Adam B. Smith, Ultimate Bariatrics

Bariatric Surgeon

About the Expert

After losing 100 pounds, Dr. Smith has dedicated his career to fighting obesity, relating to patients’ struggles and advocating for patients’ health. He has been in practice for 30 years, focused on bariatrics for two decades. Dr. Smith founded Ultimate Bariatrics, now a group of four surgeons, and he has trained surgeons across the country for the LAP-BAND® System.


Who is a candidate for weight loss surgery?

A person who has already tried to lose weight with diet, exercise, and medically supervised weight loss without long-term success, and their health or lifestyle is being affected by their weight. We look at their body mass index (BMI), which is a mathematical relationship of someone’s height and weight. We usually don’t consider invasive surgeries until someone has a BMI of at least 30, although we have nonsurgical interventions for people with a BMI under 30. Generally, the more aggressive or complicated the operation, the higher the BMI requirement.

Which surgery is best for me?

First, we look at BMI to determine the spectrum of operations that are considered appropriate. Then, we look at any underlying health conditions like hypertension, diabetes, sleep apnea, and previous abdominal surgeries to see if one operation is better for a particular patient. We balance risk tolerance with weight loss and health resolution goals, and then we put it all together with the patient’s preference and come up with an agreed-upon solution.

How will weight loss surgery help me lose weight?

Weight loss surgery is a tool that levels the playing field. If you’ve been overweight for more than five years, your body is programmed to acquire and store food more efficiently. Once you’ve achieved a certain level of weight, you don’t have to eat that much to keep it. But to get rid of it, you have to drastically reduce calories. The surgeries allow you to drastically reduce calories without feeling like you are starving to death from a psychological standpoint. Patients will say, “You changed my life.” I didn’t, you did. You chose health, I just handed you a tool.

What lifestyle changes are necessary after surgery?

After you’ve recovered from your surgery and gone through post-op progression, you will be eliminating high-fat, high-sugar, and high-carb foods from your diet long-term and eating a high-protein, complex carb, healthy diet. You can go to a wedding and eat a tiny piece of cake, but if you do that to excess then you’ll probably get sick or be at risk for regain. We begin light exercise after the first week, allowing people to do activities of daily living. At two weeks, they can start cardio. At eight weeks, they have no restrictions, assuming a normal post-operative course. We recommend a basic fitness regimen that encourages cardio three days a week and resistance two days a week.

How much weight can I expect to lose?

Statistics are meaningless on an individual basis as they only apply to groups of people. In large groups of people, most people can expect to lose, on the low side, 40 percent of their excess weight, but the average is 60-65 percent of excess weight. On the high side, some people have lost 75-90 percent of excess weight. We’re not trying to turn you into Barbie — we just want you to be healthy.
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