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Posted May 5, 2009 | Copyright © The Northern Virginia Daily
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Filling the need: Bariatric program strives to give obese patients hope

finishing up a laparascopic adjustable band procedure
Dr. James Wiedower, center, works on finishing up a laparascopic adjustable band procedure with assistance from Dr. Troy Glembot, left, and Joe Delozier, a certified first assistant and certified surgical technologist, in an operation room at Winchester Medical Center. Dennis Grundman/Daily

Wiedower and Delozier use tools
Wiedower and Delozier use tools inserted into small incisions on the patient's abdomen to install the band with assistance from Nadia Day, a certified surgical technologist. Dennis Grundman/Daily

Delozier watches the monitor
Delozier watches the monitor during surgery. Dennis Grundman/Daily

team prepares instruments
The team prepares instruments for the surgeons. Dennis Grundman/Daily

surgery begins
The team begins surgery. Dennis Grundman/Daily

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By Jessica Wiant -- jwiant@nvdaily.com

WINCHESTER -- The seats, exam tables and even doorways are larger in the little building on Westside Station Drive that houses Winchester Medical Center's Bariatric Program -- but so is the level of hope, the program's two surgeons say.

Dr. James Wiedower and Dr. Troy Glembot both left private practice to specialize exclusively in bariatric, or weight-loss, surgery when Valley Health created the program in 2006.

It's a satisfying field that has a positive impact, Glembot says. It takes people who have no hope, and gives them a chance.

On a recent afternoon, Glembot and Wiedower can easily tick off things their obese patients can hope to achieve with treatment: the ability to walk through a turnstile, ride rides at an amusement park, fit in a seat on an airplane, or simply use public restrooms, to name a few.

"Those are the things that we take for granted," Wiedower says.

"Our goal isn't to have everyone in a size 6 dress," Glembot says, or even to make people "thin."

"It is to make people healthier," he says.

For many patients that includes alleviating the depression and social isolation that can come with being obese. Some even find this relief more important than improvement of conditions like diabetes, the doctors say.

A few mornings later, the surgery date, with all its promise, has arrived for one of the program's female patients.

With what almost looks like a small fish hook and dental floss, Wiedower weaves an adjustable gastric band into place on the woman's stomach. His hands barely appear to move as he expertly maneuvers the instruments, inserted through small incisions in the woman's abdomen -- the only part of her not concealed by sterile blue cloth.

Like his team of nurses and other observers in the room, he sees what he's doing by looking at the monitors positioned above the patient. They reveal in sharp detail the tissue of her stomach and her liver. For a moment, a large, bluish artery (it carries the blood to the lower half of the body, Wiedower explains) comes into view.

Aside from what soils several pieces of gauze in a bowl beside the patient, there is little blood. The operation typically takes about an hour, and she will be able to go home the next morning.

The surgery, one of two offered through the program, results in an adjustable band being placed around the upper portion of the stomach, restricting the amount of food that goes in.

The other procedure, gastric bypass surgery, creates a small pouch at the top of the stomach connected to the lower small intestines, bypassing most of the stomach and upper small intestines.

Bariatric surgery, while not new to Winchester, says Glembot, has evolved since another surgeon performed a variation of the surgery in the 1980s. Then in 2001, a team from the area trained in California to learn to perform the surgeries laparoscopically -- through tiny incisions and using a camera, as opposed to open surgery with a large, vertical incision.

By 2003, Winchester Medical Center hosted more than 200 bariatric operations versus about 25 in 1999, Glembot says.

While the demand for the surgeries continued to grow, medical malpractice premiums did too, and surgeons opted not to continue offering the surgeries at Winchester Medical Center, according to Glembot.

"It became very quickly evident that there's a huge need in this population," Wiedower says.

Within months, Valley Health was working to bring the surgeries back.

When the Bariatric Program was formed in 2006, they did come back, with lots of bells and whistles.

The program is fully integrated with the hospital (something not common of most places that offer bariatric surgery, according to Glembot), so Wiedower and Blembot are now employees of Valley Health.

Along with staff nurses, a dietitian, exercise specialist, behavioral health specialist, nurse practitioner and other support staff, the program offers much more than just surgery.

The entire staff of the program and any additional staff who deal with patients at Winchester Medical Center have received sensitivity training to learn how to deal with bariatric patients.

For the patients, education and wellness programs, a monthly support group and other structures are in place.

The operation is a small part of being successful at losing weight, Wiedower says, with other important components being knowledge and support.

Each patient becomes a lifetime patient, says nurse coordinator Tina Shelton, and not only that, medical alternatives are also available for patients who don't qualify for or don't want to go the surgical route.

Through the program's medical division, obese patients have the same trained staff to guide them through weight-loss plans featuring either a calorie-controlled diet, a diet combined with use of medication, or liquid meal replacements.

As for the surgeries, 170 were performed in 2008, and 45 had been done by the end of March this year. Glembot expects the program to grow by as much as 20 percent to 40 percent annually in the years to come.

There will be no shortage of patients.

Nationwide, the number of bariatric surgeries performed each year has grown exponentially -- from 16,000 procedures in 1992 to 170,000 in 2005, according to a news release from Valley Health.

In the area surrounding Winchester Medical Center alone, Glembot says, a conservative estimate is that there are 93,750 people who are candidates for bariatric surgery.

The numbers are promising for those who do decide on surgery: While obese adults can often lose weight on their own, they gain it back and lose it again in a seemingly endless cycle, according to Wiedower. For those who manage to lose 100 pounds, he says, only 5 percent manage to keep it off for five years.

The truly morbidly obese face a constant battle they can't win, he says.

In those who have gastric bypass surgery, there is an 85 percent success rate, with success being defined as keeping off 50 percent of the excess weight, Glembot explains. Success is slightly less dramatic in those who receive the adjustable gastric band.

But patients are even more successful in ways that aren't part of the statistics: They fit into smaller clothes, sometimes no longer require diabetes medicine, their risk of cancer can be lowered by as much as 50 percent, Glembot says.

And for patients who came into the program without any hope, surgery can make them feel they have something to lose after all, according to Glembot.

"They will say, 'I got my life back,'" Wiedower says.

Information for potential patients

In April, the Winchester Medical Center Bariatric Program was designated a Bariatric Surgery Center of Excellence by the American Society for Metabolic and Bariatric Surgery.

The program was formed in 2006, allowing surgeons Dr. James Wiedower and Dr. Troy Glembot and an entire cast of support staff to focus full time on treating obese patients.

Focusing exclusively on bariatric treatment has allowed the staff to do some interesting things, Wiedower says, including streamlining the process of getting patients under care.

As a result, by the time each patient first meets with a surgeon she is informed about the process, and likewise, the surgeon is informed about the patient, he explains.

In earlier days of bariatric surgery, when a patient didn't see success it wasn't that the surgery failed, but that the education and support systems weren't in place, according to Glembot.

The designation as a Center of Excellence means the program has it all figured out, Wiedower says.

Two types of surgery are offered through the program, Roux-en-Y gastric Bypass and Laparoscopic Adjustable Gastric Band. Both are meant to be permanent.

Non-surgical weight-loss programs are also available.

To be eligible for bariatric surgery through Winchester Medical Center's Bariatric Program, patients must:

* Be between age 21 and 65

* Have a body mass index over 40, or have a BMI of between 35 with two medical conditions that will improve with weight loss such as high blood pressure, type 2 diabetes or obstructive sleep apnea

* Weigh no more than 400 pounds

Potential patients are periodically invited to attend free information sessions to learn more about treatment options. Pre-registration is required. For more information, visit valleyhealthlink.com and click on "Services," then "Bariatric Program," or call the office at 536-0010.

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