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When To Consider Weight Loss Surgery, Part II

A Q&A with Dr. Alan Posner

In addition to speaking with Dr. Aaron Hoffman, Judy Sperry also interviewed Dr. Alan Posner who founded the Comprehensive Weight Loss Center.

AV: Hello, Dr. Posner, could you tell us about your specialty and the program that you started at Buffalo General?

AP: We started a program here at Buffalo General to provide mostly minimally invasive surgery for patients who require weight loss. We’ve seen a growing trend of obesity in this country, which has reached epidemic proportions. Twenty years ago, ten percent or less of the population was obese and now in more than half the states in the country, a quarter of the population or more are obese. With obesity come multiple medical problems that can lead to difficulties with daily life but can also lead to death. We find that with weight loss surgery or with weight loss in general, most patient’s medical problems improve remarkably.

The biggest problem is most people can lose weight but they can’t keep the weight off. And so weight loss surgery becomes a last resort for people. Those are our patients. We only operate on people who have tried to lose weight without surgery.

Fortunately, we find that patients, who are motivated and are willing to go through the rigors involved in not only having weight loss surgery, but also living with the regimen we give them, can markedly improve their life. There have been several research endeavors that have shown that patients who lose significant weight when they’re morbidly obese will have a greater chance of living a longer life.

AV: You started the program about six years ago?

AP: We started the program in 2003, seven years ago. And approximately five years ago we moved the program to Buffalo General Hospital because Buffalo General Hospital was willing to put in all the aspects that we needed in order to have a comprehensive program. We applied for and received Center of Excellence status through the American Society of Bariatric and Metabolic surgery, and so we are a certified Center of Excellence in Bariatric surgery.

Weight loss surgery can be very invasive and the weight loss surgeons here at Buffalo General Hospital perform virtually all of the operations laparoscopically through tiny tubes. We place a camera into the abdomen and we’re able to see the insides without having to make a big incision. And we’re able to divide the tissues and place our devices and perform multiple different weight loss operations through a group of very small incisions.

We do minimally invasive surgery for all different diseases within the abdomen. From hernias to bowel resection for benign disease, to colon surgery for colon cancer; we do anti-reflux surgery; surgery for removal of adrenal glands; kidneys, all sorts of things that previously were done through larger incisions and more invasive means.

AV: Where do you see weight loss surgery heading in the future?

AP: There’s a lot of research into how can we do less and less invasive procedures and still have excellent results. And so the weight loss field is always changing. But the gold standard for weight loss surgery for many years has been the gastric bypass, and that’s an operation that probably is not going away. There are newer procedures on the horizon, we’ve been doing adjustable gastric banding now for many years and now a newer procedure is a vertical sleeve gastrectomy, which seems to hold great promise for weight loss surgery. There’s a lot of research going on for performing similar procedures through an endoscope down the mouth and into the stomach and not actually having to do any incisions. And so research is being done right now on these types of procedures but they’re not quite ready for prime time.

The hope is that at some point we will come up with an understanding of exactly why some people become obese and some people don’t. And the hope is eventually never to need to do weight loss surgery but to be able to treat obesity through medical means. Unfortunately we don’t understand why people become obese and we don’t know how to treat them in a non-surgical fashion to have sustained weight loss in a larger percentage of patients. Surgery can give sustained weight loss in a large percentage of patients.

AV: We’ve heard talk about some kind of residential center. Is this true?

AP: We’re currently considering starting an obesity rehab center for people who are so large that they can’t move; so large that surgery is dangerous, so that they really need to have carefully monitored weight loss programs before even considering surgery. Sort of like the ‘Biggest Loser’ show on steroids, if you will. And the hope is to be able to build an obesity center because there is not an obesity rehab center anywhere close to us.

AV: In terms of bypass surgery versus the lap band, what criteria would make a surgeon say ‘This person is more suitable for bypass’ versus lap band?

AP: Patients ultimately decide what operation they would like. The gastric bypass is more extreme. It’s more dangerous than the lap band but the weight loss is faster. The gastric bypass we do laparoscopically, as well. Virtually every gastric bypass we’ve performed has been laparoscopic. And that’s something that sets us apart from other programs.

Gastric bypass always used to demand a large incision and those incisions are very hard to heal because the body tissues pull the incision and the hernia rate from open surgery can be very high. With the gastric bypass there is more overall weight loss than with gastric banding, but with either one most people lose enough weight to improve medical diseases related to obesity.

There is about a fifty to seventy five percent remission or cure rate for diabetes with a lap band and about a seventy five to ninety two percent remission rate for diabetes with the gastric bypass. There is the sleeve gastrectomy as well, which downsizes the stomach but also tends to make people less hungry and is sort of more risky than the lap band but less risky than the gastric bypass and the weight loss is probably somewhere between the lap band and the gastric bypass.

—Interview for Artvoice by J. S.

This interview is the second of two parts; in addition to speaking with Dr. Alan Posner, Judy Sperry also interviewed Dr. Aaron Hoffman at Buffalo General Hospital on the topic of obesity treatment. Read Part I of this story here.

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