Optimizing Bariatric Care through Integrated Medical and Surgical Solutions

By: Will Smith
Monday, February 22, 2016

Rather than take a one-size-fits-all approach to obesity and metabolic conditions, healthcare professionals at Allegheny Health Network’s (AHN’s) Bariatric and Metabolic Institute leverage multidisciplinary expertise to tailor care plans to each patient.

“Traditionally, obesity hasn’t been properly addressed by the medical community,” says George Eid, MD, FACS, FASMBS, bariatric surgeon and System Director for the Bariatric and Metabolic Institute. “The disease is everywhere, but only recently has sufficient attention been paid to the epidemic.”

Only a small percentage of obese patients undergo bariatric surgery, and many aren’t aware of their medical and surgical options. Providers at AHN’s Bariatric and Metabolic Institute not only deliver the full complement of traditional and leading-edge therapies to help patients shed excess weight, but they’ve also established an extensive support network patients can access at all points on the care continuum to ensure long-term weight loss.

“The morbidly obese population hasn’t always had many effective weight-loss options. That’s why we’re so excited about the Bariatric and Metabolic Institute. Not only can we improve the lives of our patients with traditional, evidence-based therapies, but we can also look to advance the field and bring new treatment and technologies to bear.”
— George Eid, MD, FACS, FASMBS, bariatric surgeon and System Director for the Allegheny Health Network Bariatric and Metabolic Institute

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George Eid, MD, FACS, FASMBS

“Obesity is just like any other disease, and there are genetic, environmental and hormonal components to consider,” says Jennifer Holst, MD, endocrinologist and Associate Endocrinology Fellowship Program Director at AHN. “We optimize outcomes by addressing each facet of the disease and providing support in the areas where patients most need it.”

To treat obesity and its often-associated metabolic disorders, such as heart disease, high blood pressure, sleep disorders, Type 2 diabetes, insulin resistance and dyslipidemia, AHN’s Bariatric and Metabolic Institute deploys a multidisciplinary approach that harnesses the expertise of surgeons, dietitians, psychologists, endocrinologists, primary care physicians, social workers, bariatric medicine specialists and nurses.

Medical Treatment Options

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Jennifer Holst, MD

The FDA has recently approved four anti-obesity medications, underscoring a rapidly expanding armamentarium of medical treatment options, notes Dr. Holst.

Patients whose body mass index (BMI) is greater than 30, or those whose BMI is more than 27 and who are at risk for comorbid conditions such as heart disease, may be indicated for weight-loss medications. Bariatric medicine specialists and endocrinologists at AHN’s Bariatric and Metabolic Institute collaborate to identify the most advantageous medications and optimize dosages for each patient.

Medical management can be challenging, as dosages can change throughout treatment. For example, patients may lose weight initially but then plateau. AHN physicians identify weight-loss dynamics and adjust medications accordingly. Concurrent with medical management, patients meet with dietitians and psychologists to make lifestyle changes that cultivate weight loss. When patients are indicated for bariatric surgery, the same providers guide those patients through the preparatory presurgical process.

Surgical Options

The bariatric program at West Penn Hospital is an accredited American College of Surgeons Bariatric Center of Excellence with the current designation of Metabolic and Bariatric Surgery Quality Improvement Program Comprehensive Accredited Center. Numerous services of AHN’s Bariatric and Metabolic Institute are available at Jefferson Hospital in Jefferson Hills and Saint Vincent Hospital in Erie, as well, making care more convenient for patients throughout the region.

To qualify for bariatric surgery, patients must have a BMI of 40 or greater, or a BMI of 35 or greater and at least one obesity-related comorbid condition. Surgical candidates must also prove their commitment to weight loss by adhering to strict presurgical dietary and exercise regimens.

The AHN Bariatric and Metabolic Institute provides innovative, minimally invasive surgical options for weight loss, including:

  • Roux-en-Y gastric bypass. Surgeons laparoscopically reduce the size of the stomach to limit how much food patients consume and remove a portion of the small intestine to limit calorie absorption. The procedure results in rapid loss of 60–80 percent of the patient’s presurgical excess body weight, according to the American Society for Metabolic and Bariatric Surgery, and can resolve many comorbid metabolic conditions.
  • Sleeve gastrectomy. Laparoscopic removal of up to 80 percent of the stomach transforms the stomach into a sleeve-like shape and helps patients lose more than 50 percent of their excess weight.
  • Adjustable gastric banding. Surgeons laparoscopically place an inflatable band that divides the stomach and creates a smaller pouch that limits the amount of food patients eat at one sitting.

Minimally invasive approaches significantly reduce surgical complications and allow patients to return to work a few weeks after surgery.

Long-term Support

While surgical weight-loss procedures can produce extraordinary results, patients face a number of challenges after surgery. Psychologists, dietitians and nurses follow patients throughout the process and provide critical support. Long-term success of the operation hinges upon dietary and lifestyle changes learned preoperatively.

Patients also have access to AHN’s network of support groups and social media pages that include recipes, events and information about healthy eating.

An Important Partnership

Because obesity and obesity-related comorbidities require extensive treatment from a team of providers, specialists at AHN’s Bariatric and Metabolic Institute are eager to partner with primary care physicians to supplement the care they deliver.

“We provide the missing pieces of treatment of obesity,” Dr. Holst says. “A patient’s primary care physician may want to refer to the AHN Bariatric and Metabolic Institute for support from a dietitian, prescribing and monitoring of a very low-calorie diet, prescribing and managing of weight loss medications, and/or a surgical intervention. We can become part of the patient’s care team and round out their treatment plans.”

For more information about AHN’s Bariatric and Metabolic Institute, visit ahn.org/specialties/bariatric-and-metabolic-institute/locations-contact-us or call 412-359-5000.