Bariatric Surgery Physician Assistant – First Impressions of the SurgeryAugust 30, 2021
Bariatric Surgery Physician Assistant - First Impressions
I’ve been practicing as a Physician Assistant for five years and switched specialties to an entirely new specialty, Bariatric Surgery, in the Spring of 2021. Since joining DFW Bariatrics and General Surgery, and working alongside Dr. Sachin Kukreja and Dr. Elizabeth Hooper, I’ve been learning the ins and outs of bariatric medicine and surgery. Very quickly, my perspective of the patients and the specialty itself have changed dramatically. I want to share my first impressions after my first several months working in Bariatric Surgery.
Bariatric Surgery Physician Assistant - First Impressions
It’s Not All About The Scale
While weight loss is often a measure of progress and something that we do monitor and track, the numbers on the scale are not the only measure of success.
For example, we do see improvement in a patient's blood pressure. We see it stabilizing, and the numbers return to normal even the day after surgery. I’ve seen patients on 3-4 different medications for high blood pressure before surgery and after have the ability to decrease the number of medications or stop the medication completely. It has been shown that in patients with high blood pressure and obesity, weight loss surgery is an effective tool for controlling blood pressure.
In one study, more than 50% of participants could control their blood pressure without the need for medications, and greater than 30% of patients were able to reduce their number of medications significantly. Furthermore, aside from controlling blood pressure with no or fewer medications, their overall metabolic profile improved. (3)
A1c, Diabetes, and Pre-Diabetes
Another number we look at is hemoglobin A1c, a blood test that measures your average blood sugar over 2 to 3 months. One study aimed to determine if a reduction in BMI had an effect on A1c, and they found that the greater the weight loss or reduction in BMI, the greater reduction in A1c levels. At 12 months postoperatively, 62.5% of patients with diabetes and 91% of non-diabetic patients achieved an A1c of 6.5% or less. (2)
These numbers are the reasons why patients schedule consultations for surgery. It’s not all about losing weight, it’s about improving their overall health and the reduction of long-term effects of comorbidities.
The Easy Way Out
It’s not the “easy way out.” There is often a stigma among society and even other healthcare professionals that bariatric surgery is the “easy way out.” Unfortunately, it’s thought that individuals with obesity are lazy, unproductive or the reason an individual has obesity is because of his or her own choice. (4) It’s something I myself have heard in discussions or comments made to patients in the past.
My impression after day one of being a part of a bariatric surgery team, is that it is definitely not the easy way out and society stigmas are far from the truth.
Before and after surgery, patients undergo a complete change in their thoughts, food choices, and behaviors. In any culture, sharing meals and the types of food we eat are so deeply ingrained we barely even think about it until a change is made.
Whether it’s that you no longer “clean your plate” or eat another slice of your grandmother’s homemade chicken pot pie because you want to show her you love her cooking, or simply going out to dinner with a close friend you haven’t seen in a while. These are everyday situations in which your thought process changes after surgery.
Other than changes in your thought process, the road to surgery ensures that you are mentally and physically prepared. Consultations and testing are required before surgery. The pre-surgery workup may include cardiac testing, psychiatric evaluation, resting metabolic rate, evaluation of swallow, and dietary and nutritional counseling.
The work does not stop after surgery. Patients follow food and liquid dietary guidelines and take nutritional supplementation life long after their surgery. This may consist of having a support group or setting reminders to take vitamins on your phone. It’s remembering how many ounces of fluid you take in each day to ensure you stay hydrated and using an app to track your daily protein intake.
Oftentimes, it’s the softer everyday successes that are the most important to patients. Success is buying a new dress or suit size, being able to cross your legs, and even being able to get down on the floor and play games with your children. Success is not always a measure of the numbers, and it may not always be an outward reflection to the general public.
Lastly, the decision and choices patients make to have surgery is all within themselves. It’s their journey. Furthermore, it is a choice to improve one’s overall health and not necessarily how you’ll look afterward or if you’ll be able to fit into a swimsuit.
While society views weight loss surgery as a way to shed pounds, for patients, it is overwhelmingly more a choice about improving their diabetes, high blood pressure, joint problems, and infertility. It’s a choice to be able to physically enjoy and experience things they remember doing years ago or have experiences they never thought they would like completing a tough mudder, enjoying a road trip because they can fit comfortably into a car or feeling more confident for a speaking event while wearing a custom made suit.
In conclusion, my first impressions of bariatric surgery have changed my thoughts toward the entire process and patients themselves.
- Rose, M. A. R., Pories, M. R. P., Robertson, D. R., & Neil, J. A. N. (2018). Bariatric Surgery: Not the ‘Easy’ Way Out—the ‘Healthy’ Way Out. Bariatric Times, 15(3), 12–14. https://bariatrictimes.com/healthy-way-out-march-2018/
- Ahmed, A., Alanazi, W., Ahmed, R., AlJohi, W., AlBuraikan, D., AlRasheed, B., ALMuqbil, B., Al-Zahrani, A., Yousef, Z., & AL-Jahdali, H. (2018). The influences of bariatric surgery on hemoglobin A1c in a sample of obese patients in Saudi Arabia. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, Volume 11, 271–276. https://doi.org/10.2147/dmso.s161540
- Schiavon, C. A., Bersch-Ferreira, A. C., Santucci, E. V., Oliveira, J. D., Torreglosa, C. R., Bueno, P. T., Frayha, J. C., Santos, R. N., Damiani, L. P., Noujaim, P. M., Halpern, H., Monteiro, F. L., Cohen, R. V., Uchoa, C. H., de Souza, M. G., Amodeo, C., Bortolotto, L., Ikeoka, D., Drager, L. F., . . . Berwanger, O. (2018). Effects of Bariatric Surgery in Obese Patients With Hypertension. Circulation, 137(11), 1132–1142. https://doi.org/10.1161/circulationaha.117.032130
- Puhl, R. M., & Heuer, C. A. (2010). Obesity Stigma: Important Considerations for Public Health. American Journal of Public Health, 100(6), 1019–1028. https://doi.org/10.2105/ajph.2009.159491
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2866597/ obesity stigma
ABOUT THE AUTHORJillian Robinson, PA-C is a certified Physician Assistant specializing in Bariatric and General Surgery at DFW Bariatrics and General Surgery in Dallas, Texas. She earned her Master of Health Science from the Physician Associate program at the University of Oklahoma Health Sciences Center in 2015. She received her undergraduate degree from the University of Oklahoma and worked as a medical assistant and first responder during her studies. She is a member of the American Academy of Physician Assistants.