By: Elizabeth Landry
Obesity is a major chronic disease affecting many adults in the United States. At St. Peter’s Health Partners, the St. Peter’s Bariatric and Metabolic Care team treat obese and overweight patients in the greater Albany area, from Saratoga County, to Vermont, Western Massachusetts and even as far South as Poughkeepsie. Working out of both Samaritan Hospital and St. Peter’s Hospital, the multidisciplinary team includes providers specializing in bariatric surgery, internal and bariatric medicine, nutrition, and behavioral health to support a full range of individualized care for bariatric patients.
Samuel Hykin, MD, FACS, Director of Bariatric Surgery for St. Peter’s Health Partners, has been leading the team since 2021 and has spent over seven years performing bariatric surgery. Once patients have attended an informational seminar about bariatric medicinal options and chosen to pursue care with the team, the providers put together a weight loss plan that looks different depending on each patient’s needs and goals, as Dr. Hykin described.
“We really focus on individualizing strategies and procedures for patients, meeting them where they are in their journey. We look at the patient as a whole, determining what other medical comorbidities they have and what their goals are in terms of how much weight they want to lose. Whether patients decide bariatric surgery is right for them, or if they prefer to go the non-surgical route, our integrated team approach helps support them in reaching their goals,” said Dr. Hykin.
Minimally Invasive Bariatric Surgery Options
For many patients experiencing obesity, bariatric surgery is selected as the best strategy to help them reach their targeted weight loss. At St. Peter’s Bariatric and Metabolic Care, patients are required to receive several clearances to qualify for surgery, which helps to ensure patients are ready and can be as successful as possible. Prior to receiving a date for surgery, patients must achieve 5% weight loss, receive clearances from nutrition, behavioral health, and cardiology, have an endoscopy and possibly also a sleep study. To be considered for surgery, patients need to have a BMI (body mass index) of 35-40 or higher and may need to have at least one of the comorbidities associated with obesity, including diabetes, high blood pressure, sleep apnea and high cholesterol.
There are two main surgical options offered at St. Peter’s, a sleeve gastrectomy and gastric bypass, both minimizing parts of patients’ digestive systems, which can result in a loss of between 50-75% of excess body weight. Dr. Hykin explained how these surgeries have become significantly less invasive over the years, with most patients now able to go home the day after surgery.
“About ten years ago, medical society made a shift toward minimally invasive surgery and shorter hospital stays which have dramatically improved patient outcomes,” said Dr. Hykin. “Right now, I complete a gastric sleeve surgery in three to five small incisions, and a gastric bypass is done in four to five small incisions. Patients can be in and out relatively quickly and get back to their everyday lives without much interruption.”
Importantly, improved patient outcomes are tied to lower complication rates. Dr. Hykin has consistently achieved a
complication rate at or below the national average while performing bariatric surgery at St. Peter’s, and the patient success rate at the bariatric care center has remained strong at about 85-90% even while seeing a high volume of patients.
In fact, the bariatric surgery center located at St. Peter’s Hospital has received the Bariatric Center of Excellence designation from the American Society for Metabolic and Bariatric Surgery (ASMBS),
which requires a stringent certification process in addition to high patient success rates and low complication rates.
“The process is about patient safety, protocolizing your approach, low complication rates, quality follow-up care – all of that combined. If you meet the bar, you’re granted Center of Excellence status, and you must recertify every three years. During those next three years you need to continue to meet the standards you were originally qualified by, and the ASMBS reviews
that time to ensure the standards were achieved. It’s a very rigorous process but it
ensures excellence in bariatric care, which is what makes it so
important,” stated Dr. Hykin.
Multidisciplinary Approach to Metabolic Medicine
Whether patients opt for bariatric surgery or if they choose to work toward weight loss using non-surgical strategies, the integrated, multidisciplinary team at St.
Peter’s offers cohesive support to help patients overcome obesity. Leading the way in non-surgical bariatric medicine at St. Peter’s is Priyangika Pathirana, MD, board-certified bariatric medicine and internal medicine physician, who’s been with St. Peter’s Health Partners for about 17 years.
Dr. Pathirana’s approach to bariatric medicine involves four main strategies: changes in diet and nutrition, changes in exercise, behavioral modification, and medications, when appropriate. Her strategy for patients is highly customized based on each patient’s individual needs, and she explained how the process and the goals are about much more than reaching a target weight.
“My goal for each patient is to help them become a healthier person, medically and psychologically. It’s not just about appearance – it’s about much more than the weight. Patient goals are very individualized, and so we receive a full patient history and create an individualized plan for how to change their eating and exercise habits. For example, some people cannot do regular exercises so we may teach them how to do chair exercises. It’s certainly not a ‘cookie-cutter’ type of approach,” said Dr. Pathirana.
Working with Dr. Pathirana to provide customized plans for weight loss through diet and exercise is a team of three registered dieticians including Lauren Zielinski, RD. Seeing non-surgical metabolic patients as well as surgical patients both pre- and post-operatively, Zielinski and the team help guide patients in balancing out their meals, focusing on a low-carbohydrate and higher-protein diet to achieve weight loss goals.
Zielinski aims to provide realistic strategies for patients that help them be more likely to achieve success. “I like to 
meet patients wherever they’re ready to make changes. I’m all about sustainability and being realistic with where the patient currently is and what changes they want to make,” she said.
Rounding out the integrated medical weight loss team is Alyssa Kontoh, licensed mental health counselor and board-certified bariatric counselor. She completes psychological assessments for patients pursuing surgery and offers support for any patient needing mental health guidance, including non-surgical patients seeing Dr. Pathirana, as well. Many patients have been struggling with obesity and weight issues since childhood, and Kontoh works with patients regarding their family history of eating habits, including food rules or messaging they may have carried over into adulthood.
Kontoh emphasized how the integrated team approach at St. Peter’s, as well as the support groups she offers, set the team apart from other bariatric medicine centers.
“Our office is truly based in a multidisciplinary approach,” Kontoh said. “We’re a very close office and we have very good communication with each other. We make sure we’re letting each of the other providers know if a patient may have a higher need for enhanced support as they work toward their goals. I also think the support groups we offer are a major highlight of our office – we cover topics ranging from binge eating to navigating change to the stress of the holiday season. The number of resources we offer is often surprising to patients.”
Helping Patients Attain Long-Term Success
With all the medical weight loss providers working together, the team at St. Peter’s helps set bariatric patients up for success on the rest of their journey. Once weight loss goals are reached, patients can choose to remain engaged with the office as often as they like, and surgical patients are seen regularly post-operatively at one week, one month, three months, six months, one year and yearly thereafter.
Although each provider or team of specialists at St. Peter’s approaches bariatric medicine through a different lens, a common thread that connects them all is how rewarding they each find it when they can celebrate their patients’ successes alongside them. For each, overcoming obesity is less about the number on the scale and more about the unique and often seemingly simple achievements that affect each patient’s life in different ways.
“My goal for patients is to give them their lives back,” said Dr. Hykin. “My favorite story is about a gentleman who came to me for bariatric surgery, and I asked him the true reason for why he came to our office. He told me he had been at the Great Escape over the summer and couldn’t fit into the rollercoaster with his son. He remembered riding the rollercoasters with his father when he was young and it being the best time they had together. When he couldn’t create that memory with his own son, he said that was the moment he knew he needed help. He was very motivated, completed the program, and when he came back for his six-month follow-up, he said, ‘Doc, you’re going to like this. We went back to the Great Escape, and I was able to ride that rollercoaster with my son. It was a blast.’ You can’t put a price tag on that. It was one of those moments that just sticks with you.”
Certainly, as the practice expands and grows to help support more patients in reaching their weight loss goals, the motivation for each provider at St. Peter’s will remain focused on finding strategies that work for each individual patient, as Dr. Pathirana emphasized.
“It’s the patient’s weight loss journey and I’m here to help them and offer support as needed for each individual,” she said. “It’s the simple things that really do matter, which show how their progress really affects their life. It’s a very rewarding job. This is my happy job. I so enjoy working with my patients.”