Obesity, defined as a condition where a person’s body fat percentage negatively impacts their health, is a significant concern. It typically occurs when the Body Mass Index (BMI) reaches 30 or higher. Morbid obesity signifies a weight level where an individual's life expectancy is statistically reduced due to their weight. For individuals with a BMI over 30 and at least one health issue exacerbated by their weight, medical weight loss programs offer a viable solution. Sentara Comprehensive Weight Loss Solutions provides such an all-inclusive center to manage patients struggling with obesity.
Is Medical Weight Loss Right for You?
Medical weight loss is a suitable option for patients with a BMI over 30, which indicates obesity. Many health problems are associated with obesity, including high cholesterol, high blood pressure, diabetes, and heart disease, as well as knee and hip arthritis, fatigue, and shortness of breath during exercise. If you’re unsure whether your health concerns could improve with weight loss, please call our office, and we will be happy to assist you in determining if you are a good fit for our clinic. Your health insurance may cover your visit if you meet the criteria mentioned above. by Stephen D. Dr. Bariatric Times.
The Sentara Promise and Multidisciplinary Approach
At Sentara Medical Group, the program includes thorough observance of ‘The Sentara Promise’ to treat all patients with dignity and respect, respond to their questions and needs and engage them as informed partners throughout their weight loss journey.
Sentara Comprehensive Weight Loss Solutions embraces a multidisciplinary approach. The clinical team is comprised of experienced providers, nurses, medical assistants and registered dietitians ready to guide patients and answer their questions. The facility is 17,000 sq. ft. dedicated to the management of the bariatric patient. Furniture in the waiting rooms and other public spaces is sized for the bariatric patient. Every exam room has a table that can accommodate any patient of any size. Tables are low to the floor so patients do not have to climb to get onto them.
Comprehensive Facilities and Services
Sentara Comprehensive Weight Loss Solutions is a unique facility with everything needed for bariatric patient care under one roof: medical, surgical, psychology, exercise, nutrition, a retail store, 3D body scanner, and a conference room with space for up to 100 people.
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Highlights include the full-service exercise facility; blood draw station for labs for research; and dedicated bariatric psychologist, exercise specialist, and dietitian. There is a unique commercial three-dimensional body scanner whose origins are in the custom clothing industry. The scanner creates a 3D archival image with consistent reproducible measurements that allows us to track patients’ progress and to do studies of body-image assessment. It’s a real motivator to patients as they see the results of the scans.
The program is fortunate to have a comprehensive bariatric retail store that stocks multiple vitamin and mineral lines as well as a full complement of protein supplements, meal replacement items, snacks and beverages. They also offer books, pedometers, scales and fitness tracking devices.
Surgical Expertise and Technology
All surgeries are performed at Sentara Norfolk General Hospital. The operating room at Sentara Norfolk General Hospital is fully staffed according to ASMBS and ACS Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MSBAQIP) Center of Excellence guidelines for patients up to 1,000 pounds. The program goes above and beyond the MBSAQIP requirement by offering a specialty pod for patients to recover. The bariatric patient pod has six beds specifically designed and outfitted for postsurgical patients. It also features bariatric seating and extra wide doors to accommodate the extra wide beds and stretchers. Every room in the center has an overhead lift for patients who need help getting in and out of bed.
Sentara CarePlex offers the only robotic weight loss surgery program on the Virginia Peninsula, coupled with the Sentara Comprehensive Weight Loss Solutions service. The da Vinci robot gives unparalleled dexterity and precision. Robotic surgery helps patients recover faster with less pain than traditional laparoscopic surgery, so they’re up and moving sooner, which gives them a greater opportunity for a successful weight loss journey.
The Team
Stephen D. Wohlgemuth, MD, is the Medical Director of Sentara Comprehensive Weight Loss Solutions and Assistant Professor of Clinical Surgery at Eastern Virginia Medical School. He is certified by the American Board of Surgery and a member of numerous associations. Dr. Wohlgemuth is currently involved in numerous research projects dealing with bariatric surgery and has presented his research at numerous national medical meetings, such as Obesity Week and Obesity Weekend. After a broad-based general surgical career he has made bariatric surgery and development of this comprehensive center his main focus.
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Mark A. Fontana, MD, is Surgical Clinical Director of Sentara Comprehensive Weight Loss Solutions. Dr. Fontana has performed more than 1,000 laparoscopic gastric bypass surgeries and LAGBs. He is currently in the process of developing the general and bariatric robotic programs. He is certified by the American Board of Surgery and is a Fellow of the ACS. Dr. Fontana is also a member of the ASMBS.
Caren D. Beasley, MD, is Medical Clinical Director of Sentara Comprehensive Weight Loss Solutions. As the Lead Physician of the Medical Bariatric program at Sentara Comprehensive Weight Loss Solutions, Dr. Beasley specializes in treating patients with obesity with serious medical complications. Her evidence-based approach integrates behavior modification with specific dietary and exercise guidance, which are completely customized to patients’ individual health needs.
Dr. Ninoska Peterson, PhD, is the Bariatric Psychologist for Sentara Comprehensive Weight Loss Solutions. Dr. Peterson’s role is to provide psychological evaluations for potential bariatric surgical patients and provide psychological support for medical and surgical patients at various stages of their weight management program. Dr. Peterson is a licensed clinical psychologist.
Erick M. Vitug serves as Director of Operations of Sentara Comprehensive Weight Loss Solutions.
Surgical Procedures and Outcomes
The team consistently performs over 350 surgical cases a year. As with most bariatric programs, 80 percent of surgical patients are women. The average BMI is 48, and the average age is 47. From 2008 to 2010, gastric bypass made up the majority of procedures (45-56%) followed by LAGB (35-48%). In 2011, the program began performing laparoscopic sleeve gastrectomy (LSG). Since then, the percentage of LSGs has steadily increased from 30 to 88 percent. In the most recent 2014 Semiannual Report from the MBSAQIP all of sleeve outcomes were as expected with four categories being exemplary.
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The practice illustrates the worldwide popularity of LSG. In general, patients looking for significant weight loss coupled with good resolution of comorbidities catapulted the sleeve into its current position of popularity. There has been a decrease in use of the LAGB.
Accreditation and Patient Engagement
The program was the second program in Virginia to receive the American College of Surgery designation as an Adult and Adolescent Bariatric Center of Excellence (COE). It has undergone two three-year reaccreditations, and is undergoing a site visit for the MBSAQIP program before the end of 2015. The COE process reinforced and highlighted all the good things that were being done, as well as areas for improvement. MBSAQIP accreditation is explained to patients at information sessions, which are offered online and in-person.
Patient engagement begins at one of six monthly public information sessions. From there, all interested patients are scheduled for their initial surgical consultation with one of four bariatric surgeons. A bariatric trained psychologist meets with the patient to assess whether there are any major psychological or behavioral issues that may impede success. If the patient has obesity related comorbidities, such as obstructive sleep apnea (OSA), cardiovascular disease, or type 2 diabetes mellitus (T2DM), they are referred to appropriate specialists. A bariatric anesthesiologist sees high-risk patients before undergoing any weight loss operation. All clinical members of the staff meet once a month to discuss difficult patient cases.
The team believes that their team members and patients should set realistic expectations for weight loss prior to surgery. Patients are told that they are patients for life, not just during the preoperative period, and are encouraged to come back yearly after the two-year mark.
Cost Efficiency and Patient Safety
As employed physicians, the team feels they have a responsibility to be as cost efficient as possible in the operating room. They are continually reviewing their outcomes as well as the literature to either eliminate unnecessary items or change to more cost effective products. In the operating room, there are special transferring devices that help move larger patients. In the bariatric patient pod at Sentara Norfolk General Hospital, there are lifts in all the rooms. All members of the clinical team are trained in patient safety. Every new nurse at Sentara must complete an educational module that covers sensitivity training and patient transfer. There is mandatory refresher training for all staff as well as multiple in-services every year for all staff by the BSCN Jeanne Sander.
Case Studies
- Case 1: A 63-year-old man with a non-ischemic cardiomyopathy and ejection fraction of 10 percent was in need of a cardiac transplant. Unfortunately, his BMI (45.9kg/m2) made him ineligible according to our transplant center criteria. He had a left ventricular assist device placed as a temporizing measure and after extensive evaluation, he underwent an uneventful sleeve gastrectomy in July 2013. Within 12 months, he had lost 100 pounds and decreased BMI to 30kg/m2.
- Case 2: Another challenging case was a 41-year-old man diagnosed with early stage prostate cancer. After much discussion with his urologist, he wanted to pursue a robotic prostatectomy but his BMI (46kg/m2) made him ineligible. The bariatric team initially evaluated him in July 2010. We were able to expedite his pre-operative process and performed a gastric bypass on August 2010. Within three months, he had lost 40 percent of his excess weight and his BMI decreased to 36kg/m2, enabling him to undergo a successful robotic prostatectomy in December 2010. He is now four-and-a-half years postsurgery. He has lost a total of 135 lbs, 77 percent excess body weight, and now has a BMI of 27kg/m2.
- Case 3: One of our most challenging cases was a 24-year-old women who underwent a straightforward sleeve gastrectomy only to have a proximal leak on postoperative day 10. Despite aggressive nonsurgical management with multiple stents, percutaneous drainage, and hyperalimentation, we were unable to get the leak to resolve. After three months, we were able to perform a combined radiologic, gastroenterologic, transoral placement of an anal fistula plug made of biologic material to plug the leak from inside the sleeve.
Partnerships and Community Service
The size and scope make Sentara Comprehensive Weight Loss Solutions a unique facility. There are endocrinologists from Eastern Virginia Medical School (EVMS) and a research partnership with EVMS’s Strelitz Center for Diabetes.
Sentara Comprehensive Weight Loss Solutions proudly serves our community with three convenient locations in Hampton Roads.
A New Beginning
Sentara Comprehensive Weight Loss Solutions guides patients to best choices. New Year’s resolutions often include losing weight. For some people, it’s some extra pounds they put on over the holidays. For others, it’s a life-and-death decision. Sentara Comprehensive Weight Loss Solutions can be the answer for patients battling obesity and resulting conditions such as diabetes, heart disease, and hypertension.
Some patients won’t consider surgery, so the team designs a medical weight loss plan around prescription medications, diet modification, and healthy lifestyle changes to achieve a desired result. The team asks about their life in terms of work and family and all the other factors that may contribute to weight management issues. Then they ask them what’s a plan they can work with.
Surgery cannot overcome a bad diet or an unhealthy lifestyle. Surgery resets your new normal. When you’re ready for your new beginning, the team is here to support you and will be with you every step along your journey toward a healthy weight and lifestyle.
Jenny Sisk’s Story
Jenny, 54, tried Weight Watchers (twice), the Atkins diet, gym memberships and countless other weight loss programs. Each time, she lost weight, only to regain it later.
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