Caitlin Whyte (Host): Welcome to Doc Talk, presented by Montefiore St. Luke's Cornwall. I'm Caitlyn Whyte, and with me today are two esteemed guests, Dr. Vadim Meytes, a Bariatric and General Surgeon at the Medical Group at Montefiore St. Luke's Cornwall and Kathryn Ham, a Bariatric and General Surgery Physician Assistant. Join us as we discuss weight loss management options. So, Dr. Meytes, to start us off today, please give us an overview of the Weight Loss Management Center at the Medical Group at Montefiore St. Luke's Cornwall.

Vadim Meytes, DO: We've actually been around for two years already. We are a comprehensive weight loss center, meaning that we offer both medication as well as surgical options for people seeking weight loss. We take all comers, new patients, even people that have already tried weight loss modalities in the past, such as medications or even had surgery, we are happy to treat them. Once the patients come to our center, we identify what options they are suited for best, whether they need medication, whether they need surgery, or both. Again, we're a fully comprehensive center, meaning that we are partnered with nutritionists as well as mental health professionals that help the patients succeed and stay on track through the entire process of their weight loss journeys.

 I always like to tell patients that we try to keep them, in the program for life in order to maintain good follow up and to make sure that they're doing well.

Host: Wonderful. And Doctor, what are some of the different types of bariatric surgery available?

Vadim Meytes, DO: So there are two main types of bariatric surgery in this country. The first one is a sleeve gastrectomy. Patients just like to refer to it as a sleeve.It is a very straightforward procedure where we basically go inside with a camera and we take out a large portion of the patient's stomach, and what they have left is often referred to as a banana stomach.The sleeve works on the concept of portion control and restriction for the most part to aid patients in weight loss. The second common procedure is called a gastric bypass. Patient selection will basically decide whether one patient is better for a sleeve or a bypass, depending on different medical history and surgical history that they've already had in the past. But those are the two main procedures, sleeve and bypass.

Host: Gotcha. And Kathryn, what are the different types of weight loss medications out there?

Kathryn Ham, PA: There are some more newer medications that are coming out which are really helpful for weight loss. There are two broad categories. There are pills which people can take orally, which have been around for a while. Most people on these medications are going to lose about five to 10% of their body weight.

So it can be helpful in people that have maybe less weight to lose.We've been seeing a lot of really good results with some of the newer injectable weight loss medications. People are losing upwards of you know, 20% of their body weight. So it can be very, very effective for people that have a bit more weight to lose. They're once weekly injections. So people would be injecting themselves at home, versus the pills, which people would obviously take by mouth which may be helpful for people that maybe are reluctant to do an injection. But we kind of base it again on, what are their comorbidities? What is their past medical history? What's their family medical history, what's their lifestyle? So these things all come into play whenever we're deciding the best medication for people. One of the things we like to do with the weight loss center too is, we really try to work with people in changing their lifestyle as well.

 We want people to incorporate healthier food choices and physical activity as a part. These medications work the best when you combine them with diet and exercise. So part of our weight loss program is we work with people on finding ways to make physical activity part of their life and how we can fit it in and making healthier food choices.

Host: Great. And between surgery and medications, Kathryn, what are the benefits of both?

Kathryn Ham, PA: I think, you know, it kind of depends on the patient. We really try to tailor our approach to each individual. We have people that for either because of past medical history, either can't be on medications. Sometimes their insurance doesn't cover medications. Insurances have been really good about covering surgery historically, whenever certain requirements are met.

So a lot of times that kind of persuades us one direction or the other. But you know, medication can be a good starting point for a lot of patients and we often use medication in conjunction with surgery. Sometimes we'll have people that get started on medication if they're not quite sure they want to make a commitment to surgery and kind of get them started on their initial weight loss journey.

I have also seen patients in the office that we're a bit reluctant to have surgery and have opted to go the medication route and maybe they just weren't as successful as they were hoping in getting as much weight loss as they wanted. So then we had a conversation about maybe going the surgery route.

So we really try to tailor it to each individual and what works for them. We've used a combination of medication and surgery. We've also, you know, had patients that have been successful with each individual thing by itself. So, lots of patients that have been successful with just surgery or just medication.

Host: Great. And my last question here, I'll ask both of you and I'll stick with you, Kathryn, for right now. But can you tell us what are the first steps to a weight loss journey?

Kathryn Ham, PA: Well, I think like any commitment, you want to be ready. We certainly have seen people by the time they get to us at the weight loss center, they have usually been on this journey for a while. For a lot of people, it's a lifelong journey. They've tried some things that have been successful. They've tried some things that have not been successful. So I think, commitment is the first step. We really like to work with people and make sure that they are ready.

 But just showing some interest in coming in. You know, we can always adjust our plan of treatment. Obviously we want people to be ready for weight loss and sometimes people fall off the wagon a bit and then come back and see us. So just coming in and making an appointment with either myself or Dr. Meytes, and we can answer any questions that you have and get you started.

Host: Thank you. And same question for you, Dr. Meytes. What would you say are the first steps to starting that weight loss journey?

Vadim Meytes, DO: That's a great question. Honestly, when I'm seeing patients for an initial consult, the hardest thing for them is to make thatappointment. Oftentimes people have been thinking about doing this or thinking about weight loss, for a while before they actually take that first step and make the appointment.

And I try to kind of ease the tension from day one saying that we're going to be moving at the patient's pace. There's no rush and we try not to push people, obviously when they're not ready. The best way to learn more about our program, we have a website, where you can take a look at the different services that we provide. There's some patient testimonials as well as a video that describes the entire process of bariatric surgery. There's also phone numbers that patients can call to directly schedule a consultation. They do not need a referral, so anybody that is interested can just come in for a consultation and find out more about medical weight loss as well as surgical weight loss.

Host: Thank you both so much for this insightful conversation today. That was Dr. Vadim Meytes and Kathryn Ham. To learn more about our weight loss center and other primary and specialty services, visit slcmedgroup.com.

I'm Caitlin Whyte and this is Doc Talk, presented by Montefiore St. Luke's Cornwall. Thank you for listening.