Joey Wahler (Host): It's an option for those looking to lose pounds and have a healthier lifestyle. So, we're discussing weight loss surgery. Our guest, Dr. Felix Spiegel. He's a general and bariatric surgeon with Memorial Hermann's New Start Surgical and Medical Weight Loss Programs.

Welcome to Every Day Well, a health and wellness podcast brought to you by Memorial Hermann Health System. Tune in for the latest tips and information about healthcare topics that matter most to you. Thanks for joining us. I'm Joey Wahler. Hi, Dr. Spiegel. Welcome.

Dr. Felix Spiegel: Hello. Thank you.

Host: Great to have you aboard. We appreciate the time. So, first in a nutshell, could you tell us a little bit about your journey into bariatric surgery and what is it that first interested or inspired you to specialize in that?

Dr. Felix Spiegel: Well, I began as a general surgeon, like most bariatric surgeons. And then, 25 or more years ago, I started to see patients who had a problem with morbid obesity and all kinds of related conditions. And then, I went to my first course in bariatric surgery and started performing a few surgeries and how dramatic the results are in improving these people's health and quality of life. It kind of took over my practice little by little. In those days, there weren't too many bariatric surgeons. And the patients referred other patients, and my practice grew to the point where I stopped pretty much doing all other surgeries and general surgery and just specialized in bariatrics. But it's very rewarding, and it's really amazing to see these people even years later as they're maintaining their weight and preventing health problems, et cetera. So, yes, that's how it happened for me and pretty much became my entire career. 

Host: How do you typically determine the best approach for a patient, whether it's surgery, medication, or a combination of both?

Dr. Felix Spiegel: Well, it has to be done by individualizing due to the patient's history of weight loss, their history of medical conditions, their physical examination, and the amount of weight they need to lose, because some patients are good candidates for a non-surgical therapy, but some patients will only have adequate results if they do have surgery. So, it's very individualized based on all of the above.

Host: What are the different types of weight loss surgeries available these days? And how do you determine their suitability for various patients?

Dr. Felix Spiegel: The different types of surgeries are really down to three surgeries. The most common and the most established is the gastric bypass that has been around for a long time where the patient gets a small gastric pouch. And the food passes around the large stomach. That's called the gastric bypass.

And then, less than 20 years ago, the sleeve gastrectomy was popularized. And I've been doing it since 2007. And this surgery entails making a small banana-shaped stomach and removing the rest of the stomach without any bypass. And for some patients, that's a good option depending on their history and their eating style, et cetera. 

The third option is called the duodenal switch, which I really specialize in extensively, because it's the best option by far for people who need to lose over a hundred pounds. And that surgery entails making a small stomach that's shaped like a banana, like a sleeve, and also doing a bypass with that of the intestine. And that surgery has actually been around way longer than the sleeve. And it's an excellent option for a lot of patients.

But yes, the choices are those three mainly. And there are some semi-experimental surgeries like all these balloons and all these mini-bypasses, but they're really not approved in the United States, and they really don't have a track record, so I don't do them, and most surgeons at Memorial Hermann do not.

And of course, there's the laparoscopic gastric banding, which was extremely popular up until 2010, but it's not really as sought after by most patients anymore and has an average much lower results than the surgeries that I mentioned just now. So, very rarely is there any gastric banding performed anymore.

But yes, over the years, there's been other surgeries that fell out because of inadequate long-term results. But these three surgeries actually have excellent long-term results with 10, 15, 20-year followup studies, and that's why we're doing this. We're doing this not just to lose 100 pounds or more or less. We're doing this to maintain that weight loss long-term, because that's what gives you the health benefits that we're after. You know, it's not just cosmetic. This is done for morbid obesity, which is a medical condition.

Host: When you look at those three options, Doctor, what are the potential benefits and risks associated with each?

Dr. Felix Spiegel: The benefits with each is long-term weight loss. And of course, quality of life and the things I mentioned, getting rid of all your medical conditions and getting your primary care doctors or other specialists that are treating the patient to taper and even discontinue a lot of the medications that they're on.

The risks of the surgeries are divided into immediate risk and long-term risk. So, immediate risk has become extremely minimal over the years, especially at centers of excellence like Memorial Hermann Medical Center. So, immediate risks include bleeding and leak from the intestines during the creation of these surgeries and, usually, are only possible in the first few days after surgery. Because of our expertise and because of the Center of Excellence and many years of experience and improvements in our equipment, our risks of bleeding and the leaks are actually much, much less than they are in general surgery. So, this is very minimal.

Long-term risks include possible vitamin deficiencies or losing too much weight or gaining it back. And that can be minimized with follow up, which we like to call aftercare. I tell my patients the first time I see them in consultation that I really wanted to follow them for life, just like a primary care doctor does to make sure that they're doing well with this surgery. We can think of the surgery as a car, and the followup is like a maintenance schedule. So, I have them follow up once a month during the first year, during which the biggest weight loss change occurs. And then, I have them follow up about every six months after that to make sure there's maintenance and make sure they're having a healthy lifestyle and having a good nutrition. So, that's what the risks and benefits entail.

Host: You mentioned earlier, Doctor, that that switch method is often for those looking to lose at least a hundred pounds or more. How about overall-- whether we're talking about the bypass, the sleeve-- generally speaking, how much weight can someone lose? I'm sure many are wondering that from weight loss surgery overall.

Dr. Felix Spiegel: We measure weight loss in these surgeries by percentage of excess weight. So if someone is 100 pounds overweight, and they have the duodenal switch, and you do this surgery on a thousand people, then the average person is going to lose 85%, or 85 pounds. If they're 200 pounds overweight, they'll lose 170 pounds on average. After that is the gastric bypass, which has 70% average weight loss, which is 70 pounds out of 100. And then, the sleeve alone has about 60% excess weight loss, which is 60 pounds out of 100. And these statistics are very, very accurate because they've been measured on so many thousands of patients. So, they're the average. But I tell my patients, it doesn't mean you. Some people lose more or less, but they're very accurate average results that people can expect.

Host: What's the typical recovery process after surgery? What can patients expect in terms of things like pain, restrictions, healing time?

Dr. Felix Spiegel: Typically, surgeries take one to two hours, and they're done laparoscopically. That means that we place the camera inside the abdomen through these tiny incisions and use air to create a little space to see what we're doing. So, the pain level is much, much less than an open surgery like a C-section, for example. You're just kind of gassy. And this actually almost goes away by the end of the first day that you had surgery by walking around and just time. And then, there's minimal pain or discomfort.

The average person stays in the hospital one night just for safety, for observation. And when they go home next day, they really don't have almost any complaints, they're not nauseous, they're not having much discomfort at all. And they start on a liquid diet consisting of protein shakes and other liquids. And then, over the first two weeks, they move on to a soft food diet. And the patients are able to return to office-based work like desk work in about a week, and then heavier type of jobs where there's some heavy lifting involved in two weeks, sometimes a little bit longer. But recovery is very fast compared to open surgery, because it's minimally invasive and it's laparoscopic.

Host: So, a few other things. You alluded, of course, earlier, Doctor, to post-surgery, the importance of lifestyle changes. Patients still have work to do in order to maintain what's been started with the procedure. So when we talk about diet, exercise, et cetera, what are some of the main challenges that they have in trying to keep going from that point on.

Dr. Felix Spiegel: The reason they're getting this surgery is because they have low metabolism, and that is hereditary. Their genetics are pointed towards being obese as they can see in their family members. But also, they have made choices that let them eat mostly high-calorie fattening foods as opposed to more healthy choices.

So, my job after surgery in doing their meal planning is to try to make them eat more like an athlete, try to make them eat a high-protein, low fat, medium carb diet, which will give them the best possible results in losing fat and maintaining their muscle mass. We don't want them to lose too much muscle mass. We want them to lose the fat. That's what their job is to try to listen and try to follow that meal plan as closely as possible by eating protein and vegetables and staying away from fat and salt calories.

And it's a change. It's a lot of work for them because they're not used to eating like athletes most of the time, but the surgery makes it so much easier. It's not like doing it alone. The surgery controls your hunger. Even their food preferences change. The things they used to not like, now they crave, things that are healthy for some reason. And the things that they used to like that are not healthy or fattening, now they don't want them.

It works together. Surgery, like I said, it's like a car or a tool. And what they're doing is choosing the right fuel for the tool. And doing the maintenance and service. And it works hand in hand. But yes, they definitely have a lot of work to do. They need to change their lifestyle and help the surgery give them the best possible results. 

Host: And of course, that includes exercise and being more active too, right?

Dr. Felix Spiegel: Yes. But we need to get them away from this excessive exercise. Because in the past and even now, there's some misconceptions, in the general public and even among doctors that if you do a lot of exercise, the more, the better, you're going to lose weight. Well, it doesn't really work for people that are morbidly obese. Because if they do a lot of exercise or too much exercise and don't pay attention to the diet, sometimes they can bulk up and build extra muscle, but they're not losing fat. They're not losing weight like they want to. We want them to do moderate exercise for toning and for general well-being, but not excessive exercise like a lot of them have done in the past without any results, because they were still eating too much, sometimes because they were exercising too much. It's kind of like a Catch 22. So, the exercise is a relatively small part of it, but it's very helpful. And as the person gets smaller and smaller, then I increase their exercise more and more, because then they actually need to exercise more if they want to lose that last 20 pounds,. But at the beginning, we don't want them to excessively exercise, like they might have done in the past.

Host: In summary here, Doc, what's your message to those joining us who are considering weight loss options? Where do they start?

Dr. Felix Spiegel: My message is to get on the New Start website and search out doctor for consultation to get informed and to get educated about their condition or their morbid obesity. Just going on the internet by themselves may not give them the right information. If they come for consultation, it's amazing how many things they'll learn. And they may or may not choose a medical treatment or surgery or both, but at least they'll know the options and they'll understand what can be done and what we have been doing for tens and tens of years.

That's kind of the biggest regret my patients have, and they even, tell that to their friends and other associates and doctors after they have these surgeries is, "Man, I wish I did this five years ago." They have nothing to lose by getting this visit and getting an understanding of this. It's just a doctor's visit. There's no obligations to have the surgery next week or next month. Some of my patients have it right away, but some think about it for a year or more and then they come back again and then they wind up having it, because some people need more time than others. But to get informed and to understand what it's all about, I think, is the next step to know what their options are, you know.

Host: As the old saying goes, Doc, no day like today, right?

Dr. Felix Spiegel: Yes, because these conditions are serious. Sleep apnea, diabetes, high blood pressure, people suffer from them and can have terrible complications. The sooner you can get rid of these health conditions, the better you're off, that's for sure.

Host: Well, folks, we trust you're now more familiar with weight loss surgery options. Dr. Felix Spiegel, keep up the great work. We can tell how passionate you are about it. And thanks so much again.

Dr. Felix Spiegel: Thank you so much.

Host: To learn more about Memorial Hermann's New Start Surgical and Medical Weight Loss programs, please visit mhhs.org/weightloss. If you found this podcast helpful, please do share it on your social channels and be sure to check out the entire podcast library for topics of interest to you.