Weight loss surgery, either through gastric bypass, or gastric sleeve, has been endorsed by the National Institutes of Health as the only effective means of bringing about long-term weight loss in the severely obese. Two to five years after the procedures, patients have usually lost 50 to 70% of their excess body weight. Typically, patients' co-morbidities gradually start to resolve. These include improvement in diabetes control. In fact, many patient’s with Type 2 diabetes find that their blood sugars levels improve almost immediately after surgery and become completely normal within a year of surgery. Other improvements include: lowered blood pressure and total cholesterol, relief from sleep apnea, severe acid reflux and urinary stress incontinence, and eased lower back pain and osteoarthritis.
People who may benefit from gastric bypass or gastric sleeve surgery include those who:
- Have a body mass index of 40 or higher.
- Have a body mass index of more than 35 with significant obesity related health problems, such as diabetes, sleep apnea, high blood pressure and other complications of obesity.
- Click here to determine your BMI, using the American Society of Bariatric Surgery's calculator.
- Are between the ages of 18 and 65.
- Have tried multiple attempts at non-surgical weight loss programs without success. Studies have shown that only 3 to 5 percent of people with severe obesity have lasting success with non-surgical methods.
- Are motivated and committed to complying with the lifelong post-operative care and lifestyle changes that weight loss surgery demands.
- Agree to quit smoking or other forms of nicotine use prior to applying to the program and must stay tobacco and nicotine free up to and following surgery (Ask about smoking smoking cessation classes at SMHC).
- Must have a dedicated support partner.
- Women must agree to use birth control for one year after surgery.
- Have physical, psychological, social or economic problems that could be significantly improved by weight loss.
Some people who meet the above requirements still may not be considered for surgery. For example:
- Obesity caused by a metabolic or endocrine disorder.
- Men who have a BMI of above 55 and a BMI over 60 in women.
- A history of substance abuse.
- Patients who do not meet psychiatric guidelines.
- Have severe medical problems for which surgery would be dangerous.
- Unable to commit to appointments and requirements of the program.
Michael Carroll, MDDr. Michael Carroll is the medical director of the Weight Loss Surgery and Weight Management Program at Southern Maine Health Care. He is certified by the American Board of Surgeons and is a Fellow with the American College of Surgeons. Dr. Carroll is also a member of the American Society for Metabolic and Bariatric Surgeons and the Society of American Gastrointestinal and Endoscopic Surgeons. He has practiced in Maine since 1996 and has been performing bariatric surgery since 2003. He currently performs Laparoscopic Roux-en-Y gastric bypass, Laparoscopic gastric banding and Laparoscopic sleeve gastrectomy.
Shannon Wickman, RD, Bariatric Program Coordinator
Shannon Wickman is a licensed bariatric dietitian and the Bariatric Program Coordinator here at SMHC. Through her role, she coordinates the care of patients who undergo weight loss surgery. Shannon attends all informational seminars and support groups, answers questions about insurance coverage and guides patients through the program. She is available for advice and support through the entire surgical process. She brings 10 years of experience working with the bariatric population through nutrition and weight management counseling. She is a strong advocate for her patients and is passionate about helping people reach their health goals through nutrition education and support. Shannon enjoys good food, music of all kinds, hiking, dancing and spending time with her family.
Devin Cain, LCPCDevin Cain is a Licensed Clinical Professional Counselor at Southern Maine Health Care. Devin completed her undergraduate studies in Psychology at the University of Maine in Orono. She then continued her education at William James College in Newton, Massachusetts. Devin graduated with a Master’s in Clinical Mental Health Counseling, specializing in Behavioral Health and Medicine. While in graduate school, Devin discovered her passion for working with bariatric patients, interning for a full year at a large Bariatric Surgery facility in MA. During this time, Devin was certified as a My Hungry Head facilitator and a FreshStart Smoking Cessation facilitator. Devin conducts behavioral health assessments for the bariatric program and provides patients with counseling and additional support services as they progress through the program. Devin enjoys spending time with her family at the beach, video games, hiking, and other outdoor activities during the summer.
Chelsea Ferk MS, RD, LDChelsea is a Clinical Dietitian, specializing in bariatric nutrition, at Southern Maine Health Care. Chelsea completed her undergraduate studies in Dietetics at the University of Wisconsin – Stout. Chelsea was then accepted into the dietetic internship program at the University of Maine in Orono, where she also earned a Master’s Degree in Food Science and Human Nutrition. Currently, she is entering her third year of helping patients achieve their nutrition and weight management goals. Outside of the hospital, Chelsea enjoys synchronized skating, downhill skiing, cooking and spending time outdoors.
Our program uses a team approach to ensure success and long-term weight control. The primary player in this team is the patient. We take a team approach before, during, and after treatment with surgery. However, no operation alone is a cure for obesity. The operation gives most patients better control of their food intake for the rest of their lives. We expect our patients to stay in touch with us and involved in the program during the 12 months after surgery and then annually. The Weight Loss Surgery Team consists of the patient, dietician, psychologist, nurse, surgeon and the patient care coordinator.
For more information, please call 207 - 284-2630.
The two weight loss surgery options at Southern Maine Health Care are:
Roux-en-Y Gastric Bypass
The Roux-en-Y gastric bypass is one of the most popular and successful surgical options for long term weight loss in the morbidly obese in the United States. It is a restrictive and malabsorptive procedure.
A portion of the stomach is divided off creating a small pouch for reduced food intake. The new pouch only holds about an ounce of food or less. This causes a feeling of fullness just after eating a few bites or restriction.
The small intestine is brought up and sewn to the pouch. Because most of the stomach and small intestine has been bypassed, this allows less calories and nutrients to be absorbed or malabsorbed.
Laparoscopic Sleeve Gastrectomy
The third procedure offered at SMHC is the Sleeve Gastrectomy. As the name describes, a portion of the stomach is permanently removed, leaving a small tube or "sleeve" that will hold only a little bit of food. This will make you feel full more quickly and less hungry after meals.
Normal digestion and absorption is unchanged. This procedure is not reversible. This procedure may also be used as a staged procedure; a first step to gastric bypass for patient’s that are severely morbidly obese for initial weight loss.
Weight Loss Following Surgery
Surgery alone will not remove the excess pounds and keep them off. It is only a tool. To reach a healthy weight, patient’s must adjust their eating habits and exercise patterns. The greatest weight loss usually occurs in the first year to 18 months following the Rou-en-Y surgery with 50 to 75 percent loss in excess body weight and greatest weight loss in 2 to 3 years for the Lap band with 45 to 60 percent loss of excess weight. Southern Maine Health Care has had excellent results from surgeries performed with high patient satisfaction rates
The medical and emotional benefits of these procedures begin almost immediately after surgery, and the cosmetic benefits follow in their wake. Over time, the benefits may include:
- Significant sustained weight loss
- Blood-sugar levels for patients with Type 2 diabetes that improve almost immediately and become completely normal within a year of surgery
- Lower blood pressure
- Lower cholesterol
- Relief from sleep apnea and acid reflux
- Less osteoarthritis pain and improved mobility
- Improved mood and self-esteem
The three weight loss surgeries are major surgical procedures, which have risks. Your surgeon will discuss this further with you when you have your consult.
The information session will provide you with an overall guide for each of the surgical procedures. Once your application is received you will be scheduled for appointments with the:
- Dietitian consult
- Pulmonologist (evaluate for sleep apnea)
- Labs and diagnostics will be ordered
- Support group attendance (ongoing support group attendance is recommended, preferably with your support person - two support group attendances are mandatory in order to proceed with the program)
- Ongoing communication with your primary physician regarding your interest in weight loss surgery
- Physical therapy evaluation may be recommended to assess your exercise pattern
- Initial consult with Dr. Carroll once the above has been achieved
- Psychologist evaluation
- Bariatric team discussion
Some insurers consider weight loss surgery as elective. Although there are many that recognize that obesity increases the risk of serious health conditions, such as Hypertension, Type 2 Diabetes, sleep apnea, hypercholesterolemia.
Therefore, we must obtain insurance approval prior to scheduling your surgery.
It is important to call your insurance company to make sure that you have bariatric benefits in your plan. Many will ask you for a CPT code specific to your procedure of choice. Please see codes below:
Laparoscopic Roux-en-Y gastric bypass: 43644
Laparoscopic sleeve gastrectomy: 43775
While many of the costs that will be incurred during the evaluation process will be covered by your insurance, some charges may become the responsibility of the patient. Due to program certification criteria, we are unable to accept patient’s with Medicare insurance as either their primary or secondary insurance coverage.
If a patient qualifies medically for surgery, the surgeon’s office will request pre-approval for coverage of the procedure from the patient’s health insurer. When the insurance company gives their approval, they notify the surgeon’s office. In most cases a date for the operation will be scheduled during this notification. Once the surgery has been scheduled, patient’s are often asked to come into the office about a week before the procedure to obtain informed consent.
We will work with you and your insurance to make sure that you meet their requirements. Some of these requirements are:
History of failed weight loss attempts (ie. Physician-supervised weight loss, Weight Watchers, Nutri system)
Letter of medical necessity from PCP
Psychological evaluation — to ensure patients have a clear understanding of the commitment to weight loss surgery and how life after surgery may impact one’s life.
Nutrition evaluation — used to identify dietary changes and habits that need to be changed in order to ensure a successful transition after weight loss surgery.
Second Wednesday of Each Month: 5 to 6pm - SMHC Biddeford 1st Floor Classroom
Free. Is weight loss surgery the right decision for you? Have you tried the other weight loss methods and nothing seems to work? If you're considering gastric bypass surgery, then this introductory class is for you. Information will be presented about nutrition, resources, and other topics to help with the lifestyle and emotional adjustments you may face. For more information, please call 207-283-7987.
Successful weight loss surgery patients say that their support network helped them maintain their new lifestyle changes. The patient network often gives patients the encouragement and support needed to succeed. Research has documented that patients will have greater success in achieving and maintaining weight loss when they attend support groups. Our support groups are run by healthcare professionals to answer questions and concerns and they are an excellent resource. At the support groups you will people who have similar wellness goals, who want to celebrate your successes, and who support you in challenging times. Support groups are devoted to these common experiences, so you can share your feelings in a safe environment. Many of our patients continue to come even when they have reached their 1 year anniversary. Some of our patient’s will also support you as a "buddy" and can be available for those stressful times or when you just need someone to talk to.
Our program feels strongly about the need for a strong support system in order for this lifestyle change to be successful. The first step in getting support is talking to your family and friends about the weight loss options. You might find that they are completely supportive, or you might find that they are not. If they are not, it may be due to fear or minimal knowledge of obesity related health issues and they may be concerned about the surgical risks. We encourage your support partner to attend the free educational seminar and also to accompany you to support group meetings. You should also explain to them why you are considering surgery and share with them the knowledge that you have.
Southern Maine Health Care’s Weight Loss Surgery and Weight Management Program has support groups on the third Wednesday of each month from 6:00 to 7:00pm in the 2nd floor classrooms at the Biddeford Medical Center, 1 Medical Center Drive.
For more information, please call 207-284-2630.