Losing weight is a personal and ongoing struggle for so many, with critical decision points that require support, particularly the choice to have bariatric surgery.
Whatever phase of the weight-loss journey you are in, nutrition and fitness are crucial.
Whether you are just beginning to think about losing weight or you have already begun your journey, eating right and exercising are the two most important factors in reaching a healthy weight.
From chronic disease to immobility, obesity can cause many health issues.
Dr. Jonathan Reich is here to discuss your options as you choose your best ways to reach a healthy weight.
Selected Podcast
Understanding Weight-Loss Options
Featured Speaker:
Learn more about Jonathan Reich, MD
Jonathan Reich, MD
Jonathan Reich, MD is a bariatric surgeon at Southern Ocean and Bayshore.Learn more about Jonathan Reich, MD
Transcription:
Understanding Weight-Loss Options
Bill Klaproth (Host): Losing weight is a personal and ongoing struggle for so many with critical decision points that require support, particularly the choice to have bariatric surgery. My guest today is Dr. Jonathan Reich, bariatric surgeon with Meridian Health. Dr. Reich, thanks so much for being on with us today. Bariatric surgery is the umbrella for different weight loss procedures. Can you start by explaining that to us?
Dr. Jonathan Reich (Guest): Yes, I can. Thanks for having me, too, Bill. It’s a pleasure to be talking to you. The bariatric surgery really encompasses the fancy term for anything to be done regarding to weight. So, when we are talking about bariatric surgery, we are talking about weight loss surgery and the different procedures it encompasses.
Bill: What are those main procedures that fall under bariatric surgery? I know there’s gastric bypass and others. Can you quickly explain those to us?
Dr. Reich: Yes. It’s interesting because it’s a rapidly evolving field and has certainly come a long way in the past 20 years. About 15 years ago, the main thing was the gastric bypass and everybody that was getting the surgery 15 years ago was certainly getting a gastric bypass done. There were a couple of other surgeries that were also being done but not with as good of a result and then, what really happened is, the gastric bypass was the main surgery for probably about seven or eight years and then, gastric band devices became a better product. When the gastric band became a better product, we started to get a similar result with the gastric bands that people were getting with gastric bypass but it was a lot less invasive. From our practice, we started to see a lot of patients that were coming in saying, “I don’t want the big major surgery. I’d rather have a gastric band,” because it’s potentially reversible and the results were also very good with the gastric band devices. We’ve even seen another big change in the field in the past three years because three years ago, this new procedure called the “sleeve gastrectomy” was actually insurance approved and that’s when we began to do a lot of these gastric sleeve procedures which, from our practice is, by and large, the leading procedure right now that people are getting--the gastric sleeve procedure.
Bill: Out of those three, how do you determine what fits the potential patient the best?
Dr. Reich: That’s a great question. The way that we work it is, we’re a group that really emphasizes educating our patients. So, when someone comes in to ask us exactly that question and says, “Well, what do you think is going to work best for me?” we sit down with that patient and we review the different surgery options. If someone has in their mind what they think they want, a lot of times the patients are very savvy nowadays and do a lot of the research on their own, but really we answer the finer points of the procedures. We’re a group that really believes that, really, there’s no one size fits all. Everybody has their own individual personality and idea of what they think is going to work best for them and we think that that’s a great starting point. We, then, explain the risks and benefits and the patients make an educated decision on what really seems like is going to be the best procedure for them. That being said, the sleeve gastrectomy procedure that I mentioned at the end, really is leading the way now because it’s a lot better option than a gastric bypass procedure just because it’s less of a surgery. We’re getting a lot of excellent results with it because it’s really now showing to be the only surgery that is actually working on appetite specifically. So, the people that are getting the sleeve procedure are actually seeing a reduction in hunger levels which really makes dieting easy. So, the sleeve is now one of the main procedures. It is, again, a stomach stapling procedure very similar to gastric bypass but you don’t reroute intestines with the sleeve procedure. The gastric banding procedure is still being done, it’s just done to a lesser extent. Some patients really still like the fact that with the gastric band system, they can have it removed if they want it removed. So, that, I don’t think, will ever go away. We always have some patients that are getting gastric bands done and, really, if it’s working well for that patient, then they can do well with it long term as well.
Bill: It’s interesting how bariatric surgery is evolving through time here. Who is a good candidate for one of the bariatric surgery procedures?
Dr. Reich: The candidates are really anyone struggling with their weight. It’s usually a slow, gradual process. There are some insurance restrictions. By and large, we try to work with insurance companies for doing all of these surgeries and the insurance companies right now have a restriction limit. Part of the issue is, these insurance requirements have not been changed in 20 years. What we, as a society for the weight loss surgery, we would love to see the day when people that are 50 pounds overweight can still become eligible for these surgeries because they’re doing so much good nowadays. People that are 50 pounds overweight with diabetes and get a surgery done could still see a complete resolution to their diabetes. In the time being, we’re stuck with the insurance requirements. They are pretty strict. You need to have a body mass index of 35 and if somebody has a body mass of 35, it’s really a ratio of their weight to their height and they put it in a little equation and people can just check that on their cell phones, if you just type in BMI you can actually check your weight and height and see what body mass index you are. If your body mass index is 35, you are about 70 pounds over an ideal body weight range so that will qualify for surgery with an associated medical problem. A lot of times, and these are different per insurance carrier, but if someone has high blood pressure or diabetes or sleep apnea and they have a body mass index of 35, they will often times qualify for the surgery. If someone has a body mass index of 40 which is about 100 pounds overweight, that automatically qualifies for a patient for these surgeries.
Bill: Let’s talk about the procedure itself. Is sounds like it’s not an inpatient type of a thing? This is still fairly major surgery, correct?
Dr. Reich: These are big surgeries done through small incisions. Nowadays, we do everything laparoscopically which is using these tiny little instruments. Most of the incisions are about 1 cm in size, so, by and large, it’s never been a better time than now to get these surgeries done because we are able to do them all through these tiny little incisions. The internal work, people really don’t feel. There’s no nerve endings inside, so that’s why they are so well tolerated. Even people that get a sleeve gastrectomy or gastric bypass or the band, the same night of surgery, they’re up and walking around in the halls the same night. Nobody is laid out for a whole week’s time in bed and recovering like people that have these surgeries done. By the next day, everybody’s walking around and doing things. We usually recommend about three or four days until people start driving. Once they are over their initial soreness. So, there really is a fast recovery associated with the procedures and within just a couple of weeks’ time, usually we recommend just taking only about a week off of work for the basic recovery and most patients, by about that time, are able to go back to work and resume normal activity levels.
Bill: Once they do resume that after surgery, how important is it that the person follow a healthy diet. It’s not like, “Hey, I have the band! I can eat whatever I want now,” right? So, talk to me about that.
Dr. Reich: This is where dieticians become very important. We all understand, you know, if I have a patient that’s 60 years old getting these weight loss surgeries done, that person is not going to, with a snap of the fingers, going to start doing new dietary habits and techniques. These are people’s habits that they’ve had with them their whole lives. So, the way that everyone approaches food is a gradual change and we never expect anybody to have a surgery and automatically do things different. That’s where, with our practice, we have a very strong dietician presence, so that when anybody comes in to see they physician, they can also sit down with the dietician for 20 minutes just to go over their dietary patterns. The best thing about doing that is, really, everyone is an individual. So, people have different likes and dislikes and if you tell someone to follow a diet that they don’t like, they’re not really going to follow it. You really have to mold the diet for that patient. Then, the education really stems towards trying to eat healthier food types, trying to understand the difference of food types and what proteins do for the body and how protein-focused diets are typically the better way to go. So, we have a strong dietician presence to educate the patients. It’s an ongoing thing. It’s something that, really, five years after surgery, a patient can still come back to the office and sit down with the dietician at any point they get some extra questions.
Bill: So, diet and exercise is still very important after bariatric surgery. Let me ask you this Dr. Reich…
Dr. Reich: I would say diet is more important. Yes, the exercise is something we don’t actually recommend until the weight comes down. With the exercise and activity levels, somebody that’s 100 pounds overweight, if they try to run right into gym, the chance of them having an injury related with the extra weight and stresses and strains is pretty high. So, our main goal is weight loss first and exercise second. That said, we do recommend, just simply, a daily walking program. For anybody that is able to and is not suffering from really bad joint pains, just doing a 10-20 minute walk on a daily basis really does a lot for increasing the heart rate and really helping the weight come off more quickly.
Bill: Dr. Reich, great information. Thank you so much for your time today. For more information on bariatric surgery, please visit MeridianHealth.com. That’s MeridianHealth.com. This is Meridian Physician Podcast with Meridian Health. I’m Bill Klaproth. Thanks for listening.
Understanding Weight-Loss Options
Bill Klaproth (Host): Losing weight is a personal and ongoing struggle for so many with critical decision points that require support, particularly the choice to have bariatric surgery. My guest today is Dr. Jonathan Reich, bariatric surgeon with Meridian Health. Dr. Reich, thanks so much for being on with us today. Bariatric surgery is the umbrella for different weight loss procedures. Can you start by explaining that to us?
Dr. Jonathan Reich (Guest): Yes, I can. Thanks for having me, too, Bill. It’s a pleasure to be talking to you. The bariatric surgery really encompasses the fancy term for anything to be done regarding to weight. So, when we are talking about bariatric surgery, we are talking about weight loss surgery and the different procedures it encompasses.
Bill: What are those main procedures that fall under bariatric surgery? I know there’s gastric bypass and others. Can you quickly explain those to us?
Dr. Reich: Yes. It’s interesting because it’s a rapidly evolving field and has certainly come a long way in the past 20 years. About 15 years ago, the main thing was the gastric bypass and everybody that was getting the surgery 15 years ago was certainly getting a gastric bypass done. There were a couple of other surgeries that were also being done but not with as good of a result and then, what really happened is, the gastric bypass was the main surgery for probably about seven or eight years and then, gastric band devices became a better product. When the gastric band became a better product, we started to get a similar result with the gastric bands that people were getting with gastric bypass but it was a lot less invasive. From our practice, we started to see a lot of patients that were coming in saying, “I don’t want the big major surgery. I’d rather have a gastric band,” because it’s potentially reversible and the results were also very good with the gastric band devices. We’ve even seen another big change in the field in the past three years because three years ago, this new procedure called the “sleeve gastrectomy” was actually insurance approved and that’s when we began to do a lot of these gastric sleeve procedures which, from our practice is, by and large, the leading procedure right now that people are getting--the gastric sleeve procedure.
Bill: Out of those three, how do you determine what fits the potential patient the best?
Dr. Reich: That’s a great question. The way that we work it is, we’re a group that really emphasizes educating our patients. So, when someone comes in to ask us exactly that question and says, “Well, what do you think is going to work best for me?” we sit down with that patient and we review the different surgery options. If someone has in their mind what they think they want, a lot of times the patients are very savvy nowadays and do a lot of the research on their own, but really we answer the finer points of the procedures. We’re a group that really believes that, really, there’s no one size fits all. Everybody has their own individual personality and idea of what they think is going to work best for them and we think that that’s a great starting point. We, then, explain the risks and benefits and the patients make an educated decision on what really seems like is going to be the best procedure for them. That being said, the sleeve gastrectomy procedure that I mentioned at the end, really is leading the way now because it’s a lot better option than a gastric bypass procedure just because it’s less of a surgery. We’re getting a lot of excellent results with it because it’s really now showing to be the only surgery that is actually working on appetite specifically. So, the people that are getting the sleeve procedure are actually seeing a reduction in hunger levels which really makes dieting easy. So, the sleeve is now one of the main procedures. It is, again, a stomach stapling procedure very similar to gastric bypass but you don’t reroute intestines with the sleeve procedure. The gastric banding procedure is still being done, it’s just done to a lesser extent. Some patients really still like the fact that with the gastric band system, they can have it removed if they want it removed. So, that, I don’t think, will ever go away. We always have some patients that are getting gastric bands done and, really, if it’s working well for that patient, then they can do well with it long term as well.
Bill: It’s interesting how bariatric surgery is evolving through time here. Who is a good candidate for one of the bariatric surgery procedures?
Dr. Reich: The candidates are really anyone struggling with their weight. It’s usually a slow, gradual process. There are some insurance restrictions. By and large, we try to work with insurance companies for doing all of these surgeries and the insurance companies right now have a restriction limit. Part of the issue is, these insurance requirements have not been changed in 20 years. What we, as a society for the weight loss surgery, we would love to see the day when people that are 50 pounds overweight can still become eligible for these surgeries because they’re doing so much good nowadays. People that are 50 pounds overweight with diabetes and get a surgery done could still see a complete resolution to their diabetes. In the time being, we’re stuck with the insurance requirements. They are pretty strict. You need to have a body mass index of 35 and if somebody has a body mass of 35, it’s really a ratio of their weight to their height and they put it in a little equation and people can just check that on their cell phones, if you just type in BMI you can actually check your weight and height and see what body mass index you are. If your body mass index is 35, you are about 70 pounds over an ideal body weight range so that will qualify for surgery with an associated medical problem. A lot of times, and these are different per insurance carrier, but if someone has high blood pressure or diabetes or sleep apnea and they have a body mass index of 35, they will often times qualify for the surgery. If someone has a body mass index of 40 which is about 100 pounds overweight, that automatically qualifies for a patient for these surgeries.
Bill: Let’s talk about the procedure itself. Is sounds like it’s not an inpatient type of a thing? This is still fairly major surgery, correct?
Dr. Reich: These are big surgeries done through small incisions. Nowadays, we do everything laparoscopically which is using these tiny little instruments. Most of the incisions are about 1 cm in size, so, by and large, it’s never been a better time than now to get these surgeries done because we are able to do them all through these tiny little incisions. The internal work, people really don’t feel. There’s no nerve endings inside, so that’s why they are so well tolerated. Even people that get a sleeve gastrectomy or gastric bypass or the band, the same night of surgery, they’re up and walking around in the halls the same night. Nobody is laid out for a whole week’s time in bed and recovering like people that have these surgeries done. By the next day, everybody’s walking around and doing things. We usually recommend about three or four days until people start driving. Once they are over their initial soreness. So, there really is a fast recovery associated with the procedures and within just a couple of weeks’ time, usually we recommend just taking only about a week off of work for the basic recovery and most patients, by about that time, are able to go back to work and resume normal activity levels.
Bill: Once they do resume that after surgery, how important is it that the person follow a healthy diet. It’s not like, “Hey, I have the band! I can eat whatever I want now,” right? So, talk to me about that.
Dr. Reich: This is where dieticians become very important. We all understand, you know, if I have a patient that’s 60 years old getting these weight loss surgeries done, that person is not going to, with a snap of the fingers, going to start doing new dietary habits and techniques. These are people’s habits that they’ve had with them their whole lives. So, the way that everyone approaches food is a gradual change and we never expect anybody to have a surgery and automatically do things different. That’s where, with our practice, we have a very strong dietician presence, so that when anybody comes in to see they physician, they can also sit down with the dietician for 20 minutes just to go over their dietary patterns. The best thing about doing that is, really, everyone is an individual. So, people have different likes and dislikes and if you tell someone to follow a diet that they don’t like, they’re not really going to follow it. You really have to mold the diet for that patient. Then, the education really stems towards trying to eat healthier food types, trying to understand the difference of food types and what proteins do for the body and how protein-focused diets are typically the better way to go. So, we have a strong dietician presence to educate the patients. It’s an ongoing thing. It’s something that, really, five years after surgery, a patient can still come back to the office and sit down with the dietician at any point they get some extra questions.
Bill: So, diet and exercise is still very important after bariatric surgery. Let me ask you this Dr. Reich…
Dr. Reich: I would say diet is more important. Yes, the exercise is something we don’t actually recommend until the weight comes down. With the exercise and activity levels, somebody that’s 100 pounds overweight, if they try to run right into gym, the chance of them having an injury related with the extra weight and stresses and strains is pretty high. So, our main goal is weight loss first and exercise second. That said, we do recommend, just simply, a daily walking program. For anybody that is able to and is not suffering from really bad joint pains, just doing a 10-20 minute walk on a daily basis really does a lot for increasing the heart rate and really helping the weight come off more quickly.
Bill: Dr. Reich, great information. Thank you so much for your time today. For more information on bariatric surgery, please visit MeridianHealth.com. That’s MeridianHealth.com. This is Meridian Physician Podcast with Meridian Health. I’m Bill Klaproth. Thanks for listening.