University Health System Blog

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: “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 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: “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.

Dr. Shawn Tsuda answers the question: “I’ve heard a lot about minimally invasive surgery. What exactly is it?”

Minimally invasive surgery refers to operations performed with small scars. Typically this can be accomplished laparoscopically, or with the use of a tiny camera and long, narrow instruments. The advantages of minimally invasive surgery include less post-operative pain and quicker recovery. The cosmetic result is also more favorable.

The vast majority of weight loss procedures such as the Roux-en-Y gastric bypass and the adjustable gastric band are performed laparoscopically, along with common procedures like gallbladder removal and hernia repairs.

Recently researchers have been looking into performing “scarless” surgery, also known as natural orifice and transluminal endoscopic surgery (NOTES) or single-incision laparoscopic surgery, through a tiny hole in the belly button. Although these advanced techniques are still in development and not widely performed, it is likely we will continue to see more surgery performed with either reduced scars, one single scar in the belly button, or no scars at all.

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.