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Transforming lives through bariatric surgery

April 07, 2022 | UCI Health
Dr. Brian R. Smith explains advances in bariatric surgery techniques and who benefits most from the wight-loss procedures.

"Bariatric surgery should always be a last resort," says UCI Health gastrointestinal surgeon Dr. Brian R. Smith. But it's an important option for people with a body mass index of 40 or higher who have serious health problems. Photo by Michael Der


The COVID-19 pandemic has unexpectedly refocused Americans on obesity as a major health concern. About 70% of American adults are overweight or obese, and studies show that obesity heightens the risks for a poor outcome among people who contract the virus.

Moreover, many people are coping with weight gain related to two years in which we stopped going to gyms, worked from home and couldn’t partake in many of the physical activities we enjoy.

Live Well asked Dr. Brian R. Smith, a board-certified UCI Health gastrointestinal surgeon, to discuss the value of bariatric surgery for people who have been unable to lose weight with diet and lifestyle changes alone.

Is bariatric surgery a good option for health?

Diabetes, heart disease, hypertension, joint damage, severe sleep apnea and gastroesophageal reflux disease are all serious conditions linked to obesity.

Over the last five years, patients considering bariatric surgery have become much better informed about these secondary health problems.

Now it’s less about looking better and more about improving overall health and eliminating weight-related medical conditions.

Bariatric surgery should always be a last resort.

But you may be a candidate for bariatric surgery if you have a body mass index (BMI) of 40 or higher — or 35 or higher in combination with such health problems as high blood pressure, high cholesterol or diabetes.

What’s involved? Can you just show up one day for surgery?

Quite the opposite. Insurance carriers nowadays require patients to undergo up to six months of medically supervised weight loss before approving them for surgery.

This is to ensure patients are actively committed to losing weight and changing their lifestyles, a predictor of success long before surgery.

UCI Health bariatric surgeon Dr. Brian R. Smith checks in with vertical sleeve gastrectomy patient Michael Feldman.
A year after Dr. Brian Smith performed bariatric surgery on Michael Feldman, the Laguna Beach resident has dropped nearly 150 pounds, his hypertension and sleep apnea are gone and he has a new hobby: cycling. Photo by Michael Der.

Is bariatric surgery typically effective?

Studies show that more than 90% of people who have bariatric surgery maintain at least 50% of the weight lost after the procedure.

Patients who lose significant weight also experience a 60% to 80% improvement in obesity-related health problems. Type 2 diabetes can be put into remission about 70% of the time after sufficient weight loss.

Which bariatric procedure is best?

There are two mainstream options: sleeve gastrectomy and Roux-en-Y gastric bypass.

The first procedure restricts the size of the stomach to reduce the amount of food you can eat. The Roux-en-Y also restricts the size of the stomach but it bypasses some of the digestive tract to limit calorie absorption as food passes through your intestines.

Both are minimally invasive procedures. Cosmetically, they are indistinguishable. We also offer an endoscopic bariatric procedure that is not covered by insurance.

We also do perioperative evaluations to determine which procedure may be better for the patient. A sleeve gastrectomy, for example, may worsen a patient’s gastroesophageal reflux disease.

If the two procedures are equal, I educate the patient and allow them to choose.

What distinguishes the UCI Health bariatric program?

We have a truly comprehensive bariatric surgery program. We offer nonoperative approaches, such as medical management, as well as endoscopic and surgical options.

Our multidisciplinary team also includes a social worker who counsels patients through their continuum of care; a dietitian who meets with the patient at every visit to support their weight loss, as well as psychiatrists and psychologists who help evaluate patients before and after surgery.

We also have a support group that connect patients with others who have or are going through the process.

What happens after surgery?

If a patient thinks of surgery like a diet — a short-term behavior change with an endpoint — they will lose weight then regain it.

The operation isn’t the only key to success. You need to think of success as a three-legged stool: the operation, regular exercise and making consistently good dietary choices. If you lack any one leg, the stool tips over.

Which patients do best?

The most successful ones find a physical activity that doubles as a hobby. For example, patients who take up biking often meet other people who bike regularly. They serve as good influences and new friends with whom to share their passion.

I tell my patients to find an activity they love, something they look forward to doing. Then the weight loss will seem easy.

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