Fayetteville physician creates destination for bariatric surgery on national scale

As Northwest Arkansas continues its journey to becoming a healthcare destination, one group of doctors is already there. Over the past 12 years, Dr. Josh Roller and his team of bariatric specialty surgeons and dietitians have created a practice that is a destination for more than 6,000 people seeking permanent weight loss solutions.

The Roller Weight Loss & Advanced Surgery Center in Fayetteville and Northwest Medical Center in Springdale were recently named a Center of Excellence (COE) bariatric surgery practice in the Employers Centers of Excellence Network (ECEN). There are only five COE facilities in the country. Roller said the group applied for the ECEN designation and underwent a review process which considered the volume of cases and their outcomes at the Fayetteville center over its 12-year history.

With the ECEN credential, Roller added Walmart Inc. as one of its corporate partners. Roller said Walmart added coverage of bariatric surgery to its health plan about two years ago. Today, Roller is one of five Centers of Excellence clinics in the country for Walmart employees seeking bariatric surgery.

Roller said his practice is in good company. Walmart has health system partners in 18 cities around the country with the likes of Mayo Clinic, Cleveland Clinic, Johns Hopkins, Geisinger Health System and Memorial Hermann in Houston. Roller and Northwest Medical Center are the only COE partner in Walmart’s home state of Arkansas.

Roller said Walmart has more than a million employees in the U.S. His clinic is one of five choices those employees have for bariatric surgical care under the company’s health insurance plan. Walmart is not the first corporate partner for Roller. His practice is the exclusive bariatric surgical choice for J.B. Hunt Transport, Simmons Foods and NorthWest Arkansas Community College.

He said establishing those corporate connections was tough in the beginning because, in 2007, bariatric surgery was getting mixed reviews around the country. He partnered with Northwest Medical Center in Springdale to grow a reputable bariatric practice. Roller’s practice only employs surgeons with bariatric fellowships. That takes an additional year of specialty training in the field. Roller got his fellowship at Duke University Hospital and his partners hail from Stanford and the University of Washington in Seattle.

Roller said he and wife, Dr. Kristin Roller, came to Northwest Arkansas and fell in love with the area. He said they were going to set up a practice in Tulsa, but the opportunity to work with Northwest Health to engineer a bariatric program from the ground up was intriguing.

“At the time, two of the health providers in the region had discontinued their bariatric service. We thought this was a great opportunity to build a center of excellence from ground zero,” Josh Roller said.

Denten Park, Market CEO of Northwest Health, said now being able to access nationally-recognized care close to home is significant for Northwest Arkansas.

“We are grateful for the opportunity to serve along with the wonderful bariatric surgeons at Roller Weight Loss to deliver exceptional outcomes to our neighbors,” Park said.

Kristin Roller is the bariatric medical physician on staff who evaluates all patients before and after surgery, including the long-term follow-up care for patients of the clinic. She said becoming a bariatric destination took some time, especially overcoming the stigma bariatric surgery had more than a decade ago.

“I have treated patients who traveled here from New York, Texas, several mid-western states, Alabama, Oklahoma and several other states. For people to travel to your region for health care they are looking for excellence, a level of service they can’t get at home,” Roller said.

Josh Roller said the Fayetteville practice was set up to handle quick turnarounds for people who were traveling long distances for the surgery. The business model follows that of M.D. Anderson, in that all the testing needed before surgery can be done in-house for quick results to minimize the time a patient has to stay.

Roller said for Northwest Arkansas to become a true healthcare destination, the level of specialty care excellence will have to increase. He said Arkansas Children’s Northwest is a significant first step, but there is still much work to do.

Roller’s practice conducts about 1,200 weight loss surgeries a year, and Roller himself does about 650 of those. He said as more businesses are covering the procedures, the demand is growing. Roller said the techniques in the field continue to change. The latest is the modified duodenal switch, which leaves a bit more of the stomach intact than the traditional gastric bypass procedure. Just 50% of the small intestine is bypassed, which allows for more absorption of nutrients reduction malnutrition risks.

Roller said the modified procedure allows patients to continue taking aspirin, nonsteroidal anti-inflammatory drugs like Advil and steroids without risking ulcers. He said the procedure results in up to 90% of excess weight loss, the highest of all procedures. He said it is also the most effective in reversing Type 2 Diabetes. Roller was the first surgeon in Arkansas to perform the surgery.

“We have an 80% cure rate of Type 2 Diabetes in patients who have the surgery,” Roller said. “That is what is getting employers’ attention to cover the surgery. Diabetes costs on average around $13,500 per year per insured and the surgery pays for itself in under two years.”

He’s had a number of patients lose more than 300 pounds from having the modified duodenal switch surgery. Roller said losing the weight, reversing diabetes and sleep apnea can add up to 12 years to a person’s life. Lastly, he said a significant number of all knee replacement surgeries could be eliminated if a patient lost enough weight. A typical knee replacement can cost between $40,000 and $60,000, according to Roller.

While bariatric surgery can be useful in helping people lose weight, Roller said it’s just one tool. Without close patient follow up and a long-term plan for success, the outcomes can be mixed. He noted the patients’ diets have to change. Some adjust better than others, but in general, weight loss surgery is an “amazing tool” with tremendous success.

Roller requires follow-up visits six times the first year, two trips in year two and then one annual visit each year after that. He said frequent visits in the first year make it easier to see how well patients are adjusting to new dietary habits. He said if the weight starts creeping up, intervention strategies can be used to help put patients back on track.

“Roughly 5% to 15% of bariatric patients nationwide will put the weight back on, particularly if they don’t have the complete bypass,” Roller said. “Compare that just 1% of people who lose significant weight without surgery and keep it off for two years. Most would take the 5-to15% gamble against the 99% failure rate without surgery.”

For the region’s efforts to become a healthcare destination, Roller said he would love to be part of the conversation and planning.