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The Bariatric Toolbox

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LOUISVILLE John Oldham, Jr., MD, FACS, FASMBS, has seen the field of bariatrics have its fair share of controversy over the years, but it’s the innovation and growth that got him passionate about making bariatrics his life’s work.

Originally from Owensboro, Ky., Oldham attended the University of Louisville Medical School and then completed his residency in Dayton, Ohio. He practiced general surgery for two years before he was approached with a unique opportunity to start a minimally invasive bariatric program at Georgetown Community Hospital in Georgetown, Ky.

“During my residency, everything in bariatrics was done invasively, nothing minimally invasive,” states Oldham. “I saw many patients lose weight but also many complications because of open incisions. When I started seeing the change to laparoscopic and the benefits outweighing the risks, I knew I wanted to get involved.”

With the assistance of his then-partner, Derek Weiss, MD, the program was a success and led the way to the creation of Bluegrass Bariatric Associates, which opened several practices across the state.

After practicing at Baptist Health Louisville for five years, in 2013 Oldham signed on as the medical director of the Weight Loss and Bariatric Surgery Program. Early this year, he also took on the role of director of bariatric surgery at Floyd Memorial Hospital & Health Services in New Albany, Ind.

A Singular Focus

While most bariatric surgeons also perform general surgery, Oldham’s sole focus is bariatrics. His practice offers a full range of bariatric procedures, as well as a medical weight loss program that provides access to dieticians, medications, psychologists, exercise trainers, and much more.

“A lot of people think of the old days when they think of bariatric surgery, but it’s not that way anymore,” adds Oldham. “It can be done very safely with very few complications. The patient has to understand that this is just a tool to help with weight loss, not some magic fix. That’s why they go through a long process of education to understand how all these tools work. Our goal is to educate our patient to help them decide what tool is right for them.”

The Toolbox

And his tools are abundant. From gastric bypass, including revisional surgeries, LGCP (laparoscopic greater curvature plication), and the gastric sleeve to the LAP-BAND® and the newest ORBERA™ gastric balloon, which was just FDA approved in the fall of 2015, Oldham makes it his mission to help his patients find the right method to keep the weight off permanently. “If the patient is a diabetic, then we may lean them toward a more metabolic or physiologic procedure like a gastric bypass or a sleeve gastrectomy,” states Oldham. “If a patient has a high BMI, they would also be directed toward these procedures. We want the patient to be comfortable with the procedure and decide which tool works best and fits them.”

While performed laparoscopically, the sleeve gastrectomy and gastric bypass are surgical procedures that involve removing a portion of the stomach (sleeve) or rerouting of the intestines (gastric bypass). The LAP-BAND is a minimally invasive laparoscopic option that is adjustable and leaves the stomach intact. The new ORBERA gastric balloon is the least invasive approach yet. Performed endoscopically, the ORBERA balloon stays in the stomach for six months, to help promote a feeling of satiety and reduce appetite, and is then removed.

“A patient’s weight is definitely a factor when it comes choosing the right procedure,” states Oldham. “Patients with a lower BMI of 30 or those not ready for surgery are ideal candidates for the balloon, while individuals with a BMI of 35 and greater are usually better candidates for the surgical procedures.”

All patients are advised to see their primary care physician first to get them in the right frame of mind for surgery. Most insurance companies require a three-month or six-month diet before the procedure, but dieting can only go so far for some.

Oldham explains that each individual has a genetically determined set weight point, which is the main reason for a high dieting failure rate. After surgery, a new weight point is set. Some bodies will lose 50 to 60 percent of the excess weight, and some will lose 100 percent of the excess weight. The average range is 60 to 80 percent excess weight loss, with long-term sitting at 50 to 60 percent.

“Our bariatric surgical options help patients fight against heredity and lose as much excess weight as possible, but it all depends on the work put in,” says Oldham. “If a patient is on the lower end of weight loss, they can use our tools, along with a healthy lifestyle, to get to where they want to be.”

And if a patient is not seeing results, revisional surgeries are available to remove the old method and put a tool in place that will ensure positive outcomes.

“Obesity is a disease in which there is a treatment. It is not a willpower issue; all bodies are genetically predetermined,” states Oldham. “Everyone can diet and exercise, but keeping it off is the hard part.”

He adds, “Instead of having patients struggle and struggle, we have now have a very safe, effective solution. A solution that allows people to once again play with their kids, grandkids, get off lifelong blood pressure and diabetic medications, and do things they couldn’t do before. I love getting the chance to change lives that way. It’s awesome.”

Our bariatric surgical options help patients fight against heredity and lose as much excess weight as possible, but it all depends on the work put in.

John S. Oldham, Jr., MD, FACS, FASMBS3900 Kresge Way Suite 42 Louisville, KY 40207Phone:502.894.9499