Weight Loss Options at Saratoga Bariatric Center

Surgical Options

Dr. Baranov performs the laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy procedures. These are “restrictive” type weight-loss operations that work similarly, but there are some important differences. The key things to know about each are discussed below.

Roux-en-Y Gastric Bypass

The gastric bypass procedure helps patients feel “large-meal” satisfaction with very small meals and is considered the gold standard of bariatric operations.

With gastric bypass, surgeons construct for the patient a new, smaller stomach out of the top of the old one. This new stomach is called the “pouch,” and it is the most important part of the bypass operation; the rest of what goes on is just to give the pouch a way to empty. The job of the pouch is to provide the early arrival of the fullness that comes with eating.

When it’s made, a pouch holds about an ounce of food. Now, an ounce is a lot less than the patient’s stomach used to fit, since a normal human stomach holds more than a quart. After a bypass operation, the patient who used to be able to eat a very large meal will find that they now have much, much less room. When they sit down to dinner, they are going to have to fit their whole meal into a space not much bigger than a walnut. This walnut-sized stomach, however, still can deliver the normal full-stomach feeling. Even though the patient now only eats a few bites, if they eat those bites properly, they will leave the table feeling full.

A video animation of the gastric bypass procedure can be viewed on YouTube here.

With the bypass, malabsorption of calories does not contribute meaningfully to weight loss. There is decreased absorption of vitamins and minerals, but the malabsorption of calories is trivial, and it is not how the operation is designed to work; it works by making you want to eat less.

Weight loss with the gastric bypass is the best of the restrictive surgeries. On average, excess weight loss peaks about 18 months after surgery and then settles at 70%.

The gastric bypass operation has been performed for more than 40 years for obesity, and it had been performed laparoscopically for the last 20. Patients are typically in the hospital for one or two days afterward.

Sleeve Gastrectomy

Sleeve gastrectomy is growing faster than any other operation as a percentage of all bariatric surgeries. It is almost always done with minimally invasive laparoscopy, and takes anywhere from 45 to 90 minutes.

With the sleeve, most of the stomach is removed. At the end of the operation, the patient is left with a narrow tube or “sleeve” of stomach – just enough to connect the end of the esophagus to the starting point of the intestine. This narrow tube can’t fit anywhere near as much food as the old, bag-like stomach did. As with all restrictive surgeries, sleeve patients find they get full with much smaller quantities of food, so they eat less.

Weight-loss with sleeve gastrectomy is better than with adjustable banding, but not quite as good as with the bypass. Excess weight lost averages 60-65 percent. If a patient decides their weight loss with the sleeve is unsatisfactory, consideration can be given to converting it into a duodenal switch, which adds a malabsorptive effect to boost the weight loss.

A video animation of the sleeve gastrectomy procedure can be viewed on YouTube here.

The sleeve doesn’t involve the small intestine and is often a good choice for patients with small intestinal disease. Unlike the bypass and the adjustable bands, the sleeve is not reversible.

Despite being around for more than a decade and its growing popularity, the sleeve hasn’t yet found quite as wide acceptance with health insurance companies as it is a comparatively newer procedure.

Do You Qualify for Surgery?

Non-Surgical Options

If you are not a candidate for weight-loss surgery or are not ready to try this approach, you have other options — and we're here to help. We offer a variety of non-surgical weight-loss tools, including supportive one-on-one nutrition counseling. More information is below.

Intergastric Balloon

The intragastric balloon has been developed as a non-surgical alternative for those who have been unsuccessful trying to lose weight. Ideal candidates don’t qualify for or have serious concerns about bariatric surgery, and must need or want to lose a significant amount of weight.

At your individual consultation, our surgeon will ask you about your medical history and conduct a physical examination to determine whether this procedure will be the best option for you.

The first step of this two-part, 12-month program, begins with a non-surgical procedure typically done under sedation. A thin, deflated balloon is placed into the stomach and then filled with saline until it’s about the size of a grapefruit. The procedure normally takes about 20-30 minutes and people usually go home the same day.

The balloon remains in your stomach for six months and enforces portion control by making you feel full. This helps you eat smaller meals and learn proper portion control. Our team will support you in learning new eating habits and lifestyle changes for long-term success. To be successful you will have to keep making these healthy lifestyle choices.

The second step begins once the balloon is removed. You will need to continue to follow a six-month diet and exercise plan after the balloon is removed. Our team of experts will help you reach your weight loss goals by retraining your appetite, advising on healthy nutritional choices, controlling portion sizes, and developing an exercise routine.

Adopting and maintaining these healthy habits will ensure that you succeed.

Results vary, but people lost around three times the weight with this procedure as patients that maintained diet and exercise plans alone.

Side effects are possible. In the first few days after the balloon has been placed, you may experience nausea or vomiting. In some patients this may last up to two weeks. We will work with you to prescribe medication that will proactively manage these symptoms and help you adjust to the balloon.

The stomach balloon procedure is considered a safe and effective weight loss solution, with over 220,000 placements worldwide. Complications that may result include standard risks associated with any endoscopic procedure. More information is available during a consultation session.

Weight Loss Medications

Our program offers available FDA-approved effective weight loss medications to qualified patients. These medications can help with hunger, appetite suppression, cravings and fullness. You can also take these medications if you are working towards surgery, not a surgical candidate, or might have regained some weight after bariatric surgery. While on weight loss medications you will also be working with our dietitians to help ensure the best weight loss success.

Medications we offer are:

Saxenda: This is a daily injection. This medication works like a hormone in your body so you feel full quicker, as well as reduces your hunger and cravings.
Wegovy: This is a weekly injection. This medication works just like Saxenda, helping to decrease appetite, hunger and cravings and aiding you to feel full quicker.
Contrave: A combination pill that contains Wellbutrin and Naltrexone. The combination of these two medications reduces hunger and decreases cravings.
Qsymia: A combination pill consisting of Phentermine and Topiramate. This combination works by reducing your appetite and helping you to feel fuller.
Phentermine: This medication decreases appetite and increases many patients’ energy level.
Ozempic: This medication is a weekly injection used to treat pre-diabetics and diabetics. This medication works very similar to Saxenda and Wegovy.
Naltrexone: This is a pill that is taken twice daily. It helps to reduce hunger and cravings.
Topiramate: This is a pill taken once or twice daily. It helps to reduce your hunger and appetite.
Plenity: This medication is taken prior to lunch and dinner. It helps you to feel full and eat less.
Mounjaro: This medication is a weekly injection used to treat pre-diabetics and diabetics. This medication works like a hormone in your body so you feel full quicker, as well as reduces your hunger and cravings.

We will work with you to find the right medication or combination of medications to help with your weight loss. If your insurance does not cover weight loss medications, we will work with you to prescribe less costly options.

Nutritional Services

Our registered dietitians have extensive training in helping people make lifelong changes for better health. Following are some of the many benefits of taking advantage of our nutritional services and scheduling a consultation:

All of our registered dietitians are certified by New York State. Many have master’s degrees or advanced credentials in nutrition specialties, such as diabetes education and management.
All can develop customized plans to meet your needs and goals.
Your customized plan will be based on science, research, and proven strategies to help ensure your safety and success. Your plan also will include practical options that meet the needs of today’s busy individuals and their families.
Our registered dietitians are available to provide lifelong, non-judgmental support and the extra motivation that can make all the difference when challenges arise or the going gets tough.

Body Composition Analysis

For most of us, when we step on the bathroom scale and see we’ve lost three pounds, we don’t know what we really lost. Was this three pounds of fat? Muscle? Water?

Measuring your body composition allows you to truly understand the changes in your weight.

Body composition, or fat vs. fat-free (lean) mass, has long been considered one of the best determinants of disease prediction and a person’s overall health. It reflects the results of your physical activity and nutritional practices.

Going by body weight alone can be misleading, because a scale can’t tell the difference between a pound of fat and a pound of muscle. Our non-invasive assessment is a medical-grade body composition analyzer that provides an in-depth evaluation more accurate than a bone density test. It measures fat mass, fat-free mass, total body water, intracellular water, extracellular water, and skeletal muscle mass. In just 17 seconds. And it allows us to print you out a detailed report.

With our advanced Seca mBCA, you will see the whole picture of what’s really going on in your body, so you can track progress and make changes for better nutrition, exercise and health and wellness.