- Most weight loss surgery at Yale Medicine is done laparoscopically.
- Weight loss procedures include gastric bypass, “lap band,” and “sleeve” surgery.
- 85% of patients who have bariatric surgery at Yale Medicine lose more than 100 pounds – and keep it off for at least five years.
- Gastric bypass is most effective against diabetes. It has a cure rate of 80%.
Lisa Jordan-Sharog could be picking up her grandson up after his high school baseball practice, or picking up a few groceries. Wherever she goes, it seems, she gets compliments.
A chance encounter with a male friend at her grandchild’s soccer game resulted in a kidding marriage proposal. And one day at the supermarket an old friend walked right past without recognizing her. “I said, ‘Linda!’” says the 61-year-old from West Haven. “She looked at me and couldn’t believe it.”
Jordan-Sharog has lost more than 100 pounds, the result of the bariatric surgery Yale Medicine performed by Yale Medicine physicians. And while her appearance has changed, that is only one part of the transformation. Along with the weight, she has shed diabetes, high blood pressure and high cholesterol. From five daily medications, she is down to two.
“People say, ‘You look fabulous! You look beautiful!’ I hear that all the time,” Jordan-Sharog says. “I get a lot more attention now. But this wasn’t done for looks. This was done for health.”
She says she could not have done it without Yale Medicine’s bariatric surgery program.
Bariatric surgery: A Yale Medicine specialty
More than 600 people undergo bariatric surgery at Yale Medicine in a typical year, according to Andrew Duffy, MD, director of Bariatric and Metabolic Surgery at Yale Medicine. He says most patients are in their 30s or 40s.
To be eligible for the surgery, a patient’s body mass index (BMI) must be at least 40, or 35 if they have associated medical conditions such as diabetes, high blood pressure, high cholesterol or sleep apnea. Often, health insurance will cover the procedure.
Unlike most bariatric surgeons in the region, all of Yale Medicine’s bariatric surgeons are fellowship-trained, meaning they devoted an additional year to specialized training after their medical residency. On all metrics, from safety to complications to success rates, Yale Medicine’s program meets or exceeds national standards.
“We have the most comprehensive program around,” Dr. Duffy says.
Types of bariatric surgery
Among Yale Medicine’s cases, about 80 percent are first-time surgeries, most done laparoscopically. These include gastric bypass, which reroutes food past most of the stomach; “lap band,” which restricts entry to most of the stomach; and “sleeve” surgery, which cuts away a large portion of the stomach, leaving only a sleeve-shaped portion. The remaining 20 percent are “revisions” of previous bariatric surgeries. Most often these were done by less experienced doctors at other institutions, resulting in serious complications that require surgery to fix or procedures that did not work properly the first time.
“We get a lot of inquiries from patients looking to see if there’s a revisional surgery option to help them deal with issues they’re having, like ulcers, hernias, bleeding or abdominal pain,” Dr. Duffy says.
The surgeons at Yale Medicine stay on top of developments in the field. For example, they offer the intragastric balloon, in which a deflated ball is placed in the stomach through a tube down the esophagus. It is then inflated with saline to make the stomach feel full. “You leave it in for six months, then take it out,” Dr. Duffy says. “It’s fully reversible, which makes it appealing to patients.”
Equally important, the program at Yale Medicine incorporates dieticians, social workers, exercise physiologists, psychologists and advanced practice registered nurses for truly comprehensive treatment. They offer pre-operative education and post-operative support. “We’re uniquely set up to customize programs to help patients keep on top of their weight, and to intervene if they’re struggling,” Dr. Duffy says.
Eighty-five percent of patients who have bariatric surgery at Yale Medicine lose a significant amount of weight—usually more than 100 pounds—and keep it off for at least five years.
Committing to a surgical fix
Jordan-Sharog’s weight had crept up as she got older, mostly as a result of inactivity brought on by osteoarthritis and related surgeries on her knees, ankles and other joints. She had been thinking about bariatric surgery for at least five years, she says. “Some of my doctors even suggested I have it.”
“Plus, I wasn’t always eating right,” she says, though her habits were not as bad as you might think. “People think fat people eat mounds of spaghetti all day,” she says. “You can eat two ham sandwiches a day and nothing else, and you’ll still gain weight.” Jordan-Sharog, who is 5 feet 7 inches tall, eventually topped 300 pounds.
She had tried Weight Watchers three times. “I spent a lot of money, only to lose 35 pounds in six months, and then put back on 60,” she says. Meanwhile, several of her friends had experienced positive results from bariatric “sleeve” surgery at Yale Medicine. “They lost a ton of weight,” she said, “and I saw how they were eating and how they were living and how happy they were. And their health was better. And I said, ‘That’s for me. I’m going to do that.’”
In June 2015, she attended a seminar on bariatric surgery at Yale New Haven Hospital’s Saint Raphael campus, where Kurt Roberts, MD, an associate professor of Gastrointestinal Surgery at Yale School of Medicine, presented the options. Jordan-Sharog had heard great things about Dr. Roberts from a friend and thought the “sleeve” surgery sounded best. On her way out, she and signed up for a consultation.
“The appeal to me about it was, it wasn’t an open surgery,” she says. “They don’t have to reroute your intestines, you won’t have dumping syndrome. [This is the name used to describe a common side effect in which food moves into the small intestine too quickly, causing uncomfortable symptoms such as abdominal cramping, nausea, diarrhea, flushing, sweating and rapid heart rate.] It just removes two-thirds of the stomach and you have to eat according to their new portions.”
Jordan-Sharog’s journey to choosing bariatric surgery was typical. “Most patients come to us after considering it for a long time,” Dr. Roberts says. “They need to be comfortable with their decision and self-motivated, without anyone pushing them. I have lots of patients who come and get information but don’t do it. Quite often, after a year or two or three, they come back ready.”
Preparing to have bariatric surgery
Jordan-Sharog appreciated Dr. Roberts’ bedside manner. “He’s a very nice man, very relaxed and easy to talk to, and he explained everything,” she says. She also met with Yale Medicine nutritionist Rebecca Bonetti, who would become like a “sister from another mother,” Jordan-Sharog says. A psychiatric evaluation and a cardiac stress test confirmed she was eligible for surgery.
The nutritionist jump-started Jordan-Sharog’s weight loss by giving recommending foods to choose—such as chicken, fish, Greek yogurt and greens—or avoid, such as bacon, cheese, potatoes and trail mix. She followed the diet for three weeks, then shifted to a stricter diet for two weeks before surgery to prepare her liver for restricted calorie intake. She lost 20 pounds before her Sept. 8 surgery date.
Jordan-Sharog went under general anesthesia for the surgery. Dr. Roberts made five small incisions in her belly. He used a tiny camera to locate Jordan-Sharog’s stomach and measured out its new size. “The stomach is about the size of a football,” he said. “We make it the size of a banana.”
Using surgical staples to provide the new shape, he cut away the excess tissue and then tested it for leaks by submerging it in fluid and blowing it up with air to look for bubbles. “Once we confirm everything is in order, we finish the surgery,” he says.
Most patients can start sipping liquids once they have emerged from the anesthesia, and can go home the next day. “From the minute I walked in, to the minute I walked out, it was a five-star event,” Jordan-Sharog says. “I took one pain pill the day I came home from the hospital. I never took another one after that. I was sore, but not sore enough that I needed medicine.”
She was ready for the real weight loss to begin.
The pounds fall off
“The key to the surgery is that it removes the part of your stomach that has the hunger signal,” Jordan-Sharog says. “And that’s the part that makes it really easy.”
Before her surgery, Jordan-Sharog’s stomach would start growling and she would feel her blood sugar dropping as mealtime approached. “I’d say, wow, I’m starving,” she says. “We have to get something to eat.” Now she experiences hunger as a “weird, tiny sensation” that is sometimes so subtle that she does not have her first bite of food until 3 p.m. “I’m drinking my protein shakes and my water, but I don’t need food right away,” she says.
Jordan-Sharog had no problem following the strict post-surgery diet—first liquids, then pureed foods, then soft foods, then small portions of healthy fare. Frequent meal choices include scrambled egg substitute, light cheese wedges, low-sodium cold cuts or tuna salad made with light mayo. But she can also have a four-ounce meatball made with 90 percent fat-free meat or a slice of meatloaf, along with vegetables and fruit. “Oh, and Greek yogurt—I adore that,” she says. .
Jordan-Sharog aims to eat more than 80 grams of protein daily—“it keeps you fuller longer and it helps the weight come off”—and takes vitamins, including calcium and B12. This is essential for bariatric surgery patients, who may not get all needed nutrients in the smaller portions they consume.
Jordan-Sharog’s nutrient levels have been perfect, and her weight dropped fast. “The weight comes off pretty quick. Five pounds every couple of days; 10 pounds, 15 pounds a month,” she says. After six months she had lost 100 pounds and was down four clothing sizes. Her goal is to achieve what is known in bariatric surgery circles as “one-derland”—weight below 200 pounds. Her ultimate goal: 170 pounds, what she weighed in her early 20s when she got married.
Benefits of a shrinking waistline
For most patients, bariatric surgery is a health and happiness booster.
“I love doing them,” Dr. Roberts says. “One of the reasons we became doctors is to help people. With this type of surgery, we’re helping a lot of patients change and prolong their lives.” Among people of the same weight and baseline medical problems, he says, those who get bariatric surgery live 10 years longer, on average, than those who do not.
As the weight disappears, so do many ailments. For instance, Type 2 diabetes is a disorder of how the body responds to food. “Gastric bypass is most effective against diabetes—it has a cure rate of 80 percent,” Dr. Duffy says. “By diverting food away from the pancreas, the duodenum and the liver, you’re bypassing all the hormonal mechanisms that contribute to Type 2 diabetes.”
“Sleeve” surgery can also benefit diabetics. Jordan-Sharog was taking metformin for her mild case but no longer needed that medication, nor one for high blood pressure, after her surgery. Her cholesterol also reverted to normal levels after a few months.
Exercise is a must for people who have had bariatric surgery; it ensures that the body burns fat rather than sedentary muscle. Jordan-Sharog now visits the gym three days a week and takes long walks on the beach a few miles from her home.
Her overall mood is “more chipper and happier,” she says, and her life is fuller.
“I hosted a big birthday party for my mother,” she says. “I cleaned and decorated and served 19 people, which was something I was never able to do because I was too heavy and sluggish to move around. My daughter was so thrilled and proud. She said, ‘It’s like you’re your old self again.’ It was awesome. I felt like a person again.”
“You lose yourself when you’re heavy and not happy with yourself,” Jordan-Sharog says. “So I’m going through the process of finding myself again. Realizing who I am, and what I’m capable of. Remembering the dreams and hopes and visions that got kinda got stuffed down in the cellar. It’s a big emotional change and an emotional healing process.”
She says she would like to take an Alaskan cruise or visit Prince Edward Island. “I’m not sure about romance,” she says, “but if the right one comes along.”
Dr. Roberts sees wide-ranging improvements in all of his patients. “If they’re depressed, the depression goes away,” he says. “It’s like they feel more comfortable in their own skin. It’s great to see our patients’ happiness afterward.” Most patients tell him they wish they had had the surgery earlier, a sentiment Jordan-Sharog echoes. “I feel sad that I lost my prime years—my 40s and 50s—being overweight,” she says.
She is encouraging other overweight friends who qualify to consider bariatric surgery. “I tell people all the time, I wouldn’t advise you to go jump on the operating table if you can successfully lose weight on your own,” she says. “But if you can’t, this is the way to go. And I’ll send you to a great office if you want to be like me. It’s 1,000 percent amazing!”
“I’m completely satisfied,” she says. “The people at Yale Medicine listen to you and treat you with respect. They care about you. They’re here to support you and to encourage you. It’s a fine group, I would recommend them, I’ve been sending people there already.”