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Education is the integral component to patients' approach to bariatric surgery. Because each procedure carries with it specific requirements for follow-up, diet and recovery — in addition to risks and benefits — surgical candidates need to have detailed knowledge about each surgery. In addition to the weight-management program, patients undergo psychological and medical evaluations, including cardio- vascular, gastrointestinal and pulmonary workups, and laboratory and radiological investigations. Each patient must also attend one of the Center for Weight and Life Management's free educational seminars about bariatric surgery and two meetings of the bariatric support groups for pre- and postsurgical patients, where they can speak with patients who have recently undergone a procedure. "We don't decide what surgeries they will have," Dr. Vohra says. "We help them understand the intricacies of each procedure, so they can make their own informed decisions." Surgical intervention is an option for obese patients who meet guidelines established by the National Institutes of Health (NIH) and have demonstrated a commitment to losing weight but cannot on their own. The NIH deems patients suitable for bariatric surgery if they have: + a BMI greater than 40 or + a BMI greater than 35 with associated comorbidities, including, but not limited to, sleep apnea, heart disease and type 2 diabetes As the nation's obesity statistics inflate, preventive measures are being taken to make surgical intervention accessible to a larger at-risk population. Recently, the U.S. Food and Drug Administration (FDA) approved the use of adjustable gastric banding for patients whose BMI is greater than 30 and who have an associated comorbidity. In June 2012, the Centers for Medicare & Medicaid Services (CMS) chose to provide coverage for laparoscopic sleeve gastrectomy, joining major insur- ance companies who already provide coverage. Essentially, insurance groups and South Nassau Communities Hospital's Center for Weight and Life Management's OR support team get ready to begin its day of bariatric surgeries. From left to right: M. Attiq, CST; M. Houston, M.D.; R. Vohra, M.D.; C. Faulding, R.N.; Dr. Cruz; and G. Nishimura, M.D. MEET THE TEAM AT SOUTH NASSAU COMMUNITIES HOSPITAL's Center for Weight and Life Management, patients receive care from a specialized team of providers experienced in caring for bariatric patients. + Rajeev Vohra, M.D., FACS, a pioneer in the field of laparoscopic and bariatric surgery, earned his medical degree in India and completed his residency at New York University Medical Center. Dr. Vohra served as assistant professor of surgery at Mount Sinai School of Medicine and is currently a member of the American College of Surgeons, American Society of Metabolic and Bariatric Surgery, and the Society of American Gastrointestinal and Endoscopic Surgeons. + Gregory Nishimura, M.D., FACS, is a board-certified surgeon specializing in laparoscopic and bariatric surgery. He attended medical school at Hahnemann University in Philadelphia, PA, and completed his surgical residency at Nassau County Medical Center. He is a member of the American Society of Bariatric Physicians, the American Obesity Association and the Obesity Action Coalition. + Gabe Bechinelli, P.A., graduated from St. John's University and has been a surgical physician assistant with South Nassau Communities Hospital for seven years. Since joining the hospital's staff, he has gained experience in LAP-BAND adjustments and related follow-up care. + Danielle Solomon, R.D., CDE, graduated from C.W. Post Campus of Long Island University with a Bachelor of Science degree in nutrition and interned at Cornell Medical Center. A registered dietician for 20 years, Solomon specializes in bariatric weight loss management and has worked in that capacity at South Nassau Communities Hospital since 2001. + Jay Comcowich, Ph.D., ("Dr. Jay") is a licensed clinical psychologist who earned his doctorate from Hofstra University in August 1987. He is a cognitive behavioral psychologist specializing in addictive behaviors and mood. Dr. Jay joined the staff of New York Bariatrics and Laparoscopy in 2004. medical guidelines are playing catch-up to bariatric surgical innovation. Sleeve Gastrectomy — The New Gold Standard? A laparoscopic procedure, sleeve gastrec- tomy was initially used as a stepping-stone to gastric bypass or duodenal switch for patients who were severely overweight and could not tolerate the stress that a more invasive procedure would place on their bodies. Recognition of its tremendous success in helping patients lose weight is what catalyzed its use as a stand-alone procedure with excellent results. According to Dr. Vohra, sleeve gas- trectomy has emerged in the last five years to become one of the most popular MDNEWS.COM s MD NEWS Long Island | 7 COVER PHOTO © DON DEMPSEY, WHITE LIGHT PHOTOGRAPHY

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