Dr. Jorge Sosa, MD

No, Dr. Sosa states that weight loss surgery is not a cop-out; it's a solution that requires significant bravery and commitment from the patient.

Patients must be brave to accept the associated risks and tolerate the discomfort and long recovery period that weight loss surgery entails.

Weight loss surgery is a viable option for individuals who have not succeeded with medical management for weight loss.

The typical advice is to wait a year after weight loss surgery before getting pregnant. This is because rapid weight loss makes it difficult to assess a baby's growth. While a new study indicates similar pregnancy success rates for those who conceive earlier, waiting a year is still considered good advice.

Recovery is typically fast, with very small wounds and little pain. 97% of patients can drive and return to work within one week. For very physical jobs, recovery may take two to three weeks.

Every operation carries a risk of death, including weight loss surgery, appendectomy, gallbladder surgery, and even cosmetic surgery. However, the risk with weight loss surgery is pretty low, typically around 0.2%. In Dr. Sosa's program, after more than 10,000 patients operated, the risk of death is also around 0.2%. It's important to understand that no surgeon can promise everything will be perfect and nothing will happen with surgery.

The relationship between weight loss surgery and alcohol use is complicated. While some studies suggest an increased risk of alcoholism, others indicate rates similar to the general population. However, weight loss surgery definitively alters the amount and speed of alcohol absorption. Patients should be very cautious, limiting consumption to very occasional social events, or ideally, avoiding alcohol altogether due to potential long-term problems.

No, Dr. Sosa does not offer the gastric balloon or endoscopic sleeve procedures. He believes these are temporary and expensive solutions that do not provide lifelong results for obesity. The typical balloon procedure costs around $8,000 and must be removed after six months, often leading to weight regain as the stomach does not shrink. The endoscopic sleeve, which costs about $7,000-$8,000, involves sewing the stomach from the inside with stitches that Dr. Sosa states do not last long-term, breaking open after 3-6 months, causing the stomach to return to its normal size and the procedure to fail with brief and insignificant weight loss. He would only consider such procedures if they were very cheap (a couple of hundred dollars) and could be performed once or twice a year.

A surgical sleeve gastrectomy involves resecting and permanently removing extra stomach tissue, providing a lifelong solution. In contrast, an endoscopic sleeve involves sewing the stomach from the inside with stitches placed through a scope, which Dr. Sosa states do not last long-term and break open after 3-6 months, causing the procedure to fail and weight to be regained.

Yes, Dr. Sosa strongly recommends weight loss surgery for patients with diabetes and obesity. The American Diabetic Association now recommends bariatric surgery as a first-line treatment for diabetes, a change from its previous second-line status. Gastric bypass is particularly recommended for diabetic patients as it is much more successful than gastric sleeve in eliminating diabetes and normalizing insulin, sugar levels, and H1C, almost universally eliminating diabetes. While gastric sleeve might work, it is much less likely to eliminate diabetes compared to gastric bypass. For patients with obesity and diabetes, weight loss surgery can be a very powerful tool to improve their health.

The total weight loss depends on the specific operation and the patient's starting weight. For sleeve gastrectomy, which provides portion restriction but not sugar malabsorption, patients can expect to lose around 80 pounds. Gastric bypass, offering both portion control and malabsorption of sugar and simple carbohydrates, typically results in much greater weight loss, around 80% of excess weight, with patients often losing 100 to 150 pounds. Dr. Sosa has observed patients losing up to 250 pounds with gastric bypass, especially for patients starting at higher weights (e.g., 500 pounds compared to 300 pounds).

While bariatric surgery is generally safe, some patients are not candidates due to high risks. These include individuals with severe heart disease (especially congestive heart failure where the heart isn't pumping well), major immunological deficiencies, or severe clotting deficiencies. The practice always performs a screening test to ensure patients can safely undergo surgery, and in rare cases, patients are deemed too high risk.