The Center for Bariatrics

at SOCH

At the Bariatric Center at SOCH, our expert physicians work together with you and our dedicated staff of nurses, nutritionists, and administrators to assure the best possible results.

Our approach to our patients is highly personal. We create individual care plans based on your unique situation. Our dedicated team consists of highly qualified and experienced surgeons, nutritionists, and psychologists in order to ensure the best possible outcome for each and every patient. Our multidisciplinary team provides you with a complete executive level evaluation before surgery and continuous education and support after surgery.

We are with you every step of the way, from your first phone call, through your surgery, and after surgery. After surgery, we become your resource, ensuring that you receive the most appropriate support for outstanding lifelong outcomes.

Long-term Success

For people suffering from the lifelong disease of morbid obesity, bariatric surgery can be a powerful tool that allows people the ability to manage their condition. The surgery works using both malabsorption and restriction; therefore, patients do not absorb some calories and nutrients and are satisfied with smaller portions of food.

Of course, bariatric surgery is a tool, not a cure. For the surgery to be effective long term, it must be used properly. Through lifestyle changes such as regular exercise and a healthy food plan, many patients are able to make a long-term change for better health.

Physicians Specializing in Bariatric Surgery at SOCH

Karl Strom, MD is the Medical Director for the Center for Bariatrics at SOCH.  He has performed more than 1,500 gastric bypass and gastric band procedures and holds advanced training in laparoscopic surgery.  He has also contributed to both research based medical publications and events.  Dr. Strom has successfully completed a fellowship in minimally invasive and advanced bariatric surgery at the Institute of Minimally Invasive Surgery in New York, and completed his residency in general surgery at Westchester Medical Center/New York Medical College, where he was chief resident.  He has been designated by the American Society for Bariatric Surgery as a Center of Excellence Surgeon, and he earned the distinction of being named a “Top Doc” in 2007 and 2008 in New Jersey Monthly Magazine.

Joseph Barbalinardo, MD, FACS earned his undergraduate degree in Biology from Villanova University. He completed an internship and residency in General Surgery at the University of Medicine and Dentistry-New Jersey Medical School. He is board-certified by the American Board of Surgery. He is a member of the American Society of Breast Surgeons and the Society of Laparoendoscopic Surgeons. He also serves as Assistant Clinical Professor of Surgery at the University of Medicine and Dentistry of New Jersey – New Jersey Medical School. Dr. Barbalinardo earned the distinction of being named a “Top Doc” in New Jersey Monthly Magazine and brings 25 years of experience to the program.

Jonathan Reich, MD is a surgeon with the Center for Bariatrics at SOCH. He completed his fellowship at the Bariatric and Metabolic Institute, Cleveland Clinic, OH. Prior to this he completed 6 years of general surgery residency at Morristown Memorial Hospital, NJ, with a focus on advanced laparoscopy and bariatric surgery. He has performed over 800 advanced laparoscopic surgical procedures. Dr. Reich’s specialties include extensive training in laparoscopic gastrointestinal surgery, morbid-obesity surgery, hernia, and reflux disease. He has served as a presenter and lecturer to worldwide audiences during academic teleconferences. He is certified by the American Board of Surgery and currently holds unrestricted licenses in the states of New Jersey and Ohio to practice medicine.

Bariatric Procedures

At the Bariatric Center at SOCH we offer patients the following weight-loss surgical procedures.

Laparoscopic Gastric Banding: A Restrictive Procedure

The Laparoscopic Adjustable Gastric Banding procedure is a purely restrictive surgical procedure in which a band is placed around the uppermost part of the stomach. This band divides the stomach into two portions: one small and one larger portion. Since the stomach is divided into smaller parts, most patients feel full faster. As the name indicates, the band is adjustable. So if the rate of weight loss is not acceptable, the band can be adjusted. Food digestion happens through normal digestion.

Minimal Trauma

• Least invasive surgical option
  
• No intestinal re-routing
  
• No cutting or stapling of the stomach wall or bowel
  
• Small incisions and minimal scarring
  
• Reduced patient pain, length of hospital stay and recovery period

Fewer Risks and Side Effects

• Reduced risk of hair loss
• No "dumping syndrome" related to dietary intake restrictions

Adjustable

• Allows individualized degree of restriction for ideal rate of weight-loss
  
• Adjustments performed without additional surgery
  
• Supports pregnancy by allowing stomach outlet size to be opened to accommodate increased nutritional needs
  

Risks and Disadvantages

• The access port may leak or twist, which can require an operation to correct the problem.
• Surgery may not provide the necessary feeling of satisfaction that one has had enough to eat.
  
• Band may erode into the stomach wall.
  
• Band may move or slip.
  
• Weight loss is slower than that following Roux-en-Y gastric bypass surgery.
  
• The procedure could result in death.

Roux-en-y - Gastric Bypass Surgery: A Restrictive and Malabsorptive Procedure

According to two organizations, the American Society for Bariatric Surgery and the National Institutes of Health, Roux-en-Y (pronounced ROO-en-why) gastric bypass surgery is the most popular bariatric surgery in the United States.

In this procedure, the surgeon creates a small stomach pouch and then constructs a "bypass" for food. The bypass allows food to skip parts of the small intestine. By skipping a large part of the small intestine, the body cannot absorb as many calories or nutrients.

Advantages

• A 2004 analysis of more than 22,000 patients showed that those who underwent a bariatric surgical procedure experienced complete resolution or improvement of their co-morbid conditions including diabetes, hyperlipidemia, hypertension, and obstructive sleep apnea.
  
• 83.7 percent of type 2 diabetes cases were resolved.
  In the studies analyzed, the control group that didn't have bariatric surgery was at a higher risk for type 2 diabetes: 3.7 times higher.
  
• Resolution of type 2 diabetes often occurred within days of the surgery.
  
• 96.9 percent of hyperlipidemia cases were resolved.
  
• 75.4 percent of hypertension cases were resolved; 87.1 percent were resolved or improved.
  
• Substantial weight reduction occurred; 61.6 percent of excess weight was lost.
  
• In 2000, a study of 500 patients showed that 96 percent of co-morbidities (the study looked specifically at back pain, sleep apnea, high blood pressure, type 2 diabetes, and depression) were improved or resolved.
  
• A great deal of excess weight was lost, and patients experienced resolution of co-morbidities, and improved appearance, social opportunities, and economic opportunities.
  

Risks and Disadvantages

• Because the duodenum and other sections of the small intestine are bypassed, poor absorption of iron and calcium can cause low total body iron and a greater chance of having iron-deficiency anemia. Patients who experience chronic blood loss during excessive menstrual flow or bleeding hemorrhoids should be aware of the chance of iron-deficiency anemia. Women, already at risk for osteoporosis that can occur after menopause, should be aware of the possibility of increased bone calcium loss. By taking a multivitamin and calcium supplements, patients can maintain a healthy level of minerals and vitamins.
  
• Bypassing the duodenum can cause metabolic bone disease in some patients, resulting in bone pain, loss of height, humped back, and fractures of the ribs and hipbones. Eating foods rich in nutrients and taking vitamins can help patients avoid this.
  
• Chronic anemia due to vitamin B12 deficiency may occur. The problem usually can be managed with vitamin B12 pills or injections.
  
• A condition known as dumping syndrome can occur from eating too much sugar or large amounts of food. While it isn't considered a serious health risk, the results can be very unpleasant. Symptoms can include vomiting, nausea, weakness, sweating, faintness, and, on occasion, diarrhea. Some patients are unable to eat sugary foods after surgery.
  The bypassed portion of the stomach, duodenum, and parts of the small intestine cannot be seen easily using X-ray or endoscopy if there are problems such as ulcers, bleeding, or malignancy.
  
• The procedure could result in death.

What to Expect Through Your Bariatric Surgery and Hospital Stay

First and foremost, you can expect to be treated with first class service by our expert and compassionate team.

For New Patients:

• Free Informational seminar

Initial consultation with your bariatric team, includes:

• Meet with our nurse manager will help you complete your detailed history of medical and weight loss attempt history.
  
• Executive level physical is completed which includes physician exam, discussion of your surgical options, benefits and risks. Review necessary consulting services to gain clearance for surgery such as: psychological evaluation, dietary requirements, cardiovascular, pulmonary, GI, and any areas deemed necessary for safety purposes and to assess that you are fit enough to participate in the surgery.
  
• Obtain tentative surgery date that day.
  
• Our nurse case manager will personally guide you through the executive level physical process. We will review our plans with your personal physician.
  
• Priority appointments with consulting physicians provided.
  
• Once you've completed the executive level physical our administrative team works with your insurance company to qualify you. And because of our experience, we have a high rate of approval from insurance companies.
  
• Scheduling your surgery - we will schedule your pre-admission testing and the date for surgery.
  
• Dr. Strom will review your preoperative tests, explain the surgery again along with risks and benefits, and obtain your consent.
  
• You will meet with our dietician to review postoperative diet requirements.
  
• Your surgery will take place.
  
• Postoperative surgical care - bi-weekly visits with your surgeon and nutritionist in your first three months after surgery to ensure that you are on the road to living a healthier life.

Education

What Is Obesity?

Obesity results from the excessive accumulation of fat that exceeds the body's skeletal and physical standards. According to the National Institutes of Health (NIH), an increase in 20 percent or more above your ideal body weight is the point at which excess weight becomes a health risk. Today 97 million Americans, more than one-third of the adult population, are overweight or obese. An estimated 5 to 10 million of those are considered morbidly obese.

What is Morbid Obesity?

Obesity becomes "morbid" when it reaches the point of significantly increasing the risk of one or more obesity-related health conditions or serious diseases (also known as co-morbidities) that result either in significant physical disability or even death. As you read about morbid obesity you may also see the term "clinically severe obesity" used. Both are descriptions of the same condition and can be used interchangeably. Morbid obesity is typically defined as being 100 lbs. or more over ideal body weight or having a Body Mass Index of 40 or higher. According to the National Institutes of Health Consensus Report, morbid obesity is a serious disease and must be treated as such. It is a chronic disease, meaning that its symptoms build slowly over an extended period of time.

Causes of Morbid Obesity

The reasons for obesity are multiple and complex. Despite conventional wisdom, it is not simply a result of overeating. Research has shown that in many cases a significant, underlying cause of morbid obesity is genetic. Studies have demonstrated that once the problem is established, efforts such as dieting and exercise programs have a limited ability to provide effective long-term relief.

Science continues to search for answers. But until the disease is better understood, the control of excess weight is something patients must work at for their entire lives. That is why it is very important to understand that all current medical interventions, including weight loss surgery, should not be considered medical cures. Rather they are attempts to reduce the effects of excessive weight and alleviate the serious physical, emotional and social consequences of the disease.

Contributing Factors

The underlying causes of severe obesity are not known. There are many factors that contribute to the development of obesity including genetic, hereditary, environmental, metabolic and eating disorders. There are also certain medical conditions that may result in obesity like intake of steroids and hypothyroidism.

Genetic Factors

Numerous scientific studies have established that your genes play an important role in your tendency to gain excess weight.

• The body weight of adopted children shows no correlation with the body weight of their adoptive parents, who feed them and teach them how to eat. Their weight does have an 80 percent correlation with their genetic parents, whom they have never met.
  
• Identical twins, with the same genes, show a much higher similarity of body weights than do fraternal twins, who have different genes.
  
• Certain groups of people, such as the Pima Indian tribe in Arizona, have a very high incidence of severe obesity. They also have significantly higher rates of diabetes and heart disease than other ethnic groups.
  

We probably have a number of genes directly related to weight. Just as some genes determine eye color or height, others affect our appetite, our ability to feel full or satisfied, our metabolism, our fat-storing ability, and even our natural activity levels.

Environmental Factors

If you have a genetic predisposition toward obesity, then the modern American lifestyle and environment may make controlling your weight more difficult.

Environmental and genetic factors are closely intertwined. Fast food, long days sitting at a desk, and suburban neighborhoods that require cars all magnify hereditary factors such as metabolism and efficient fat storage.

For those suffering from morbid obesity, anything less than a total change in environment usually results in failure to reach and maintain a healthy body weight.

Metabolism

We used to think of weight gain or loss as only a function of calories ingested and then burned. Take in more calories than you burn, gain weight; burn more calories than you ingest, lose weight. But now we know the equation isn't that simple.

Obesity researchers now talk about a theory called the "set point," a sort of thermostat in the brain that makes people resistant to either weight gain or loss. If you try to override the set point by drastically cutting your calorie intake, your brain responds by lowering metabolism and slowing activity. You then gain back any weight you lost.

Eating Disorders & Medical Conditions

Weight loss surgery is not a cure for eating disorders. And there are medical conditions, such as hypothyroidism, that can also cause weight gain. That's why it's important that you work with your doctor to make sure you do not have a condition that should be treated with medication and counseling.

Am I Morbidly Obese?

Answering this question may give you the courage you need to take the first step. Below are tools you can use to determine if you are morbidly obese and potentially a candidate for weight loss surgery.

There are several medically accepted criteria for defining morbid obesity. You are likely morbidly obese if you are:

• more than 100 lbs. over your ideal body weight, or
  
• have a Body Mass Index (BMI) of over 40, or
  
• have a BMI of over 35 and are experiencing severe negative health effects, such as high blood pressure or
• diabetes, related to being severely overweight
  
• unable to achieve a healthy body weight for a sustained period of time, even through medically supervised dieting
  

Obesity-Related Health Conditions

Obesity-related health conditions are health conditions that, whether alone or in combination, can significantly reduce your life expectancy. A partial list of some of the more common conditions follows. Your doctor can provide you with a more detailed and complete list:

Type 2 Diabetes. Obese individuals develop a resistance to insulin, which regulates blood sugar levels. Over time, the resulting high blood sugar can cause serious damage to the body.

High blood pressure/Heart disease. Excess body weight strains the ability of the heart to function properly. The resulting hypertension (high blood pressure) can result in strokes, as well as inflict significant heart and kidney damage.

Osteoarthritis of weight-bearing joints. The additional weight placed on joints, particularly knees and hips, results in rapid wear and tear, along with pain caused by inflammation. Similarly, bones and muscles of the back are constantly strained, resulting in disk problems, pain and decreased mobility.

Sleep apnea/Respiratory problems. Fat deposits in the tongue and neck can cause intermittent obstruction of the air passage. Because the obstruction is increased when sleeping on your back, you may find yourself waking frequently to reposition yourself. The resulting loss of sleep often results in daytime drowsiness and headaches.

Gastroesophageal reflux/Heartburn. Acid belongs in the stomach and seldom causes any problem when it stays there. When acid escapes into the esophagus through a weak or overloaded valve at the top of the stomach, the result is called gastroesophageal reflux, and "heartburn" and acid indigestion are common symptoms. Approximately 10-15% of patients with even mild sporadic symptoms of heartburn will develop a condition called Barrett's esophagus, which is a pre-malignant change in the lining membrane of the esophagus, a cause of esophageal cancer.

Depression. Seriously overweight persons face constant challenges to their emotions: repeated failure with dieting, disapproval from family and friends, sneers and remarks from strangers. They often experience discrimination at work, cannot fit comfortably in theatre seats, or ride in a bus or plane.

Infertility. The inability or diminished ability to produce offspring.

Urinary stress incontinence. A large, heavy abdomen and relaxation of the pelvic muscles, especially associated with the effects of childbirth, may cause the valve on the urinary bladder to be weakened, leading to leakage of urine with coughing, sneezing, or laughing.

Menstrual irregularities. Morbidly obese individuals often experience disruptions of the menstrual cycle, including interruption of the menstrual cycle, abnormal menstrual flow and increased pain associated with the menstrual cycle.