Scott Webb (Host): Bariatric surgery has come a long way over the years, and joining me today is Bariatric Surgeon, Dr. Bethany Briggs, to give us some updates on this life-changing surgery, and tell us about how GLP-1 Medications are helping weight loss patients.

It's nice to have you here today. We're going to get some bariatric surgery updates from you. So let's start there. Like how has bariatric surgery evolved over the years?

Bethany Briggs, DO: Over the years, bariatric surgery has overall become more effective and safer. It first started about 70 years ago, so it's a pretty young discipline overall, but back then they were just kind of doing anything that they could to try to help people lose weight when they were, you know, very morbidly obese and it was something that helped save their lives.

So, at the original time of the surgery getting started, all of the cases were open, so big incisions, they were sort of testing out different things. Nowadays, we know a lot more of the science behind bariatric surgery, why people lose weight, how to manage the weight loss safely. All of the surgeries themselves are laparoscopic, which means they are done through small incisions in the abdomen, thus making it a lot safer, a lot easier recovery as well.

So overall, with advancement of science and knowing what the anatomy and the physiology is; bariatric surgery overall has become much more safer, more effective, and easier to recover from.

Host: Yeah. I like hearing those things. Safe, effective, better and faster recovery. And I do know, Doctor, from speaking with other experts that this is really a, it's like a multidisciplinary approach to treating obesity, right? It's not in the hands of just like one doc or one expert. So maybe you can share some of the reasons why that approach seems to work best.

Bethany Briggs, DO: Yeah, exactly. As far as surgery goes, bariatric surgery is one of the disciplines that is the most comprehensive, the most holistic, it's almost sort of like the family medicine of surgeries of sorts. So we've known for a long time that obesity, weight gain, and therefore the loss of all that weight has, is a very multifactorial issue.

We don't gain weight just because we eat too many calories. We do it because we have cravings. We have a psychological dependence upon it. We have social and cultural pressures. It can also be due to hormones. We found out that weight loss is really impeded by the body's natural physiology where it just doesn't want us to lose weight because it's worried that we are going to starve. So really it needs to have a holistic, multidisciplinary approach for it to be successful. So when you come to a bariatric surgery office, there are certain things that you'll have to kind of go through before getting surgery in order to have a safer, more effective operation. So you usually will talk to a nurse practitioner or a dietician. Do several appointments to make sure that you are actually doing things beyond just the surgery to help lose weight. So surgery itself, it's not a magic bullet. It's never going to just on its own be effective. It comes alongside things that the patient is already doing, like diet changes, exercise, getting the right nutrition, to actually make those interventions effective.

So we have someone, like a nurse practitioner and a dietician to help with that side of things. We always have a patient see a psychologist because not only is the process necessary for insurance to make sure, yes, you're actually somebody that knows what you're getting yourself into, but also, it's a pretty drastic life change.

And we want to make sure the patient has somebody as a support, if anything were to come up or be needed after surgery. And also to help figure out, okay, what are those psychological influences that can make this process either more or less successful? And then of course, you also have the surgeons themselves.

We see our patients at least twice before surgery. And then us physicians actually see you at least once in the first year after surgery, and then every year after that. And then we also have them see the nurse practitioners multiple times at that first year after surgery as well, just to give the patient extra support on a lifelong basis to help this process be successful.

Host: Yeah. It's like, okay, the surgery's done, but there's plenty of support available, for that first year or more. And it makes me wonder, Doctor, like who really benefits or qualifies for bariatric surgery? We're talking about this multidisciplinary approach and everything that's involved. So who's a good candidate?

Bethany Briggs, DO: Yes, so this is a very good topic because we are kind of inundated with media and shows that demonstrate people as just very, very morbidly obese, being the people that would benefit from this surgery. How do we actually even determine whether or not an operation or a treatment is something that's going to be good for a patient?

We look at what are the risks of the procedure or the treatment and what are the benefits. So we have determined through extensive studying of all the things that obesity can affect; your blood sugars, your heart, your even your risk of getting cancer in the future, and then kind of see which patients will actually benefit going through this process.

And it's people with a BMI, which a BMI is sort of a calculation based off your height versus your weight. Somebody with a BMI of 40 or above without any extra diseases or problems will automatically qualify for surgery. So if you're a woman that's, you know, 5'4", that's as little weight as 235 pounds, or a man who's 5'9", that's as little as 260 pounds, so it'll automatically qualify you for bariatric surgery. Also, if you're someone that has a lower weight and other things that are medical problems that are related to the weight, things like diabetes, high blood pressure, sleep apnea, those will qualify you at a lower weight because we know that you are having difficulties with something that losing the weight would help.

So that would qualify you if you are somebody who's 205 pounds at 5'4" or 240 pounds at () 5'9". So you don't have to be this very overweight person who can barely get outta bed. I've had so many patients that have come to me and it's like, I didn't realize that I would qualify for this surgery. But we're seeing that it's so effective, it's so beneficial that even at these lower weights, it can make a massive improvement on your life.

Host: You know, we're just scratching the surface here today, Doctor, but I want finish up today and talk about GLP-1 medications. When we think about the, you know, surgical alternatives, if you will, for obese people, you know, where do they fit into this, as folks are working their way, perhaps towards surgery, but trying some things first.

Bethany Briggs, DO: Yeah, so this is actually a very exciting frontier right now. First and foremost, before I became a surgeon, I became a doctor. And that means that, you know, I want to have our patients see a benefit, see an improvement in their health and their quality of life, no matter where it comes from.

So ultimately, yes, I love doing surgery and think that bariatric surgery is a great tool, but not everybody needs it or it's not necessarily going to be a first step for everyone. So, GLP-1s, even though they're still kind of new and we're still trying to figure out exactly what all the different aspects of that medication are, they have been demonstrating that there is a phenomenal weight loss compared to any other medication beforehand.

There still is some side effects and some drawbacks, so we are seeing that people may not be able to take them long-term, but I think that it's a good first step for a lot of people to say, Hey, I feel better with this weight off. A lot of my life is better. What are the other options that we have? Or we're also seeing that it is beneficial to make it so patients are safer to get bariatric surgery in the first place, by losing some weight beforehand when people have a lot of extra weight to lose, to make it safer to go undergo surgery. Or what's also very exciting is it's something to help people maximize their weight loss after surgery. Because there still is a certain amount that patients do not completely lose or they may regain after surgery.

And having the GLP-1s in our pocket to help with those patients and make our surgery more effective is going to be a great thing. And we actually are in our office now in Champagne, we are offering GLP-1s now as part of our integrative service.

Scott Webb: That's great. Yeah, and it seems to me, I keep hearing more and more great things about GLP-1s sort of unexpected benefits of GLP-1s and we're still just learning so much, this undiscovered, you know, unrealized potential so far. But for today, thank you so much.

Bethany Briggs, DO: Yeah. Thank you, Scott. I appreciate you having me on.

Host: For more information and to get connected with one of our providers, please visit carle.org. And that wraps up this episode of Expert Insights with the Carle Foundation Hospital. I'm Scott Webb. Stay well.