Which procedure is lower risk--gallbladder surgery or a gastric sleeve? "Even physicians are often surprised when I tell them a bariatric sleeve procedure is lower risk the way we do it today," Ascension St. Vincent's surgeon Katie Novitski, MD said

Bariatric surgery has come a long way since the early days of big incisions and complex after care. "With laparoscopic robotic surgery, only a small incision is necessary," Novitski said. "Using the DaVinci system, I can visualize the abdomen in 3-D. The robot is attached to a specially designed bariatric operating table that moves with it, so it's easier to keep the patient in the best position. You don't have to stop and reset everything, which saves time. We can usually complete a sleeve procedure in a half hour or less."

Patients with comorbidities like diabetes may opt for a bypass procedure. "It's a more involved surgery, but in some cases it virtually eliminates type 2 diabetes symptoms," Novitski said.

She also does bariatric revision surgery. "Patients who have a gastric sleeve may decide to switch to a bypass if they have another issue such as reflux or diabetes, or one of the older procedures may need a touch up," she said.

If anyone thinks bariatric surgery is taking the easy way out, it isn't. "Many of our patients have been struggling with serious obesity their entire life," said Aimee Rothe, BSN, RN, CEN, who serves as the director of Ascension St.Vincent's Metabolic and Bariatric Surgery program. "They have been down the diet road all too often. Some have lost more than a hundred pounds more than once, only to end up back where they started or even farther behind," Rothe herself has walked many a mile in her patients' shoes, having struggled through years of dieting before achieving a major weight loss. She understands because she has been there, and she teaches her nurses and patient navigators so that they empathize with what their patients are experiencing.

Why would a patient choose a bariatric surgery center rather than a surgery center that does bariatric procedures? "Everything in the center is geared to bariatric patients," Rothe said. "When they come here, they don't have to worry about whether there will be a chair they can fit into. All our chairs are designed for bariatric patients. Many patients have mobility problems, so the center is in an easy access location and the services they are likely to need are nearby.

"Patients usually have the same nurses and staff who they get to know. When patients come here, they can be confident they will be treated with respect."

Novitski said "Another advantage is that all the health professionals here are passionate about the work we do. I trained in general surgery, but bariatric surgery is my primary interest. It gives me the opportunity to save both lives and quality of life."

Physicians and health care professionals in other areas, especially those who have never struggled with their own weight, can find it hard to know what to do with patients facing severe obesity. And they may have difficulty understanding why the patient has so much trouble controlling their weight with diet and exercise. Until recently, most efforts to lose weight ended in frustration for both the patients and the providers.

"The specialists who care for our patients have experience with this population and in interpreting the differences obesity may make in their care," Novitski said.

To be considered for bariatric surgery, patients must have a BMI of 40 or more, or 35 if they have a co-morbidity that could benefit from surgery. They should be at least 18 years old and may be up to 60 or older, depending on their physical condition.

"All our patients go through a thorough health screening, including evaluation by a cardiologist and pulmonary specialist. If there are indications of sleep apnea, we may also order a sleep study," Novitski said. "One of the most important presurgery evaluations is a psychological screening."

Rothe said, "Obese patients tend to have a disturbed relationship with food and may use eating as a coping mechanism for stress. When emotional eating is no longer an option, we want them to have better ways of coping in place to deal with difficult times.

"Also, going from eating like everyone else to only being able to eat a small volume that has to be reserved for high nutrition foods is a major adjustment in lifestyle. We have to be confident that they will be able to do it. We also look for a commitment to learning about nutrition and activity to help them succeed and get what their body needs to stay healthy."

Post op support includes nutrition and conditioning classes and a support group where patients can exchange ideas with others who are on the same journey.

"I make sure every patient has my mobile number and knows they can call or text me any time," Rothe said. "One patient called me to say she had just touched her toes for the first time in years."