Overcoming Obesity Takes a Village

KentuckyOne uses a team approach to increase weight loss success

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LEXINGTON When it comes to overcoming obesity, it takes a medical village to ensure success. Few understand this better than board-certified general and bariatric surgeon, Alberto Zarak, MD. “The procedure is only a little part of the program. Our bariatrics program is a multidisciplinary program with dieticians, exercise physiologists, and psychologists that help with the long process that every patient goes through to achieve the results that are proposed by us,” says Zarak.

After receiving his medical degree at San Martin de Porres University in Peru, Zarak moved to the United States for his residency training at the University of Miami Miller School of Medicine, where he served as a research associate in transplantation. This was followed by a fellowship at Atlanta Medical Center in Atlanta, Georgia. In 2017, he joined KentuckyOne Health Weight Loss Surgery at Saint Joseph East.

Since then, Zarak has been performing both general and bariatric surgeries. For the latter, the village approach begins during the initial screening. After meeting the basic guidelines set forth by the American Society for Metabolic and Bariatric Surgery (ASMBS) and National Institutes of Health (NIH), patients still undergo an extensive evaluation. Zarak states, “Every single patient requires comprehensive analysis before scheduling for surgery.” During this process, the patient meets with the program coordinator, a physician assistant, psychologist, registered dietician, exercise physiologist, and health physiologist to determine whether they are a viable candidate. Both functional status and general clinical status are considered.

Candidacy and Comorbidity

Current recommendations dictate that to qualify, a patient must either have a body mass index (BMI) of 40, without any accompanying medical problems, or a BMI of 35 in conjunction with other comorbidities. Due to the presence of these comorbidities, bariatric surgery usually comes with a special set of challenges.

“Most of our procedures only require a one-night stay in the hospital.”— Alberto Zarak, MD

“These patients are in general a sick population, because they have multiple medical problems that accompany obesity. They have cardiac problems, breathing problems, sleep apnea, high cholesterol, diabetes, and high blood pressure.” Zarak continues, “So, most of our patients have metabolic diseases and most of them are referred by their primary care physician due to these medical problems. It is not so much about losing weight for aesthetic reasons.”

For most patients, as they continue to lose weight, outcomes are excellent and healthier futures are possible. For this reason, Zarak urges primary care physicians to not shy away from discussing obesity with patients and giving them the opportunity to educate themselves on the options. He asks primary care physicians to “encourage their patients to call the bariatric office and enroll in one of the free seminars that we give multiple times a month where the patient can receive all the information they need about bariatric surgery.”

Less Invasive with Fewer Complications

Zarak also wants primary care physicians to assure patients who fear an extended hospital stay that times have changed. “One of the biggest problems that we overcame in the past few years is the misconception that bariatric surgery was a high-morbidity procedure, meaning that it was a procedure that would require a long hospitalization. Currently, most of our procedures only require a one-night stay in the hospital.”

According to Zarak, 95% of patients are released the next day with very few complications. A recent study compared it to a gall bladder removal in terms of post-operative difficulties. Zarak attributes this to the decline in open surgeries requiring laparotomy and the sharp increase in the newer, less-invasive techniques. “With laparoscopic techniques developed in the past decade or so, and the automatic stapler, the complication rate of these procedures has dropped dramatically.”

Once a patient has been approved for and committed to bariatric surgery, there are three proven, primary surgical options offered through the program at Saint Joseph East, including the Roux-en-Y gastric bypass and sleeve gastrectomy (gastric sleeve).

Though not yet recommended by the ASMBS, a new alternative in the form of the endoluminal sleeve or gastric balloon, a reversible, incision free weight loss procedure, is on the horizon.

An Ongoing Relationship

The relationship between Zarak and his patients does not end with the surgery: it continues throughout the patient’s recovery and far beyond. Zarak states, “That is key in bariatric surgery. As opposed to other general surgery procedures where you would see the patient once or twice after surgery, we follow up with the patients forever.” Initially, he meets with the patient quite often, and then slowly spaces out the visits. However, they will continue to meet annually for life.

During these appointments, Zarak stresses the importance of permanently adopting a healthier lifestyle. “For me, in my practice, I focus a lot on the psychological aspect, the nutrition aspect, and the exercise aspect. I always tell the patient that the surgery is a little fraction of the treatment. And, I spend a lot of time both before and after surgery talking to the patient about lifestyle modifications. What I intend to do is to change the way they think about co-creating healthy habits.”

Zarak finds the most rewarding part is when a patient follows this advice and drastically improves their health. “Patients will tell you, ‘I can now walk. I can now play with my kids. I can bend over and pick up something on the ground.’ They couldn’t do it before. That joy that they experience, that they couldn’t before surgery, is the most gratifying thing.”