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Scott Webb: Bariatric surgery, known more commonly as weight loss surgery, can change your life for the better by helping you to lose weight and keep it off and, in many cases, eliminating other health issues like sleep apnea and diabetes. And joining me today to discuss the many benefits to weight loss surgery and the various surgical options is Dr. James Harris. He's a general surgeon who specializes in bariatric surgery with New Hanover Regional Medical Center.

This is Healthy Conversations, the podcast for New Hanover Regional Medical Center. I'm Scott Webb. Doctor, so great having you on today. I want to have you start by telling us a little bit about yourself, what you do at NHRMC, basically tell us about your specialty.

Dr. James Harris: My name is Jim Harris I am a general surgeon and I specialize in gastrointestinal surgery and that's been my interest ever since my training.

So bariatric surgery is obviously gastrointestinal surgery. It fits well into my practice. What really draws me to bariatric surgery is the ability to make such a difference in someone's life. Doing a bariatric surgery impacts the quality of life for my patients. They do very well. We follow them for years and we can see the transition from somebody who has potentially many medical problems and then we watched those problems just dwindle away. Patients are very happy. They're gracious. And so for all those reasons, it is a very enjoyable specialty within general surgery.

Scott Webb: Yeah, there's no doubt. And we have a bunch to cover today and outcomes are great. And we're going to get to all of that. But as you say, it's really about quality of life and that journey for people. So let's talk about bariatric surgery and its place in an individual's weight loss journey. Why and when would a person consider bariatric surgery?

Dr. James Harris: Well, somebody may want to consider surgery if they've done multiple diets, maybe they've had some diet pills. A lot of people can lose 20, 25 pounds, but then when they come off those diets or when they come off those pills, they'll see that it's very difficult to maintain the weight loss and they might gain that weight back and then some.

There is a fair bit of frustration with this yo-yo tendency. It's also difficult because patients are hungry all the time. Many times after 20, 25 pounds, their body adjusts to the new diet, and then it becomes more difficult to lose any more. So it can be frustrating. So for that person, weight loss surgery can offer more of a long term, powerful tool to get them over that hump of the 20, 25 pounds, because the tool that they have now is there forever.

Bariatric surgery many times is sort of a natural appetite suppressant because of the hormonal changes directly due to the surgery. They'll always have that small stomach that we create and so they should always be getting full fast. So this is a long-term solution. It does require some lifestyle changes, but it can be very effective.

Scott Webb: Yeah, it sounds like it. And I think we're all kind of familiar with that yo-yo effect when it comes to eating and dieting. And I just love that you're focused really on the long-term plan and really helping people over the rest of their lives, which is great. And I want to have you talk a little bit about NHRMC's bariatric surgery program and really what sets it apart.

Dr. James Harris: The program at the hospital, really about 20 years ago made a significant effort to improve everything about our program. It was about that time as well with the national scene for bariatric surgery started to change as well. So centers of excellence started to crop up.

We created a program that had a clinical protocol that every patient followed. We have since then tracked all of our outcomes for at least five years for every patient. We track everything from incidents of complications, reoperations, readmissions length of stay. We also track the results, long-term resolution of their medical problems, short and long-term weight loss. And that is all reported to the people who accredit us, the American College of Surgeons. Our results and our program is reevaluated every couple of years. And we are always ranking in the top of the bariatric surgery programs across the country.

The hospital also has a specialized bariatric surgery floor, all the patients go to the same floor, the same nurses. They all know exactly what is expected of the patients, what is expected of these protocols. Length of stay is short. Our results are really quite excellent and the hospital has been really good at supporting the program and doing whatever it takes to make sure that we have a great program.

Scott Webb: And when we talk about patients, we talk about the qualifications to be a candidate for bariatric surgery. Let's go through those because not everybody is necessarily a candidate, right?

Dr. James Harris: That's true. So you do have to meet the criteria to qualify through the insurance companies. So the main thing we look for is this thing called the body mass index or BMI. And so that is a calculation that is done with height and weight. And if you just get on the computer, you can Google body mass index calculator, punch in your height, your weight.

So for most people, your body mass index should be above 40. And for most people of average height, that turns out to be about a hundred pounds overweight. Also, you can be a body mass index below that, 35 to 40, if you have one of the medical problems that is related to being overweight and most commonly that would be type 2 diabetes, high blood pressure, sleep apnea, heart disease, arthritis. Those are the main ones. There's others as well, but body mass index is the main thing.

Now, you have to be 18 years old or above, and then, after about the age of 65, we can look at it by a case to case basis. Once you get up into the seventies, maybe mid seventies, that would be unusual to be operating for weight loss at that point. It's not good to be smoking. You can't be doing drugs, things like that. That should be obvious. You can't have an obvious eating disorder. And plus you have to be able to understand a little bit about how the surgery works. You have to be willing to make the lifestyle changes to make it work long-term.

You also have to be an acceptable risk. You can't have let these medical problems that you have because you're overweight have gotten to a point where it makes you too risky to do the surgery. So at some point, it sort becomes too late to have the surgery. But everybody knows exactly if they qualify or not. So most of the time, people will call the office. We have physician assistant nurses who can ask just a few questions and try to figure out if you qualify with the basic criteria or not.

Scott Webb: Yeah, that's good. I mean, people could maybe start with their primaries, but just call the office and find out. Lay it all out there, starting as you say, with the most important, one or the biggest, metric there, which would be BMI, and then you can move on from there and find out and people can find out if they're good candidates for the surgery.

There's three basic types or main types of bariatric surgeries performed at NHRMC. So let's go through the three.

Dr. James Harris: So, these days really, it's the gastric bypass, laparoscopic Roux-en-Y gastric bypass, which remains the gold standard of weight loss surgery. It's been around for 50, 60 years. There's also the laparoscopic sleeve gastrectomy, which is a little bit newer. It's been around 15, 20 years. Most of you will have heard of the gastric band or the lap band. That probably is more of historical interest. The results long-term and the complication rate has pretty much taken it off the market.

So the gastric bypass is a surgery where we make a really small stomach out of the top part of your stomach. And then we go down onto the first part of the small intestine and we bring that up and we connect it to that small stomach pouch. So nothing is taken out in that surgery. It's just all rearranged a little bit. The other one, the sleeve gastrectomy as its name implies, we're actually taking out probably 75 or 80% of the stomach. We're taking it out. So what's left is a stomach that is sort of shaped like a sleeve. It's not very big. Both surgeries are intended to make a small stomach. So these surgeries mostly work by restricting the amount of food one can eat. That's the main way these surgeries help you lose weight short-term and long term.

But there's also other effects that both surgeries have that are called metabolic effects. Probably the most useful metabolic effect for both surgeries is this change in the hunger hormone called ghrelin. It's a GI hormone. And if you do these surgeries, the hunger hormone immediately decreases its levels in the bloodstream. So what that means is most people aren't physically hungry like they used to be. It makes it very useful, especially when comparing it to a diet where you're hungry all the time. You have weight loss surgery and it actually takes physical hunger away. That effect typically lasts a long time. You'll find people who have had the surgery 10, 15 years ago, and they say that they're never really as hungry as they used to be. So that is part of the reason why the surgeries work so much better than diets. But those are the two main surgeries that are done today. Always there's developments for new ones, but those are the main ones today.

Scott Webb: Let's do a review of the support services offered to patients at NHRMC.

Dr. James Harris: Like I said before, the system is set up so that everybody who has the surgery, every nurse, all the ancillary services, everybody knows what the protocols are. It's run through the same departments every time. So that is very helpful. All of the patients before surgery get counseling and education. Everyone sees a dietician so that they can learn not only how to advance the phases of diet after surgery, but then also how to adjust your eating habits forever to make this a long-term success. We have support groups through the hospital and our nurse coordinator and bariatric coordinator in the hospital, Kim Joyner, runs those. Currently. They're virtual, but they go on several times per month. Each meeting, there's a different subject, maybe as guest speaker. Those can be very useful and educational and it keeps people intact with the program and just helps them long term.

Other things that people end up doing before surgery is everyone sees a psychologist. They're also available post-operatively to deal with anything that comes up because of the lifestyle changes. So this is not just a surgery that can work in a vacuum. This is a group effort and every bit of it is important. It's not just the surgery.

Scott Webb: Yeah. I love that. The group effort, the team approach, patient centered, all great stuff. Doctor, lastly, today, just want to have you go back over again and talk about the weight loss journey for people and how bariatric surgery can really improve and really change their lives

Dr. James Harris: For certain, any of the obesity-related health problems are markedly altered and improved. So people with diabetes, high blood pressure, those things can go away completely. In fact, 90% of the people getting the surgeries can get rid of all that sleep apnea. There's a whole list of medical problems that are related to being overweight. And we see that the vast majority of those go away.

And then, so there's this quality of life improvement. Not only your medical problems better, your mobility is better. The weight bearing joints don't have so much strain on them.

You just get to enjoy life better, the quality of life. And it actually has been proven through the studies that average length of life increases by like five and six years for certain groups. So quality of life, quantity of life, it affects these people dramatically. I hear it every day. "Boy, I am so glad I had the surgery. I just wish I had done it 10 years before."

Scott Webb: And I'm sure that's a great feeling. And, you know, we started the conversation today about how you came to this area of specialty and you can really see how you got there. Helping people changing lives, uh, getting that great feedback from people. And a lot of things in medicine, there always seems to be a catch or maybe a possible downside. It's really hard. I'm not hearing a lot of downsides here. Maybe the only thing might be that it does require some lifestyle changes and people really do need to be vigilant in order for this to work and work long term. But other than that, it's really amazing stuff. And I really appreciate your time today. Thanks for everything. And you stay well.

Dr. James Harris: You're very welcome. You too.

Scott Webb: For more information, go to NHRMR.org/bariatric-surgery. This is Healthy Conversations, the podcast for New Hanover Regional Medical Center. I'm Scott Webb. Stay well.