Speaking of Health Episode 42 – “Obesity and Weight-Loss Surgery”

Speaking of Health Episode 42 – “Obesity and Weight-Loss Surgery”

January 6, 2020 0 By Ewald Bahringer


Hello, I’m Jason Howland and welcome to
Speaking of Health, the place to help you learn how to live a longer and healthier
life. You know obesity is an epidemic in this country. It’s common, serious and
very costly with medical costs, associated with obesity in America,
nearing 150 billion dollars. Being obese means you are at greater risk of having
health problems and some of them can be very serious, but the good news is that
even with modest weight loss, that can lower risk, that risk, dramatically and
improve your health. So here to talk more about obesity and bariatric surgery
options is Dr. Megan Gilmore. Dr. Gilmore is a bariatric surgeon from Mayo Clinic
Health System. Dr. Gilmore, thanks for joining us today on Speaking of Health.
Thank you for having me. Well, obesity in America is on the rise, and we talked
about that, can you tell us first if someone is obese, what exactly does that
mean? Well, obese is just a term that we use to describe someone who has an
excess amount of body fat. We use a number that’s calculated with a formula,
that takes into account a person’s weight and height, and that’s called your
BMI, which stands for body mass index. If your BMI is greater than 30, that’s
considered obese. And there are millions of Americans that are obese? Yes, and the
numbers have continued to rise over the last 15 to 20 years. And being obese, it’s
not exactly, it’s not always, and shouldn’t be, just a cosmetic concern. It
can, it’s a, it’s a serious health concern? It is. There’s many medical conditions
that are associated with obesity such as high blood pressure, diabetes, sleep apnea,
osteoarthritis, some cancers are even associated with obesity. So this is a, is
a disease that affects people physically, more, even more than it does cosmetically.
So what is causing so many Americans to become obese in this country? Well,
obesity is caused by several different factors. We know that there’s genes that
play a role in it. You know our genes can affect the
way that we store body fat and also our metabolic rate. We also know that
lifestyle plays a role in that, as far as, the amount of activity that we have, the
amount of exercise that we get, and then also the environment. There’s a component
of genes, but also a component of you eat what you were taught to eat. You know,
that’s kind of where you get into the fast food and processed foods that we
see a lot of now in our country. And I know, I know obesity is a complex issue and there are many factors, but is it as simple as basically taking in more
calories than you burn? iI is. It’s calories in versus calories out and
that’s what what leads to the weight gain. So what are some unhealthy diet
choices that people make that lead to obesity? Well, there’s a variety of
different choices that people make as far as their diet that are unhealthy. And
a lot of them, people aren’t even aware of, things like Gatorade. They think that
they’re doing good by drinking Gatorade instead of coke, but really Gatorade has
a lot of sugar in it too. So there’s a lot of education that we do in our program
to help people understand that sometimes choices they don’t even know are
unhealthy, actually are unhealthy. You know it’s becoming more and more you see
like supersize and in large portions and that’s kind of play a big factor too,
right? Absolutely portion size is a huge problem and we generally ask patients
what they see is their problem, whether its food choices, activity levels, or
portion size? And often it’s a combination of all three. So at what
point is weight loss surgery, or bariatric surgery, when is that an option
for someone? Well, that becomes an option when patients have tried other forms of
weight loss, such as conventional weight loss, including exercise, medications,
different diets, when those have not worked and patients aren’t having
success with that, then they become candidates for surgery. Now in order to
be a candidate for surgery, for health insurance reasons, patients have to have
what we call BMI greater than 35 and a medical comorbidity, such as
hypertension, sleep apnea, diabetes, osteo arthritis, or they can have a BMI 40
without any other medical problems. And Then do you also have to meet certain
medical qualifications to to have surgery? You need to have, you know,
cardiology clearance and pulmonary clearance, If that’s necessary. And you
also have to have your diabetes under control and just overall be fit for
surgery. So what sort of evaluation and preparation is there for weight loss
surgery patients, what do they have to go through before they can actually have
surgery? In my program it varies, it’s very individualized to each patient.
There are certain requirements that all people have to fulfill and that’s that
they have to have three visits with a registered dietitian, and that’s to help
identify some other unhealthy eating habits, as well as, help prepare them for
the surgery and what they’ll be able to eat after surgery. They also have two
visits with a behavioral health, that we can help identify any behavior
modification that they might need and those are the requirements for our
program, but then on additionally some patients need to have sleep studies. Some
patients need to see the GI doctors and have scopes and h pylori testing, and
that type of thing, some patients just need to be followed by their medical
doctor and get medical clearance. And all patients need to stop smoking. So it’s
not just a matter of a patient coming in to see you and a day later they have
weight loss surgery, it’s you have a whole team, and in, it’s a matter of over
months, right? It’s not like regular general surgery procedures where you
come in and we get you scheduled the next time we have an opening. Patients
typically will take, I would say, on average, about six months to get through
the program, but it can be up to 12 months, even up to two years to get
through the program, so that they’re mentally, emotionally, and physically
ready for the surgery. So what are the most common forms of weight loss surgery, there’s not just one, so what are the most common forms? The three types that
we do at Mayo Clinic Health System are the ruined my gastric bypass, the sleeve
gastrectomy, and the adjustable gastric banding. Gastric bypass is the most
commonly performed bariatric surgery in United States and that’s the one that’s
had the most success for weight loss, as well as, resolution of comorbidities such
as diabetes and hypertension. And then there’s the sleeve gastrectomy which has
has results similar, not quite, to the bypass, but approaching that, and then the
gastric banding, which has weight loss of about fifty percent and a little bit
lower resolution of the other comorbidities. In all three of those
surgeries the principle is all the same, right? You’re limiting the amount of food
that your body can consume, right? The procedures are classified as restrictive
and malabsorptive and some are combination of both. A gastric bypass is
a combination of both. Its restrictive and malabsorptive, because we re-route the intestines to help with, limit the amount of absorption, as well as, the amount of
food, that’s patients can take in. The sleeve is strictly restrictive, although
a portion of the stomach is removed and there’s certain hormones in the stomach
that are removed with that, and so it does have a little and that’s why it’s a
little bit better weight loss than the band. Where the band is purely
restrictive and there’s no hormonal changes or anything that happens with
that. So it just completely functions by limiting the amount that someone can
eat. So let’s, let’s go step-by-step through the three procedures. So start
with gastric bypass, what exactly are you doing to the body there? First we make
the stomach smaller. It’s about 30 CC’s, which I tell patients is about the size
of an egg. The remainder of the stomach stays inside the body in its normal
place, but we re-route the small intestines and hook that up to the small
pouch and that aids in malabsorption of food. Okay, and then next with the sleeve.
The sleeve gastrectomy is, we simply remove part of the stomach, and that part
of stomach actually comes out of the body, and their stomach is reduced to
about the size of a banana. And then lastly, the band. And the band is where we
take a silicone band ,that goes in and around the top of the stomach, and that has a
balloon on it. And there’s a port that’s placed in
their abdominal wall that has a tube that connects to the band and we can
adjust that with saline. And all these procedures are laparoscopic, right? They
all are. So what what are the benefits of that ? The benefits of laparoscopic
surgery is that the recovery time is much faster, patients have a lot less
pain, cosmetically they don’t have a big scar. So how effective is weight loss
surgery, bariatric surgery, how effective is it? This surgery, the effectiveness of
it, is measured by what we call excess body weight. So any, if your ideal body
weight is say 200 pounds and you weigh 300, if you lose half of that, we consider
that a success. Now with the gastric bypass, people will lose seventy
percent of their excess body weight. So if they weigh, should weigh 200 pounds, and
they weigh 300 pounds, they can expect to weigh 230 pounds after the surgery. And
that’s, those are rough numbers, but you know that’s kind of the average. With the
sleeve gastrectomy, we see about sixty percent of excess body weight is lost. In,
with the Lap Band, we see about fifty percent. What about complications, can
there be complications with the surgery? There can. There’s complications with the
surgery just like there is complications with any surgery. We make sure that the
patients are counseled on that and we have worked very hard to improve the
quality of bariatric surgery. It kind of had a bad rap, 15-20 years ago, and we’ve
worked very hard to make this a much safer surgery for patients but there are still
significant risks. Well, it’s important to note for folks, that this is not a quick
fix. You don’t have the surgery and suddenly your life changes. You have to
make changes in your life, for your life to change, right? And to keep that weight
off? Yes, the surgery, what I tell patients is, that the surgery is going to
work for you for about 12 to 18 months, and during that time period you’re going
to lose weight, no matter what you do. And then, if you haven’t adjusted your life
and improved your nutrition, and increased your activity level, and
started actually exercising, you will likely gain some of that weight back.
Because, initially, after a patient’s had bariatric surgery, the amount of food
that they can eat is very minimal, right? Which is why they’re losing the weight.
How much food can someone eat or what kinds of food can you eat, like say the
first month or two after surgery? After a bypass, people can eat real soft, kind
of mashed, foods and they can usually eat about half a cup at each meal. They have
to take a lot of protein in, so there’s a lot of protein shakes and then slowly
they can eat more and more and it depends kind of on what people do, some
people will kind of stretch that out to where they can eat normal amounts of
food, but we don’t like to see that. With the sleeve patients actually leave the
hospital on a liquid diet and they stay on a liquid diet for about three weeks
and then they can start with the softer foods. Quantity wise it’s similar,
probably about half a cup to a cup, that they eat at each meal. And with the band
also they stay on a softer diet for a little while to and kind of the same
amount of food that they can eat, about a cup. How do you ensure that
patients are getting the nutrition that they need still, or the the vitamins and
that kind of thing, if they’re not getting much for food intake? Patients do
take a multi-vitamin after surgery. We also check lab work at their 3-month
visit so we check all their iron, vitamin levels, protein levels, to make sure that
they’re getting in the right amount of protein. And at every visit when they
come back after surgery, we see them frequently, and the dietitians going to
calculate how many calories they’re taking in, as well as, how much protein
and then if they’re not getting in enough protein, we make sure that we
encourage them to up their supplements. You know, I think there are many folks
out there that have probably met, or know someone, who’s had bariatric surgery and
there are probably some out there that have known someone, who’s had that surgery, lost weight, and then gained most of it back. Well, what words of advice can you
give, for someone who’s contemplating having the surgery, or has just recently
had the surgery, to keep that weight off long term? One of the things is to stay
contact with your team. We are here to help and we have dietitians ,we have
behavior health, myself, we have a program coordinator that are always there for
patients and when they feel like they’re slipping, you know, we really encourage
them to come back, meet with us for an hour, half an hour, get some
accountability, get them back on track. Also really important is support groups
and we will be starting support groups for patients and we hold those monthly.
That’s really a huge benefit for people because it’s really difficult to
describe what this is like for patients to go through this, because it’s so
life-changing. And so really the only people that can really understand it are
other people that have gone through it. So we really encourage that and people
find tremendous support and again accountability through that. And do you
think it’s important for patients to know that you know this is an
opportunity, it’s, it’s not just about you come in and like getting your oil
changed. You know this is an opportunity for you to change your life. Yep,
absolutely and you know I tell patients that this is a gift and that they really
need to treat it that way. And you know people that do look at it that way, do
really well and you know it is life changing. Very rarely do patients ever
come in saying that they want the surgery because they want to look better.
It’s always because they want to be able to get on the floor with their kids or
their grandkids and they want to be able to get off all their pills, and you know
they want to be able to walk out to their mailbox, without having to stop and
rest. So, you know, these are real issues for these people and it’s amazing what
it does even at six months, even at a year, how different they are. So someone’s
contemplating having weight loss surgery, what’s the first step for them?
First step would be to attend one of our informational sessions. We offer these
twice a month and you can find information on the website. They’re free
seminars that are held in the evening and once you attend one of the
informational sessions, you’ll get information about conventional weight
loss, as well as, the surgical weight loss options, and if you think it’s something
you want to pursue further, after you’ve attended that session, you can call make
an appointment and get in to start seeing the team.
Can they also maybe just talk to their primary doctor too and and say that
they’re interested in, or maybe interested? They can but we still do
require them to come to the informational session, before. But I do
think that the first place to start is with discussing it with your primary
care doctor. All right, fantastic. Well unfortunately, we’re all out of time. I’d
like to thank our guest today Dr. Megan Gilmore, bariatric surgeon at Mayo Clinic
Health System for joining us today on Speaking of Health. Thank you very much.
Thank you. Have a great day everyone and be healthy. you