Melanie Cole, MS (Host): Welcome to Bryan Health Podcast. I'm Melanie Cole and joining me today is Dr. Anthony Tabatabai. He's a General Surgeon specializing in bariatric weight loss surgery at Bryan Bariatric Services and Surgical Associates PC. And he's here to give us a really good explanation of bariatric surgery and what's going on that's really exciting in the field today.

Doctor, thank you so much for joining us today. I'd like you to start by defining obesity for us, because that's changed over the years and whether it's considered a chronic disease or a disease at all, which it did not used to be. Can you explain a little bit about it and the complications, the comorbid conditions that go with obesity?

Anthony Tabatabai, DO: Yeah, absolutely. Thanks, Melanie. Happy to be here. We've really learned a lot more about obesity over the last 20 to 30 years. Early stigmatism about people eating too much or not exercising enough. And that we've really changed our thought process on that.

It's a lot more to do with metabolism and how the body processes food and how you exercise and things like that. So, the way we kind of characterize it is based on your body mass index. And so that's a measure of your height versus weight. And, once you've got a BMI above 30, you're considered obese and these are patients that really have trouble getting the weight off, even with lifestyle changes, like, eating healthier and getting exercise. And we really know that obesity itself really affects a lot of other organ systems, and so that's where we've really streamlined our treatment of this as a chronic disease.

Obesity can cause a lot of comorbid conditions like hypertension, high cholesterol, obstructive sleep apnea, diabetes. And it's interesting that one condition can cause all of these problems, and that's what we're really trying to help patients out with.

Host: Well, thank you for that. And as you said, we've learned more and more over the years about these comorbid conditions. So let's talk about one of the treatments for them and people have tried weight loss modalities, other ones, and you can talk about those as well, but tell the audience what bariatrics. What does that really mean? And there are certain parameters to even consider to be a patient, a candidate for bariatric surgery. So doctor, would you just tell people what that is? What does your field involve?

Anthony Tabatabai, DO: So I think, the biggest thing is a lot of bariatric surgeons or physicians or providers that treat obesity, there are multiple modalities and really we're trying to help patients get this weight off, long term with a sustained weight loss. There are multiple modalities. There are number one lifestyle changes, right? And that's in regards to having you see our And our medical weight loss team, as far as making good decisions with what you're eating and probably getting some exercise. Those are two foundational things. But separate from that, bariatrics has changed a lot more recently with the advent of some of these medications that have helped people, number one, not feel so hungry and also how their body manages food that they take in.

And then the third line or one of my specialties is actual bariatric surgery, where we perform surgeries that really help you get this weight off and change your set point where your body thinks you live at as far as weight and then helps you maintain it. That's kind of the cohesive, aspect of bariatric medicine or bariatric surgery.

We kind of all work together to help patients get weight off and sustain weight loss long term so that they can decrease these comorbid conditions such as high blood pressure, diabetes, and hopefully come off a lot of medications. And really just change their life, you know? getting 100, 150 pounds off some of these patients; I mean, literally, it's a new life for them.

Melanie Cole, MS (Host): Dr. Tabatabai, I'd like to, I'd like you to clear something up for the listeners because many people think of bariatric surgery as the easy way out, but instead it is just merely a tool, another tool in the toolbox to help people get healthier. So can you please speak a little bit about that myth and bust that up for us because it is not easy.

Anthony Tabatabai, DO: It's a huge stigma, I think that this is some shortcut out of eating better and exercising. It really isn't. My patients are working their butt off to get this weight off and the surgery is a tool. And I would tell you it's the best tool to get weight off and sustained weight loss, more than anything, really.

Back in the day, this surgery was done with big incisions and patients stayed in the hospital many days. And now we've really streamlined this to be very safe. The surgery is done in a couple of hours with small incisions. Some people go home after surgery the day of, usually the next day, and do very well.

We've created a safe surgery that is on par with hip replacements or gallbladder removal, which are very common procedures that a lot of people get. So, we've really stamped that stigmatism out. It's getting better and better, and people are noticing that patients do very well with this surgery, and really, the patient's doing all the work, They're eating appropriately, getting some exercise, allowing this tool to help get the weight off, and then sustained weight loss long term.

Host: So then help us to understand the different types that are out there, whether it's malabsorptive or a combination of restrictive. There's so many different options now today and they've evolved so much. It's really an exciting time in your field. So explain a little bit about the procedures you perform.

Anthony Tabatabai, DO: Way back in the day, the original kind of mainstay gold standard that's kind of stood the test of time is a gastric bypass, where we cookie cutter out part of your stomach and make a little stomach, and then we bring up the small intestine and hook it up to that little stomach and then rehook up the small intestine kind of farther down.

So it works in two ways. It's restrictive, meaning you feel full very quickly, and then it's also malabsorptive, meaning the food that you take in, you don't absorb all those calories. That's a very good surgery and it's been around for a while. Another surgery that we offer is the sleeve gastrectomy. That's where we take out about 85 percent of the stomach. That's a purely restrictive procedure, meaning you'll feel full very quickly. About 4 to 5 ounces, you'll feel full. And also we take out the top part of the stomach, the fundus, that has a lot of hormone receptors for appetite. So patients don't feel as hungry, or you might not, think you need that afternoon snack, which you probably don't, but our mind and our body is telling us, and that's, the metabolic component that we really have an effect on.

Another surgery that, I don't really perform, I usually take these out, but the lap band. Some of the patients have done really well with that, and some people have issues with that. I don't necessarily perform that anymore but there are options to perform one of these other procedures.

There are a couple other procedures that are still very good options. One is called the biliopancreatic diversion with duodenal switch, and that's basically a kind of modified form between the bypass and the sleeve, where you actually have a sleeve and then you have a bypass component with that, so that has a restrictive component and a malabsorptive component. And then a newer surgery that's been on the up and up now is called the single anastomosis duodenal ileal bypass with sleeve gastrectomy or a modified duodenal switch. So that's another combination with a sleeve and a bypass component. So there are all these options that we have surgically to really help get this weight off and, get that sustained weight loss.

Host: So after surgery, if they've become a candidate, they've gone through their counseling, they've done all that you've asked them to do before surgery, what is life like? Because I think that's the million dollar question that anyone that's considering bariatric surgery has. What is life like? Can I go to restaurants? Will I have to be on vitamins, supplements the rest of my life? Are there things I can't eat? Can you speak a little bit about the support that you offer and what life is like after surgery?

Anthony Tabatabai, DO: So I think that is a key question about our process before surgery. That gives us the correct path forward after surgery. So as being part of a center of excellence that Bryan has, we have a robust preoperative phase where we have you meet with the dietitian, we have you meet with the exercise physiologist, the psychologist, our medical weight loss team, one of our surgeons, and we get you ready for surgery So that three to six month period is where you're doing all the homework and getting ready. And then after surgery we have support groups, we have close follow up. You're our patient for years, so we have you see us two weeks after surgery, five weeks, three months, six months, nine months, a year, and then yearly after that.

As far as lifestyle changes, yes, any of these surgeries, you're going to eat a lot less, but you're going to feel satisfied with what you eat and move on and you're going to see that dramatic weight loss. I think going out to restaurants and things, yes, you're going to eat a lot smaller portion, but the long term payoff of having 100, 150, 200 pounds off is totally worth it. And patients, always tell me they wish they did this 10 years prior. So I think we set everybody up for success and obviously we're here along the way, postoperatively too, to address any concerns.

As far as vitamin deficiencies and things, sometimes these malabsorptive surgeries can have some vitamin deficiencies, but usually with just a multivitamin, even a Flintstone vitamin, that's enough to keep people from not having any vitamin deficiencies. And post operatively, a lot of things do change with how you eat and maybe some foods don't sit as well as others, but we really kind of navigate those waters and people deal with them pretty, pretty easily.

Host: Wow, this has really been so informative, Dr. Tabatabai. I'd like you to wrap up with your best advice for people that are going back and forth because they've heard a lot about this type of surgery, but they're not sure if it's for them. And you did mention that Bryan Medical Center is an accredited center of excellence for bariatric surgery. So, I'd like you to kind of give us your best advice. Tell people what you want them to know about the safety, the efficacy of bariatric surgery, and really how it helps just so many people.

Anthony Tabatabai, DO: If you've been considering this the first thing I could advise you to do is come talk to us, and learn about it. And we can really give you the ins and outs about the process and how we can really help get this weight off. I think surgery is the number one way to get weight off and have it sustained.

Patients that have high blood pressure, diabetes, sleep apnea, these types of conditions, we can literally stop all those things with this surgery. So I think the biggest thing is just come talk to us. I think I speak for myself and my partners and our program that we would never push surgery on anybody if you weren't wanting that. We can just give you the options. And then we also have the medical weight loss side that, can try medications and other processes, including lifestyle changes like diet and exercise alone. But what I've seen is when you get this kind of weight on, just diet and exercise alone is usually not enough.

This tool of weight loss surgery really allows this weight to come off and then you maintain those habits and the weight will stay off. So I guess my number one piece of advice is, come see us and we can really talk this through. And I can try and answer any questions and our team can answer any questions that is maybe a stigma or whatnot, that this is an easy way out.

It really isn't. The biggest thing I see a lot of patients that always tell me they wish they did this, 10 years ago. So, my goal would be to get people more information about what we can offer and how this surgery or this program encompassing can help patients out.

Host: Well, it really can be a life saving procedure and Dr. Tabatabai, you're such a nice man and thank you so much for educating us so very well today and giving your really great advice. And to learn more, you can visit bryanhealth.org/podcasts because we have so many there and you can get so much more information at bryanhealth. org. That concludes this episode of Bryan Health Podcast. Please always remember to subscribe, rate, and review Bryan Health Podcast on Apple Podcasts, Spotify, iHeart, and Pandora. Until next time, I'm Melanie Cole. Thanks so much for joining us today.