Jamie Lewis (Host): This is Palmdale Regional Radio. And today, we are discussing bariatric surgery. Obesity is a serious health concern in the United States. According to the Centers for Disease Control, the prevalence of obesity is 41.9% of the adult population and obesity related conditions include heart disease, stroke, type 2 diabetes, and certain types of cancer, all of which are among the leading causes of preventable premature death.

For those interested in weight loss options, Palmdale Regional is a center of excellence for bariatric surgery and is certified through the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program. Today, we're talking with Tabitha Mort, a registered nurse and bariatric coordinator at Palmdale Regional Medical Center.

This is Palmdale Regional Radio with Palmdale Regional Medical Center. I'm Jamie Lewis. Hello, Tabitha. Thanks for talking with us about this important subject.

Tabitha Mort: Hello, Jamie, and thank you very much for that introduction.

Host: Of course. So, let's start with what are the different types of bariatric surgery and how do they work?

Tabitha Mort: So, the bariatric surgeries that are currently being performed at Palmdale Regional Medical Center are the sleeve gastrectomy and gastric bypass. Our surgeons also perform revisions, conversions to other types of bariatric surgery, and single anastomosis duodeno-ileal bypass with sleeve gastrectomy, which are called SADIs.

So, most of our surgeries are performed laparoscopically with four to six incisions in the upper abdomen. Today, I'd like to discuss the sleeve and the bypass for initial surgeries. So, during the sleeve gastrectomy, about 80% of the stomach is removed. Your stomach will go from the size of a small football to the size of a banana. This is going to reduce the size of your stomach and restricts the amount of food you can eat in one sitting, allowing a person to feel full faster, and it also reduces the amount of hunger hormones produced in your stomach, decreasing your appetite and cravings. Patients who have a sleeve gastrectomy can expect to lose up to 75-80% of their excess body weight. So, excess body weight is the difference between your ideal weight and your current weight. So, if you start out weighing 300 pounds, you can lose 80 pounds, which would leave you weighing approximately 170 pounds.

For the gastric bypass, the surgeon is going to separate the top portion of your stomach to create a pouch about the size of a small egg. The surgeon will then attach that newly created pouch to your small intestine, and this bypasses most of your stomach and upper intestine. Nothing is removed from your body in this procedure. The bypass restricts the amount of food a person can consume in one sitting. And the small pouch makes you feel full faster and reduces the amount of food eaten.

There are also changes in your hunger hormones, which create less cravings and less hunger. Patients who have gastric bypass can expect to lose 80-85% of excess body weight. And that would be for a 300-pound person, you can expect to lose 100 to 120 pounds after surgery. And that would also depend on other factors as well.

Host: What are some of those factors that contribute to the weight loss?

Tabitha Mort: So, factors that might affect weight loss with bariatric surgery are nutrition and diet, exercise, being physically active, lifestyle changes, commitment to change old habits, age, body type, size, and genetics. Many patients who suffer with obesity have other health conditions related or affected by the excess weight. Bariatric surgery is a very effective way to improve hypertension, type 2 diabetes, hyperlipidemia, obstructive sleep apnea, and GERD. Patients who have bariatric surgery have a higher life expectancy, better health, and higher quality of life than similar people who don't.

Host: So, how do weight loss medications work? And what are the different types available?

Tabitha Mort: Sure. Today, I would like to discuss semaglutide and tirzepatide. They're most common in the news right now. We know them by their brand names. Semaglutide is Wegovy and Ozempic. And tirzepatide is ZepBound and Mounjaro.

So, let's talk about semaglutide first. The brand names for semaglutide are Wegovy and Ozempic. The medication is the same. It is just different doses, and what they've been approved for by the FDA. Ozempic was approved by the FDA to treat type 2 diabetes in 2017. Wegovy was approved by the FDA for weight loss in 2021. This medication is a glucagon-like peptide 1 receptor agonist, GLP-1. And it can be used by people 12 and over. This medication works by mimicking a naturally-occurring hormone. As these hormone levels rise, the molecules move to your brain and tell your brain that you're full. It also slows digestion in the stomach, allowing you to feel full longer. Individuals who use this medication are able to lose on average 15% of their weight, which is approximately 35 pounds.

Tirzepatide is sold under the brand names ZepBound and Mounjaro. And the difference between them are the two doses and what they're approved for. This medication is both a GLP-1 and a glucose-dependent insulinotropic polypeptide, which is a GIP receptor agonist, and it works by reducing your appetite. Mounjaro was approved by the FDA for the treatment of type 2 diabetes in 2022, and ZepBound was FDA approved for weight loss in 2023. This medication is approved for adult patients only. And in the research, on average, a person can expect to lose 20% of the total body weight, and that's 35.5 to 52 pounds at 72 weeks during the trial. Both medications are injectables, and patients self-administer these medications weekly. The dosage is titrated up, so you start at the lowest dose and you move to the highest dose gradually. And they are to be used in conjunction with a healthy diet and exercise. They're not miracle drugs. They're a tool that can be used for successful weight loss. And it is common for people to regain that weight after stopping the weight loss medication.

Host: Let's say I'm interested in help with weight loss through you. What criteria do I need to be a candidate for bariatric surgery or weight loss medication?

Tabitha Mort: So to have bariatric surgery, your body mass index, your BMI, needs to be greater than or equal to 40. With weight-related conditions such as hypertension, type 2 diabetes, hyperlipidemia, your BMI needs to be equal to or greater than 35. And then for weight loss medication, your BMI needs to be equal to or greater than 30, or with weight-related health conditions, greater than or equal to 27.

To decide what option's best for you, you need to speak to your doctor. They're going to consider your health conditions and your goals. Remember that none of these are miracle solutions to weight loss. They are tools that you can use to have successful weight loss. The key to maintaining your weight loss is a healthy diet and exercise.

Host: Right. Well, what are the potential side effects and risks associated with weight loss medications and with bariatric surgery?

Tabitha Mort: So with surgery, bariatric surgery, anesthesia-related complications, anastomotic leak, GI bleed, bowel obstruction, infection, hernia, nausea, vomiting, GERD, gastric ulcers, blood clots are all potential complications. And complications from weight loss medications are nausea, vomiting, diarrhea, constipation, injection site reactions, abdominal discomfort and pain, fatigue, GERD, acute kidney injury; diabetic retinopathy, which is damage to the eye retina in patients with type 2 diabetes; medication-induced gastroparesis, which is delayed stomach emptying not due to a mechanical obstruction; pancreatitis, and thyroid cancer. If you have a family history of thyroid cancer, you would not be a candidate for this type of medication.

Host: What's the typical recovery process like after bariatric surgery? How long does it take to resume normal activities? And will I need to follow a specific diet plan before and after the surgery?

Tabitha Mort: Yes. Before bariatric surgery, you will need to follow a pre-op diet. Your surgeon will give this to you, and this is going to help to make your liver smaller, which makes the surgery safer for you. After surgery, the recovery process to heal is about a month. After that, you'll be cleared to go back to the gym and resume all activities.

After surgery, you will be on a liquid diet while your body heals. And after you stop the liquid diet, you will gradually progress through food stages until you are able to resume eating regular food. Your diet will focus on protein intake, so it'll be a high-protein, low-fat diet. And while you progress through the food stages, this is going to give you a chance to change old habits and learn new habits, such as logging your food into a food journal, eating slowly, and concentrating on drinking water. You're going to need to focus on vitamins, since your body will no longer absorb all the vitamins that you need from your diet.

Host: How about weight loss medication? Are there any lifestyle changes or dietary recommendations that accompany the use of these medications?

Tabitha Mort: Yes, weight loss medications need to be used in conjunction with a healthy diet and exercise. If you do not learn new habits, such as eating the right types of foods, logging your food, and exercising, once you stop using the weight loss medication, you're more likely to regain the weight that you've lost.

Host: How do bariatric surgery and weight loss medications impact any existing medical conditions I might have?

Tabitha Mort: So, patients who 10-15% of their total body weight while having a minimal impact on their comorbidities. Whereas patients who choose bariatric surgery can expect to lose 60-70% of their excess weight while seeing a significant impact on their comorbidities such as hypertension, diabetes type 2, obstructive sleep apnea and hyperlipidemia. In these conditions, often we see remission after bariatric surgery.

Host: What support services do you offer before, during, and after surgery like counseling or nutritional guidance?

Tabitha Mort: Once you've discussed bariatric surgery with your doctor and you've met the criteria, you're going to attend classes. This process can take quite a while so you'll have time to receive support from the surgeon and his team. You're going to learn about nutrition and how to develop new habits and your surgeon's team will answer questions and help you along the way.

Palmdale Regional Medical Center does have a bariatric support group that meets the third Thursday of every month from 5:30 to 6:30 p.m. And we alternate Zoom and in-person for those meetings. You can contact me at 661-382-5052 if you'd like more information or would like to be placed on our email list.

Host: Are there any long-term effects or considerations I should have while taking these medications?

Tabitha Mort: The first consideration in taking weight loss medications is your overall health. Talk to your doctor. Use these medications under the guidance of a medical provider who understands how to prescribe these medications and can provide nutrition and physical activity advice. This will increase your success while using these medications and help you maintain your weight loss once you stop taking the medication.

Another consideration is cost. Unless you have diabetes type 2, then your insurance may not pay for these medications. Without insurance, these medications can cost between $1,200-$1,400 a month. These medications are in high demand and there have been shortages. Some people decide to use compounded medications. The FDA has reported that they have received reports of adverse events after patients have received a compounded weight loss medication. Compounded semaglutide products are not the same as Ozempic or Wegovy, and they are not FDA approved. Patients can have unexpected outcomes when taking them.

Another thing to consider is gastroparesis or paralysis of the stomach can also be an issue with GLP-1 medications. Factors that contribute to gastroparesis are how quickly the medication is titrated, underlying health conditions, how fast you eat, and the fat content of meals and other dietary factors.

Host: Well, this is fascinating. Thank you so much for joining us.

Tabitha Mort: Thank you very much for having me, Jamie.

Host: That was Tabitha Mort, a registered nurse and Bariatric Coordinator at Palmdale Regional Medical Center. I'm Jamie Lewis and that concludes another episode of Palmdale Regional Radio with Palmdale Regional Medical Center. Please visit our website at palmdaletegional.com for more information and to get connected with one of our providers. And for more health tips and updates, follow us on your social channels. Please also share this episode on your social media, and be sure to check out all the other interesting podcasts in our library.

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. Individual results may vary. There are risks associated with any surgical procedure. Speak with your physician about these risks to find out if bariatric surgery is right for you.