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Prakash Chandran: This True Care Health COVID-19 podcast was recorded on June 14th, 2021.

The stress and depression of having to stay at home as well as the fear and grief of the coronavirus has led many of us to engage in unhealthy habits, such as emotional eating, eating out of boredom, reduction in physical activity and increased alcohol consumption. This in turn leads to unwanted weight gain. And while losing weight for some might be easy with diet and exercise, for others, it may require a more multidisciplinary approach.

We're going to talk about it today with Dr. Christina Sanders, a board-certified general and bariatric surgeon and the medical director of ECMC Synergy Bariatrics. This is the True Care Health podcast, the official podcast from the Erie County Medical Center. My name is Prakash Chandran.

So Dr. Sanders, it's great to have you here today. I just wanted to start by asking a general question around what you've been noticing during COVID with regards to people and weight gain.

Dr. Christina Sanders: Well, with COVID, we've seen a lot of people with worsening depression, and most people are working from home. On top of having work from home, they are needing to take care of their kids and deal with schools. We've seen a lot of stress and anxiety and ,around that, a lot of people use eating to deal with that stress and anxiety. So as a weight loss surgeon, what we have been seeing in the clinic is people have been coming in, gaining anywhere from 10, 20 up to a 100 pounds over this last year due to the stress and strains of the pandemic. And not only have the gyms been closed and people have been working from home and just bored, but we've also seen an increase in other habits like alcohol consumption and so that also presents a problem. Not only is it high calories, but also another way of dealing with stress that isn't a good, healthy habit.

Prakash Chandran: Yeah. You said two things is there that I want to emphasize and focus on. One is that, you know, the gyms being closed and really just things that people had normally made a part of their routine, they just hadn't been able to do anymore. And the second thing is not only that alcohol consumption, but just the accessibility to more food, more alcohol, just because we've all been siloed in at home. So it feels like understandable that people are gaining weight during this time, wouldn't you say?

Dr. Christina Sanders: Yes, that's true. And also a lot of healthy foods weren't available or when people go into the store, there's limited things on the shelf. So things that people are buying, things that don't expire or, you know, have a long shelf life rather than good, healthy fruits and vegetables.

Prakash Chandran: Yeah, absolutely. So one of the things that I talked about at the beginning of the episode is that there are going to be some people that can lose the additional weight gained. I guess it's called the quarantine 15 as in 15 additional pounds. For me, it was the COVID-19 for 19 additional pounds. For some people, they are going to be able to lose that with diet and exercise. But that is not the case for a lot of people, especially those that are obese. Can you maybe speak to this a little bit?

Dr. Christina Sanders: Sure. A lot of people that fit into the obese category are people who tend to be limited in their mobility because of their weight, back pain, joint pain. So adding on another 10 to 20 pounds, it gets even harder. So you can be in the gym, you can work out for a half hour, you can work out for an hour. But if you look at the number of calories you're burning, you may only be burning a hundred or 200 calories. So in order to take off that additional weight, and the more you gain, the more calories you have to burn, and that just gets harder. And most people don't have that time to commit to be in the gym five to six hours a day.

Prakash Chandran: Yeah. And before we get into what they can do about that, I'm just curious as to why it's so much harder for some people to lose weight than others.

Dr. Christina Sanders: There's a lot of things that play into a person's metabolism. So one thing that I feel people in the United States, we don't tend to eat three meals a day, and most people sit down to eat one meal a day and it might be one larger meal. So of course, our metabolisms can be very slow. If we are not used to eating throughout the day, our body kind of goes into this preservation mode where we tend to store most of the energy that we eat when we do eat. So that's a factor.

A lot of people forget about liquid calories. So that's another reason why it can be very hard to lose weight. People start off their day with a specialty coffee that may be 400 calories alone once they've got all their cream and sugar and additional flavors added.

It all comes down to what a person already weighs and what they're eating. So if you have a person that's, you know, 400 pounds that's exercising in the gym an hour or doing a mile on the treadmill, they have to expend so much more energy in order to burn the amount of calories than someone who weighs a 100 pounds and working out the same amount of time.

Prakash Chandran: Yeah, that makes a lot of sense. And so, you know, just moving back to what they can do about it. Let's say someone is listening to this, they've already tried to start exercising and dieting, but they can't seem to lose that weight. What options are available to them?

Dr. Christina Sanders: First and foremost, you have to start with diet and exercise and some diets work better for one person over another just depending on their body types and things like that. So after diet and exercise fail, the next step would be looking into behavioral modifications, eating slower and not drinking and eating at the same time. And then when that fails, then we have to consider other things. And a lot of people will turn to over-the-counter medications for weight loss, or they'll see one of their physicians for potential drug therapy. But people who are more than a 100 pounds overweight, then there is the option of having bariatric surgery, which has been the most effective at long-term weight loss out of all of those measures, most effective

Prakash Chandran: Before we get into the dynamics of bariatric surgery, I know it's something that people have heard about. But there tends to be a stigma around getting weight loss surgery like it's a sign of giving up, like, "Why couldn't I have just dieted or exercised my way out of this extra weight that I'm gaining?" Can you maybe speak to those dynamics and how people that are overweight should be thinking about it?

Dr. Christina Sanders: Bariatric surgery is just a tool for weight loss. Most people, it does carry that stigma and most people think that surgery is the easy way out and it's not the easy way out. People are making the decision to alter their body permanently. So it's not an easy decision to make and along with having the surgery, you still have to be committed to diet and you have to be committed to exercise. So it's not the easy way out. It's a tool that we have to help with weight loss and it is highly effective for weight loss, but it is not the easy road out. And there's a whole process for approval for bariatric surgery as well. So it's not that someone comes into the office and they talk with the surgeon and the next week they are on the surgical table.

Prakash Chandran: Yeah. So let's talk about that process for approval. What exactly is necessary for someone to get qualified to get bariatric surgery?

Dr. Christina Sanders: So for approval for bariatric surgery, the minimum that was required is a person would have to meet with a registered dietician and they have to discuss various diets. Most the time we focus on high-protein, low-calorie diets. But that's sort of the first steps, is starting diet education.

The next part of it is meeting with a social worker or psychiatrist to have a psychological evaluation. And there are people that may have anxiety and depression and if there are other eating disorders, like binge-eating, all of those things have to be under control before they become a candidate for bariatric surgery. So that is another part of it.

And then, they have to undergo an evaluation in terms of either physical therapy or work with an exercise physiologist in order to learn different ways to exercise and improve mobility before surgery. And then of course there is meeting with the surgeon and discussing the different surgical options that are available.

On top of that, patients have to have a letter from their primary care doctors stating that they're healthy enough to undergo surgery and depending on what their comorbidities are, then they also have to have clearances by other treating physicians like a cardiologist or a pulmonary doctor.

Prakash Chandran: So this speaks to that multidisciplinary team that was mentioned at the beginning. You're not only meeting with the surgeon, but you're meeting with a registered dietician and a psychiatrist and a potential cardiologist. It seems like all of these people are there to help patients make the best informed decision possible and also to make sure that it's going to be sustainable in the long run. Is that correct?

Dr. Christina Sanders: Yes, that's correct.

Prakash Chandran: Okay. So let's talk a little bit about, at a high level, how does the weight loss surgery work and what is the success rate like?

Dr. Christina Sanders: So there are a couple of different options that patients can undergo for bariatric surgery. The most common operations that are performed in the US would be the sleeve gastrectomy or the Roux-en-Y gastric bypass. Previous options would include the Lap Band, although a lot of places have gotten away from doing that procedure because of the high failure rate and risk of complications. And then there's also the duodenal switch, which is performed less frequently than the sleeve gastrectomy or the Roux-en-Y gastric bypass.

In terms of the success rate, sometimes 10% to 20% of patients will regain some weight after these procedures. But what we consider a good result from the surgical procedures is typically losing a minimum of 50% of a patient's excess body weight. And most of the time, the weight regain happens typically years after the surgery.

Prakash Chandran: I see. And is it generally considered a safe surgery?

Dr. Christina Sanders: Bariatric surgery is very safe. It got a bad reputation years and years ago because of the risks and complications. But the chance of that from a bariatric surgery is 0.3% and so that is very similar to having a hip replacement done.

Prakash Chandran: If someone is listening to this, maybe they're obese or they kind of fall into that category of being qualified for bariatric surgery and they've gained some weight during COVID-19 and it's completely understandable. There's a lot going on, a lot of restrictions, what is the best way that they can start exploring these options?

Dr. Christina Sanders: The first steps when you're considering bariatric surgery is to have a conversation with your primary care doctor, because ultimately a patient does need a letter of medical necessity from their primary care doctor. And then most bariatric surgery programs have what's called a new patient seminar. So for instance, if you go to the Synergy Bariatrics website, we have a part on our website, which has a new patient seminar and patients can log on to that and they can meet with the surgeon, or we have an online version and they can just scroll through, but it explains how to become a patient and what the different surgical options are and what the risks and complications of those surgeries are.

Once a patient has completed a new patient seminar, then they're typically scheduled to see a provider in the office and talk about these procedures more in detail to determine if it's a good option for the patient.

Prakash Chandran: Yeah. And so just before we close here today, Dr. Sanders, you know, you've probably seen hundreds, if not thousands of patients that have gone through this life-changing operation. What's one piece of advice or something you'd like to leave our audience with, something that maybe you wish they knew before they came to see you?

Dr. Christina Sanders: I wish people would not place judgment. Obesity is very common. Forty-two percent of the adult population is obese. And so they're not alone. And I think that's what people think that there aren't many people out there that are suffering, but the majority of the population are suffering. So the best thing is to take action against that. And maybe it's not bariatric surgery, but if you come in and you speak with a provider, then you can definitely work on what's the best treatment plan for that person.

Prakash Chandran: Yeah, Dr. Sanders. And that last point can't be emphasized enough, the fact that you are not alone. Let's face it. This year has been very difficult on all of us. And if you've gained weight during this year, that is completely understandable. The world has shifted from beneath us. And I think that if this is something that you've been thinking about for awhile, ways to lose weight, ways to get back on track, it doesn't hurt to have that conversation with your primary care provider because it affects more than your weight, right? And it affects your mental health, how you view and perceive yourself. And luckily, there is the technology and there is the medicine to cure this and to make your life better. Wouldn't you agree with that, Dr. Sanders?

Dr. Christina Sanders: I would definitely agree with that.

Prakash Chandran: Dr. Sanders, thank you so much for your time today. This has been a truly informative conversation.

For more information, visit SynergyBariatrics.com or call (716) 565-3990. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks for listening to this episode of True Care Health. My name is Prakash and we'll talk next time.