According to the Centers for Disease Control and Prevention (CDC), more than 42% of American adults are considered obese, with a body mass index (BMI) greater than 30. Many of these people have struggled with excess weight for years, trying various diets and exercise regimens, with limited success. Fortunately for residents of New Hampshire, two of the nation’s leading bariatric surgical experts are close by.
Bernard Benedetto, MD, FACS
Bernard Benedetto, MD, FACS, is board-certified and fellowship-trained in minimally-invasive general and bariatric surgery. He is the chief of Surgery at Portsmouth Regional Hospital. He is a graduate of the University of Connecticut School of Medicine and completed his surgical residency at the Baystate Medical Center/Tufts University School of Medicine. Dr. Benedetto completed a fellowship in trauma surgery and critical care at the University of North Carolina in Chapel Hill, followed by a second fellowship at Albany Medical Center in minimally invasive and bariatric surgery. Prior to joining Atlantic Surgical Associates, Dr. Benedetto was a member of the Massachusetts General Hospital Department of Surgery and the director of Bariatric Surgery at North Shore Medical Center in Salem, Massachusetts. He has extensive experience performing robotic bariatric surgeries.
Donald Yarbrough, MD, FACS
Donald Yarbrough, MD, FACS, is considered a pioneer in the field of robotic bariatric surgery. He is a board-certified and fellowship-trained general and bariatric surgeon with Nutfield Surgical Associates, an affiliate of Parkland Medical Center in Derry, New Hampshire. In 2006, Dr. Yarbrough co-founded the Oregon Bariatric Center, in Eugene, Oregon and served as the founding medical director of the Samaritan Weight Management Institute at Good Samaritan Regional Medical Center. He is a graduate of the University of Alabama School of Medicine and completed his general surgery residency at the Mayo Clinic in Rochester, Minnesota. Dr. Yarbrough also fulfilled a fellowship in minimally-invasive bariatric, gastrointestinal, and esophageal surgery at University of Alabama—Birmingham.
Risks factors of obesity and the benefits of bariatric surgery
The risk of premature death is twice as much for people with obesity than those who are not obese. Medical conditions related to obesity include diabetes, hypertension, high cholesterol, sleep apnea, gastric reflux, and arthritis. Once patients reach a certain point with these types of conditions, it becomes difficult to sustain weight loss and improve overall health without having surgery. While people suffering from obesity may be concerned about the risks involved with bariatric surgery, the health issues related to their excess weight often carry a greater risk.
Researchers don’t fully understand why, but weight loss surgery has a more dramatic effect on the body’s metabolic and endocrine systems than traditional weight loss methods. According to the American Society for Metabolic and Bariatric Surgery (ASMBS), “Nearly all individuals who have surgery for diabetes show improvement in their blood sugar levels and reduce or eliminate the need for diabetes medication.” Risk factors for certain cancers, including breast, endometrial, prostate, and colorectal, also are reduced after bariatric surgery.
Following bariatric surgery, Dr. Benedetto and Dr. Yarbrough agree that patients who are the most successful are those who focus not just on losing weight but on reducing the medical conditions associated with their obesity.
Nationally recognized criteria for bariatric surgery
Both Dr. Benedetto and Dr. Yarbrough are guided by the principle that the needs of the patient come first, with a focus on long-lasting wellness and exceptional clinical outcomes. “The definition of success,” counsels Dr. Yarbrough, “is not how much weight is lost, but how surgery improves weight-related comorbidities and how much patients regain their quality of life.”
Weight loss surgery is not for individuals who want to shed an extra 10 to 20 pounds. The ASMBS has specific criteria to qualify persons with obesity for bariatric surgery:
- Must exceed ideal body weight by at least 100 pounds.
- Must have a BMI of greater than 35.
- Those with a BMI between 35 and 40 must also have comorbidities such as diabetes, high cholesterol, heart disease, etc.
- Those with a BMI over 40 automatically qualify.
- Must not be pregnant or have impaired liver function or similar conditions.
- Must be at least 18 years old.
Preparing for bariatric surgery
Patients planning to have bariatric surgery must be highly motivated. For at least three months leading up to their procedure, they will participate in a program that stabilizes any existing medical issues and instills healthy lifestyle habits.
Dr. Benedetto and Dr. Yarbrough both perform surgery at facilities with high-quality, comprehensive bariatric program that include:
- On-staff patient advocates including nutritionists, physical therapists, counselors, and diabetes management specialists who support patient care before, during, and after surgery.
- A focus on individualized quality of care.
- An investment in the long-term success of their patients.
Types of bariatric surgeries
Most bariatric surgeries are performed using minimally-invasive, robotic techniques that lessen pain, complications, and length of recovery. In fact, most patients only have a one-night stay following their procedure. Many patients fear they will never be able to enjoy food again, but Dr. Benedetto advises, “You can eat almost anything, just in moderation. The end goal is to find a healthy relationship with food.”
The most common bariatric surgeries are:
- Sleeve gastrectomy—Sleeve gastrectomy, also known as gastric sleeve surgery, is the most frequently performed type of bariatric surgery. The size of the stomach is reduced by 75 percent or more, limiting the amount of food it can hold.
- Roux-en-Y gastric bypass—Gastric bypass surgery reduces stomach size and reroutes the small intestine to lessen the calories the body absorbs.
- Revision or conversion surgery—Revision surgery makes corrections or improvements to a previous weight loss surgery.
There is no magic button for weight loss. Surgery helps improve self-esteem and put patients back in control of their lives, but long-term success is built on a foundation of ongoing lifestyle and diet changes. “It is up to each person to earn the pounds they lose,” says Dr. Yarbrough. “Weight loss surgery is the starting point of a journey, not the finish line.”
To help ensure their success, patients have regular follow-ups with their surgeon and support team for the first year after surgery and periodically for the rest of their lives. They should also maintain regular appointments with their primary care physician. Both Parkland Medical Center and Portsmouth Regional Hospital also offer bariatric support groups pre- and post-surgery.
While it is rewarding to see a patient’s overall health improve after losing weight, the most gratifying part is witnessing them reclaim the smaller moments in their lives. According to Dr. Benedetto, “My greatest motivation is having a patient tell me that they are dating again, that they can now fit on the rides at Disney World®, or that they have children they never thought would be possible. It is really something special to play a small part in that.”