Friday, January 7, 2011

What Is A Bariatric Center Of Excellence?

As you look for providers for your weight loss surgery in the Houston area, you may have noted that some providers list themselves as "centers of excellence" (COE). What does this designation mean though? Who is accrediting these facilites as COEs. In case you were confused, check out what Gary M. Pratt, the CEO of surgicalreview.org and independent nonprofit entity that monitors bariatric surgery worldwide, has to say about the COE program:
Surgical Review Corporation (SRC), in collaboration with the American Society for Metabolic and Bariatric Surgery (ASMBS), has created a program to help highlight providers who deliver excellent care. The ASMBS Bariatric Surgery Center of Excellence® (BSCOE) designation helps identify where patients like you can expect to receive safer and more effective surgical treatment. Our program is tough, comprehensive and increasingly recognized by leading government and private insurers when making coverage decisions. These aren’t general surgeons who “dabble” in bariatric surgery - instead, you’ll hear most BSCOE surgeons refer to their work as a vocational calling. 
Simply put, the application process to become a BSCOE is tough. In fact, we believe it to be the most rigorous in the industry. Applicants must meet a list of requirements. They must pass a thorough site inspection that includes a full review of the facilities; interviews with surgeons, staff and leaders of the hospital; and a detailed review of medical charts.
But, our process is tougher for another reason. Other center of excellence programs focus their review on the hospital only. We believe that both the hospital and the surgeon must work together to ensure that you receive the best care possible. SRC reviews both and designates them individually based upon whether they meet program requirements. Just because the hospital receives the BSCOE designation does not mean that all surgeons working there should automatically pass, 
The requirements of the BSCOE program are comprehensive. They were established to assess each facet of care specific to bariatric surgery patients. Once the center and its surgeons achieve this prestigious designation, they must continue to work hard to keep it. In fact, they are re-evaluated and site inspected every three years. 
Education and commitment are two key elements of designation. BSCOE surgeons must be board-certified and demonstrate significant expertise in bariatric surgery. They must also stay abreast of the most current and appropriate treatments through ongoing continuing medical education. 
Experience is demonstrated through the number of cases that BSCOE centers must perform each year. Studies show that surgeons and hospitals with higher volumes achieve better results with fewer mortalities, complications, re-operations and revisions.
Also, higher volume centers are more likely to offer extended resources, such as a multidisciplinary team of specialists, important for the care of bariatric patients.
SRC requires that each BSCOE hospital perform at least 125 bariatric surgical cases each year. BSCOE surgeons must perform at least 50 bariatric cases each year with a minimum of 125 total bariatric cases in their lifetime. 
Multidisciplinary care is integral to the treatment of a bariatric patient and is required for BSCOE designation. The multidisciplinary team assembled at a BSCOE generally includes nutritionists, psychologists, pulmonologists, cardiologists and other medical specialists trained in bariatric care. 
BSCOE centers devote a tremendous amount of time and resources to training these team members, BSCOE centers also offer support groups that meet regularly and are led by healthcare professionals who can address questions you might have before and after your surgery. BSCOE centers also invest thousands of dollars annually to ensure that their patients return after surgery for proper follow-up. This postoperative care is critical to maintaining weight-loss and ensuring your nutritional needs are met. 
All BSCOE participants are also required to report their detailed patient outcomes information on a regular basis using SRC’s Bariatric Outcomes Longitudinal Database™ (BOLD™). It helps SRC keep watch on how well these hospitals and surgeons are doing in real-time, but it also serves other important purposes. 
Several major health insurers have taken notice of the ASMBS BSCOE program and BOLD™. Insurers such as the Centers for Medicare and Medicaid Services (CMS), CIGNA, Humana, Kaiser Permanente, and some Blue Cross and Blue Shield plans, require the BSCOE designation as a first-step for inclusion in their bariatric surgery networks and reimbursement. However, more work is needed to increase access to bariatric surgery. SRC and the Obesity Action Coalition are actively committed to patient advocacy, but your voice is needed. 
While the BSCOE designation represents excellence, it doesn’t guarantee perfection. As with any surgery, there are associated risks and complications with bariatric treatment. Care is particularly challenging because morbid obesity usually involves a myriad of other medical problems that need to be addressed. 
To summarize, here are the key points that separate a bariatric surgery center of excellence from other providers of weight loss surgery around greater Houston:

  • Board-certified Houston-based surgeons
  • Separate certification process for Houston area bariatric surgery hospitals
  • Re-evaluation process every 3 years
  • Surgeons must perform 50 bariatric surgeries per year with a minimum of 125 weight loss surgeries performed lifetime
  • Weight loss centers must perform at least 125 obesity surgery cases per year
  • Multidisciplinary care
  • Long-term follow-up 
  • Improved insurance coverage
While no system can guarantee weight loss surgery success, having your weight loss surgery in a Houston area Bariatric Surgery Center of Excellence can improve your chances of having a safe and effective bariatric surgery experience. 

Wednesday, December 22, 2010

More People To Become Eligible For Obesity Surgery

The FDA is considering revising the thresholds that guide who is allowed to have bariatric surgery. While there may be some concern that this is being pushed by the manufacturer of one of the lap-band products, there is some valid medical merits to having a more nuanced set of guidelines. A one-size-fits-all (pardon the pun) approach simply does not encompass the diverse needs of patients with not only obesity issues, but other comorbid conditions such as hypertension or diabetes. As the NYTimes article from December 1, 2010 notes:
Weight-loss surgery, once a last resort for extremely overweight people, may soon become an option for those who are less heavy.

An advisory committee to the Food and Drug Administration will consider on Friday a request by Allergan, the pharmaceutical company, to significantly lower how obese someone must be to qualify for surgery using the company’s Lap-Band device, which restricts intake to the stomach.

On Wednesday, the F.D.A. acknowledged that a new study by the company showed that people in the proposed range of obesity who had the band experienced “statistically significant decreases in all measures of weight loss.”

If the agency approves the change, the number of Americans eligible for the Lap-Band operation could easily double, ensuring more sales for Allergan and probably more insurance coverage for such operations. But the proposed change, sought at a time when the obesity epidemic in the United States seems intractable, still leaves some people uneasy, in part because of side effects and failure rates. In addition, long-term weight reduction is hard to maintain.

“You’re talking about millions and millions of people who would meet these criteria,” said Dr. George Blackburn, associate director of the division of nutrition at Harvard Medical School. “Let’s make sure by the most rigorous research that this is safe and effective.”

Like any medical advance, it is important to consider the benefits as weighed against the risks. Specifically, one must consider a metric called the "number needed to treat" or NNT. What the NNT is define the number of people that have to receive a treatment in order for one person to have the intended outcome. For example, the NNT of lap-banding might be 3, meaning that 3 people need to have lap-banding in order for (on average) one person to achieve a BMI less than 25 (ie, a normal BMI). But, there already is a large research on banding itself showing it to be effective; the issue now is merely extending this research. The article goes on to discuss how lap banding has expanded over the years:
Doctors have already started to operate on extremely heavy teenagers, not just adults. And some experts are recasting weight-loss procedures, known as bariatric surgery, as metabolic surgery, saying that it might be justified to treat diabetes, even in people who are barely obese or not obese. Gastric banding involves placing an inflatable silicone ring around the upper part of the stomach, which limits food consumption and makes one feel full faster.

Current guidelines say weight loss surgery is appropriate for people who have failed to lose weight through diet and exercise and have a body mass index, or B.M.I., of 40 and above, or 35 and above if a person has at least one serious health problem, like diabetes or high blood pressure, that is tied to obesity. Allergan wants to lower the threshold for the Lap-Band to a B.M.I. of 35 with no associated health problems and to 30 with such problems.

For instance, a person who is 5 feet 6 inches and has diabetes would have to weigh 216 pounds to qualify now. Under the proposed lower threshold, that person could weigh 30 pounds less, or 186 pounds.

Federal statistics suggest that nearly 20 percent of the adult population has a B.M.I. between 30 and 35, more than double the population above 35. Probably half or more of the people between 30 and 35 have some associated health condition.

Bariatric surgeons and some obesity experts say that surgery has proven to be the only way many people can lose a lot of weight and keep it off, and some cite a Swedish study suggesting that it prolonged lives. And, they say, the operations have become safer since the obesity thresholds were first set in 1991 in a meeting organized by the National Institutes of Health.

“The whole risk-benefit ratio is completely different than it was back then,” said Dr. Marc Bessler, chief of the division of minimally invasive and bariatric surgery at Columbia.

Banding is a less radical operation than the main alternative, the gastric bypass. It is also reversible and costs less — from $12,000 to more than $20,000, compared with $20,000 to more than $30,000 for a bypass. But banding also leads to a weight loss of about 20 percent on average, less than that of bypass.

Bypass has been the preferred operation in the United States, though Allergan executives said on a recent call with investors that banding now has about 50 percent market share. Within the banding market, Allergan’s Lap-Band has about 70 percent market share, according to the company, with the rest belonging to the Realize Band sold by Ethicon Endo-Surgery, a division of Johnson & Johnson. Allergan’s band was approved in 2001.

The research also needs to consider the impact on not only BMI but other comorbid conditions like diabetes (blood glucose levels) and hypertension (blood pressure). These other major diseases are leading causes of kidney and heart disease, not to mention blindness and amputations. If banding can help stem the onset of the epidemic of diabetes in this country, then it may possibly be worth the fact that some people will not be helped by the procedure. And, even in those cases, is it the banding that failed, or that the individual did not stick with the treatment plan? If you get banding, you need to realize that this is a total life change, not a one-stop quick fix. Be the change you want to see in your life. The article describes these comorbid effects:
One factor that is moving some experts to advocate surgery for lower body mass index levels is its effectiveness in resolving diabetes, hypertension and some other ills associated with obesity.

“There are dramatic metabolic effects that in many cases go well beyond the weight loss effects,” said Dr. Lee M. Kaplan, director of the weight center at Massachusetts General Hospital.

He said that while it was once thought that surgery worked mainly by mechanically restricting how much one can eat, it is becoming clear that gastric bypass, at least, has effects on hormones.

Some experts say body mass index does not adequately measure risk of health problems. For instance, Asians tend to get diabetes at a lower B.M.I. than whites.

“The B.M.I. limitation of 35/40, set in the period when the major objective of the operations was weight control, is no longer the primary appropriate guideline for the selection of candidates for bariatric surgery,” Dr. Walter J. Pories, a surgeon, and colleagues wrote in the journal Obesity earlier this year. Dr. Pories will be a member of the F.D.A. advisory committee on Friday.

Today can be the day you make the change. Whether you live in downtown Houston or the outer reaches of Galveston, the Woodlands to Sugar Land, start the process of your personal metamorphosis today. Don't simply be that man or woman in the mirror you've come to despair about. Be the change you want to see in your life now!


Reference:
1. http://www.nytimes.com/2010/12/02/business/02obese.html?_r=1

Monday, November 30, 2009

Tips On Finding Your Weight Loss Surgeon

Once you have made the decision to get bariatric surgery, the next major step is choosing the right surgeon. There are many factors to consider in making this decision, and many ways to go about it. Here are some general tips and pointers about what to consider in making this key decision:

Know your options - Before deciding, check out who the bariatric surgeons in the Houston area are. Consider where they are located relative to you. Is it close by? Convenient? Also, consider whether they are covered under your insurance plan and if you have sufficient funds to pay their fees.

Visit their websites - Start looking at websites of weight loss surgery centers in the Houston area. Find out what services they offer and how they differentiate themselves from their competitors. Learn about the experience and expertise of the surgeons at the weight loss centers.

Ask a friend - There's a good chance you have a friend who has had gastric bypass or lap banding, or at least, a friend who knows someone who has had the procedure. Get in touch with this person and ask them about their experience. What did they like about their surgery and surgeon, and what did they dislike. This kind of firsthand experience is invaluable in making a final decision.

Call their office - Ultimately though, you have to decide for yourself. Make a list of questions that capture your concerns. Call up the surgery center that interests you and ask them your questions. Call up any other centers you are interested in, and elicit the same responses. Compare the responses and see what makes sense to you.

Make an appointment - The last major step is setting up an appointment with your potential surgeon. They should be happy to see you, explain your options in detail, and allay any concerns you may have. You can do all the research you want beforehand, but this meeting is key to see whether you feel comfortable with that particular surgeon performing this procedure on you. You have to be committed in this process, and you need a person you can depend on, as well as care team, that will help you achieve your goals.

Choosing a surgeon and bariatric center can make a significant difference in your overall outcome. Take your time, and you will feel much more comfortable with your decision! Good luck!

Friday, November 20, 2009

Gastric Bypass And Diabetes

Obesity is a very common disease. Diabetes is also a very common disease. It comes as no surprise that these two diseases occur together with a high frequency. While there is no clear causal link between obesity and diabetes, there is a fairly high correlation. If you are obese, you are at much higher risk of developing diabetes, and vice versa.

The link between two diseases raises the question: is gastric bypass surgery an option for diabetic obese patients? The question is intriguing. Diabetes is a disease in which the body has either a total lack of insulin, or decreased insulin production paired with decreased sensitivity to insulin in end organ tissues. The result of this is that blood sugar levels remain elevated, a state termed 'hyperglycemia.' Diabetes can lead to many debilitating problems, such as blindness, kidney problems, and even foot amputations. Diabetes also increases your risk for strokes and heart attacks. With such harmful effects a possibility, the question of whether gastric bypass surgery can be effective for diabetic patients is a valid one.

To address this question, the American Diabetes Association, or ADA, released in 2009 a Standard of Care statement addressing bariatric surgery specifically:
Gastric reduction surgery, either gastric banding or procedures that involve bypassing or transposing sections of the small intestine, when part of a comprehensive team approach, can be an effective weight loss treatment for severe obesity, and national guidelines support its consideration for people with type 2 diabetes who have BMI at or exceeding 35 kg/m2. Bariatric surgery has been shown to lead to near or complete normalization of glycemia in 55–95% of patients with type 2 diabetes, depending on the surgical procedure. A meta-analysis of studies of bariatric surgery reported that 78% of individuals with type 2 diabetes had complete “resolution” of diabetes (normalization of blood glucose levels in the absence of medications), and that the resolution rates were sustained in studies that had follow-up exceeding 2 years (96). Resolution rates are lowest with procedures that only constrict the stomach and higher with those that bypass portions of the small intestine. Additionally, there is increasing evidence that intestinal bypass procedures may have glycemic effects that are independent of, and additive to, their effects on weight.

Given these results and this view from the ADA, if you are diabetic, obese, and living in the greater Houston area, you should consider asking your physician about gastric bypass surgery, or contacting a bariatric surgeon yourself. Ultimately, the person in charge of your obesity and your diabetes is *you*, so take charge today and make a difference in your life!

Saturday, November 7, 2009

How Bariatric Surgery Can Gain You Respect

A recent study from Johns Hopkins showed that doctors treat obese patients with less respect as compared to their non-obese patients:
Scientists reporting in the November issue of the Journal of General Internal Medicine say they found that the higher a patient’s body mass index (BMI), the less respect their doctors had for them.

Mary Margaret Huizinga, MD, MPH, of Johns Hopkins University School of Medicine and lead author of the study, says she came up with the idea for the research from her experiences working in a weight loss clinic.

She says that patients who'd visit would, by the time they left, “be in tears, saying 'no other physician talked with me like this before,'" and had failed to listen.

“Many patients felt like because they were overweight, they weren’t receiving the type of care other patients received,” she says in a news release.

She and colleagues looked at data on 238 patients and 40 physicians. The average BMI of the patients was 32.9.

A person with a BMI of 25 to 29.9 is considered overweight, and 30 or greater obese.

In the study, patients and physicians filled out questionnaires about a doctor’s visit. They were asked questions about their attitudes and perceptions of one another at the end of their encounter. Physicians were asked to rate the level of respect they had for each patient compared to “the average patient” on a 5-point scale.

The patients for whom doctors expressed low respect, on average, had a higher BMI than patients for whom the physicians had high respect, the researchers report. The researchers note that the findings don’t show a cause/effect relationship between BMI and physician respect. Their study also didn’t investigate patients’ health outcomes.
For more on this, Medscape: Doctors' Lack of Respect Weighs on the Obese.

Clearly, getting bariatric surgery will not only help directly in terms of disease burden but will also improve how you are perceived by health professionals and society at large. Ideally, doctors should treat all of their patients equally, with dignity and respect. However, doctors for better or worse are human as well. They have their own perceptions and biases, which can affect how they provide care in a detrimental manner. As this report indicates, being overweight can cause doctors to hold certain beliefs about their patients, in terms of the patient's attitude or commitment to change, leading the doctors to unconsciously change how they treat those patients.

Bariatric surgery can help change those perceptions. By helping patients who are unable to lose weight on their own get over the hump of weight loss, bariatric surgery can change the external morphology, or body shape, of a patient in a quick and dramatic manner. This change may alter perceptions by healthcare physicians, who may then be better able to look past their patient's weight in order to address other health issues. Instead of weight being a perceptual roadblock, bariatric surgery can help the patient-physician team on the right path to lifelong health.

Should doctors discriminate or disrespect overweight and obese patients? Of course not, but the reality is that it occurs. While obese patients may have sadly come to expect such callousness from the public at large, no one should have to endure disrespectful or suboptimal care at the hands of someone they place their trust in. A morbidly obese patient should be motivated to consider any options available, including weight loss surgery, to take control of their lives and commit to living healthily. Whether you choose lap band or gastric bypass or some other procedure, the important thing is that you have taken the first step in taking charge of your health and your life.

Sunday, November 1, 2009

Texas Bariatric Surgery Centers Of Excellence

Among the sites listed in the Houston Bariatric Surgery Directory and Houston Bariatric Surgery Directory Updated, some are Centers of Excellence. According to the Surgical Review Corporation, the following sites in Texas are Centers Of Excellence for Bariatric Surgery. Many centers are located in or near the Houston area:

FACILITYPRACTICESURGEON
Austin, TX
Seton Medical Center
1201 West 38th Street
Austin, TX 78705
512-324-3404
Southwest Bariatric Surgeons, PLLC
3705 Medical Parkway, Suite 210
Austin, TX 78705
512-338-5024

Dr. Mark R. Sherrod
--------Dr. Tim L. Faulkenberry
--------Dr. Patrick C Dillawn
--------Dr. Nancy G Marquez
--------Dr. Steven M Fass
St. David's Medical Center
919 East 32nd Street
Austin, TX 78705
512-544-5433

Southwest Bariatric Surgeons, PLLC
3705 Medical Parkway, Suite 210
Austin, TX 78705
512-338-5024

Dr. Mark R. Sherrod
--------Dr. Tim L. Faulkenberry
--------Dr. Patrick C Dillawn
--------Dr. Nancy G Marquez
--------Dr. Steven M Fass
Bellaire, TX
First Street Hospital
4801 Bissonnet
Bellaire, TX 77401
713-275-1111
T. Jayakumar, MD, PA
7737 Southwest Freeway #830
HOUSTON , TX 77074
713-995-1202

Dr. Thirumalairaj Jayakumar
--------Said Bina, M.D., P.A.
11850 F.M. 1960 W.
Houston, TX 77065
281-469-0596
--------Dr. Said Bina
Carrollton, TX
Baylor Medical Center at Carrollton
4343 N. Josey Lane
Carrollton, TX 75010
972.394.2332

North Texas Bariatric
4333 N Josey Lane Suite # 207
Carrollton, TX 75010
972-939-8218

Dr. Frank David Veninga
Dallas, TX
Weight Loss Surgery Program at BUMC
3500 Gaston Avenue
Dallas, TX 75246
214-820-7528
WLS Surgical Associates, P.A.
3409 Worth Street
Suite 420
Dallas, TX 75246
1-877-WLS-DOCS (957-3627)

Dr. Colleen Irene Kennedy
--------Dr. Joseph Allen Kuhn
--------NICHOLSON CLINIC
5425 W. Spring Creek
Suite #140
Plano, TX 75024
972-494-3100
visit website
--------Dr. Nick Nicholson IV
Methodist Dallas Medical Center
1441 N. Beckley Ave.
Dallas, TX 75203
214-947-8181

New Beginnings Surgical Group, PA
221 West Colorado Boulevard
Pavilion II, Suite 740
Dallas, TX 75208
(214) 948-0475

Dr. Manuel Eduardo Castro-Arreola
Columbia Hospital at Medical City Dallas
7777 Forest Lane, Suite A240
Dallas, TX 75230
972-566-6938

WLS Surgical Associates, P.A.
3409 Worth Street
Suite 420
Dallas, TX 75246
1-877-WLS-DOCS (957-3627)

Dr. Colleen Irene Kennedy
--------Dr. Joseph Allen Kuhn
THR Presbyterian Dallas
8200 Walnut Hill Lane
Dallas, TX 75231
214-345-7474

Bariatric Surgery Center Dallas
8210 Walnut Hill Lane Suite 513
Dallas, TX 75231
214-265-7546

Dr. James A Davidson
--------Southwest General Surgical Associates
(No contact info provided)
--------Dr. Robert Miller Hagood
--------Dr. richard scott anderson
Doctors Hospital at White Rock Lake
9440 poppy drive
Dallas, TX 75218
214-324-6629
Wade Barker, PA
(No contact info provided)
Dr. Wade N. Barker
Renaissance Hospital Dallas
2929 S. Hampton Road
Dallas, TX 75224
214-623-4444

Metroplex Surgical Specialists
1420 8th Ave
#101
Fort Worth, TX 76104
817 207 9775

Dr. Michael Lewis Green Jr.
Edinburg, TX
DBA Day Surgery at Renaissance,
308 Lindberg Avenue
McAllen, TX 78501
956-994-1423

Renaissance Surgical Associates
5513 Doctors Drive
Edinburg, TX 78539
956-994-1423
Dr. Robert Eugene Alleyn III
El Paso, TX
Providence Memorial Hospital
1250 E. Cliff, St 1-C
El Paso, TX 79902
915-577-7939

Southwest Surgeons for Obesity and General Surgery
125 W. Hague
Suite 550
El Paso, TX 79902
915-351-6272

Dr. Bruce Jeffrey Applebaum
Del Sol Medical Center
(No contact info provided)
Rio Grande Surgeons, P.A.
(No contact info provided)
Dr. Jorge Acosta
--------Dr. Michael David Lara
Frisco, TX
Baylor Medical Center at Frisco
5601 Warren Parkway
Frisco, TX 75034
214.407.5006
Stephen V. Hamn, M.D.P.A.
6020 W. Parker Rd
Plano, TX 75093
972-981-8440
Dr. Stephen Victor Hamn
--------Dr. Allan Joseph Cribbins III
Ft. Worth , TX
Plaza Medical Center of Fort Worth
900 8th Avenue
Fort Worth , TX 76104
817-87PLAZA

Metroplex Surgical Specialists
1420 8th Ave
#101
Fort Worth, TX 76104
817 207 9775

Dr. Michael Lewis Green Jr.
Garland, TX
Vista Hospital of Dallas
2696 W. Walnut St.
Garland, TX 75042
972-665-3000

Bariatric Surgery Center Dallas
8210 Walnut Hill Lane Suite 513
Dallas, TX 75231
214-265-7546

Dr. James A Davidson
--------Wade Barker, PA
(No contact info provided)
--------Dr. Wade N. Barker
Houston, TX
Memorial Hermann Hospital
6411 Fannin St.
Houston, TX 77030
713-704-4000

The University of Texas Bariatric Center
6700 West Loop South, Suite 500
Bellaire, TX 77401
713-892-5500

Dr. Terry Kent Scarborough
--------Dr. Erik Browning Wilson
--------Dr. Sherman C. Yu
Cypress Fairbanks Medical Center Hospital
10655 Steepletop Dr.
Houston, TX 77065
281-890-4285

Not Found
11302 Fallbrook Drive, Suite 305
Houston, TX 77065
281-894-9200
Not Found
(No contact info provided)
--------Carlos A Ferrari MD,PA.
915 Gessner Road, Suite 375
Houston, TX 77024
713 864 5487

--------Dr. Carlos Abel Ferrari
Memorial Hermann Memorial City Hospital
921 Gessner Road
Houston, TX 77024
713-242-4290

T. Jayakumar, MD, PA
7737 Southwest Freeway #830
HOUSTON , TX 77074
713-995-1202

Dr. Thirumalairaj Jayakumar
--------Carlos A Ferrari MD,PA.
915 Gessner Road, Suite 375
Houston, TX 77024
713 864 5487

--------Dr. Carlos Abel Ferrari
Park Plaza Hospital and Medical Center
1313 Hermann Drive
Houston, TX 77004
713-527-5127

The University of Texas Bariatric Center
6700 West Loop South, Suite 500
Bellaire, TX 77401
713-892-5500

Dr. Terry Kent Scarborough
--------Dr. Erik Browning Wilson
--------Dr. Sherman C. Yu
--------Hadar Spivak, MD P.A.
1200 Binz
Suite 1470
Houston, TX 77004
713-520-8900

--------Dr. Hadar Spivak
Renaissance Hospital Houston
(No contact info provided)
CLIFTON THOMAS MD BARIATRICS
800-664-9177

Dr. Clifton Erwin Thomas
--------Metroplex Surgical Specialists
1420 8th Ave
#101
Fort Worth, TX 76104
817 207 9775

--------Dr. Michael Lewis Green Jr.
Houston , TX
Houston Northwest Medical Center
710 FM 1960 West
Houston , TX 77090
281-716-1028

Philip L. Leggett, M.D.
800 Peakwood
Suite 8B
Houston, TX 77090
281-580-6797
Dr. Philip L. Leggett
--------Dexter G. Turnquest, MD,
17070 Red Oak, Ste. 507
Houston, TX 77090
281-444-8090

--------Dr. Dexter G. Turnquest
Houston, TX
University General Hospital
7501 Fannin Street
Houston, TX 77054
713-375-7000

Houston Surgical Consultants
6560 Fannin Suite 738
Houston, TX 77030
713-528-0597

Dr. Garth Philip Davis
--------Dr. Robert Davis
--------Houston Surgical Specialists
1213 Hermann Dr.
Ste. 470
Houston, TX 77004
713-993-7124

--------Dr. Robert George Marvin
--------CLIFTON THOMAS MD BARIATRICS
800-664-9177

--------Dr. Clifton Erwin Thomas
--------Texas Laparoscopy Center
(No contact info provided)
--------Dr. FELIX SPIEGEL
McAllen, TX
Rio Grande Regional Hospital
101 E. Ridge Road
McAllen, TX 78503
956-661-3560

Luis Reyes, M.D. P.A.
416 Lindberg Avenue
McAllen, TX 78501
(956)630-4161

Dr. Luis M. Reyes
North Richland Hills, TX
North Hills Hospital
4401 Booth Calloway
North Richland Hills, TX 76180
817-255-1720

Dr. David D. Kim Bariatric Surgery Center
35 Veranda Lane Ste 100
Colleyville, TX 76034
817-581-6100

Dr. David D. Kim
Pasadena, TX
Surgery Specialty Hospital of America - SE Campus
4301 Vista Road
Pasadena, TX 77504
713-378-3000
T. Jayakumar, MD, PA
7737 Southwest Freeway #830
HOUSTON , TX 77074
713-995-1202

Dr. Thirumalairaj Jayakumar
Plano, TX
Presbyterian Hospital of Plano
6200 W. Parker Road
7C Tower
Plano, TX 75093
972-981-3861

Stephen V. Hamn, M.D.P.A.
6020 W. Parker Rd
Plano, TX 75093
972-981-8440
Dr. Stephen Victor Hamn
--------Dr. Allan Joseph Cribbins III
Baylor Regional Medical Center at Plano
4700 Alliance Blvd.
Plano, TX 75093
469-814-2547
NICHOLSON CLINIC
5425 W. Spring Creek
Suite #140
Plano, TX 75024
972-494-3100

Dr. Nick Nicholson IV
San Antonio, TX
Methodist Healthcare System
8026 Floyd Curl Drive
San Antonio, TX 78229
210-575-8111

New Dimensions Weight Loss Surgery
9150 Huebner Rd
Suite #250
San Antonio, TX 78240
210-614-9210

Dr. Michael V Seger
--------Dr. Lloyd Stegemann
--------Dr. John Pilcher
--------Dr. Frank Dauterive Duperier Jr.
--------Dr. Dana Lynne Reiss
--------Bridges Center for Surgical Weight Loss
7500 Barlite Blvd.
Ste 311
San Antonio, TX 78224
888-870-9474

--------Dr. Paresh Kanu Rajajoshiwala
Southwest General Hospital
7400 Barlite Blvd
San Antonio, TX 78224
(210) 921-2000

Bridges Center for Surgical Weight Loss
7500 Barlite Blvd.
Ste 311
San Antonio, TX 78224
888-870-9474

Dr. Paresh Kanu Rajajoshiwala
Nix Hospital
414 Navarro Street
San Antonio, TX 78205
210-846-2935

South Texas Surgeons, P.A.
414 Navarro
Suite 810
San Antonio, TX 78205
210-220-1726

Dr. JOSEPH KEITH WRIGHT
--------Dr. Gerardo Enrique Carcamo
Northeast Baptist Hospital
8811 Village Drive
San Antonio, TX 78217
210-297-2034

Bridges Center for Surgical Weight Loss
7500 Barlite Blvd.
Ste 311
San Antonio, TX 78224
888-870-9474

Dr. Paresh Kanu Rajajoshiwala
--------Texas Center for Medical and Surgical Weight Loss
8811 Village Drive
Suite 300
San Antonio, TX 78217
210-651-0303

--------Dr. Ramiro David Cavazos
--------Texas Bariatric Specialists
P.O. Box 691996
San Antonio, TX 78253
210-695-2757

--------Dr. Nilesh A Patel
Texarkana, TX
Wadley Regional Medical Center
Lori Epperson, RN - Bariatric Coordinator
1000 Pine Street
Texarkana, TX 75501
903-798-8872

Ark-La-Tex Gastric Banding
2717 Summerhill Road
Texarkana, TX 75503
903-794-2263

Dr. Rachael Audrey Keilin
--------Dr. Ron Hekier
Tyler, TX
East Texas Medical Center
1000 South Beckham
Tyler, TX 75701
866-886-3835

Tyler Bariatrics
1100 E. Lake
suite 230
Tyler, TX 75701
903-593-0230

Dr. Hugh Paul Babineau
Mother Frances Regional Healthcare Center
800 East Dawson
Tyler, TX 75701
903-593-8441

Trinity Clinic General Surgery
910 E Houston, Suite 550
Tyler, TX 75702
903-510-8718

Dr. Charles V Beall
Victoria, TX
Citizens Bariatric Center
2701 Hospital Drive
Victoria, TX 77901
361-574-1738

Citizens Bariatric Center
2701 Hospital Drive
6th South
Victoria, TX 77901
361-574-1738

Dr. Brian Dean McDaniel
--------Dr. Craig G. Chang
Wichita Falls, TX
United Regional Health Care Systems
1600 11th St
Wichita Falls, TX 76301
940 764-7000

Bariatrics Of Texas
# 6 Eureka Circle
Wichita Falls, TX 76308

Dr. Kenneth M.R. Warnock