Caitlin Whyte: When it comes to weight loss, sometimes surgery is the best option for a patient. But what happens after surgery? What becomes the new normal and what are the options under the umbrella of bariatric surgery here to talk about the quality of life after bariatric surgery is Dr. David Lautz, a Bariatric Surgeon at the Emerson Hospital Center for Weight Loss. This is Health Works Here. I'm your host, Caitlin Whyte. So Dr. Lautz, Why should a patient consider weight loss surgery?

Dr. Lautz: There's a whole variety of reasons. Some patients decide they want to consider weight loss surgery because they've been dieting for years and they're not making progress. Others are concerned about their medical problems that they know are directly from their weight, diabetes, or high blood pressure are common reasons why. And then others will choose it for lifestyle or quality of life considerations. Things like they have a harder time functioning day to day in their lives with certain activities etcetera.

Host: So who makes a good candidate for bariatric surgery?

Dr. Lautz: There are a number of criteria that our center has and some of them are very old criteria. Back in 1991 their National Institutes of Health put together the basic criteria, which essentially means you have to be having enough and have done something to try to be losing weight along the way. We don't want patients to consider weight loss surgery as their first attempt at getting their weight down, but what we usually see are patients who have been trying to lose weight for years and years, if not most of their life. In terms of how heavy you have to be, you have to have a body mass index over 40 body mass index or BMI is essentially just a way of adjusting your weight for your height. There are a number of online calculators that you can use to put in your height and weight and calculate your BMI. So a BMI over 40 would say that you're heavy enough. If you have medical problems directly related to your weight, like diabetes, high blood pressure, sleep apnea, then that number drops down to 35

Host: Now, for someone who's tried a lot of different options, what makes bariatric surgery different than a diet?

Dr. Lautz: That's a common question. A lot of patients who consider surgery often, I think there's a lot of, almost a guilt at times that they're taking a quote unquote easy way out. And there's also a concern that if they failed diets, how do they know they're going to do well with weight loss surgery? Weight loss surgery is not a diet or exercise program. We're fundamentally changing the patient's anatomy that changes the way their body works or their physiology, and that actually has an indirect impact on their behaviors. So for instance, many of the procedures that we, or some of the procedures that we perform will affect the hormones that drive their eating behavior. There's more and more evidence that there are hormones secreted by the stomach and the intestines that feed back to the brain that tell you that you're hungry. So a lot of the issues that will make it very hard for them to stick to a diet. Things like their hunger drive for some at least, the way the anatomy works, it's not just that we make a small pouch or we make it harder to get a large amount of food. We're also affecting hormones that drive your behavior that then have an indirect effect on weight. In addition to hormones having other effects like change their metabolism, etcetera.

Host: Now, once you've had the surgery, what are the effects for patients? What is the biggest impact?

Dr. Lautz: You know, these patients experienced a just an absolute tremendous change in their life and it really affects all parts of their life. Obviously the biggest impact in some ways, it's their weight that we watch closely and they will lose a fairly large amount of weight pretty quickly. And that weight loss, the vast majority of it is sustainable over the rest of their lives for most of the patients. There are then secondary effects on their medical problems. Many patients who have type two diabetes will actually come off all of their medications and have a normal hemoglobin A1C. Many patients come off their blood pressure medications or their cholesterol medication. So we have a lot of patients who will come in with a hand taking a handful of pills three times a day who a year out after surgery or just taking a multivitamin. But all that being said, the area that we probably have the biggest impact is on quality of life. Patients come in and just tell us really amazing stories about, you know, they used to not be able to exercise and now they're running a marathon or they have had three promotions at their job after not having a promotion for 15 years because of the differences in how they're perceived or they feel like they're not, they're now listened to in conversations whereas they used to be ignored. So it changes not only their, their weight and their medical problems, but it has a greater effect on their overall day-to-day quality of life

Host: Under the umbrella of bariatric surgery. What are some of the most popular operations you see?

Dr. Lautz: The gastric bypass is still very popular, but the most popular operation we offer is a sleeve gastrectomy. I think a lot of patients like it because in some ways it's simpler, more straightforward does not involve a rerouting of your intestines and it's largely what we're doing is making your stomach smaller. So that's the most popular operation, not only in our center but nationally now.

Host: And is there anything special for patients with diabetes?

Dr. Lautz: Well, there's a lot of evidence that goes back 10 or 20 years now looking at the effects of gastric bypass in particular on type two diabetes, there are hormones that the bypass changes that is thought or thought to have a direct impact on type two diabetes so that, you know, anyone who loses weight will have some improvement in their insulin resistance. Insulin resistance is the main problem with type two diabetes, but there's evidence that with a bypass, the insulin resistance improves before the weight loss even occurs. And they also have an improvement in the insulin secretion, how much insulin their pancreas makes and secretes after each meal. So there are a number of things that changed that directly impact diabetes for a bypass that are independent of weight loss. And as a result many, many of our patients who have diabetes, some of them on large amounts of insulin and large doses of insulin, two or three times a day can come off all of their medications and no longer even have to check their blood sugars.

Host: Now, if I'm listening to this and I'm interested in getting bariatric surgery, where should I start? What should I do?

Dr. Lautz: Well, the first thing to do would be to attend an information session. These are sessions that are run by in our center by the surgeons where we give a general overview of a background on obesity, who should be considering surgery, what you have to do to be a candidate, and then we spend a fair amount of time going into the procedures, each procedures, risks and benefits, and then talk about some administrative steps if you decided to go ahead and look into surgery further. But these are nice sessions to attend, if you're not quite sure and thinking about it, it'll give you at least a flavor of what the operations are and how they work.

Host: Well, we certainly appreciate your time and your expertise today, Dr. Lautz. That was Dr. David Lautz, a bariatric surgeon at the Emerson hospital center for weight loss. Thank you for listening to the Health Works Here Podcast. Subscribe to this podcast on your favorite podcast source, including Apple podcasts, Google Play Music, and Spotify. I'm your host, Caitlin Whyte. We'll catch you next time.