University Health System Blog

Las Vegas weight-loss surgeon Dr. Shawn Tsuda answers the question: “What if I regain the weight after undergoing weight-loss surgery?”

More than two-thirds of Americans are either overweight or obese.

For patients who are morbidly obese, or have a body mass index greater than 40kg/m2, it can be difficult to achieve substantial weight loss through diet and exercise alone. In fact, studies show that 95 percent of people who are morbidly obese are unsuccessful in maintaining long-term weight loss.

In 1992 the National Institute of Health established that weight-loss or bariatric surgery is the only treatment proven to provide durable weight loss in the morbidly obese.

Today the laparoscopic Roux-en-Y gastric bypass, laparoscopic adjustable gastric band and the sleeve gastrectomy are options for patients who suffer from extreme obesity. However, none of the operations are easy fixes.

Diet and exercise are essential components of maintaining weight loss after these procedures. The best way to incorporate the three modalities of surgery, diet and exercise is to continue a close relationship with your weight loss surgical program. Watching portions, achieving effective exercise and monitoring nutritional status are functions of a comprehensive surgical weight loss program. Absence of close follow-up is responsible for the majority of failed results after weight-loss surgery.

The University of Nevada School of Medicine program on weight-loss surgery in Las Vegas is a comprehensive program that helps patients achieve optimum results.

Shawn Tsuda, M.D. is vice chief for bariatric surgery at University Health System and the University of Nevada School of Medicine in Las Vegas. Dr. Tsuda completed his fellowship training in minimally invasive and bariatric surgery at Harvard Medical School. He is board certified in general surgery. More information on the University of Nevada School of Medicine Weight Loss Surgery Center.

Have a health question? University Health System doctors answer select questions from readers like you.

Robin Morello, bariatric surgery nurse coordinator at the University of Nevada School of Medicine’s weight loss surgery center in Las Vegas, was featured in the Las Vegas Review-Journal yesterday. It chronicles Morello’s first-hand experience with battling obesity and how weight loss surgery changed her life, helping her shed more than 100 pounds. Today, Morello has dedicated her nursing career to helping patients overcome obesity. The weight loss surgery center at the medical school is a collaboration between the University of Nevada School of Medicine and University Medical Center. The center is led by bariatric surgeon, Shawn Tsuda, M.D.

Edgar Antonio Nunez is creative director at University Health System, the clinical practice of the University of Nevada School of Medicine. For media inquiries, contact him by email or call 702-671-2230.

Have a health question? University Health System doctors answer select questions from readers like you.

Dr. Shawn Tsuda answers the question: Is pregnancy safe after weight loss surgery such as gastric bypass or lap band?

Many women who suffer from severe obesity also suffer from hormonal problems that make it difficult for them to conceive children. Even for women who are not trying to conceive, menstrual irregularities related to obesity can be a significant burden.

After a patient undergoes surgery such as gastric bypass, sleeve gastrectomy or laparoscopic adjustable gastric band to lose weight, a period of hormonal and menstrual irregularity can continue. However, it is also commonplace for women to regain their ability to conceive after weight loss. Rapid weight loss, however, can come with relative nutritional deficiencies. Therefore, it is imperative that patients take vitamin and mineral supplements guided by their physician.

Most patients after weight loss surgery reach their goal between 18 and 24 months. At the University Weight Loss Surgery Program, it’s our practice to encourage nutritional supplementation and appropriate birth control until at least 18 months after bariatric surgery. Only after the patient is deemed nutritionally robust by their doctor should they consider bearing a child.

However, if these criteria are met, the ability to conceive can be a positive life-changing event in patients who were otherwise limited by their severe obesity to have children.

Shawn Tsuda, M.D. is vice chief for bariatric surgery at University Health System and the University of Nevada School of Medicine in Las Vegas. Dr. Tsuda completed his fellowship training in minimally invasive and bariatric surgery at Harvard Medical School. He is board certified in general surgery. More information on the University of Nevada School of Medicine Weight Loss Surgery Center.

Have a health question? University Health System doctors answer select questions from readers like you.

Dr. Shawn Tsuda answers the question: “Gastric banding surgery for teens: Is it effective for weight loss?”

A new study shows that gastric banding surgery may help teenagers lose weight more effectively then medical treatment with lifestyle changes alone.

Obesity among adolescents continues to rise and 75 percent of obese children eventually become obese adults. For certain, teens who suffer from severe obesity, defined as a body mass index greater than 35 kg/m2 or worse, surgery for weight loss may represent the only effective means of preventing the health problems associated with their weight.

Surgery is not risk free and any decision to use a restrictive operation such as laparoscopic adjustable gastric banding must be approached with care. At our university adolescent weight loss program, a multidisciplinary team of bariatric surgeons, pediatric surgeons, pediatric heart doctors, endocrinologists, social workers, psychologists, and dieticians evaluate obese teens and their families to assure that the decision to move ahead with weight loss surgery is a safe and desirable one.

For those patients who are good candidates, the tool of gastric banding in conjunction with diet and exercise can provide a healthier future.

The School of Medicine offers free weight loss seminars on the first Thursday of every month that will answer your questions about weight loss surgery and to find out if you’re a good candidate for gastric banding surgery.

Shawn Tsuda, M.D. is vice chief for bariatric surgery at University Health System and the University of Nevada School of Medicine in Las Vegas. Dr. Tsuda completed his fellowship training in minimally invasive and bariatric surgery at Harvard Medical School. He is board certified in general surgery. More information on the University of Nevada School of Medicine Weight Loss Surgery Center.

Have a health question? University Health System doctors answer select questions from readers like you.

Dr. Shawn Tsuda answers the question: “Can you be considered obese if you have a normal body weight?”

If you are what is considered an ideal body weight, according to the Metropolitan Life Insurance tables from the 1940s, you will generally not be considered overweight or obese.

The Centers for Disease Control (CDC) defines being overweight and obese by a body mass index (BMI). BMI is a person’s weight in kilograms divided by their height in meters squared.

BMI is a better value for measuring a person’s weight compared to actual weight in pounds. This is because a 210 pound man who is 6 feet 6 inches tall is probably more lean than a 210 pound man who is 5 feet 6 inches tall.

The CDC defines a normal weight as a body mass index between 18.5 and 24.9. Overweight is between 25 and 29.9. Obesity is defined as a BMI greater than 30 and morbid obesity a BMI greater than 40.

The problem with body mass index is that it does not directly measure fat content.

However, it is still a valuable tool because for most people other than very muscular body builders or athletes, a BMI suggesting overweight or obesity means that medical problems and a shortened life expentancy comes along with it.

A diet and exercise plan and in some cases, surgical treatment for morbid obesity, can resolve medical problems, improve quality of life and avoid premature death.

Shawn Tsuda, M.D. is vice chief for bariatric surgery at University Health System and the University of Nevada School of Medicine, in Las Vegas, Nevada. Dr. Tsuda completed his fellowship training in minimally invasive and bariatric surgery at Harvard Medical School. He is board certified in general surgery.

Have a health question? University Health System doctors answer select questions from readers like you.

Dr. Shawn Tsuda answers the question: “What are some general guidelines that make me a good candidate for weight-loss surgery?”

Obesity remains one of the most significant health epidemics in the U.S.

There are more than 60 health problems that have been linked to obesity, including diabetes mellitus type II, hypertension, arthritis, and obstructive sleep apnea.

The current recommendations for weight-loss surgery is based on the body mass index (BMI), which is a person’s weight in kilograms divided by their height in meters squared.

If your BMI is greater than 40 kg/m2, or 35 kg/m2 with significant obesity-related health problems, you are a candidate for weight loss surgery. Your BMI can easily be calculated from a number of free online calculators. (Here’s the Centers for Disease Control BMI calculator.)

The most common operations considered are the Roux-en-Y gastric bypass, adjustable gastric band or sleeve gastrectomy. For the most part, these procedures are performed laparoscopically. The operation is not a quick fix, but rather a tool to help with weight loss.

For patients who are severly obese, traditional diets and exercise can often be frustrating and unsuccessful. Weight-loss surgery may be the best option for prevention of medical problems and risk of early death, and consultation with a weight loss surgeon for more information is the next best step.

Shawn Tsuda, M.D. is vice chief for bariatric surgery at University Health System and the University of Nevada School of Medicine, in Las Vegas, Nevada. Dr. Tsuda completed his fellowship training in minimally invasive and bariatric surgery at Harvard Medical School. He is board certified in general surgery.

Have a health question? University Health System doctors answer select questions from readers like you.

Dr. Shawn Tsuda answers the question: “What’s the difference between minimally invasive versus ‘open’ surgery? Is one approach safer or better than the other?”

Ever since the first laparoscopic cholecystectomy was performed in 1986, many general surgical operations have transitioned to a minimally invasive approach because of less pain, shorter hospital stays, less infectious complications, and a quicker return to work.

The list of procedures continues to expand but include weight loss surgery, colon surgery, anti-reflux surgery, and removal of solid organs like the spleen.

In the right hands, a laparoscopic approach is as safe as surgery with a larger incision.

Reviewing guidelines by national bodies and societies such as the National Institutes of Health and the Society of American Gastrointestinal and Endoscopic Surgeons can help a patient understand what procedures can be performed laparoscopically in a safe manner.

Shawn Tsuda, M.D. is vice chief for bariatric surgery at University Health System and the University of Nevada School of Medicine, in Las Vegas, Nevada. Dr. Tsuda completed his fellowship training in minimally invasive and bariatric surgery at Harvard Medical School. He is board certified in general surgery.

Have a health question? University Health System doctors answer select questions from readers like you.

Dr. Shawn Tsuda answers the question: “What happens if I regain the weight I lose after gastric bypass surgery? Can the surgery be redone?”

Weight re-gain following bariatric surgery remains a concern for many patients who have had, or are considering, surgery for weight loss.

While weight-loss procedures – whether the gastric bypass, adjustable gastric band, or the sleeve gastrectomy – remain the best option for durable weight loss in patients with morbid obesity, regain of most or all of one’s preoperative weight is possible.

While the primary cause of weight re-gain can be from a gastric pouch that is stretched, a gradual re-connection between the remant stomach and “new” stomach, or a band that is too loose or malfunctioning, the most common reasons are poor behavioral choices.

Grazing for food, snacking, eating too close to bed time, lack of exercise, and lack of portion control are the common culprits.

This emphasizes the importance of having weight loss surgery-when indicated-in the context of a comprehensive program that has support groups, personal follow-up with the surgeon, and a committment to life-long care.

Shawn Tsuda, M.D. is vice chief for bariatric surgery at University Health System and the University of Nevada School of Medicine, in Las Vegas, Nevada. Dr. Tsuda completed his fellowship training in minimally invasive and bariatric surgery at Harvard Medical School. He is board certified in general surgery.

Have a health question? University Health System doctors answer select questions from readers like you.

Dr. Shawn Tsuda answers the question: “Is the new way of using ultrasound to blast fat without surgery looking promising?”

Methods of reducing areas of fat in the body without the use of incisions, but instead with ultrasonic energy through the skin, holds promise as a cosmetic procedure for patients concerned with “probem areas” on their body.

This procedure, now starting to see use in the U.S., is akin to liposuction, but minus the incisions. Doctors are quick to note that this is not a weight-loss procedure, but purely a cosmetic one.

It’s important for patients to recognize when obesity is better served by methods of weight reduction rathar than targeted fat reduction, for which liposuction or ultrasonic methods may be useful.

Occasionally, obesity can be accompanied by serious health problems—morbid obesity—that has more to do with extra fat on conspicuous areas on your body.

Your physician can identify the relationship between your height and body surface area known as the body mass index, or BMI, which tells doctors whether you are overweight, obese, or severely obese.

In some cases, lifestyle changes and a tailored diet and activity plan may be warranted to help reduce your risks for heart disease, diabetes mellitus, hypertension, and numerous other obesity-related health problems.

In cases of severe obesity, surgical management options such as laparoscopic gastric bypass or gastric banding may be the best option for weight reduction.

Shawn Tsuda, M.D. is vice chief for bariatric surgery at the University of Nevada School of Medicine, in Las Vegas, Nevada. Dr. Tsuda completed his fellowship training in minimally invasive and bariatric surgery at Harvard Medical School. He is board certified in general surgery.

Have a health question? University Health System doctors answer select questions from readers like you.

Dr. Shawn Tsuda answers the question: “Laparoscopic gastric bypass versus the laparoscopic adjustable gastric band: Is one or the other better for long term weight loss results?”

The number of weight loss procedures performed over the past ten years has increased by more than a ten-fold in the U.S., exceeding 200,000 operations in 2006. The laparoscopic Roux-en-Y gastric bypass, which provides both restriction and malabsorption of food intake, is still considered the gold standard operation for long-term weight loss.

However, the laparoscopic adjustable gastric band, which uses one of two FDA approved devices for primary restriction of food into the gastrointestinal tract, is the second most commonly performed procedure and is quickly gaining in popularity. There is an abundance of data that supports both the gastric bypass and laparoscopic adjustable gastric band as safe (but not risk-free) procedures with sustainable weight loss and a positive impact on obesity-related diseases such as diabetes mellitus, hypertension and obstructive sleep apnea. (Learn more about weight loss surgery procedures from the U.S. National Library of Medicine).

The amount of weight loss that can be expected on average for the gastric bypass ranges between 60 and 80 percent of excess weight loss, or loss of weight beyond a calculated ideal body weight. The laparoscopic adjustable gastric band has a wider spectrum of success, ranging between 30 and 70 percent of excess weight loss.

Both operations are endorsed by most professional medical societies as acceptable treatments for the severely obese. The choice of operation depends on the patient’s preference, along with his or her surgeon’s counseling on any specific contraindications to either of the operations. An informed decision is essential to undergoing any weight loss procedure.

Shawn Tsuda, M.D. is vice chief for bariatric surgery at the University of Nevada School of Medicine, in Las Vegas, Nevada. Dr. Tsuda completed his fellowship training in minimally invasive and bariatric surgery at Harvard Medical School. He is board certified in general surgery.

Have a health question? University Health System doctors answer select questions from readers like you.