Helping the obese at Mercy Medical

According to the Centers for Disease Control and Prevention (CDC), more than one third of U.S. adults (35.7%) are obese, medical costs in 2008 related to obesity were $147 billion and obese people spent $1429 more than normal weight people on health issues.

“Unfortunately, in the Jewish community, obesity is not addressed,” said Rabbi Dr. Aaron Glatt, executive vice president and chief administrative officer at Mercy Medical Center. He noted that Mercy has a “very comprehensive” bariatric, or weight-loss, surgery program that has done 3000 procedures since it opened in 2003 with over 125 done per year. Bariatric surgery is done on patients who are overweight by 100 pounds or more and have failed to lose weight on diet and exercise regimens or medications.

The overeating that leads to obesity is a psychological issue that requires behavior modification, explained Glatt, and “eating is like smoking.” He also said that this is not for people with a metabolic problem. These procedures are not for most people and not “lechatchila (first option),” continued Glatt, but it is a “medically significant procedure and halachically and medically appropriate for a patient where all other options have failed, then it is a halachically and medically indicated procedure.” He stressed that there are “rigid criteria to make sure that the right patients get the surgery and the wrong patients don’t get the surgery.”

“It’s always reasonable to discuss these things with your local rav,” said Glatt, “and it should be done if there is any halachic doubt in your mind. In general, weight loss surgery is halachically permitted when it is medically indicated.”

When a patient has a BMI, a Body Mass Index, of over “30 with one medical problem related to obesity or greater than 40 BMI with no medical problems,” explained Dr. Shawn Garber, Director of The New York Bariatric Group and Chief of Bariatric Surgery at Mercy Medical Center, the patient is a candidate for bariatric surgery.

“There are many reasons that patients are obese,” said Glatt. It could be metabolic he said, but it’s “usually from overeating, poor nutrition choices, with caloric intake more than the caloric requirements.”

Weight loss surgery is only for obese patients and involves one of three possible procedures. The patient losses weight either by making the stomach smaller by using an implanted medical appliance as in gastric banding, by removing part of the stomach, as in sleeve gastrectomy or by making a smaller stomach pouch bypassing part of the stomach and connecting to the middle part of the small intestine as in gastric bypass surgery. Studies show that following surgery, patients maintain their weight loss and show a decrease of obesity related diseases.

Patients come for treatment, explained Garber, “because they are uncomfortable with their weight, they are developing medical problems related to obesity like diabetes, sleep apnea, hypertension, high cholesterol, joint problems, and their lives are severely limited by their weight. We perform virtually scar less single incision Lap-Band and sleeve gastrectomy as well as laparoscopic gastric bypass surgery. We do mostly Lap-Band and sleeve gastrectomy because they are the safest procedures.”

The program is “high quality,” emphasized Glatt, with “very experienced surgeons…delivering a supreme outcome in a high complication field.” He pointed out that the bariatric section in Mercy has specially sized wheelchairs, lifts to help the patients up and about after surgery, gurneys for larger sized patients, special equipment and staff experienced in the use of this equipment. “They do it regularly and have the equipment there all the time and a capable and knowledgeable staff to take care of such patients. They are in a separate area when they come out of the operating room and most go home the next day and return as an out patient to a private doctor’s office and not the hospital for follow-up. “

The surgery “doesn’t allow the patient to ‘pig out,’” stressed Glatt. They are on a “lifelong diet, that’s the nature of the disease, of obesity.” The procedure is a “tool, it doesn’t cure it but it helps you control it. The patient is counseled on diet and exercise. The repeat surgery rate is low; the procedures have a good success rate. The key component is behavior modification assisted by psychologists and counselors.” Garber concurred, “Most patients will lose an average of 60% of their excess weight after weight loss surgery. Depending on their motivation, they can do better or worse. It is important for patients to remember that bariatric surgery is a tool and not a cure for obesity and that they need to work with the surgery to get the best results.”

“Most patients maintain their weight loss long-term as opposed to non-surgical diets where most patients regain their weight,” stressed Garber. “Surgery is different than dieting because we give them a tiny stomach pouch and physically restrict how much a person can eat. If they eat too much they will vomit. Also patients report they feel much less hungry after surgery as well. Non-surgical diets patients are always hungry and eventually will just start eating more.”

When asked about reports of depression, malnutrition and osteoporosis in bariatric patients, Garber said, “Depression is common in 98% of patients who suffer from morbid obesity, so that is not a result of surgery but something they had prior to surgery. As far as malnutrition and osteoporosis, which are extremely rare, we monitor our patients very closely and do blood tests to recognize any problems and correct them promptly.” He noted that he never had a problem of suicidal tendencies in his patients. “We have a multidisciplinary team including psychologists and nutritionists that work at The New York Bariatric Group.”

Both Glatt and Garber touted the expertise of the staff and benefits of treatment at Mercy. “At Mercy we have one of the largest experiences and largest practice in the Northeast for bariatric surgery. We are also the only program on Long Island to offer the virtually scar less single incision laparoscopic Lap-Band and sleeve gastrectomy surgery which results in less scarring and less pain than the traditional laparoscopic surgery. The program at Mercy has also been ranked in the top 5% of bariatric surgery programs in the United States for the past six years in a row with the lowest complication rates.”