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.

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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. James Lau answers the question: “What’s the difference between being overweight and obesity?”

Obesity means having too much body fat. It is different from being overweight, which means weighing too much. Both terms mean that your weight is greater than what’s considered healthy.

Obesity most often occurs over time when you eat more calories than you burn or use. The balance between calories-in and calories-out differs for everyone. Genetics, overeating, eating high fat foods and being physically inactive are factors that can make you obese.

It’s important to note that obesity is not just a cosmetic concern. Obesity and carrying excess body fat places you at greater risk of developing high blood pressure, diabetes, stroke, arthritis, certain cancers, and other serious health problems. Losing even five to ten percent of your weight if you’re obese can help delay or prevent some of these diseases.

If your body hasn’t responded to diet and exercise, you may be a good candidate for weight loss surgery, or bariatric surgery, such as the gastric bypass or the lap band using laparoscopic techniques. It’s important to get the facts about your choices if you believe you’re a good candidate for weight loss surgery.

The University of Nevada School of Medicine and University Medical Center sponsors free seminars in Las Vegas on bariatric surgery that Dr. Shawn Tsuda and I personally conduct. These free seminars are usually held once or twice a month at the School of Medicine. For a complete schedule, and for more information, please contact Robin Morello at 702-671-5150.

James Lau, M.D. is an assistant professor and chief of the bariatric surgery division at the University of Nevada School of Medicine Department of Surgery. Dr. Lau is board certified in general surgery and completed fellowship training in bariatric and minimally invasive surgery at Stanford University. He specializes in weight loss surgery.

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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.