Joey Wahler (Host): More than half of Americans make New Year's resolutions related to it. So we're discussing getting healthier and weight loss options. Our guest, Dr. Maurice Pagé. He's a Bariatric Surgeon with Mount Carmel Health System. This is Wellness in Reach, a Mount Carmel podcast.

Thanks for joining us. I'm Joey Wahler. Hi there, Dr. Pagé. Welcome.

Maurice Pagé, MD: Hi, Joey.

Host: Great to have you aboard. So first, remind us please of, in a nutshell, how does being overweight affect a person's overall health?

Maurice Pagé, MD: There's many side effects to suffering from obesity or being overweight; cardiovascular, consequences on the heart, lungs, also effects on your joints, carrying too much weight, and overall, creating inflammation in the body when you're carrying a lot of excess weight. There's also some links to cancers as well, so it's a disease state that affects the whole body.

Host: And of course, so many people in America suffer from that, right?

Maurice Pagé, MD: Absolutely. And, more and more people, the epidemic of obesity is getting worse. It's not getting better.

Host: So in terms of medical weight management, if someone is ready to lose pounds, but is not a good candidate for surgery for whatever reason, what are their options and why would they be a better candidate for the non surgical approach?

Maurice Pagé, MD: Some patients, first of all, we like to start with the basics to look at other medical conditions that affect the way that someone can lose weight. There are many metabolic conditions that a patient can suffer from that need to be optimized before we can lose a significant amount of weight. So meeting with that patient, looking at their individual needs. Going over their medications that they're currently on, because sometimes medications are also weight gainers, so that's very important, and as you said, not everybody is a good surgical candidate.

Host: Now you mentioned medication. And of course, these days, Ozempic and similar weight loss meds are all the rage. How about that as an option?

Maurice Pagé, MD: It is an option, it's not the first option. We like make sure that everything else is optimized before we go with the injectable drugs. We have a comprehensive program and as long as our patients are within that program, they are reliable, follow up, they also are committed to making lifestyle changes and dietary changes; then we will consider adding the injectable weight loss drugs.

Host: So all that being said, for those unfamiliar, what is bariatric surgery and what are the benefits?

Maurice Pagé, MD: Bariatric surgery is generally a laparoscopic surgery, so small incisions on the abdomen, and the goals of all the surgeries basically is to reduce the size of the stomach so that patients cannot eat as much food but also feel full earlier, that they're more satisfied. And the other side effect of those surgeries is that it changes the hormones in a patient's body so that nutrients are absorbed differently and that they're able lose weight.

Host: Really? I didn't know about that second point. I would imagine many people don't, right?

Maurice Pagé, MD: Absolutely. So, we talked about the injectable drugs. So, the injectable drugs are hormones that we inject. That's one hormone. Actually one of the medications on the market is two different hormones. But, bariatric surgery, if we talk about a gastric bypass, that's going to modify about 30 different hormones in the body after surgery.

Host: So, what makes someone a good candidate for weight loss surgery?

Maurice Pagé, MD: A good candidate would be someone that's healthy enough to undergo surgery. We talk about physically, but we also talk about mentally. So if a patient has challenges mentally, binge eating disorders and so forth, we have to address those issues before. We have to make sure that, as I said, that overall they are in a good health, so working in collaboration with their primary care physician.

And for the criteria, the patients have to be we look at BMI and that's the way that insurance companies look at approvals for these surgeries, so the BMI has to be over 40, which is a ratio of the height and weight of our patients, or have a BMI between 35 to 40 with some medical conditions related to their obesity, such as diabetes, cardiovascular disorders, high blood pressure, sleep apnea, to name a few.

And some insurance companies now are starting to consider metabolic surgery in patients with BMIs over 30, if they suffer from diabetes as well.

Host: Gotcha. And so if someone is to undergo this procedure, what should they do, if anything, leading up to it to get ready, so to speak?

Maurice Pagé, MD: We encourage people to make the commitments right away, cause it's a big change in their life. We talk about diet, we talk about lifestyle. We ask them to implement some of those modifications already before surgery, that way they're more ready after surgery and also, we encourage them to find a support system, to have support people to help them throughout the process.

Host: So even post weight loss surgery, patients have to maintain an adjusted lifestyle, you alluded to that. What are some of the keys to success after their procedure in terms of following up?

Maurice Pagé, MD: As with any bariatric procedure or medical weight loss programs, activity is key. Most people have the misconception that being very active will make you lose a ton of weight. Your body will get used to the level of activity that you are doing, but after surgery or after you start a medical weight loss program to maintain the weight loss, to prevent weight gain, it's very important to exercise, which what we recommend is 150 minutes of moderate exercise per week.

So, it's not unachievable. And moderate exercise, for example, would be a brisk walk. So we're not talking about, you know, running or riding a bike for several miles.

Host: So that's about two and a half hours a week, right?

Maurice Pagé, MD: Correct. Yep. So about 30 minutes, 5 days a week is what we recommend and that's enough to signal your body that you're an active person, which, in turn, will help you to keep your body from gaining more weight. It will help to keep your weight stable or maintain your weight loss.

Host: And then how about dietary adjustments post procedure? Generally speaking, what does that involve?

Maurice Pagé, MD: We talk about a variety of things. We touch on ultra processed foods, we talk about food labels, but generally, if we're talking about surgery, one important aspect long term is to measure the portion that an individual is eating. And knowing what's in their food, how many calories in their food, and not using your stomach to tell you when you're full, but have an idea based on what it looks like on your plate, or when you measure it, what's an appropriate quantity of food.

Host: Now, naturally, I'm sure those joining us for this conversation are wondering how much weight can I lose here, doc? So it's based not so much on total pounds as much as body weight percentage, right?

Maurice Pagé, MD: Correct. So, for us surgeons, we like to use the excess body weight to look at weight loss. So when you look at the numbers, initially, patients after a gastric bypass will lose about 70 percent of their excess weight. So, meaning if I'm a 300 pound man and an ideal weight would be 200 pounds, I could expect to lose probably about 70 pounds because I'm about 100 pounds overweight.

With the sleeve gastrectomy, we look at about 60 percent of the excess weight. With some of the injectable drugs now, the data varies, but we can see results to about 30 percent of the excess weight.

Host: To put that another way, patients typically are not going to lose all the weight that they need to from these approaches alone, right?

Maurice Pagé, MD: Right, not generally, it's possible, but it's not the majority of patients, it's a minority of patients that are going to lose all the weight that they would need to to be at a quote unquote perfect BMI because our bodies are very complex organisms and it's very difficult to lose weight.

Host: And of course BMI standing for Body Mass Index, yes?

Maurice Pagé, MD: Correct, yeah.

Host: And so since, as you just confirmed, most patients undergoing these treatments will not lose all the weight they need to, there's still work to be done. How important a job is it for you and yours to impress that upon people before they undergo this road so that they know there's still a responsibility on their end as well as yours, right?

Maurice Pagé, MD: Right, absolutely. Follow up is key. Understanding that obesity, I tell my patients, obesity is a chronic medical condition. I should add that some patients will initially lose all of their excess weight, but the majority of patients will regain some weight, and that's also part of the follow up, is to make sure that they stop regaining some weight at a certain percentage and support them to keep most of their weight loss.

Host: And you led me perfectly into my next question. Couple of other things. One being, you mentioned support there. Earlier, you alluded to the importance of a support system such as family, friends, anyone close to you at home to help you get down this road. But how about you and your staff and the support that you offer as well?

Maurice Pagé, MD: Yeah, so, support at home is very important as far as with our medical weight loss program and, and surgical weight loss program. We have different support groups, that we offer to support our patients and they are free to our patients. We have a nutritional support group, more of a social and lifestyle support group, so, tailoring to what patients need.

And we also have social events that we invite patients to where we can mingle and talk about different issues.

Host: That sounds great. How about what would you say, Doc, is the biggest misconception these days about weight loss surgery and some of these other approaches? There's so much information out there, there's stuff on social media, it seems almost everyone is an expert, right? But the fact is, relatively few are.

You are. So, tell us, what's the story here? What are people missing, if anything, about all this information?

Maurice Pagé, MD: From the surgery standpoint, probably the biggest misconception now is that in 2025 that the surgeries are risky and that the patients are malnourished, which there's no reason in 2025 that patients should be malnourished after surgery. The surgeries are very safe now. We're talking about the same safety profile as a gallbladder operation.

 So the surgeries are much safer than what they used to be in the past. That's probably the biggest misconception. Another big misconception is that you can inject a drug in your body and expect to lose all your excess weight. That's not true. You're going to lose a percentage of that excess weight, as long as you change your lifestyle, you change your diet, you're consistent, and also, what most people don't know is that those injectable drugs, once you stop injecting them, they stop being effective and people can regain a big amount of weight.

Host: And when we talk about follow up, by the way, how important is it, Doc, that people make sure that they come for follow up visits and just simply are diligent about remaining in contact with medical personnel because these are not procedures and drugs that can or should be done without expert supervision, right?

Maurice Pagé, MD: Absolutely, there are side effects to the surgery, there are side effects to the drugs. They're very safe, both of them generally, but it's important to see a qualified provider or professional that can identify if something's not right, if there's a complication, something to watch for. So follow up is very important, and as you said, to go to an expert, not somebody that full time does Botox injections, for example, and on the side does medical weight loss, just to name an example.

Host: Indeed. In summary, where can people find out more information about Mount Carmel's Bariatric Surgery and Medical Weight Management Programs?

Maurice Pagé, MD: The easiest way would be to go to the Mount Carmel website at Mount Carmel Health, and look for the Bariatric Surgery Program and Medical Weight Loss Program website. They can submit an application through the website, that's probably the easiest way. Another way would be to contact our practice, our surgical practice where we see patients. It's Central Ohio Surgical Associates, and the phone number for the practice is 614-228-0768.

Host: Well, folks, we trust you're now more familiar with weight loss surgery and other such options. Dr. Maurice Pagé, valuable information indeed. Thanks so much again.

Maurice Pagé, MD: Thank you.

Host: And so if this is indeed the year that you want to get healthier by losing weight, please do contact Mount Carmel Health System to discuss which of these options is right for you? Simply go to mountcarmelhealth.com/bariatrics and complete that pre screening application to start the conversation. If you found this podcast helpful, please share it on your social media. I'm Joey Wahler. Thanks again for being part of Wellness in Reach, a Mount Carmel podcast.