MDNews - Long Island

COVER FEATURE REFERRAL THE BARIATRICAND Wellness Program at Brookhaven Memorial Hospital Medical Center maintains a rigorous selection process to determine which patients are appropriate candidates for surgery. James A. Sapala, M.D., FACS, FASMBS, Director of Bariatric Surgery at Brookhaven Memorial Hospital Medical Center, attributes the program's high surgical success rate to this process. Dr. Sapala notes that although not every patient referred to the Bariatric and Wellness Program meets the criteria for surgical treatment, the Wellness Program offers alternate solutions for weight-loss success. Candidacy for surgery begins with GETTING IT RIGHT FROM the patient's commitment to making dramatic, long-term lifestyle changes, as well as case-specific clinical pathways, including clearance from a cardiologist, a pulmonologist, a psychiatrist and the primary care physician depending on the patient's medical status. In addition, Dr. Sapala and his colleague Farhad Anoosh, M.D., FACS, FASMBS, a minimally invasive bariatric surgeon, use the following body mass index (BMI) guidelines to select the most appropriate course of treatment: + If the patient has a BMI less than 30, he or she is referred to the Wellness Program. + If the patient has a BMI of 30 to 34 with one comorbidity, such as diabetes, hyperlipidemia, hypertension or sleep apnea, he or she may be a candidate for laparoscopic gastric banding. + If the patient has a BMI of 35 accom- panied by one comorbidity, he or she may be a candidate for laparoscopic gastric banding and laparoscopic or open gastric bypass. + If the patient has a BMI of 40 or greater with one or more comorbidities, he or she may be a candidate for either laparoscopic procedure or the Bariatric and Wellness Program's patented surgery, the Sapala-Wood Micropouch gastric bypass. 8 | Long Island MD NEWS ■ MDNEWS.COM Farhad Anoosh, M.D., FACS, FASMBS; James A. Sapala, M.D., FACS, FASMBS; and Mary Zotos, M.S., R.D., nutritionist and Program Director of the Bariatric and Wellness Program at Brookhaven Memorial Hospital Medical Center, review a patient's medical record. what type of surgery they choose or if they choose to have their surgeries performed by us or not," says Dr. Anoosh. "It is the patient who is important — because he or she determines the final success. Thus, even at the beginning of patients' time with us, we have a presentation to teach them how to change their lives." Choosing the Best Path Providers in the Bariatric and Wellness Program are very careful in developing an individualized course of treatment for each patient. In addition to weighing each patient's ability to fully commit to a lifelong partnership, Drs. Sapala and Anoosh utilize body mass index (BMI) guidelines to determine the most appropriate candidates for surgery. The selection process optimizes not only the surgical success rate for the Bariatric and Wellness Program — whose providers have dedicated their practice entirely to weight-loss surgery, rather than also incorporating general surgery — but also each patient's success. For those not suited for surgery, Brookhaven Memorial Hospital Medical Center provides its state-of-the art Wellness Program. "Not everyone is a surgical candidate, and some patients are not comfortable having surgery. Some are too old or too young or too sick," says Dr. Anoosh. "The Wellness Program opens the door to offer a solution for everyone and complete our menu of services." The nonsurgical treatment route involves a strict nutritional and exercise regimen. Dr. Sapala, Dr. Anoosh and Zotos work with patients to identify their personal challenges to losing weight and develop strategies for overcoming those barriers. The team identifies forms of exercise that patients can immediately perform and types they can build up to, healthful food choices, and solutions to challenging aspects of their lives, such as work schedules and environments that may be contributing to unhealthy habits. If a patient is deemed appropriate for surgery according to BMI guidelines and medical clearances from the neces- sary specialists, he or she begins a preoperative curriculum of education and behavior modification. Patients learn an entirely new approach to food, from the difference between farm-raised and wild-caught fish to how to use extra virgin olive oil in their cooked meals and how omega-3 fatty oils boost heart health. They are also informed of the dangers of excess trans fat consumption. Patients become aware of how proper blood chemistry plays into their bodies' functions. They also are placed on a regimen of chelated supplements. The shift in thinking about food as fuel for the body prepares patients to make better

• Cover