Novant Health bariatric surgeons treat obesity as a chronic disease.

Bariatric surgeons across the Novant Health system treat obesity as a chronic, relapsing, lifelong disease. “We need to treat it like any other chronic disease by not just offering surgery but by providing a multidisciplinary program,” said David Voellinger, MD, bariatric surgeon at Novant Health Bariatric Solutions in Charlotte. “That includes lifestyle management such as nutrition, exercise and activity, behavior modification, improving habits and sleep hygiene. On top of that, we’ll apply medications and bariatric surgery.”

Novant Health offers laparoscopic adjustable gastric banding, laparoscopic vertical sleeve gastrectomy, laparoscopic Roux-en-y gastric bypass, one anastomosis gastric bypass, biliopancreatic diversion with duodenal switch and revisional surgery. “We want to take the least risky approach possible that will be as effective as possible,” Dr. Voellinger said.

Weight loss is not the focus of bariatric surgery at Novant Health — long-term health is.

“We don’t like to call it weight-loss surgery, we like to call it metabolic surgery,” said James Dasher, MD, director of bariatric surgery at Novant Health Bariatric Solutions - Kernersville. “What we’re out to do is fix serious metabolic issues like diabetes, high blood pressure, high cholesterol and sleep apnea, so folks live longer. The nice side effect is losing a bunch of weight.”

Weight loss from bariatric surgery is key to surgical optimization work in collaboration with other subspecialties.

“We do care collaboratives, where we do surgical optimization work for patients before they need to get another surgery, such as joint replacement” Dr. Voellinger said. “A BMI less than 40 can decrease complication risks. When a patient comes to us first, we can help them lose weight to get to that BMI. Then they can move forward with their other surgery. That applies to orthopedic surgeons, spine surgeons, gynecologic oncology surgeons and breast surgeons, among others.”

“Usually, it takes about three to four months to get through the process to get bariatric surgery and about six months to lose a bunch of the weight,” Dr. Dasher said. “So usually in less than a year someone who was at a very high risk for bleeding, infection and joint failure can be in a normal risk category.”

Partnerships with referring physicians and primary care physicians are integral to the work Novant Health’s bariatric surgeons do.

“A metabolic or bariatric surgical procedure is not going to be successful unless we have everyone involved,” Dr. Dasher said. “Every patient has to see the nutritionists, counselors and trainers in our program. Then we have to have the integration of others involved — endocrinologists to make sure diabetes goes into remission and stays in remission, primary care for blood pressure and cholesterol trouble, cardiologists to provide risk scores for surgery, pulmonologists to manage sleep apnea.”

“Our goal is to have an open-door policy for our system so we can care for the whole patient,” said David Voellinger, MD

“These patients need primary care, bariatric solutions, CoreLife and surgical options. Once the patient walks through any of these doors, whether it be primary care or bariatric care, we can then help them decide what’s the best and more effective care plan for them.”

Bariatric surgeons at Novant Health are champions of lifelong health.

Lifelong follow-up for patients is an expectation to ensure long-term positive outcomes. “If I see that someone has not done as well over the past year, they haven’t met with a dietitian and they are slipping back into old habits, that’s an opportunity to say, 'Let's meet with a dietitian again,'” said Colston Edgerton, MD, bariatric surgeon at Novant Health General Surgery & Bariatrics - Wilmington. “Even though we’re the surgical team and not the final destination for some of those services, we’re still that point of contact with the patient.”

It’s about being invested in patient success. Novant Health collects data on outcomes, nutritional components and weight loss over years to better understand how patients respond to surgeries down the road. “It allows us to look at how chronic medical conditions change after the surgery and how those changes are durable, effective changes,” Dr. Dasher said. “That includes diabetes, high blood pressure and sleep apnea. But more data is showing overall prolonged life expectancy in patients who have had bariatric surgery compared to matched patients who have not had it.”