In the spring of 2023, a 28-year-old woman consulted Fareed Cheema, MD, a weight loss surgeon at NYU Langone Hospital—Brooklyn, feeling deeply discouraged. In the six years since her first bariatric procedure in 2017, she had regained 66 pounds, nearly all the weight she had lost. Still with morbid obesity at 4 feet 11 inches and 279 pounds, she was desperate to find a better way to drop at least 100 pounds, once and for all.
She had come to the right place, and just the right surgeon. NYU Langone Hospital—Brooklyn launched its bariatric surgery program in 2004, becoming one of the first in the United States to be accredited as a national center of excellence by the American Society for Metabolic and Bariatric Surgery (ASMBS). The hospital’s four bariatric surgeons perform nearly 400 weight loss operations annually, and more of these cases are done robotically than at any other hospital in Brooklyn.
Dr. Cheema joined the surgical team last year as a clinical assistant professor of surgery at NYU Grossman School of Medicine, and he has already made his mark. On May 30, he became the first bariatric surgeon at NYU Langone Hospital—Brooklyn to perform a newer type of bariatric surgery, which debuted in 2007, that’s ideal for patients who have both diabetes and obesity, as well as for those whose previous bariatric intervention has failed. The procedure, called single-anastomosis duodenal–ileal bypass with sleeve gastrectomy, or SADI-S, is the most recent to be endorsed by the ASMBS. Dr. Cheema, a member of the Weight Management Program at NYU Langone Hospital—Brooklyn, has since performed 22 SADI-S procedures, more than any other bariatric surgeon in Brooklyn. NYU Langone’s Weight Management Program locations at Tisch Hospital and NYU Langone Hospital—Long Island also offer the procedure.
“The SADI-S has been proven to have a higher initial weight loss and higher long-term weight loss, as well as lower weight regain overall, than the two other commonly performed procedures, the sleeve gastrectomy and gastric bypass,” notes Akuezunkpa O. Ude Welcome, MD, a bariatric surgeon and chief of surgery at NYU Langone Hospital—Brooklyn.
Some patients who have bariatric surgery eventually regain much of the weight they lose because they find it hard to comply with dietary restrictions, leading nearly one-third of them to opt for a second procedure. What makes the SADI-S a game-changer is that it achieves better results by fundamentally altering the digestion process.
Patients are eligible for the SADI-S if they have morbid obesity—defined as a body mass index (BMI) of 40 or higher—or have severe obesity (BMI of 35 to 40) with diabetes, a disease for which the procedure has a 90 percent cure rate. Because the SADI-S is highly effective for long-term weight loss, the procedure is also well suited to patients whose previous bariatric surgery hasn’t produced the desired results, like the young woman who consulted Dr. Cheema. On June 13, she became his third SADI-S case. One month after surgery, she lost 33 pounds—12 percent of her total weight. “My expectation,” says Dr. Cheema, “is that by the one-year mark, she will lose 35 percent to 40 percent of her initial weight, almost 100 pounds, and that she’ll keep it off because she’s no longer relying solely on a restricted diet.”
The need for an effective treatment for sustained weight loss has never been greater. The prevalence of obesity—a BMI of 30 or higher—has tripled over the last five decades, according to the Centers for Disease Control and Prevention. An estimated 42 percent of American adults have obesity, and 9 percent are classified as having severe obesity. In Brooklyn, the obesity rate is 25 percent, while in Sunset Park, the neighborhood surrounding NYU Langone Hospital—Brooklyn, it’s 19 percent.
“Obesity touches on every single organ system,” says Dr. Welcome, noting that it’s associated with higher rates of stroke, heart disease, type 2 diabetes, male infertility and female infertility, osteoarthritis, and certain cancers. Yet only 1 percent of those eligible for weight loss surgery get it.
“Some patients say to me, ‘I don’t want to have surgery because I’d rather try one of those new diabetes medications that make you lose weight,’” says Dr. Cheema. These medications are semaglutide injections, the newest class of anti-obesity drugs. They are currently approved by the U.S. Food and Drug Administration for the treatment of diabetes but are also widely prescribed for weight loss. Dr. Cheema explains to patients that while these medications can give patients with severe obesity a head start before surgery, they achieve a maximum weight loss of only 15 to 20 percent compared to the 30 to 40 percent that surgery affords. Moreover, studies show that 80 percent of those who stop taking their medication regain nearly all the weight they lost. “These medications are a useful adjunct, though they’re currently unaffordable for most people over the long term,” notes Dr. Cheema. “But they are never going to be a substitute for bariatric surgery, which remains the gold standard. The two markers of a great weight loss operation are high success rates for reversing diabetes and keeping weight off. The SADI-S has both.”