Sentara Healthcare offers a wide range of medical services throughout Virginia and North Carolina, including comprehensive weight loss solutions. Recognizing that obesity is a complex, chronic disease influenced by many factors, Sentara has developed a multidisciplinary program to address the unique health needs, lifestyles, and goals of each patient. This article explores the services, team, and philosophy behind Sentara Comprehensive Weight Loss Solutions.
Understanding Obesity and the Need for Comprehensive Care
Obesity is defined as a condition in which a person’s body fat percentage reaches a level that negatively impacts their health, typically when the Body Mass Index (BMI) reaches 30 or higher. Overweight means carrying more weight than what’s considered healthy for your height. That extra weight could come from fat, but it can also come from muscle, bone, or even water. Morbid obesity refers to a weight level where an individual is statistically less likely to live as long as they should due to their weight. 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.
Having obesity often results from a combination of genetic, environmental, and lifestyle factors, not just one cause. The more we learn about having obesity, the more we understand that treating obesity is about far more than simply not having willpower. There is no single approach to prevent or treat obesity because it is a complex, chronic disease influenced by many factors. If your BMI is over 30 and you have at least one health issue worsened by your weight, you are a strong candidate for our program.
Locations and Access to Care
Sentara operates more than 100 sites of care across Virginia and North Carolina, with three locations in Hampton Roads dedicated to comprehensive care for weight loss patients. Sentara offers convenient options for care depending on your condition. These dedicated weight loss centers provide both surgical and non-surgical weight loss options.
The Sentara Promise: Patient-Centered Care
At Sentara Medical Group, we are fortunate to have developed a totally comprehensive, all-inclusive center to manage patients struggling with the insidious disease of obesity. Our process 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.
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A Multidisciplinary Team of Experts
Sentara Comprehensive Weight Loss Solutions embraces a multidisciplinary approach. At Sentara, you’re not just getting a procedure or medication; you’re gaining a team of weight loss experts dedicated to your success. Our program includes guidance from the moment you begin to consider a weight journey through the process of learning habits to help you keep the weight off for life. The team includes:
- Medical Director: Stephen D. Wohlgemuth, MD, is the Medical Director of Sentara Comprehensive Weight Loss Solutions. Dr. Wohlgemuth is also an Assistant Professor of Clinical Surgery at Eastern Virginia Medical School. After a broad-based general surgical career he has made bariatric surgery and development of this comprehensive center his main focus.
- Surgical Clinical Director: 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.
- Medical Clinical Director: 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.
- Bariatric Psychologist: 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.
- Director of Operations: Erick M. Vitug serves as Director of Operations of Sentara Comprehensive Weight Loss Solutions.
Comprehensive Services and Facilities
Sentara Comprehensive Weight Loss Solutions offers a wide range of services and facilities to support patients throughout their weight loss journey:
- State-of-the-art facility: Our facility is 17,000 sq. ft. dedicated to the management of the bariatric patient. In our 17,000-square-foot center, we have 15 fully wired exam rooms to offer both medical and surgical options for weight loss. 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.
- Surgical Options: All of our 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. We go 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.
- Medical Weight Loss: Medical weight loss is a suitable option for patients with a BMI over 30, which indicates obesity.
- Exercise Facility: We have a fully integrated conference room, which can accommodate 100 people, a 500-square-foot exercise facility
- Retail Space: and a 300-square-foot retail space. We are 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. We also offer books, pedometers, scales and fitness tracking devices.
- 3D Body Scanner: We have 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.
- Patient Education and Support: Patient engagement begins at one of our six monthly public information sessions. From there, all interested patients are scheduled for their initial surgical consultation with one of our four bariatric surgeons. Our bariatric trained psychologist meets with the patient to assess whether there are any major psychological or behavioral issues that may impede success. We believe that our team members and patients should set realistic expectations for weight loss prior to surgery. We tell our patients that they are our patients for life, not just during the preoperative period. We encourage them to come back yearly after the two-year mark.
- Research Partnership: We have endocrinologists from Eastern Virginia Medical School (EVMS) and a research partnership with EVMS’s Strelitz Center for Diabetes.
- Cost Efficiency: As employed physicians, we feel we have a responsibility to be as cost efficient as possible in the operating room. We are continually reviewing our outcomes as well as the literature to either eliminate unnecessary items or change to more cost effective products.
Surgical Procedures and Outcomes
Our team consistently performs over 350 surgical cases a year. As with most bariatric programs, 80 percent of our surgical patients are women. The average BMI is 48, and the average age is 47. Table 1 shows the percentage and types of surgical procedures performed to date. From 2008 to 2010, gastric bypass made up the majority of procedures (45-56%) followed by LAGB (35-48%). In 2011, we began performing laparoscopic sleeve gastrectomy (LSG). Since then, the percentage of LSGs has steadily increased from 30 to 88 percent. We continue to have excellent outcomes. In the most recent 2014 Semiannual Report from the MBSAQIP all of our sleeve outcomes were as expected with four categories being exemplary.
In general, patients looking for significant weight loss coupled with good resolution of comorbidities catapulted the sleeve into its current position of popularity. We see a decrease in use of the LAGB. Our practice illustrates the worldwide popularity of LSG.
Accreditation and Recognition
Our 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). We have undergone two three-year reaccreditations, and are undergoing our site visit for the MBSAQIP program before the end of 2015. We have fully endorsed the COE process from the very beginning. The process reinforced and highlighted all the good things that we were doing, as well as areas for improvement. Dr. We explain MBSAQIP accreditation to our patients at our information sessions, which we offer online and in-person.
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Examples of Success
Sentara Comprehensive Weight Loss Solutions has helped numerous patients achieve their weight loss goals and improve their health. Here are a few examples:
- 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.
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