St. Johns

Nationally recognized for clinical excellence, UF Health St. Johns understands the special needs that come with having bariatric weight loss surgery.

Obesity affects more than 1 in 3 adults in the United States. It's a disease, classified as such by major health organizations, including the World Health Organization, National Institutes of Health, American Medical Association, National Academy of Sciences and Centers for Disease Control and Prevention. For those suffering from morbid obesity, surgical weight loss is the only proven, reliable and long-term weight loss solution.

As an accredited bariatric surgery center, we can help you determine if weight loss surgery is right for you and which bariatric procedure best suits your specific needs. A team of medical professionals will also walk you through the process of preparing for surgery, recovering and reshaping your everyday routine to include healthier habits. Our nutritional and exercise programs, spiritual counseling and support groups are all vital components of your post-operative success. We'll help you make them part of your lifestyle change and realize your weight loss goals.

UF Health St. Johns Bariatrics is led by Robert Marema, MD, FACS, who is a board-certified bariatric surgeon. As a whole, our comprehensive program covers the full scope of weight loss services, including access to:

• Bariatric surgeons
• Nutritionists
• Exercise physiologists
• Psychologists
• Gastrointestinal specialists
• Pulmonologists
• Cardiologists
• Endocrinologists
• Nephrologists
• Medicine physicians
• Plastic surgeons
• Spiritual and emotional support groups

Your journey to surgery

Each individual's health information is carefully evaluated for any related medical conditions. This often requires special studies and occasional consultations from accredited medical specialists. We must be confident that weight loss surgery is right for you. We need to make sure that both you and the bariatric team are fully aware of associated risks before we will schedule the surgery to promote positive lifelong outcomes. Please be aware that certain insurance companies require a six-month, physician-supervised weight loss program prior to covering weight loss surgery. We have a dedicated insurance specialist to assist with preoperative mandates required by individual insurance plans.

Meet our team

Let the UF Health St. Johns Bariatrics program help you overcome your obstacles. With world-renowned bariatric surgeon Dr. Robert T. Marema serving as medical director, we can help you defeat obesity once and for all. We can help you determine if surgery is right for you and which procedure best suits your specific needs.

Our comprehensive program includes access to nutritionists, exercise physiologists, psychologists, GI specialists, pulmonologists, cardiologists, endocrinologists and plastic surgeons, in addition to spiritual and emotional support groups.

Is surgery for me?

We'll help you find the answer

It's important to know you're not the only one asking this question. Over 40% of adults in the U.S. suffer from obesity or excess weight, and nearly 1% of people have severe obesity. At UF Health St. Johns Bariatrics, we recognize that weight loss surgery is not just about shedding pounds. It's about regaining control of your health and rewriting the story of your life.

According to the Centers for Disease Control and Prevention, excess fat in the body is commonly associated with more than one life-threatening health condition. Heart disease, stroke, Type 2 diabetes and certain types of cancer are among them. In addition, obesity also impacts quality of life and can commonly interfere with social and personal activities. Sometimes a lifestyle change related to diet or exercise can help prevent diseases like obesity, but not always.

Bariatric surgery helps people lose excess weight by changing the structure of the stomach and intestines. Learning about the expenses of a bariatric procedure helps patients plan with confidence. Weight loss surgery reduces a patient’s premature death risks by 30 to 50%. While it can be expensive, many additional costs arising from being overweight can be eliminated.

Surgical criteria

Weight loss surgery candidates must meet the following criteria for surgery:

• Have a body mass index (BMI) of 40 or more OR have a BMI greater than 35 with at least one significant health problem
• Be between the ages of 18-80 years old (some exceptions apply; will be determined on an individual basis)

What if surgery isn't the solution?

UF Health St. Johns Bariatrics doesn't just focus on surgical options to help you achieve your ideal body weight. We also are dedicated to working with each patient to assist with weight management and create a healthy lifestyle.

As a center accredited by the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program, you are guided through your weight loss journey by a team of experts from different disciplines. Every member of our program works together to help you meet your weight loss goals.

How to tell if you're obese

The most common way to assess your weight and measure health risks related to your weight is through your body mass index.

BMI is calculated using height and weight. To determine your BMI, use this online calculator or:

1. Multiply your weight in pounds by 703
2. Divide that answer by your height in inches
3. Divide that answer by your height in inches again

For example, a woman who weighs 270 pounds (122 kilograms) and is 68 inches (172 centimeters) tall has a BMI of 41.0.

See below to determine what category your BMI falls into:

• Below 18.5 = Underweight
• 18.5 to 24.9 = Healthy
• 25.0 to 29.9 = Overweight
• 30.0 to 39.9 = Obese
• Over 40 = Morbid obesity (extreme or high-risk obesity)

*According to the latest data from the Centers for Disease Control and Prevention.
Source: Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion.

Common questions

Live seminars

During our educational programs, we will provide you with all the information needed to help you decide whether weight loss surgery is right for you. We will highlight the health risks of obesity, including diabetes, heart disease, high blood pressure, respiratory complications and arthritis.

Support groups

UF Health St. Johns Bariatrics provides a comprehensive educational program to assist in your post-operative weight loss success. Monthly support groups are held covering topics such as diet and exercise, eating success and lifestyle management.

To learn more or participate, contact our Bariatrics Coordinator at bariatricinfo@flaglerhealth.org.

Frequently asked questions

Is bariatric surgery covered by insurance?

Insurance plans vary and have different criteria for coverage eligibility. Our dedicated insurance navigator will work with your insurance company and guide you through the entire process.

When can I go home after surgery?

Usually patients stay 1-2 nights in the hospital. You will not be discharged until your medical team is comfortable that you can tolerate small sips of water and a protein supplement, nausea and any pain or discomfort is well controlled. Do NOT force this process; we want to discharge you home so you can be successful with your new knowledge and habits from your decision to have weight loss surgery.

Why do I have to stop smoking?

Smoking leads to complications during and after surgery. We want you to be successful with your decision to have weight loss surgery and eliminate any unhealthy habits that would not lead to improving your health and lifestyle.

Will I lose my hair? Can I prevent hair loss?

Hair thinning can occur due to nutrient changes in your body. Meeting your protein goal, vitamins and mineral supplements each day can help. Hair loss is usually noted three months after surgery and after seven months regrowth begins. Not everyone has hair loss and for those who do, it is temporary

How often should I weigh myself?

Patients who are most successful after weight loss surgery make it a habit to weigh themselves regularly. This is another habit that commits you to being accountable and responsible for your success. How often is regularly? Once a week is reasonable. Use the same scale, same time of day upon waking and after using the bathroom, wearing the same clothes (or none). Keep a log of your weight. An extra pound/kilogram each month can add up to gaining back weight that becomes too overwhelming to lose again. Stay on top of your success. Checking your weight more than once a week can be too excessive.

Understanding your surgical options

Each patient is different and requires a different approach. Our team of experts will meet with you, one-on-one, to discuss the best weight loss option for you.

Common bariatric surgeries

Gastric Bypass

The most common and successful surgical weight loss surgery is the Roux-en-Y gastric bypass. Not only does gastric bypass generate weight loss, it has also been recognized to resolve Type 2 diabetes long before any weight loss even takes place.

During surgery, a small stomach pouch is created to restrict food intake. Afterward, a Y-shaped section of the small intestine is re-routed and attached to the new pouch. This allows food to bypass the lower stomach and the upper parts of the small intestine, reducing the amount of calories and nutrients the body absorbs. The small stomach pouch created during surgery can hold only about 2-4 tablespoons (3 ounces), drastically reducing the amount of food that can be eaten at one time. A gastric bypass patient will typically lose 75% of their excess body weight in the first 18 months, which is maintained long term.

In most cases, the Roux-en-Y gastric bypass procedure can be achieved through minimally invasive laparoscopic methods. Dr. Robert T. Marema, M.D., F.A.C.S., was a pioneer in the development of laparoscopic techniques in bariatric surgery.

As with any laparoscopic procedure, the recovery time, patient discomfort and risks are reduced when compared to open surgery. However, not all patients are candidates for laparoscopic procedures. Gastric bypass surgery carries the same risks as any other major abdominal surgery.

Shortly after surgery, patients are back in their hospital room. Sitting up in a chair or walking around is encouraged. Patients are usually discharged approximately two days post-surgery. Gradually, physical activity will increase, with near-normal or normal activity resuming a few weeks after surgery.

Sleeve Gastrectomy

Dr. Marema was the first surgeon in Florida and second in the world to perform a single-incision vertical sleeve gastrectomy. He has since trained physicians from around the globe on this procedure.

Watch Dr. Marema explain sleeve gastrectomy.

Vertical sleeve gastrectomy is the latest and fastest-growing type of surgical weight loss procedure, which dramatically minimizes the size of a patient's stomach. The stomach is divided lengthwise and a narrow, banana-shaped tube (sleeve) is created by removing 80% or more of the stomach.

The gastric tube is much smaller than the stomach's natural size, thus restricting the amount of food that can be eaten at a given time. The remainder of the stomach is removed and, since no bypass is created, absorption of nutrients remains normal.

The procedure takes about 30 minutes and has been reported to produce a loss of 50% or more of excess weight.

Revisional Bariatric Surgery

If you have previously had weight loss surgery, Dr. Marema is well-versed in revisions. This type of surgery is performed for a variety of reasons, including complications related to a surgery, weight regain and reflux after prior procedures.

Gastric Band Removal

In instances where the band system needs to be removed, this can be completed laparoscopically.

Contact us

UF Health St. Johns Surgical Specialists
300 Health Park Blvd. Suite 5002 | St. Augustine, FL 32086
(904) 819-5861

UF Health St. Johns Bariatrics Coordinator
Christina Mazone, RN, BSN, CCM
(904) 819-4675
bariatricinfo@flaglerhealth.org