In the fall of 2021, Marla Pergrem, a retired nurse and nurse educator, decided to focus on her health. She has three grandchildren and wants to be around to see them grow up.
Dr. James Dasher, a bariatric and general surgeon at Novant Health Bariatric Solutions – Kernersville performed her gastric bypass surgery that November. After her husband, Craig, saw how much more energy Marla had as a result, he had the same procedure seven months later.
“I had tried so many things,” Marla, 66, said. “I wanted to keep up with our growing family, but I also had some medical reasons. I'd been diagnosed a year prior with sleep apnea and was using a CPAP machine. I also had gastroesophageal reflux disease – or GERD. I knew that both those things would get markedly better, if not totally cured, with bariatric surgery.”
Having worked at Novant Health, Marla knew Dasher’s reputation. (So did Craig, 66, who is Novant Health’s senior director of patient access.) She also had a friend who’s had bariatric surgery who told her how happy she was with the results.
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“Getting yourself mentally prepared is probably the biggest part,” Marla said. “This surgery is definitely not a magic bullet. It's a lot of work; you have to understand going in that it will change your relationship with food completely. I eat almost anything I feel like eating now; I just can't eat a whole lot of it.”
Marla was an ideal surgical candidate – but not everyone is. “Dr. Thomas Walsh and I operate on about 60% to 65% of the patients we see,” Dasher said. “Some folks aren't good candidates because they’re high risk from prior cardiac issues, and some folks just don’t pass the preoperative process. Everybody sees a nutritionist ahead of time, and that can be anywhere from as little as one visit to six visits. All our folks have to see our counselors to talk about the big lifestyle changes required – everything from stress management to making sure you can get to the gym and eat right.”
Some patients also meet with the clinic’s physical fitness team before surgery.
Marla had only one of what Dasher calls “the big four” health issues bariatric surgery can help solve – diabetes, high blood pressure, high cholesterol and sleep apnea.
She also wanted to lose weight and has shed 115 pounds. More importantly, she no longer needs her CPAP or medications for GERD. Dasher had told her there was a high probability (85%) that surgery would eradicate Marla’s sleep apnea.
Dasher said weight loss isn’t really the point of bariatric surgery; it’s a benefit. “Dr. Walsh and I say that we do metabolic surgery, and the nice side effect is you lose weight,” he said. “A lot of folks think of it as weight-loss surgery, to which we say: Who cares if you’re heavy? We fix metabolic problems like diabetes. Yes, you’ll feel and look better, but our primary goal is to make folks live longer, healthier lives.”
“People who fall into the 'morbidly obese’ category lose, on average, 15 years of life expectancy,” he added. “Most studies show that you can get 10 to 12 of those 15 years back with appropriate bariatric surgery.”
If your BMI or body mass index is over 40, you’re considered morbidly obese. “It’s a widespread epidemic,” Dasher said. “One out of three Americans qualifies for bariatric surgery based on their size. The childhood obesity rate continues to go up every year, which is frightening.”
Both underwent sleeve gastric bypass
Like Marla, Craig wanted to lose weight. Plus, he had three of Dasher’s “big four” – sleep apnea, high blood pressure and high cholesterol, as well as degenerative disc disease. He had the advantage of seeing firsthand how his wife did and knew that weight loss would certainly ease some of the back pain, as well.
Both Pergrems had what’s called a single anastomosis bypass, also known as the sleeve gastric bypass. “‘Sleeve’ is a little confusing because most folks think of the sleeve gastrectomy, which is an operation in which we take out most of the stomach,” Dasher said. “Anastomosis is just a fancy word for bypass.”
Dasher said it’s not unusual for him to operate on members of the same family. “Families tend to come in together,” he said. “We’ve done husbands and wives, sons and daughters. It becomes a family affair because metabolic issues and obesity can often be genetic, as well as environmental.”
Dasher and Walsh won’t operate on anyone younger than 18, but there’s no upper age limit. “We look at the patient’s physiological age and not their chronologic age,” Dasher said. “We might have someone who’s 74 and a wonderful candidate for surgery, and we may have somebody who’s 60 but has too many risk factors to be a good surgical candidate.”
Dasher stresses the safety of bariatric surgery. It’s safer than routine gallbladder removal, he said. And he said there’s no shame in not being able to lose weight and keep it off: “Metabolism is a very, very complex equation.” Many people who have a serious weight problem need surgery to overcome it, he said.
Craig has lost 76 pounds since his August 2022 surgery and is on track to lose a total of 100. He is now walking three miles a day with little to no back pain, and his blood pressure has stabilized. His cholesterol is back in the normal range, and he is hoping that eliminating the CPAP will be the next milestone.
Dasher isn’t surprised. His and Walsh’s patients tend to do really well – and not just in the immediate aftermath of surgery.
“Most centers of excellence throughout the United States follow you for one year after your operation,” Dasher said. “We follow up with patients a little longer – meaning forever. We want to make sure nutritionally they're doing well. There's normal and there's ‘bariatric normal’ for labs, so I always stress that you can’t expect other doctors to be bariatric nutritional experts.
“What we don't want to happen is somebody gains a little weight one year and doesn’t come in because they think we’re going to be mad,” he added. “Then, it becomes two years, and they’ve gained 20 pounds. After five years, it’s now 60 pounds and, well – we can still help but it's a lot more work. We're never going to finger-point. We'll talk about what happened and ask where you need support. The nutritionist, the counselors, the exercise folks – all those who help patients before surgery are here to help them afterward.”
Traditionally, follow-up rates at Dasher’s clinic for the one-year visit are above 90%, while the national average for follow-up at the one-year mark is between 25% and 45%.
Life after surgery
Life looks different after bariatric surgery. It has to.
Patients need to stick to the right (high-protein) diet. They also need to stay active, and weight training is an important part of that. “Resistance training leads to your body burning fat at a much higher rate,” Dasher said. “We don't want patients to just get smaller but have no energy.”
Good proteins and lots of green, leafy vegetables are part of the program. Some fruits – like berries – are good choices, but Dasher advises patients to have really sweet fruits like pineapple, grapes and bananas in moderation.
Marla remains committed to her new lifestyle. “You've got to understand those signals that your body's starting to get full,” she said. “I sometimes get full with only three or four bites of something. If I go beyond that, it's unpleasant. When my body says it’s full, I don’t take another bite, even if there's still food on the plate.”
“I don’t fixate on some of the foods I used to think I couldn't live without,” she added. Like pizza. She can usually take two bites before feeling full.
“We eat protein first,” she said. “For two people who have eaten a certain way for 65 years to suddenly change, it’s major – but it's been worth it. We feel better about ourselves, and food is no longer the focus as much as having a healthy lifestyle. We both have so much more energy. This is not a magical overnight change, but you get so much support from Dr. Dasher and his team.”
Marla appreciates little things now that she didn’t even realize had become issues. “Being able to give myself a pedicure is so nice,” she said. “I work out now; I do cardio. I get up and down stairs very quickly. What’s amazed me is how much easier I can get around. I can sit down on the floor and jump right up.”