Selected Podcast
Criteria for Weight Loss Surgery
What is the criteria for weight loss surgery; what is the recovery immediately after surgery and then the months following.
Featuring:
Dr. Mandelbaum received his medical degree from the Indiana University School of Medicine and served his residency in surgery at The Ohio State University Hospitals.
He serves on numerous societies and is an accomplished presenter having presented at many conferences. He has won multiple awards in his field of practice, including being recognized as a “Top Doc” for general surgery fifteen times by Indianapolis Monthly.
Jonathan Mandelbaum, MD
Dr. Jonathan Mandelbaum practices at Franciscan Health where he serves as the Medical Director of Surgery for Indianapolis, Director for the Franciscan Weight loss Center in Indianapolis, and the Chairman of the Surgery Governance Committee.Dr. Mandelbaum received his medical degree from the Indiana University School of Medicine and served his residency in surgery at The Ohio State University Hospitals.
He serves on numerous societies and is an accomplished presenter having presented at many conferences. He has won multiple awards in his field of practice, including being recognized as a “Top Doc” for general surgery fifteen times by Indianapolis Monthly.
Transcription:
Scott Webb: Bariatric weight loss surgery has become very common, but it's important to know that there are criteria to qualify. And in order for these surgeries to be successful, patients have to do their part. And joining me today to talk through things is Dr. Jonathan Mandelbaum, he's a bariatric surgeon and the Weight Loss Center Medical Director at Franciscan Health.
This is the Franciscan Health Doc Pod. I'm Scott Webb. So doctor, thanks so much for your time today. We're going to talk about weight loss surgery, and it's something that my mom had a couple of years ago. So I'm a little bit familiar with this. But for others who maybe aren't as familiar, let's just talk in general terms, when would someone be considering or when should they consider weight loss surgery?
Dr. Jonathan Mandelbaum: We kind of go by this height-weight number called your body mass index. And once your body mass index gets up into the mid-30 range, if you look up what's a normal body mass index, it says 21 to 25. Once you get up to a body mass index into the mid to high 30s and certainly 40, that's when we start seeing medical problems that are directly related to being overweight. And so that's the time to start considering more serious weight loss measures.
Scott Webb: Yeah. And so for folks, as they begin to possibly consider weight loss surgery and from your perspective as an expert, what's the criteria for weight loss surgery?
Dr. Jonathan Mandelbaum: The criteria that are set out by what we call the ASMBS, which is the American Society of Metabolic and Bariatric Surgery, if you have a body mass index of 40, which for an average height female would be say 80 pounds overweight and, for an average size male, about a hundred pounds overweight, the studies say that from a medical perspective, that you would benefit from having a weight loss procedure. If your body mass index is between 35 and 40, and you have one serious medical issue, which is related to obesity, and we call those comorbidities or comorbid conditions, then you would qualify. And that list, the common ones that we all know are sleep apnea, diabetes, hypertension, fatty liver and heart disease. If your body mass index is over 40, without any medical problems, the studies say you'd benefit. If it's in the 35 to 40 range and you have one of these serious medical problems that have at least an 80% chance of resolving with successful surgery, the studies say that you would be a candidate.
There are some places where if your body mass index is between 30 and 34 and you have uncontrolled adult-onset or type 2 diabetes, that would consider doing a weight loss procedure for you.
Scott Webb: Yeah. And I referenced earlier about my mom having this surgery. And one of the things that I learned through her was that it's more than just the surgery and the associated weight loss. Some of the things that you mentioned there, the comorbidities, she was a type 2 diabetic and she no longer is, or is no longer at least, you know, being medicated as such, if that makes sense. So maybe you can talk about when you're meeting with people, when you're consulting with them, and you're talking about the intended benefits, the outcomes from this surgery, maybe you can take us through some of them.
Dr. Jonathan Mandelbaum: Somewhere in the range of roughly 80% of patients with medical conditions that are caused by their obesity, the hypertension, the type 2 diabetes, the sleep apnea, the high cholesterol, the fatty liver, 80% of those will either improve or resolve. And it's pretty amazing.
What impressed me most when I started doing weight loss surgery in 2002 was how fast this happens. I thought, "Okay, they'll have to lose 50 pounds. They'll have to lose 100 pounds." I see patients that have surgery, come back to see me in two weeks, and they're already off their diabetes pills, they're off their blood pressure pills, they're off their cholesterol pills. And it's a pretty quick response to this rapid weight loss and taking in less calories where we see a marked improvement in patient's medical conditions.
Scott Webb: It's really amazing. And then, that was my experience, that it didn't take 50 pounds, 100 pounds of weight loss, it was almost immediate. Really truly amazing. And so when folks are thinking about this surgery in terms of what they need to do both before and after, you know, to be successful, what do you tell them?
Dr. Jonathan Mandelbaum: Exhaust your nonsurgical options. In other words, we don't want someone to listen to this podcast today and then tomorrow show up at the clinic and say, "Hey, I want weight loss surgery." You know how people are, we're the fast food environment. We want everything now. We're the now environment. You should have tried the old diet and exercise and lifestyle changes. Most of the patients I see have lost the same 20 pounds 20 times over. And they've tried all the diets. They've tried all that. And they're ready for, as I call it, a shove in the right direction, so we can really help them get on track.
And obviously, if you want to be successful, I recommend that you go to a bariatric center of excellence where you know that the facility has and a full complement of staff that's familiar with all the the latest techniques and treatments. You have to go through the appropriate classes and teaching and because there are a lot of things that you need to change, you need to learn how to eat. You need to learn what to eat. There are different vitamins and supplements. And the studies say that if you have one of these operations, you're more likely to be successful if you stay engaged with your weight loss center. We see patients that fly out of the country to have the operation, to spend a lot less money. They don't get the appropriate teaching before surgery. They certainly don't get the appropriate followup after surgery. And the chance of those patients being successful is not near what the chance of being successful in one of the big centers of excellence.
Scott Webb: Yeah, I see what you mean. And one thing that I noticed from my mom after she had the surgery was the portion sizes, right? So if she would be over for dinner or something, I was used to serving her a certain amount of food. And after she had the surgery, it was a fraction of that. And I kept wondering, I'm like, "How does this work? How can you feel full?" And she's like, "I just don't need that much food." So maybe you could talk about after the surgery, what folks can expect, whether it's portion sizes or any restrictions they may have, and so on.
Dr. Jonathan Mandelbaum: So the key word is restriction, because the way these operations work is two-fold. One is there are operations that keep you from absorbing all the calories you eat. That would be the duodenal switch and a part of the gastric bypass. But the main part of these operations is what we call restriction. We have made your stomach capacity a lot smaller.
The most popular procedure done in the United States and across the world now is called the sleeve gastrectomy. We basically take your big boot-shaped stomach, which can hold a big 32-ounce drink, like you get at the gas station and we change it into a banana-shaped tube that initially is going to hold a shot glass. So it's going to hold about a two-ounce portion. Literally, your first meals are eaten out of a little medicine cup. So by restricting how much you can eat, when you eat two ounces that first day, you're going to feel stuffed.
Because we know walking around hungry doesn't work, I tell patients, "Hey, you don't need to have surgery. For the next month, eat two-ounce portions, take two protein drinks a day and vitamins, you'll be fine, but you're going to walk around starving." And until we figure out a pill that blocks the hunger hormone, and there is one, it's called Grehlin, until we can figure out a way to block that hormone, what we need to do is we need to restrict what your stomach can hold, so it sends a signal to your brain that you are full.
And so basically, over the course of 18 months, we have patients, they measure their portions and they start out at two ounces and then gradually over 18 months, they use bigger and bigger cups to where they're eating six to eight-ounce portions. You know, I always tell my patients, "An eight-ounce portion will fit basically on a small saucer." I say, "None of us go to the buffet line with only a saucer, unless it's to put a couple roll on next to our salad and our main dish." And so it's really about restricting your intake. So if you restrict your portion sizes and you're making healthy choices and you're getting out and walking and exercising, that's how these operations work and that's how you're successful.
Scott Webb: Yeah, that's perfect. As you said earlier, rounding it up, about 80% of the time, this is successful. This has been really educational and fun today, doctor. Thank you so much. You stay well.
Dr. Jonathan Mandelbaum: Okay, thank you.
Scott Webb: And for more information, visit franciscanhealth.org/weightloss. And if you found this podcast helpful, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.
Scott Webb: Bariatric weight loss surgery has become very common, but it's important to know that there are criteria to qualify. And in order for these surgeries to be successful, patients have to do their part. And joining me today to talk through things is Dr. Jonathan Mandelbaum, he's a bariatric surgeon and the Weight Loss Center Medical Director at Franciscan Health.
This is the Franciscan Health Doc Pod. I'm Scott Webb. So doctor, thanks so much for your time today. We're going to talk about weight loss surgery, and it's something that my mom had a couple of years ago. So I'm a little bit familiar with this. But for others who maybe aren't as familiar, let's just talk in general terms, when would someone be considering or when should they consider weight loss surgery?
Dr. Jonathan Mandelbaum: We kind of go by this height-weight number called your body mass index. And once your body mass index gets up into the mid-30 range, if you look up what's a normal body mass index, it says 21 to 25. Once you get up to a body mass index into the mid to high 30s and certainly 40, that's when we start seeing medical problems that are directly related to being overweight. And so that's the time to start considering more serious weight loss measures.
Scott Webb: Yeah. And so for folks, as they begin to possibly consider weight loss surgery and from your perspective as an expert, what's the criteria for weight loss surgery?
Dr. Jonathan Mandelbaum: The criteria that are set out by what we call the ASMBS, which is the American Society of Metabolic and Bariatric Surgery, if you have a body mass index of 40, which for an average height female would be say 80 pounds overweight and, for an average size male, about a hundred pounds overweight, the studies say that from a medical perspective, that you would benefit from having a weight loss procedure. If your body mass index is between 35 and 40, and you have one serious medical issue, which is related to obesity, and we call those comorbidities or comorbid conditions, then you would qualify. And that list, the common ones that we all know are sleep apnea, diabetes, hypertension, fatty liver and heart disease. If your body mass index is over 40, without any medical problems, the studies say you'd benefit. If it's in the 35 to 40 range and you have one of these serious medical problems that have at least an 80% chance of resolving with successful surgery, the studies say that you would be a candidate.
There are some places where if your body mass index is between 30 and 34 and you have uncontrolled adult-onset or type 2 diabetes, that would consider doing a weight loss procedure for you.
Scott Webb: Yeah. And I referenced earlier about my mom having this surgery. And one of the things that I learned through her was that it's more than just the surgery and the associated weight loss. Some of the things that you mentioned there, the comorbidities, she was a type 2 diabetic and she no longer is, or is no longer at least, you know, being medicated as such, if that makes sense. So maybe you can talk about when you're meeting with people, when you're consulting with them, and you're talking about the intended benefits, the outcomes from this surgery, maybe you can take us through some of them.
Dr. Jonathan Mandelbaum: Somewhere in the range of roughly 80% of patients with medical conditions that are caused by their obesity, the hypertension, the type 2 diabetes, the sleep apnea, the high cholesterol, the fatty liver, 80% of those will either improve or resolve. And it's pretty amazing.
What impressed me most when I started doing weight loss surgery in 2002 was how fast this happens. I thought, "Okay, they'll have to lose 50 pounds. They'll have to lose 100 pounds." I see patients that have surgery, come back to see me in two weeks, and they're already off their diabetes pills, they're off their blood pressure pills, they're off their cholesterol pills. And it's a pretty quick response to this rapid weight loss and taking in less calories where we see a marked improvement in patient's medical conditions.
Scott Webb: It's really amazing. And then, that was my experience, that it didn't take 50 pounds, 100 pounds of weight loss, it was almost immediate. Really truly amazing. And so when folks are thinking about this surgery in terms of what they need to do both before and after, you know, to be successful, what do you tell them?
Dr. Jonathan Mandelbaum: Exhaust your nonsurgical options. In other words, we don't want someone to listen to this podcast today and then tomorrow show up at the clinic and say, "Hey, I want weight loss surgery." You know how people are, we're the fast food environment. We want everything now. We're the now environment. You should have tried the old diet and exercise and lifestyle changes. Most of the patients I see have lost the same 20 pounds 20 times over. And they've tried all the diets. They've tried all that. And they're ready for, as I call it, a shove in the right direction, so we can really help them get on track.
And obviously, if you want to be successful, I recommend that you go to a bariatric center of excellence where you know that the facility has and a full complement of staff that's familiar with all the the latest techniques and treatments. You have to go through the appropriate classes and teaching and because there are a lot of things that you need to change, you need to learn how to eat. You need to learn what to eat. There are different vitamins and supplements. And the studies say that if you have one of these operations, you're more likely to be successful if you stay engaged with your weight loss center. We see patients that fly out of the country to have the operation, to spend a lot less money. They don't get the appropriate teaching before surgery. They certainly don't get the appropriate followup after surgery. And the chance of those patients being successful is not near what the chance of being successful in one of the big centers of excellence.
Scott Webb: Yeah, I see what you mean. And one thing that I noticed from my mom after she had the surgery was the portion sizes, right? So if she would be over for dinner or something, I was used to serving her a certain amount of food. And after she had the surgery, it was a fraction of that. And I kept wondering, I'm like, "How does this work? How can you feel full?" And she's like, "I just don't need that much food." So maybe you could talk about after the surgery, what folks can expect, whether it's portion sizes or any restrictions they may have, and so on.
Dr. Jonathan Mandelbaum: So the key word is restriction, because the way these operations work is two-fold. One is there are operations that keep you from absorbing all the calories you eat. That would be the duodenal switch and a part of the gastric bypass. But the main part of these operations is what we call restriction. We have made your stomach capacity a lot smaller.
The most popular procedure done in the United States and across the world now is called the sleeve gastrectomy. We basically take your big boot-shaped stomach, which can hold a big 32-ounce drink, like you get at the gas station and we change it into a banana-shaped tube that initially is going to hold a shot glass. So it's going to hold about a two-ounce portion. Literally, your first meals are eaten out of a little medicine cup. So by restricting how much you can eat, when you eat two ounces that first day, you're going to feel stuffed.
Because we know walking around hungry doesn't work, I tell patients, "Hey, you don't need to have surgery. For the next month, eat two-ounce portions, take two protein drinks a day and vitamins, you'll be fine, but you're going to walk around starving." And until we figure out a pill that blocks the hunger hormone, and there is one, it's called Grehlin, until we can figure out a way to block that hormone, what we need to do is we need to restrict what your stomach can hold, so it sends a signal to your brain that you are full.
And so basically, over the course of 18 months, we have patients, they measure their portions and they start out at two ounces and then gradually over 18 months, they use bigger and bigger cups to where they're eating six to eight-ounce portions. You know, I always tell my patients, "An eight-ounce portion will fit basically on a small saucer." I say, "None of us go to the buffet line with only a saucer, unless it's to put a couple roll on next to our salad and our main dish." And so it's really about restricting your intake. So if you restrict your portion sizes and you're making healthy choices and you're getting out and walking and exercising, that's how these operations work and that's how you're successful.
Scott Webb: Yeah, that's perfect. As you said earlier, rounding it up, about 80% of the time, this is successful. This has been really educational and fun today, doctor. Thank you so much. You stay well.
Dr. Jonathan Mandelbaum: Okay, thank you.
Scott Webb: And for more information, visit franciscanhealth.org/weightloss. And if you found this podcast helpful, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.