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Spring Survey 2012

Who is a Candidate?

Program: Weight Loss Surgery: A New Incision-Free Procedure
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Andrew Schorr:

So, Dr. Rogers, we wondered about whether somebody would be a candidate for one procedure versus another.  What about the TOGA procedure?  Who would be a candidate for that? 

Dr. Rogers:

So candidates for this surgical procedure as well as other surgical procedures would have to qualify based on the standard criteria set forth by the NIH in their 1991 consensus panel, and that is specifically patients who have failed a supervised weight-loss program, patients who are well informed and motivated, those who have acceptable operative risks, and those who have a BMI, or body mass index, greater than 40 or between 35 and 40 with co-morbidities such as hypertension, diabetes, high cholesterol or sleep apnea.

Andrew Schorr:

And it was the sleep apnea that was the comorbidity and also Sheila had hypothyroidism as well, so although her BMI was a little bit lower she had those conditions. 

Dr. Rogers:

That’s correct.  Sheila’s BMI was actually in the mid 30s, and so she qualified based on the BMI of 35 or greater with a co-morbidity.

Andrew Schorr:

Dr. Rogers, do you see this as the next generation of bariatric surgery, the incision-free TOGA approach? 

Dr. Rogers:

Yes.  This would be a next generation procedure in general.  A lot of the minimally invasive procedures that we perform now are becoming even less invasive with what’s called NOTES surgery, natural orifice transluminal endoscopic surgery.  And so these NOTES procedures, of which TOGA is one of them, is part of the new generation of surgical procedures.

Andrew Schorr:

That’s certainly neat and sounds like real progress.  Sheila, so somebody is listening who maybe would be like watching TV.  They’re listening to us like you watched TV and heard about this.  Somebody is listening to this and hears about it. 

What would you say to them because you had wondered about surgery but this sort of sparked you to do something.  How do you feel about having done something.  What would you say to somebody else who is sort of on the fence? 

Sheila:

Well, I would say if they have an opportunity to be a part of a clinical study like I did at UCSF for this TOGA procedure I would jump on it.  I would not hesitate.  This procedure, TOGA, as Dr. Rogers and I have both stated, it is a tool that is to be used for your weight loss journey.  It’s not foolproof, as Dr. Rogers stated, and it’s not magic.  We have to do our part, and that means we have to as the patient make sure that we’re eating correctly, eating smaller portions, getting our exercise, taking our vitamins and getting or daily exercise.  So we have to do our part.  You can’t get the TOGA and expect that, oh, everything is going to be fine.  You still have to be a part to make your weight loss a success.  And I still have some weight to lose and I’m still working on it, but this TOGA procedure has helped me significantly.

Andrew Schorr:

That really puts it into perspective.  One last thing for you, Dr. Rogers, there’s a lot of guilt people have when they’re overweight and they try all these programs and they just can’t either get the weight off or keep it off.  There’s a lot of research going on about the genetics of obesity too, right? 

Dr. Rogers:

Yes.  Clearly there is a genetic association with obesity as well as the development of medical problems associated with obesity.

Andrew Schorr:

Well, what I’d say to our listeners is don’t beat yourself up about it.  Now, nobody wants to have surgery if you can avoid it and you want to do whatever you can to control your weight, keep it from getting to a point of obesity, but certainly, clearly, Doctor, there are some significant health risks, as Sheila mentioned.  If you get to a point where you’re what you call morbidly obese and you just can’t get a handle on it, that’s the time for a consultation.  Am I right? 

Dr. Rogers:

Exactly right.  The time for the consultation is even before those co-morbidities present. 

Sheila:

Yes. 

Dr. Rogers:

So in a person who does have obesity being aware of options available is very important.  Being aware that there are surgical as well as nonsurgical options to help lose weight, being aware that there are medical problems associated with obesity including diabetes and hypertension and hypercholesterolemia and sleep apnea, as Sheila mentioned, as well as other problems, early death being one of them, one of the problems associated with obesity.  And pursuing a program to help lose weight with either a nonsurgical or surgical option is an important aspect to helping people lose the weight and avoid these medical problems.

Andrew Schorr:

And all of that can be discussed with qualified healthcare providers at the bariatric center at UCSF.  If you want to find out more you can always just call the physician referral service at UCSF.  That’s 888-689-UCSF.  And you’re glad you called, right, Sheila? 

Sheila:

Definitely.  It’s made a difference in my life.

Andrew Schorr:

Okay.  Well, we wish you well with your continued control of your weight, losing more.  What size are you trying to get down to? 

Sheila:

Probably I guess about an 8 or a 10.

Andrew Schorr:

Okay.  Well, you sound determined.  Wish you luck with that.  Dr. Stanley Rogers, thanks for the work you do.  It’s really with your partners there and in researching this and really having the evidence that makes a difference.  You’re really pioneering surgical techniques to really help change lives.  Congratulations on the work you’re doing, sir, and thank you for being with us. 

Dr. Rogers:

Thank you very much. 

Sheila:

Thank you, Dr. Rogers. 

Dr. Rogers:

Thank you, Sheila.  Great job.

Andrew Schorr:

You’re grateful, aren’t you, Sheila? 

Sheila:

Definitely.

Andrew Schorr:

Okay.  Well, we like telling these stories.  Thanks to UCSF Medical Center for the work they do and in sponsoring our Patient Power programs.  I’m Andrew Schorr.  Remember, knowledge can be the best medicine of all. 

Please remember the opinions expressed on Patient Power are not necessarily the views of UCSF Medical Center, its medical staff or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor.  That’s how you’ll get care that’s most appropriate for you.

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