Transcription:
Bariatric Coordinator, Christina, Discusses Weight-Loss Surgery

Melanie Cole (Host):  Welcome to Palmdale Regional Radio. I'm Melanie Cole and I invite you to listen as we discuss weight loss surgery today. Joining me is Christina Phillips. She's a Certified Bariatric Nurse at Palmdale Regional Medical Center. Christina, it's a pleasure to have you join us today. People hear this term, bariatrics. Tell us what that means.

Christina Phillips (Guest): Well, bariatrics is actually the study of obesity. Specifically at our facility, we specialize in surgery for bariatrics and obesity. There are components of the medical side which those are typically handled by the surgeon's office with the primary care physician's assessment as well. But at our facilities specifically, when we talk about bariatrics, we do mean surgery.

Host: So, since it's the study of obesity, what is defined as obese? Tell us about BMI and obesity and really what is considered obese to the point where somebody would consider a surgical intervention.

Christina: So, I mean, when you're really wanting to approach the idea of having surgery, the body mass index is probably the most common form of determining if you're a potential candidate for surgery. Other factors do go into it. It's not simply having a body mass index ratio of X. However, those who do have a body mass index of greater than 40, are considered good candidates depending on other health conditions that they have that we typically call co-morbidities, including diabetes, hypertension, high cholesterol, sleep apnea. There's a lot of different medical conditions that are associated with obesity. So, those are always considerations.

So, yeah, I mean, a lot of it just has to be considered truly a candidate. It's not enough to say, oh, your body mass index is greater than 40. You should have surgery. We also want to determine the likelihood of success. There has been documented complications from people having surgery that cannot be ideal. Like for somebody who obviously is maybe bound to a wheelchair or does have other type of health conditions that they wouldn't particularly benefit from the surgery. I mean, they would, but their other health conditions kind of trump the benefits that would make you a good candidate.

So, there is a lot of workup involved and a lot of various considerations that need to be made before just doing the calculation on the computer saying, oh, my body mass index is 40. I should call a surgeon right away. That's not exactly how that always works out.

Host: Well, it's such an interesting field that you're in Christina. So now, as we're talking about who should consider bariatric surgery, tell us what's involved in all of the pre-surgical evaluation because it's not just a next day thing. And also kind of reiterate that bariatrics is not the magic pill. It is a tool and yet another tool in the toolbox for weight loss.

Christina: That's correct, a misconception with bariatric surgery. I think as it becomes more of a commonplace surgery, people are starting to see their friends and family go through it and the mentality around it is changing. And obviously for the better too, because I think historically it was like, oh, you couldn't lose the weight on your own. So, the quick fix is, oh, I'll just have surgery. And that's something that I always try to strive to change too. And that's part of the education I provide and along with the surgeons is that it's not a quick fix. We always say it's a tool. A tool is only good if you use it correctly.

So, with that being said, a lot of the education is geared around lifestyle management techniques, including how you exercise, how you eat, when you eat, the portions, the amount of water you drink. These aren't simple things like, oh, I did good on Monday so I can take a break on Thursday and go back to my old habits. The habits are really at the core of success with weight loss surgery. That's where the long-term success can be a challenge because for the patient, it's really important that they see this is not a diet. This is not a three month ordeal where I lose a bunch of weight or maybe even a about a year or so, we hope patients would reach their ideal body weight. No, it's not a one-year hiatus, and then return back to your old ways. Which is the long-term challenge for weight loss surgery. And that's where a lot of patients do struggle is keeping the weight off. Of course, we hear a lot of stories about patient did well, and then they gained back their weight plus some, and that's unfortunately, it does happen. And so, at least for our program, we really like to create that long-term followup with the patients so that they understand it's not a quick fix. We try to instill the values of healthy lifestyle habits and changes, and we try to go through them for the first year to year and a half at least, and then follow up every year just to make sure that we're doing the best we can.

Host: Well and speak about after surgery, because really that's when the hard work comes in. Right? What is it like for patients after surgery? What's it like going to a restaurant? What's it like if they were someone who really liked to eat meat or things along those lines? Do they have to take supplements? Tell us how you work with patients afterwards and what it's like for them.

Christina: So, before surgery ever even occurs, the education is really at the center of the success. So, I like to bring it up a lot, but patients you know, are prepared and understanding that the portions that they eat, the kind of foods that they eat, obviously those are going to change, but it's not taking away as much. Some of the types of foods, obviously we do need to strike off the list. But really just reducing the amounts of foods. And the way that some people might say, well, I'm not going to get enough nutrition. And that's where the supplementation with the vitamins, those and the protein drinks, that's where those really come into play because the stomach is smaller in all the surgeries.

So, you won't be able to consume the same amounts of foods as you did before. So, you do need to take the supplements, which are daily and forever. So, depending on what's recommended for your health, the certain amount of protein will be assigned to you every day in the form of the liquid protein shakes. And then the supplements are generally the same for everyone, a multivitamin twice a day, B12 once a week. We give a calcium citrate supplementation two to three times, depending on the type of surgery you had. So, that would be daily. So it, it can be kind of a chore on paper, but eventually you create a habit out of it.

And regarding going out and socializing, because a lot of times I don't think, I mean, I'm guilty of this too. A lot of the daily tasks that we do is with our friends and our family and enjoyable activities. I mean, when we think vacation, we think oh, relaxing on the beach, eating this kind of food, there's certain things like when we think a party, we think food. I mean, it's one of the top things that kind of comes up in our brain. And that part doesn't change after surgery. You're still gonna think about food, but you just have to approach it differently. And that's where it’s really connecting the message between your stomach and your brain.

You're restructuring how you look at food, how you think of food, which is probably the number one challenge. It's a lot of what we kind of don't consider. Yes, the stomach has altered, right? But is our mentality about food altered and that's one thing that surgery does not fix. And so, it can be very stressful for a lot of patients, especially in the beginning where they might go to a restaurant and they feel that because they cannot eat the same way or the same amount or some of the certain foods that they did before with their friends and family, they're not able to be an active participant. And of course that can be very isolating and depressing. So, regarding bariatric surgery, there is a psychological component and evaluation that we do for patients. And that's kind of lends the reason that we want that long-term followup with them.

Because that mental toll that can occur because of surgery, it can be very isolating. And I mean, that obviously leads to depression. And with that, sometimes patients will eat through their depression and then we're back where we started. But you can find joy in eating smaller portions. That's really where the challenge is to flip the association you have with food as the focus. Shifting that focus and realizing, you know, I'm more valuable than the appetizer. The appetizer doesn't define the fun I'm going to have. The cake doesn't define how much fun I did have.

So, this is one of those topics that could go on forever and ever, because we are complex individuals and we all have our own triggers and we all see the world differently and how we define our self-worth and value in different scenarios. But at the core of it, is just really because we're human. I mean we eat to live and that's really where we want patients to restructure themselves as eating to live, not living to eat and not giving food as much power as we have in the past.

Host: What a great summary and education as you say is really the key. And that's what it's all about. And thank you for also mentioning the psychological counseling that's involved. And before we wrap up, tell us about the support groups afterwards and who can attend them. Because you've been talking about working with the patient and changing that mindset and the lifestyle and behaviors, but what about family members that could be either contributing to or not involved? Can you also work with the family members? Kind of wrap it up for us with your best advice about bariatrics at Palmdale Regional Medical Center and how you involve the whole family in this journey?

Christina: Part of my role here at the hospital as the manager is I provide the education for one of our surgeon groups and one of the first questions I do ask my patients is what is your support like at home? And I'm always really excited whenever family and when my patients do tell me, you know I have a great supportive spouse. My sister-in-law had the surgery. My daughter had it. Whoever in their family. And so, it's really wonderful when I have patients who have friends and family or coworkers, especially, it's really great whenever they say, oh, I have great support. And for those who are kind of teeter, maybe they're not sure if they have good support cause you, you might not really know until you go through it that you needed more, and that's why we do the support group is for those who maybe don't have the kind of support they need.

When people love you, they want to help you obviously. But to really experience that journey, with somebody else who had the surgery, there holds a lot of value for that, for the patient. Somebody who says I was three months out before too from surgery and I struggled with the same thing. And this is how I conquered it. You can do it. And you're going to be fine, and to get that kind of level of support is really invaluable. So, at the hospital we used to hold in-house sessions, but obviously because of COVID, now we're doing it through the Zoom meeting option, which have opened it up to the community.

I always want people who've had bariatric surgery to feel like they have the support they need. Obviously, there's various surgeons and different kinds of surgeries out there. And for people who've relocated to the area or for my patients who've maybe relocated across the country, it's a way for them to always feel grounded. Knowing that we're still supporting the right kind of lifestyle and program and we're always accessible. So, for those who may want to get involved with support group who've had surgery. Okay. Well, I do limit it to the patients alone, for now.

But for those who are interested, all they would have to do is call the hospital and they can reach me. Just ask for Christina, the Bariatric Manager. And I'm happy to provide that information. As far as trying to help with the family aspect, I always encourage patients to have a real conversation with their friends and family. Explain to them what they need, what kind of support they need. Some patients might feel more comfortable, kind of doing it by themselves and that's okay too. We all have our different ways of managing ourselves. But you know we do discuss this in our education and continuously. Do you feel like you're getting the right level of support? Is there anything that we can do? Do we need to maybe consult for mental health counseling, because there's value in any type of help. But obviously the patients have to be ready and able and willing. So yeah, as far as the support groups go I run a very open program.

I like to just provide as much information as I can. I like to have guest speakers. Dr. Yadegar has joined a couple of them in the past. We just try to just make sure that we're always continuously present. You know, I never want patients to ever feel like they're going through this alone. Because, as we mentioned before, the isolation and depression that can occur with weight loss surgery. So, it's really just important to have something and somewhere for people to go and know that they always have a resource here at the hospital.

Host: Great information. Thank you so much for joining us today, Christina, and really telling us about bariatric surgery at Palmdale Regional Medical Center. For more information, please visit Palmdaleregional.com/services/weightlosssurgery to get connected with one of our providers. That concludes another episode of Palmdale Regional Radio with Palmdale Regional Medical Center. Please remember to subscribe, rate and review this podcast and all the other Palmdale Regional Medical Center podcasts. Physicians are independent practitioners who are not employees or agents of Palmdale Regional Medical Center. The hospital shall not be liable for actions or treatments provided by physicians. I'm Melanie Cole.