For many people, it takes a journey to arrive at the point where they realize that bariatric (weight-loss) surgery and significant lifestyle changes are their best hopes for improved health—and it can be something of a struggle as well. Brandy Shifflett, of Shenandoah, Va., knows that struggle all too well. Although over a 10-year period she had tried a variety of weight-loss methods—including exercise, the Atkins diet, Weight Watchers and prescription pills—surgery wasn’t an option she was willing to consider.
“People told me not to do weight-loss surgery, and that I would regret it if I did,” recalls Shifflett. “I listened to the skeptics, so I was very much against it for a long time.”
Her opinion began to change, however, when one of her cousins underwent bariatric surgery.
“Her results were fantastic,” says Shifflett. “She had such success and felt so much better that
I began to reconsider. I went online and completed one of the weight-loss surgery seminars offered by Sentara. At that point I made the decision that surgery was my best option.”
Preparing for Weight-Loss Surgery
Having made the choice to move ahead, Shifflett’s journey was just beginning. Six months were required, in fact, for her to prepare for the surgery itself, during which she would meet with a nurse practitioner and dietitian every month and put into motion some of the changes that would help make her surgery a success. Those changes, she says, included learning about portion control before the procedure and healthful eating habits afterward.
“The caregivers at Sentara RMH counsel you fully and help bring you to the realization that your life is going to change,” says Shifflett, who works at the hospital in the Physician Billing Department. “That preparation is important because if you’re not ready to make the necessary changes in your lifestyle, there’s no point in having the surgery.”
For Shifflett, the sleeve gastrectomy—a permanent procedure in which a portion of the stomach is removed—was determined to be her best option. Her January 2016 surgery with Sentara RMH bariatric surgeon Robert Garwood, MD, was “perfect,” she says, and she was blessed to have “zero complications.” After a two-day stay at Sentara RMH, Shifflett went home, where she adhered to a prescribed regimen of walking. She was back at work within two weeks of her surgery and followed up with Dr. Garwood every three months for the first year. After that, follow-ups were scheduled only when needed.
Making the lifestyle changes she had learned about in the run-up to surgery was a no-brainer for Shifflett.
“Now, every single day, I make conscious decisions about my diet,” she says. “I think about what I eat and how I eat it. There’s nothing that’s really off-limits, although I do generally avoid high-fat foods, but I make the portions smaller and consider something before I eat it.”
As a result of her efforts, Shifflett says she feels much better. Her back no longer hurts, her feet no longer bother her, and now she frequently has lots of energy to get out and do things. She has dropped a phenomenal 121 pounds (having weighed approximately 300 pounds at one point prior to surgery), and she continues to gradually, healthfully work toward what she regards as a desirable weight.
“The surgery is a tool,” notes Shifflett. “It’s not an easy way out, though—you have to make a concentrated, personal investment to benefit from it. I’ve done the work, and I’m beyond ecstatic with my results.”
Getting Serious About Weight Loss
Diann Van Huss, of Harrisonburg, also had a sleeve gastrectomy after trying traditional and specialty diets, prescription medications, and exercise for about 16 years. While she was familiar with bariatric surgery—her sister and a friend had had success with gastric bypass—Van Huss was reluctant to go that route, due to the lifestyle changes such a procedure would require. She investigated the lap band procedure as well, but wasn’t sure it was right for her, either.
“I just didn’t take my weight loss seriously,” says Van Huss, an employee of the MillerCoors Shenandoah Brewery in Elkton. “I wasn’t willing to give up the overeating and all that. I hadn’t reached that point in my life.”
During a class at Sentara RMH about the lap band procedure, which Van Huss initially pursued, she learned more about the sleeve gastrectomy.
“Again, I knew the gastric sleeve procedure would involve a lifestyle change,” she says. “I simply had to get my mind around that and ask myself if I was serious about changing. The determining factor for me to have this type of surgery was strictly about my health. I didn’t have the energy to go places and do things with my grandchildren, for instance, and my goal was to make it to their weddings.”
“I knew the health choices I was making wouldn’t get me there,” she adds. “I was on the wrong path, and I knew it.”
She finally made the decision to go forward with the gastric sleeve, despite having some anxiety about the requisite lifestyle changes. However, she echoes Shifflett in praising Sentara RMH for thoroughly preparing her for surgery and for the shifts she would have to make afterward. In 2015, Van Huss had her surgery with Dr. Garwood, and she recuperated without complications.
“At first, the taste of food was different,” remembers Van Huss. “I didn’t have the desire to eat the foods I’d been eating for years—which was good, because we’re not supposed to eat that stuff anyway, right?”
“Then,” she continues, “I began to make conscious changes in the way I ate and the amounts that I ate. Surgery doesn’t stop you from wanting to eat steak, or half a chocolate cake, but you just need to make better choices. The surgery and the preparation provided by Sentara RMH reinforce that and help you make better health decisions. I recommend them for anyone who is in my situation.”
Since the surgery, Van Huss has lost about 150 pounds. She’s very pleased with her results and feels she is well on her way to being walked down the aisle at the weddings of her grandchildren.
The Lap Band: A Slow, Steady Weight-Loss Process
Unlike some other bariatric procedures, the laparoscopic band, or lap band, is reversible. And for Bethany White, of Elkton, also an employee of the MillerCoors Shenandoah Brewery, the lap band seemed to be the best weight-loss option. White’s situation differed from those of Shifflett and Van Huss in that she was prevented from exercising, due to her fibromyalgia. The pain and resulting loss of mobility caused by the condition led her to engage in what she calls “depressed eating,” which in turn contributed to her weight gain.
“When I got over 200 pounds, I knew I’d never be able to lose weight without some kind of help,” says White. “I chose the lap band because I didn’t feel I was at a point where I needed to lose weight quickly, as someone with serious health issues might.”
White had a successful surgery in 2012 with no complications. She says as long as she adheres to the guidelines she received from Sentara RMH before and after surgery, she has no problems with either the lap band or the required lifestyle changes, which together help to ensure healthful, lasting weight loss.
“I can eat anything I want, as long as I eat slowly, chew my food well and stick to a low-fat, high-protein diet,” says White. “I do avoid breads, rice and pasta, and I take my vitamins. Because I can’t exercise due to my fibromyalgia, I haven’t lost weight quickly, but it’s a slow and steady process that I continue to work at every day.”
White, who went into surgery at 230 pounds and has lost 70 pounds to date, says she is “absolutely pleased” with the procedure, Dr. Garwood and Sentara RMH.
A Life-Changing Choice
Dr. Garwood, who is also Sentara RMH Medical Center’s chief of surgery and the medical director for Sentara RMH Medical Group Surgical Services, says that the long-term prospects are excellent for people who have bariatric surgery and are committed to making lifestyle changes. According to Dr. Garwood, most of those patients will lose 70-75 percent of their excess body weight.
“Diabetics can see improved blood sugar control, those suffering from sleep apnea can get off their CPAP devices, and people with gastroesophageal reflux can experience a marked reduction in that condition,” he says. “In addition, weight loss through bariatric surgery reduces the risk of getting cancer in individuals who suffer from morbid obesity. We also see benefits in women who want to get pregnant, since excess weight can affect menstrual cycles and fertility.”
“All those are medical improvements,” he adds, “but bariatric patients are also able to look better and enjoy life more, and to be more active and engaged. In short, bariatric surgery, accompanied by a commitment to making the necessary adjustments, can be a life-changer.”
Obesity is a complex disease that has no single cause. Some of the elements that influence obesity include, but are not limited to, lifestyle, eating habits, genes, self-esteem levels, emotional concerns, trauma and medications. Health risks associated with obesity include high blood pressure, diabetes, heart disease and stroke. The American Heart Association reports that obesity costs approximately $190 billion a year in weight-related medical bills in the United States.
Who is Obese?
Obesity is determined through body mass index (BMI), which is a ratio of a person’s weight to his or her height. Anyone whose final BMI number is 30 or higher is considered obese (a simple BMI calculator can be found on the website of the National Heart, Blood and Lung Institute at https://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm).
The Bariatric Option
Bariatrics is the branch of medicine dealing with the causes, prevention and treatment of obesity. Bariatric surgery began in the 1950s but didn’t become reliably safe until 1965, when the gastric bypass was developed. Since then, additional techniques—most notably the lap band and gastric sleeve procedures—have been added to the available bariatric options. Both the lap band and gastric sleeve procedures are staples of the Sentara RMH Bariatric Surgery Program, which is headed by Robert Garwood, MD.
“Generally, an indication for bariatric surgery is a BMI above 40,” says Dr. Garwood. “However, some associated medical conditions, such as Type 2 diabetes and sleep apnea, can indicate that a lower number is applicable.”
“It’s important to note, though,” he adds, “that the operation is the easiest part of the whole deal. We tell patients that weight loss in and of itself isn’t a magic bullet—it takes an investment and commitment by the patient to make the lifestyle changes necessary to ensure that the weight loss is successful and lasting.”
Types of Bariatric Surgery at Sentara RMH
Laparoscopic Adjustable Gastric Banding
Also known as lap band surgery, this is a reversible procedure using laparoscopy, a surgical method that employs a fiber-optic instrument to view organs in the abdomen or to permit surgery. Being minimally invasive, the technique allows for rapid recovery and less discomfort than open surgery. A silicon band, into which a saline solution is introduced in the doctor’s office, is placed around the upper portion of the stomach, promoting a slow, steady weight loss.
“The goal of the lap band, which is adjustable, is to make the patient feel full quicker, resulting in reduced food consumption and, in turn, weight loss,” says Dr. Robert Garwood.
The sleeve gastrectomy, also known as gastric sleeve surgery, is the most recent of the available weight-loss surgery procedures, and involves laparoscopically removing approximately 75-85 percent of the stomach. The remaining stomach takes the shape of a tube or “sleeve” about the size of a banana. Limiting the amount of food the patient can eat and helping the patient feel full sooner, this procedure allows for normal digestion and absorption—consumed food passes through the digestive tract in the usual order, allowing it to be fully absorbed by the body.