UCLA Metabolic and Bariatric Surgery Program
Roughly 300,000 patients die every year as a direct consequence of obesity-related complications and more than $100 million is spent annually on treating the consequences of obesity. At any given time, 50 million Americans are dieting, yet only 5 percent of them are able to maintain their weight loss over a long period of time.
Over the past four decades, bariatric surgery has been proven as an effective and durable tool in fighting this epidemic. In 2004, the Journal of the American Medical Association published a meta-analysis of more than 22,000 weight-loss surgery patients, demonstrating a dramatic resolution of co-morbidities such as diabetes, hyperlipidemia, hypertension and sleep apnea in more than 80 percent of the studied subjects. Consequently, the Centers for Medicare and Medicaid Services redefined obesity as an illness and has since approved bariatric surgery for its members.
A Unique Program Approach
Since its inception in January 2003, UCLA’s Metabolic and Bariatric Surgery Program has provided more than 1,000 dedicated patients with a powerful tool to help them lose weight and sustain their weight loss. Surgery alone, however, can not be expected to bring about the desired results. UCLA’s multidisciplinary bariatric team believes that in order to be successful, weight- loss surgery must be accompanied by radical changes in a patient's lifestyle, including eating and exercise habits. These changes must occur prior to surgery and be maintained on a lifelong basis. The UCLA team lays the foundations for successful postoperative outcomes by providing its patients with a thorough preoperative education, preparation and support program. This comprehensive process distinguishes UCLA's program from many other programs in the area.
The UCLA bariatric program has demonstrated excellent results when compared with published benchmarks such as the University Healthsystem Consortium Benchmarking Project. In comparison with the national audit, the UCLA surgeons have had 50 percent fewer reoperations, a 99.7 percent laparoscopic completion rate and a 24-hour shorter hospital stay.
High Standards for Success
A key to the UCLA bariatric program's outstanding outcomes has been setting appropriately high standards for itself and its patients. The patient-selection guidelines surpass those set by the National Institutes of Health (NIH) in 1991. Patients are required to demonstrate recent weight loss through a supervised diet and exercise program before being considered for bariatric surgery. The program, however, does provide the necessary assistance to those patients who fail to meet this requirement. In addition to confirming a patient’s commitment to a radical lifestyle change, preoperative weight loss has also been shown to decrease visceral obesity, abdominal wall girth, liver size, and obesity-related chronic systemic inflammatory state, all of which contribute to a safer laparoscopic surgery and faster recovery.
Candidates for bariatric-surgery must also undergo a thorough preoperative psychological evaluation to identify and treat emotional components of their improper eating habits. To ensure successful outcomes, psychological stressors and ineffective coping mechanisms must be dealt with prior to surgery. This is frequently resolved expeditiously with group support or other forms of therapy. Occasionally, however, a longer treatment period is necessary to achieve satisfactory results.
The UCLA bariatric team firmly believes that the combination of stringent preoperative requirements, thorough patient preparation and high surgeon qualifications are the reasons behind its very positive outcomes profile.
The Procedures
The laparoscopic Roux-en-Y gastric bypass (RYGB) — with or without robotic assistance — is the primary bariatric-surgery procedure performed at UCLA. The traditional "open" RYGB has been in use since the 1960s and is considered the gold standard of weight-loss surgeries. At UCLA, surgeons perform the same surgery laparoscopically, a technique associated with less postoperative pain and faster recovery times. Through five small "keyhole" incisions, the surgeons create a small gastric pouch, re-route part of the small intestine and subsequently attach the two. The modification restricts the amount of food that can be accommodated, while also promoting weight loss through delayed absorption. Furthermore, the critical gastrointestinal hormonal milieu present in the distal stomach and duodenum is bypassed. Altering this regulatory hormonal environment is thought to be a critical component of both weight loss and the very early cure for type-II diabetes seen with the gastric-bypass surgery. This benefit is not seen with either the vertical banded gastroplasty or the adjustable gastric band procedures.
Similar to other major bariatric-surgery centers around the country, in some high-risk cases UCLA surgeons will perform a modified two-stage gastric bypass. Initially, either a laparoscopic sleeve gastrectomy or large-pouch gastric bypass is performed. Should the patient choose, and once his/her weight and co-morbidities have sufficiently decreased to allow for a safe completion surgery, the second part is subsequently performed.
Postoperative Follow-up
To ensure positive outcomes, UCLA bariatric program physicians favor an aggressive approach to their patients' postoperative care, coordinating this with the patient's own primary-care physician. Program physicians are available to their referring colleagues to answer any questions, help manage care appropriately and provide educational seminars pertaining to all aspects of bariatric surgery. Patients are typically seen every three months for the first postoperative year and once a year thereafter. Routine and specific blood work is required at those intervals. Special arrangements can be made for patients whose location or insurance prevents them from returning to UCLA for follow-up care. The program's services are available to all patients on a 24/7 basis.
