Our bariatric program here at NSMC is a level 1A bariatric center of excellence which is the highest possible designation of any bariatric surgery center in the country. We do both primary bariatric surgeries and revisional bariatric surgeries. We offer laparoscopic and open procedures although the vast majority of the surgeries that we do are laparoscopic. There are three operations that we do. There is the laparoscopic gastric bypass, the sleeve gastrectomy, and the adjustable band placement, and they are all different. The gastric bypass is one where people lose the most weight, it has the biggest affect on diabetes, but it is a little more risky in the sense that we are disconnecting things and reconnecting things internally. The gastric sleeve is an operation where we make a tube in the stomach and we remove the rest of the stomach. In that operation we are not reconnecting things but we are basically making a very small stomach. And the band is a procedure where we take an elastic band that is a ring and it is placed above the upper part of the stomach to create a narrow opening. All of these operations are designed such that when a person eats afterward, it takes very little food to make them feel full. They are able to eat in smaller amounts, but gradually through the day eat and drink enough to gain adequate nutrition and hydration. As with all operations, patients really need to commit to a lifestyle, behavioral, and exercise change to make sure that they get the maximal result from their bariatric surgery and also to make sure that they have the safest outcomes from the bariatric surgery. In the preoperative stage, everyone goes through very similar testing. They may see a cardiologist, they may have a stress test, they may have a sleep study, everyone is required to go under psychiatric evaluation to make sure that they are emotionally ready for it, that their eating habits will be appropriate after the surgery. Everyone is required to attend 2 support group meetings so that they get to meet other people who have actually had the surgery and ask them questions. And in that process, which takes on average 3-6 months, people become gradually more well-educated about it and emotionally ready. At the NSMC bariatric program we use the National Institute of Health guidelines for deciding what patients qualify for surgery and what patients don't. And what those national guidelines say is that for a patient to qualify for bariatric surger , they need to have been struggling with obesity and related diseases for a long period of time. Surgery should be the last option for treating and curing obesity. Patients need to be between the ages of 18 and 65, or so. We don't have a hard cutoff for a maximal age. Patients need to have a body mass index of at least 35. And lastly patients really need to be medically and psychologically capable to have maximal success after surgery. I think that what makes us unique is our approach to the whole patient. We don't want to be a program where our goal is to just get the patient to surgery. We don't want to be a program where surgery is the finish line. In our mind, surgery is the starting gate. Once you have your surgery, that's when the changes really begin. What we think is unique about our program is that we support our patients not only before surgery, but after. This is a lifetime commitment. The weight loss is obviously an important part of it, but it's the secondary effects of it that we looked for. We want improvements in the issues like diabetes and high blood pressure and all of those things that are a result of excess weight. But, ultimately, helping those things and losing the weight gives people a better quality of life and that's what it's about. Almost every patient is going to lose weight in the first six months, twelve months, and twenty four months after surgery. And that's wonderful but we really define success as those patients who change their lives permanently. Who lose the weight and keep it off for five or ten years, who cure their diabetes and their high blood pressure, and really get to a point where they don't even remember what it was like before. This becomes their new normal; this becomes their new healthy self. And that's our goal for the long term, and I think that that really requires a buy in from the patients, the surgeon and the program, and that's really what we strive for here at NSMC.