Since 2002, The Weight Loss Surgery Program at Baylor University Medical Center at Dallas has offered qualified patients options for surgical weight loss. The program was recognized last year by the American Society for Bariatric Surgery as a Bariatric Surgery Center of Excellence, a designation for centers with a demonstrated track record of favorable surgical outcomes. Baylor Innovations spoke to Todd McCarty, MD, medical director of the Weight Loss Surgery Program, about Baylor's program:

National Estimates of Bariatric Surgery

	In the past 10 years, the number of bariatric surgeries has skyrocketed, according to a survey by Agency for Healthcare Research and Quality. This chart shows the growth from 1998 to 2004 in bariatric surgeries by payer. Private Medicare Medicaid Uninsured Other 10,167 1,106 940 704 469 94,947 9,015 6,560 6,408 4,125

A. Generally somebody who is at least 100 pounds overweight. We use a more accurate description using the body mass index (BMI). Most patients need a BMI greater than 35 (according to the National Heart, Lung, and Blood Institute, a normal BMI is less than 25) and need to have failed previous attempts at nonsurgical weight-loss therapy. Patients also need to understand the role of surgery — that it is not a magic bullet. Significant behavioral and dietary modifications must be made after surgery to maximize the weight loss.

A. Today the majority of what primary care physicians treat and the problems they see are related to obesity. This includes diabetes, heart disease, joint disease and reflux disease. Bariatric surgery [along with behavioral and dietary changes] is incredibly effective in solving these medical problems . So, when you think about that, surgery is the most effective treatment we have for some of the most common medical problems.

A. We spend an extraordinary amount of time with our patients, including a free three-hour patient information seminar. Patients also have dietary counseling and psychological counseling along with surgeon consults to make sure they understand the magnitude of the surgery, the expected results and the possible risks.

A. We have a very extensive after-care program to optimize their weight loss, which includes weekly support group meetings that focus on improved health and include subjects such as depression, nutrition, plastic surgery, how to cope with stress, and holiday stress. The lifestyle and health considerations after surgery are fairly significant. We expect our patients to maintain a healthy diet and to integrate significant exercise into their life. In the end, even though the surgery is significant, it is an operation and it pales in comparison to the changes the patient has to make in his or her life. It takes two to three years to lose the weight and by that time, the surgery was a small part of it. It is the after-care, the commitment, the changes to a patient's lifestyle that ensure long-term success.

A. It depends on where the surgery is done. In the past, these surgeries were not closely tracked. Currently there is an emphasis on hospital-based programs, especially Centers of Excellence...[because] at a Center of Excellence, the [level of risk] is inherently lower. As for the surgery, the patient has a 0.1 percent chance of dying from the surgery. Within 30 days of the operation there are risks of bleeding and blood clots, as well as leakage from the intestinal tract.

A. We want the patients to choose the procedure they are most comfortable with. Which one would be prescribed over another is an individual decision made after extensive discussion and dialogue with the program and the surgeon. Revisional surgery is more complex and the risk is slightly higher so we have to individualize that based on what the previous surgery was.  : :

	Baylor offers three types of surgery: laparoscopic Roux-en-Y gastric bypass surgery (RYGB), laparoscopic adjustable gastric band surgery (Lap-Band®), and laparoscopic revisional surgery. During RYGB and Lap-Band® procedures, the stomach size is reduced to limit the amount of food it holds. As a result, you eat less food and lose weight. During RYGB procedures, 2/3 of the stomach is bypassed by creating a small pouch with the remaining portion of the stomach. The small intestine is then attached to the pouch. The intestine absorbs less food than before. As a result, you absorb less of the food you eat. In Lap-Band® procedures, the stomach is wrapped with an adjustable silicone band connected to an access port next to the abdominal wall, allowing the physician to increase or decrease the band's tension by injecting or withdrawing saline. Either procedure can be reversed through revisional surgery if results of a prior gastric surgery are unsatisfactory or if other issues indicate a reversal. Most revisional surgeries performed at Baylor are laparoscopic.

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* Patients should discuss the risks with their surgeons. Risks include those that are related to all types of surgeries as well as certain risks that are specific to this surgery.