Amanda Wilde (Host): This is UAMS Health Talk, a podcast from the University of Arkansas for Medical Sciences. I'm Amanda Wilde. On this episode, what you need to know about bariatric surgery with Dr. Tyler Rives, Director of Metabolic and Bariatric Surgery at UAMS. And Dr. Lexie Vaughn, Surgeon and Division Chief at the UAMS, Medical and Surgical Weight Management Clinic. Doctors, thank you so much for being here.

Tyler Rives, MD: Thank

Lexie Vaughn, MD: Thank you for having us.

Host: Well, Dr. Vaughn, I'm going to toss the first question to you. What is obesity? How is it classified as a disease?

Lexie Vaughn, MD: Yeah, that's a really good you know, jumping off point. I think the most important thing to understand about obesity is that it really is a chronic disease. We think of chronic diseases, we think of high blood pressure, we think of high cholesterol. All these things that people see a doctor regularly for and are on medications for, and have kind of routine treatments for.

And obesity really falls in that same category. It is a chronic disease. It's also interestingly related to all of those other chronic diseases, and so it contributes to and can sometimes make worse those other chronic diseases like high blood pressure, high cholesterol, diabetes. So it's a really important thing for us as a medical community to understand that it's kind of vital to take care of as a chronic disease.

It's a super prevalent disease process. In our state, in Arkansas, over 40% of adults have obesity. So it's a super important thing that we're taking care of, and as I said, it has a kind of downstream effect on, on these patients' health and, and has a real big impact for the health system.

Host: So if this is a chronic disease, Dr. Rives, how can diet and exercise help?

Tyler Rives, MD: Well, I think diet and exercise in general are incredibly important for overall health. However, when it comes to obesity, oftentimes they're not enough to really treat it. In fact, research shows that lifestyle changes alone only really get patient's three to 5% of excess body weight loss. That's because they're really fighting their body's biology.

And when you have these hormonal surges and these genetics that are working against you, the brain has decided that your weight set point is higher than what's actually healthy for your body. And just diet and exercise alone won't be enough.

Host: Dr. Vaughn, so who qualifies for bariatric surgery?

Lexie Vaughn, MD: Yeah, so bariatric surgery is one of now many treatment modalities for obesity. But there are very specific criteria for who can kind of qualify medically for bariatric surgery. And these are patients that have a BMI greater than 40, a body mass index greater than 40, or a body mass index greater than 35 with an associated obesity-related health problem.

So again, that kind of includes a number of things. Anything from high blood pressure and diabetes to heart disease, to sleep apnea, all of those things can kind of fall into the category of obesity-related medical problems. Insurance coverage, interestingly, for bariatric surgery has really never been better, and in our state actually kind of leading the charge in the nation for increasing access to bariatric surgery as a treatment modality for obesity. At the beginning of this year, January 1st, 2026, the Arkansas Act 628 actually went into effect. And that has made it where all private insurers as well as Arkansas Medicaid, have to cover bariatric surgery as a treatment for obesity.

So it's a really good time if patients didn't have coverage previously, which many didn't. Now their insurers have to pay for bariatric surgery. So it's a really great time for patients to be kind of investigating whether or not this is a good option for treatment. And again, to kind of get back to your question that the criteria is a BMI greater than 40 or a BMI greater than 35 with an associated health problem.

Host: So, bariatric surgery has evolved significantly in recent years. And so have the medications to treat obesity. Dr. Rives, where do weight loss medications like Ozempic or Mounjaro or Zep Bound fit into this picture?

Tyler Rives, MD: No, you're exactly right. Like you can't turn on the TV or listen to your favorite podcast without hearing about these new medications that are on the market. And it seems like, you know, every time you talk to someone, either they're on those medications or somebody that they know is. And it's a very good treatment for obesity.

I think it's especially great for those patients that are needing to lose, you know, 10 to 15% of their excess body weight in order to get down to a healthier BMI. So we collaborate closely with our UAMS Medical Weight Loss Clinic. We have some great providers there that prescribe those medications.

And then, you know, at the end of the day, oftentimes for patients needing to lose more weight if they don't get there with the medications, we still stay in touch with them and we're there to offer them bariatric surgery later down the road.

Lexie Vaughn, MD: And I think just to piggyback on that, if I may, prior to these medicines, which are actually really amazing medications and really recent kind of advantages within the, the treatment of obesity care. Prior to that, we really didn't have any adjuncts to add to bariatric surgery, either before or after.

And these, these medications have really changed the game in regards to that because it's really not an either or situation. It's really kind of a compliment of the two therapies. Sometimes at the same time, sometimes in stepwise fashion. But it has really kind of opened our access and diff and our patients access to different treatment modalities for their obesity.

And has given us a lot of, of really good tools in our toolbox for the care of these patients.

Host: With that in mind, Dr. Vaughn, what are options for bariatric surgery? Are there various options to use medications to not use medications. What does it look like?

Lexie Vaughn, MD: Yeah. So, kind of a layered question, but just to kind of start with the surgical approaches specifically. There's kind of two big categories of the way that we, we target weight loss with surgery and that is something called restrictive surgery, which means we basically decrease the amount of food that a patient can take in.

And then the other category is called malabsorptive surgery. And as you can kind of surmise, malabsorption can lead to decreased intake and absorption of calories and nutrients, that can contribute to weight loss. And so there's a different kind of pathway for those, in the operating room in terms of the technical aspects, but also in the recovery for those patients.

And so in that sort of restrictive category, the most common procedure that's offered in the country and the most common procedure that we offer at our center is the sleeve gastrectomy. And in addition to that, we also offer a Roux-en-Y gastric bypass and a SADI which is a kind of acronym for a single anastomosis duodenal ileal bypass.

You can see why we call it the SADI. And those last two procedures are kind of in that malabsorptive category, so there's kind of an increased, potential for weight loss with those other two procedures.

Host: And then can we talk about what happens after the surgery? Dr. Rives?

Tyler Rives, MD: Yeah, so for all of these procedures, our patient's stay at least one night in the hospital. That's just so we can monitor them to make sure they don't have any complications from surgery, which are rare. But also too, to just make sure that they're able to get enough in by mouth to go home and safely kind of start on their weight loss journey.

And then we follow-up with them frequently in clinic. You know, we see them a couple of weeks after their surgery, a month after, but then we follow them for life. And we also have a support group that meets every other month for continued support. And I always tell patients that honestly, the surgery is the easy part.

What really determines success is staying plugged in with us and our program.

Host: It sounds truly life-changing and it's really reassuring to know you follow patients beyond the surgery, For those interested in getting an appointment with the UAMS Bariatric Surgery Clinic, um, how do they do that? Dr. Vaughn?

Lexie Vaughn, MD: Yeah, so we have a lot of really good information on our website. So if you actually just Google UAMS bariatric surgery, it'll take you right to it. There's a lot of information and, and more detailed information there about the types of operations that we offer. So it can go into a little bit more detail about what the day of surgery looks like, what recovery looks like, what the aftercare looks like, so it's a great resource for patients.

We also have on that website access to our nutrition guidelines for patients. And so it's a good thing for patients to look at and kind of get an idea about the life change that you mentioned, in terms of their diet plan and their exercise and things like that. The easiest way to get an appointment with us is to call at (501) 214-2400 and request an appointment with the bariatric surgery clinic there. And your primary care provider can also send a referral as well.

Host: Well, Dr. Lexie Vaughn, Dr. Tyler Rives, thank you so much for sharing your expertise today.

Tyler Rives, MD: Thank you.

Lexie Vaughn, MD: Thank you so much for having us. We really appreciate it.

Host: You can find more information@uamshealth.com/bariatricsurgery. To request an appointment at the UAMS Bariatric Surgery Clinic, call 501-214-2400. You can have your primary care provider place a referral to the clinic as well. Thanks for listening to UAMS Health Talk, a podcast from the University of Arkansas for Medical Sciences.