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Lose weight and regain health

In Saudi Arabia, one in three adults suffer from obesity, and at least one in 10 have morbid obesity. To help patients lose weight and regain health, Johns Hopkins Aramco Healthcare (JHAH)  has, in collaboration with Johns Hopkins Medicine, implemented a multidisciplinary weight management approach. 

JHAH’s distinctive integrated approach to obesity management

The patient was a grandmother. She had diabetes, obstructive sleep apnea and a body mass index of 84—more than four times what experts consider healthy. She waited four years to become an eligible candidate for bariatric surgery, but physicians deemed her case too risky. 

Then, last October, Dr. Hien Nguyen, a bariatric surgeon visiting Johns Hopkins Aramco Healthcare (JHAH) from Johns Hopkins Medicine (JHM) in Baltimore, accepted her as a patient. He and Dr. Michael Schweitzer, director of the Johns Hopkins Center for Bariatric Surgery, were on a clinical rotation to share knowledge with their colleagues at JHAH and to perform surgical procedures, including this patient’s operation and 10 other complex cases. 

Five months later, the patient is doing well and meeting her weight loss benchmarks. She says she can now walk in her garden for the first time in a very long time, and she even brought in her extended family to thank Dr. Abdullah Madaani, JHAH's bariatric surgery program director, and her expert care team. 

“I could tell this was a milestone,” says Manal Al-Talal, R.N., JHAH’s bariatric coordinator. 

While this case of obesity may seem extreme, it is far from an isolated occurrence. In Saudi Arabia, one in three adults suffer from obesity, and at least one in 10 have morbid obesity. 

JHAH had established the first bariatric weight management program in the eastern region of the Kingdom back in 2009. However, obesity rates among JHAH’s patient population continue to increase—underscoring a global health crisis. 

In 2016, JHAH, Saudi Aramco and JHM felt an urgency to expand the weight management program by developing a dedicated, multidisciplinary center for obesity care and enhancing bariatric surgical services, including introducing new procedures and techniques. 

Comprehensiveness was key. The partners strived to engage all departments that are involved in obesity care. And they wanted to serve JHAH patients’ needs across the continuum of care—from pre-surgery assessment to post-surgery support services. 

“When we launched the program, it was the JHAH bariatric team and a group of us from Johns Hopkins Medicine in Baltimore—me, Dr. Schweitzer, our nutritionist, our psychologist, our administrator and our bariatric coordinator,” says Dr. Nguyen. “Because we had a good complement of all the people who play a major role within the bariatric program here at Hopkins, we were able to give them solid feedback about roles, workflow and collaboration.” 

Partnering on pathways

The JHM team has been sharing best practices to help JHAH continue to develop the interconnections among services involved in a successful obesity management program, including nutrition, psychology, nursing, care coordination and health education. 

“JHAH was already embracing a multidisciplinary approach to obesity management,” says Dr. Nguyen. “But when you’re building a clinical program, especially one that is as ambitious as a bariatric program, there are a lot of nuts and bolts, a lot of pathways. These things won’t be gleaned unless you interact with a program that is already very well-established.” 

This kind of information sharing is strengthening the obesity management program JHAH has been cultivating for nearly a decade. A significant amount of collaborative work has gone into defining clear-cut pathways to get patients through the preoperative, perioperative and postoperative processes in the most efficient way. 

JHAH dieticians are providing patients with both pre- and post-surgery education using tools developed by the bariatric team at Johns Hopkins Bayview Medical Center. JHAH clinical psychologists are using JHM evaluation forms before treatment to ensure patients are good candidates for bariatric surgery, and they’re setting up post-surgery support groups using a Johns Hopkins model. 

“We now have structured a process map, going from identifying patients with the best chance of success and ending with them graduating from our program ready to live healthier lives,” says Al-Talal. 

JHAH’s program emphasizes that weight loss isn’t a quick process, nor is it a quick fix. Making positive changes for long-term wellness is a journey that requires conscious effort. JHAH obesity management patients participate in a four-month educational program taught by a clinical dietitian, social worker and registered nurse. During that time, patients also receive individual counseling by a clinical dietitian, which includes goal setting and postoperative bariatric nutrition education. The goal is for patients to achieve at least a 10 percent change in their body composition or weight. 

It isn’t until the end of this months-long journey that the clinical dietitian and behavioral therapist will assess whether a patient should pursue bariatric surgery.

Long view on good health

Three years ago, JHAH used to perform two or three bariatric surgery cases each week. Now, JHAH has four dedicated bariatric surgeons who continue to train for and embrace advanced procedures such as laparoscopic sleeve gastrectomy, laparoscopic gastric bypass and revisions. Since the start of the focused collaboration between the partners, JHAH has been performing nearly eight surgeries a week, though this number could easily double to meet patient needs. 

However, the volume of surgeries isn’t what’s noteworthy about JHAH’s obesity management vision. “With most other obesity management programs, patients go see the surgeon and get scheduled for their procedure. It’s thought of as a quick fix,” says Al-Talal. “What makes JHAH a pioneer is that in addition to having excellent, well-trained surgeons, we also have a structured program that instills an emphasis on lifelong nutrition, exercise and behavior changes.”

Dr. Nguyen emphasizes the impact this approach could have for the community and beyond: “For every bariatric patient you take care of, you’re also helping the community of people who surround them. If you’re taking care of a matriarch or a patriarch, their children will see that they’re happier and healthier, and may be positively motivated to change their lifestyles, too."

This content

This content was originally published by the Marketing and Communications office of Johns Hopkins Medicine. It has been published here with that office’s permission. Additional reuse and republishing is not allowed. Information is intended to educate readers and is not a substitute for consulting with a physician. 

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