UCLA Bariatric Surgery: Comprehensive Overview
Obesity is a significant medical condition demanding effective treatment to avert long-term health complications. Bariatric surgery serves as a valuable tool in addressing obesity and its related health issues. At UCLA Bariatric Surgery, the focus is on delivering exceptional surgical outcomes and unparalleled expertise in managing obesity and its associated health problems. Specialists and dietitians dedicate themselves to educating, understanding, and supporting patients as they embark on their journey toward improved health and enhanced quality of life.
Understanding Bariatric Surgery
Bariatric surgery, also known as weight loss surgery, encompasses surgical procedures designed to facilitate significant weight loss. These procedures work by either reducing the size of the stomach or rerouting the digestive process to limit calorie absorption. Research indicates that bariatric surgery can lead to a substantial reduction in excess weight, potentially up to 85%.
How Bariatric Surgery Works
Bariatric surgery procedures aim to induce weight loss through two primary mechanisms:
- Restriction: Reducing the size of the stomach limits the amount of food a person can consume at one time, leading to a feeling of fullness with smaller portions.
- Malabsorption: Altering the digestive tract reduces the number of calories and nutrients the body absorbs from food.
Types of Bariatric Surgery Offered at UCLA
UCLA Bariatric Surgery offers a range of surgical options, employing advanced and minimally invasive techniques to ensure expert care for each patient. These include:
- Roux-en-Y Gastric Bypass (RYGB): This procedure is considered the "gold standard" of weight loss surgery. The surgeon creates a small stomach pouch and connects it directly to the small intestine, bypassing a portion of the stomach and duodenum. This limits food intake and reduces calorie absorption.
- Sleeve Gastrectomy: Also known as gastric sleeve, this procedure involves removing a significant portion of the stomach (up to 80%), creating a smaller, sleeve-shaped stomach. This restricts food intake and can also reduce the production of ghrelin, a hormone that stimulates appetite.
- Lap Band Removal and Revision: For patients who have experienced complications or unsatisfactory results with Lap Band surgery, UCLA offers removal and revision procedures. This may involve converting the Lap Band to a gastric sleeve or gastric bypass.
- Gastric Bypass Revision: A procedure performed to help patients lose more weight after a previous failed gastric bypass surgery.
- Anti-Reflux Surgery: Many obese patients also suffer from gastroesophageal reflux disease (GERD). Gastric bypass surgery can effectively treat GERD and other obesity-related conditions.
Roux-en-Y Gastric Bypass (RYGB) in Detail
Roux-en-Y gastric bypass is a common bariatric surgery that involves creating a smaller stomach pouch and rerouting the small intestine.
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- A large part of the stomach is closed off, leaving a small pouch to hold food, limiting the amount that can be eaten at one time.
- The small intestine is cut below the duodenum and reattached to the new stomach pouch. This leaves a shortened path for food to travel through. As a result, some of the food that's eaten leaves the body as waste and is not absorbed as energy.
- The remaining pouch of the stomach and duodenum are also reattached to the small intestine farther down.
- This surgery can be done by open incision, laparoscopic, or robotic methods.
Advantages and Disadvantages of Gastric Bypass
Gastric bypass surgery’s advantages include:
- Very good short term weight loss (60 to 80 percent excess weight loss)
- Lasting, long term results. The data show that up to 20 years after surgery, most patients maintain more than 50 percent of their excess weight loss.
- Excellent resolution of obesity-related health problems
While it has many benefits, disadvantages may include:
- The long term complication rate is slightly higher than sleeve gastrectomy. Complications can be avoided with proper care, however.
- Patients are not allowed to take aspirin or other NSAIDS after surgery.
- All patients need to take vitamins for life after surgery. If they don’t, it could lead to long-term vitamin/mineral deficiencies, particularly deficits in vitamin B12, iron, calcium and folate.
Laparoscopic Approach
UCLA performs the Roux-en-Y technique for gastric bypass surgery laparoscopically, which means a shorter hospital stay, recovery time and less pain and scarring for you.
Is Bariatric Surgery Right for You?
Bariatric surgery is not a one-size-fits-all solution. It is typically considered for individuals who:
- Have a Body Mass Index (BMI) of greater than 40.
- Have a BMI of greater than 35 and one of the related health problems caused by obesity, such as hypertension (high blood pressure), diabetes, sleep apnea, severe joint pain, hyperlipidemia (high lipid (fat) levels in the blood), non-alcoholic fatty liver disease, heart disease.
- Have been unable to achieve a healthy weight loss sustained for a period of time with prior weight loss efforts.
Contraindications
Patients are not allowed to take aspirin or other NSAIDS after surgery.
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UCLA's Comprehensive Approach to Bariatric Care
UCLA Health distinguishes itself through its comprehensive and multidisciplinary approach to bariatric care. The program integrates various services to support patients throughout their weight loss journey.
Multidisciplinary Team
UCLA's COMET team features top surgical and disease specialists and dietitians - all working together to provide you with the best care possible.
Pre-Surgical Evaluation
Before deciding on the best treatment for you, our program’s physicians will meet with you one-on-one to understand your unique health issues and circumstances. If you choose to undergo surgery, our team of specialists meets monthly to discuss your care and identify any risk factors you may have.
Extensive Patient Education and Support
UCLA offers free information seminars for interested patients and their friends and family, supervised weight loss programs, psychological evaluations and support groups.
Advanced Technology
UCLA's operating rooms are equipped with the latest technology available, including two da Vinci Robotic systems, which allow surgeons to operate through a few small incisions and with enhanced vision and control.
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Post-Operative Care and Follow-Up
UCLA emphasizes long-term follow-up care to ensure the continued success of bariatric surgery. This includes:
- Nutritional guidance: Patients receive detailed instructions on post-operative dietary guidelines, including the gradual reintroduction of solid foods.
- Regular check-ups: Patients are typically seen every three months for the first postoperative year and once a year thereafter.
- 24/7 availability: The program's services are available to all patients on a 24/7 basis.
Benefits of Bariatric Surgery
Beyond weight loss, bariatric surgery can offer numerous health benefits, including:
- Improved Management of Obesity-Related Conditions: Bariatric surgery has been shown to improve or resolve conditions such as type 2 diabetes, hypertension, sleep apnea, and high cholesterol.
- Increased Life Expectancy: Studies suggest that bariatric surgery can increase life expectancy and reduce the risk of premature death for individuals with morbid obesity.
- Enhanced Quality of Life: Many patients report significant improvements in their physical and mental well-being after bariatric surgery.
Weight Loss Expectations
Within the first two years after gastric bypass surgery, you can expect to lose one-half to two-thirds of your excess body weight. Weight loss will continue, in most cases, for a year and a half before stabilizing.
Safety of Bariatric Surgery
The Agency for Healthcare Research and Quality (AHRQ) and many recent clinical studies have reported significant improvements in metabolic and bariatric surgery safety. The overall mortality rate for bariatric surgery is about 0.1 percent. That is less than gallbladder surgery (0.7 percent) and hip replacement (0.93 percent).
The primary reasons for improved safety include:
- The increased use of laparoscopy (At UCLA COMET, almost all bariatric procedures are done laparoscopically.)
- Advancements in surgical techniques
- ASMBS and American College of Surgeons (ACS) accreditation program
Studies show metabolic and bariatric surgery also increases lifespan. Individuals with morbid obesity, or a BMI (body mass index) greater than or equal to 30, have a 50 to 100 percent increased risk of premature death compared to individuals of healthy weight. Studies have shown that gastric bypass patients may:
- Improve life expectancy by 89 percent
- Reduce risk of premature death by 30 to 40 percent.
Over the long term, the risks of morbid obesity outweigh risks of metabolic and bariatric surgery.
Areas of Care at UCLA Bariatric Clinics
UCLA Bariatric Surgery Program offers a range of weight loss and weight management services.
- Adolescent bariatric surgery: The American Society of Metabolic and Bariatric Surgery recommends bariatric surgery as a treatment for some obese adolescents. These guidelines are based on recent data about the rising rate of childhood obesity and the effectiveness of weight loss surgeries. If adolescents have a body mass index (BMI) higher than 35 and another condition related to obesity, they may be candidates for weight loss surgery.
- Healthier Weight Management Program: This eight-week series educates participants about lifestyle modifications for long-term weight maintenance. Each week, a physician or specialized dietitian addresses a different factor that affects weight, such as nutrition, exercise or stress.
- Medical Weight Management Program: We use a holistic approach that assesses every element that affects weight loss. These elements might include environmental, metabolic, genetic or social factors. Treatment through this program may include an individualized diet plan, medically supervised weight loss or group cognitive behavioral therapy classes. Because we understand that weight maintenance is just as important as weight loss, we also offer a program for long-term weight management.
Conditions Treated
Bariatric surgery can also be part of your treatment plan for a range of obesity-related conditions, including:
- Diabetes: A disease that affects how your body processes blood sugar.
- Fatty liver: Fat buildup in the liver (the organ that digests food and gets rid of toxins).
- Hyperlipidemia (high cholesterol): When there are high levels of fat particles in your blood.
- Hypertension (high blood pressure): When the pressure against your artery walls is chronically too high.
- Osteoarthritis: A degenerative disease in which cartilage (the flexible tissue that cushions between your bones) wears down.
- Polycystic ovary syndrome: A hormonal imbalance that can lead to small cysts on the ovaries.
- Sleep apnea: A sleep disorder characterized by breathing stopping and starting throughout the night.
Adolescent Bariatric Surgery
Childhood obesity remains a major public health problem. Adolescents with morbid obesity require a multidisciplinary approach to their care involving at minimum a physician, dietitian, and psychologist. Patients who meet criteria and demonstrate a commitment to follow up can be considered for bariatric surgery.
There are several benefits to early intervention including the following:
- earlier resolution of comorbid conditions
- lower achievable weight
- earlier improvements in quality of life.
Considerations for Adolescent Bariatric Surgery
Adolescents with morbid obesity should undergo extensive evaluation prior to consideration for bariatric surgery. As with adults, bariatric surgery is only a tool to aid patients achieve better health. Patients must demonstrate a commitment to lifestyle changes, including diet and physical activity. In general, patients must undergo a physician-supervised behavioral therapy program for a minimum of six months. BMI criteria recommended for adolescents are similar to those for adults (BMI >35 with serious comorbidities or BMI >40 with other comorbidities). Physical and skeletal maturity is advised especially if intestinal bypass is considered. In general, the minimum recommended age is 13 for adolescent girls and 15 for adolescent boys. Patients must be evaluated by a psychologist or psychiatrist ideally with expertise in both adolescent and bariatric psychology. As bariatric surgery requires strict adherence to post-operative dietary regimens and follow up, patients and their families are expected to be have excellent attendance at preoperative clinic visits as this may be predictive of postoperative adherence. Female patients must commit to avoiding pregnancy for the first two years after surgery. Ideally, adolescent bariatric surgery candidates should be evaluated by a multidisciplinary team consisting of a bariatrician, dietitian, psychologist, surgeon, and other specialists when indicated. Some have proposed the ideal setting for adolescent bariatric surgery centers to be a children’s hospital within an adult hospital. This setting provides the pediatric specialty support with the backbone of a large-volume adult bariatric practice. In addition, this environment facilitates transition of care from adolescence to adulthood.
Surgical Options for Adolescents
Gastric bypass remains the gold standard weight loss surgery for both adolescent and adult patients. Gastric bypass has been demonstrated to have similar results in adolescents as in adults. Gastric bypass in adolescents has also been demonstrated to be more effective than gastric banding in weight loss and resolution of comorbidities. The mean excess body weight loss for adolescents patients undergoing gastric bypass is greater than 60 percent. The majority of patients with preoperative type 2 diabetes can expect to be off medications with normal hemoglobin A1C levels within one year of the surgery. Dramatic improvements in quality of life have also been demonstrated. The disadvantage of gastric bypass is the malabsorption caused by intestinal bypass and the life-long need for nutritional supplementation. Furthermore, intestinal bypass can impair medication absorption and impair the ability to perform endoscopic surveillance of the bypassed foregut.
Gastric Banding in Adolescents
Adjustable gastric banding has become increasingly popular in adults because it is heavily marketed, considered less invasive and reversible, and requires a shorter hospitalization than other bariatric procedures. Utilization of the gastric band for adolescents has been somewhat limited as bands have not yet received United States Food and Drug Administration (FDA) approval for patients under age 18 in the United States.
Why Choose UCLA Health for Weight Loss Surgery?
UCLA Bariatric Surgery offers surgical treatments for sustained weight loss, with the goal of improving your quality of life.
Exceptional Outcomes
Bariatric surgeries are among some of the safest procedures, thanks to advanced techniques and strict quality measures. UCLA patients report a surgery satisfaction rate of greater than 95%. Compared to the national average, UCLA surgeons perform 50% fewer revision operations and their patients have a 24-hour shorter hospital stay.
Advanced Technology
UCLA equips its operating rooms with the latest technology. For example, they have two da Vinci Robotic systems, which allow surgeons to operate through small incisions with increased precision and control. Robotic and minimally invasive surgeries offer patients a lower risk of complications, less pain and faster recovery times.
Extensive Patient Support
UCLA offers free informational seminars and organized programs to educate patients and their family members about bariatric surgery and weight management. You may work with a dietitian, connect with a psychologist or join one of our support groups.
Comprehensive Team Approach
Because obesity is associated with many conditions, you may need more than one specialist on your treatment team. UCLA's program includes experts in bariatric surgery, hepatology (the study of liver disease), cardiology, gastroenterology and endocrinology.
Streamlined, Convenient Care
UCLA aims to ensure that your time at their center is as productive and stress-free as possible. They take the time to get to know you and learn about your individual circumstances so that they can write a treatment plan that best meets your needs.
Potential Risks and Considerations
- Gallstones: Rapid weight loss can cause deposits in the gallbladder called gallstones. The gallbladder may need to be removed at a later date. If you already have gallstones, the gallbladder may be removed at the time of your RYGB operation.
- Vitamin and Mineral Deficiencies: All patients need to take vitamins for life after surgery. If they don’t, it could lead to long-term vitamin/mineral deficiencies, particularly deficits in vitamin B12, iron, calcium and folate.The disadvantage of gastric bypass is the malabsorption caused by intestinal bypass and the life-long need for nutritional supplementation.
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