All posts in weight loss surgery

Weight Loss Surgery – The Ins and Outs

Weight Loss Surgery – The Ins and Outs

Maybe you’ve heard of weight loss surgery before, and maybe you’ve thought it sounds like a pretty sweet deal for losing weight fast. This is not exactly the case. Weight loss surgery is a very comprehensive lifestyle change that takes time, effort, and discipline. Weight loss surgery, also known as bariatric surgery, is valuable for those who need it and are committed to being successful post-surgery. We will dive into weight loss surgery and the entire process in this blog below.

Am I a candidate?

Obesity is an epidemic in the United States and sadly obesity is rarely unaccompanied. Many people who suffer from obesity also suffer from high blood pressure, high cholesterol, diabetes, heart disease, acid reflux, sleep apnea, and more. Weight loss surgery is extremely helpful because not only does it assist the patient in losing weight but it is known to address these health conditions as well. In order to be a candidate for weight loss surgery, you must have a body mass index (BMI) of 40 or above or 35 with comorbidity (one of the issues listed above). Calculate your BMI at the bottom of the page here!

What weight loss surgery options are there?

There are a few different types of weight loss surgery available:

Gastric Sleeve

This is the most common type and ranked #1 in the US. This is a laparoscopic procedure, meaning the surgeon makes a few small incisions and performs the surgery through them. In this surgery, the surgeon removes about 80% of the stomach. Now the patient has a much smaller stomach than before. To put it into perspective, a stomach is usually football-sized and after this surgery, it is similar to the size of a small banana. Because of this, the patient feels full eating much less. Most patients experience tremendous weight loss over a period of time, about a year or so. This type of surgery is very safe and very successful but is not the best at combatting heartburn.

Gastric Bypass,

The second most common option is also a laparoscopic procedure. In this surgery, the surgeon creates a new stomach at the top of your normal stomach. S/he reroutes the intestine to this new part, allowing food to skip the rest of the stomach. This procedure restricts the amount of food the stomach can hold and limits the calories and nutrients your body absorbs. In this option, the stomach shrinks from football-sized to golf ball size. Gastric Bypass usually leads to very rapid weight loss (the most weight loss of all the options) and is the best for treating heartburn and diabetes. However, due to the limited nutrient absorption, it is crucial for the patient to take the necessary vitamins for the rest of their life.


Lap-band is a laparoscopic procedure in which the surgeon places a silicone ring around the upper part of the stomach. This creates a smaller pouch and decreases food consumption by making the patient feel full sooner. While many people experience success with this option, it is not the most appropriate anymore. This procedure places a prosthetic system into your body that can potentially cause other issues, and the weight lost from this procedure is usually less than the others. This form is a two-year weight loss process.

Orbera Balloon

Orbera is a non-surgical procedure that can be approved for a person with a BMI of 30 or higher. This surgery is best for those who are not severely obese, as weight loss is typically 20-40 pounds. The surgeon inserts the balloon orally with a scope and places it in the stomach. He or she fills the balloon with a saline solution, expanding it into the stomach and limiting space for food. After 6 months with the balloon, the surgeon pops and removes the balloon. Since this option is temporary, weight regain is very common. Learn more about Orbera here.

What is the entire process like?

Weight loss surgery is not a quick fix as mentioned earlier. It is a tool to help you achieve weight loss, but ultimately your behaviors and habits are what determine success. We want to give you the education and support necessary to build and maintain this lifestyle. For that reason, we have a comprehensive program in place. You start by attending a weight loss seminar to learn all about the surgeries, who is a candidate, the process, and if it truly is a good fit for you. Watch a recording of our seminar here. After that you will begin the consultation process, attend educational meetings with a dietitian and registered nurse, undergo a psychological evaluation, and more, before you have surgery. Typically it takes three months from starting the process until surgery actually happens.

After surgery, you will continue to follow up with the dietitian, registered nurse, and surgeon. To ensure you have the tools critical to achieving long-term success, we recommend following up with your surgeon for life. You will attend support group sessions for more education and interaction with others who are going through the same thing. As previously stated, this is a lifestyle change and it can be difficult to adjust to new a diet, exercise, and vitamin regimen. Having others who can relate and provide insight and advice is very important. Read more in-depth about our process here.

Next Steps

Our goal for all of our patients is health and happiness. Weight loss surgery can vastly improve one’s quality of life. It can eliminate existing health conditions and is even recognized as a treatment option for type 2 diabetes. It’s never too late to take control of your life and health, so take the first step and watch our seminar video to see if weight loss surgery could be an option for you. Do not hesitate to call our team and ask any questions about our weight loss program. Our bariatric coordinator, Heather, will be happy to assist in any way she can: 605-217-5511.


COVID-19 Response and Screening

COVID-19 Response and Screening

With COVID-19 officially being classified a pandemic, we as a healthcare facility need to act appropriately and carefully to protect our compromised patients, staff, and every person for that matter. Effective immediately, Midlands Clinic kindly asks that all patients experiencing flu like symptoms or who have traveled overseas or to infected areas in the last 14 days call our clinic at 605-217-5500 to receive instruction on how to move forward with any appointments.


Telehealth Virtual Visits

Right now, during the outbreak of COVID-19, we need your help to protect our ability to take care of you, your family and the patients who need us the most. We are continuing to explore ways to practice social distancing at our office and will continue to update you of these practices. One of those practices being implemented is telehealth visits.

Midlands Clinic now offers virtual visits!  If you have an upcoming appointment, our providers may be able to continue your care via a secure virtual visit. We will use a platform called is a secure site that allows you to have a video appointment with your provider through your desktop, tablet, or smartphone. It is extremely simple and easy to use for both clinicians and patients.

If you have an upcoming appointment, a representative from our office may reach out to you and offer a virtual or telehealth visit if they feel this is a good alternative for you.
If you need an appointment or would like to reschedule your appointment, you may call us at 605-217-5500, Opt. 8, to see if you would be a candidate for a virtual or telehealth visit.

For more information on accessing your virtual appointment, click the link below.
How to access your telehealth appointment


Your Health Matters: weight loss surgery options increase along with obesity rates

Your Health Matters: weight loss surgery options increase along with obesity rates

Our newest, FDA-approved weight loss surgery option, the gastric balloon, was featured on KCAU’s Your Health Matters segment this week.

To watch the video and read the story, click the link below:

To find out more about Weight Loss surgery, click here, or RSVP to one of our weight loss seminars.


Supporting lifestyle changes

This article was featured on KMEG14 Siouxland News.

Bariatric Surgery is a complete life style change

“We look at weight loss surgery as just a tool it is not a quick fix or an easy way out,” said Megan Cleveland, Midlands Clinic. “So to really help the patients be successful with this tool, the educational program is really necessary along with the support group.”

The Educational program team includes registered dieticians, registered nurses, psychologists and bariatric surgeons.

“And so we really work together as a multidisciplinary team to help the patients not only physically but emotionally mentally prepare for the life style changes that they will have to make,” said Cleveland.

Doctors also recommend these patients join support groups to help them through these major life changes.

“If you are on a typical diet, you have the decision of either following your diet that day or not,” said Cleveland. “They don’t have that decision any longer because weight loss surgery is a permanent change to your body.”

Each group includes 10 to 30 patients and they talk about good eating habits and avoiding bad habits.

“So we really try to teach them not only alternatives of things they can do other than rewarding with food but also coping mechanisms to not use foods for comfort or to celebrate or to mourn” said Cleveland. “But to try to rely on some other things.”

Though the Midlands Clinic is one place to find a weight loss support group, you can also find other groups in the community and online.



Obesity Surgery

This article was featured on KMEG14 Siouxland News.

It is no surprise that obesity can lead to a lot of complications.

Dr. Keith Vollstedt of Mercy Medical Group said, “That excess weight that we carry also contributes to pain on the joints, pain in the back, contributes to high blood pressure, acid reflux disease and getting that weight off can improve people’s overall physical condition. And hopefully reduce the use of medications or pills, and maybe some further surgeries down the road.”

This is why doctors recommend surgeries that can help with weight loss for patients who are 100 pounds overweight and have other health problems.

“Mercy and our group Midlands Clinic Office, offers a gastric by-pass, we offer a gastric sleeve resection, and we offer the adjustable gastric band.”

Each surgery has its benefits over the other and you and your doctor can decide which is best for you.

The surgeries usually require one to two nights in the hospital and up to 3 weeks of recovery at home.

Doctors also recommend time with a dietician before the surgery to create good eating habits.

But the key thing is, “When the person is ready to change their life, when they are ready to eat differently, when they are ready to give up foods, certain foods, when they are ready to start exercising, then we can have a successful operation and people are successful with the surgery.”

But remember these surgeries are not permanent, when patients fall back into old habits they will regain the weight.


Laparoscopic sleeve gastrectomy: One more option for the obese

Laparoscopic sleeve gastrectomy: One more option for the obese

Article and photo courtesy of the Sioux City Journal

Obese patients wanting to go under the knife to lose weight now have another option: laparoscopic sleeve gastrectomy.

Since it made its debut in Siouxland in May, the procedure, which decreases feelings of hunger and the capacity to eat more by removing a portion of the stomach and re-shaping the remaining stomach into a sleeve, has grown in popularity, according to William Rizk, a bariatric surgeon at Midlands Clinic in Dakota Dunes.

By late August, Rizk and his colleague, Keith Vollstedt, had performed 10 laparoscopic sleeve gastrectomies between the two of them in Sioux City. The procedure joins laparoscopic gastric banding and laparoscopic gastric bypass.

“This is the en vogue surgery right now,” Rizk said just minutes before stepping into the operating room at Mercy Medical Center to perform the procedure on a woman.

“We really started doing it to satisfy patient demand. People come in absolutely seeking to have a sleeve. It’s very popular.”


Laparoscopic gastric bypass surgery is the most common weight loss sugery. It is also the most invasive and effective, according to Rizk. Laparoscopic gastric banding on the other end of the spectrum is the least invasive and the least effective. Laparoscopic sleeve gastrectomy, he said, falls somewhere in the middle.

“Why someone would choose the sleeve gastrectomy is it’s less invasive as far as intestinal rerouting,” Rizk said. “There would be less malabsorption of certain vitamins while still having the advantage of significant weight loss.”

During the procedure, special laparoscopic stapling devices are used to reduce the human stomach from the size of a football to the size of a banana, according to Rizk.

“We put a sizing device that goes through the mouth, down the esophagus, down through the stomach and we staple along this sizing device to help us determine the diameter of this little banana,” he said.

About 80 to 85 percent of the stomach is then removed through one of five little incisions in the patient’s abdomen. A smaller stomach, Rizk said, will hold less food.

Ghrelin, a hormone produced by cells in the stomach, causes the feeling of hunger. After removing part of the stomach, Rizk said hunger dramatically decreases.

“As a patient eats a smaller amount of food, the stomach stretches slightly and sends a signal to the brain,” he explained. “The brain interprets that as being satisfied and the patients are no longer hungry.”


Although the stomach will stretch some after surgery, Rizk said it won’t stretch enough to allow patients to eat normally again. Eating frequent small meals, he said, is how most people gain weight back after having weight loss surgery.

“Grazing is the Achilles heel to all weight loss surgery, whether it’s a band, bypass or a sleeve,” he said. “If you eat a small amount for many hours a day, there’s potential that weight will be regained.”

Patients can expect to lose half a pound to a pound a day for the first four to six weeks following laparoscopic sleeve gastrectomy, according to Rizk. He said someone who weighs 450 pounds will lose more total pounds than someone who weighs 250.

“Most of these patients are morbidly obese, so to lose 100 to 150 pounds is very common,” he said. “If someone is going to go through surgical weight loss, it’s usually for a significant amount of weight. Our goal is to get them not to ideal weight, but to a healthy weight.”

Rizk cautions that weight loss surgery is a significant behavioral and psychological undertaking for patients and requires extensive counseling before and after surgery.

“Someone might see me today and have a gall bladder surgery tomorrow, it doesn’t work that way with weight loss surgery,” he said.

Rizk said occasionally patients will decide not to go through weight loss surgery after beginning counseling. Some, he said, will come back a year later when they feel more prepared to make lifestyle changes.

“If you’re going to undergo a surgery that is dramatically going to change the way you eat, you have to be ready to change your lifestyle,” he said.


To read the full story, CLICK HERE.


Midlands Clinic now offers Laparoscopic Sleeve Gastrectomy

Tired of feeling like you’ve tried every diet and failed? Do you worry about how your weight is impacting your health? Are you experiencing joint pain, diabetes, high blood pressure, high cholesterol, sleep apnea or other conditions? Is your weight affecting your family relationships – or the ability to have one? Do you feel discriminated against at work and in public?

If you answer yes to all of these questions, you may be a candidate for a new bariatric surgery being performed by Drs. William Rizk and Keith Vollstedt at Midlands Clinic in Dakota Dunes.

Starting mid-May, Midlands Clinic will be offering Laparoscopic Sleeve Gastrectomy, a procedure that limits the amount of food you can eat by reducing the size of your stomach.

Like other metabolic surgeries, it also helps to establish a lower, healthier body-fat set point by changing the signals between the stomach, brain and liver.

Here’s how it works: The surgeon creates a small stomach “sleeve” using a stapling device. This sleeve will typically hold 50 mL to 150 mL and is about the size of a banana. The rest of the stomach is removed.

Dr. William Rizk, general surgeon with Midlands Clinic, said 80 percent to 85 percent of the stomach is removed, dramatically reducing its size.

This procedure induces weight loss in part by restricting the amount of food (and therefore calories) that can be eaten, and therefore absorbed, without bypassing the intestines.

Laparascopic Sleeve Gastrectomy is the latest option that Midlands Clinic will be able to offer patients who come to them with co-morbid conditions, lack of mobility and a low quality of life.

In addition to the Laparoscopic Sleeve Gastrectomy, Midlands Clinic offers two other weight loss surgeries to fit with patients’ lifestyles: Laparoscopic Gastric Bypass and Laparoscopic Lap-Band.

Because all three procedures are laparoscopic, they only require five or six small incisions – all 1-2 centimeters – and are performed under general anesthesia. The surgeries are between 45 minutes to 1 1/2 hours long.

“There is no perfect surgery for weight loss or no magic bullet. Each surgery has a certain level of invasiveness, starting with Lap-Band surgery, which is the least invasive and offers the least amount of weight loss, to gastric bypass surgery, which is the most invasive with the most weight loss potential. All three surgeries work by diminishing the capacity of the stomach and restricting how much a patient can eat. They just do it in different ways,” Rizk said.

During the Lap-Band surgery, a silicone band is placed around the upper part of the stomach, and a small pouch is created. As a result, the stomach holds less food and the patient feels full faster and longer. The size of the restriction can be adjusted after surgery.

During gastric bypass surgery, six small incisions are made to hold laparoscopic instruments, then the stomach is separated through the use of staples to create a small pouch. The smaller stomach is attached to the middle of the small intestine, bypassing the section of the small intestine (duodenum) that absorbs the most calories. Patients eat less because the stomach is reduced from the size of a football to the size of a golf ball and they absorb fewer calories because food does not travel through the duodenum.

During the sleeve gastrectomy, the surgeon uses a spiral stapling device that divides the stomach and seals it off. The procedure causes hormonal changes to disrupt hunger.

“The Laparoscopic Sleeve Gastrectomy has been popular over the past five years. It has overtaken the Lap-Band surgery. It’s very effective with less nutritional complications than gastric bypass. It’s also relatively easy to perform. In bariatric literature, it’s more popular and studies to support its effectiveness are being done across the U.S,” he said.

The key to any surgery is to eat smaller meals, eat less between meals, and feel less hungry, he said.

“It’s important to change your lifestyle, drink more water between meals, and increase exercise. We’re available to counsel patients and teach them how to eat with the dramatic change. Portion sizes are a lot smaller. It can be done,” said Rizk.

Oftentimes, not only do patients lose a significant amount of weight, they also are able to reduce and/or eliminate medications while positively impacting their overall health with bariatric surgery.

“Behavior modification is very important,” said Megan Cleveland, registered dietitian at Midlands Clinic. “Weight loss surgery is a tool, not a quick fix or an easy way out. It’s a way to be successful.”

When you choose bariatric surgery at Midlands Clinic, you will receive all the support you need to positively take control of your health and your future.

“We’re here to help people. We know what they’re going through,” Cleveland said. “We’re here to listen to them and let them know the options that are available.”

Midlands Clinic offers:

  • A highly trained team of doctors, nurses, psychologist and a dietitian who specialize in weight loss surgery. This multidisciplinary team helps patients make lasting changes to their lifestyles, in conjunction with their weight loss surgery, to promote long-term success.
  • A facility geared toward the bariatric patient, with chairs and scales that accommodate the bariatric patient.
  • All staff have been trained in bariatric sensitivity – meaning, they understand your struggle, they don’t judge it.
  • Proven experience. Midlands Clinic has been performing weight loss surgery continuously since 1976. Since 2002, they have performed more than 1,000 laparoscopic weight loss surgeries, with complication rates well below the national average.
  • Real life, lasting results.
  • Excellent safety record.
  • Personal support – They will be with you for every stage of your weight loss journey, including all the years after your journey.

If you would like to explore your options or have questions about bariatric surgery, call Midlands Clinic at 605-217-5511.


Dr. Keith Vollstedt Receives Recertification

Dr. Keith Vollstedt Receives Recertification

Dr. Keith VollstedtDr. Keith Vollstedt, a general surgeon at Midlands Clinic P.C. in Dakota Dunes, received his recertification from the American Board of Surgery.

Dr. Vollstedt has been practicing general surgery since 1992 and has a strong, professional interest in bariatric, general, thoracic, laparoscopic and trauma surgery.

He received his original certification in 1993. The Board, an independent, non-profit organization, was founded in 1937 to certify surgeons who have met a defined standard of education, training and knowledge.

Dr. Vollstedt is a fellow with the American College of Surgeons and the International College of Surgeons.