Minimally Invasive Weight Loss Surgery: Expert Q&A
Obesity is a very challenging condition people struggle with weight and are often frustrated with a lack of results today on at the forefront live we’ll look at bariatric surgery options and how this can change lives here you Chicago medicine bariatric surgery programs are tailored for each individual to get the maximum outcome and benefit also today we’ll meet one patient who lost over 80 pounds and gained control over her diabetes Linnea now has quite a story to tell and is a different person today because of bariatric surgery that’s next on at the forefront live [Music] and welcome to you Chicago Medicine at the forefront live this is your chance to ask our experts your questions by typing in the comments section we’ll get to as many as possible over the next half hour remember this program does not take the place of an actual visit with your physician now joining us today we have two experts in bariatric surgery dr.
Vivek Prashant and dr. Mustapha Hussain welcome to the program thank you first of all just tell us a little bit about bariatric surgery in general exactly that entails I think a lot of people when they think of bariatric surgery they think oh you’re just cheating you’re not you know not dieting and take an easy way out but that’s really not the case thank you for the question a bariatric surgery is basically surgery which means manipulation of your organs and your stomach and your intestine to really change the way your body perceives hunger and when it feels full it works by changing your Anatomy but also your physiology which is sort of the chemical nature of your body’s relationship and understanding to food and it works by mechanisms that we partially understand but not fully and we’re definitely working on that but it’s definitely not cheating it is for people who have tried several things before but really need additional help from us in terms of losing weight and it’s really for people who are looking to lose 75 or 100 pounds so dr.
Bachand why is it called obesity or a metabolic surgery instead of weight loss surgery yeah I think that that’s a really good question and I think it’s something that’s really changed in the field over the last five to ten years so the emphasis used to really be about weight loss in the past and so we would really be emphasizing how many pounds people lost and so forth but the American Medical Association about five years ago recognized obesity as a disease and one of the things that we’ve always recognized with these operations is that in addition to achieving the weight loss which is pretty substantial and sustainable is the impact on the medical problems related to obesity and so you know the importance of thinking about obesity and metabolic surgery is to really keep in mind and emphasize the fact that these operations also have the opportunity to impact all the different medical conditions that come along with obesity such as diabetes high blood pressure high cholesterol sleep apnea severe joint problems we even see patients who might benefit from transplantation but are too heavy to qualify to undergo transplant a bariatric surgery can really make a difference we spoke to one patient who had bariatric surgery here at UChicago Medicine and here’s her story and that has drastically changed my life I mean not to have to take insulin shots I feel significantly better Linnaean l was taking four insulin shots a day it was the only way she could control her diabetes I feel better emotionally physically and I’m just I’m very very pleased now Linn is much lighter in off most of her medications including those for insulin shots as of today I’ve lost 80 pounds in six months and I’m very excited about that I would maybe like to lose another ten but everyone tells me that I should leave a b-lynch OHS the bariatric program at the University of Chicago Medicine one of the leading programs in the country she had the gastric bypass procedure and is very happy with the results the reason that I chose University of Chicago medicine is because they had a program dr.
Hussain had a program to go along with the bypass you had to go to classes you had to follow up I mean there was a whole plan what differentiates us from everybody else is I think our come our experience our judgment and our comprehensive evaluation of patients use Chicago medicine offers many options for weight loss some of those options include surgery their sleeve gastrectomy gastric bypass and a procedure for extremely heavy patients that is only done at about 1% of the centers country that’s called the duodenal switch as an institution we are providing a wide array of options for patients we’re trying to lose weightweight whether it’s that ten pounds you need to lose after Christmas or it’s that 200 pounds that you know you’ve accumulated over years each of these procedures requires a team approach the patient will work with several caregivers to assess their challenges and provide solutions there is also follow-up after the procedure to make sure the patient has the right support to keep the weight off so at a single hospital visit they will see the surgical team they will see our bariatric dietitians as well as our psychologists and so it’s a one-stop shop if you will weight loss isn’t easy and the patients who participate in the surgical program have struggled with their situations for years prior but the positive news is there is hope and it can be a lasting change despite all of our biases we don’t know why people are overweight it’s easy to say they eat more food than they actually burn off and while that may be true we don’t understand why some patients are more efficient at burning off food than others OBC is a complex issue it has to do with your genes what you’re eating what your habits are what your social behavior is what your psychological situation is so it’s a complex issue so it doesn’t have just one solution surgery happens to be the most effective way to help people lose weight but we realize it doesn’t function in a vacuum Lynn’s family is happy with her outcome as well it has changed her life and helped her to a healthier existence since I did the surgery I feel much better about myself I am much more confident I do a lot more things I do double takes in the mirror every time I walk by our window every time I absolutely do not believe that I look like this and I feel very very good about it that’s a it’s an interesting story and it’s fascinating to hear the difference in her life particularly with her diabetes so you know to your point just a moment ago it really does make a significant health difference and one thing that you touched upon in the video dr.
Persona I wanted you to talk maybe a little bit more about this is that the the overall plan it’s not just surgery but there there are many different aspects and different things that people go through before the surgery and after talk to us a little bit about how that works if you will sure so as was alluded to in the video we really have a true multidisciplinary program and what I mean by true as opposed to virtual is that we literally have our dietitians and psychologists in the clinic with us and we take turns seeing the patients while they’re in the clinic office and then we discuss and confer amongst ourselves to really formulate a good game plan so this takes place when patients come in for their initial evaluation so we identify if there are some particular behaviors or education that we can work on to really get people ready to to be successful with surgery and we also have the same approach in the aftercare and all of this is really focused on selecting the patients that we think will have the best chance of success with surgery and getting the best outcomes that we can have after surgery so really having that team approach is I think what what sets us quite a bit apart and it really sets the patients up for success in the future absolutely so we want to remind our viewers that we are taking your questions so type them in the comments section we’ll try to get to them as many as possible let’s let’s start off with talking about the the different types of bariatric surgery available with they were mentioned in the video but if you could tell us a little bit about what they are and and what would they entail sure so there are currently four approved bariatric surgeries that are performed nationwide we are really one of the only centers that actually offers all four types of surgeries the most common one being performed these days is something called the sleeve gastrectomy or vertical sleeve gastrectomy some people call it VSG this is a procedure that’s done laparoscopically which means surgery through some very small incisions so most of the incisions are about about a quarter of an inch or so and this can be done with general anesthesia and most people actually wind up leaving the next day so the sleeve gastrectomy is a procedure which reduces the size of your stomach by permanently removing a portion of it so I like to tell people if you think of your stomach like a big handbag that you can stuff lots of things into maybe something you know if you were going some way over the weekend it by removing a portion of it you basically are trimming it down to wear just the essentials fit in so some people say it’s a banana shape or I like to say from the big handbag to maybe just like a small person you would take to a party or something like that and so that reduces the space where you can fit food but also we’ve learned that actually impacts some hormones in your body that affect hunger and how full you feel so it’s not that you feel hungry but can’t eat but it’s actually changes the relationship that you have with food so that’s why it’s one of the reasons it actually works better than restricting yourself on a diet so that’s currently the most common procedure another procedure that that’s performed also laparoscopically or using the small incisions is called the gastric bypass sometimes call it people call it the Reuben why this is a procedure that’s been performed actually the longest for weight loss since like the 60s or something like that and it has a really excellent track record because it’s been around you know there are some stories out there maybe that it was not safe in the past etc but but this actually is not true it’s a very safe procedure as likely as safe as all the other procedures and has certain advantages over the sleeve and sometimes we recommend it for people with severe heartburn or reflux we may also recommend it if you have diabetes on insulin such as the patient that was highlighted earlier and it can be quite effective in getting people off the insulin that they’re on the other procedure is a procedure called the duodenal switch which is a procedure that we specialize in here at the University of Chicago dr.
Prashant was actually the person to perform it first using the minimally invasive techniques here in the Midwest and very few centers around the country perform it it is a little bit more complex procedure but also has more rewards the duodenal switch is a procedure that get affords you the most weight loss particularly if you’re in the category of people who may need to lose around 200 pounds and that’s people who are whose BMI which is body mass index is over 50 and also is very effective for people who have very severe diabetes that have been diabetic for greater than 10 years on insulin and can be a very powerful way to to treat that metabolic disease that combination of obesity and diabetes the last procedure is something called the laparoscopic adjustable gastric band technically we do offer it but it is a pursue that that is becoming sort of less popular these days mainly because it is a device it is subject to moving and breaking and also we’ve seen over the last few years that the weight loss is not as effective as some of the other procedures and so it is a procedure that is approved but we are actually performing it less frequently these days now we are getting a questions from viewers I want to get to those and try to answer as many as we possibly can during the program first question which you I pretty much just answered but we’ll go ahead and and throw it at you again anyway when you were talking about the Duat no switch this is somebody who says do you think a person whose BMI is over 50 should think about surgery and I guess the question would be then what types of surgery should they should they first consider and either one of you can feel that one yeah so you mentioned BMI of greater than so again BMI stands for body mass index and we get that number by combining height and weight into a formula and it gives a pretty good estimate of how much extra fat a person has for their height it’s not a perfect number and you’ll see a lot of new stories and a lot of sort of complaining about BMI but the reality is is unless you’re a NFL linebacker or a professional athlete it actually does a pretty decent job of estimating this so just to quickly review a normal BMI is between 20 and 25 and a person is considered obese if their BMI is greater than 30 and so we talked about surgery for obesity when the BMI is 40 or higher or if it’s between 35 and 40 and the person has other significant medical problems related to their obesity as we mentioned earlier so when we’re talking about BMI have greater than 50 that’s typically somebody who’s 150 to 200 pounds overweight and typically and frequently associated with that are those other obesity related medical conditions like diabetes high blood pressure and so forth so in the past when gastric bypass was the most common operation performed say 15-20 years ago what was seen quite frequently is that patients who had BMI so greater than 50 or 60 they frequently failed to lose enough weight after they had gastric bypass or they would regain a significant amount of weight and that’s really what prompted our interest in performing the duodenal switch because historically it seemed to be associated with a greater amount of weight loss but there really had not been any head-to-head studies comparing the two operations to determine which is actually more effective for this very difficult to treat group of patients with the higher BMI so we did the first study comparing not only the weight loss but the impact on diabetes high blood pressure and high cholesterol and we were the first to find that there was in fact a significant advantage for patients with greater than a BMI of 50 now that doesn’t mean that every patient with the BMI greater than 50 should have a duty no switch and I think that one of the key things that we really try to convey to our patients when they come for an evaluation and what we really take most of our time in our conversations and discussions with patients is figuring out what the right tool is for you as an individual because there’s not one operation that’s the best for everyone in all circumstances and so it’s really about finding that right match between the operation and the patient taking to account the fact that each person has a different amount of weight that they need to lose each person has a different medical conditions that are related to their obesity different side effects of the operations and different effectiveness in terms of weight loss and impact on these medical conditions and so that conversation that that we have as the surgeon with the patient is really the key so we’ve talked about people with with the higher BMIs and we have a question from a viewer somebody without that level of BMI and the question is for someone struggling to lose 25 pounds with surgery be an option generally probably not again we don’t necessarily go by how much weight you’re overweight but the BMI so you would have to calculate your BMI but the minimum BMI is basically 40 which correlates to roughly around hundred pounds for people who are more –ml Heights or an average height I should say or if your BMI is over 35 and you have a medical condition closely related to obesity such as diabetes high blood pressure high cholesterol or sleep apnea generally if you’re about 25 pounds overweight you’re but you’re you’re probably around a BMI of 30 again if you’re an average height individual and around that BMI generally are the first recommendation would be intensive lifestyle modification which is also the first step for anyone who’s trying to lose weight so that’s generally meaning working with a professional such as the dietitian or a medical specialist that works with obesity medicine or maybe even a therapist or a psychologist that can help you lose weight but having those regular visits with a professionals really been shown to affect success with people trying to lose weight and that’s one of the nice things about you Chicago medicine we do offer services like that as well so we can cover the whole whole range how save his bariatric surgery yeah so I think that there’s a lot of myths and concerns when it comes to surgical safety with these operations and again this I think dates back to 20 years ago when these operations really work considered to be risky and frankly there’s a lot of high-profile cases and the newspapers and so forth as the operations initially started to become more popular but over the years with modifications and techniques and the management of these patients using laparoscopic approaches instead of the traditional open incision which required a pretty large incision extending from the breastbone down to the belly button by using these approaches and really the management of the team the safety today in Centers of Excellence such as ours is very similar to patients who have gallbladder surgery which is to say that it’s a very safe operation we have more questions coming from our viewers I’ve heard hair loss can be a common side effect of bariatric surgery is there a way to avoid this and does it taper off on its own this can happen after bariatric surgery but it can happen also if you’re losing weight with any other means when you do lose a significant amount of weight particularly quickly it is a the body’s natural response to sort of make sure it’s not wasting resources if you will and not that hair is a waste of a resource but basically it does require protein from your body to to make hair so when you’re in that initial period of rapid weight loss your body may say let’s just see what’s going on make sure we have enough nutrients for essential functions so it may shut down new hair growth for a little bit and that may come off as seeing that you’re losing hair generally this is temporary and fully recoverable and it generally is not significant to a point where others would notice but you may notice that your your hair is thinning our dieticians who are nutritional specialists that we work with are very good at counselling our patients through this period and making sure that they keep up with the appropriate protein and vitamin recommendations they can really limit the amount of hair loss that they experience and certainly help with hair regrowth period and we’ve got a follow-up question of that let’s talk a little bit about the vitamins and supplements and things that people will take after a surgery like this how long does that go on and how significant is that yeah so with all the operations that we do taking vitamins is something that’s necessary after surgery forever each of the operations is slightly different in terms of the way that the body absorbs and handles different nutrients and vitamins but in all cases because of that reduction in appetite and because there’s less food being taken in if you don’t get enough in and if your body is not absorbing in the way that it had been previously you’re at risk of developing deficiencies so taking vitamins every day is an important part of being as successful as you can be after surgery you know I like to tell patients you know you wouldn’t want to get a transplant operation and then not take your immune suppression medication afterwards and you have to almost look at vitamins in the same way after you have these operations one of the common I think criticisms that people will make when they talk about bariatric surgery is oh people will just gain the weight back is that true or what do we do now to try to prevent that so if you look at you know let’s say a hundred people who’ve had bariatric surgery the majority of those patients let’s say 5 10 years afterwards will be down from the point where they from the initial point that they had surgery so let’s say if they had a hundred pounds to lose their the majority of them that’s over fifty percent of those patients will be down sixty seventy eighty pounds it is very normal though after the first year or two after the surgery to regain a little bit of weight I tell my patients it’s kind of like setting your thermostat you should think of surgery as resetting your body’s thermostat of where the normal weight will be so initially you will lose a lot of weight and your body will then find its new steady state and then everybody regains just a little bit of weight back and then it’s our job working with the patient’s to make sure that that little bit of weight regain which is normal stays at that level and doesn’t you know skyrocket back so people are gaining excessive amounts of weight back there are some patients that do gain a significant amount of weight back usually not to the point where they start off at but you know if you if they’ve lost like 80 pounds they may regain back 3040 pounds which is not you know a result that we wanted and we definitely work with them to to limit that a major way to prevent that from happening is close follow up with us close follow up with our dietitians and a continued understanding that surgery as we talked about earlier is not the easy way out it is basically a tool to help you continue to do what you know you should you should have been doing which is modifying your diet increasing your physical activity and the everything else that we normally talk about with weight loss so here’s another question right along those lines from a viewer for those of us who have had gastric sleeve surgery this person was june of 20-14 they’ve gained some weight back they want some motivation or suggestions to kind of get back on track what would you tell somebody to jumpstart that process again and and how would you help them sure so the way that I would begin with that patient is make sure that they go in to see their their surgeon and and re-engage with the program oftentimes patients will sort of drift away because of you know job changes or they move and so forth and if they can come back and see their team that first step can help substantially typically what we were doing that sort of circumstances make sure that there’s not any sort of anatomic problem that might be contributing to the weight regained and at the same time we would have a full assessment by our dieticians and our psychologist to make sure that the diet hasn’t drifted or shifted in a negative direction and really kind of re-educating and just getting back on track and to be honest I think that that’s really where the value of the long-term follow-up comes in because the reality is that nobody can be perfect every single day every multiple times a day for the rest of their lives we kind of use a ratio of if you do the right thing 80 85 percent of the time you’re gonna be fine and life happens and there’s things that happen and with regards to employment relationships and so forth and stresses that can lead to people kind of getting off the track a little bit and we’re here for our patients to really get them redirected and re-engaged and kind of moving forward again here’s another viewer question and that’s your why this is when it’s me and a spur I’m gonna go ahead and throw it out anyway they want to know what form of vitamins would they would they take chewable gummy or pills that’s actually a great question after bariatric surgery we are in generally altering the anatomy so the way some things are absorbed or taken up by your body is is a little different and that’s partially how the surgeries work so after certain types of certain procedures we do counsel our patients to take vitamins that are absorbed better sometimes the gummy vitamins those are vitamins that can basically dissolve in water you know you chew them and your saliva or spit and they dissolve and you can swallow them and that’s adequate for some of the vitamins but some vitamins acts we are not well absorbed in that format and we may then recommend different [Music] combinations or formulations of vitamins that are better absorbed some vitamins you may notice come in a little drop a droplet of oil and those may not be good after certain procedures so we and our dietitians come up with an individualized plan for each patient based upon the surgery they had and also actually their pre vitamin levels you may have noticed in Chicago that it’s actually pretty cloudy today so that means vitamin D levels are low and actually most people actually even before surgery come in with some low vitamin levels and what we do is we actually before your surgery check all those levels come up with an individualized plan about what your vitamin regimen should be based on that and the surgery you’ve had so each patient will vary somewhat if just what they’ll have to take and and how they’ll have to have to take that so here’s an interesting question how do you make sure that people don’t lose too much weight I don’t know if that’s ever a concern with patients but how would you how would you handle that well I think that it is a realistic concern I think patients all have in their minds I sort of what they would consider to be a target or a goal weight if you will and I would say that the the first step is you have the right operation to begin with as I said earlier you know there’s not one operation that’s best for everyone in all circumstances and it’s really that initial determination and decision that we come together with the patient about the surgery choice that will significantly determine not only the risk of losing too much weight or also not losing enough weight so really finding that sweet spot in between so are there certain foods or drinks that will be off-limits after the surgery it’s a great question so again it sort of depends on the type of procedure you’ve had in general you know many people come in thinking that oh gosh have to eat baby food for the rest of my life and/or just drink liquids that’s actually not true at all our goal is to get you to eat normal healthy food again and you know three months after the surgery consistency wise there’s really no restriction so you can eat vegetables again you can eat meat again you know all those things but we do counsel you on the types of foods you should be avoiding and foods that sort of work against the weight loss so a high carb low carbohydrate diet that’s again a lot of starches flour rice pasta potatoes anything that has that sort of white color and consistency generally to be avoided mainly for weight loss sugars sugary things sweet things again works against weight loss but sometimes can make you feel ill after certain types of surgeries so if you eat something that’s very sweet or high concentrated in sugar that again may not agree with you and also is not good for your weight loss generally we tell people to avoid carbonated beverages that’s things like soda beer pop and again because that as that gas expands in the stomach that may be a little smaller or in your intestine that can be uncomfortable and not make you feel well so I would say if things to be avoided our carbonated beverages high sugars and a higher high carbohydrate foods we’re about out of time but I do want to ask this one last question and it’s concerning insurance and I think there’s always you know obviously if you’re gonna have a procedure done there’s always some concern from the patient standpoint and whether or not something like this would be covered by insurance is can you speak to that a little bit yeah so you know I think that there’s kind of a perception out there that these operations are are cosmetic and in many cases cosmetic operations are not covered by insurance but I think it’s really important to understand that these obesity and metabolic operations are not cosmetic you know as dr.
Hussein alluded to these things actually change the physiology of the body and country to the weight loss as well as to the improvement and the medical conditions related to obesity and because of that medical aspect most insurance companies actually do cover obesity surgery although the individual patient has to look at their plan to see if it’s a covered benefit it turns out that with the reduction of medications and the overall gain and health that takes place after these operations in the long run it’s actually a cost savings to the healthcare system for individuals who undergo these operations it makes perfect sense well gentlemen thank you very much that was great thank you appreciate it that’s all the time we have for at the forefront live thanks to our guests for their participation in today’s program and thanks to you for watching and submitting questions if you want more information about bariatric surgery please visit our website I use Chicago Medicine dot-org or you can call eight eight eight eight two four Oh 200 join us for our next at the forefront live we will learn about minimally invasive robotic cardiac surgery that’s Monday February 4th also check out our Facebook page for future at the forefront live dates and subjects thanks for watching and have a great week