Bariatric Surgery

Should I have surgery to lose weight

Research indicates many patients cannot achieve and maintain large amounts of weight loss without the assistance of weight loss surgery one they are over a certain weight.

Along with the burden of obesity, often, these patients are plagued with diseases associated with excess weight. These diseases are referred to as co-morbidities and include:

• Hypertension
• Type 2 Diabetes
• Sleep apnea
• GERD
• Joint pain

Co-morbidities may be reduced or eliminated by weight loss.

The bariatric program aims to assist patients who may benefit from significant weight loss and have had little success with more conservative treatment methods.

Retirees and dependents who meet specified criteria are eligible for the bariatric surgery program.

What surgeries and procedures are available?

The program's bariatric surgical procedures are sleeve gastrectomy, roux-en-y gastric bypass, single anastomosis duodenal-ileal bypass with sleeve (SADI-S,) and revisional surgery for patient that have failed a previous bariatric surgery. Endoscopic procedures available are Trans-outlet Reduction Therapy, Endoscopic Sleeve Gastrectomy, and for patients that do not meet the criteria for surgery or choose not to have surgery, we offer the intragastric balloon.

All procedures are very effective but differ in surgical technique, dietary modifications, lifestyle changes, medical monitoring, and risk to the patient. Each patient is unique and will consult the bariatric surgeon to determine the best surgical procedure.

Intragastric Balloon

Intragastric balloon placement is an effective weight loss modality for patients with a BMI of 30-40. A silicone-based balloon is placed in the stomach at the time of an upper endoscopy. The balloon is filled with saline and remains in place for 6 months. At 6 months the balloon is removed during and upper endoscopy. The balloon occupies a large amount of space in the stomach and slows how fast food can leave the stomach causing a sensation of fullness and reducing food intake.

Sleeve Gasrectomy

Sleeve gastrectomy is another very effective surgical weight loss procedure in which the stomach is stapled, and part of the stomach is removed. The remaining portion of the stomach is called a sleeve. The sleeve remains attached to the small bowel, and digestion usually occurs. The small stomach fills quickly, allowing the patient a feeling of fullness, reducing the food intake, and resulting in weight loss.

Roux-en-y Gastric Bypass Procedure

In the roux-en-y gastric bypass procedure, the stomach size is reduced to a pouch, and the upper portion of the small bowel is bypassed. Weight loss occurs by reducing the amount of food intake into the smaller stomach and by the GI tract's reduced ability to absorb calories and nutrients. Following bypass surgery, the patient will require lifetime medical monitoring for nutritional deficiencies and supplemental vitamins and minerals

Single Anastomosis Duodenal Switch with Sleeve Gastrectomy (SADI-S)

Single Anastomosis Duodenal Switch with Sleeve gastrectomy (SADI-S). In this procedure, the stomach size is reduced to a sleeve anatomy, and the upper portion of the small bowel is bypassed. Weight loss occurs by reducing the amount of food intake into the smaller stomach and by the GI tract's reduced ability to absorb calories and nutrients. Following SADI-S surgery, the patient will require lifetime medical monitoring for nutritional deficiencies and supplemental vitamins and minerals. The targeted protein goal is 100gm daily with this procedure as compared to other surgical procedures. 

Transoral Outlet Reduction Endoscopy for patients that have been evaluated by their surgeon/GI

Transoral Outlet Reduction Endoscopy for Post Bypass patients is an endoscopic procedure for patients who have experienced weight regain after bypass surgery and have a dilated pouch connection diagnosed on Endoscopy. 

Endoscopic Sleeve Gastrectomy

Endoscopic Sleeve gastrectomy is another very effective surgical weight loss procedure in which the stomach is sutured through an endoscope to reduce the volume of the stomach. The sleeve remains attached to the small bowel, and digestion usually occurs. The small stomach fills quickly, allowing the patient a feeling of fullness, reducing the food intake, and resulting in weight loss. This is a great option for patients with a BMI between 30-35 with comorbidities. It is indicated for BMIs between 30-40. 

Do I qualify for the Surgical Weight Loss Program?

The eligibility criteria for a consultation with one of our bariatric surgeons are as follows:

• BMI >35 or patients with a BMI of 30-34.9 with metabolic disease (type 2 diabetes, hypertension, hyperlipidemia). Asian patients with metabolic disorders can be offered surgery with a BMI of >27.5. BMI is classifying body mass used to predict morbidity and mortality. BMI is calculated by weight in kilograms divided by height in meters squared.
• Retired military
• Dependents of active duty or retired military
• 18+ years old
• TRICARE Prime beneficiary
• Not pregnant or lactating
• No multiple medical severe complications related or unrelated to weight 

NOTE: Active duty service members cannot have weight loss surgery as mandated by Department of Defense but are eligible for intragastric balloon and medical management.

How do I begin the process?

You can self-refer to an information session if you meet the criteria above. Please call WRNMMC at 301-319-2664 or ATAMMC at 571-231-2556. You can be referred by your PCM as well. You must keep in close contact with your PCM throughout the process. Your health maintenance needs to be up to date with the optimization of current medical problems.

TRICARE Coverage

Please visit the TRICARE website for coverage information.

Army Wellness Center at Fort Belvoir
703-806-1323

Exercise Physiology and Physical Therapy (WRNMMC)
301-295-4065

Required Consults: Exercise Physiology and Physical Therapy

Our Exercise Physiologist and Physical Therapist are multidisciplinary team members caring for you in the Surgical Weight Loss Program. Their expertise lies in evaluating muscle response to activity and maximizing its positive effect on the body. This enables them to formulate exercise programs for professional athletes and patients suffering from cardiac conditions, asthma, chronic obstructive pulmonary disease, or bariatric patients with limited ability to exercise normally.

In collaboration with your surgeon and other team members, they will develop a customized exercise program for you. Their program will assist you in developing techniques and movements to improve your mobility and body strength. Exercise, as a requirement of the weight loss program, is a critical element in achieving and maintaining long-term success in managing a healthy weight. This program will help you incorporate exercise into your lifestyle. Please call 571-231-2556 for an appointment or more information.