Transcription:
Weight Loss Solutions for a Healthy Life

Melanie Cole (Host): Being seriously overweight can lead to life-threatening medical conditions such as severe diabetes, high blood pressure, sleep apnea, and so much more. There are many options both surgical and non-surgical to help you live a healthier life. My guest today is Dr. Jonathan Arad. He's a board certified general surgeon specializing in bariatric surgery at St. John's Riverside Hospital. Dr. Arad, let's start with some non-surgical options. If somebody is considered severely overweight or obese, tell us what that looks like. What does that even mean to be obese? What are we talking about as far as BMI, and what are some solutions they can try that do not involve surgery to begin with?

Dr. Jonathan Arad, MD (Guest): Sure, well thank you for having me, first of all. Weight loss is a very common problem that now exists, and the classification of obesity like you mentioned is all based on BMI or body mass index. A body mass index of forty or above is generally considered morbidly obese, or a BMI of thirty-five with one of the comorbidities as you mentioned before. These typically include either diabetes, coronary artery disease, sleep apnea, high blood pressure amongst other medical problems. At those BMI levels, patients are at increased risk for those comorbidities if they don't have them already, or worsening of them.

Some of the things non-surgical that people can do and that we do recommend are high protein diets, low carb diets. Some of these already exist on the market. There's programs such as Weight Watchers, Atkins, things of that nature. There are other essential components to it as well as high levels of exercise, which we also encourage as well.

Melanie: So where does somebody get good quality information, Dr. Arad? Because when they're going to try these high protein, or Atkins, or Weight Watchers, they don't know what to believe or how it will work or- what do you want them to know about sorting through the information because it can be very confusing reading labels and trying to understand sodium versus sugar versus fats versus proteins. What do you want them to know about sort of clearing up some of that confusion?

Dr. Arad: Well I agree with you, it's very confusing, and that's why what we recommend is we work very closely with nutritionists in our program that will go step-by-step through all of those components that exist such as sodium, sugar, as you mentioned. It's very hard to differentiate. There's a lot of products out there, some are so-called organic, some are so-called low-fat or low-sodium, but it's very hard to read in between the lines. And honestly the best way to do it is sit down with one of our nutritionists and really go through it step by step.

Melanie: If someone has tried many of these things, diet and exercise, and none of them have worked, and someone has that BMI as you've discussed and is severely obese, who should consider bariatric surgery? Are there certain parameters to consider bariatrics, and who can qualify?

Dr. Arad: So the perimeters for bariatric surgery are all based on BMI. So anybody with a BMI of forty or above or thirty-five with one of the respective comorbidities as I mentioned before do qualify for surgery. There are other requirements, and we have a very detailed program. You do have to see your primary care physician, have a six month weight history, you have to see a cardiologist, see a pulmonologist, a nutritionist is part of the program, as well as a mental health professional. These are all required by all insurances, and this is so that every single patient not only gets a detailed approach to their weight loss, but also understands the change in lifestyle.

Now once they do meet criteria, the main surgical options that exist that I perform are what's called vertical sleeve gastrectomy, commonly referred to as sleeves, as well as the lap band, which is typically referred to as the band. These can be done laparoscopically through very small incisions, or even robotically at St. John's where I am the Chief of Robotic Surgery at that hospital.

Melanie: Tell us about those kinds of procedures. What are the benefits and what are they like for a patient to go through the gastric sleeve? Explain that procedure for us.

Dr. Arad: Sure. So the gastric sleeve is a procedure that takes about an hour, there are five very small incisions that are made in the abdomen. The stomach is identified free from its surrounding structure. There is then a tube, a banana shaped tube that goes into the mouth while the patient is sleeping, and the stomach is stapled along that tube, leaving almost a banana shaped stomach. What this does is it not only allows for restriction, meaning that the patient cannot eat as much, but it also removes the portion of the stomach called the fundus which has one of the main hunger hormones called ghrelin. By doing so, patients usually have what's called early satiety, which means that they're less hungry, they have less of an urge to go and raid the fridge, for example. So there's much more control associated with the sleeve. Patients, again, are usually in the hospital for a night or two, and then the recovery is really like any other abdominal surgery such as a gall bladder or an appendix, usually they're back to work either that week or the week after.

The gastric band is a same-day procedure, and again it is done laparoscopically as well. The band is a bio-prosthetic device which means that it is a foreign body that goes around the stomach which is very safe. It's supposed to be in the body for the patient's lifetime, and what happens is the band goes around the top part of the stomach, almost like a belt, and the tubing attached to it gets secured to a port which is sutured to the abdominal wall. By filling sterile saline up that tube, the inner tubing of the band either gets tighter or looser depending on whether you put the fluid in or out, and that causes the restriction either allowing the patient to eat less or more as desired.

Melanie: Are either of these procedures reversible, Doctor?

Dr. Arad: The sleeve is not reversible, and that is one of the reasons that it works so well. The band is reversible, although we try to explain to people that the way that they should think about it is that it is a procedure that is meant for their lifetime. However if they are having problems with the band, it is able to be removed.

Melanie: What would you like people to know in advance of either of these procedures? As you said, they should go into it not thinking that this is something that they can reverse, but would you like them- because you mentioned all of the different counselors that they have to see, would you like them to be exercising? Would you like them to be trying to lose weight? What do they have to know before they make this big decision?

Dr. Arad: Sure, so again this is a change of lifestyle decision. This is going to be something that we want the patient to understand that this is going to be a change in the way that they approach their life. We do want them, and we need them to continuously exercise and have a healthy diet plan with a high protein, low carbohydrate diet, which we do assist with. The surgeries are highly, highly effective. People usually lose about 65% of their excess weight loss over approximately a two-year period. However, what we do try to make patients understand is that it's not a miracle, it's a tool, and when used appropriately it's a very, very effective tool. However, if patients do not adhere to an exercise program and a healthy lifestyle and diet, then they will not get the results that they're seeking.

Melanie: And what is life like for them afterwards? Are they able to go out to restaurants? Are they now just only able to eat a smaller amount? Do they still need to read labels? What is life like?

Dr. Arad: So life is a little bit different obviously, but the whole point of the procedure, which I try to explain, is to make the person overall healthier. It is a weight loss procedure, and it obviously has its cosmetic benefits, but the whole point of the procedure is to alleviate some of the comorbidities such as diabetes, or high blood pressure, sleep apnea, that can carry a very high risk for someone's future. It is important to read labels, as it is for all of us. There is a little bit of a change in how people do eat. There's going to be smaller, more frequent meals. Patients will get full faster, however they're more satisfied. They don't have that urge, again, to eat these large meals. So there's not as much of a craving. Patients are very, very satisfied with the results. They generally are not thinking about that next meal, or eating a full plate. They actually adjust pretty quickly, and most patients are extremely happy with the results afterwards.

Melanie: Tell us about your team at St. John's Riverside Hospital, and why people should consider coming there when they are really interested in weight loss.

Dr. Arad: So we have a comprehensive weight program. We offer everything, like we spoke about, from non-surgical to surgical options. We've been doing this for a while now, we have the entire program down pat to the nutritionist, to the mental health professional, to everything that people need. We try to offer a one stop shop so people can come and get all their clearances at once to make it a much more enjoyable experience to get to surgery. And the team at St. John's Hospital, again, is very, very effective. The nursing team and the staff that work in the hospital has been trained to take care of bariatric patients in particular, and so they're very, very well-versed in not just the surgical part of it and the operating room component, but also the aftercare as well. My team also is very, very well-prepared to handle any issues, or any concerns during the process, and we try to make it as comfortable for the patient as possible.

Melanie: And now your best advice with a wrap-up please, Dr. Arad, what you want people to know when considering a life-changing procedure such as bariatric surgery. What do you want them to know about weight loss, healthy lifestyle, prevention if possible, and bariatrics?

Dr. Arad: I want people to understand that weight loss and especially morbid obesity are big concerns, especially in today's age, that there are options. There are very successful and effective options out there that they don't have to be alone, there's plenty of support, and that we can offer the latest technology including robotics, including endoscopic approaches for weight loss after bypass surgery that's called the OverStitch. That they don't have to be afraid. The technology has come so far that, again, the procedures are very quick, patients are in the hospital only for a short amount of time, and the results are very effective, and we can really reverse a lot of these serious comorbidities with the latest technology and approaches.

Melanie: Thank you so much, Dr. Arad, for being with us today, for sharing your expertise when it's such an important topic and so many obese people with the obesity epidemic going on in this country. What a great, great job and profession that you're in today. Thank you again for being with us.

You're listening to Riverside Radio HealthCast with St. John's Riverside Hospital. For more information on weight loss, both surgical and non-surgical, please visit www.RiversideHealth.org. That's www.RiversideHealth.org. This is Melanie Cole, thanks so much for listening.