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The Weight Loss Center

The Weight Loss Center

From the time that we are born, we have many beginnings in life. Throughout our life we don't always make the right choices and we are forced to live with our consequences somehow. Whether it is nature or nurture, or a little of both, that get us where we are today, we sometimes find ourselves in need of intervention. Very seldom are we given second chances to correct our mistakes.

The Weight Loss Center at Harlingen Medical Center is a method of long-term weight control for morbidly obese adults. Compared to other treatments, bariatric surgery and procedures have the longest period of sustained weight loss in patients who have failed other therapies. Obesity is now recognized by leading government health authorities, such as the Centers for Disease Control (CDC) and National Institutes of Health (NIH) as a disease. Weight loss surgery is recommended as a treatment option for people with obesity that have a BMI > 40 or a BMI of 35 - 39.9 with serious medical conditions.

If you are reading this, then you are investigating options of weight loss alternatives for yourself or someone you care about. Many (i.e. medications, diet and exercise, behavior modification) have been tried and again nothing seems to keep the weight off. Well-established studies have demonstrated that 90 to 95 percent of the dieters will regain all of the weight lost during dieting.

Are you or someone you care about a part of the 90 - 95 percentiles? Are you ready to venture down the path with us beside you, to a fresh start in life?

Call Harlingen Medical Center for more information, or see our Patient Information Seminar Calendar for dates and times that will provide you with more in depth information about our program.

Overview of Obesity

Obesity has reached epidemic proportions in the U.S. over the past 20 years. At any given time, 50 million Americans are on some type of diet and yet only 5 percent are able to maintain their weight loss over a period of time.

Numerous factors have been identified that contribute to being overweight. Obesity is genetic. Somewhere in your family, others have dealt with the same issues you are dealing with now. Environmental factors include lack of nutritional information and motivation, lack of self-confidence, and today's lifestyle that revolves around the television and fast food.

It seems that once a person exceeds a certain obesity level, it is often harder to lose the weight because of the complications and restrictions caused by the disease itself. "Yo-Yo" dieting is the worst enemy and yet it becomes a part of life. How many times do we say, "I am starting on my diet again come Monday?" We also tend to reward ourselves with dinners. We comfort ourselves with our favorite snack. These types of behaviors contribute to the vicious cycle of obesity.

Individuals are usually morbidly obese if their weight is more than 100 pounds in excess of the Ideal Body Weight. Most physicians use a scale based off of the Body Mass Index (BMI).

If you are categorized as very obese, then you may have a higher rate of medical problems. The more obese you are, the higher the BMI and the chance of associated problems (heart disease, high blood pressure, diabetes, asthma, etc.), which increase dramatically as weight increases.

Classification

BMI

Overweight

>25.0

Obese (Class I)

Obese (Class II)

30.0 - 34.9

35.0 - 39.9

Clinically Severe Obesity (Class III)

≥ 40.00

Obesity is associated with significant health problems (comorbidities):

  • Osteoarthritis
  • Hypertension
  • GERD (Reflux)
  • Congestive Heart Failure
  • Gallbladder Disease
  • Depression
  • Diabetes
  • Urinary Stress Incontinence
  • Hyperinsulinemia
  • Asthma
  • Sleep Apnea
  • Heart Disease
  • Anemia
  • Neoplasia
  • Dyslipidemia

The death rate from severe obesity can exceed 12 to 20 times that of ideal weight individuals of the same age. Autopsy studies have shown that sudden unexplained death occurs up to 40 times more frequently in the severely obese.

If the physical complications were not enough, obese individuals may lose their self-confidence, tend to isolate themselves and sometimes sink into a state of helplessness and no longer function outside their home.

Requirements for Bariatric Surgery

Who is Eligible

Patients must meet specific criteria before they are allowed to proceed with the process. Selection is based on guidelines established by the National Institute of Health (NIH). We look at the body mass index (BMI) of each individual person.

There is a chart that informs us of your BMI.

  • If you have a BMI of 35 - 40 and have obesity related comorbidities, you are a candidate for this surgery.
  • If you have a BMI greater than 40, even if you do not have comorbidities, you may still be a candidate for this program.
  • If you have a history of failure in at least one medically supervised weight reduction program within the last two years.
  • If you are between the ages of 18 - 65 years old. If you are older than 65 years old, you will be considered on a case by case basis.
  • If you do not drink alcohol in excess.
  • If you are prepared to make substantial changes in your eating habits and lifestyle and are willing to continue working with the specialist treating you.

Ineligible Patients

  • If your obesity is related to metabolic or endocrine disorder.
  • If you have a history of substance abuse or untreated major psychiatric disease.
  • Surgery contraindicated or high risk.
  • Women who want to become pregnant within the next 18 months.
  • You have an inflammatory disease or condition of the gastrointestinal tract, such as ulcers, severe esophagitis, or Crohn's disease.
  • You have cirrhosis.
  • You have chronic pancreatitis.
  • You are addicted to alcohol or drugs.
  • You are under 18 years of age.
  • You are on chronic, long-term steroid treatment.

Requirements for The Intragastric Balloon Procedure

Who is Eligible

  • If you are at least 18 years of age.
  • If you have not had success with other weight loss methods
  • If you are not pregnant and have no interntion of becoming pregnant in the 6 months following balloon procedure.

Ineligible Patients

The referring and operating physicians will be able to inform patients of ineligibility based on various factors.

Setting Realistic Expectations

We believe the right patient is someone who understands the life-long commitment to healthy weight maintenance and is committed to that goal. We also need to make sure that you are an appropriate candidate for our program. With the right patient and commitment, this can reduce or prevent health problems. This is not cosmetic surgery or an easy answer to weight loss.

Keep in mind that:

  • Other medically managed weight loss methods must be tried first. Surgery is only an option if other methods have not been successful.
  • Surgery is meant to be permanent for bypass patients. You will need to make lifestyle changes for the rest of your life.
  • You must commit to making good food choices and being more active after surgery. Otherwise, you will not maximize your weight loss.
  • The surgery/procedure is only a tool, which will help you lose weight. It is up to you to be diligent with exercise, attend support group meetings and stay compliant with healthy eating choices and your chances of losing more weight will dramatically increase.

Procedures/Background Information

Normal Digestive Process

Your food is swallowed and it moves down the esophagus to the stomach, where a strong acid continues the digestive process. The stomach can hold up to 6 ½ cups of food at one time. Food moves from stomach to duodenum, the first segment of the intestine, bile and pancreatic juice speed up digestion. Most of the calcium and iron in the foods we eat is absorbed in the duodenum. The two remaining segments are the jejunum and ileum. These segments of small intestine are nearly 20 feet long and complete the absorption of almost all calories and nutrients. The food particles that are not digested in these segments are stored in the large bowel until eliminated.

Two Ways Surgical Procedures Promote Weight Loss

  1. Restrictive - Surgery limits the amount of food the stomach can hold by closing off or removing parts of the stomach. This operation also delays emptying of the stomach.
    NOTE: The majority of patients report feeling full and satisfied after eating a small amount of food, and not feeling excessively hungry most of the time. If much more than a quarter cup of food is eaten at once, the patient will feel uncomfortable and may vomit.
  2. Malabsorption- Surgery causes the food to be poorly digested and absorbed.
    NOTE: Vitamin and mineral supplements and a high protein intake will be required for life to prevent the problem of nutritional deficiencies.

Surgical Procedures

Gastric Bypass

Gastric bypass is a surgical procedure in which the stomach is divided into a small upper pouch and a much larger lower "remnant" pouch and then the small intestine is rearranged to connect to both. Surgeons have developed several different ways to reconnect the intestine, thus leading to several different gastric bypass (GBP) procedures. Any GBP leads to a marked reduction in the functional volume of the stomach, accompanied by an altered physiological and physical response to food.

ADVANTAGES (Gastric Bypass)

  • Does not require a medical device implant into body
  • Some patients see dramatic weight loss quickly
  • Improvements in health complications caused by obesity

DISADVANTAGES: (Gastric Bypass)

  • Malnourishment can occur is proper vitamins and supplements are not taken
  • Affects how your digestive system absorbs calories
  • Some patients may be more susceptible to gallstones

https://www.youtube.com/watch?v=l4vREUUv9Lw

Gastric Sleeve

This is a relatively new approach. It is the first component of the duodenal switch operation and involves removing the lateral 2/3rds of the stomach with a stapling device. It can be done laparoscopically ( keyhole surgery) but is not reversible. It basically leaves a stomach tube instead of a stomach sack.

ADVANTAGES (Gastric Sleeve)

  • Does not require a medical device implant into body
  • Pyloric valve and small intestine are kept intact
  • Reduces hunger (the portion of stomach that produces Ghrelin, the hunger stimulating hormone, is removed)
  • Few food intolerances
  • Low malnutrition risk
  • Revision option for gastric band patients

DISADVANTAGES: (Gastric Sleeve)

  • General surgical risks, including blood clots, bleeding, infection, and pneumonia
  • Leakage at stomach suture/staple edge
  • Not reversible

https://www.youtube.com/watch?v=rpj385r4HAY

Adjustable Gastric Banding (LAP -BAND Surgery)

A restrictive procedure where an adjustable gastric band is placed around the upper part of the stomach pouch, which restricts the amount of food that can be consumed at one time and increases the time it takes for the stomach to empty. As a result, patients achieve sustained weight loss by limiting food intake, reducing appetite, and slowing digestion. The band is then adjusted after surgery to either increase or decrease restriction by injecting a port placed underneath your skin on your abdomen.

ADVANTAGES (Lap Band)

  • No stomach stapling or cutting, or intestinal rerouting
  • Adjustable
  • Reversible
  • Lower operative complication rate than with gastric bypass
  • Less dietary deficiencies
  • Outpatient procedure or overnight

Disadvantages (Lap Band)

  • Less weight loss
  • Weight loss is slower
  • Less effective with sweet eaters
  • Regular follow-up critical for optimal results
  • Requires an implanted medical device
  • Effectiveness may be reduced due to slippage of the band
  • In some cases, the access port may leak and require minor revisional surgery

https://www.youtube.com/watch?v=0H3hkRHWgh4

Non-Surgical Procedures

The Orbera Intragastric Balloon Procedure

The Intragastric Balloon Procedure is a two-part weight loss program designed to help you to lose weight and maintain a healthy lifestyle. Long-lasting weight loss and overall health is much more achievable with ORBERA®'s gastric balloon technology, a healthy diet, and exercise. It has been shown that patients can lose up to 3x the weight with ORBERA®'s weight loss system than with just diet and exercise alone. ORBERA® is a simple, non-surgical outpatient procedure. A deflated balloon is inserted into your stomach and then it is filled to the size of a grapefruit. The entire process usually takes 20 minutes and most people go home hours later.


ADVANTAGES (Orbera Balloon)

  • Non-surgical, low-risk, one day procedure: no incisions or stitches
  • Can be used for patients who don’t qualify for surgical weight loss
  • Balloon is temporary and can be removed at any time

DISADVANTAGES: (Orbera Balloon)

  • Gastric discomfort, nausea and vomiting are common for the first few days following balloon placement
  • Possible abdominal and/or back pain
  • Non-permanent
  • Non-insured

https://www.youtube.com/watch?v=19BzT_G33PE

Frequently Asked Questions

1. Is there an age restriction for the surgery or procedures?

Most procedures are performed on patients between the ages of 18 and 65.

2. How do I know if I am eligible?

Patients must meet specific criteria before they are allowed to proceed with the process. Selection is based on guidelines established by the National Institute of Health (NIH). We look at body mass index (BMI) of each individual person.

There is a chart that informs us of your BMI.

  • If you have a BMI of 35 - 40 and have obesity related comorbidities, you are a candidate for this surgery.
  • If you have a BMI greater than 40, even if you do not have comorbidities, you may still be a candidate for this program.
  • If you have a history of failure in at least one medically supervised weight reduction program within the last two years.
  • If you are between the ages of 18 - 65 years old. If you are older than 65 years old, you will be considered on a case by case basis.
  • If you do not drink alcohol in excess.
  • If you are prepared to make substantial changes in your eating habits and lifestyle and are willing to continue working with the specialist treating you.

To see the list that may make you ineligible, read the information in "Requirements."

3. How much weight will I lose?

With the gastric bypass, most patients lose 50-80% excess body weight within 12-18 months after surgery. With the gastric sleeve, patients are usually expected to lose 65%-70% excess weight within 12-18 months after surgery. However, this weight loss may vary depending on calorie content of food consumed & physical activity levels.

The Lap Band procedure will allow you to lose 50% of your excess body weight at 2 years. It is also effective in reversing obesity related comorbidities.

With the Orbera Balloon, patients typically experience around 20 to 30% weight loss

4. What are the pre-operative requirements to have either surgery?

  • You must attend an Information Seminar at Harlingen Medical Center.
  • You must have a dietician evaluation.
  • You may be required to have a psychological evaluation. Based on your medical history, we may need to verify that you are mentally ready for a lifestyle change.
  • If you have a history of heart disease, if you have taken Fen-Phen in the past, if you are over the age of 50, or other cardiac risk factors you will require an echocardiogram.
  • If you have not had your gallbladder out and have had abdominal pain, you may need to have an ultrasound of your gallbladder.
  • Before surgery you will have a chest x-ray, EKG and blood tests.
  • If you have any history of smoking you might be require to have a pulmonary function test.
  • If you have any history of sleep apnea or snoring, you may have to undergo a sleep apnea test.

5. When will my surgery be scheduled?

Once you have met all the requirements of the surgeon and the program, we will work with you to schedule your surgery.

6. What are the risks of the surgery?

Weight loss surgery is major abdominal surgery with significant risks. The following complications include, but are not limited to:

  • Risk from general anesthesia
  • Bleeding
  • Infection
  • Pneumonia
  • Blood clot in the legs or lungs
  • Hernias
  • Blockage or obstruction
  • Narrowing where surgeons suture the pouch to the intestine, which can require another endoscopy and dilation
  • Leakage from the stomach or the intestines
  • Injury to liver and/or spleen
  • Pulmonary and/or cardiac and/or renal failure
  • More than 1/3 of bypass patients' develop gallstones, which could lead to a procedure known as cholecystectomy to remove your gallbladder.
  • Almost 30% of patients who have bariatric surgery develop nutritional deficiencies such as anemia, osteoporosis. These deficiencies can be avoided if lifelong vitamin and mineral intake are maintained.
  • With the LAP BAND there is a risk that the band can either slip or erode. There is a risk that you will not lose weight if you do not follow the diet and exercise program.

7. How do I know which procedure is best for me?

Deciding which procedure is best for you is largely a personal choice best achieved in discussion with your surgeon.

8. Will my primary care physician (PCP) be involved in any part of my care?

Absolutely. Your PCP is an integral part of surgery and will be involved in the peri-operative care.

9. Will I feel hungry?

It is very important that you know and understand that these procedures will not affect your eating habits and hunger on their own. It will NOT cause you to lose your desire to eat and it will NOT remove any of the psychological cravings that you may have for food. If you eat when you are stressed, you will still feel like eating when you are stressed. The success of your weight loss depends on understanding the stresses that make you feel like eating and identify other ways of dealing with the stress.

How to Get Started

  1. You must contact the program coordinator to schedule your attendance to an information seminar.
  2. At the seminar, we will make a copy of your insurance card. A patient profile is completed and reviewed to determine eligibility.
  3. If you meet the requirements you will be given an appointment to meet with a surgeon.
  4. The surgeon will review your medical history and determine which tests will need to be performed.
  5. Once the pre-operative tests/exams are performed, you will be scheduled for your procedure and a pre-operative appointment.
  6. You attend your pre-operative appointment and pre-register for your procedure.
  7. You meet with your doctor before your procedure date to review procedure and have any remaining questions answered.
  8. Procedure/surgery is performed.
  9. You will be given follow-up appointments with the doctor and/or dietician.
  10. You will need to attend support group meetings in order to achieve the best results of your procedure.

Glossary of Terms

Anesthesia - The loss of sensation and feeling. Also refers to the process or drugs used to produce this effect. Anesthesia is commonly employed prior to surgery, so that a patient will not feel any pain or discomfort.

Bariatric - Related to the branch of medicine that deals with the prevention and treatment of obesity.

Bariatric Surgeon - A surgeon who specializes in the surgical treatment of obesity.

Body Mass Index (BMI) - The most widely used measurement for obesity. The BMI approximates body mass, using a mathematical ratio of weight and height (kg/m²) or weight in pounds divided by height in inches squared and this amount multiplied by 703. A BMI of 30 or more is regarded by most health agencies as the threshold for obesity. A BMI of 40 or more generally qualifies as morbid obesity. However, the BMI does not distinguish between muscle and fat.

Chronic Pancreatitis - A progressive inflammatory disease of the pancreas, which may be accompanied by abdominal pain and problems in digestion.

Cirrhosis - A chronic condition in which the liver becomes scarred, fibrous, and filled with fat, thus reducing its ability to function.

Comorbidity - A medical condition that exists in addition to and is caused or worsened by obesity or any other primary disease being studied or treated. With sufficient weight loss, obesity-related comorbidities such as type 2 diabetes, hypertension, and sleep apnea generally improve or completely resolve.

Contraindication - A factor that makes a particular treatment or procedure inadvisable.

Dumping Syndrome - A physiological reaction frequently seen following gastric bypass surgery. This operation is designed to alter the function of the stomach and intestines and interrupt normal digestion. Therefore, whenever patients eat certain foods such as sugar and sweets, they may experience "dumping". The patient may feel nausea, flushing and sweating, light-headedness, and watery diarrhea. Of course no one likes these feelings, especially patients who love sweets. This is a real help to them in their efforts to lose weight.

Laparoscopy (Laparoscopic Surgery) - A minimally invasive surgical approach where the surgeon makes several small incisions to access the interior of the body. A long, slender camera attached to a light source and specially designed instruments are used to perform the operation. Compared to the large incision of conventional open surgery, there is typically less pain and scarring following this operation. Usually, hospital stay and overall recovery time are also reduced.

Morbid Obesity - A disease in which excess weight begins to interfere with basic physiological functions such as breathing and walking. Generally, it can be defined as being 100 pounds overweight. A more precise indicator, however, is a Body Mass Index of 40 or greater.

Obesity Related Comorbidities - Diseases that are directly associated with morbid obesity:

  • Osteoarthritis
  • Hypertension
  • GERD (Reflux)
  • Congestive Heart Failure
  • Gallbladder Disease
  • Depression
  • Diabetes
  • Urinary Stress Incontinence
  • Hyperinsulinemia
  • Asthma
  • Sleep Apnea
  • Heart Disease
  • Anemia
  • Neoplasia
  • Dyslipidemia

Sleep Apnea - The temporary cessation of breathing during sleep. Typically, the sufferer will awake gasping for breath. Sleep apnea may occur repeatedly, resulting in a poor night's sleep and daytime drowsiness. One of the comorbidities associated with morbid obesity.

Type 2 Diabetes - A chronic endocrine disorder characterized by the inability to properly utilize sugar, specifically glucose, a simple carbohydrate. This results in excessively high glucose levels in the blood. Diabetes involves a relative or absolute shortage of insulin, a hormone that regulates the body's breakdown of carbohydrates. A higher percentage of obese individuals have type 2 diabetes than does the general population.

Meet Our Doctors

Carlos A. Barba, M.D.

Dr. Barba has been a pioneer in the Valley and in the nation in performing various types of weight- loss surgeries – having performed over 5,000 weight loss surgeries. His credentials include: Associate Professor of Surgery UCONN, Center of Excellence Surgeon from Central Connecticut Surgeons, LLC, Past President Connecticut Chapter ASMBS, Owner Central Carlos A. Barba, MD, PLLC; He has performed over 5000 bariatric cases including gastric bypasses, sleeve gastrectomies and lap bands, as well as more than 200 revisional surgeries.

Ashraf Hilmy, M.D.

Dr. Hilmy has been a pioneer in the Valley in performing various types of weight-loss surgeries. Dr. Hilmy graduated from medical school at Ain Shams University in Cairo, Egypt. He earned a Masters of Business Administration degree from the University of Texas Pan American. Dr. Hilmy completed a residency in Surgery at Scott & White Memorial Hospital in Temple, Texas, as well as a residency in Anesthesiology from New York Medical College. He also completed a fellowship in Cardiac Anesthesia at Westchester County Medical Center and New York Medical College. Dr. Hilmy is licensed by the Texas State Board of Medical Examiners. He is a Certified Diplomate of the American Board of Surgery, the American Board of Anesthesiology, and the American Board of Healthcare Executives. He also holds a Certification of Special Qualifications in Critical Medicine from the American Board of Anesthesiology. He is a Fellow of the American College of Surgeons.

Nicole Grigg-Gutierrez, M.D.

Dr. Grigg is board certified in Internal Medicine and Gastroenterology by the American Board of Internal Medicine. In addition to her fellowship in Advanced Endoscopy at the Carolinas Healthcare System / Carolinas Medical Center -- and her fellowship in Gastroenterology and residency in Internal Medicine at the Department of Veterans Affairs / Caribbean Healthcare System – she also received a medical degree from the Universidad Central Del Caribe-Escuela de Medicina in San Juan, Puerto Rico.

Dr. Grigg-Gutierrez is now helping in the fight against the potentially-deadly disease of colon cancer by offering colonoscopy screenings at Knapp Medical Canter’s gastrointestinal lab, as well as at Harlingen Medical Center.

Surgical Weight Loss
Information Seminar & Support Group

The Weight Loss Center at Harlingen Medical Center hosts Information Seminars and Support Groups. To learn more about these special meetings, please contact Bariatric Coordinator at (956) 365-1888 or at PMuniz@Primehealthcare.com.

Contact:

Patsy Muniz
Program Coordinator
The Weight Loss Center
(956) 365-1888 (O) | (956) 365-1875 (F)
PMuniz@primehealthcare.com