“These successful treatments are life-changing”: Amid weight loss drug craze, bariatric surgery remains safe, proven method, Dartmouth Health providers say

While injectable weight loss drugs have exploded in popularity in the last year, bariatric surgery remains the best long-term treatment option for many living with obesity. The surgery involves surgically altering the size of the stomach and, depending on the method, bypassing part of the intestine. The majority of patients lose a significant amount of excess weight, have better control of diabetes, and reduce their use of blood pressure and diabetic medications. Patients who undergo bariatric surgery on average live significantly longer than patients with obesity who do not undergo surgery.

Dartmouth Health is a regional leader in the use of the procedure, with more than 400 procedures performed annually in Lebanon, Concord, Manchester and Nashua. The success of bariatric surgery depends in large part on preparing patients, physically and emotionally, for a life-changing experience. 

An interdisciplinary team of nurses, nutritionists and mental health practitioners collaborates on helping people with severe obesity and metabolic disorders to decide whether surgery is the choice, and then shepherd them through a rigorous eligibility and preparation process.  After the surgery, patients receive support from the team, both in the immediate transition period of six to eight months, and in the following years to identify and address any medical issues that might arise. 

Kristin L. Slack-Potwin, one of the coordinators for the bariatric surgery program in Lebanon, is often the first point of contact for patients, and helps lead them through many steps, such as meeting medical qualifications for the surgery, attending orientation programs and making dietary changes. Slack-Potwin says insurance requirements vary, but can include patients keeping a journal of everything they eat, a psychological evaluation, and several months of counseling with a nutritionist to enable patients to implement new eating habits. 

Sivan Rotenberg, PhD, a psychologist with the Weight & Wellness Clinic at Dartmouth Health’s Dartmouth Hitchcock Medical Center (DHMC), conducts many of the required psychological evaluations. Rotenberg’s conversations with patients center on the person’s relationship to food and how patients can start changing that relationship. Living well post-bariatric surgery, requires patients to make a strong commitment to change their lives pre-surgery, she says, and may require months of therapy or counseling.

“These successful treatments are life-changing in that they change a person’s entire approach to food and eating,” said Rotenberg. It’s important that these lifestyle changes become engrained before the surgery to maximize the chances for success.  

Krystal Kebler, a teacher in her mid-30s, became a candidate for bariatric surgery due not only to her weight but a chronic liver condition that threatened to shorten her life. She lost 166 pounds over two years since her surgery. Intensive outpatient therapy prior to the surgery, that helped change Kebler’s attitudes and use of food as a coping strategy, “was one of the hardest things I have ever done,” she said. But the outcome has been worth it, as her health and quality of life are better, and she feels freer to do things that her excess weight prevented her from doing before. 

Sarah E. Billmeier, MD, MPH, a surgeon with the Bariatric Surgery Program at DHMC, hopes more patients with severe obesity will consider surgery. “It is an option that is very underutilized, very safe and has such an incredible success rate,” she said.  

Billmeier finds her work gratifying. “I get to make such an enormous difference in someone’s life,” she said. “After the surgery, our patients are more active, and they have a much better quality of life.”