by Thomas W. Clark, M.S., M.D., FACS The Downfall of Bariatric Surgery is It Works!!! What?! What I mean is that weight loss surgery often works so well that patients commonly do NOT make the lifestyle/behavioral changes that they need to make in order to optimize weight loss or keep it off long-term. The problem is they receive positive reinforcement (weight loss) for often doing the wrong things. The patients “wrongful” thinking is “I’m losing weight, so I must be doing it right.” Unfortunately, this often leads to less than optimal weight loss and weight regain. Over the past two decades I have performed nearly 4,500 weight loss surgery procedures. What I quickly realized early in my career was that the real solution to long-term weight loss success was NOT any one particular surgery, but rather the importance of behavioral modification to optimize weight loss and provide long-term weight maintenance. For most patients who are regaining weight, it is not that they didn’t have a good operation, but rather they never learned or implemented the lifestyle changes necessary for long-term success. These lifestyle changes are absolutely essential to optimize weight loss and prevent regain. When I was seeing “Mrs. Smith” at one of her long-term follow-up visits and noted she had regained about 20 pounds over the past year, it was relatively easy to rattle off the “list” of what she needed to do to get back on track. But often, the “Mrs. Smith’s” already knew the list. We had educated her well. The problem wasn’t her understanding of what to do. The real problem was “how to do it.” How does one go about incorporating necessary changes into their life? Ten years ago, this was the question I set out to answer. I realized that one of the first steps I needed to make was to learn as much as I could about medical weight loss. I began this journey by joining the American Society of Bariatric Physicians (ASBP) and attending their conferences. I soon realized that as a surgeon I had a lot of catching up to do to truly understand my patients and how to go about inspiring them to make those tough lifestyle changes. One of the best ways to do this is to live what we do and set the best example possible. This eventually led me to taking the American Board of Obesity Medicine exam (previously ABBM) and becoming board certified in Bariatric Medicine. During this time and over the past six years, my staff and I have worked on developing ways to constantly engage, educate and inspire our weight loss surgery patient population. In addition to the normal post-operative and one on one counseling sessions, we have developed a multifaceted program which engages the patient each month over the first year after weight loss surgery. Each month a new comprehensive module is delivered to the patient through the mail. This module includes a printed chapter (addressing what to expect that month, what to expect the following month, a staged meal plan, a success story for motivation, homework assignments and more), a DVD and an audio CD on the particular weight loss theme for that month. In this way, the patient slowly builds their textbook and program without being overwhelmed. Each module is relevant for where they are during the first year post-op. We have found that the physical, tangible version of this program works much better at keeping the patient engaged/inspired than a digital version delivered electronically. An electronic version was too easy to file away to “look at later” (and “later” never arrived). When a hard copy arrives in the mail, it forces the patient to make a decision to do something with the materials. We refer to this entire program as Weight Management University for Weight Loss Surgery (visit www.wmu4wls.com for more information). This program serves as a counseling guide throughout the first year, as well as a safety net to support patients as they struggle with change. It also improves patient satisfaction, enhances weight loss and provides a better “connection” for long-term follow-up. Whether you are a bariatric surgeon, a bariatrician or both, I feel we have an obligation to provide weight loss surgery patients with not just a surgical tool to lose weight, but also the tools for optimal long-term success. It’s not easy to coordinate surgery, pre-operative and post-operative education, individualized counseling, online and on-site support, optimal nutritional and fitness — especially to people who may not even want it or understand that they need it. However, it is the right thing to do. As surgeons, this is our opportunity to work together with bariatric physicians to make this happen as we strive to improve the health of our communities. To educate is important. To inspire is life changing… About Thomas W. Clark, M.S., M.D., FACS Dr. Clark is the founder of the Center for Weight Loss Success. He is also author of Weight Management University and Weight Management University for Weight Loss Surgery. To learn more, visit www.wmu4wls.com and www.cfwls.com. You can also follow him on Twitter at www.twitter.com/docweightloss , Facebook at www.facebook.com/weightlossdrclark, You Tube at www.youtube.com/docweightloss and his online weight loss TV station at www.DocWeightLoss.TV. Dr. Clark is board certified in both surgery and obesity medicine. He provides comprehensive surgical weight loss, medical weight loss, weight loss fitness and weight loss nutritional services in Newport News, Virginia.