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.
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