Dr. Mike (Host): Welcome to Meaningful Medicine, the Novant Health Podcast. I'm Dr. Mike, and with me today is Dr. Jamie Stokes, a bariatric surgeon from Novant Health's Weight Management and Wellness Clinic. We will be exploring tips to maximize longevity as we dive in to a healthier lifestyle. Dr. Stokes, welcome to the show.

Jayme Stokes, MD: Thank you, Dr. Mike. Glad to be here.

Host: The prevalence of obesity has increased in recent decades across the country, even across age ranges. Can you touch on some of the specific health impacts?

Jayme Stokes, MD: Absolutely. Obesity is one of those diseases or chronic conditions that affects every part of a patient's life. Cardiovascular health, increased risk of hypertension, stroke, myocardial infarction or heart attacks, COPD, the ability to breathe well. Some cancer risk goes up as patients increase their weight. The effects on kidney and kidney disease, muscle and joint pains, the need for knee replacements or hip surgeries increases significantly. So, there's absolutely no part of a patient's physiology and normal body function that's not affected by being overweight.

Host: You brought up cancer, and I wanted to ask you about that. So, not only do we have an obesity epidemic happening, we also see colon cancer rates increasing, especially in younger people. Is there a connection there that you see?

Jayme Stokes, MD: So, what we believe the connection in the obesity world is mostly in the sexual-linked cancers, some that are more sexual hormone-related, such as your breast cancers, your ovarian, uterine cancers. The fat cells will actually store estrogen and progesterone to high levels. And those increased levels in the body can have negative effects downstream on some of those organs that are affected by those hormones. And certainly, the increased inflammation that is present in obese individuals that leads to different inflammatory markers circulating throughout the body can cause damage to the cells. The cells are turning over at a more rapid fashion, and that can lead to more error-prone reproduction, and then that can lead to dysplasia or cancer. And so, again, obesity affects every part of a patient's body.

Host: Even a shorter lifespan, correct?

Jayme Stokes, MD: That's right. There's inflammatory markers we know have an effect on some of the more microscopic DNA aspects that can affect a person's overall length of life and certainly quality of life, right? So, it's one thing to live on a nice long life, but you want those last years of your life to be a high quality, high impact part of your life.

Host: Right, for sure. Let's first talk about diet. Many of us eat multiple times a day, including main meals, snacks. When we think about our overall health, how important is the food I'm eating, when I'm eating it, how much I'm bringing in, how important is all that?

Jayme Stokes, MD: Critical. It's absolutely critical. And before we even talk to a patient about a surgical approach to losing weight, we want to make absolutely sure that their diet and their lifestyle behaviors are as absolutely as good as they can be. And so, part of the process, if you were pursuing surgery for weight loss, would be to go through a several month counseling session with our dietician to make sure that the choices you're currently making are as good and as healthy as they can be. Are you eating high protein foods? Are you minimizing your carbohydrates and sugars? Are you minimizing your fat load? And then, if all of those are in place, are you eating at appropriate times? So often we can get into a busy lifestyle and we're only eating one meal a day, and that's a really hard way to live. And so, we want to make sure the patients are eating three meals per day with some nice, healthy snacks in between.

Host: So, we've talked about diet, and now I kind of want to focus on the other side of this: activity, exercise. How important is regular sustained activity for living a healthy life? And if somebody can do that, what are some of the long-term benefits?

Jayme Stokes, MD: Absolutely. So, activity is critical. So, diet certainly comes first. And activity, I would put right after that, a second. Too often, again, with our social pressures and professional pressures, we don't make time to be an active participant in our own physical health. But we counsel patients that it doesn't have to be hard, it doesn't have to be a big change. We're not asking you to go to a local gym and take out the highest membership and show up for three hours a day. Start small. Walk in your neighborhood. Walk for 15, 20, 30 minutes per day for three days a week. I think that's a fair ask for somebody to start, who was committed and serious about losing weight. For some patients who may find walking difficult, certainly water aerobics or some other low impact activity. We counsel patients about possibly doing some resistance training in the comfort of their home, on their couch. You're using some resistance bands, just any type of physical activity to get the joints moving, get the muscles moving, get the heart rate up, get a little bit of a broken sweat. That only helps to burn calories and to get the metabolism cranked up.

So, all of these efforts are adjusting the set point of a patient's weight, which is managed by the brain. And if you can alter that set point, then that's what really allows a patient to lose weight and get down to a lower, more manageable situation.

Host: I know that many of us can be stress eaters, emotional eaters. Sometimes that can extend into other bad habits like alcohol and cigarette smoking. What advice do you have to help us curb some of these behaviors?

Jayme Stokes, MD: Absolutely. So, just like the name of our clinic implies we're about weight management and wellness. And so, we take the whole body approach as, yes, we're one of our primary goals is to help a patient lose weight, but we're also trying to help a patient improve their overall health, their overall wellness.

And so, we do counsel patients about what appropriate amount of alcohol may be. And certainly, we ask our patients to cease all nicotine consumption, whether they be cigarettes or vaping or patches or gum. Some of the operations that we perform absolutely cannot have a patient be consuming nicotine because it could lead to some serious complications down the road. And so, we make sure that they understand those risks that are inherent to the surgeries that we do. And again, it goes back to their overall wellness. We don't want to have a patient lose 30, 40, 50, 60 pounds.

But then, also have these other lifestyle choices that we are having major impacts on their life in addition to the weight. So, it all goes hand in hand. It's not uncommon as patients make healthier choices in their diet and activity that sometimes you may have an addictive transfer. And so, you may have a patient who had a manageable consumption of alcohol or other lifestyle choice prior to these changes. But then, as those changes became into place, that addiction found another place. And so, those less desirable lifestyle choices may worsen. And so, we constantly look out for that and we caution patients about that and say, "Hey, make sure your family's looking out for this. Make sure you're looking out for this. And if you notice these behaviors, come talk to us. Come get some help early rather than later.

Host: What do you say to the patient who maybe has some bad eating habits? Just really doesn't like exercising at all. They know they've got to lose some weight. They know they need to get healthier. And I think a lot of them feel a little hopeless, a little like, "It's too late for me." What do you say to that patient?

Jayme Stokes, MD: It's never too late. It's never too late. We have patients who pursue our services into their seventh and eighth decade of life. And again, it goes back to, yes, we are attempting to add years of life to a patient, but we're also more importantly trying to add quality of life. So in your final years, let's make sure that you have as enjoyable a life as possible. Let's see if we can improve your mobility. Let's see if we can improve your pain. Let's see if we can improve your breathing. All of those are certainly on the table. And we tell patients, "Look, let's start small. Let's make one change." Instead of consuming a regular caffeinated beverage, maybe let's go for a diet version or maybe can we take your sweet tea and mix it with unsweetened tea and do a half and half? Let's start small, baby changes. We're not going to expect you to make wholesale changes the first day we meet you. No. Let's start small. We'll work to it. Try it on for size and see how you feel. But it's never too late.

Host: So, you're a bariatric surgeon, and I wanted to ask, if you have patients who you have been trying really hard, they're with a dietician, they're doing their exercise, at what point though do you come in and say, "All right, I think surgery is the best option for you"?

Jayme Stokes, MD: No, that's a great question. So if a patient has tried all the strategies, they've tried the lifestyle changes, they've tried the dieting, they tried the increased physical activity, maybe they've tried medications, and they still remain morbidly obese, their BMI is over 40, or the BMI is over 35, and they have hypertension or diabetes or sleep apnea, that's the patient who needs to strongly consider a referral to surgery and to sit down with me or one of my partners to discuss the surgical options and what the surgery can provide for them, that the other strategies could not. And those other strategies that they've been doing don't go away. They still need to do those other strategies. The lifestyle changes, possibly medications in concert with the surgery.

I liken obesity and obesity medicine to treating a cancer really. So, some cancers require surgery, some cancers require chemotherapy, some require radiation. Sometimes you require two or all three of those. And weight management and obesity is the same. Sometimes it requires one or the other or a combination of the different therapies.

Host: So, in summary, what would you like to say to the listening audience? As you wrap all this up, obesity, diet, exercise, do you have like an elevator pitch that you like to give to people so they can really remember some good things?

Jayme Stokes, MD: Absolutely. I have the best job in the world. That's my elevator pitch. I had the best job in the world taking care of the best patients on the planet. We give out tons of high fives, tons of hugs, tons of fist bumps. Our office is a happy place. To see patients who are struggling with their health, to see them struggling with their heart, their lungs, their kidneys, their mobility, and then to come and join our family-- because we truly are a family to join our family-- and to work with us either on the medical side, lifestyle side, the surgical side. And then, within 2, 3, 4, 6 months, their lives are changed and they're walking without their canes. They're able to go and travel. They've stopped their diabetic medications. Their hemoglobin A1cs have fallen to normal, their blood pressure is falling down. And those are just some really celebratory moments. The biggest complaint that we hear is a patient will say, "I wish I had done this sooner."

Host: I bet you hear that a lot. This has been fantastic, Dr. Stokes. I really appreciate you coming on today.

Jayme Stokes, MD: Thank you for having me.

Host: For more information, you can visit Novant Health and explore more health and wellness tips at healthyheadlines.org. If you enjoyed this podcast, please go ahead and share it on your social channels, and explore our podcast library for more intriguing topics. This is Meaningful Medicine. I'm Dr. Mike. Thanks for listening.