Joey Wahler (Host): June 8th is Family Health and Fitness Day, the perfect opportunity to discuss both bariatric surgery plus a healthier lifestyle for families. Our guests, both from Southeast Georgia Health System, Dr. Will Tsai, he's a general and bariatric surgeon; and Bobbie Sumner, she's a licensed practicing nurse and Quality Coordinator, and she's a bariatric patient herself.

This is Health Matters from Southeast Georgia Health System. Thanks for joining us. I'm Joey Wahler. So first for you, Bobbie, you'd been diagnosed with diabetes. You were also looking to lose weight. So in a nutshell, what would you say brought you to Dr. Tsai in the first place? Also, what went into your decision to have bariatric sleeve surgery?

Bobbie Sumner, LPN: Well, I think the main reason was the diabetes and not wanting to be on insulin. That was my next step. And just knowing that, for most of my life, I've done the yo-yo dieting and just kind of wanted to take it a step further.

Host: And so, Dr. Tsai, what exactly is bariatric sleeve surgery, simply put in layman's terms, before we go any further? And why would you say it was right for Bobbie in this particular instance?

William Tsai, MD: A sleeve gastrectomy is a very common bariatric procedure now that we perform in America, and it can be a very effective way to lose a large amount of weight if you are morbidly obese to treat not just obesity, but weight-associated comorbidities. How it works is we place a guide in your stomach and small bowel, and we drastically reduce the volume of your stomach. And so, what is created is an elongated neoesophagus, a.k.a the sleeve, and a smaller gastric pouch. And so, you're going to have smaller meals with improved appetite, cessation, and what have you.

Host: Gotcha. And so, what are some of the other surgical options that are available for weight loss?

William Tsai, MD: One of the not as common and previously very popular was gastric bypass. In the past, gastric bypass has come with a little bit of baggage that we talk about in our bariatric classes. We still perform that here, not typically as a first option, but it's still available for patients that are looking for another option. But sleeve gastrectomy really has helped a lot of folks and it is a very good first-choice surgery.

Host: So, Bobbie, back to you. And I wonder, what was your surgical experience like? What do you take away from it?

Bobbie Sumner, LPN: Oh man, the takeaway from that, the surgery went well. I didn't have any complications. It was, for me, minimal pain. I was only out of work for about two weeks. It was just a learning process.

Host: And so, when you say learning process, for those watching and listening, what would you say is the most important thing from the experience that you'd want others considering having it done to know?

Bobbie Sumner, LPN: I would say just learning what you can eat and what you should be eating. It's changing your mind, changing your thought process.

Host: And speaking of which, Dr. Tsai, even before surgery, Bobbie had a wellness journey leading up to it, and that's where your bariatric program and your team comes into play, right? So, what does that entail?

William Tsai, MD: Right. Our program is very comprehensive. It is six months long. You'll initially meet our bariatric group, myself, and our bariatric coordinator. It's six months of nutrition education and dietary programs. There is support group meetings that you have to attend and numerous things to get you on board and ready before you even have surgery.

Host: And so, what would be an example or two of things that people need to become educated on during that process before surgery can even take place?

William Tsai, MD: Right. There is a very large component of nutrition education. So, there is multiple classes on nutrition, morbid obesity, and the diets you're going to have after the surgery. There is a bariatric support group, a meeting integration, so working on the behavioral components of morbid obesity. We also highly encourage physical activity. And so, we require you to have a exercise regimen, show us your logs and what have you. So, it's a holistic approach and not just we are going to do one thing or the other. We require that you do all different components of wellness and health to have a good outcome.

Host: So Bobbie, what was your experience like participating in that program?

Bobbie Sumner, LPN: Well, like Dr. Tsai said, it was a lot of steps. But just the way they encourage, you know, just moving, taking the stairs versus an elevator, and just learning that the simple things that I could be doing different really helped me in the long run, and I'm able to stick with it. It's not just a diet, it's a complete lifestyle change. And that six-month process really helps focusing on that. It's not just another diet.

Host: And Bobbie, when you say lifestyle change, that's a great point, because that's really what we're talking about here in terms of the big difference between just dieting, as you mentioned earlier, you had done before, and being involved in something like this, right?

Bobbie Sumner, LPN: It is. It's not just another diet. You're not just counting calories. It's are you moving, are you exercising, what you're eating? It's how it's going to make you feel and how you're going to develop new habits. You got to change the way you're thinking.

Host: Absolutely. A big part of this is mental, right, Dr. Tsai? How important is it that patients understand that and the fact that this is a process that goes well beyond just the surgery?

William Tsai, MD: Yeah. We push that this is a lifelong process. And that starts first when you meet us, that it is multifactorial, that there are many things that go into obesity. It's not just sedentary lifestyle and perhaps poor nutrition. It is many different things that affect this. And mental resiliency and behavioral health are obviously a big component of this as well.

Host: So Bobbie, how far along post-surgery are you now? How happy are you with the results? How are your health overall and your diabetes in particular?

Bobbie Sumner, LPN: I am just a little over a year post-surgery and I am happy with my results. I haven't hit my goal yet, but I'm working on it. No more diabetes, haven't been on medication since just prior to the surgery. So, that was the first goal. I did meet that goal. So, I was very happy about that. Just trying to stay focused and work on it for the long haul and not just for that first little bit.

Host: Indeed. Let me ask you about that, Bobbie, because part of this too, as you just hit on, is taking it one day at a time, one step at a time, being happy with small victories, so to speak, as part of the larger picture, right? You're not going to do this all at once.

Bobbie Sumner, LPN: Absolutely. And trying to compare your journey with someone else's is not good. Other people may not be where you are. You may not be where someone else is and you can't compare your journey to someone else's. I feel better. I sleep better. I do those things like park out way in the parking lot and walk in. And I move at lunchtime. You know, I changed the smaller things that I was able to stick with. And I feel like I can stick with for, hopefully, many years to come.

Host: Absolutely. So, Dr. Tsai, speaking of which, how much of what you and yours do is, for lack of a better term, just motivational, cheerleading, so to speak, keeping these people like Bobbie on the right track so that they don't give up and stick with it and do eventually reach their overall goals?

William Tsai, MD: My goal is to be supportive and helpful. But the vast majority of my patients, our process is six months long. We're always open here for our patients. I rarely have to do that, actually. I find that most of our patients, they buy into it. They want to be better. They want to cure their diabetes, their obstructive sleep apnea. So, it's very uncommon where we're having to try to rally. It's that they're doing it and they're showing you their accomplishments. So, I actually have to see the flip side of that where they're very encouraging to continue wellness and healthy eating and what have you. And it's patients like Bobbie that cure their diabetes and is truly inspiration for everyone else.

Host: Well, that's great to hear. So, how about this, Dr. Tsai? How rewarding is it for you and yours when you change someone's life and improve it for the better to the extent that you have in the case of someone like Bobbie here?

William Tsai, MD: That is certainly one of the most gratifying parts of bariatrics, is to be able to interact with patients a year out who are no longer morbidly obese. They have fundamentally changed their lifestyle, nutrition and wellness. They have cured many of their comorbidities. They are off of their diabetes medicine. Typically, we'll also hear that their household is healthier because of their changes in lifestyle and what have you. That really is one of the very positive parts of bariatric surgery for sure.

Host: Well, Dr. Tsai did a great job of leading me perfectly into switching gears just a little bit here. Because as mentioned, June 8th is Family Health and Fitness Day. And Bobbie, I understand you have three teenage children. So, let me start by asking you, any tips for keeping a whole family eating right, exercising regularly and, most importantly, staying healthy overall?

Bobbie Sumner, LPN: You know, they were my biggest cheerleaders. They really wanted this for me. To see them make changes that I made, you know, no more soda, they're eating whole foods versus processed foods, and they've really stuck with it. And they've done things, you know, like different sports and activities. And their bodies have changed too for the better, and they feel better. So, to have them on board, I think, made the difference, because I wasn't having to fight two battles.

Host: Understood. And so, how about from the standpoint of being a mom and knowing that your kids now see you in perhaps a different light, so to speak, at least where your health is concerned, where they have the peace of mind just as you do, and they can be motivated. If you will, to do certain things themselves, because their mother has already done them kind of walking the walk, not just talking the talk.

Bobbie Sumner, LPN: Yeah. I didn't realize how important that really was until we set out on this journey. In the beginning, it didn't seem as important. But as we got into it and realized, you know, I had to overhaul the house. And having them do things, you know, like I said, changing the foods that they ate and having them brag on me, you know, to their friends and our family, and it does make you feel good. And knowing that they took away something from this too, not just to help your mom.

Host: Yeah. If there's something you want your kids bragging on about you or anyone bragging on about you for that matter, it's your health, right?

Bobbie Sumner, LPN: Absolutely.

Host: And you mentioned there, Bobbie, cutting out soda as someone, myself, that I'm not going to say totally cut out soda, I'll still have a little now and then, but all but cut it out, certainly greatly reduced it. Dr. Tsai, that's a big one, right? Get rid of the soda.

William Tsai, MD: There's so many things, soda, processed foods. There's so many things out there that are highly addictive, highly marketed, it's insidious, it's marketed well. It's everywhere. So, there are a lot of pitfalls out there that make it hard for our everyday folks to try to navigate through life.

Host: So, Dr. Tsai, concerning family health and fitness, what would you say is the best first step toward a whole family kind of banding together and getting everybody back on the right track?

William Tsai, MD: That's exactly it. That wellness in my opinion, is a family event. It is not a mom event, it's not a dad or a son or a daughter. It is the whole family has to get together and buy in on eating well. You can have a great meal that doesn't involve highly processed and refined foods. That it is fun to go out together and go in the pool or go bike riding together, that it includes the whole family. And so, if one person or one parent is not bought onto this, it makes it very challenging to make a meaningful effect on the whole family.

So, start first with being together, being a family, and deciding that the food is going to be good. It's just maybe going to be prepared differently. It's not going to be store bought or pre-made or, you know, highly refined and processed. But we can still have pizzas and we can still have burgers, it's just maybe not McDonald's or Domino's. It's made differently and from scratch and it's together as a family, maybe more fun to do together than sitting in a car line. And then, the same with the wellness, go out there, go do things together. And that way, when some part of the family is kind of not wanting to do that, the other half says, "No, let's go out and let's go for a walk or what have you."

Host: A couple of other things before we go, Bobbie, just to pick up on what doc was saying there, one example of something quick and easy, families, especially those doing the cooking, always looking to save time, right, as well as being able to get that meal together. What's an example of a quick and easy thing that you make now that's healthy for the family that maybe you didn't eat or eat as much before?

Bobbie Sumner, LPN: Definitely, what works for us is just preparing, just planning ahead. So, we know this week we're having chicken and vegetables. So, there's no thought behind it when we're running behind. We just know Tuesday, we're having chicken and vegetables. And then, we don't have to be put in those situations where we have to go through a drive-thru. And that was a learning process of having to figure out what we're going to do. So usually, it's whatever we can pop in the oven, chicken or whatever, a fish and a vegetable. And then, we try not to center everything we do around meals. You know, it doesn't have to involve food every time.

Host: You don't have to get up every morning and say to your partner, "What's for dinner tonight?" Right?

Bobbie Sumner, LPN: Right.

Host: So in summary, Bobbie, for those struggling with weight and diabetes as you had been, any advice, kind of parting advice here for those considering that next step toward wellness that you've now successfully taken?

Bobbie Sumner, LPN: Definitely reach out, whether that be call Dr. Tsai's office, schedule the initial class, which is packed full of information. The support group here in Brunswick is open to the public. It's free. And that is also on the website, I believe, that information. That network of people just is awesome. Reach out and get some information. It's totally worth it.

Host: And Dr. Tsai, from your standpoint, what's the biggest misconception, as we wrap up here, about this whole process that Bobbie went through? You can clear up for people that maybe it'll give them that extra little nudge they need to go ahead and pursue something like this?

William Tsai, MD: I think a lot of people out there believe that morbid obesity is a personal failing, and it is not. It's a disease. Like I said, there are a lot of things out there that factor against you. And there are things out there, folks like myself and others who can help. You don't have to struggle with obesity and do the yo-yo dieting. It's not about you have or willpower would have you. It's a multifactorial disease. And we can be here to help.

Host: Well, folks, we trust you're now more familiar with gastric surgery and keeping your whole family healthy and fit. Bobbie and Dr. Tsai, a pleasure. Thanks so much again.

Bobbie Sumner, LPN: Thank you.

William Tsai, MD: Thank you.

Host: And for more information, please visit sghs.org/bariatric-surgery. If you found this podcast helpful, please share it on your social media. And thanks again for being part of Health Matters from Southeast Georgia Health System.