 Hi, I'm Meredith Marr from the University of Maryland Medical Center. Today we're discussing bariatric surgery with patient navigator Ashley O'Housen from the Center for Weight Management and Wellness. Thanks for being here today. Thanks for having me. Thanks to all of you for watching. We invite you to leave your questions for Ashley in the comment section below and be sure to like this video if you're watching. Ashley, what is bariatric surgery exactly? So bariatric surgery is a surgical procedure to make your stomach smaller, to help you eat less and eventually lose weight. So how is that? I guess what would be the benefit to the surgery versus just trying to lose the weight on your own? So bariatric surgery is for people who have tried to lose weight on their own. So if you have been trying dieting, exercise, taking medications, help you lose weight and they're failing. So you've gone through the motions, you've lost weight, you've gained weight, you've come back and you're just like, I can't do it. We are here to help you and give you a tool to help you lose weight. About how long after they've started trying to lose the weight on their own or taking medications should they then start to consider weight loss surgery? Because after like five years of trying or I mean, you don't want them to give up right away, right? Everybody's different. So there's some people that takes them 10 years to make the decision to have surgery. There's some people that takes them three years. Some people that takes them like, hey, I heard about this. It sounds like a great option for me. I know friends that have done it that are like, this is what I need to do. So everybody's journey just such as life is different. So everybody's when they come in to decide to have surgery. It's whenever it's right for them. And who is a good candidate for the surgery? So to qualify for surgery, you have to be over 18 in our program. And we go up to about 65, 70, depending on health criteria. And then you have to have a body mass index of 35 to 40 with a comorbidity. And then if your body mass index is over 40, you qualify just based on that. What would some of the comorbidities be for the under 40? So if your BMI is under 40, the comorbidities would be such as like sleep apnea type two diabetes or like high cholesterol or high blood pressure. What are some things that would exclude somebody from being a candidate? There are a few exclusions to bariatric surgery. Those would be discussed with Dr. Kligman, he'd be able to better decide what would or would not be a candidate. But most people, if as long as their doctors clear them, if they have any issues, they go, they get clearances from all their doctors. And if they're everybody's on board with them having surgery, shouldn't be a problem. So you mentioned Dr. Kligman, who else would be on a patient's care team? So a lot. So we have Dr. Kligman, obviously, we have three dietitians on staff, which are all in house. And then we have a nurse, a nurse practitioner, and then all of our administrative staff. And you're as the patient navigator, what's your role in dealing with the patients or building that relationship? Yeah, no. So I am with a patient from day one through surgery, and then I continue maintaining contact after surgery. I will be with them on their first appointment. So when they come in to meet with Dr. Kligman, they'll see me, they'll see Dr. Kligman, they'll see our dietitian, and we kind of get the ball rolling there. And then through the next few months to get to surgery, I make sure they're getting all their clearances completed, and they're getting through to surgery, and just maintaining, making sure they're on the right steps. What are the different types of procedures that we offer for bariatric surgery? We do two procedures here at the University of Maryland. We do the sleeve gastrectomy and the gastric bypass. And what are the major differences between the two? The differences in the two, the sleeve gastrectomy will take out about two-thirds of your stomach, so making it like the size and shape of a banana, but like the size of a highlighter, so pretty skinny. And then the gastric bypass makes your stomach into a small little pouch, and we reroute your intestine to bypass the main portion of the stomach. And how is it determined which of those procedures is best fit for each patient? So it really depends on your health history. So if you have certain things will push you in a direction to the bypass, certain things might push you in the direction of the sleeve, and that's definitely something that is a good conversation to have with Dr. Kligman so you can, you ask him together, come up with a plan that works best for you personally. Does one have a shorter recovery time than the other, or are they about the same? They're pretty much about the same. You're in the hospital the same amount of time. You're back to work in the same amount of time. Everything's pretty much the same. It's just whatever you decide is based on what works better for you. And what would your biggest tip be for someone who has just had the surgery in order for them to be the most successful in their weight loss journey? Biggest tip to trust the process. Dr. Kligman has been a bariatric surgeon for many years, and he and his team and all of us have created a great program to maintain healthy life for our patients after surgery. So we educate you on what to eat, how to eat, why it's important, why we want you doing these things, and really get to the root causes of making sure that you understand why we want you doing these. Not just throwing you out there and saying, here's your surgery, good luck. We really truly care to make sure that you have the best outcome possible. And what are the first steps that a person should take who's considering weight loss surgery? So the first step would be to obviously want to have surgery. And then if that is something that you're interested in, we do have multiple seminars across the state of Maryland to make it convenient for patients all around. So we're over on the eastern shore. We're down in southern Maryland. We're here in Baltimore and Anarondo County. So we're trying to broaden our horizon. And also it's available online 24-7 as well. So you can go on our website. You can get all the information there. And then we get you in to meet with Dr. Kligman. So once you meet with Dr. Kligman, he goes over your health history. It's determined that you would be a good candidate for one of the two procedures. What does that journey look like leading up to the actual surgery? Great. Yeah. So every patient's going to be different. And it depends on insurance. So insurance does cover the procedure. Again, if you meet those criteria of the BMI and so on like that. But after that, if your insurance company requires six months of nutrition, you will have to go through. So have some other clearances that get completed, like a psyche valve, a cardiac clearance, some blood work just to make sure you're healthy and healthy enough to undergo the procedure. After that, we get you submitted to your insurance company, and it can take anywhere from a couple days to a couple weeks to get that approval. And then we get you into the operating room. So I know you mentioned insurance will cover bariatric surgery itself. Post-surgery, after they've lost a lot of weight, they potentially have some loose skin. Is plastic surgery always needed? And if it is needed, is that also covered by insurance? It is not necessarily always needed. It's up to the patient. Some patients lose an extreme amount of weight and have a lot of excess skin, and they want to get it removed. Sometimes it is covered by insurance. Other times it is considered a cosmetic procedure. You wouldn't have to come out of your own pocket. But we work closely with the plastic surgery department here at the University of Maryland and have a great connection with them, and they do a wonderful job with our patients. So when patients come in before their surgery, what's the biggest concern that they typically have? The biggest concern is usually that I get from patients is they are slightly embarrassed and embarrassed that one that they've got to this point, that their friends or family think that it's the easy way out, and they're just like, I'm here, I'm embarrassed, whatever. But it's not the easy way out. It is a lot of work to get to surgery. It's a lot of work after surgery. So I try to encourage patients to understand that this is not an easy way out. This is a lifestyle change. This is 100% on you. We're helping you out. We're giving you this tool to help you make the correct lifestyle changes and to make the right decisions. But it's hard work for the patient, and I don't want anybody to ever feel like they're taking the easy way out and feel uncomfortable or guilty or just like ashamed that they are choosing bariatric surgery. For someone who may have had the surgery, whether it be the sleeve or the bypass or even lap band surgery, are they able to have surgery for a second time? Yeah. It depends if there are complications that happen with the surgery. If sometimes it can be covered, like there can be a revision if there has been weight gain, whether or not your insurance company is going to cover it, that is up for debate. But there are options and Dr. Klingman does do revision surgeries if and when they're necessary. Yes. Do you have any idea? I know you're not necessarily clinical, but do you have any idea how long you would have to wait until you would get that second surgery? So let's say you had the surgery. You lost weight initially. You gained weight back. It's like two or three years later. Is that enough time to pass between having the revision surgery? Would you have to go through the psyche valve again and all of that? Yes and no. Some people would. Some don't. So again, if there has been a complication, there's an internal complication with the surgery that maybe if you went to a different surgeon, they made your pouch too big or made something like something was done incorrectly, anatomy wise, then the revision could be done without having to redo the process. But if you gained weight just based on not following direction, so to speak, then we would probably have you go read through the process again, go back to nutrition counseling, go back to the psyche valve, make sure there's no causes mentally that may be making you want to eat more and maybe you gain weight. So it definitely it's a case by case basis. And then you mentioned people come in and they feel embarrassed or feel like they're taking the easy way out. What are some other myths about bariatric surgery? Other myths about bariatric surgery? There are there are so many like not everyone's going to gain their weight back. Some people are going to gain back five, 10 pounds, but it's life. Not everybody gains their weight back. And a lot of people think that a lot of other myths are that if you have the gastric bypass, you're going to look sick because people will be like, oh, like I know so and so that had it and they just they had and they just look so sick, they look sickly. I don't want to look sick. Well, again, Dr. Coleman and our staff have made sure that we provide our patients with such education to make sure that does not happen. They are going to be taking vitamins, they're going to be eating properly, exercising, drinking water, doing everything to make sure they maintain a healthy lifestyle. So that is something I like to make sure people don't get that in their head. Like you are not going to look sick after surgery, you are going to be healthy, you are going to be happy and you're going to be able to interact with the world differently. And like I said, the health benefits of surgery are so great. I guess what else should people know about it? Do you think before we take audience questions, is there anything else that any other facts or myths that you think somebody who's considering surgery should really know? How much weight can they expect to lose, I guess, after surgery? What's the average monthly or weekly? So on average, if you say you're 100 pounds of weight, with the gastric bypass, you will lose about 80% of that. So you'll lose about 80 pounds. Some people obviously do better, some people don't do as well. And the sleeve gastrectomy, roughly 60-70% of your excess body weight. So 60-80 pounds. So that can come in six months, it can come in a year. Everybody's weight loss is different. And Dr. Kligman usually projects in the first few months after surgery that people lose a half a pound to a pound a day following surgery. So if they lose up to 80% of their weight on average just from having the surgery, is the other 20% dependent on exercising or what would contribute so that if there were 100 pounds of weight that they would be able to achieve that goal? Exercise is definitely a huge factor. And then how long after surgery are they able to start exercising again? So we want patients to start exercising right now. So if you can just walk, if you can get in a pool and do aerobic activities in the pool to like not be on, to be like not weight bearing, do whatever you can. But as soon as you wake up from surgery, Dr. Kligman wants you up and walking within two to four hours after surgery. So whether that's just around the like the little hospital ward, whether that's whatever you can do, we want you up and walking. And then when you get home, walk, walk, walk, keep walking, do what you can. And then after six weeks or so, you can start lifting heavy, pushing, pulling so you can get into any strength training that you might want to do, whatever you enjoy, we want you to do. So if you don't like to walk, don't walk, go to a class at your gym, go swimming, go do whatever that you enjoy because this is what you're going to be doing forever. So if you want to run half marathon, that's your goal, then set out and do that. So it's really, we want you to do whatever is best for you. But at a minimum, we want you walking or walking in the pool or whatever for at least 45 minutes, four days a week at a minimum. And then immediately following surgery the first day or second day, are you able to start eating solid foods at that point? Or are you on a liquid diet? You're on a liquid diet. Because if you think like when you say you sprain your ankle, your ankle is going to swell. And it's going to hurt. It's going to be a little uncomfortable. That's kind of what's happening when we do surgery. So your stomach is going to be a little swollen. So you're not going to be able to eat something like you're not going to be able to go home and eat a real meal because you're not going to be able to get it down. So that's why we put you on like a liquid diet. And then slowly over time, you will be able to eat some soft foods and then you'll be able to get back to a modified regular diet. All right. Before we take more questions from the audience and we're here with Ashley, just a reminder we're discussing bariatric surgery. She's from the Center for Weight Management and Wellness at University of Maryland. Some introductions behind the camera. We have Grace Purse and Stephanie Huffner, both from the University of Maryland Marketing and Communications team. Steph, do we have questions? Yes. For those who just joined us, actually Paul Smith asks, will Medicare and Medicaid pay for this surgery? Yes. So Medicare, again, like we discussed earlier, you have to qualify for surgery. So you have to meet the BMI, Body Massive Nex Requirement. Once you meet that, you should be covered for surgery. Yes. How is BMI determined? BMI is determined. It's a ratio of your height and weight. So if you say you are 300 pounds and five, two, your BMI is going to be over 40. So you're going to qualify for surgery. That can be found on our website as well. Do you take into consideration like the amount of muscle mass? Because I'm sure there are, let's say, professional football players out there who might have a crazy BMI, but they're not necessarily overweight. Yes. So BMI, we take it into consideration more when you are talking more overweight. So if you're a professional athlete, you might want to take your body fat percentage instead of a body mass index. Okay. What's our next question? Caroline Hoffman asks, do you have to reach a certain weight to have surgery? Yes and no. So it really depends on how you're built and how much weight you, how much you weigh, and it will depend on your insurance company as well as your conversation with Dr. Clickman. So we might have a goal weight for you to get to based on just how you're built or your insurance company might set a goal weight for you to have done. So speaking of how someone's built, where they carry most of their weight, does that also come into play with like the success of their bariatric surgery or does it not really matter where they hold their weight? It doesn't necessarily matter. I can't tell you where you're going to lose your weight from though. So some patients will come in and want to lose their weight from their stomach, but maybe not necessarily their legs or whatever. We don't know where it's going to come off of. So it's, it could come off all from below whatever, but usually you'll proportionally lose weight. Yeah. What's our next question? Eliza Lin asks, would someone qualify if weight causes them knee and ankle pain? That definitely wouldn't deter you from having surgery. That's definitely a benefit to having weight loss surgery is to lose the weight because you won't have the joint pain anymore. But that won't necessarily be a reason for you to have surgery. That won't, that's not technically a comorbidity, but if you qualify with another condition, then yes, that would aid in you having weight loss surgery. Do you have another question? Yes. Last question. Mark Morris asks, is the kitchen really where I can make a difference in my weight loss journey? Absolutely. So what you eat is definitely plays a huge factor into weight loss. And that is something that you guys will discuss when you come in and meet with Dr. Kligman and our dietitians. And they'll definitely go into what to eat, why it's important, so on and so forth. So what makes the difference, what, I guess, how are we different here at University of Maryland from other entities, hospitals, outpatient centers who offer bariatric surgery? So we have been a center of excellence for the last 10 years. So that's pretty impressive for us. And also we have been expanding our scope of service. So we are, like I mentioned earlier, we are all over the state of Maryland. So we want to come to you because getting down to Baltimore City isn't always the easiest for patients. So we have made it our mission to get as far as possible to make the patients be able to come back for their follow-up appointments. We really want patients to continue to follow up. Like we are with you, this is a lifelong procedure and lifelong journey for you. So we want to make sure that you are staying on Terrac, you're taking your vitamins, you're maintaining your health. So it is important for us for you to come back to us. Would the surgery be held in Baltimore at University of Maryland Medical Center? Yes. Okay. So we only do surgery here, which is great because we have a dedicated floor for bariatric surgery patients after surgery. So everybody there is aware of what they need, what not to give them, so the staff isn't going to come up and bring you pancakes after surgery. You're going to be given what you need. So we want to keep everybody here. Great. So for people watching who still are interested, have questions, how can they reach you or what should they do next if they're interested in bariatric surgery here? Definitely. I believe our link to our website is below, so you can either register for that online seminar or register for one in person. And then after that's completed, then you get in, make your appointment to meet with Dr. Clickman. And any additional questions can be commented below or it can also give our office call for any other questions. Okay, great. That's all the time we have. Thanks again for watching. If you have questions for Ashley, you can leave them in the comment section below and we'll get back to you within 48 hours. Thank you. Thank you.