MEDICAL Associates Hospital in St Andrew has its sights on becoming the premier institution for bariatric surgery in the English-speaking Caribbean.

In fact, just over two weeks ago, doctors there performed the first-ever laparoscopic gastric bypass on the island, allowing them to now boast of being the only medical institution in Jamaica with a fully fledged bariatric programme.

This programme is being promoted as a solution to reducing the incidence of Type 2 Diabetes as well as other medical conditions associated with obesity. Bariatric surgery, which is the collective name for the different types of weight-loss procedures performed on the morbidly obese, involves making changes to the digestive system by reducing the absorption of nutrients or by limiting how much one eats. After the procedure, the patient must commit to follow-ups and lifestyle changes.

“What we anticipate, first of all, (is to become) the premier centre for bariatric surgery in Jamaica and hopefully we can convince our English-speaking partners that we are a formidable centre and that we can be an option for bariatric surgery as opposed to the United States of America,” Medical Associates CEO Dr Michael Banbury told the Jamaica Observer in a recent interview.

“We see it as important because obesity is a big problem in Jamaica, particularly among women, and it’s one of the main drivers of the prevalence of Type 2 Diabetes, and we think that by introducing bariatric surgery, we will be able to make an impact on the comorbidities associated with obesity, such as hypertension, diabetes, abnormal lipids, certain type of cancers, joint diseases, etc,” Dr Banbury said.

The bariatric programme at Medical Associates is being spearheaded by general, laparoscopic and obesity surgeon Dr Alfred Dawes, who invited bariatric surgeon Dr Alcides Jose Branco Filho from Curitiba, Brazil, to help with the hospital’s first laparoscopic gastric bypass.

Dr Banbury told the Sunday Observer that the institution is willing to facilitate any bariatric procedure requested, but would like to be known for the gastric bypass procedure.

“This is the first time we are doing the gastric bypass and this is the procedure we would like to do because the weight loss is more excessive and the weight loss is also more sustained,” stated Dr Banbury. “The data, in terms of the reversal of the clinical issues of Type 2 Diabetes, is with gastric bypass as opposed to any other bariatric surgery.”

Having done the first bariatric surgery in 2013, Medical Associates hopes to use its experience to market itself as the place for weight-loss surgeries in the region.

“Well, seeing as this is a novel procedure, I think that if we market ourselves properly to our English-speaking neighbours; we plan to do that through the different medical associations in these territories, to inform them that we have this service available and that we are willing to offer it to their patients,” explained Dr Banbury.

“In addition to that, we are going to be approaching the insurance companies in Jamaica, Sagicor and Guardian Life, to try and get their participation in this, seeing that it is not a cosmetic surgery.

“It is not like liposuction or tummy tuck. It is a procedure that is done with an anticipation of a clinical outcome, like the reduction of Type 2 Diabetes, for instance, the reduction of blood pressure,” he continued. “So we hope to make presentations to the insurance companies to see if they will hopefully buy into it, where they will offer it in patients with severe obesity and comorbidities.”

Dr Dawes said the cost of the laparoscopic gastric bypass internationally is between US$15,000 and US$25,000. However, according to Dr Banbury, having bariatric surgeries done in Jamaica would cost half that amount. He admitted, though, that it is likely that those who could most benefit might not be able to afford it, but that Medical Associates is not ruling out a philanthropic approach.

“Women are most affected. I don’t think any data has looked at socio-economic groups as it relates to obesity in Jamaica. I know that internationally, lower socio-economic groups are said to be associated with obesity,” said Dr Banbury. “We will probably do a few cases at reduced cost, depending on the condition of the patient… because we are not only in this for money; we are in this to provide a service and to ensure we improve the health of people.

“This philanthropic approach would, of course, take into consideration the risk factors, the degree of obesity and those who are really sick as a result of obesity,” Dr Banbury explained. “They would contact the hospital because there are certain investigations that have to be done to see if the patient is suitable.”

He stressed that although bariatric surgery has been shown to have more sustained weight loss than exercise and lifestyle changes, the two go hand-in-hand.

Dr Dawes reiterated this.

“Lifestyle changes and bariatric surgery are complementary. The good thing about bariatric surgery is that it actually forces you to make that lifestyle change in terms of decreasing the portions of food that you eat,” Dr Dawes told the Sunday Observer. “Some people will cheat and have their burgers and pizzas, but the portion is very small, so the calorie intake, compared to what they would’ve had before if they cheated and had a super-sized meal, is different.”

The obesity surgeon said that one of the problems with bariatric surgery is that if the patient is undisciplined, that patient can overeat, which causes the stomach to stretch.

“… (This) is why we carefully select our patients; if we think that there is some psychological deficit where they are addicted to food or they are not willing to maintain their lifestyle change, then those patients are not offered this procedure,” Dr Dawes explained.

“Part of the work-up for every patient we have for bariatric surgery is psychological assessment, so we find out not only if they are ready for the procedure, because some people actually come in because they want a quick fix; those are not candidates for surgery because those are persons who regret not being able to eat as much as before,” Dr Dawes said.

“Some people tend to go into depression if they have food addictions, some people have repressed tendencies towards drug abuse or infidelity. With the weight loss and attention, some people may end up being drug abusers, some people may cheat on their spouses. It is very important that you assess psychologically the state of the patient before you offer them surgery,” Dr Dawes said.

Dr Banbury told the Sunday Observer that in terms of skill set and facilities, Medical Associates Hospital is more than equipped to cement its place as the bariatric surgery institution in the English-speaking Caribbean. The doctor at the helm of the programme told this newspaper that the institution is ready.

“This is a big step for the hospital… we now offer a full gamut of bariatric procedures, from the gastric balloon, which is non-invasive and done as a day case and outpatient procedure, to the sleeve gastrectomy, and now the gastric bypass,” Dr Dawes said. “So whichever bariatric procedure you think suits

you well, and whichever procedure you have an indication for, be it you have Type 2 Diabetes which you would like to try and cure, then we have a procedure for that.”

Dr Alcides, who has been performing bariatric surgeries for more than 15 years, gave the programme and Dr Dawes his stamp

of approval.

“Excellent surgeon, very good surgeon,” Dr Alcides told the Sunday Observer recently. “I believe the future of Jamaica’s bariatric surgery is in good hands.”