For severely obese patients, weight loss surgery or bariatric surgery may be an option when non-surgical treatments fail. With dietary changes and an active lifestyle, bariatric surgery helps patients lose pounds and maintain a healthy weight. There are three types of bariatric surgery procedures that may be recommended. Each uses different techniques to interrupt digestion or reduce the amount of food the patient eats.
Listen in as Dr. Christian Birkedal discusses bariatric surgery as a tool to help control obesity and what factors might qualify someone for this type of surgery.
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Are You A Candidate For Surgical Weight Loss?
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Learn more about Christian Birkedal, MD
Christian L Birkedal, MD
Christian Birkedal, MD, is board certified in general surgery and is a certified wound specialist. He received his Bachelor of Science in biochemistry from Florida State University in Tallahassee, Fla., and his medical degree from the University of Alabama Medical School in Birmingham, Ala. Dr. Birkedal completed his residency and internship in surgery at Baptist Health Systems in Birmingham, Ala.Learn more about Christian Birkedal, MD
Transcription:
Are You A Candidate For Surgical Weight Loss?
Melanie Cole (Host): For severely obese patients, weight loss surgery or bariatric surgery may be an option when non-surgical treatments fail. With dietary changes and an active lifestyle, bariatric surgery may be a tool to help patients lose pounds and maintain a healthy weight. My guest today is Dr. Christian Birkedal. He's a board-certified general surgeon at Florida Hospital. Welcome to the show, Dr. Birkedal. Who should consider bariatric surgery and are there certain parameters when considering surgery of this type?
Dr. Christian Birkedal (Guest): Well, as you said, bariatric surgery is a tool to help patients lose weight. Bariatric surgery will not help anyone lose weight in and by itself. The patients have to put in the hard work--change their diet and exercise--in order to be successful with losing weight. All patients have to go through a very extensive training process and education process before surgery that includes exercise counseling, diet and nutritional counseling, and psychological counseling before they're considered candidates for surgery because it is a major lifestyle change that they have to do for the rest of their lives in order to get the weight off and keep the weight off. Patients who are morbidly obese, who have what's called a body mass index of over 40 or over 35 with a lot of medical problems, are ideal candidates for weight loss surgery.
Melanie: So, if somebody comes in, what do you tell them to consider before considering weight loss surgery? Have they had to have tried every diet and such out there before they would consider bariatric surgery?
Dr. Birkedal: They don't have to, but pretty much every patient who comes in has tried at least 20 different diets, and has failed at 20 different diets. The decision to come see a surgeon and to admit that you need help is a very emotional decision, so these patients have been trying for years to lose weight, trying all the latest diets that all these celebrities sell on TV and usually have not been successful. So, when they come in, they've spent months, if not years, contemplating the decision. So, it's a very difficult decision for patients to make.
Melanie: So, tell us about the types of bariatric surgery available today.
Dr. Birkedal: There are basically four options that are available. Two of them work very well; two of them don't work quite as well. The least invasive option is what's called the gastric balloon, where a gastroenterologist puts a dumbbell-shaped device inside the stomach and inflates. That works temporarily, but after six months, the balloon has to be taken out, and the weight typically comes back on. Another option that doesn't work as well as we had hoped, was the LAP band, or the gastric banding, where basically we create a tunnel behind the stomach, put a band around it, the band is attached to a little reservoir that sits under the skin, and then we can adjust how big the opening in the stomach is based on how tight we make the band. Initially, everybody thought that was going to be a great answer to weight loss. Unfortunately, patients did not lose nearly as much weight as everybody had hoped and the bands have a lot of complications. So, nowadays, we take a lot of bands out for those various complications. The two that do work are called the “gastric sleeve” and the “gastric bypass”. Both of them work because one, we're making a smaller stomach; and two, we're lowering a hormone the stomach makes called Ghrelin. Ghrelin is responsible for hunger. Ghrelin also interacts with different centers in your brain to help your brain set the set point what it wants you to weigh. That's why people are not successful, long term, with diet and exercise alone because you're doing nothing to change that set point. With the sleeve and with the bypass, we're lowering the ghrelin level; therefore, we lower the set point of what the brain wants you to weigh. So, therefore, if you lose the weight, you don't get the drive from your brain to put the weight back on.
Melanie: Are these reversible procedures? The sleeve and the gastric bypass?
Dr. Birkedal: The sleeve is not reversible. In the sleeve, we remove the lateral two-thirds of the stomach. We do that little camera incision. Patients typically spend the night in the hospital and go home the next day, and then we slowly advance their diet up over about a month or so. The part we remove is the part that produces the ghrelin hormone. The bypass technically is reversible, but it is a very complicated surgery to reverse with a fair amount of risk, so we only reverse it in cases of severe problems afterwards.
Melanie: So, you would like people not to go into this thinking that it is a reversible procedure?
Dr. Birkedal: Correct.
Melanie: So, then, what is life like for somebody after one of these procedures? What do you tell them about that first week of diet? And, as we said at the beginning, Dr. Birkedal, it's a tool to help you lose weight. So, what is life like, then, afterwards as far as restaurants, activity, exercise--what are they supposed to do and what is it you'd like them to do?
Dr. Birkedal: Initially, when they go home, they go home on a diet basically of clear liquids. Tea, broth--things like that. They want a low-calorie, liquids. The goal of first week is just to stay hydrated. Then we see them back each week for a month, slowly advance their diet back up to regular food. Long-term, because they have a smaller stomach, they'll be eating off a salad plate, not off a dinner plate, they're going to fill that with vegetables, lean cuts of meat, and a little bit of carbohydrates. The reason that our society is obese is because we eat way too many carbohydrates and sugar, which is the same thing as carbohydrates. So, the long-term diet we want them on is high in protein and low in carbohydrates. In terms of exercise, we want them to commit 30-40 minutes, three or four times a week of some exercise that they enjoy doing. If we give them exercises to do but they don't enjoy doing them, nobody's going to stick with that long-term. So, we encourage them, if they like water, to join a water aerobics class or swim; if they like walking the bridge with a friend, then do that. But, whatever exercise program they choose, the long-term commitment to it is much more important than which exercises they choose.
Melanie: Certainly, it's really great advice. And, what about family and lifestyle? Can they still go out and be social when food is involved?
Dr. Birkedal: Yes, they certainly can. Every restaurant has healthy options. You can go to McDonald's, order a grilled chicken salad with balsamic vinaigrette and you're making a very, very healthy choice. Or, you can go order a Big Mac, fries, and a milkshake and you're making very unhealthy choices. That's part of the pre-operative education process is we teach people how to make healthy choices, no matter what the situation they're in so that they can succeed for the rest of their lives in keeping the weight off.
Melanie: And, can the pouch that you create get bigger? Can it go back to being the size that it was at one point if they just continue to eat more and more? Can they gain the weight right back?
Dr. Birkedal: They can. It's very rare for the pouch to dilate or stretch. Weight regain after weight loss surgery is typically because carbohydrates are sneaking back in the diet. One of the tools we teach the patients early on is how to journal their food. We have them do that from the first visit and we go back to it periodically. We follow our patients for the rest of their lives and if we notice that weight is starting to come back, we go back to having them journal their food, bringing their diet log in with them, and we sit down, go over it line by line, and help them figure out why carbohydrates have snuck back in and how we can get back on track.
Melanie: So, in just the last few minutes, Dr. Birkedal, wrap it up for us--what you want patients to know that are considering bariatric surgery; the most important bits of information, and tips for really a healthy lifestyle.
Dr. Birkedal: Bariatric surgery is a wonderful tool to help patients who are very motivated to lose weight and keep it off, but without the patient's putting in the hard work of changing their diet and exercising, it's worthless. It's just like digging a hole. You can buy a nice shovel but if you don't use it, you don't get a hole. Same thing with bariatric surgery. Diet, exercise, and surgery combined are necessary for patients who are morbidly obese to lose weight and to keep it off and to keep the ravages of obesity away for the rest of their lives. Patients can return to a normal life, their diabetes can resolve, their high blood pressure can go away, their sleep apnea with the pressure machine, all resolve as patients lose the weight. So, you can get control of your life if you lose the weight and get back to making healthy choices.
Melanie: Tell us about your team at Florida Hospital.
Dr. Birkedal: We have a wonderful team and staff who is in the office and in the hospital. We have an office staff who is dedicated to bariatric surgery. We have a bariatric coordinator. We have a bariatric physician's assistant--they do a large part of the education. We have our bariatric office manager who handles all the insurance and other patient-related issues, and on the hospital side, from the pre-op area to the operating room to the recovery room to the floor, we have a very dedicated bariatric team and staff that have undergone extensive training in how to take care of the bariatric patients both before surgery, during surgery, and after surgery. And, the hospital is world-class in terms of equipment and quality of staff.
Melanie: Thank you so much for being with us today, Dr. Birkedal. You're listening to Health Chat by Florida Hospital. For more information, you can go to www.hcpphysicians.org. That's www.hcpphysicians.org. This is Melanie Cole. Thanks so much for listening.
Are You A Candidate For Surgical Weight Loss?
Melanie Cole (Host): For severely obese patients, weight loss surgery or bariatric surgery may be an option when non-surgical treatments fail. With dietary changes and an active lifestyle, bariatric surgery may be a tool to help patients lose pounds and maintain a healthy weight. My guest today is Dr. Christian Birkedal. He's a board-certified general surgeon at Florida Hospital. Welcome to the show, Dr. Birkedal. Who should consider bariatric surgery and are there certain parameters when considering surgery of this type?
Dr. Christian Birkedal (Guest): Well, as you said, bariatric surgery is a tool to help patients lose weight. Bariatric surgery will not help anyone lose weight in and by itself. The patients have to put in the hard work--change their diet and exercise--in order to be successful with losing weight. All patients have to go through a very extensive training process and education process before surgery that includes exercise counseling, diet and nutritional counseling, and psychological counseling before they're considered candidates for surgery because it is a major lifestyle change that they have to do for the rest of their lives in order to get the weight off and keep the weight off. Patients who are morbidly obese, who have what's called a body mass index of over 40 or over 35 with a lot of medical problems, are ideal candidates for weight loss surgery.
Melanie: So, if somebody comes in, what do you tell them to consider before considering weight loss surgery? Have they had to have tried every diet and such out there before they would consider bariatric surgery?
Dr. Birkedal: They don't have to, but pretty much every patient who comes in has tried at least 20 different diets, and has failed at 20 different diets. The decision to come see a surgeon and to admit that you need help is a very emotional decision, so these patients have been trying for years to lose weight, trying all the latest diets that all these celebrities sell on TV and usually have not been successful. So, when they come in, they've spent months, if not years, contemplating the decision. So, it's a very difficult decision for patients to make.
Melanie: So, tell us about the types of bariatric surgery available today.
Dr. Birkedal: There are basically four options that are available. Two of them work very well; two of them don't work quite as well. The least invasive option is what's called the gastric balloon, where a gastroenterologist puts a dumbbell-shaped device inside the stomach and inflates. That works temporarily, but after six months, the balloon has to be taken out, and the weight typically comes back on. Another option that doesn't work as well as we had hoped, was the LAP band, or the gastric banding, where basically we create a tunnel behind the stomach, put a band around it, the band is attached to a little reservoir that sits under the skin, and then we can adjust how big the opening in the stomach is based on how tight we make the band. Initially, everybody thought that was going to be a great answer to weight loss. Unfortunately, patients did not lose nearly as much weight as everybody had hoped and the bands have a lot of complications. So, nowadays, we take a lot of bands out for those various complications. The two that do work are called the “gastric sleeve” and the “gastric bypass”. Both of them work because one, we're making a smaller stomach; and two, we're lowering a hormone the stomach makes called Ghrelin. Ghrelin is responsible for hunger. Ghrelin also interacts with different centers in your brain to help your brain set the set point what it wants you to weigh. That's why people are not successful, long term, with diet and exercise alone because you're doing nothing to change that set point. With the sleeve and with the bypass, we're lowering the ghrelin level; therefore, we lower the set point of what the brain wants you to weigh. So, therefore, if you lose the weight, you don't get the drive from your brain to put the weight back on.
Melanie: Are these reversible procedures? The sleeve and the gastric bypass?
Dr. Birkedal: The sleeve is not reversible. In the sleeve, we remove the lateral two-thirds of the stomach. We do that little camera incision. Patients typically spend the night in the hospital and go home the next day, and then we slowly advance their diet up over about a month or so. The part we remove is the part that produces the ghrelin hormone. The bypass technically is reversible, but it is a very complicated surgery to reverse with a fair amount of risk, so we only reverse it in cases of severe problems afterwards.
Melanie: So, you would like people not to go into this thinking that it is a reversible procedure?
Dr. Birkedal: Correct.
Melanie: So, then, what is life like for somebody after one of these procedures? What do you tell them about that first week of diet? And, as we said at the beginning, Dr. Birkedal, it's a tool to help you lose weight. So, what is life like, then, afterwards as far as restaurants, activity, exercise--what are they supposed to do and what is it you'd like them to do?
Dr. Birkedal: Initially, when they go home, they go home on a diet basically of clear liquids. Tea, broth--things like that. They want a low-calorie, liquids. The goal of first week is just to stay hydrated. Then we see them back each week for a month, slowly advance their diet back up to regular food. Long-term, because they have a smaller stomach, they'll be eating off a salad plate, not off a dinner plate, they're going to fill that with vegetables, lean cuts of meat, and a little bit of carbohydrates. The reason that our society is obese is because we eat way too many carbohydrates and sugar, which is the same thing as carbohydrates. So, the long-term diet we want them on is high in protein and low in carbohydrates. In terms of exercise, we want them to commit 30-40 minutes, three or four times a week of some exercise that they enjoy doing. If we give them exercises to do but they don't enjoy doing them, nobody's going to stick with that long-term. So, we encourage them, if they like water, to join a water aerobics class or swim; if they like walking the bridge with a friend, then do that. But, whatever exercise program they choose, the long-term commitment to it is much more important than which exercises they choose.
Melanie: Certainly, it's really great advice. And, what about family and lifestyle? Can they still go out and be social when food is involved?
Dr. Birkedal: Yes, they certainly can. Every restaurant has healthy options. You can go to McDonald's, order a grilled chicken salad with balsamic vinaigrette and you're making a very, very healthy choice. Or, you can go order a Big Mac, fries, and a milkshake and you're making very unhealthy choices. That's part of the pre-operative education process is we teach people how to make healthy choices, no matter what the situation they're in so that they can succeed for the rest of their lives in keeping the weight off.
Melanie: And, can the pouch that you create get bigger? Can it go back to being the size that it was at one point if they just continue to eat more and more? Can they gain the weight right back?
Dr. Birkedal: They can. It's very rare for the pouch to dilate or stretch. Weight regain after weight loss surgery is typically because carbohydrates are sneaking back in the diet. One of the tools we teach the patients early on is how to journal their food. We have them do that from the first visit and we go back to it periodically. We follow our patients for the rest of their lives and if we notice that weight is starting to come back, we go back to having them journal their food, bringing their diet log in with them, and we sit down, go over it line by line, and help them figure out why carbohydrates have snuck back in and how we can get back on track.
Melanie: So, in just the last few minutes, Dr. Birkedal, wrap it up for us--what you want patients to know that are considering bariatric surgery; the most important bits of information, and tips for really a healthy lifestyle.
Dr. Birkedal: Bariatric surgery is a wonderful tool to help patients who are very motivated to lose weight and keep it off, but without the patient's putting in the hard work of changing their diet and exercising, it's worthless. It's just like digging a hole. You can buy a nice shovel but if you don't use it, you don't get a hole. Same thing with bariatric surgery. Diet, exercise, and surgery combined are necessary for patients who are morbidly obese to lose weight and to keep it off and to keep the ravages of obesity away for the rest of their lives. Patients can return to a normal life, their diabetes can resolve, their high blood pressure can go away, their sleep apnea with the pressure machine, all resolve as patients lose the weight. So, you can get control of your life if you lose the weight and get back to making healthy choices.
Melanie: Tell us about your team at Florida Hospital.
Dr. Birkedal: We have a wonderful team and staff who is in the office and in the hospital. We have an office staff who is dedicated to bariatric surgery. We have a bariatric coordinator. We have a bariatric physician's assistant--they do a large part of the education. We have our bariatric office manager who handles all the insurance and other patient-related issues, and on the hospital side, from the pre-op area to the operating room to the recovery room to the floor, we have a very dedicated bariatric team and staff that have undergone extensive training in how to take care of the bariatric patients both before surgery, during surgery, and after surgery. And, the hospital is world-class in terms of equipment and quality of staff.
Melanie: Thank you so much for being with us today, Dr. Birkedal. You're listening to Health Chat by Florida Hospital. For more information, you can go to www.hcpphysicians.org. That's www.hcpphysicians.org. This is Melanie Cole. Thanks so much for listening.