Bariatric Surgery

with Joseph Regan, M.D., Bariatric Surgeon, Columbia St. Mary’s

Last Updated: Nov. 1, 2003

“This is not a character flaw, it’s a disease that we’re treating.”

Dr. Joseph Regan, a bariatric surgeon at Columbia St. Mary’s, is talking about obesity, and he’s not referring to people who look in the mirror and see a few extra pounds. He means the nine million Americans whose body mass index (BMI) is greater than 40 and are considered severely obese.

“If you have a BMI of 40 and are of average height,” he said, “you have approximately 100 pounds of excess weight.”

Joseph Regan, M.D., Bariatric Surgeon, Columbia St. Mary's "We treat the whole person. This goes beyond being just a surgical procedure. We try to help each patient create a healthier lifestyle."

It’s estimated that 45,000 people in the greater Milwaukee area fit that description, one reason Columbia St. Mary’s doctors began performing laparascopic Roux-en-Y gastric bypass operations in August 2003.

Dr. Regan, who has performed more than 150 of the surgeries before coming to Milwaukee, said that Columbia St. Mary’s doctors felt that the procedure – one of several bariatric surgeries available in the U.S. – is the safest and has the most reliably consistent results.

The operation, which is performed using small incisions and instruments attached to a camera, involves forming a small stomach pouch about the size of an egg, and bypassing a length of small intestine.

Post-surgery, patients who follow the instructions of Dr. Regan and the bariatric team can expect to lose 70% to 80% of their excess weight within a year of the procedure. Long-term, people who’ve had the procedure maintain weight loss of 50% to 60% of their excess weight.

Reasons to undergo bariatric surgery
Dr. Regan said it’s much more than a cosmetic procedure. “More than 90 percent of obesity-related health problems improve or disappear,” he said, a major consideration in light of some stark facts.

The number of obese Americans is increasing annually, and 300,000 deaths per year are directly attributable to the problem. “That is second only to tobacco as a killer,” Dr. Regan said, “and it will probably overtake tobacco in the near future.”

Costs associated with treating obesity-related medical problems, the most common of which are high blood pressure, diabetes, sleep apnea and high cholesterol, amount to $120 billion per year. And that doesn’t take into account the psychological effects of being that much overweight.

“There are a lot of prejudices that exist,” Dr. Regan said, adding that there is no single cause for the problem.

“There’s a genetic component, a familial component and behavior-related issues,” he said. “Food is cheap and readily accessible here, and our lifestyle and eating habits reflect that.”

Surgery candidates
Candidates for the surgery have, as a rule, tried and failed at multiple diets and other weight-loss programs. Dr. Regan encourages anyone considering the procedure to do some research on his or her own before coming to see him.

“There’s plenty of information out there, and a well-informed patient is really ideal in the workup for bariatric surgery,” he said.

Working with patients who are ready to learn about the procedure is key, he said, because there’s a lot more to the process than just the operation.

“They have to be approved by a psychiatrist or psychologist, they have to be medically cleared to undergo the operation and they have to understand that the surgery is a tool for weight loss,” he said.

Most patients stay in the hospital for two to three days after the procedure, but don’t return to work for three to six weeks. That’s because there’s more than simple recovery involved in a bariatric procedure.

“Patients have to learn how to eat again,” Dr. Regan said. “Portion size changes dramatically, and patients have to learn to stay hydrated. With a small stomach pouch, you can’t take in large amounts anymore. You have to learn to spread your eating and drinking out over time, and that takes time.”

For that, and other reasons, Columbia St. Mary’s Surgery Center uses a team approach in its bariatric medicine program. Patients work with specialists in bariatric nursing, psychiatry, nutrition, physical therapy, exercise physiology and endocrinology both pre- and post-surgery.

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