past 19 years. She is currently a doctoral candidate at New York University.

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by Carol Bradley, RN, CS, MSN

From the Saint Mary’s Regional Medical Center; Adjunct Clinical Professor, Orvis School of Nursing, University of Nevada, Reno, Nevada

Address for correspondence:
Carol Bradley, RN, CS, MSN, Saint Mary’s Center for Health, Bariatric Surgery Center of Excellence, 645 N Arlington Ave., Suite 200, Reno, NV 89503; Phone: (775) 770-3174; Fax: (775) 770-6908; Email: carol.bradley@saintmarysreno.com.

Background

There is increasing consensus that bariatric surgery is superior to medical intervention for long-term weight loss in morbidly obese persons.[1] Most postoperative patients are able to lose a significant amount of weight, profit from reduced or resolved comorbidities, and have an improved quality of life (QOL).

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