March 2019 - Advanced Laparoscopic Associates
Advanced Laparoscopic Associates Surgeons Win Healthgrades Award

Advanced Laparoscopic Associates Surgeons Win Healthgrades Award

Please join us in congratulating the dedicated surgeons of The Bariatric Surgery Center at Hackensack Meridian Health Hackensack University Medical Center for earning a 5-star Bariatric Surgery Excellence Award from Healthgrades. The surgery center is staffed primarily by surgeons from Advanced Laparoscopic Associates, and our own Dr. Hans Schmidt is the chief of the bariatric program.

Healthgrades rates hospitals and hospital departments based on safety and clinical outcomes. The Bariatric Surgery Center received five stars, easily beating out the three-star national average. Its actual rate of complications was a mere 1.7 percent, more than 50 percent lower than the national average.

Advanced Laparoscopic Associates offers a wide range of bariatric and general surgery procedures. We specialize in—and are one of the only practices in the region to offer—advanced surgical and nonsurgical techniques such as LINX for gastroesophageal reflux disease and AspireAssist for weight loss. If you need surgery to correct a medical condition or are seeking bariatric surgery, request an appointment today.

Could This Weight Loss Surgery Be a Cure for Type 2 Diabetes?

Could This Weight Loss Surgery Be a Cure for Type 2 Diabetes?

Nearly 10 percent of Americans have a form of diabetes, a condition that affects the ability to regulate blood sugar. Add in the number of people with prediabetes—high blood sugar—and that number jumps to more than 100 million, or about one-third of the U.S. population.

There are two main types of diabetes:

  • Type 1: the immune system mistakenly destroys cells in the pancreas that produce insulin, which brings sugar from the bloodstream into the cells
  • Type 2: through repeated exposure (i.e., a diet high in sugar), the body becomes resistant and eventually immune to the effects of insulin

The outcome of both types of diabetes is that sugar remains in the bloodstream, where it can damage cells and blood vessels. Diabetes is associated with heart disease, kidney disease, liver disease and even vision and hearing problems. In addition, most people with type 2 diabetes are obese.

No Cure for Diabetes… or Is There?

Currently there is no cure for diabetes, but the condition can and does go into remission, which means that blood sugar is normal and there are no signs or symptoms of diabetes. However, because blood sugar fluctuates based on a number of factors, it’s possible the disease will come back.

But what if there really is a cure? Evidence is beginning to mount that a simple, safe, effective weight loss surgery procedure may also be a true cure. You’ve probably even heard of the procedure: gastric bypass.

What Is Gastric Bypass?

Roux-en-Y gastric bypass—or simply gastric bypass—was, until recently, the most popular bariatric surgery procedure in the U.S. (it has since been overtaken by vertical sleeve gastrectomy). It’s been performed since the 1960s, and its benefits for obesity are well-established.

Gastric bypass surgery has two parts. First, the stomach is sectioned off, creating a small pouch that can hold much less food than an unmodified stomach. Then, the intestines are rerouted to connect directly to that pouch, which bypasses part of the intestines. This reduces the number of calories the body absorbs. So, not only do people with gastric bypass eat less food due to a smaller stomach, they absorb fewer calories.

How Does Gastric Bypass Help Diabetes?

Gastric bypass is known to have a strong effect on type 2 diabetes. The American Society for Metabolic and Bariatric Surgery estimates that 80 percent of people who have gastric bypass will achieve complete type 2 diabetes remission. Other estimates are similar.

In fact, bariatric surgery is so promising for diabetes improvement that in 2016, an international group of diabetes authorities voted to include surgery as standard treatment for type 2 diabetes in clinical guidelines.

“This change is supported by documented clinical efficacy and by the evidence of an important role of the gut in metabolic regulation, which makes it an appropriate target for anti-diabetes interventions,” wrote Dr. Francesco Rubino, one of the authors of the consensus statement on clinical guidelines.

Dr. Rubino, a bariatric surgeon who practices in the U.K., was featured in a fascinating 6-minute video by The Economist, which you can view below.

In the video, Dr. Rubino stated that he believes that the section of the intestines that is bypassed in a gastric bypass procedure figure heavily into the development of diabetes. Bypassing this section of the intestines can change a large number of factors independent of weight loss, such as:

  • Bile metabolism
  • Glucose metabolism
  • Hormones
  • Intestinal flora (bacteria, etc.)

Dr. Rubino and others believe these changes can combine to permanently send diabetes into remission.

Who Is a Candidate?

The selection criteria for bariatric surgery to treat obesity are clear and simple. People who want weight loss surgery must have either:

  • A body mass index (BMI) of 40 or greater
  • A BMI of 35 or greater and co-morbid conditions related to obesity, such as diabetes, heart disease or obstructive sleep apnea

The 2015 guidelines (published in 2016) for surgery to treat diabetes are more complicated. In addition to BMI, bariatric surgeons must also take into consideration:

  • Heart disease risk
  • How long the person has had diabetes
  • How well the diabetes is controlled

If you are considering treatment for diabetes, request an appointment at Advanced Laparoscopic Associates. We can tell you if you meet the criteria for bariatric surgery, and we’ll give you options and advice on the best form of surgery to choose. We’ll be with you every step of the way, from consultation to postoperative follow-up and beyond.

Get SMART About Your Weight Loss Goals

Get SMART About Your Weight Loss Goals

Congratulations on your decision to take control of your weight! Maintaining a healthy body weight and body mass index (BMI) is essential to living a healthy life. Research strongly suggests that keeping to a healthy weight reduces the risks of heart disease, many types of cancer, diabetes, osteoarthritis and more, and may even help you live longer.

However, you probably know by now that losing weight isn’t as easy as it sounds. Sure, it’s simple: If you burn more calories than you consume, you’ll lose weight. But that doesn’t mean it’s easy.

We’re here to help. At Advanced Laparoscopic Associates, we’ve dedicated our professional careers to helping people live a healthy life. While we specialize in bariatric surgery, setting weight loss goals is good for all of our patients, whether they want to lose weight through surgery or through lifestyle changes. It’s time to get SMART about your weight loss goals.


Goals are great, but they need certain characteristics to be successful. Without these characteristics, you’re setting yourself up for failure. When setting goals, remember to be SMART about them.

SMART is an acronym that stands for:

  • Specific
  • Measurable
  • Attainable
  • Relevant
  • Time-based

Let’s take a weak goal—”I want to be healthier”—and make it SMART.

Specific. “I want to be healthier” is much too general. There’s no detail. “I want to lose weight” is a little more specific, but it still lacks enough actionable detail. Let’s start with one measurement. It can be pounds, or inches around the waist, or a percentage of your body mass index (BMI). For this example, we’ll start with fat loss. The goal becomes, “I want to lose 25 percent of my body fat.”

Measurable. This new goal is already measurable. However, percentage of fat loss can be one of the more difficult metrics to measure. Not everyone has access to a DXA scan, but most people do have bathroom scales. While it may not be as precise, let’s change the goal to something more readily measurable: “I want to lose 50 pounds.”

Attainable. You need to be able to see results and make progress toward your goal to avoid becoming overwhelmed and giving up. The current goal—losing 50 pounds—is attainable, but very ambitious and will take a long time to achieve. It’s better to break big goals into smaller chunks. Our goal becomes more attainable when we change it to, “I want to lose 10 pounds.”

Relevant. This is the “why” of your goal. Make sure your goal aligns with your values, and that you’re trying to meet it for the right reason. Let’s add some relevance to our goal: “I want to lose 10 pounds to cut my risk of heart disease.”

Time-based. Finally, giving yourself a deadline will spur you to action and help you focus. Make it short- or medium-term. It’s good to have long-term goals, but they should be broken down into short-term goals with timely deadlines.

“I want to lose 10 pounds in two months to cut my risk of heart disease” is now a SMART goal. It will require you to lose, on average, a little more than a pound a week, which is challenging but achievable. It is specific, has a defined metric for measurement and has a relevant reason for setting the goal.

Focus on Process, Not Outcome

Outcomes are not always fully within your control, but process is. Our goal of losing 10 pounds in two months is a SMART goal, but it’s outcome-oriented. It’s dependent on an external factor: a number on the scale.

Process goals are dependent on what you do. They are fully in your control. We can change our current SMART goal to be process-oriented by thinking about what it will take to achieve it.

Losing weight is a matter of burning more calories than you consume, so we can attack our weight loss from either side of the equation—consuming less or burning more. Let’s try consuming less.

One pound is equivalent to 3,500 calories. So, to lose a pound a week, you’ll need to consume 500 fewer calories than your total daily energy expenditure (TDEE), the approximate number of calories your body burns on a given day due to age, weight and activity level. You can figure your TDEE with any number of calculators; here’s one.

A 40-year-old sedentary woman’s daily TDEE is approximately 1,640 calories per day. That means her new, process-based SMART goal would become, “I will eat 1,140 calories a day for two months to bring my weight down and cut my heart disease risk.”

Get Help With Your Weight Loss Goals

If you want to lose weight but don’t know where to start, request an appointment at Advanced Laparoscopic Associates. We have a registered dietician on staff, Jennifer Blume, who can ensure you have the tools you need to meet your goals. We can tell you if you’re a good candidate for weight loss procedures, describe your options and help you get on a path toward a healthy, sustainable weight.