Caitlin Whyte (Host): This is Wise & Well, presented by Community Memorial Healthcare. I'm Caitlin Whyte. And with us today is Dr. Barry Sanchez, a bariatric surgeon at Community Memorial Healthcare. We are talking about bariatrics, what it is, who it can help, and how it can transform not just weight but overall health and quality of life.

Dr. Sanchez, you have dedicated more than two decades to treating obesity and metabolic disease. What drew you to this field, and what continues to motivate your work with patients?

Dr. Barry Sanchez: That's a great question. I've had the honor of practicing bariatric and metabolic surgery for over two decades now, 20 years. But what originally drew me to the field was how dramatically I was able to see the change in not just somebody's weight, but their overall health and quality of life. I remember being a fellow at Stanford, and we were doing these bariatric surgeries, and just noticed when they came back for their postoperative visits how amazing they felt and how a lot of their medical problems were disappearing, which was amazing to me.

You know, obesity, it's a chronic metabolic disease. It affects all aspects of life. It can affect diabetes, high blood pressure, sleep apnea, your risk of cardiovascular disease, fertility, so many aspects of the health. And when you're really treating the underlying disease or what I like to say, getting to the root of the actual issue, you see improvements across so many different facets of that patient's life, which was just amazing to be part of.

What continues to motivate me really is what happens beyond the operating room. As a surgeon and as a bariatric surgeon, I spend so much time with these patients outside of the operating room, months and months preoperatively and then years and years postoperatively. The patients come back, they have more energy, they're more active, they're reducing their medications or getting rid of their medications altogether. Their diabetes most likely is gone, and they're doing things they haven't been able to do for years, which makes me so excited about what we're building at Community Memorial Hospital, is we're actually developing an outpatient bariatric clinic really designed to care for patients not only just before surgery and right after surgery, but for years and years after surgery for that long-term follow-up. Because really, the operation is just one day, but the relationship with the patient, it's got to last much longer than that.

Host: Absolutely. Well, what makes someone a good candidate for bariatric surgery?

Dr. Barry Sanchez: One of the biggest misconceptions I think that's out there is you have to be extremely overweight to qualify for bariatric surgery. Back in the old days, it was 100 pounds of excess weight would get you qualified. We use a body mass index or a BMI to kind of judge candidacy, but that's still even a crude measurement.

The other misconception is that surgery is really a last-ditch effort. And we want to get the word out that that's not necessarily the case anymore, because we're not necessarily just treating weight, we're treating the metabolic disease burden. Again, I mentioned the BMI. It used to be a body mass index greater than 40 or greater than 35 with medical problems. And now, we realize that the medical issues present themselves earlier on a BMI. Obesity is really a body mass index greater than 30. And if your body mass index is greater than 30, that is considered obesity and you have a 20 times more likelihood of developing these medical problems. So, we really look beyond just a number and we look at the entire patient, their weight, their BMI, and their comorbid conditions: diabetes, high blood pressure, sleep apnea, fatty liver disease, if they have joint issues.

We also like to take a look at their previous attempts at weight loss, what medications they're on, and really how this is affecting their quality of life. And we like to look at what have they tried? What have they tried to institute? Are they on these GLPs? Have they seen dieticians in the past? Because ultimately, it's about matching really the right patient and the right treatment. Some people, that's just medical therapy. For others, it's bariatric surgery. And we really need to take all of those into account when we're looking at a patient.

Host: Well, I'd love to focus on what you mentioned about how many people think bariatric surgery is simply weight loss surgery. Can you dive more into how these procedures really improve that overall health and any chronic conditions that may be occurring?

Dr. Barry Sanchez: Yeah. You know, the term used to be weight loss surgery. And we keep saying we, as bariatric surgeons, came together and realized that this was much more than weight loss. It really was a metabolic disease burden.

The original name of our society was the American Society for Bariatric Surgeons, and I remember when I was a fellow, that's what it was called. And quickly, a couple years after I became an attending, we actually added the word metabolic, so the American Society of Metabolic and Bariatric Surgeons. So, we realized it was a metabolic surgery that we're working on, not just weight. Because the difference that we see with the patient is much more than their weight loss. Their metabolism changes almost immediately after surgery before a significant amount of weight is lost.

And really, the procedures that we're doing not just lead to weight loss, they really change the physiology that regulates hunger and satiety and glucose metabolism and insulin sensitivity. We know it regulates certain hormones in the body such as ghrelin, leptin. And again, that's why we see these improvements in conditions such as diabetes, sometimes right after surgery before there's significant weight loss. We see improvements in high blood pressure, in sleep apnea, in fatty liver disease, in lipid profiles, again, before a lot of weight is even lost. So, we know there's a significant change in the metabolism right off the bat. So, we don't really talk about it in terms of pounds, and I don't sit in the room with a patient and say, "Hey, how much weight can we help you lose?" It's really, "Hey, how much healthier can we help you become?" And that's really the goal of metabolic surgery.

Host: Well, with GLP-1 medications becoming more common for weight loss, how do you counsel patients who have tried them but maybe haven't achieved the results that they were hoping for? And when might bariatric surgery then become the next step in their care journey?

Dr. Barry Sanchez: Yeah. This is a really important point specifically now. I would say one in six Americans have tried or have been on a GLP. And so, this is something that we can't ignore. And I do think GLP-1 receptor agonist medications have been transformational for obesity and treating obesity. Early on when we didn't know a lot about them, there was some resistance, you know, in the surgical world about one or the other. And a lot of physicians were seeing patients coming to their office with weight issues. And now, they had a new shiny penny of a GLP, and they would try these medications for a while. We're seeing some meaningful weight loss when it's directly affecting these pathways to regulate that appetite and metabolism. And I think we understand more about GLPs today.

I don't think medication and surgery should be viewed as competitors. They're different tools for treating the same disease. Some patients do extremely well on GLP therapy. Others don't lose enough weight and have side effects, or they reach a plateau early, or they regain their weight after they've stopped. And so, these are the conversations that we have, like, are you a candidate for metabolic surgery? Just because you may or may not have done well on a GLP doesn't mean you're excluded from that conversation.

And again, having surgery doesn't mean that medical therapy disappears forever. We treat patients pre and postoperatively in our bariatric clinic with GLPs. Someone's body changes over their years. Their metabolism changes. Their age changes. Their hormonal status changes. So, I believe GLP medications have a role for long term.

But I do think that that's where obesity treatment is headed, not medication versus surgery, but using nutrition, exercise, behavioral health, you know, other medications, and surgery intelligently together to really treat the overall patient. And that's really what we're excited to be building at Community Memorial Hospital as well as really an overall obesity medicine and surgical program where we can treat the whole patient and not just surgery alone or medications alone, but combinations of things.

Host: Well, that leads me right into my next question. Beyond surgery itself, what other steps can patients take throughout their weight loss and wellness journeys to support that long-term success?

Dr. Barry Sanchez: Yeah, I think that this probably is the most important thing for patients to understand, is the operation is powerful and I call them tools because that's really all they are, is they're tools. They're not magical. And just like any other tool, if you don't know what to do with a tool or use a tool incorrectly, it doesn't work. So, it's not just about the operation. There's so much more to it.

Follow-up is every bit as important as the surgery itself. The body six months after surgery isn't the same body that it was right at surgery. Specifically two years, five years, 10 years down the line, the body continues to change, metabolism changes, the hormones change, nutritional needs change, life throws you curve balls. All these things really have to kind of be taken into consideration.

So, the overall treatment plan changes with the patient. That's really at the center of kind of what we're building at Community Memorial Hospital, is we want patients to have a long-term home to help with these aspects before and after surgery. It means to give access to our registered dieticians that have familiarity with bariatric surgery and the unique nutritional needs that are needed for that bariatric patient. We also have psychologists and ongoing therapy to help the patients navigate the emotional and mental challenges that accompany the weight loss and really major life changes that happen on a day-to-day basis.

It also means we have dedicated staff. We have bariatric nurses, advanced practice providers, support staff. We also have support groups for the patients where they're a group of peers that they can talk to about their journey either before or after surgery. I think it adds tremendous value for all of these patients.

And again, our medical management doesn't necessarily end with someone who just had an operation. In appropriate patients, our clinics can incorporate those metabolic tools, including GLPs and hormone optimization as part of that long-term strategy. You know, weneed to keep focusing on diet. We need to keep focusing on protein and resistance training, maintaining that lean muscle and also the foundational pieces: nutrition, sleep, stress reduction, body composition. It's just continuing to work with the patient over time is important.

And the one of the frustrating things is patients sometimes will obsess about a number on a scale, but the goal isn't really to become a smaller person or significant weight only. We're really trying to strive to get a healthier, stronger, more metabolically healthy patient. So, we're not just dedicated to getting someone through the operation. We're really dedicated to the long-term success of that patient.

Host: Doctor, what surprises patients most about the health improvements that they experience after surgery?

Dr. Barry Sanchez: Yeah, it's funny we talk about this before surgery, but I don't think they're prepared for it. But what they notice pretty much right off the bat is the changes that they notice don't, again, have anything to do with the weight that they're losing. They sleep better. Their energy improves. They notice that their blood pressure is amazing. Their diabetes, their fasting glucose number is normal off medications. The pain that they used to have in their hips or in their knees start disappearing. They're able to travel more comfortably. I mean, I can't tell you the number of stories of people that tell me, "I was able to actually get on the floor and play with my kids or my grandkids and was able to get up where I couldn't do that before." They're going hiking and they return to activities that really they haven't done for a very long time.

The other thing when you start to get to know these patients is they start telling you very intimate details and things that we don't think about. They can go into a clothing store and buy normal-sized clothes. They can fit into an airplane seat. They can go on a rollercoaster ride where they couldn't do this before. They can actually get down and tie their shoes without having a tremendous amount of time or effort. So, what I love is when they're coming back to the office and they stop telling me about how much weight they've lost, but they start telling about everything that they're able to do that they haven't done for a very long time. And I think those really are the victories that continue to keep me going and make me proud every day.

Host: So, what message would you like to share with patients who may be still on the fence considering bariatric surgery?

Dr. Barry Sanchez: Yeah. I think the number one first step is to get yourself educated, to understand. There's a lot of misnomers out there in the community about bariatric surgery. I hear it every day despite the fact that we know that bariatric surgery is the best improvement for long-term health. But coming for a consultation and seeing me doesn't commit you to having surgery. It really gives us an opportunity to understand your health, see what you've tried, see what you're struggling with, and how you want your life and your health to look going forward.

One of the things that I ask during the interview is, what are your goals? And I'm not talking about a weight goal. What truly are your goals? And I would say a great majority of the time I actually get the patients to be tearful because they hadn't thought about this. They hadn't really focused on themselves for a really long time.

The other important thing that we attempt to do and talk to them about is really removing the stigma that having bariatric surgery represents failure—failure that anything that they've done has not worked. We know that obesity is a chronic disease. These patients aren't ones that are just "lazy or overeat." It's an actual biological disease. It's genetically a disease. It's environmental. It's societal. There's so many factors that lead to obesity, and it's not just about one thing or the other. We don't tell someone who has high blood pressure or diabetes, that using effective treatment means they've failed their disease. We offer them what is right for those things. So, we shouldn't treat obesity any differently. And really, for that appropriate patient, metabolic surgery can be simply one of the most effective tools we have.

So, what I want patients considering surgery at Community Memorial to know is they're also not expected to do it alone. The goal is to surround the self with a team, and that's why we have a team. And the team is there for that patient not just leading up to surgery, but years and years and years afterward to continue to follow them while they're postoperative and when they're going through this journey.

So, my job isn't really to convince someone to have surgery. It's really to help them understand their options and to give them the right treatment for them and to help them succeed.

Host: And wrap it up for us today, Doctor. How can patients get in touch with you?

Dr. Barry Sanchez: Sure. So currently, I'm seeing patients at the Community Memorial Healthcare Clinics in Ventura. Currently, we are at the MMG Clinic on Brent Street, but we are soon moving over to Telegraph location where they're building out a brand new bariatric clinic.

Host: That was Dr. Barry Sanchez. For more information, go to mycmh.org/weightloss. If you enjoyed this podcast, please share it on your social channels. I'm Caitlin Whyte. This is Wise and Well, presented by Community Memorial Healthcare. Thanks for listening.