[Calm music]
- Folks will gain weight slowly over time,
and it may start early on in life or it may start later in life.
They finally get to a weight
that their body,
although it is unhealthy at that weight,
is comfortable at that weight
and to try to drive their weight down
with diet and exercise doesn't work,
the body fights it
and at that point,
we're dealing with a disease,
the disease of obesity.
Our basic primitive drives are,
when faced with high-calorie food to consume it,
even if at that particular time,
we don't need the calories.
The willpower is really not useful
when you try and use it to curtail basic instincts.
It just doesn't work.
- It's really a disease.
We know that this is mediated by hormones in the body,
which promote weight gain in some people
and don't allow for weight loss.
- We all have a certain spectrum,
a range where we fall in
and you can affect that range.
You can be above and below that range,
but you are set in a certain precondition
that's based on your own body history,
your family history, your own physiology.
- To treat obesity, you need to treat it like a disease with medical therapy.
- I never gave a second thought to what I was eating.
I was pretty skinny my whole life,
and it just gradually crept up on me.
- Even as a teen, I never really had
a good image of myself
and when I started gaining weight
it just really made that a lot worse.
- Clearly nutrition is very important but
people become obese through a combination of many different factors.
- [Laurie] Your body gets comfortable at a certain weight
and my body was comfortable at 240 pounds.
- [John] People would refer to me as Big John.
I'd never thought of myself in those terms,
but that was kind of sobering.
- [Laurie] I didn't realize how big I was,
'cause I didn't feel that big,
but when I saw pictures,
I just didn't recognize myself
and I'm like, I really need to do something about it
because I'm heading into my 40s soon,
and I really want to just be healthy.
- At my heaviest, I still took the stairs two at a time,
but the difference was,
when I got to the top of the stairs,
I was winded, my heart was pounding.
My doctor said I was pre-diabetic.
That really scared me.
That was the catalyst that really
spurred me into action.
- [Dr. Mehal] There are a multitude of health risks,
heart disease, diabetes,
high blood pressure,
fatty liver disease
and, at the end of the day,
it affects mortality.
People become obese through a multitude of different routes,
and they lose weight through a multitude of different routes.
It's a question of identifying very early on for patients
what might be the best intervention.
- [Dr. Hubbard] We know that many people are trying,
and they lose weight and they gain it back.
They yo-yo up and down.
If I could take that same effort and apply it after surgery,
when we know we've changed those hormones,
it gives the patient a tool to use their hard work to achieve their weight loss goals.
- [Dr. Nadzam] Bariatric surgery is a broad term.
In essence, it is any operation that helps surgically reduce weight.
There are two main bariatric surgeries performed.
That would be a gastric sleeve or a gastric bypass.
We do them laparoscopically
with small incisions and long instruments.
With surgery we are able to drive the weight down for long enough
that now their body is comfortable back at a weight that is more reasonable.
This is a disease that we treat surgically,
but that afterward is treated in a multi-disciplinary approach.
It's part surgery and part patient
and I tell patients that all the time.
- [Laurie] It's not a free pass.
You really have to work on it to maintain your weight.
- [Dr. Nadzam] Patients will lose more than half
of all of the weight they're gonna lose
in the first three months after surgery.
- We would like to wait until at least a year,
when a patient is close to their new low weight
before we'd approach skin removal surgery.
- [Dr. Alperovich] When you go through these operations,
your body transforms.
You are a different person at the end of the surgery.
So it's hard to take on this new, healthier persona
when you have this daily reminder of how you used to look.
Part of it is aesthetic, but a lot of it is just quality of life.
So a lot of the people who seek body contouring
just want to return to normalcy.
- [John] My highest weight loss was 145 pounds
in eight or nine months.
- It is nice to see them now,
two-and-a-half years out from their surgeries,
maintaining phenomenal weight loss.
- [John] When I look at us now,
we just seem so much happier and full of life
and I don't think you can put a price on
feeling wonderful about yourself
and looking at yourself and saying,
yeah, I look good.
- [Dr. Nadzam] With weight loss surgery,
we know that we're adding
years back onto people's lives
and that's very rewarding.
- [Dr. Alperovich] It's a privilege, it's something we're very lucky that we get to do.
You have these bonds with patients that last years
and there's a gratefulness there
and an appreciation there from them,
and for me, there's an honor
that I get to be a small part of
something in their life that gets them
to feeling good about themselves.
- I don't think you can be a successful bariatric surgeon
if you don't have empathy for your patients,
and with that empathy comes a lot of reward
when they've done well.
Every time I see folks in the office,
there is positive reinforcement
that what I'm doing makes a difference.
There may come a time
when we find a neurotransmitter,
a gut hormone or a non-invasive treatment.
If that's the case,
then I don't do bariatric surgery anymore,
but that will be a happy time for me
'cause it means
we have cured the disease of obesity.