Q&A with Dr. Lee D. Trotter

What are the most common types of bariatric surgery?
Most experts consider the Roux-en-Y gastric bypass (RNY) the “gold standard” of surgical weight loss options due to its high success rate. Today, RNY comprises the majority of all bariatric procedures.

Surgeons can perform the RNY as an open procedure or laparoscopically, through small incisions. During the surgery, the stomach is made into a pouch that restricts food intake. Next, a portion of the small intestine is bypassed and attached to this pouch, which reduces the amount of nutrients and calories the body absorbs.

Is bariatric surgery considered an effective method for treating obesity?
Bariatric surgery is very effective in treating obesity and boasts an impressive success rate long-term. Comparatively, conventional weight-loss methods such as diet, exercise, behavior modification, and anti-obesity drugs are not nearly as effective for severely obese adults. In fact, recent reports have shown that the majority of patients utilizing these conventional methods regain all the lost weight in the next five years.

Do I qualify for bariatric surgery?
This answer requires an examination by a qualified bariatric surgeon. However, the National Institutes of Health suggests you may be a candidate for bariatric surgery if you have:

• A body mass index (BMI) of 40 or more—about 100 pounds overweight for men and 80 pounds for women
• A BMI between 35 and 40 and a serious obesity-related health problem such as type 2 diabetes, heart disease, or obstructive sleep apnea
• Failed conventional approaches to weight-loss
• An understanding of the procedure and the lifestyle changes you’ll need to make
• The ability to tolerate the surgical procedure

If I am a surgical candidate, what else should I consider before electing for bariatric surgery?
You should understand that surgery for weight loss is a serious undertaking and is by no means a “quick fix.” In fact, success requires a lifelong dedication to behavioral change and cooperation with your medical team. My best patients are those who are motivated to actively participate in their health and recovery, with the understanding that their health is more important than their weight.

Bariatric surgery should be considered a tool—a means to help you change your eating habits, lose weight, and become healthy. But without the lifestyle and dietary changes, your bariatric surgery will not likely be successful.

How can I find a qualified bariatric surgeon?
The Lite and Hope Network’s Web site has an online directory of registered surgeons. You can visit this page to find a doctor in your area: http://www.liteandhope.com/gastricbypass_surgeons.html

What are some common side effects of bariatric surgery that I can help control?
After recovering from surgery, “early” problems—such as vomiting and dumping syndrome—will be easily recognized and treated. Dumping syndrome occurs when high concentrated food (typically sweets) is “dumped” too quickly into the small intestine and results in cramping, nausea, and diarrhea. Other symptoms can include rapid heartbeat, sweating, shakiness, and faintness.

Long-term or “late” problems include nutritional deficiencies. Because your new stomach pouch will resemble the size of a golf ball following RNY surgery, your body may not be receiving an adequate amount of nutrients to meet its needs. “Starving” your body of these nutrients can lead to malnutrition, which can manifest in a variety of ways including hair and nail loss, fatigue, anemia, and bone mineral loss. All patients are susceptible to nutritional deficiencies and most require lifelong nutritional supplementation.

Patients have to be especially conscious of the following nutritional deficiencies:

• Protein
• Iron
• Calcium
• Vitamin B12
• Vitamin A
• Vitamin D
• Folate
• Thiamine
• And other micronutrients

Why is nutritional supplementation so important?
In the months following surgery, most patients find it difficult to meet their nutritional needs despite choosing the “perfect” foods. There simply is not enough space in the small pouch to hold enough nutrition. As a result protein and vitamin deficiencies are very common. In addition, it is extremely important to drink plenty of fluids each day. Meeting the nutritional and fluid requirement is clearly impossible without a high quality supplement. When supplements are taken as a liquid meal replacement or meal enhancer both requirements are met simultaneously.

It is important to remember that not all protein supplements, meal replacements and vitamins are created equal. Quality varies greatly.  Supplements must be absorbed by your body to be of any value. Cheap, low quality products may just pass through your body offering no benefit to your health.

Why use the Metagenics line of nutritional products?
Simply put, I use Metagenics products because of the results. The health and well-being of my patients is my primary concern, and previous experiences with lesser quality products led me to Metagenics and their line of bariatric nutritional products. And since I began incorporating Metagenics products in my practice, my patients have never been happier or healthier and I believe that speaks for itself.

Unlike some manufacturers, Metagenics doesn’t cut any corners. I’ve toured their facilities and examined their raw ingredients. Everything that goes into a Metagenics formula is provided in the right quantity, in the right form, and represents the latest in nutritional science. For example, their protein is one of the highest quality and absorbable proteins in existence, their vitamins and minerals are gentle yet designed for optimal absorption, and every formula is guaranteed for purity.

I encourage you to discuss Metagenics products with your doctor.

Will I be healthier after losing all of this weight?
Not necessarily, and this is a critical point. Unhealthy weight loss is common following bariatric surgery. Some patients lose too much weight too quickly, or lose too much muscle tissue. I often ask my patients: yes you’ve lost 25 lbs this month, but 25 lbs of what? Did you lose fat, muscle, or water? This is a very important question because body composition can be directly correlated with your health and metabolism. If you’re diet lacks protein and other nutrients—which is common for bariatric patients—your body will borrow (or steal) these nutrients from your muscles and other tissues. The end result: poor health and low metabolism. To be “skinny” and sick is not your goal.

Again, nutritional supplementation can play a crucial role in helping you lose the right kind of weight and improve your body composition (percent body fat to lean muscle). For example, Metagenics BariatrX Essentials medical food is formulated with a blend of superior soy and whey proteins to promote the growth of lean muscle mass while supporting the loss of unhealthy fat.

If you focus on eating healthy and are committed to taking your nutritional supplements, your weight loss is virtually guaranteed—and it will be the right type of weight loss.

What is the role of physical activity in managing my weight and staying healthy?
It is absolutely essential. In addition to a healthy diet, physical activity will fuel your weight loss while helping to maintain and grow your lean muscle mass. Exercise can also improve your emotional health and overall vitality. Speak with your doctor about developing an exercise routine. The use of physical therapy to provide personalized assistance and equipment may be helpful.

Besides a healthy diet, nutritional supplementation, and exercise, are there any other factors of a healthy lifestyle that I should incorporate?
Your emotional health should not be underestimated, and for many patients, this represents a significant hurdle to get over. But there are solutions. In my practice I incorporate a team approach to bariatric surgery that includes psychiatric counselors (coaches) and specialized support groups to help with the psychological adjustments that every patient will have to make. Even professional athletes, who are the best in their sport, have coaches to assist them. I encourage you to seek out these resources prior to your surgery and develop a detailed plan of action with your doctor that will put you on the path to success. Good luck and good health!

Lee Trotter, D.O.
Medical Director
Carson-Tahoe Hospital Medical-Surgical Weight Loss Center
Carson City, NV 89703

Dr. Lee D. Trotter was born and raised in Southern California. He graduated from Brigham Young University in 1984. He then attended Western University of Health Sciences earning his medical degree, graduating in the top ten of his class. Dr. Trotter served as Medical Director of a regional trauma center, life flight system and surgical intensive care unit. He is a board-certified surgeon and a member of the American Society for Bariatric Surgery. He has earned a reputation as a nationally recognized speaker on advanced laparoscopic techniques.

Dr. Trotter has excelled in the understanding of bariatric nutrition. He has personally developed one of the only medical meal replacements which is now manufactured and distributed internationally. His nutritional program is setting new standards for bariatric surgery.