Gina Schnathorst (Host): Welcome to the Iowa Specialty Hospitals and Clinics' ISH DISH podcast; practical health advice from Iowa Specialty Hospital experts. We want to connect the members of our communities with the latest healthcare information that's understandable, relatable, and useful to your daily life.

I would like to welcome Dr. Todd Eibes to our ISH DISH Podcast today. Dr. Eibes is one of the most experienced bariatric surgeons in the Midwest, having performed over 5,000 bariatric surgeries over the past 20 years. Dr. Eibes leads the team of medical experts at Iowa Weight Loss Specialists in Des Moines.

Under Dr. Eibes's leadership, Iowa Weight Loss Specialists Facilities has been named a center of excellence from the American Society of Metabolic and Bariatric Surgery. Previous to his role at Iowa Weight Loss Specialists, Dr. Eibes started and directed a weight loss program with the hospital in the Des Moines area for over seven years. He grew the program from 50 surgeries per year to nearly 500 surgeries annually. Welcome to the podcast, Dr. Eibes.

Dr. Todd Eibes: Thank you so much for having me.

Host: I am so excited to talk to you today, because I know that you speak so well on this topic. You are so well versed and well respected, and I think that it's time to really give you the floor and let you tell the world more about what you do and why you do it. And I know that everybody has questions. At the time of the recording here, it is just the beginning of January of 2025. So, I'm sure weight loss is on everybody's mind right now.

Dr. Todd Eibes: Sure. It seems like wherever I go, if I go to a dinner party, everybody wants to talk about weight loss. And if they find out that I'm a bariatric surgeon, everyone's got a lot of questions.

 So, I like to backtrack. And in the very beginning, I like to talk to patients a little bit about what controls our appetite, because I think most people have spent many years, you know, not happy with their body, trying to lose weight, trying to start New Year's resolutions. And they've been on this cycle, and I call it the cycle of failure where they try to diet. They'll diet for three or four months, they'll lose weight and then gain it back. And this happens over and over again. And most people, by the time they come and see me, have been on 20 different diets and they've tried everything, all the new fad stuff, CrossFit, keto, intermittent fasting, all of these different things.

But I think we really need to step back a minute and think about what really controls our appetite and what really controls our weight. And we didn't know a lot of this stuff 10 and 20 years ago, but a lot of your appetite is controlled by hormones. And when I say the word hormone, people are thinking about testosterone and estrogen. Well, hormone is just a term that means a messenger between one organ in the body and another organ. So when I'm talking about hormones, I'm talking about ghrelin in the stomach, pancreatic polypeptide, leptin, glycogen-like peptides. All of these things are managing your appetite.

And so, when patients come in and they talk about this cycle that they've been on, if we really think about it, anytime you try to lose weight, you have to decrease your total calories. You have to go below your metabolic needs so you will start burning fat. And the minute you do that, your body is going to make adjustments to these hormones. It's going to raise the levels because your body is designed for a thousand years ago. A thousand years ago, food wasn't as readily available. So if you missed a meal, or you start to lose weight, your body would raise your hormone levels, trying to increase your appetite to keep you from starving to death. Well, the food supply has changed dramatically. In the last 20 years, we have what I would say are very calorie-dense foods, sweeter than things you found in nature, more calories than things you found in nature.

And so now, anytime you diet, and you go on this and you lower your calories, and these hormones start to go up and increase your appetite. You can diet all week. You might diet a week and you're down five pounds this week. And you get to a weekend and you're starving because your levels are high, and you go eat a pizza or you go out to one of the fast food restaurants, you can get a massive amount of calories very quickly and completely ruin your progress.

I mean, you might lose weight for two months or three months and do something in those hormone levels or tell them you're hungry. And you're going to overshoot. And most people feel like complete failures. You know, "Why can't I do this? I know that I have diabetes. I know that I have heart disease. I need to get my weight under control." And so, they try very hard, but until you recognize the fact that a lot of this, you know, the choices that got you there may have got you in this situation, but how do we get out of it?

One of the things I like to talk to people is I don't really care how you got to this situation, but we've got to think about over the next 10 years, how are you going to get out of this? And I think the first step is recognizing that while you may have made bad choices, we need to get out of this. What actions are we going to take? And we need to use some evidence about this.

Host: People can actually say it's not my fault. A lot of this may be out of our control a little bit.

Dr. Todd Eibes: I think there's been so much blame over the years. For example, I think one of the most common phrases I hear is that they've gone to a doctor and the doctor has told them, "You know what to do, move more, eat less." Well, I think that's a very damaging statement because it sounds so simple, but the minute you start doing that, and let's see your ghrelin level, your hormone level, and your stomach controlling appetite is varying from 300 to 400. And now, you go on a diet and it's 700 or 800, and your body is telling you that you're starving to death.

It's not clear to me that your willpower is ever going to be able to overcome that. So, that's where I look at the medical studies. And if we step back and look at somebody that's a 100 pounds overweight, for example, what is their chance of losing half of their excess weight with dieting? It's 1%. The drugs have really changed the world on that, and the surgery has changed the world on that. And what we're finding is if we alter these levels, we can have dramatic improvement. With surgery, for example, you have a 90% chance that you're going to lose at least half of your excess weight.

So when the patients come to me, they're usually coming to me for a surgery or they're coming to our team to talk about the medications. And this is the hot topic right now. I mean, you see the Ozempic, Wegovy, Mounjaro, ZepBound commercials all over the place. And so, my first stage is usually talking to the patient about what all of the options are. And so, you've got to think about how are you going to control your appetite? And there's really two main routes.

The first one which for years we've had is surgery. With doing surgery, we are going to alter the appetite hormones. And if I do a sleeve gastrectomy and I remove 60-70% of the stomach, I'm going to remove a lot of those cells that are making the hormones controlling their appetite. Or if they have a gastric bypass, we're going to bypass food away from the bottom part of that stomach and alter those levels. We're going to decrease the appetite hormone dramatically. And that's where over the last 50 years, we've seen tremendous improvements in different diseases when we do surgery, because we can drop these levels and allow people to finally get control of their appetite. And when I step back and look at the diseases, the diseases these people are dealing with, you know, diabetes, for example, if they come into me for surgery and they're a type two diabetic and have been diabetic less than seven years, I will put up to 70% of diabetes in complete remission. And the current standard in the United States is if you're a newly diagnosed type 2 diabetic, you should diet for six to eight months, maybe nine months. After that, the chance of you ever curing it, if you haven't been able to, that's when you really got to start thinking about a medication or surgery. Because if we could cure 70% of diabetes in the world today, it's tremendous. Sleep apnea, there's many studies out there, if I do surgery, I can cure 50% of sleep apnea. High blood pressure is 30%. We can decrease your risk of heart disease by 50%. We can decrease your risk of cancer by 30%. So, this is pretty dramatic. So, that's why I tell patients it's important to get control of your weight and surgery is the tool that I commonly use to do it.

Now, balancing that, there's risks. And you've got to think about the risks of surgery and that really scares people because if I do surgery, if they get a leak from their sleeve, they have a massive infection, it's a disaster. But the leak rate is two out of a 1000, or if they get a blood clot with their surgery, it's terrible. But the blood clot rate is two out of a thousand.

The major complication rate with surgery is about one to 1.5%. And I tell people, you have to contrast that with living with your diabetes or your high blood pressure. You know, you're not going to die tomorrow from your obesity, but if obesity is causing high blood pressure, diabetes, I mean, the chances of you being around 10, 20, 30 years from now, you're clearly taking 10 years off your life expectancy right off the bat. And you're leading to the eye problems, the heart problems, the vascular problems, the toe amputations. And so, I always tell people, you want to think about, if you have young kids and you want to see them graduate, or you want to be with them 20 years from now, 30 years from now, we have to get your weight under control. And so, that's where there is some risk with surgery, but you've got to compare that. What's the risk of living with diabetes, or what's the risk of living with high blood pressure?

Now, if we contrast this to the medications, and this is where everyone gets really excited. So, the medicines are a mimic of a hormone that is made in your body. The GLP hormone is made when you eat food and it goes into your small bowel. You make your own natural GLP. I always tell the patients, when you eat lunch, within a half an hour, as food is starting to get into your small bowel, you're making this hormone and it's saying, "Hey, slow down, we're full." And it will decrease your appetite. Well, these companies have made a synthetic version of this that we can inject, and we can mimic that, and we can decrease your appetite with it. And it's fantastic. It's really the thing we've been looking for for 50 years, especially if people are scared to have surgery and they don't want to go anything that drastic, okay, we have this medicine that we can use to say, "Hey, we're full, slow things down." You lose slightly less weight than with the surgery, but not a lot less. So if you're a 100 pounds overweight and you on average lose 65 pounds with the surgery, maybe you lose 40 or 50 pounds with the medication. So, you've got to compare and contrast that.

I hear some people talk about risks of the medications. That's another common thing that we get. Well, many of these medicines have been around for a long time. There's been research on GLPs for over 20 years now, and they've been around for quite some time. And like I say, there is synthetic analogue of stuff produced in your body. So, I don't expect anything too dramatic. There are certain groups of people with pancreas issues or thyroid issues that it could cause tumors. But for the vast majority of people, the real side effects you're going to see are relating to the slowdown effects. If it slows down your gallbladder emptying, you could get a gallstone. If it slows down your GI tract, you could feel bloated, you could feel full. If it slows down your colon, you might feel constipated. And sometimes it's just a matter of working with an experienced team. We have a team of medical professionals in my office that deal with this all the time. We have a thousand patients on these medications and we deal with it. And they're definitely not the kind of medicine that you just start somebody on the maximum dose. You've got to adjust things on what they can tolerate. And if they get a little bloated, okay, maybe you back the dose down a little bit. Or if they're constipated, we can make adjustments. But again, you've got to think about what are the risks of these medications versus living with diabetes or high blood pressure. And there's really an interplay between the groups because if you can't tolerate the medicines, maybe surgery is the answer for you. Or, what I'm fascinated by, let's say you're, really obese. Let's say you're 500 pounds and I do surgery and you lose 200 pounds and you're still 300 pounds. It's fascinating to me that if we add the medications, if I would give you a GLP medicine after a sleeve, it's going to work even better because it's no longer competing with the appetite hormone from the stomach and it's working to improve the action of your sleeve. So instead of 60% weight loss, maybe you get 80% weight loss.

Now, the one big thing with the medicines is the cost. And this is where we struggle. There is a significant cost to the healthcare company to develop these medicines and they have to charge a certain amount to recoup their research expense. On the other hand, what is appropriate? And it's far beyond me to decide this. This gets into the upper political levels. But if I have a medicine that I can give you and cure your diabetes, what's a fair price for that? Or cure your high blood pressure, things like that. I believe that market pressure itself, I mean there are 19 new GLP ones, I read, that are going to be potentially coming to market within the next five to seven years.

And if you have many of these options available, costs, I'm predicting, will come down. And I can see a day where even if there's not insurance coverage. What if it's $50 a month? What if it's $75 a month to cure your medical problems? I mean, right now, it's a $1000. That's a problem.

Host: That is a problem. Talk to me a little bit then about the difference between Ozempic, let's just take that for example, versus the compounding. It's confusing just in normal life, the difference between those two.

Dr. Todd Eibes: Yep. So, compounding is when there's a shortage in the United States. These pharmacies can do compounding and make their own version of it because the company that's making the drug can't supply enough quantity. So, you've seen these compounding because Ozempic has been on the national shortage on the FDA shortage list. There are compounding pharmacies making this. However, the original molecule is patented by the Lilly and by Novo. They have patents on tirzepatide and on semaglutide. So, the compounds have come about because there's such a shortage, which of course there's a shortage because there's a tremendous demand. There's over 35 million people in the United States that are obese. And look at type 2 diabetes alone. There's 30 million type 2 diabetics. So, there's a massive need for this stuff, and it works really well and they haven't been able to meet demand. As they're able to meet demand, these are coming off the compounding list, and it is questionable whether it's going to be legal for these compounding pharmacies to make these, as tirzepatide or ZepBound is no longer on the shortage list. So, that's changing it.

The other concern you have with compounding pharmacies, they're just not regulated to the same level when you're having the brand name. So, it's a little bit scary If you get what you think is a 5 milligram dose. And really, if you test it, it's only three, or it's only two, or maybe it's four. So, that's where there's concern in the medical community. We're balancing can we make these things cheaper because they are helping people? But you don't know exactly the dose you're giving. So, I would say from a medical provider standpoint, I prefer to use the brand name, but I also have compassion for people who can't afford a $1,000 a month for a brand name, but to get a compound at $200 a month, and it's pretty good, and it might be 5 milligrams, might be 2, might be 3, they're losing weight, you can see there's two sides to the story,

Host: Yeah, for sure. So, we've got that as a barrier perhaps. And also, then the insurance coverage seems to be a topic of conversation as well.

Dr. Todd Eibes: For sure.

Host: What are you seeing or hearing?

Dr. Todd Eibes: Well, I think the problem that the insurance companies are having is that the drugs are working so well and they dramatically improve so many people's lives. That's great. But there is such a demand out there. There are so many people. I mean, imagine, like I say, when I start saying if we could cure even half the diabetes in the United States or 20% of the high blood pressure, and as more studies come out, there's just a study recently showing ZepBound or  terzapatide decreases sleep apnea dramatically. So now, there've been studies on Ozempic decreasing heart disease, congestive failure, things like this. You've got Cardiology prescribing it. You've got Sleep Medicine doctors prescribing it. So, the insurance companies are getting overwhelmed, by a massive amount of claims that come in. So, they're looking at their costs being exponential.

 On the other hand, think of how much we spend on insulin pumps or how much we spend on open heart surgery for the heart disease. So, yes, we're looking at short term expense right now, but if we can prevent all these other things. As a doctor, you get caught in a rock and a hard place because I now have treatments. I tell people it's almost a renaissance in weight loss care because with the sleeve, a very low risk surgery, lower risk than having your gallbladder out, and I can make tremendous improvements with a sleeve gastrectomy, for example, my patients stay one night in the hospital, but many are doing it outpatient. They're back to work within a week. And if we can cure all of these medical problems, it's great. Or we have the drug options that are fantastic out there.

 The real problem is cost. And now, I have all these great tools that I can really help people. But if their insurance doesn't cover it, and the biggest argument I've heard from insurance companies about surgeries over the years is, on average, people change insurances every two to three years. Maybe your employer changes or your employer decides that, okay, we're Blue Cross this year, but we're going to get a discount. We're going to United or we're going to something else. And so, the company that paid for the surgery, now two and three years later, are not getting the payoff from the weight loss.

So, with the surgery, that was the problem. So, somehow we have to get to the point, because obesity is a disease, that can be treated and eliminate so many other diseases. If all of the companies could get together and cover it, it'd be great. But we have people where some have coverage, some don't. One spouse has coverage, one don't. It's a real problem.

Host: So, let's pretend that somebody comes in as a patient and they could go either way, but don't really know. What's the best option is for them? Obviously, the surgery is permanent. I mean, that's a permanent option. You know, when you're talking about the sleeve versus the medical weight loss, tell me like if I'm your patient, what are the benefits and the negatives for each? What would you tell me?

Dr. Todd Eibes: Well, so what I tell people, first of all, if you have any doubt about anything, you need to work with an organized medical weight loss team. I mean, I've been directing Iowa Weight Loss for a long time. I've been doing weight loss surgery almost 25 years now, and you need to go to a team that's a certified center of excellence. We're a national center of excellence for surgery. We have a comprehensive overall team, including a psychiatric team, dieticians, medical weight loss, nurse practitioners, PAs on the surgery side. So, you need all of the options laid out for you. And then, we just have to decide what's right for them and let the patient participate in the decision.

I think, for most people, they're scared to death about surgery. And so, I tell people, if you're in this boat, you really should come and work with our team and try medical weight loss. And maybe you lose all your weight on medical weight loss, you never need to see me. That's fantastic. I mean, I know the reality when they're 150 pounds overweight with these problems, they're going to struggle,

Host: Are they going to be on that forever though?

Dr. Todd Eibes: Well, you can do straight medical weight loss. I think what you're getting at, the medications are not a short-term fix. And what people don't understand, I always tell people, these medicines are like my blood pressure medicine. I have high blood pressure. I take a blood pressure medicine every day. If I stop my medicine for the next two days, my blood pressure is going to be high. These medications for weight loss work just like that. You're not going to learn correct eating and be able to go off the medicines. The medicines will suppress your appetite, but you need to stay on them. Most studies show the minute you stop the medicines, your appetite is going to return and you're going to gain the weight back.

And if you're medicine. I picked up my blood pressure medicine the other night. It's $2 for a 90-day supply. If it was $2 for Ozempic for a 90-day supply, no problem at all. But if it's $1,000 a month, that's the problem. So, our team will work with you and we'll figure out whether you have coverage or not. And if you have coverage, what is the right dose? And are we going to use something like Ozempic that's a one hormone, or we're going to use tirzepatide, which is two hormones. And as more and more options become available, we'll look at the cost analysis and see what we can do. If you are sick from those medicines, then we can talk about surgery, or if you don't get good results with them, or if you simply don't want to stay on medication long-term, that's really where surgery comes down. Some people say, "I don't want to take a medicine indefinitely." And so, you've got to decide, you could either take this medicine and keep your diabetes and high blood pressure under control, and you're probably going to be on it the rest of your life, or we can do a surgery. And you take a little surgical risk and we deal with that. But long-term, your weight should stay under control.

Host: What do you think is the probability, in your expert opinion, if somebody starts the medical weight loss, such as Ozempic, and they say, "I'm going to utilize this as a tool until I lose my weight, then I'll stop taking it and I'll be fine?"

Dr. Todd Eibes: I think at least 90% or more, you're going to gain your weight back because your hormones in your body are going to go back. We're artificially suppressing your appetite with this medicine. It's okay. Again, it's like a blood pressure medicine that's dialing in your blood pressure. I tell people, just think about your appetite, like somebody's blood pressure. We're adjusting your appetite level and we're adjusting it to help with the food supply that we have today, or I'm going to do a sleeve and I'm going to remove part of your stomach. And what I always tell people, I'm making your stomach the size you need for the food supply you have today. My standard joke is you're not going to go out and hunt a deer or you're not going to eat tonight. Most people are going to go to the grocery store and get food. But the food that we have nowadays is so high calorie coupled with the lifestyle. I mean, obviously, you're running kids to practice, people are at school, people have busy lives and you've got to just get food quickly sometimes, but it's different than how we eat in the 1940s and 1950s. And so, I'm going to adjust your appetite. And so if nothing else, if I control your appetite, even if you're making some of these choices, if you're less hungry, you're eating less food, you're decreasing your calories.

Host: Staying on the topic of surgery, what are the long-term effects or lifestyle changes that take place after the surgery?

Dr. Todd Eibes: Well, the two main surges in the United States are the sleeve gastrectomy and the gastric bypass, and there's kind of some big differences between them. With the sleeve gastrectomy, we just remove 70% or so of the stomach, but you're still hooked up normal, digest normal, absorb normal. So, vitamin deficiencies and issues and problems long-term are much more unlikely. You still probably need to take a multivitamin every day, some calcium, and maybe some vitamin D. But if you do that and we follow your levels, you're probably going to be stable and be fine long term. And we have a lot of research. I mean, since the 1950s, we've been removing stomachs for gastric cancer.

And so, there's all kinds of research on how to take care of these patients. We just want the side effect of that, which is appetite suppression. And so, we're using it to get their weight under control, that sort of thing. We believe you should continue to follow with a medical weight loss team because your disease of chronic obesity, we need to be aware of it. We talk about keeping it in remission. Just like a cancer patient, we want your obesity and remission.

If we do a gastric bypass, we're going to bypass one-third of the small bowel. And the bypass is more susceptible to bowel obstructions, to marginal ulcers, and vitamin deficiencies can be dramatic with that. So, it's just something to think about that you need to have more followup with a team that's familiar with this sort of thing. You know, 10 years from now, 20 years from now, something happens with your bypass, you need to have an expert team. Or with a sleeve, let's say you move to Alaska. There aren't people around necessarily. If you have family doctors and things, they can follow your vitamin levels and you're probably going to be okay. And that's why in the United States now over 60% of the weight loss surgery is sleeve gastrectomy. And even though you lose just a little less weight than with a gastric bypass, your chances of major problems are so much less, and that's where people, when they're weighing risks.

And ultimately, I also tell them, you also have to think about the future because as these medicines become better, the GLP-1s work great after a sleeve. And so, I'm not convinced that if you do a sleeve and put somebody on a GLP-1, they're probably going to lose more weight than they would with a bypass.

Now, perhaps you could put the bypass on GLP-1, too. How aggressive do you get for a little more weight? And I'm definitely a believer in the least invasive, lowest risk that we can and get effective results.

Host: I know you've highlighted this throughout our conversation so far, but can you just kind of take the listeners back to the beginning of what exactly iowa Weight Loss Specialists Entails and why we really do set ourselves apart from maybe any other facility that does a bariatric surgery and then just says, "See you later"?

Dr. Todd Eibes: So, this is basically in our mission statement. And when I started this program over 10 years ago, I believed that my mission in life is to treat obesity. And I don't think treating obesity is just doing surgery, even though I'm a surgeon. I think you also have to address the medical issues with it.

So, I believe you have to have a big medical team. I think you have to have a psychiatric team. There's a lot of reasons we eat and I can control your appetite. But if you eat because you're depressed, you eat because you don't get along with your spouse, you eat to stay awake at night because you're working the night shift. There's other factors.

And so, while I'm an expert in surgery, I believe I have to surround myself with all of these other experts so that we treat the medical problems long term. We treat the psychiatric issues. The dieticians work with you and they can do meal planning, calorie counting, talk to you about your vitamin levels, that sort of thing.

I'm very passionate that you have to have an overall comprehensive team. And I know across the country, there have been bariatric programs that turn you loose or graduate you a year later or something like that. And that's where we talk about maintaining remission. Because I think you still have those same genetic tendencies, and you have a tendency two, three, five years from now, you go through a divorce, you have a death in the family, you have issues that come up, or maybe your other hormones, five years from now, your leptin level, for example, changes, or things happen, your appetite comes back. Maybe our medical team needs to make adjustments to your medications. So, I think when you look at one of the biggest fears people have is they start this thing and they get surgery and they're going to gain their weight back down the road. You need a comprehensive team that deals with this all the time to deal with all of the issues that come up. And we tell people, maybe you just need once-a-year checkup with us that after we get your weight under control, we just keep an eye on you, but we're always there for you. I hear people all the time. They're afraid to come back in because they think, "Oh, they've let us down that they've gained their weight back." No, we want to see you because we have other tools. I tell them we're like a carpenter. You have a lot of tools in your tool belt. We have more things that we can use to help you. I'm definitely a believer, more surgery is usually not the answer. It's these other tools. But if you're going to a place that's just offering one thing, like surgeon, you're out the door, or come in here, take this medicine real quick, or get this compound in med real cheap, it's going to help you some, but it's not going to be as good a care as you could get.

Host: Yeah. And I think there are some other things too that definitely set us apart. And while you were talking, I was thinking each one of our patients has the opportunity to sign up for our online support group. we have a private Facebook group, for example, and there's a lot of conversation going on in that just supporting each other. And I have seen some people ask the question, "I've gained some of the weight back. I don't know what to do." Well, the simple answer is call us. Come in and talk to us. There's no judgment ever.

Dr. Todd Eibes: I think it's the little dirty little secret about weight loss. I think many of our patients have been discriminated against and treated so poorly and made to feel like it's their fault their entire life, that I strongly believe you need some psychiatric counseling. Most people don't believe that they do. They think, "Okay, we'll get their appetite under control and everything." But I believe that they've been treated poorly and discriminated. If you just think about how you felt about yourself and your weight and you've internalized and think it's your fault and I all of a sudden tell you, "Well, your hormones are regulating your appetite," think about how you've been treated over the last 20 years and there's got to be some emotional damage from that. So, I think if nothing else, our counseling team should help you, and there's only benefit from that, really. You're going to get better and better results, or like you say, connect in the support group with people. Our dieticians lead some exercise classes and different things, or we can partner with places and talk to you about where we think you should go exercise and do different things. There's just a lot of options out there.

Host: We have great information on our website. I will highlight that at the end of our conversation. And just to throw this out there, we have a health risk assessment on our website. We call it HRA. And it is just a simple 10-question tool that you can fill in your information, answer the questions about maybe some different conditions you have or have been told that you have, and then that will enter your weight, your height. And it will simply evaluate you and put you in a bucket, and kind of let you know whether you're eligible for a medical weight loss or surgical weight loss. It's certainly not a one-and-done But it does kind of give you an option and then you can look into the website a little bit further and get the information that you need, possibly make an appointment to come in and see somebody. So, do you have any parting thoughts? any second advice that you'd like to give our listeners?

Dr. Todd Eibes: I would say a couple things I heard today. Because I saw two patients today that I did their spouses a year ago and the spouse has lost 100 pounds and now they're sending them in for surgery. I mean most people regret that they didn't do things sooner. They didn't realize how bad they felt until this point and now they see, oh, 100 pounds down, I feel fantastic.

 And the thing we say to a lot of family doctors and things, obesity is a very difficult field to deal with. And if you're a busy family doctor seeing 40 patients a day, it is very difficult to sit down and counsel these patients. You have to have a huge team around you. So we try to make it just very easy for people. Let us have the difficult conversations, and we can sit there and discuss. If you're a patient out there with diabetes, high blood pressure, sleep apnea, and are significantly overweight, And you can go on any website and look at a BMI calculator. And if you're over 30 with any of those conditions, you really should talk to us about what are the options, because instead of treating your high blood pressure or whatever, we should get to the root cause of it and maybe cure it. And the cheapest thing you can do is come in and get a consult with our medical team and talk and get some accurate information. And again, we're not trying to sell one product or another product. We make no money off of any of that stuff. We just want to get the right medical care out there to people.

Host: Yep. I'm glad you said that because I was going to say that too. It costs nothing to call, make an appointment, just have a consultation, have the conversation.

Dr. Todd Eibes: For sure. The surgical class that I teach is online. And if you have any doubts about surgery, it's a free educational class. And I cannot tell you how many times that I have taught this class. We used to do it in-person all the time. And I'd have spouses sitting there definitely afraid of their wife having surgery and all of a sudden they realize, "Oh my gosh, my wife's dying from her diabetes, her high blood pressure. Here's the real statistics." And so the wife has surgery. And then a year later, the husband has surgery. I see it all the time, but you deserve a chance. And if any doubt, look at the free class. If it's not right for you, that's fine, but you don't have to live feeling miserable all the time.

Host: I agree. If anybody wants any more information, our phone number is 515-327-2000. You can call anytime to make an appointment for a consultation. Again, there's a plethora of information on our website that is currently being upgraded. So, it'll have even better information very soon. that website address is iowaweightloss.com. Thank you so much, Dr. Eibes, for taking the time to talk to our listeners today. I think the information was outstanding and I hope a lot of people got a lot of good benefit from it.

Dr. Todd Eibes: Absolutely. Thank you for having me. And I just want to get the information out there because it's such a disease that before COVID, I was always saying it's the greatest epidemic we're going to face, and it's either one or two, and it just continues to affect people. So, let's fix it.

Host: Thank you for listening to Iowa Specialty Hospitals and Clinics' ISH DISH Podcast. For more information on the topic we discussed today, visit us on the web at iowaspecialtyhospital.com. There, you can read a transcript of today's episode or previously aired episodes, as well as get the latest news from Iowa Specialty Hospitals and Clinics and explore all of the services that we offer. For the ISH DISH Podcast, I'm Gina. Thanks for tuning in