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MOMENTS IN MEDICINE
Fall | Winter 2012

Bariatric Program: The Lighter Side of Life

Kelly Maki
Kelly Maki

Kelly Maki couldn’t remember the last time she could look down and see her toes. It had been even longer since she could cross her legs.

At 286 pounds, she had learned to give up a lot of things in life that most people take for granted.

She hadn’t always been that heavy. But over the years, the pounds had snuck up on her.

Call it life: two children, a serious car accident, grabbing quick bites as she carpooled her children to after-school sports, and no time at the end of the day for herself. One by one, month by month, year by year, the pounds gradually added on.

Kelly jumped from one fad diet to the next: low-carb diets, protein diets, Slim-Fast® shakes, amphetamines, TOPS® weight loss program. You name it, Kelly had tried it. Sure she lost some weight, but it always came back.

The extra pounds were taking a toll on her health. Chronic pain in her joints, neck and lower back had become unbearable.

So when Kelly heard several women at work discussing weight loss surgery and suggested she consider the same, she gave it careful consideration.

In the end, it came down to how she wanted to live the rest of her life — in pain, immobile and in constant fatigue or healthy and living life again. She chose the latter.

“I hated looking at myself in the mirror,” she says. “And I was tired of how I felt and what I couldn’t do. When I took the kids to the pool, I would just sit in a chair and watch. Going to an amusement park was out of the question.”

Kelly attended a seminar at The Nebraska Medical Center to learn more about bariatric or weight loss surgery. She met the criteria: she was at least 80 to 100 pounds over her ideal weight and she had additional health problems related to her obesity.

“I hated looking at myself in the mirror. And I was tired of how I felt and what I couldn’t do.”
Kelly Maki

The word bariatric comes from the Greek word “baros,” which means weight. Bariatric surgery is reserved for the most obese patients. Patients must have a body mass index (BMI) of greater than 40, which is equivalent to about 100 pounds over the ideal weight. Insurance companies often require a patient to have additional health problems related to obesity such as joint or back pain, diabetes, high blood pressure, sleep apnea or arthritis.

Once a person reaches a BMI over 40, losing weight with other non-surgical forms of weight loss becomes very difficult, says Corrigan McBride, MD, a minimally invasive and bariatric surgeon and medical director of the bariatric program at The Nebraska Medical Center.

“Bariatric surgery has become a very effective and safe option that can help the average person lose 50 to 75 percent of his or her excess weight.”
Corrigan McBride, MD

“Bariatric surgery has become a very effective and safe option that can help the average person lose 50 to 75 percent of his or her excess weight,” says Dr. McBride. With the longest running track record in the area, Dr. McBride and surgical partners Vishal Kothari, MD, and Matthew Goede, MD, perform more than 200 bariatric surgeries annually.

Dr. McBride joined the staff at The Nebraska Medical Center in 2002 and was appointed associate professor of the Department of Surgery at the University of Nebraska Medical Center (UNMC). Drawn to bariatric surgery due to its ability to dramatically improve peoples’ health and enhance their quality of life, Dr. McBride has been the driving force behind the hospital’s program, helping it become one of the largest and most successful bariatric programs in the region.

Corrigan McBride, MD
Corrigan McBride, MD

In 2009, the bariatric program received the American Society for Metabolic and Bariatric Surgery (ASMBS) Bariatric Surgery Center of Excellence® designation. The designation recognizes surgical programs with a demonstrated track record of favorable outcomes in bariatric surgery. Clinical research shows that the most experienced and best-run bariatric surgical programs have much lower rates of complication, says Dr. McBride. To earn a Bariatric Surgery Center of Excellence designation, the hospital must perform at least 125 bariatric surgeries annually.

“Before this designation, bariatric surgery was often performed by surgeons who didn’t have the experience and proper training necessary to perform the surgeries,” says Dr. Kothari, assistant professor of Surgery at UNMC and a general and minimally invasive surgeon who specializes in bariatrics. “That is becoming far less common today. With the Center of Excellence designation, surgeries are now performed in a very systematic way, resulting in better outcomes.”

The Nebraska Medical Center program is staffed around-the-clock by surgeons who specialize in bariatric surgery. “One of us is always on call to care for you if there is a problem,” says Dr. McBride. “That is not always the case at other hospital programs.”

Vishal Kothari, MD
Vishal Kothari, MD

Physicians also develop a lifelong relationship with patients. “Long after their surgery, we will continue to follow our patients and help them with lifestyle and weight maintenance,” says Dr. Kothari. “It’s one of the strongest parts of our program.”

The program is also preparing for a major expansion. In the summer of 2013, the hospital will open a new and expanded center designed and equipped to accommodate the needs of larger patients. Patients will be able to see multiple health-care specialists all in one place, including a physician who specializes in weight loss, psychologists, dietitians and surgeons.

“We have an organizational commitment to caring for larger patients,” says Dr. McBride. “This will be the only center of its type in the region.”

Backed by a medical center known for its comprehensive specialty care, the bariatric program also sees some of the most complex obesity patients and performs many revisional surgeries for patients whose first surgery failed, who have regained their weight or have experienced other complications.

“Long after their surgery, we will continue to follow our patients and help them with lifestyle and weight maintenance. It’s one of the strongest parts of our program.”
Vishal Kothari, MD

Obesity has become a significant national health issue in this country and has been declared a disease by Medicare, Medicaid and the Internal Revenue Service. The Centers for Disease Control and Prevention (CCD) reports that more than one third of all U.S. adults are obese. Environmental, psychological and genetic factors all appear to play a role in this disease.

Obesity can significantly increase a person’s risk for a number of serious diseases like cancer, heart disease, arthritis and diabetes. Bariatric surgery has been gaining more popularity among the medical community due to increasing evidence that it can help patients manage these conditions. The surgery has been endorsed by the American Medical Association, American Diabetes Association and the American College of Surgeons.

Laparoscopic Adjustable
Gastric Band


Places a band around the stomach near the upper end to make a small pouch and narrow passage into the rest of the stomach. Reduces the amount a person can eat before feeling full.
Laparoscopic Roux-en-Y
Gastric Bypass


Makes the stomach smaller and bypasses about six feet of the colon, causing patients to lose their appetite and eat less because their stomach is smaller and they absorb fewer calories.
Sleeve Gastrectomy

Laparoscopically removes 80 percent of the stomach so that it can’t hold as much food. Threeyear data shows that it produces the same weight loss outcomes as the gastric bypass.

Depending on the type of surgery and the amount of weight loss, bariatric surgery has been shown to drop the diabetes remission rate by 50 to 85 percent, reduce sleep apnea by 90 percent, lower high blood pressure by 60 percent, decrease joint pain by 60 to 70 percent and drop high cholesterol by 60 percent.

Bariatric surgical patients also have fewer hospitalizations overall, shorter hospital stays and are less likely to be admitted to the intensive care unit than obese patients who don’t have bariatric surgery, says Dr. McBride. In addition, studies show that a higher percentage of bariatric surgical patients are alive five years later than those who didn’t have surgery, says Dr. McBride.

“People come to me with all types of reasons for wanting surgery,” notes Dr. McBride. “But almost always, one of them is, ‘I want to see my children and grandchildren grow up.’ Bariatric surgery will get them closer to that goal.”

Individuals considering weight loss surgery must be highly motivated and ready to make long-term lifestyle changes that include diet, exercise and a strict follow-up schedule with their physician in order to realize long-term results. When there is exercise and diet compliance, the surgery has proven to be effective 10 to 15 years after surgery.

It’s all of the positive stories about how weight loss surgery changed peoples’ lives that keeps Dr. McBride so committed to the program. “It’s the stories about how they can go on vacation now, to the pool, ride a rollercoaster or play with their grandchildren that are so touching,” she says.

And it’s Dr. McBride’s own lifetime battle with being overweight that helps her connect with her patients on a more personal level. “I have battled my weight since I was a teenager, so I genuinely understand what patients are going through and the types of decisions they have to make when deciding whether to do this,” says Dr. McBride. Dr. McBride had a lap band procedure in 2004 and replaced it with a gastric sleeve this year.

The surgical procedures work by suppressing hunger, making people feel full on smaller amounts of food and making the feeling of fullness last longer.

The most commonly performed bariatric surgeries include laparoscopic adjustable gastric band, laparoscopic sleeve gastrectomy and laparoscopic roux-en-Y-gastric bypass. All of the surgeries are performed laparoscopically, which means they involve making several small incisions that are closed with only a few stitches, result in fewer complications and a much quicker recovery time for patients.

The laparoscopic adjustable gastric band procedure is the safest and least invasive of the surgical procedures and involves placing a band around the stomach near the upper end to make a small pouch and narrow passage into the rest of the stomach. This allows the normal anatomy to be maintained so food and vitamin absorption is maintained, but it reduces the amount a person can eat before feeling full.

The laparoscopic roux-en-Y gastric bypass procedure has been done for more than 30 years and has a high success rate in helping patients lose and maintain weight loss. The procedure involves stapling shut a large part of the stomach and bypassing about six feet of the colon, causing patients to lose their appetite and eat less because their stomach is smaller and they absorb fewer calories.

The newest weight loss surgical procedure, which is quickly growing in popularity, is called sleeve gastrectomy. This involves laparoscopically removing 80 percent of the stomach so that it can’t hold as much food. Three-year data shows that it produces the same weight loss outcomes as the gastric bypass.

Actual weight loss accomplished as a result of these surgeries varies from 50 to 80 percent of desired weight loss, depending on the type of surgery and patient compliance.

Kelly decided to have the adjustable band procedure because it was the least invasive of all the procedures. She lost 93 pounds over two years and then plateaued. She later suffered a hiatal hernia and had to have surgery, which required her lap band to be replaced with a sleeve. Kelly lost another 20 pounds over the next year and is happy at a slimming 173 pounds.

Kelly says she is living life again. She put a swimming suit on for the first time in years and took her granddaughter swimming. She participated in the 2.5 mile Omaha Heart Walk and goes camping with her husband.

“I couldn’t walk up a flight of stairs before surgery. Now I mow, do yardwork and have walked up to 30 miles a week.”
Rick Maki

And then there’s the little things, like being able to see her feet again when she looks down, crossing her legs and being able to shop at stores other than Lane Bryant, a plus-sizes women’s clothing store.

Kelly’s new energy and outlook on life got her husband Rick’s attention. He was 46 years old and on a fast track for a heart attack.

At 268 pounds, just bending down to tie his shoes would make him huff and puff. His blood pressure, triglycerides and cholesterol had skyrocketed and his diabetes was out of control. He knew he needed to exercise but he just didn’t have the energy and nearly every joint in his body ached. Dieting wasn’t working for him either.

Seeing Kelly’s success, Rick decided to opt for surgery for many of the same reasons as Kelly: a chance to live a better life and even more importantly, to prevent a premature end to his own life.

Rick and Kelly Maki
Rick and Kelly Maki

Rick opted for the gastric bypass surgery and has never regretted it. “I didn’t have any pain after surgery,” he says. “I walked the hospital floor so much that they kicked me out and suggested I walk the rest of the hospital.” Rick weighed in at 268 pounds at his heaviest and in about 18 months was down 83 pounds and still losing.

“I couldn’t walk up a flight of stairs before surgery,” he recalls. “Now I mow, do yardwork and have walked up to 30 miles a week.”

Rick’s and Kelly’s eating habits have also changed. “We’re making better choices and we’re eating less,” says Rick. “If you are going to do this, you have to be mentally strong and ready to make changes in your life, too. They give you the tool to make the change and it’s your choice what you do with it.”

To help her remember how big she was at her largest, Kelly saved a pair of her old pants. Now she can fit her entire body into one leg of the pants.

When Kelly and Rick look back at their lives now, they feel like they can draw a line in the sand: their lives before surgery and their lives after surgery. “It’s definitely been a life-changer for us,” says Kelly.

Not only can Kelly see her toes, but she can see a new life ahead of her.

Next article in the Fall | Winter 2012 issue of One Thousand And One:
Finding His Place