We are for sharing innovative treatments and preventing disease before it ever develops. Learn how our team is working to better care for you on this edition of UVA Health System Radio. Here's Melanie Cole. 

Are you severely overweight? Have you ever considered bariatric surgery? But who is really a candidate for this weight loss surgery, and what does it involve? My guest today is Dr. Peter Hallowell. He's a board certified surgeon and director of bariatric surgery at the UVA Health System. Welcome to the show, Dr. Hallowell. Tell us a little bit about bariatric surgery. What does it involve? 

So bariatric surgery involves an operation on the patient, and it describes a field of surgery where there are multiple different procedures that we do, all with the goal to help the patient lose a significant amount of weight and to improve the medical problems that are associated with carrying a significant amount of weight. 

What are the different kinds of bariatric surgery out there now? Some of them are permanent, and some of them are not, correct? 

Yes. In a general sense, what we've found is that even the procedures that are somewhat temporary, once that procedure is withdrawn, there's the tendency to regain weight. So there tends to need to be a procedure that's, in effect, to maintain this weight loss. The procedures that are commonly done in the United States include the gastric bypass, the sleeve gastrectomy, and the lap band, as far as the common surgical procedures. 

So who are candidates? Who really should be considering any of these types of bariatric surgery? 

Excellent question. So patients who are severely overweight-- and in medical terms, we measure that by a tool called the body mass index. This is effectively a ratio of your height and weight so that taller people can carry a lot more weight. Think of a person like Shaquille O'Neal, who's nearly 7' tall, versus somebody who's 5 foot 4. Shaquille O'Neal can carry a lot more weight on his frame and not be unhealthy. 

The body mass index is not something you can easily calculate in your head. Most places have a calculator on a website. And we use we use that in our own clinic. And what we're looking to see is if your body mass index is greater than 40, you would be a candidate for surgery or if your body mass index was greater than 35 and you had a significant medical problem, like hypertension, diabetes, obstructive sleep apnea. And body mass index in those ranges translates to roughly 80 to 100 pounds over your ideal weight. 

So Dr. Hallowell, explain a little bit about these types of surgery. So it makes your stomach-- people think of a stomach getting smaller and not being able to-- limiting the amount of solid food. But does that also be like malabsorptive? Does it make it so that you cannot retain that food? Explain a little bit about it. 

Yeah. So each of the main procedures that we do works in a slightly different way. So I'll take them kind of each in and of itself. So gastric bypass, we will take the upper part of your stomach and staple that off and make it into what we call a small pouch. It's generally about the size of an egg or smaller and holds pretty much up to about an ounce to an ounce and a half of food or fluid. 

We then take part of your small intestine and attach it to that pouch that the food you eat will go into the stomach and then into a part of the small intestine that's usually further down. And then we make another connection either even further down the small bowel, where the rest of the body's juices from the liver or pancreas and the rest of the stomach come in to help you digest. So in a traditional sense, we think that operation as sometimes limiting the amount of food that you can eat because of the size of the pouch and also inducing a little bit of malabsorption because of where the digestive enzymes come into the system and shortening your intestine a little bit. 

Some of the newer research into bariatric surgery indicates that some of the effects that we're having may be more hormonal or biochemical than pure restriction of food or malabsorption. And while that hasn't been fully fleshed out, it's one of the most interesting areas in the field. The next procedure that's commonly done in the United States and, in fact, is the most common operation performed these days, is called the sleeve gastroscopy. And simply put, that is taking the stomach and turning it into a thin tube about the size of your esophagus. 

So if you think of your stomach as a big reservoir that can stretch out, especially around Thanksgiving time when you may overindulge in food and it becomes a big reservoir, the sleeve gastrectomy turns that into much smaller reservoir, a much smaller tube. And you cannot hold as much food. And then the last procedure that's commonly done in the United States, the lap band, we take basically a plastic belt with a balloon on the inside and put that around the upper part of the stomach, right by the entrance to the stomach. And by inflating the balloon, we cause that area to narrow it down and allow patients to feel hungry earlier than they would with eating food. So it gives a lot more restriction. 

So what questions would you advise patients to ask their doctors when they're considering these types of surgery? 

They need to ask their doctor, if they're considering the surgery, which operation may be best for them. They should at their doctor how much experience have they had in the various operations that they've proposed. It would be very prudent to ask what the risks of the surgery that they're thinking about [INAUDIBLE], what the potential benefits for them are, and if the surgeon is a member of an organization that specializes in bariatric surgery, and the hospital and center they're going to is recognized as a center that performs these in a high volume with good outcomes. 

So tell us a little bit about the recovery. We don't have much time left. But what can patients expect afterward? 

Again, it depends on the procedure that they have. But in general, it's about a two-day hospital stay. Most of the procedures in the United States are performed in a minimally invasive surgery fashion, or what we call laparoscopic surgery. So there'll be multiple small incisions on the patient's abdomen. This allows it to have a lot less pain than a traditional open surgical incision. 

The patients will generally recover pretty quickly from the surgical side of the equation. However, they begin losing weight, especially with a gastric bypass or sleeve, sometimes up to a pound a day. So they may feel a lot of fatigue up until six weeks after surgery. So those should to be some of the expectations going in-- that they may be out of work for a week or two after surgery, and they may feel tired for up to a month, a month and a half. 

And Dr. Hallowell, why should patients come to UVA for their bariatric surgery? 

Well, UVA has been doing bariatric surgery for the longest period of time in Central Virginia. And we have the most experienced team taking care of our patients. And we are at a recognized center of excellence for bariatric surgery. And we've held that designation since the beginning of the program to designate hospitals as centers of excellence. So it's really our experience, our knowledge and our skill at doing these operations that should drive patients to come to see us. 

Thank you so much. You're listening to UVA Health Systems Radio. For more information, you can go to uvahealth.com. That's uvahealth.com. This is Melanie Cole. Thanks so much for listening.