Food for thought on Thanksgiving


The four surgeons at NOCHS’s independent bariatric practice have, together, performed more than 6,700 bariatric procedures. Photo via

As folks are getting ready to sit down today –– gazing in anticipation on the bountiful Thanksgiving dining table –– few, if any, are wondering where all that food ends up.

But Dr. James Foote knows. He makes his living getting rid of it; he’s a bariatric surgeon.

Foote, a third generation general surgeon, has performed more than 2,400 bariatric operations and is one of the better known weight loss doctors in Grand Rapids, with a national reputation. He is medical director of North Ottawa Community Health Systems’ Bariatric Clinic in Grand Haven, and performed the West Michigan region’s first robotic bariatric surgery on the lakeshore.

NOCHS is one of the first bariatric clinics to have the latest da Vinci Si robotic surgical system, and the first outside of Detroit and Traverse City to use it in bariatric surgery. It was the first to perform a single-site robotic gall bladder removal — and is still the only location in West Michigan where it is possible to have that done robotically, according to a NOCHS spokesperson.

On behalf of NOCHS, Kristie Burns said the bariatric surgery program there is one of the major investments NOCHS is making to address a key finding in the 2012 Ottawa County Community Health Needs Assessment — obesity is expanding. Three out of five Michiganders could be obese by 2030, and that will push health care costs higher yet. Michigan is now the fifth-fattest state and got an F for Fat by the Trust for America Health.

More than one-third of U.S. adults are obese, according to the Centers for Disease Control and Prevention. Those are people with a body mass index of 30 or more — 78 million people. Technically, a five-foot, nine-inch person weighing 203 or more pounds is considered obese, although doctors caution that the numbers are considered rough indicators and don’t necessarily confirm good or bad health.

The use of robotic equipment in laparoscopic surgery allows greater precision by the surgeon and lessens the physician’s fatigue and back pain during surgery because she or he is not standing in front of the patient. Laparoscopic surgery, through a very small incision, is minimally invasive, which results in a shorter hospital stay, less pain, significantly less blood loss, and quicker recovery.

Foote said there is an obesity epidemic underway.

“There are over 70,000 persons in just our area who would qualify for the surgery,” he said. “There are over 20 million Americans who would benefit from the surgery based on diabetes alone. The surgery essentially cures Type 2 diabetes in over 70 percent of the cases.”

Foote said there are four types of bariatric surgery, the simplest being the placement of adjustable bands around the stomach, which gives the individual a sense of fullness after eating a less amount than normal.

He said the most popular procedure now is laparoscopic vertical sleeve gastrectomy, in which a major portion of the part of the stomach that stores food is removed. Afterward, the patient can’t eat as much, and physicians also have learned that part of the stomach has hormones that cause hunger, so after the surgery the patient may not get as hungry.

The “old standby” done for the past 20 years is gastric bypass surgery, although now, according to Foote, it is usually only done if the patient’s insurance doesn’t cover the other bariatric surgeries.

“It’s been around so long that all insurances cover gastric bypass,” said Foote.

The fourth, less common type is a combination of sleeve and gastric bypass procedures, called duodenal switch.

Foote said the sleeve gastrectomy, which is somewhat in the middle of the varying costs, generally runs about $17,000 total, including the surgeon’s fee, anesthetic, hospital costs and medications. The hospital stay is usually one or two days.

“The surgery pays for itself, usually within two years, by reduction of medication and doctor visits and just improved health,” said Foote. “That’s why the insurances cover (bariatric surgery), because they know that in the long run, it will pay for itself.”

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