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sessions promoting better eating practices and exercise regimens. "We want patients to begin losing weight from the moment we meet with them," says Jonathan Giannone, MD, DABS, bariatric surgeon at Putnam Hospital Center. "The more weight loss patients achieve before surgery, the better outcomes are. Marshaling our support services before surgery ensures that patients are safe candidates for a weight-loss operation and confirms each patient's commitment to undergo a life- altering procedure." In addition to nutrition counseling, preoperative patients attend a weight- loss seminar — held at Putnam Hospital Center, Northern Dutchess Hospital or Vassar Brothers Medical Center, and led by the Bariatric Coordinator and the team of dietitians — where they gain a better understanding of the process from postopera- tive patients who are at different points on their journeys. This fellowship between candidates for and beneficiaries of bariatric surgery allows preoperative patients the opportunity to hear firsthand accounts of each bariatric surgical option and learn about postoperative successes and setbacks that can occur. "The opportunity to meet patients who have already undergone a bariatric surgery can play a major role in the preoperative patient's choice of procedure," Dr. Giannone says. "While surgical candidates receive educational materials and lectures during the support group, talking with postoperative patients can open their eyes to another aspect of surgery they hadn't considered." For example, a patient who previously decided to have a laparoscopic gastric band procedure because of its minimally invasive nature may change direction and choose sleeve gastrectomy after hearing successful patients attest to the procedure's minimal pain and significant weight loss. Health Quest provides these services so patients — in consultation with their surgeon — can choose the operation that will produce the greatest benefit for their medical needs and weight loss goals. Selecting the Right Operation Because each bariatric procedure engen- ders specific benefits, bariatric surgeons at Putnam Hospital Center counsel patients about the relative merits of a malabsorptive or restrictive surgery. During presurgical consultation, bariat- ric surgeons elicit important information pertaining to patients' eating habits, weight- loss goals and weight-related comorbidities. Patients who eat large portions benefit from all surgeries because each limits the stomach's size, whereas grazers — those who eat small portions throughout the day — likely benefit the most from malabsorptive surgeries, such as gastric bypass or duodenal switch, which facilitate earlier satiety and limit the absorption of calories. Rapid weight loss is the most visible benefit of bariatric surgery, but perhaps the most striking is the significant improvement or resolution of obesity-related comorbidities, including Type 2 diabetes, high blood pres- sure, heart disease and sleep apnea. "When we began performing bariatric surgery, the goal was to help patients lose weight," Dr. Kaul says. "Now, weight loss is only one aspect of success. The most signifi- cant benefit is the resolution of metabolic disorders. This patient population has the highest associated risks and sees the most dramatic benefits from bariatric surgery." An Increasingly Popular Surgery While gastric bypass and duodenal switch surgeries may be ideal for patients who have poorly controlled obesity-related comorbidi- ties, sleeve gastrectomy has become one of the most commonly performed bariatric surgeries at Putnam Hospital Center because of its success in curbing appetite and facilitat- ing portion control. BARIATRIC SURGERY ISN'T a front-line treatment for weight loss. Patients are carefully vetted against stringent national guidelines to embark upon the process. Bariatric surgeons at Putnam Hospital Center perform Roux-en-Y gastric bypass, gastric banding or sleeve gastrectomy for patients who meet the following criteria: + Body Mass Index (BMI) of 40 or greater + BMI of 35 or greater and at least one weight-related comorbidity "Primary care physicians should begin thinking about how patients might benefit from bariatric surgery," says Jonathan Giannone, MD, DABS, bariatric surgeon at Putnam Hospital Center. "Assess the patients' interest and refer them to us so we can consult with them and arrange for them to attend a presurgical seminar. There are no commitments, and patients can decide against surgery at any time. Referral can only help." M EE TI N G T H E C R IT ER I A Thomas Cerabona, MD, outside the pre-operative area of Putnam Hospital Center. Patients find bariatric surgical excellence complemented by an extensive support system ranging across Health Quest's network. M D N E W S . CO M ■ MD NEWS Mid Hudson | 7