Melanie Cole, MS (Host): Welcome to Bryan Health Podcast. I'm Melanie Cole. And today, we're talking about non-surgical weight loss options. Joining me is Tara Troyer. She's a nurse practitioner and a bariatric nurse navigator at Bryan Medical Center.

Tara, thank you so much for being with us today. Let's start by talking a little bit about obesity. I mean, it's becoming an epidemic. And what do you see every day?

Tara Troyer: We see that definitely it is an epidemic. And I also feel like it really got a lot worse starting with the COVID pandemic that went around too. People were at home, got out of their healthy activity habits, out of their healthy eating habits. But it is starting a lot younger as well too, and pediatric obesity is a big concern as well.

But I do feel like the rates of obesity are going up, and unfortunately, it's getting to be a little bit more accepted as well. And with all of that, our chronic medical conditions are getting worse and more complex and harder to treat.

Melanie Cole, MS: Well, I certainly agree with you. And it is pretty pervasive, and so many other conditions happen as a result. It puts you at risk for so many other conditions. And so, it's something that is really important to take note of, to take care of. So, why don't you start by telling us a little bit about some of the non-surgical weight loss options that are out there? Because now, I mean, we hear about the GLP-1s, we hear about medical weight loss. Of course, there's all these millions of diets out there and groups and support groups. Tell us about some of these options.

Tara Troyer: We really look at a whole comprehensive care model that really looks at every single aspect, including like medical nutrition therapy, starting with behavior modifications, physical activity, and absolutely medical and surgical then interventions as well could be an option.

Melanie Cole, MS: Okay. So in your profession and what you do every day, who makes good candidates for these kinds of methods when somebody comes to you and they're not really looking yet for bariatric surgery? What do you do with them? Who makes a good candidate for trying some of these other options?

Tara Troyer: Sure, absolutely. Pretty much anybody would be a good candidate when they're concerned about their weight, if it's affecting their quality of life, especially when it comes to medical nutrition therapy or even just looking at healthy eating lifestyle, behavior modifications that could attribute maybe later on to an obesity issue, physical activity.

Now, the medication interventions do come a little later on. They have become more appropriate for pediatrics, but that would be a very specific timeframe. We look more at BMIs of thirty or more, which takes into consideration height and weight. But then if also BMI is a little bit lower, if they have some of those conditions that you were alluding to, such as like type 2 diabetes, high blood pressure, heart disease, sleep apnea, there's a lot of things that could be affected by obesity that lead to these chronic medical conditions.

And also to mention that we really do focus on obesity is chronic, it's a complex disease process, and it should be treated that way. It's a long-term care for a chronic disease problem. And it's not just for quick-fix, short-term changes it needs to be a long-term approach.

Melanie Cole, MS: It certainly does. And all the things we're talking about and including the surgical options that are out there are just tools. They are tools to help with this situation. As you say, it's a chronic disease state and can yield so many other more serious diseases, like you said, like heart disease and high blood pressure. So when we think of the lifestyle changes that must go along with these tools for them to work, what are we looking at?

Tara Troyer: Well, I had mentioned those pillars, and one of them is nutrition therapy. So really, we look at what does a healthy plate look like? What do healthy food choices look like? What do good portions look like? I mean, our portions these days are out of control. You go out to eat and you get enough. You should have about four meals most of the time with some of these portions that we get. And looking at labels, the portions are just big.

And so, we like to really focus on what whole foods are good. We don't need supplements. We don't need special drinks and all of that stuff. Looking at the whole foods that you can purchase at the grocery store, looking at the foods that fit into certain lifestyles, cultures, eating habits. I mean, night shift, day shift, there's so many different situations. So, it's a very specific personal-focused approach. And it's, again, set to be long-term changes.

And then, we look at behavior modifications, incorporating, you know, what's the psychological impact having on their weight loss or weight gain. I mean, in our office, we even now have a counselor in our office available two days a week. So, it's that important to pull that entity in. Physical activity, structured exercise. It doesn't have to be an expensive equipment, in an expensive gym, or a gym at all. You can park further away, take the stairs, focus on something, go slowly, safely increasing your activity. It could be as much as just walking to go get the mail and walking back if normally we're just sitting on the couch. So, many different ways that we can increase activity in our day-to-day.

Then, we talked about the medical interventions with weight loss medications. It is another opportunity, another intervention. And you mentioned perfectly these are all just tools.

Melanie Cole, MS: Yeah, so they are. Now, when those lifestyle changes are not enough, there are medications that we keep hearing about in the media and all over now. I mean, they're really all the rage. They can be a really good option when prescribed by your practitioner, by your clinician. So, speak a little bit about these medications.

Tara Troyer: Yes. And I am first going to speak a little bit about reviewing what current medications that the patients are on. There are so many medications out there that we're not aware of that can be a cause of either weight gain or a barrier to weight loss, maybe increased appetite. So, it's really good to review those with a specialist in this area like myself or looking towards your PCP, mental health provider, whatever it might be, but to review what medications currently might be attributing to some of the issues.

But right now, with different kinds of medications that we have, there are some requirements for those. You have to have BMIs that are equal or greater to 30 or 27 if you have some of the comorbidities that we talked about, such as type 2 diabetes, hypertension. And then, some of the medications, like those GLP-1s that we hear so much about, there are a lot of requirements with those in order to be eligible for coverage, which is a whole 'nother podcast in and of itself.

 But types of medications that we have right now, there are specific ones for appetite suppression, and these class of meds are usually like a stimulant, something to help you feel fuller faster. And then, we have meds that address some of the metabolic dysfunctions that we have, such as insulin resistance.

And the biggest class I would say that we use a lot is the behavior modification medications. These address the constant thoughts of food, that nagging need to want to snack and eat even when you're not hungry; the inability to stop eating once you've started eating; cravings for sweet treats, carbohydrates such as breads and pastas. So, there's a certain class of meds for those too.

Then, there are the meds that are multifactorial that can take care of a lot of those things in one, which specifically would be like those GLP-1 medications that are all over the news.

Melanie Cole, MS: Well then, Tara, tell us some of the reasons why a medication wouldn't be suitable for someone. Does it interact with the medications that they've been on? And as you said, there are certain criterias, especially for those GLP-1s. So, why might some medications not be suitable for people?

Tara Troyer: Each medication that we have and each class of medication, they all come with their own possible side effects, interactions, contraindications. And that is why it's really important to discuss these medications with someone that specializes in the area or that's very familiar with their medical history, such as their primary care provider.

Certain conditions, obviously, if you are taking medications for a certain kind of mental health disorder that they may have, the medications we use for behavior modifications might collide with those. If you have certain conditions, maybe like gallstones or kidney stones, there's medications that can cause that to get worse.

If you have anxiety, some of the stimulants for appetite suppression can definitely make that worse. So, it's really going step by step through the current medications they're taking and some of their medical history in order to find a very specific plan that would work for them and be safe when it comes to medications.

Melanie Cole, MS: Tara, have you seen these medications work? Tell us a little bit about what you've seen, and if they are working and someone loses the weight and gets to their goal weight, do they have to stay on those medications?

Tara Troyer: I have seen medications work phenomenally when it comes to utilizing nutrition therapy, physical activity, and using this as just an adjunct to that to help with those cravings, with the constant thoughts of food. But also, with some of the mental health medications that we take specifically, they can cause an insulin resistance and increase in appetite. And sometimes we can't change those meds all the time. So, we need to work with it. We all need to work together for it. And I have seen people find a better quality of life, decrease their pains, decrease their amount of meds because they have a comprehensive look at how their weight is affecting them and what they can do.

As far as lifelong, it really depends on the reason behind the medication. If they were taking a medication to help modify a behavior and they're able to come off of that medication and be monitored and be able to establish those long-term habits, then maybe it can be a short-term med with a long-term behavior change. My experience shows, though, majority of the time they do become lifelong as part of their long-term weight management plan. This is very similar to the medications that are taken for management of any other chronic disease state. So if you're taking a medicine to help with food noise that is maybe part of a other medication or part of another condition, going off the medicine that has curbed that, those other aspects are still there, and they're not going to go away.

And so, the appropriateness is really important, I should say, to be able to work with a provider that can spend the time and be able to prescribe these meds and monitor it on a long-term basis as the progress goes. Sometimes we change meds as the patients progress. Maybe they don't need the same things all the time. It's just an ongoing condition. It's ongoing monitoring.

Melanie Cole, MS: Yeah. You put that really well and made that very clear when we think of chronic conditions, which we now know that obesity is. And as you say, that noise, those thoughts of food that sometimes are really pervasive and intrusive for some people all the time that, as a chronic condition, sometimes those medications really do need to be lifelong or for a very long time until maybe they need to be changed up a little.

Tell us a little bit about Bryan's bariatric approach to nonsurgical weight loss options. Share for patients what the process includes, the consultation, the plan, repeat visits. Because for some patients, Tara, that's the scariest part is that first visit.

Tara Troyer: Oh, absolutely. This is such a sensitive, very personal thing that people have been battling usually lifelong or there's been a situation, and it's just life-changing. In our program, the initial consultation can get started whether you go through your primary care provider, a different specialist, or if you want to self-refer and just call into the office.

And we will just ask the questions, are you interested in non-surgery? Are you interested in surgery? And then, if you want to just meet with somebody to get an idea of maybe what are all the options, I want to know all of them, we'll get you set up with the dietician in our office, with one of myself or one of the surgeons. Do a full assessment. What has your history been like with food? What has your history been like with your weight, with your medical conditions? And then, discuss at that initial consultation what some of your options would be. And then, we do tailor the plan from there.

Then, we'll decide with the patient being they are the ones steering this boat. They get to decide what is right for them. And we will then help them in their journey to get to the goals that they are wanting, that they have set for themselves, whether it is get off some of the medications, whether it's able to run a marathon. Whatever their personal goals are, that's what our goal is for them. And whatever it takes as the process goes, we will change it up. We will work with them as things change to be able to reach the end goal for them. We do repeat visits either every couple weeks, once a month, whatever's appropriate for their needs as well.

And we always are here. There is never an end date to this process. We will be here if the weight comes off and stays off for checks to keep that in check and to keep you where you want to be. If things don't quite go as you want in life for you and you need to come back and we need to reassess things, we are here and we are non-judgmental. All of the people in our office are very open and very sensitive, when it comes to this whole process.

Melanie Cole, MS: Well, that was so well said, Tara. Thank you so much for joining us today and really explaining what that process is like and explaining all of the options out there because there's so many more in your armamentarium now to really help people that are struggling with their weight. So, thank you so much for coming on and sharing your expertise and telling us all about that.

I'd also like to thank our Bryan Foundation partner, Artisight. And for more information, please visit bryanhealth.org/bariatrics. 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.