BARIATRIC SURGERY Q&A
Cullen Carter, MD
Cullen O. Carter, MD is board certified in general surgery and surgical critical care. Dr. Carter joined BMC in August 2015, and we sat down with him to learn more about his background and the bariatric surgery program here at the hospital. To learn more about the bariatric surgery program, please visit their webpage or call 617.414.8052.
What drew you to being a surgeon, and to bariatric surgery in particular?
I went into medical school unsure about what kind of doctor I wanted to be, but I’ve always liked doing things with my hands. I worked for my family’s landscape contracting business growing up, and then spent two summers at the end of high school working for a contractor building houses. I loved the satisfaction of doing something with my hands and seeing the result of my work. Surgery, for me, was in some ways similar to that kind of satisfaction: where you can take a problem and, ideally, solve it in a permanent way.
What is rewarding about practicing bariatrics?
Bariatric surgery is such a powerful tool in overall weight loss therapy but, it’s really just one piece of a big puzzle. It gives the patient a huge jump-start in improving their health. Obesity is a life-long disease; people can go on several diets and work incredibly hard to lose weight, and may or may not be successful - even if they try very hard and are very diligent. It’s a more complex problem than our society realizes. Surgery helps patients lose a large portion of their excess weight and keep that weight off long term, especially if they continue to follow up with our team long-term. It’s nice to be part of a program that provides a service that is very effective, and gives people a real chance to improve their health before developing complications such as diabetes, high blood pressure, or high cholesterol.
Are there specific qualifications for becoming a candidate for surgery?
The patients that benefit most and qualify for surgery are those who have a BMI (a ratio of your weight compared to your height) over 40. Patients who have a BMI over 35, but also have health problems associated with their obesity, such as diabetes, high blood pressure, or obstructive sleep apnea, also qualify for surgery. It’s very important that patients have tried other means to lose weight, because there are other methods that can be effective. It’s a good sign when somebody has really tried hard (to lose weight), because that implies that they will really work hard after surgery to commit to the whole program.
Who do you partner with at BMC to treat a patient throughout their journey?
We have a team that we work with every day in the bariatric surgery clinic. Our dieticians are a crucial part of the team. We also work with medical weight loss specialists with training in both endocrinology as well as medical means of weight loss (whether through specific diets, medications, or other means), who work closely with our patients. Behavioral health is a crucial component as well, because there are a lot of lifestyle and emotional changes that occur with weight-loss surgery. Everybody is required to attend at least two support groups during the process, so that they can talk to others who have actually gone through it. It’s also very important that patients continue to attend support groups after surgery to stay motivated and on the right track.
Please describe the different types of bariatric surgery.
Gastric bypass, the sleeve gastrectomy, and the laparoscopic adjustable gastric band are the three primary types of surgery. We explain to patients the advantages and disadvantages of each option, but there are certain cases where one is clearly the best choice for a patient. For example, for patients with severe diabetes, gastric bypass provides a better chance of significantly improving their diabetes. Also, if a patient has significant acid reflux or Barrett’s esophagus, then a gastric bypass is actually an excellent anti-reflux operation -- in most patients, it will actually stop the acid reflux. Each type of operation has different risk profiles, especially in the long-term, so we want our patients to be comfortable with the type of procedure they choose to undergo.
Can you debunk any common myths about weight-loss surgery?
Some people do believe that it’s a “quick fix,” and that’s why patient education is so important. It’s really not - it’s very hard work, even after you’ve had the surgery. Education, close follow-up, and attending support groups are all equally important. By the time patients are ready for the surgery, they really understand this. They’ve made big changes and adopted a specific diet. Almost all of our patients lose weight during the period between enrolling in the surgical program and having the surgery.
Another common myth is that people gain back all of their weight. Actually, fewer than 20% of patients gain back their weight. Those are the patients who veer off of the post-bariatric surgery diet. The nice part about having bariatric surgery, is that the vast majority of patients really don’t feel that hunger that they felt before surgery. That’s due in part to the fact that there are a lot of hormonal changes that take place.
There’s also the belief that there are a lot of complications from bariatric surgery. Complications actually only occur in a very small minority of patients. The average bariatric surgery patient does very well, and in fact, are back on their feet the same day, starting to drink sips of water, and they go home in about two days. If someone is 100 pounds overweight prior to surgery, we expect them to lose 60-70 pounds within the first year post-surgery.
What do you like best about being at BMC?
I knew that I really wanted to be in an academic hospital. I really love continuing to learn new things and having the opportunity to teach the residents and students. I also enjoy performing challenging surgeries and solving issues for patients who we don’t have to send elsewhere for treatment. BMC really does it all! It’s wonderful to be part of a hospital that serves the community so well, and that treats everybody, without exception. I also enjoy getting the chance to work with people from all over the world. I learned how to speak Spanish growing up, and in medical school I learned to speak Portuguese, so it’s wonderful to be able to use my language skills here.