Dr. Elizabeth Alexandra Zubowicz, board certified in general surgery, performed the first bariatric surgery procedure at Fauquier Hospital Oct. 17. Two more patients are queuing up for the surgery soon, and almost 200 people have filled out online assessments and expressed interest in learning more. 

Lisa Poston, Zubowicz’s first Warrenton patient, is recovering well. She’s adjusting easily to eating much less at a sitting and her stomach area is healing nicely. She said, “Your body will let you know if you’ve overdone it. And I have a team to help me if I have any issues.” 

The 52-year-old Middleburg resident said she has about 100 pounds to lose, weight that she put on when she gave birth to her daughter 11 years ago. 

For years now, Poston has suffered from a multitude of orthopedic problems. She’s had four back surgeries, two neck surgeries and knee replacements. “I’m walking around with some hardware,” she admitted. 

Poston said that she has really struggled the last five years and has been unable to lose the weight. She is hoping when the pounds drop off, she’ll get some relief from the nagging orthopedic issues.  

She said her daughter is thrilled that her mom will be able to be more active. “It has stopped me from doing things with my family. It’s enough to depress anyone.” 

Poston said she is grateful Zubowizc landed in Warrenton. “Until now, if people needed this kind of surgery, they’d have to go into the city,” she said. “Dr. Zubowicz is a great doctor, and she has a good heart.” 

Zubowicz, a physician with the Drs. Farr, Wampler, Henson, Dougherty, Brown & Zubowicz general surgery practice at 432 Hospital Drive in Warrenton, has been working in bariatrics for 10 years, most recently with MedStar Washington Hospital Center in Washington, D.C. She is currently leading the team at the newly developed Fauquier Health Weight Loss Center, located at 253 Veterans Drive, Suite 205, in Warrenton. 

She said that about 80 percent of the bariatric surgeries she performs are what’s known as sleeve surgery. The procedure removes about 80 percent of the stomach, leaving a sleeve-shaped organ. Sleeve surgery effectively restricts the amount of food a person can eat at one time, said Zubowicz. It’s a permanent solution, though the surgeon said the stomach does stretch a little over time. 

Sleeve surgery is described as minimally invasive; four incisions (less than a centimeter each) are made in the upper abdomen. The surgery itself is done laparoscopically. “Patients may feel something akin to bad heartburn for about 48 hours, and there is some swelling.” 

A patient may lose 10 to 20 pounds within the first few weeks, said Lubowicz, “It depends how much they have to lose.” She said that she has worked with 1,000-pound patients who lost 30 to 40 pounds during the first few weeks.  

Those who have less to lose will drop pounds more slowly. On average, she said, patients lose 60 to 70 percent of their excess weight in the first year, and 80 percent of patients have kept the weight off for five or more years. 

She added, “Even those who have regained the weight are able to stay off their medications. Patients who have had weight loss surgery have found that it helps with co-morbidities. They have statistically longer lives.” 

Good candidates for surgery 

Zubowicz described a typical successful patient. First of all, she said, the person has to come in on their own, ready to make a change. He or she will have tried lots of other methods to lose weight, and they will have experienced weight-related medical issues.  

Those considered for surgery should have a BMI of 40 or above, or a BMI over 35 plus two weight-related medical issues. 

So far in Fauquier, most of those interested in the surgery are in their 50s or older, said Zubowicz. When she worked in D.C., patients were more often in their 30s or 40s. “We are trying to get patients to consider surgery when they are younger so they can avoid the illnesses that come with obesity.” 

When it comes to bariatric surgery, smokers are less likely to achieve the results they are after. Smoking drastically increases the risk of complications, said Lubowicz.  

Some potential patients are ill enough that they can’t be cleared to have anesthesia. Others may have untreated mental health issues that make them poor candidates for the surgery. 

A psychological evaluation is part of the surgery prep, which all told is a three- to six-month process. Lubowicz also said that early on, a dietary review allows a dietitian to counsel the patient on healthy eating so they can adjust to that lifestyle change before the surgery. The recommended diet for patients is high-protein (“It fills you up and is good for healing,” said Zubowicz.), low-fat and low-carb. 

“Exercise is absolutely crucial,” said Zubowicz. The research says that exercise is actually not a great method for weight loss, but she said, “it’s crucial for weight maintenance.” The surgeon said that although dedicated exercise is important for lots of reasons, “people who are physically active during the course of their day are more successful.” 

Gastric bypass surgery, another bariatric procedure, will not be done at Fauquier Hospital until the hospital acquires a robot that can assist with that surgery. Zubowicz said gastric bypass also reduces the size of the stomach, but connects the stomach more directly to the small intestines via a tube. The food goes directly to the small intestines, where the absorption process begins. Zubowicz said that gastric bypass patients are at a greater risk for malnutrition, so monitoring is important. “In addition to restricting the size of the stomach, it’s a malabsorption procedure,” she said. 

For either surgery, caffeine and alcohol are best avoided, especially for the first six months to a year. 

Reach Robin Earl at rearl@fauquier.com