Maggie McKay (Host): Welcome to Total Health Talks, your Cook County Health podcast, where we empower your journey to better health. I'm your host, Maggie McKay. And today, we're going to talk with Dr. Kristine Makiewicz, Clinical Director of Bariatric Surgery at Cook County Health, about More Than Weight Loss: Understanding Bariatric Surgery. Thank you so much for being here today.

Kristine Makiewicz, MD, FACS, FASMBS: Thanks for having me.

Host: Of course. Let's just dive right in. Why is healthy weight management important, and how does excess weight affect overall health?

Kristine Makiewicz, MD, FACS, FASMBS: As a doctor, as a physician, I care about someone's weight, not because of the size of their body or the shape of their pants or anything like that. I really care about the medical problems that come along from obesity or come along from extra weight. And we do know that every single organ system in the body is really affected by extra weight, and can be really injured by extra weight

Host: And weight management is often described as more complex than simply eating less and moving more. So, what factors can make losing weight and keeping it off so challenging?

Kristine Makiewicz, MD, FACS, FASMBS: The main thing is kind of our basic biology. We are really designed to protect ourselves. And one of the kind of most basic ways to protect yourself is you need enough nutrition and you need enough food. So biologically, we're not designed to lose large amounts of weight. If you think about 1,000 years ago, if someone lost 50, 80, 100 pounds, it was because there were really bad things happening, right? They were starving. They were dying of cancer. There were wars happening. And so, we have lots of really complex ways that our body protects the amount of fat that we have, because it's storing it for the future.

And so now, that we live in a society that has a lot of food for most people, we don't have to work as hard to get around. We've got buses, we've got cars, we've got trains. It's really easy for our body to develop extra weight. And then, biologically, it just wants to keep it because it's protecting itself for the future. And so, the different treatments that we have are designed to kind of break out of that cycle of the protection of the fat.

Host: So, let's talk about some of those avenues where someone looking to lose weight might think about, like bariatric surgery. What is it, and who is typically considered a candidate for it?

Kristine Makiewicz, MD, FACS, FASMBS: Bariatric is a broad term to overview a couple different types of surgery. At Cook County, we do two different types. We do the gastric sleeve and the gastric bypass. And both of them are designed to make your stomach physically smaller so you get full faster. But more importantly, it changes a lot of the hormones in your body, mostly food hormones and diabetes hormones, to help make it so you feel less hungry.

It changes how your body responds to blood sugar, how it responds to calories. Doing the surgery kind of resets some things and helps kind of go against that biology that's protecting that fat.

The people who qualify for it, it's based both on your weight and the medical problems that you have. So, it's based on your BMI and your medical problems. So, BMI is body mass index. Anyone who has a BMI over 35 can qualify, or a BMI of 30 with certain medical conditions.

Host: We touched on this a little bit, but what are the most common types of bariatric surgery today, and how do they differ?

Kristine Makiewicz, MD, FACS, FASMBS: Gastric bypass is one of them. This is one that affects both the stomach and the small intestines. So, it makes it so your stomach's smaller, but you're also absorbing less of the food that you're eating. This does mean that you're also absorbing less vitamins, so you do need to take vitamins lifelong after having this type of bariatric surgery.

The vertical sleeve gastrectomy or sleeve gastrectomy, it's the same thing, involves just the stomach. So, you're reducing the size of the stomach by about 80%. People sometimes think sleeve means you're like putting something over the stomach, but it's just changing the size of the stomach.

Host: What are some of the biggest misconceptions about bariatric surgery?

Kristine Makiewicz, MD, FACS, FASMBS: I think one of the big ones is that it's taking the easy way out, or that the surgery is doing all the work. And really, it's designed to be a tool, and it's the strongest tool that we have in medicine right now for long-term sustained weight loss. It does involve some pretty big lifestyle changes. You do have to change the way that you eat. You do have to exercise and move your body. But it's a really strong tool combined with those things to help your weight come down and, more importantly, stay down. It's the best for long-term weight loss.

Host: How do you know when surgery may be a better option than weight loss medications like GLP-1s alone?

Kristine Makiewicz, MD, FACS, FASMBS: Yeah. So, I really see both medications and bariatric surgery as part of an entire continuum of care for obesity. For some people, the medications might be enough. For a lot of people who are carrying a lot of extra weight or who have more severe medical problems, they may need the extra weight loss that bariatric surgery has.

Right now, the medications are not as strong in terms of the amount of weight loss you can expect or, like, how much they fix the medical problems compared to the surgery. The surgeries are stronger. So, it kind of depends on how severe your medical problems are. But it's not really an either/or. There are some people who may technically qualify for the medications, but they may decide that they don't want to take a medication every day for the rest of their life or every week, kind of depending on what medication that they're on. And so, they may opt for the bariatric surgery, which is a one-time procedure.

Host: You mentioned one time, that's a good point. So once you have it, you never gain weight back?

Kristine Makiewicz, MD, FACS, FASMBS: Well, for most people, they lose the weight and they maintain it. There are a subset of people who don't respond how we would expect, where they either don't quite lose as much weight as we would expect from the beginning, or they may lose weight and regain it. And there's a lot of factors that go into that.

And so, for that reason, if you are going to get bariatric surgery, you should stay under the care of a bariatric surgeon. So, we see our patients for six years after surgery, and we have a path in place of transitioning your care once you're done with us to your primary care doctor. So while it is a one-time procedure, it is something that you want to follow with lifelong because, unfortunately, obesity is a lifelong disease. And so, it needs to be treated lifelong.

Host: So, what does the patient's journey look like? What can patients expect during recovery, like, let's say in the first year after surgery?

Kristine Makiewicz, MD, FACS, FASMBS: We start thinking about the bariatric surgery journey from before surgery. We see you, we meet with you. And part of the initial conversation is, "Am I a good candidate for bariatric surgery? What are the expectations? And which surgery is the right fit for me? Because while the bypass might be great for one person, the sleeve might be better for someone else, kind of depending on their medical problems and their goals. And then, we see people before surgery for a couple of months, everyone's a little bit different, to make sure that you are ready, both physically, that your heart and your lungs are okay, but also that you're kind of emotionally ready. You know what you're getting into. You have the nutrition foundation that you need in order to take care of yourself after surgery. Then, we do surgery. Surgery's an hour, hour and a half. In some ways, that's kind of the most straightforward part of it. And then, it's usually one day in the hospital, and you go home on a special diet. It takes about two weeks of a liquid diet to let things start healing up. And then, we slowly move you forward onto real food. We have a dietician that works with you that helps teach you the balance of the right types of food to eat with your smaller stomach. And then, we check in with you regularly just to make sure that you're feeling okay, you're not having complications, that you're exercising, and to check labs and make sure that vitamins are within the ranges that we want to 'em at.

Host: And beyond weight loss, what health improvements do patients often experience after bariatric surgery?

Kristine Makiewicz, MD, FACS, FASMBS: So, that's kind of my favorite part, is watching people's medical problems get better. So, we know that bariatric surgery is one of the strongest treatments of available and, in some cases, can even reverse diabetes. It can treat heart disease. It can treat sleep apnea. It can treat lung disease. Fatty liver or metabolic associated liver disease is one of the most common causes of liver injury and liver failure these days, and it can improve or reverse that. It can help with fertility issues. It can help with mobility. And so, seeing patients in the three, six months, year afterwards and watching them come off of a lot of their other medications, have more energy, being able to play with their kids or their grandkids is kind of the best part of the job

Host: I bet that's very rewarding. What does long-term success look like and what habits are most important for maintaining the results?

Kristine Makiewicz, MD, FACS, FASMBS: Yeah. I think long-term success, it's partly lower weight. But that's really a small percentage of it. I really see long-term success as how are your other medical problems? Is your diabetes very well-controlled or is it gone? Are you off a bunch of your high blood pressure medications? Are you able to do the activities of daily living that you want to do? And a big component of maintaining that long-term is exercise. Exercise is very important and not everyone goes out to become marathon runners. That's not the goal. But to be in the gym or going on walks or moving your body pretty regularly is important and maintaining long-term healthy eating habits.

Most days, you really should be eating a high protein, high fiber, high vegetable meals. If on your birthday or on some holidays, you are eating special occasion foods, that's okay, but a long-term healthy diet really is important.

Host: And for someone who's been struggling with their weight and is considering bariatric surgery, what advice would you give them as they explore their options?

Kristine Makiewicz, MD, FACS, FASMBS: Really ask yourself what's your why? What's your reason of why you want things to change, and what are your goals? And I think that while having a weight goal or a number can be really motivating for people, it's often not just the number on the scale that really leads to people's success, but to really focus on what are the, like, practical effects of the extra weight in your life, of what are, like, the physical limitations it's leading to, what are the health conditions that it's leading to, and what are your goals on changing that?

Host: Is there anything else in closing that you'd like to add?

Kristine Makiewicz, MD, FACS, FASMBS: I would just like to add that I'm really passionate about bariatric surgery. I think it can be really life-changing for people and it can be life-extending for people. We know that on average people who get bariatric surgery live about five years longer than people of similar weights and medical problems that don't get bariatric surgery. And we know that the quality of life in those years is better. And there's not many things in the world that we know just add life to people. And so, it's a really great option.

Host: Well, thank you so much for sharing your expertise. This has been so enlightening and educational. We really appreciate your time.

Kristine Makiewicz, MD, FACS, FASMBS: Thank you. It was great talking to you.

Host: You as well. Again, that's Dr. Kristine Makiewicz. As we wrap up another insightful episode of Total Health Talks, make sure to visit cookcountyhealth.org/podcast and subscribe to our podcast, share and connect with us on social media. Stay tuned for more engaging discussions. This is Maggie McKay signing off from Total Health Talks. Stay well.