Ochsner Lafayette General has become a regional leader in bariatric surgery by using the latest technology, focusing on a patient's total wellness and providing compassionate, comprehensive care for those struggling with obesity and seeking a healthier future.
The experts at Ochsner Lafayette General Medical Center perform some of the highest number of bariatric surgeries in Louisiana and have helped make the hospital a Center of Excellence in the field. The program is led by Philip Gachassin, MD, MHCM, the Medical Director of Metabolic and Bariatric Surgery at Ochsner Lafayette General. Dr. Gachassin said his patients are often 80 pounds or more overweight and generally come to his team when they feel out of options.
"They're seeing doctors for diabetes or high blood pressure and are being told to lose weight, but no one is telling them what to do about the weight," Dr. Gachassin said. "I have to tell them that they have a disease. Fortunately, bariatric surgery is extremely successful, but it can take time to get patients to understand that we are treating a medical condition and that there is no need for shame."
In recent years, Dr. Gachassin has led efforts to have more insurance companies cover bariatric surgeries, with expanded coverage expected to begin by 2026 for some individuals. In addition, Dr. Gachassin makes it a point to educate medical students about the importance of addressing obesity in their own future practices.
Per National Institutes of Health guidelines, a person qualifies for bariatric surgery if they have a body mass index (BMI) between 35 and 39.9 in addition to at least two co-morbidities, such as diabetes, high blood pressure, sleep apnea or other conditions. Someone with a BMI of 40 or above generally qualifies for an operation without co-morbidities. Dr. Gachassin said someone who meets those criteria must meet with Ochsner Lafayette General doctors, surgeons and counselors before an operation is scheduled.
"We need them to understand that the surgery is a tool and not a magic bullet that will fix everything overnight," he said. "They need to learn how to use this tool to have success. We also want to make sure that patients are educated about weight-loss methods and believe they have tried everything they can before they proceed with surgery."
When Shelby Williams met with Dr. Gachassin and his team last year, it came after multiple unsuccessful attempts at weight loss, including working with a fitness coach and trying different diets.
"I was more than 100 pounds overweight," Williams said. "As much as I would try dieting, I was not losing weight. Nobody really understands how difficult it is until you're in that situation. People say it's just about eating less and exercising, but it's not that simple for everybody."
Williams was considering what to do next when a family vacation to Cancun in 2022 gave her a new perspective.
"We went to a zip line park, and I couldn't fit into the harnesses," she said. "I was missing out on a memorable experience with my family. I knew something had to really change. I had watched other people's journeys with surgery and it seemed like a more permanent solution without many side effects."
Williams had never struggled with her weight until about five years before her operation, when she started gaining seven to 10 pounds per month. Doctors determined there was no underlying health issue, but that Williams' metabolism had slowed down significantly. Dr. Gachassin said that is a common reason for drastic weight gain, although in other patients, it may occur because of other health conditions.
"We've actually started calling this metabolic surgery because we are changing a patient's metabolic condition," he said.
Dr. Gachassin said the most common type of operation is a sleeve gastrectomy, where surgeons remove a significant portion of a patient's stomach, thereby allowing them to feel full when eating less food. Another type of operation, a gastric bypass, reroutes the digestive system, allowing food to enter a small gastric pouch and then go straight into a portion of the small intestine.
"Both types of surgeries place restrictions on how much food a person can take in, but also have strong metabolic effects," Dr. Gachassin said. "We see patients who no longer have elevated blood sugars even before they leave the hospital."
At Ochsner Lafayette General, bariatric surgery is part of a larger process to help patients experience long-term success. The process includes nutrition counseling, which can take place before and after an operation, or independently of surgery. Kate Rountree, RD, LDN, who specializes in dietetics and nutrition at Ochsner Lafayette General, said each person she works with receives a customized nutrition plan that takes into account their health conditions, allergies and goals.
"The most important thing is to center the work on the patient and ask them what they are ready for," Rountree said. "Some people are ready to start measuring portions and want a very specific plan. That could completely overwhelm another person. We ask people what they are prepared for and start there. If they don't know, we can tell them what stands out to us and set realistic goals."
Rountree is part of a multidisciplinary team that includes two dietitians, a behavioral health educator and a certified personal trainer. Together, they work with patients on nutritional needs, exercise recommendations, emotional eating and stress management. If someone chooses a non-surgical weight-loss option, the team also helps with medication management.
"We emphasize to everyone that whether they choose surgery or medication, it's just one piece of the puzzle," Rountree said. "We're not going to successfully address chronic obesity if we don't address a person's food intake, behavioral health and exercise habits. It has to be a comprehensive approach."
Williams advises anyone considering bariatric surgery to understand that it is a long-term commitment that comes with a different mindset.
"Being able to make those mental shifts is one reason the surgery was worth it," she said. "I don't have to worry about weight limits if my family wants to go zip lining or rock climbing. I can participate in whatever I want to do. I can wear clothes from any store. I tell people they should consider this option as long as they are ready for a true lifestyle change."
Williams has lost more than 100 pounds since her surgery in the summer of 2023. She would like to lose a few more, but said that overall, she is happy with her current weight. Dr. Gachassin said that about 85 percent of Ochsner Lafayette General bariatric surgery patients lose at least half of their excess weight and keep it off long-term. The ones who see the most success avoid processed foods, avoid mixing foods and liquids and adopt a regular exercise routine that is achievable for them.
Rountree encourages people to avoid the temptation of frequent restaurant delivery services, to step outside a few times a day to take a break from screens, to avoid unnecessary snacking, and to focus on getting quality sleep each night.
"I think a lot of people don't know where to start because they feel overloaded with information about healthy living," she said. "That's where we step in and talk about their goals and what they are ready to do. Any step forward is a step in the right direction. We meet them where they are and start our work based on what someone is willing and able to do right now and where they want to go in the future."
Ochsner Medical Center - New Orleans and Ochsner Medical Center - Northshore are also accredited as Comprehensive Metabolic and Bariatric Surgery Centers by the American College of Surgeons and the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program. To learn more about weight loss services and surgery options at those centers as well as Ochsner Lafayette General, visit www.ochsner.org/bariatrics.