8 minute read
A WHOLE NEW LIFE
In 2017, Brian Bates knew he needed to find a “healthier place in life.” Although he had worked with a personal trainer and nutritionist for several years, Bates was unable to reach his weight loss goal.
The London-based international capital markets lawyer was up to 283 pounds, with a body mass index (BMI) of 39 (30 and higher is considered obese).
“I developed sleep apnea, pre-hypertension and pain in my legs, hips and feet,” Bates said. “I couldn’t enjoy the type of lifestyle that I had as a younger person. And traveling internationally, which was necessary for my job, had become increasingly difficult.”
CHOOSING THE BEST OPTION
One of Bates’ colleagues, who had undergone obesity surgery 15 years earlier, recommended a duodenal switch — a type of obesity surgery — due to her experience with long-term success. She advised him to choose a gastric surgery practice that was highly experienced in the complex procedure.
After researching surgical weight loss programs in the U.S. and London, Bates decided to fly across the Atlantic to meet with the bariatric team at the University of Chicago Medicine.
Every patient considering obesity surgery at UChicago Medicine first meets with the entire weight loss care team. The visits take a half day, with the goal of finding the right match between the choice of procedure and the patient.
“Each patient has a different amount of weight to lose and different health issues related to obesity,” said bariatric surgeon Vivek Prachand, MD. “In addition, the surgeries have different levels of effectiveness and side effects.” UChicago Medicine offers all four types of bariatric surgery — sleeve gastrectomy, gastric bypass, gastric band and duodenal switch.
“In just one stop, I met with the surgeon, nurses, a dietitian and a psychologist,” said Bates, a Midwest native with homes in London and in Northwest Indiana. “The conversation was professional, constructive and informative. Because I could speak to them directly and candidly — and due to their vast experience with the duodenal switch — I knew the UChicago Medicine team was for me.”
The duodenal switch — also called the biliopancreatic diversion with duodenal switch and commonly referred to as DS — combines a sleeve gastrectomy with an intestinal bypass. Because it reduces how much food a person feels like eating and results in improvement of metabolism, it helps patients lose weight and maintain weight loss.
“Brian’s BMI was less than the typical DS patient,” said Prachand, noting that the procedure is usually performed when the BMI is over 50, or over 40 if the patient has other health issues, such as severe diabetes. “He didn’t need DS from the standpoint of the magnitude of his weight.” Brian Bates lost 130 pounds after he had obesity surgery and learned a new way of eating.
The weight loss surgeons at the University of Chicago Medicine, leaders in the bariatrics field for more than 20 years, have performed hundreds of duodenal switch procedures.
Prachand recommended the sleeve gastrectomy. But when Bates pushed back, Prachand listened. Bates wanted the DS not only for its effectiveness at weight loss, but, more importantly, for its durability. “If I was going to have weight loss surgery, I wanted the procedure with the greatest chance of long-term success,” he said.
“The conversation we had with Brian about having the more complex procedure was a challenge, not a confrontation,” Prachand said. “There are different risks and benefits with the duodenal switch compared to sleeve gastrectomy. We needed to be sure we went into this together, in a clear-eyed way. “Based on our discussion, I felt very confident that Brian had an excellent understanding of these differences and realistic expectations about surgery. He committed to diligently using DS as a tool to achieve his health goals and understood that surgery was neither a shortcut, nor an easy way out to weight loss and health improvement.” “I’m still exploring what works, but absolutely none of this has been problematic for me,” said Bates. “I eat several small meals each day, focusing on protein from foods such as beans and porridge. And I take several vitamins and nutritional supplements daily. It’s become a part of my routine.”
SURPASSING HIS GOAL
Bates underwent the DS procedure in December 2017. After recovery, with the help of a nutritionist and a support group, he learned a new way of eating. Because about two-thirds of his small intestine was now bypassed, there were changes in the way his body absorbed certain nutrients, such as fats and protein, as well as vitamins and minerals. As his body adapted to these changes, Bates adjusted his diet. He regularly takes supplements to meet his nutritional needs. Bates has surpassed his goal of losing 100 lbs. “It’s been a miracle. I love the new me and the life I now lead, with new interests — particularly having fun in the London fashion scene. I’ve also developed far greater self-confidence and now speak on issues concerning diversity, inclusion and mental health. I am determined to assist others in finding their path to a better self.” Prachand said Bates is an example of the individualized care offered to every patient who comes to the bariatric surgery program at UChicago Medicine. “Our team worked together closely with Brian to use the right tool to achieve the best outcome possible.” Which weight loss approach is right for you? Which weight loss approach is right for you?
Vivek Prachand, MD
Which weight loss approach is right for you?
MEDICAL MANAGEMENT
MEDICAL MANAGEMENT ENDOBARIATRIC
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BARIATRIC PROCEDURES BARIATRIC PROCEDURES
UChicago Medicine offers a full spectrum of services for weight management and obesity treatment, including medication, behavioral therapy, nonsurgical procedures and bariatric surgery.
LEARN MORE UChicagoMedicine.org/weight-management
A NEW TOOL TO TACKLE CELIAC DISEASE
A research breakthrough has delivered a vital tool for efforts to treat and prevent celiac disease. After more than 20 years of work, University of Chicago scientists have produced the first accurate laboratory model of celiac disease, which causes gastrointestinal symptoms and damage to the small intestine when someone eats gluten — a protein found in grains such as wheat, barley and rye. Treatments that could reverse or prevent the disease can now be tested in a model that faithfully represents the condition in humans. There currently is no cure for celiac disease, and the only effective treatment is a gluten-free diet. Even on a strict diet, 40% of affected patients suffer inflammation and damage to the small intestine. The exact cause is unknown, but researchers have identified genetic,
immune system and environmental components that work together to trigger the disease. The laboratory models have the same genetic and immune system characteristics as humans who develop celiac disease after eating gluten. “It’s the first model where the mouse develops damage to the small intestine just by eating gluten and then later reverses the disease’s damage on a gluten-free diet,” said Bana Jabri, MD, PhD, Director of Research at the University of Chicago Medicine Celiac Disease Center and senior author of the study, published in February in Nature. The model will be used to help design new therapeutic strategies and test new treatments in collaboration with national and international academic centers and pharmaceutical companies.
LINKING CHEMICAL RHYTHMS TO EATING BEHAVIORS, OBESITY
Obesity affects over 90 million adults in the U.S., but how different chemical signals in the body are involved remains unclear. A new study shows that chemicals in the endocannabinoid system — a part of the nervous system that helps regulate appetite — are altered during obesity. Erin C. Hanlon, PhD, a research assistant professor at the University of Chicago, and colleagues found that in obese individuals, the rhythmic cycle of a chemical signal linked to eating for pleasure peaks later in the day when compared to non-obese individuals. This shift may be what causes obese individuals to eat when they aren’t hungry and to snack before bedtime — another factor linked to weight gain — or the change in rhythm may occur after weight gain and further perpetuate the cycle. The study, which was published in the Journal of Clinical Endocrinology and Metabolism, presents new avenues for understanding how the endocannabinoid system is involved in eating behaviors linked to obesity.
STUDY FINDS GAPS IN NURSING HOME SAFETY DATA
Nursing home patient falls are significantly underreported on a federal website called Nursing Home Compare, often used by families researching options for loved ones. Reviewing nearly 88.7 million Medicare claims from 2011 to 2015, Prachi Sanghavi, PhD, a University of Chicago researcher, identified 150,828 major injury falls in claims filed by hospitals for reimbursement. The data used by Nursing Home Compare accounted for only 57.5% of these falls, with far fewer falls being reported for black, Asian and Hispanic patients relative to whites. Though often preventable, falls are a leading cause of death among the over-65 population. Sanghavi suggests that the website use an objective source, like claims data, rather than numbers selfreported by nursing homes. The findings were published in December in Health Services Research.
CLOSING MACULAR HOLES WITHOUT SURGERY
The macula of the eye provides us with the sharp vision we need to read, drive and see fine details. A new method for treating macular holes — a common vision problem in people over 60 that causes distorted and blurry vision — may allow some patients to avoid invasive surgery. Traditional treatment for a macular hole involves the surgical removal of transparent gel from the middle of the eye. University of Chicago Medicine ophthalmologist and retinal surgeon Dimitra Skondra, MD, PhD, has been researching whether medicated drops can help close these holes. The three-drug regimen dehydrates the retina and decreases swelling, allowing the edges of the macular hole to creep back together. The treatment was most effective in patients who already had retinal surgery and whose macular hole was under 200 micrometers. Skondra hopes to begin a multi-center randomized trial to further study the treatment’s effectiveness.
