MDNews - Long Island

HE SHAM AT WA , MD, FACS, FASMBS, is committed to helping patients with chronic obesity overcome obstacles and live healthier lives. Often, this begins with helping them understand that contrary to popular belief, being obese or having a recurrence after treatment is not their fault. "It's important to take the blame away from the patient," says Dr. Atwa, who is Founder and Clinical Director of Long Island Laparoscopic Doctors, Director and Chief of Surgery and Director of Robotic Surgery at St. Charles Hospital, and Chief of General Surgery at Mather Hospital Northwell Health. "Obesity is a chronic disease. When we treat somebody for cancer and the cancer comes back, we don't say that we're not going to do anything else because we failed. We attack it again. It's the same with obesity. It can be in remission and come back, and we're going to treat it again." UNDERSTANDING CHRONIC OBESITY Obesity is a complex condition that can have many possible causes. While poor diet and insufficient physical activity play a big role, other factors, including genetics, are important contributors. "People can try to change their eating habits, but the rest is up to their body and genetics," Dr. Atwa says. "The body's signals control the appetite and tell you when to put down the fork and stop eating." This means that many patients who try to lose weight and keep it off with lifestyle changes alone are often unsuccessful. Additionally, weight loss surgery sometimes does not produce the desired results, due to the treatment being ineffective or the patient being a partial or nonresponder. Research has shown that various genetic factors, including signaling from glucagon-like peptide-1 receptors (GLP-1R), may play an active part in a person's ability to maintain successful weight loss. "One study showed that responders are people whose GLP-1R levels go up when they eat, making them feel full," Dr. Atwa says. "In nonresponders, their GLP levels do not go up as high, so they still feel hungry and eat more." Studies have also revealed that nonresponders often have higher insulin resistance than responders, as well as different hormonal responses to glucose. FINDING THE BEST TREATMENT OPTIONS FOR EACH PATIENT In general, a bariatric surgery is considered unsuccessful when a patient meets any of the following criteria: + Weight loss of less than 50% of excess weight + Lack of comorbidity resolution + Low quality of life due to obesity or post-op complications such as new or worsened acid reflux + BMI higher than 40 When the first surgery does not produce the desired results or the weight comes back over time, each patient is evaluated to determine why the first surgery was not successful before determining the best treatment options going forward. "We start from the beginning and make sure the patient is exercising and eating healthy," Dr. Atwa says. "The patient also sees a nutritionist and a psychiatrist to make sure there are no unresolved psychological issues that are contributing to obesity." In addition to following a healthy diet and exercise program, weight loss medications can help some patients lose weight without having surgery. GLP-1R agonist therapies have proven to be effective for some people. Hesham Atwa, MD, FACS, FASMBS, and Long Island Laparoscopic Doctors: Treating Chronic Obesity Beyond the Initial Surgery BY ELESA SWIRGSDIN FOR SOME PATIENTS, OBESIT Y CAN RECUR AF TER BARIATRIC SURGERY. THE TE AM AT LONG ISL AND L APAROSCOPIC DOCTORS OFFERS MULTIPLE TRE ATMENT OPTIONS, INCLUDING RE VISIONAL SURGERY. Hesham Atwa, MD, FACS, FASMBS, Founder and Clinical Director of Long Island Laparoscopic Doctors 1 4❱❱❱❱❱ S U R G I C A L S O L U T I O N S

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