Heartland Surgical at
Pine Lake Behavioral Health
Lasting Solutions for Obesity
By Jodi Fuson
At the start of 2019, Shayna Fox recalls, bariatric surgery wasn’t even on her radar. Then, the 30-year-old, former college volleyball athlete talked to Dr. Richard Fermelia, a general surgeon who has specialized in bariatric surgery and obesity medicine since 2004. He helped Shayna see the facts without fat-shaming her, she says. He explained that everyone’s body has a weight set point that it tries to maintain. Restricting calories doesn’t work for the long term, Dr. Fermelia says. “You can have initial success for a while, and then metabolic centers in your brain start to take control.” According to Dr. Fermelia, Shayna has a genetically abnormal set point.
All of this rang true for Shayna, who had been fighting a losing battle with yo-yo dieting and weight loss drugs. “My whole family is overweight,” she shares. “It wasn’t that I wasn’t trying. I was hindered by something I had little control over.” She ultimately decided that bariatric surgery was her best option for living a long, healthy life and raising her three children.
Obesity puts people at risk for other metabolic-related conditions, like hypertension, sleep apnea, diabetes, and cardiovascular disease. After badly herniating a disc two years ago in a fall, Shayna’s weight increased to 383 pounds. Back pain and her orthopedic surgeon’s reluctance to operate at Shayna’s weight helped tip the scales toward surgery.
Shayna opted for the gastric sleeve procedure, where two thirds of the stomach is removed, leaving a banana-sized tube that will not stretch over time. The surgery offers effective long-term weight loss by restricting the amount of food the stomach can hold and resetting the metabolism. “It is a tool that you can use, if you use it correctly, to lose weight,” Shayna explains.
“I need to make sure what I put in my body is for fuel, not fun,” she continues. That means 90 grams of protein a day, only 2 and a half ounces at a time. “I don’t regret it for a second, but it’s something I will have to work on for the rest of my life.” One of the immediate changes that she noticed was fitting into her seat at a hockey game. At 49 days after surgery, Shayna had lost 44 pounds. “Dr. Fermelia has been supportive the whole way,” says Shayna. “It was about making sure I was healthy.”
Before bariatric surgery is approved, surgical candidates must undergo a psychological evaluation. Dr. Fermelia works closely with Dr. Lisa Jones at Pine Lake Behavioral Health to get the evaluations completed. He relocated his Heartland Surgical practice to Pine Lake Behavioral Health, one of the largest private mental health and substance use partnerships serving southeastern Nebraska, to achieve the best comprehensive care for his weight loss patients. “We make sure they’re medically ready,” he says. Dr. Fermelia’s surgery patients typically weigh between 250 and 350 pounds and must have a body mass index of 35 or higher to qualify.
In addition to laparoscopic gastric sleeve procedures, Dr. Fermelia performs laparoscopic gastric bypasses. Both have been proven to be safe, effective, and durable, he shares, and both change the way gastrointestinal hormones work for the long term and decrease fat mass. Weight loss surgery will put most (83 percent) patients with diabetes in remission, Dr. Fermelia says.
Tammy Green, 49, has dieted all her life and tried weight loss drugs, with temporary success. She decided gastric bypass surgery was the way to go because of a family health history of diabetes and weight issues. Tammy clicked immediately with Dr. Fermelia. “He just is no-nonsense and factual,” she says. “He treats me like we’re working together.”
With the gastric bypass procedure, a small pouch is formed from the upper part of the stomach, bypassing the lower stomach. The small intestine is connected to the pouch in a Y-shaped configuration that changes the way gastrointestinal hormones interact with food and the brain. Weight loss is very rapid the first six months after surgery, averaging 75–100 pounds, and then it plateaus.
Prior to her August 6th surgery, Tammy was taking six different prescriptions; now, she takes just one. By mid-October, she had lost 60 pounds. “I need it to be a lifetime solution,” she says. After surgery, Tammy’s intake is limited. “I’m not hungry, and when I do eat, I get full pretty quickly,” she shares.
Dr. Fermelia will continue to monitor Shayna and Tammy for weight gain every three months for three years so they don’t lose the benefit of their surgeries. “I’m making a commitment to them,” he states, “and they’re making a commitment to me.”
Bariatric surgery is most often covered by insurance providers. Dr. Fermelia has the expertise to investigate coverage and help patients meet surgery precertification criteria. For more information about weight loss options, contact Dr. Fermelia at 402-227-8157 or visit heartlandsurg.com.
Dr. Richard Fermelia