Joey Wahler (Host): It can be classified as a medical disease. So we're discussing obesity. Our guest is Dr. Joey Jarrard. He's Medical Director of Bariatric Surgery at a Bariatric and General Surgeon at Tallahassee Memorial Healthcare. This is the Pulse, Tallahassee Memorial Healthcare. Thanks for joining us. I'm Joey Wahler. Hi there, doc. Welcome.

Joey Jarrard, MD, FACS, FASMBS: Welcome. Thanks for having me.

Host: Great to have you aboard. We appreciate the time. So first interesting topic here, what exactly is it that constitutes obesity being diagnosed as a disease when in fact that's the case?

Joey Jarrard, MD, FACS, FASMBS: Well, obesity has long been considered a failure on an individual's part to eat appropriately or to exercise. We now know there's a lot of science behind it that makes it way more complicated than that and it's not easy to treat. It's multifactorial and also leads to a lot of other medical problems associated with obesity.

Host: Absolutely. And so speaking of that, how has the classification of obesity as a disease changed the approach to treatment and management in clinical settings?

Joey Jarrard, MD, FACS, FASMBS: Sure. Identifying it as a disease instead of a condition allows more of a robust, multifactorial approach. So it's not just medications, it's not just diet and exercise. Surgery can be a component, medications can be a component. We have to realize as a chronic disease, we're not curing it, no matter what we do; we're treating a chronic disease, trying to put it into remission.

Host: And so what would separate obesity being a disease from not being one in a particular case?

Joey Jarrard, MD, FACS, FASMBS: Well, obesity is a disease if it's pathologic; if there's pathology associated with the condition of obesity, meaning your health is experiencing negative consequences as a result of the obesity.

Host: Okay, so what are the most effective evidence-based strategies currently available for the medical treatment of obesity?

Joey Jarrard, MD, FACS, FASMBS: Well, again, as a disease, we approach this with, multiple points, right? Diet, exercise, education, dietary education, medications and surgery all comprehensively together are the most effective approach. Now, any individual modality can be looked at alone. Surgery is the most effective means at treating the disease of obesity, but should never be considered a standalone modality.

Host: And so what would be some treatment examples short of surgery?

Joey Jarrard, MD, FACS, FASMBS: Sure. We have a non-surgical pathway as well. Not everyone who enters the program is necessarily interested in surgery. And this is the case that a lot of programs who treat the disease of obesity, so coming in with a bariatrician, that can be a mid-level provider or a physician with the specialty training in the treatment of obesity, will provide a lot of education in regards to appropriate diet, lifestyle, exercise.

As well as medications, and there's lots of medications out there. I know that the GLP-1s, the Ozempic, Mounjaro, Wegovy are the popular kids on the block now, but there are other options, and a lot of that is tailored to you based off of your overall goals, your overall medical conditions associated with obesity.

Host: So when you talk about someone changing their lifestyle, eating less or eating better, or both, preferably of course, exercising more, being more active, how difficult is it to get people that are obese started on a track that perhaps they've either never been on or haven't been on in far too long, hence the obesity?

Joey Jarrard, MD, FACS, FASMBS: The benefit is that a lot of these patients, by the time they come to see me, or one of my colleagues, they've taken the first step that they've identified that there's a problem and they've taken the first step and they're, that shows some motivation to improve their life situation. I think to educate someone on dieting and exercising may be an oversimplification, or that it implies that they're not already dieting or exercising or trying really hard and that their lack of improvement has led them to their visit with one of us.

So, encouraging continued effort at lifestyle changes is part of the process, but doesn't necessarily mean that an individual isn't already doing those things.

Host: And that leads me well into my next question. You're saying typically those that come to you have already tried things that for whatever reason, haven't been successful enough. So how do genetics, environment and behavior figure in the development and progression of obesity as a disease?

Joey Jarrard, MD, FACS, FASMBS: All of it is incredibly important and I have lots of patients that come in and say, I'm overweight. I have been my entire life. My brothers and sisters are, my entire family are. And how much do genetics play a role? Well, it can't be denied that genetics certainly play a role, but you can also argue that a lot of it is environmental or cultural, of multiple family members within the same household having obesity. All of it individualized is an oversimplification. I think all of it ties in together. You can't predict someone's development of obesity based off of family members alone. Genetics alone. But certainly there is a cultural, environmental and genetic interplay there, as well as an individual's own physiology.

Host: So when we talk about genetics, from your experience, how common is it that if obesity runs in one's family, they too will fall victim to that?

Joey Jarrard, MD, FACS, FASMBS: It's very common. It's very common that a patient that comes for a visit, has multiple family members also suffering from the disease. Is it impossible or is it possible to determine was this purely genetic or is this cultural? Is this how you were raised or how, you make decisions based off of food or lifestyle?

There's a very complex interplay and it's really, really hard to discern, is it genetics, is an environment.

Host: And that again, leads me perfectly into this. It seems oftentimes those that are obese have a lot going on, right? They probably have a lot going on that's causing it, and they probably have a lot of other issues as a result of it. So how much of a challenge is it to kind of weave through all of that and know where to start and how to get the person on the right track for you as the physician?

Joey Jarrard, MD, FACS, FASMBS: Yeah, that's, an incredible question and I think you did a good job there of highlighting, the complexity of managing this disease. And that's why it's very important that I don't do it alone. That's why I have a team of bariatricians, mid-level providers, dieticians providing education, psychological evaluations.

There's so much that goes into it. Because of the complex interplay of genetics and environment and culture and mental health, all of it goes together. Typically, again, patients who come for help have already been trying, this is their next step. Where do we start? Well, we sit down and listen.

Let me hear your story. Let me hear what you've tried. Let me hear, how is your family, have they tried something similar? Or are you the only person in your family who has obesity? So sitting down and hearing a patient's story is the best way to start to tailor their own journey.

Host: That's a great point. A lot of times these are people that haven't had the right support, right. And so listening is key to really hear what's at play in their particular situation. Right.

Joey Jarrard, MD, FACS, FASMBS: Correct. Very well said. And one size does not fit all as far as treatment for obesity. If you see a sign for, come here for your sleeve gastrectomy, we have a discount, I think we're missing the boat a little bit. We should tailor our treatment to the individual, their individual needs and backstory of what they may need.

Not every patient needs surgery, and that's coming from a surgeon, right? Not every patient who needs surgery needs the same surgery. There are multiple operations, and again, we have to tailor treatment to the patient.

Host: I'm going to ask you about surgery in just a moment, but first, going back to something you touched on earlier, how does treating obesity impact the prevention and management of some of these other related conditions you alluded to, Type 2 diabetes, hypertension, et cetera?

Joey Jarrard, MD, FACS, FASMBS: Sure. A lot of these conditions tie into the disease of obesity, as we mentioned, and a lot of these medical problems can be put into remission by treating the obesity itself. There's great data from the ASMBS website. That's the American Society of Metabolic, Bariatric Surgeons that show 70 to 80% remission rates for most of the comorbidities or medical conditions that you listed associated with obesity.

We talk about those a lot. High blood pressure, diabetes, sleep apnea. We've moved away from the jargon of I can cure those things to, I can help put those things into remission, much like the obesity. They may come back just like a cancer may come back. We're fighting a chronic disease. So that's an excellent question.

And beyond the medical conditions that we discuss, infertility is a common one. Cancer is a common one. We know that at least 13 or 14 different cancers are directly tied to the condition of obesity and can be prevented or at least risk mitigated by weight loss surgery.

Host: Wow. So even cancer can be a factor because of the obesity, I would imagine. Am I right, many people are unaware of that?

Joey Jarrard, MD, FACS, FASMBS: Yes. I think that's very common because a lot of the time we spend are discussing, let's treat your high blood pressure, let's treat your obesity. I think it's equally important to discuss all of the effects of managing this disease.

Host: Absolutely. So surgery, now. How do advancements in bariatric surgery techniques contribute to the management of obesity and those associated health conditions you've discussed?

Joey Jarrard, MD, FACS, FASMBS: I think we've long known the benefits of bariatric surgery. I think the modern advancements of how we deliver surgery to the patient, limiting negative impact of lifestyle, morbidity, mortality, has been incredible. So the benefits have always been there, but now the risks are plummeting.

So minimally invasive techniques are the norm now. Pretty much all of our bariatric procedures at TMH are robotic now, which is just an extension of laparoscopy, but minimal incisions. What used to be a multi-day stay in the hospital is now typically an overnight stay in the hospital. What used to be a months of recovery through an open surgery, now a week or two out of work.

And then you return to the workforce. You return to your normal lifestyle, quickly based off of robotic techniques. The safety of robotic and minimally invasive surgery in general is now nearly equilabrating a sleeve gastrectomy to a cholecystectomy or routine gallbladder surgery. The safety profile has significantly improved with the technology.

Host: And so having said that, remind us what is the most common procedure or two? What has become the gold standard, if you will, for bariatric surgery in terms of the procedure itself?

Joey Jarrard, MD, FACS, FASMBS: Well, going back in history just a little bit, if you'll allow me, the vertical banded gastroplasty was fairly popular in the eighties, early nineties, and that was rapidly replaced by the lap band. So the lap band was very popular in the nineties, early two thousands. The gastric bypass has been around for a very, very long time.

Again, as the technology, as the way we deliver surgery has improved, the gastric bypass regained a lot of popularity around that time period. Now, the sleeve gastrectomy came out also, in the early two thousands, became a little bit more popular, now has rapidly, completely supplanted the lap band.

So lap band is extremely rarely performed and completely replaced by the sleeve gastrectomy, which is probably about 70 p ercent of bariatric surgeries done nationwide, with gastric bypass being a slightly distant number two. And then we have duodenal switch and a newer procedure called a SADI that is gaining some ground. But to answer your question, a sleeve gastrectomy is by far the most common.

Host: And after bariatric surgery, there are two things it seems that patients need to keep in mind. One is that they're only going to lose a percentage of the weight they need to lose. Certainly not all of it, right? And second, along with that, there's still going to be work to do for them in terms of making sure that the progress continues because otherwise they could slip back, right?

Joey Jarrard, MD, FACS, FASMBS: Right. And again, this is one of the few conditions that I treat as a surgeon, where the patient really has to meet me halfway. If I take your gallbladder out, well, that's mostly on me. But bariatric surgery, we have to meet me halfway and again, lifestyle changes to treat a chronic condition and put it into remission requires lifelong effort.

Host: A couple of other things before we let you go. You talked earlier about the multidisciplinary approach in the treatment of obesity, a team where specialists are involved in treating the different areas of this. So what is it for you and yours, that makes that team so special?

Joey Jarrard, MD, FACS, FASMBS: Everybody, uh, communicates very well, and I think everybody's on the same page. I think that none of the surgeons believe that surgery is the only modality, and I think a lot of the, bariatricians and the medical personnel we work with believe in surgery, so there's no contention between this medicine aspect of surgery. Or sorry, medicine aspect and, surgical aspect of treating obesity. We all work collaboratively to treat the patient, which I think is a fantastic group to work in.

Host: Absolutely. And so in summary here, doctor, in what ways is ongoing education and training for healthcare professionals like yourself crucial to improving patient outcomes in obesity management? How do you keep up with the ever changing methods out there of getting to the heart of this?

Joey Jarrard, MD, FACS, FASMBS: Treating obesity is paramount, right? It's our most rapidly growing epidemic, and it's associated with so many other medical conditions, and even cancers as we alluded to. It's extremely important that we continue to fight the good fight. Where do we go next? Eliminating the stigma of obesity.

A lot of patients are just afraid or embarrassed to come seek help. Only 1% of ideal candidates ever seek surgery. So eliminating the stigma of obesity, recognizing it as a chronic disease, and then increasing education for primary care providers or other physicians to allow their patients to seek out specialized care for the condition.

Host: There certainly is a stigma, as you said, doctor, and the fact that only about 1% of people that need this are seeking help. That's an eye-opening number, isn't it?

Joey Jarrard, MD, FACS, FASMBS: Right? Truly is.

Host: Well folks, we trust you are now more familiar with obesity as a disease. Dr. Jarrard, keep up all your great work. We appreciate it. Thanks so much again.

Joey Jarrard, MD, FACS, FASMBS: Okay. Thanks a lot for your time.

Host: Absolutely. And to start your weight loss journey at TMH, please visit tmh.org/bariatric. Now, if you found this podcast helpful, please do share it on your social media. I'm Joey Wahler. Thanks so much again for being part of the Pulse, at Tallahassee Memorial Healthcare.