Southern Surgical Associates

Our goal is to support you with valuable, accurate information about bariatric surgery. Bariatric surgery is a life-changing procedure, and we want you to know the facts. Whether it’s through connecting you with a bariatric surgeon, hearing the individual experiences of patients, or browsing detailed facts about surgery from the comfort of your own home, we want to provide you with information so you can take your next step with confidence.
The Resource Library has easy-to-print, convenient lists of questions for bariatric surgeons, primary care physicians, your insurance company, and others.
The first step to transforming your health is use of a BMI Calculator. Simple to use, the BMI Calculator is an easy way to see if your health is at risk because of obesity.
If you have trouble understanding any terms you hear in a conversation with your doctor or read on this website, go to the Glossary of Terms for a clear definition.

We currently are building a library of information resource sheets for you to download. As we add to our collection, you’ll find information resource sheets designed to help you through the surgery process. Topics will include financing your surgery, advantages and risks of surgery, recovery, finding a support structure, lifestyle changes, and long-term weight loss maintenance.

Please note that the majority of the resource sheets will require the free Acrobat® Reader.

Morbid obesity can be a fatal disease that affects your health, life span, and quality of life. If you are 100 pounds or more above your ideal body weight, you may be suffering from morbid obesity. A common measure of obesity is Body Mass Index (BMI). Your BMI, especially when accompanied by one or more co-morbid condition, is important to consider when finding treatment. Another measure of obesity is the Ideal Weight Chart. Discuss your BMI and ideal weight with your primary care physician or a surgeon in your area if your BMI indicates an obesity-related health risk.

Absorption
Process in which digested food is absorbed by the lower part of the small intestine into the bloodstream

Adipose
Fatty; having to do with fat

Anastomosis
Surgical connection between two structures

Bariatric
Having to do with weight or weight reduction

Body Mass Index (BMI)
Method of figuring out the degree of excess weight. Based on weight and height.

Cardiovascular
Having to do with the heart and blood vessels

Certificate of Coverage
A document provided by the health insurance company that describes the details of the plan’s policy, including requirements for eligibility, benefits, deductibles, maximums, and exclusions of coverage.

Clinically Severe Obesity
Body Mass Index of 40 or more, which is roughly equal to 100 pounds or more over ideal body weight; a weight level that is life-threatening. Also known as morbid obesity.

Co-Morbid
Related illnesses (i.e., arthritis, hypertension) or disabling conditions related to clinically severe obesity or obesity-related health conditions

Colon
Large intestine beginning at the end of the small intestine and ending at the rectum

Contraindications
Any symptom or situation that is inappropriate for an otherwise recommended treatment (i.e., alcoholism, drug dependency, severe depression, sociopathic [antisocial] personality disorder)

Criteria
Defines what is right for surgery

Digestion
Process in which food is broken down by the stomach and upper small intestine into absorbable forms

Dilation
Process of enlarging or further opening a passage or anastomosis

Disease
Process that is a hazard to health and/or longevity

Divided Gastric Bypass Surgery
Surgical operation that provides a way to manage clinically severe obesity

Dumping Syndrome
Uncomfortable feeling of nausea, lightheadedness, upset stomach, vomiting, and/or diarrhea, related to ingestion of sweets, high-calorie liquids, or dairy products

Duodenum
First 12 inches of small intestine immediately below the stomach. Bile and pancreatic fluids flow into the duodenum through ducts from the liver and pancreas.

Fully-Insured Plan
A type of health insurance plan in which the employer pays a monthly premium for a standardized health plan from an insurance company that assumes all risk and cost involved. The insurance company generally makes coverage decisions and must abide by state and federal regulations.

Gastric
Having to do with the stomach

Gastric Bypass Surgery
Operation designed to make a portion of the stomach nonfunctioning and to reroute the small intestine

Gastrointestinal
Having to do with the stomach or intestine

Gastrojejunostomy Anastomosis
Upper connection of the gastric bypass operation

Gastroplasty
Surgical operation for morbid obesity that changes the shape of the stomach

Genetic
Having to do with inherited physical characteristics

Hernia
A weakness in the abdominal wall that results in a detectable bulge

Herniation
Process in which a hernia is formed

Hyperosmolality
Having highly concentrated substances that are capable of causing dumping syndrome

Hypertension
High blood pressure

Ileum
The 10 feet of small intestine that handle absorption

Jejunum
The 10 feet of small intestine that handle digestion

Kilogram
Measure of weight equal to 2.2 pounds

Laparoscopy
Method that allows a doctor to see and treat intra-abdominal problems with long fiber-optic instruments

Morbid
Having to do with disease, illness, and a higher risk of death

Morbid Obesity
Body Mass Index of 40 or more, which is roughly equal to 100 pounds or more over ideal body weight; a weight level that is life-threatening

Mortality
Having to do with death

Multidisciplinary Bariatric Program
Team approach to testing and treatment of clinically severe obesity; includes surgical, internal medicine, nutrition, psychiatric, and exercise physiology, assessment, and treatment

NIH
National Institutes of Health

NIH Consensus Report
Summaries of meetings about clinically severe obesity and the assessment and treatment of obesity; issued periodically by NIH

NIH Surgical Criteria
The National Institutes of Health has established minimum requirements for deciding whether bariatric surgery is the right treatment option:

100 pounds or more above ideal body weight or a BMI of 40 or greater3
BMI of 35 or greater with one or more obesity-related health condition3

Obesity
Having to do with excessive weight or adipose tissue

Obstructions
Narrowing of an anastomosis or a part of the gastrointestinal tract that slows down the normal passage of food or waste

Psychotherapy
Testing and treatment of mentally related disorders

Pulmonary
Having to do with the lungs

Roux-en-Y Gastric Bypass Surgery
A surgical method of reconnecting the stomach and upper small intestines in roughly a Y shape

Self-Funded Plan
A type of health insurance plan in which the employer assumes all risks and costs in providing healthcare to employees and, therefore, decides what is and what is not covered, such as bariatric surgery. Self-funded plans are usually administered by an insurance company. This insurance company is often referred to as the third-party administrator (TPA) of the plan. The TPA performs administrative functions only and does not determine coverage. Self-funded plans are exempt from state regulations, including mandated benefits, premium taxes, and consumer protection laws, but must meet federal regulations.

Staples
Surgically sterile devices for connecting tissue; usually they are permanent and made of stainless steel or titanium

Strictures
Narrowing of anastomosis or a section of intestine; often related to scarring or ulcers

Summary Plan Description
Employers with self-funded health insurance plans are legally required to provide this document to their beneficiaries. The document provides plan participants important information about their health benefits. This includes plan rules, financial information, and information on the operation and management of the plan. The information contained in the Summary Plan Description is similar to what is found in the Certificate of Coverage provided by the health insurance company.

Therapy
Treatment

Type 2 Diabetes
A disorder of glucose and insulin metabolism

Vertical Banded Gastroplasty
A type of surgical operation to treat clinically severe obesity. Changes the shape of and restricts the stomach. Not performed very often.

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American Diabetes Association®
The American Diabetes Association is the nation’s leading nonprofit health organization providing diabetes research, information, and advocacy. The mission of the organization is to prevent and cure diabetes and to improve the lives of all people affected by diabetes.

www.diabetes.org

American Dietetic Association
The American Dietetic Association promotes optimal nutrition and well-being for all people by advocating for its members.

www.eatright.org

American Heart Association®
The American Heart Association is a national voluntary health agency with the mission of reducing disability and death from cardiovascular diseases and stroke.

www.americanheart.org

American Medical Association
Founded more than 150 years ago, the American Medical Association’s strategic agenda remains rooted in its historic commitment to standards, ethics, excellence in medical education and practice, and advocacy on behalf of the medical profession and the patients it serves.

www.ama-assn.org

American Obesity Association
The Association will champion the cause by promoting education, research, and community action that can improve the quality of life and self-image of sufferers.

www.obesity.org

American Society of Bariatric Physicians
The Society is a professional medical society of licensed physicians who specialize in the medical treatment of obesity and its associated conditions. Formed in 1950, ASBP has been instrumental in offering practical information that doctors can use in their bariatric practices, and supporting public policies to prevent overweight and obesity.

www.asbp.org

American Society for Bariatric Surgery
The Society was founded in 1983. Foremost American surgeons have formed this society’s leadership and have established an excellent organization with educational and support programs for surgeons and allied health professionals.

www.asbs.org

Centers for Disease Control and Prevention
The CDC is the lead federal agency for protecting the health and safety of people by providing information to enhance health decisions and to promote health through strong partnerships.

www.cdc.gov

National Eating Disorders Association
The nation’s largest nonprofit organization devoted to the awareness and prevention of eating disorders.

www.edap.org

National Heart, Lung, and Blood Institute
The Institute is part of the National Institutes of Health, a federal government agency, and provides leadership for national programs in diseases of the heart, blood vessels, lungs, and blood; blood resources; and sleep disorders.

www.nhlbi.nih.gov

National Institutes of Health
Founded in 1887, the NIH is comprised of 25 separate institutes and centers, all part of the U.S. Department of Health and Human Services.

www.nih.gov

North American Association for the Study of Obesity: the Obesity Society
The Society is an interdisciplinary society with the purpose of developing, extending, and disseminating knowledge in the field of obesity.

www.naaso.org

Obesity Action Coalition
The mission of the OAC is to elevate and empower those affected by obesity through education, advocacy, and support. The OAC strives to educate obese individuals, family members, and the public on obesity.

www.obesityaction.org

Overeaters Anonymous®
A fellowship of individuals who, through shared experience, strength, and hope, are recovering from compulsive overeating.

www.oa.org

Shape Up America!
Shape Up America! is a high-profile national initiative to promote healthy weight and increased physical activity in America.

www.shapeup.org

TOPS® Club
TOPS is a nonprofit organization that offers a healthy, caring, and supportive approach to weight control.

www.tops.org

WebMD®
WebMD provides comprehensive health information and services. The website includes the Weight Control Health Center, which is dedicated to education about morbid obesity and its treatment options.

www.webmd.com

Weight Loss Surgery Info
If you’re still unsure about bariatric surgery and want to take a step back to learn more about the basics, please visit our companion website. While you’re there, sign up for the newsletter, WLS NewsSource.

www.weightlosssurgeryinfo.com

Weight-control Information Network
The Network is a national information service of the National Institute of Diabetes & Digestive & Kidney Diseases, which is part of the National Institutes of Health. It was established in 1994 to provide health professionals and consumers with science-based information on obesity, weight control, and nutrition.

win.niddk.nih.gov

1 American Society for Bariatric Surgery. Rationale for the Surgical Treatment of Morbid Obesity. [Online] 8 April 1998. <www.asbs.org/html/ration.html>.
2 Christou NV, Sampalis JS, Liberman M, et al. Surgery Decreases Long-term Mortality, Morbidity, and Health Care Use in Morbidly Obese Patients. Ann Surg 2004;240(3):416-424.
3 Buchwald H, Avidor Y, Braunwald E, et al. Bariatric Surgery. A Systematic Review and Meta-Analysis. JAMA 2004;292(14):1724-37.
4 American Diabetes Association. Type 2 Diabetes: Conditions, Treatments, Resources. [Online] 1 August 2005. <http://www.diabetes.org/type-2-diabetes.jsp>.
5 American Diabetes Association. The Link Between Obesity and Metabolic Syndrome. [Online] 1 August 2005. <http://www.diabetes.org/diabetes-research/summaries/vasquez-obesity>.
6 Sampalis J, Liberman M, Auger S, et al. The impact of weight reduction surgery on health-care costs in morbidly obese patients. Obes Surg 2004;14:939-947.
7 Presutti R, Gorma R, Swain J. Concise Review for Clinicians. Primary Care Perspective on Bariatric Surgery. Mayo Clin Proc 2004 Sept;79(9):1158-1166.
8 Wittgrove AC, Clark GW. Laparoscopic Gastric Bypass, Roux-En-Y 500 Patients: Technique and Results, with 3-60 Month Follow-up. Obes Surg 2000 Jun;10(3):233-39.
9 National Institute of Mental Health. Depression. [Online] 4 August 2005. <http://www.nimh.nih.gov/publicat/depression.cfm>.
10 Rasheid S, Magdalena B, Gallagher SF, et al. Gastric Bypass is an Effective Treatment for Obstructive Sleep Apnea in Patients with Clinically Significant Obesity. Obes Surg 2003;13:58-61.
11 Gunnbjornsdottir MI, Omenaas E, Gislason T, et al. Obesity and Nocturnal
Gastroesophageal Reflux are Related to Onset of Asthma and Respiratory Symptoms. Eur Respir 2004;24:116-121.
12 Smith SC, Edwards CB, Goodman GN. Symptomatic and Clinical Improvement in Morbidly Obese Patients with Gastroesophageal Reflux Disease Following Roux-en-Y Gastric Bypass. Obes Surg 1997;7:479-484.
13 Perry Y, Courcoulas AP, Fernando HC, et al. Laparoscopic Roux-En-Y Gastric Bypass for Recalcitrant Gastroesophageal Reflux Disease In Morbidly Obese Patients. J Lap Surg 2004 Jan-Mar;8(1):19-23.
14 Simard B, Turcotte H, Marceau P, et al. Asthma and Sleep Apnea in Patients with Morbid Obesity: Outcome After Bariatric Surgery. Obes Surg 2004;14:1381-1388.
15 Eid GM, Cottam DR, Velcu LM, et al. Effective Treatment of Polycystic Ovarian Syndrome with Roux-En-Y Gastric Bypass. SOARD 2005 Mar;1(2):77-80.
16 Dr. Joseph F. Smith Medical Library. Polycystic Ovary Syndrome. [Online] 1 August 2005. <http://www.chclibrary.org/micromed/00061250.html>.
17 Kushner RF. Roadmaps for Clinical Practice: Case Studies in Disease Prevention and Health Promotion—Assessment and Management of Adult Obesity: A Primer for Physicians (Booklet 7: Surgical Management). Chicago, IL. American Medical Association 2003.
18 Fitch K, Pyenson B, Abbs S, et al. Research Report: Obesity: A Big Problem Getting Bigger. 2004 Mar.
19 Balsiger BM, Kennedy FP, abu-Lebdeh HS, et al. Prospective Evaluation of Roux-en-Y Gastric Bypass as Primary Operation for Medically Complicated Obesity. Mayo Clinic Proc 2000 Jul;75(7):673-80.
20 Foster G, Wadden T, Makris A, et al. Primary Care Physicians’ Attitudes about Obesity and Its Treatment. Obes Res 2003;11(10):1168-1177.
21 American Society for Bariatric Surgery 2005.
22 American College of Surgeons. Recommendations for Facilities Performing Bariatric Surgery. Bulletin of American College of Surgeons 2000 Sept;85(9):20-3.
23 American Obesity Association Fact Sheet: Obesity in the U.S. [Online] 14 January 2004. <http://www.obesity.org/subs/fastfacts/obesity_US.shtml>.
24 Nguyen NT, Ho HS, Palmer LS, et al. A Comparison Study of Laparoscopic Versus Open Gastric Bypass for Morbid Obesity. J Am Coll Surg 2000 Aug;191(2):140-155.
25 Schauer PR, Ikramuddin S, Gourash W, et al. Outcomes After Laparoscopic Roux-en-Y Gastric Bypass for Morbid Obesity. Ann Surg 2000 Oct;232(4):515-529.
26 Buchwald H. 2004 ASBS Consensus Conference Statement, Bariatric surgery for morbid obesity: Health implications for patients, health professionals, and third party payers. SOARD 2005;(1):371-378.
27 Long SD, O’Brien K, MacDonald KG, et al. Weight Loss in Severely Obese Subjects Prevents the Progression of Impaired Glucose Tolerance to Type 2 Diabetes: A Longitudinal Interventional Study. Diabetes Care 1994;17(5):372-5.