Maggie McKay (Host): Meaningful Medicine is a Novant Health Podcast bringing you access to leading doctors who answer questions they wish you would ask. From routine care to rare conditions, our physicians offer tips to navigate medical decisions and build a healthier future. Joining us today is surgeon at Novant Health, Salem Surgical Associates, Dr. Nikhil Teppara, to discuss weight loss surgery. Thank you so much for being here today.

Nikhil Teppara, MD: Thank you, Maggie. Thanks for having me.

Host: This is such a hot topic. I mean, you can hardly go a day without at least reading an article about it, seeing something on TV, your friends are talking about it, you're at work. So, the conversations about obesity are everywhere from, like we said, online ads too, for supplements to TV commercials about weight loss drugs. Do you see any concerns with patients making healthcare decisions based on what they see scrolling through social media ads or TV commercials?

Nikhil Teppara, MD: You hit it on the head. The problem is there is so much information being thrown at them. And a lot of it is they're not getting fully informed information. Very rarely is it unbiased, or they're just hearing all the positives of some of these kind of different medications stuff and not really getting the full picture. So, I do think they're getting, you know, unfortunately, not the full picture of some of these treatments.

Host: And on the flip side, why do you think some patients are hesitant to schedule an appointment with their doctor or even a weight loss surgeon like yourself to discuss obesity concerns?

Nikhil Teppara, MD: You know, unfortunately, although we've made progress, there's still such a stigma with having excess weight and obesity. And there's people feeling shameful and hard on themselves for having that excess weight when in fact really, you know, we know this is a host of issues that have caused the weight gain, which could be genetic, could be behavioral, you know, folks that are on night shifts and different jobs and different things that predispose you to having that weight gain. So, I think there's still that resistance. And unfortunately, you know, it's still even in this day and age exists, but I think it's getting better. And as you said, because of the social media and the different things, you know, at least, we are addressing BC as a whole. And I think, you know, we're going the right way in terms of at least trying to address those issues.

Host: Right, exactly. Hopefully, it's making it more open to everybody to at least talk about it. I think shining a light on the unknowns can really help. So, what can a patient expect when they schedule an appointment with a Novant Health weight loss specialist?

Nikhil Teppara, MD: Well, you know, I think this is what we do, I can tell you from the Salem Surgical Associates standpoint, where we have a medical and surgical program, there's no judgment. What we do is we take care of the patient as a whole, whether you have to lose 10 pounds, and get back on track, and we have medications for that, as well as dieticians and nutritionists, exercise specialists and therapists. Or you have to lose a hundred pounds when we're looking at bariatric surgery. You know, the reality is there's no judgment. This is what we do day in, day out. And I think it's refreshing for our patient to come in. Again, it's real talk, you know, how do we get you back to where we know we want you to be from a health standpoint. And I think patients find that refreshing and that's what we've become known as a one-stop shop for everything weight loss.

Host: That's great. You often talk about the team approach. Can you explain how that works and how you personalize treatment plans for each patient?

Nikhil Teppara, MD: Yes. I think gone are the days of just take this pill, just do this diet, just do this surgery, you know, and that's it and, magically, the weight comes off. And what we realize now is this is a multi-disciplinary approach. You know, you have, like I said, dieticians, nutritionists, exercise specialists. You have therapists, behavioral health specialists, all coming together in a team approach to maximize patients' not only weight loss, but just their health goals and benefits, you know, trying to get them to be the healthiest person they can be.

And additionally, I'll say, because of surgery, we end up getting, you know, a lot of whether it's cardiology, sleep medicine experts, again, really diagnosing things that patients maybe didn't even know they had, like sleep apnea for instance. So, I think really it does take a team approach to make sure not only does weight come off, comorbidities get resolved, but the weight stays off and we keep people healthy.

Host: Is surgery an option for everyone struggling with obesity, or are there specific criteria that guide that recommendation?

Nikhil Teppara, MD: That's a great question. So, there are criteria that are developed by a host of different weight loss societies, the ASMBS, and different surgical societies and medical weight loss societies have guidelines. Insurance companies also have some guidelines. They're kind of old and antiquated. But there are guidelines that we use. Luckily, they've started to show some progression with lowering BMI requirements, for instance, for weight loss surgery and things like that. So, again, we're moving forward, which is nice to decide whether people can have surgery, but there are some criteria that, again, we can have a conversation with patients about whether they qualify for surgery or medications.

Host: It seems like one of the biggest misconceptions out there is that surgery is the "easy way out." How do you respond when patients or the public raise that concern?

Nikhil Teppara, MD: Right. I've heard that quite a bit, and I would argue that this is actually the hard way, right? You know, this is something, number one, that patients, you know, you can't go back. It's invasive, it's minimally invasive, but, I mean, something that I think you take a big step forward as opposed to a diet where you can follow it, but you fall off it. It's something you can kind of, get on and off something, but this is something where there's no going back. You're going full bore taking this seriously, these treatments. I would say, if anything, this is the serious, I'm-going-to-take-charge-of-my-life way. Not the easy way for sure.

Host: Bariatric surgery has evolved quite a bit over the years. What are the main types available today and how do they differ?

Nikhil Teppara, MD: I do think some of the fears about bariatric surgeries, decades ago we used to do this with a big open incision, and a lot of complications as a result of that. And so, some of that stigma still kind of continued. But the reality is, decades later, we do everything minimally invasive. The bariatric surgeons at Salem Surgical Associates, we do everything robotically, so very minimally invasive. Typically, people stay one night, the surgery is just so much safer. The safety profile is about the same as like a gallbladder removal, for instance. So, I think people don't realize that it's one of the safest operations we do these days, again, because we're so minimally invasive and things have progressed from many years ago.

Host: Speaking of safety, can you speak to the benefits and the risks, because if people are nervous?

Nikhil Teppara, MD: Yes. like I said, the safety profile again is so much safer than years ago. You know, there are risks as people get older, people are on blood thinners for blood clots and different things like that. So obviously, when they're on blood thinners like that, there's a risk of bleeding. When we take the blood thinner off, there are risks of blood clots, things like that. we use fancy staplers and sutures, which that's how we create these connections. So, there's always a risk of those little connections, having little leaks and stuff, which, again, because it's so minimally invasive, these complications are very, very minimal-- as opposed to, you know, years ago.

Host: And I'm sure you hear this a lot, concern from patients who may say, "What if I just gained the weight back?" How do you address that fear?

Nikhil Teppara, MD: The reality is this is a question for anything you do, whether it's a diet, whether it's a pill, whether it's a surgery. If you lose weight, there is a risk of you regaining the weight if you don't do what you are supposed to do. Now, the benefit of surgery is obviously we have this big multidisciplinary approach where we have followup nutritionists, dietician, therapists that can help you along your way. So, one year, two years, five years down the road, you have a team that's around you helping you every step of the way. So when you do have a stumble a little bit, we all do, you know, you get right back on that horse and you keep going.

So, I think, there's no question there is that stigma of that weight regain, but that's in any modality. If anything, this is the modality that's been shown to have the best long-term weight loss. Because surgically, again, we give you a tool, if you will, to help you prevent weight gain in the future. So, it's much harder to gain weight after surgery than it is, let's say, a pill or a shot or a diet.

Host: So, you answered a little bit of this question, but maybe we could talk about a little more. Do you and your team follow these patients for life and what does long-term support look like after surgery?

Nikhil Teppara, MD: That's right. So especially in the immediate perioperative period, and all the way up until one year, I think we almost overdo it, but I feel like I would rather overdo it than underdo it, we have multiple follow-ups with the surgeon, the medical PA, the dieticians, the behavioral therapists see the patients. And then, at one year, we kind of see folks once a year just to check on them. A lot of times their primary care and us work together in conjunction. So if the patients want to kind of minimize multiple follow-ups, because a lot of our patients are doing great, there's no issues, they're kept the weight off and they only need us when they have a little bump up in the weight, let's say, two or three years post-op, and they want to see us. So, we work very closely with our primary care physicians too. But yeah, once we operate on you, we have you for life. Anytime you need to see us, folks are coming back all the time.

Some of it can be even weight loss success. They lost all the weight. Now, they're looking at plastic surgery. They want to have different things done. Now, they have a little excess skin, they want to have that removed. They want to get their new body. So, all good things, you know, really. We're here anything that they need.

Host: That's amazing. Never thought about it, but it's so great to know that down the road, like you said, even five years, there's someone you can call. Let's say someone's listening right now and they might be on the fence. What's your message to them?

Nikhil Teppara, MD: My message is to do it, to grab the bull by the horns, you know, take charge of your life and do it. I think the most common thing I've heard patients tell me after, their biggest regret is, "I wish I did this sooner." That's by far the most common thing I've ever heard. It's like, "I wish I did this 10 years ago. I kind of did this and I thought I could do it on my own. And I dibbled and dabbled on all these different diets and fads and stuff. And, you know, I went from my 20s to my 30s, and my 30s to my 40s, I wish I had done this sooner, and I could have enjoyed those years and not focused so much on trying to lose weight and gain weight, lose weight, gain weight, lose weight," you know. So, I say my message is take charge, take charge of your life and do it.

Host: Yeah, that's a vicious cycle. The up and down, up and down, for sure. In closing, on a personal note, who or what ignited your interest in becoming a surgeon?

Nikhil Teppara, MD: Well, I was always interested in biology and I liked anatomy and dissecting and all this stuff. And then, when I was fairly young actually, I decided I wanted to be a surgeon. I really wasn't sure what type of surgeon. And then, in residency, I really took to minimally invasive surgery and bariatrics and robotics. I love helping people take care of a problem. But again, selfishly, I think I get joy out of taking care of that problem and then having them better, you know, whether it's fixing a hernia or taking out an organ, like a gallbladder, or doing a bariatric surgery and watching them lose all that weight. I think there are different personalities for different specialties. I think I would struggle seeing somebody for 30 years as a primary care physician. You know, I like that instant gratification of seeing a problem, dealing with it, fixing it and getting them better and, you know, on their way. So, that's kind of where I gravitated to surgery and making sure I could not only help people, fix it, and then again, selfishly get that instant gratification that I made a difference in that person's life and fixing them.

Host: That's so awesome. And I'm sure your patients are so grateful that you chose this area of medicine. Thank you so much for sharing your expertise. This has been really informative and helpful. And I'm sure a lot of people will maybe not be as hesitant to go to their doctor and ask about it.

Nikhil Teppara, MD: Yes, thank you, Maggie, for not only having me, but also tackling this topic of obesity, which, again, I think still has that stigma. But hopefully, I think it's getting better. So, I appreciate you all tackling this and talking about it.

Host: Absolutely. Again, that's Dr. Nikhil Teppara. And if you'd like to learn more, please visit salemsurgicalassociates@novanthealth.org. For more health and wellness information from our experts, visit healthyheadlines.org.