Written by SMH Senior Communications Editor Kim Savage
By the time most people visit Sarasota Memorial’s Bariatric and Metabolic Health Center, they often are facing life-threatening complications from obesity. Most have body mass indexes (BMIs) well over 40, are on multiple medications for high blood pressure, heart disease, diabetes and other high-risk health conditions.
“They come through our doors after trying every diet and weight-loss program imaginable – sometimes very dangerous ones – because they just want their health back,” said bariatric surgeon Dr. Arundathi Rao, medical director of Sarasota Memorial’s bariatric surgery program. “They know weight-loss surgery can help get them there … no other medical intervention improves people’s lives so dramatically.
“I just wish more people would come to us before they cross into danger zones.”
Alone and Afraid
For three years, Tony Tombrillo lived in near isolation in his Venice home. The retired metal worker was suffering disabling complications from chronic obstructive pulmonary disease (COPD) and pulmonary fibrosis.
Barely able to walk the length of his driveway without becoming short of breath, Tombrillo relied on oxygen 24 hours a day. Each day grew more challenging as he battled weight gain, high blood sugar, joint pain (he needed two hip replacements), vision problems, and a host of side effects from steroid medications and a reluctantly sedentary lifestyle.
“Life was very rough at that time,” explained Tombrillo, who at 310 pounds had failed every weight-loss program he had tried and was dangerously close to developing diabetes. “I knew I had to do something, or I wasn’t going to live much longer.”
At age 55, Tombrillo made his way to Sarasota Memorial’s Bariatric and Metabolic Health Center and began a life-altering path to wellness.
He spent six months with Dr. Rao and her multi-disciplinary team, learning about his condition and potential treatments, developing realistic goals and completing a checklist of requirements designed to prepare patients for weight-loss surgery.
Tombrillo underwent a vertical sleeve gastrectomy in March 2017. His recovery from the surgery was easier than he anticipated. The diet changes were significant, but the pre-surgery education prepared him well, and he said the SMH team’s ongoing support and nutrition counseling have helped him stay on track.
In the year after his surgery, Tombrillo lost 90 pounds and lowered his blood sugar to normal levels, reversing his pre-diabetes. His joint pain disappeared, his lung condition stabilized, and he averted the potentially fatal phase of pulmonary hypertension.
“I still have lung disease, but I feel 100 percent better,” he said. “I can get around easily now. I can go fishing and walk my neighborhood. I feel better than I have in decades.”
Most of all, he said, he feels hopeful for the future – one full of family celebrations and three grandchildren to visit and enjoy.
“My whole outlook on life has changed,” Tombrillo said. “I spent the first few years of being sick thinking, ‘Oh my gosh, I’m going to die.’ I’ve spent the last year thinking, ‘Oh my gosh, I’m going to live.’ ”
While decades of research and case studies have proven weight-loss surgery is a safe and effective first-line therapy for obesity, it is most often pursued as a last resort — sometimes too late to achieve optimal results.
Just 1 percent of eligible people get the operation, said Dr. Rao, in part because it remains largely misunderstood.
“Every patient is different, and it’s a big mistake to think one size fits all,” she said. “There are challenges that will test every patient’s determination, willpower and ability to change old habits. It’s our job as bariatric surgeons to dig deep and equip people with the right tool at the right time to ensure their optimal health.”
Though its mortality rate is less than a routine hip replacement, bariatric surgery comes with the risk of complications like bleeding or digestive issues, and patients have to change their eating habits dramatically to achieve lasting results.
But the benefits of bariatric surgery far outweigh the risks, in most cases. The surgery cuts obese individuals’ risk of premature death in half because of the myriad conditions it addresses.
Besides massive weight loss, bariatric surgery can improve or reverse diabetes, high blood pressure, sleep apnea, asthma, arthritis, gastric reflux, urinary stress incontinence and other obesity-related conditions in the majority of patients.
About 75 percent of bariatric patients have sustained weight loss five years after surgery, and patients who have weight-loss surgery before they become severely obese tend to achieve even better results.
Before recommending a course of treatment, Dr. Rao spends much of her initial consults getting to know her patients, evaluating their medical histories, personalities and risk factors. Selecting the right treatment for each patient is key, she said.
Candidates for surgery undergo pre-surgery counseling and a psychological evaluation to ensure that they are mentally prepared for the challenges that follow surgery. If surgery is recommended, they must complete a period of medically supervised weight loss (usually required by insurance), as well as a checklist of other pre-surgery education and preparations. The process can take six months or more. After surgery, SMH’s bariatric team provides long-term follow-up care and lifetime support.
“Surgery is actually the easiest part of the process,” Dr. Rao said. “The hard part is committing to the lifestyle changes necessary to make that surgery a long-term success.”
Weighing Your Treatment Options
To qualify for bariatric surgery, people must have a BMI of 35 or higher, plus diabetes or another obesity-related disease, or a BMI of 40 or higher without related disease. Sarasota Memorial’s bariatric surgeons primarily perform the two weight-loss surgeries that have proven over time to yield the best clinical outcomes and long-term patient success:
- Gastric Sleeve: Also known as a sleeve gastrectomy, this procedure creates a smaller, banana-size stomach, and the unused part of the stomach is removed. With no rerouting, food and nutrients are fully absorbed; it also causes changes in ghrelin hormones produced in the intestines that help reduce hunger, increase fullness and regulate blood sugar.
- Gastric Bypass: The Roux-en-Y gastric bypass surgery reduces stomach size to that of a walnut and attaches it directly to the middle of the small intestine, bypassing a large part of the stomach by stapling it shut. This limits how much you can eat and what your body can absorb. Although more invasive than the sleeve, the bypass remains the gold standard for people with severe insulin-dependent diabetes and multiple medical conditions associated with morbid obesity (BMI of 40 or higher).
- Revision Surgery: SMH’s bariatric team also specializes in reversing previous gastric procedures, removing/repairing failing gastric lap bands, and conversions for patients who have not gotten the desired results from an initial weight-loss surgery.
- Gastric Band: The laparoscopic adjustable gastric band now is recommended only in limited circumstances due to its low success rates across the nation.
- Duodenal Switch: This procedure is also known as a vertical gastrectomy with duodenal switch, biliopancreatic diversion with duodenal switch, DS or BPD-DS. SMH surgeons are not recommending this newer procedure until further studies are completed, as severe nutritional problems have been reported.
For more information, call Sarasota Memorial’s Bariatric and Metabolic Health Center at 941-917-4753, attend one of the upcoming Meet the Surgeon events, or visit smhbariatrics.com.
Kim Savage is Sarasota Memorial's public information officer and senior communications editor, overseeing media relations and external communications for the health system since 1999.
*Updated from article that first appeared in the Fall 2018 SMH Today.