Transcription:

Bill Klaproth (Host):  Obesity can cause many health problems and put you at a higher risk for certain diseases and conditions. However, bariatric weightloss surgery can eliminate many of these problems. So, are you ready? Is it time for weightloss surgery? Is it right for you? Well let’s find out with Dr. Luciano DiMarco, Head of UPMC Pinnacle Bariatric Surgery Department.

This is Healthier You, a podcast from UPMC Pinnacle. I’m Bill Klaproth. Dr. DiMarco, thank you for your time. So, let’s start with this. Why do we have this current obesity epidemic?

Luciano DiMarco, DO (Guest):  So, obesity epidemic is a huge worldwide problem. About 60% of Americans are obese or morbidly obese. And the reason for this is multifactorial. Some people call it genetic, if your family is obese, you are most likely going to continue with the obesity problem. And also, as you know, fatty foods, the easy to get foods are readily available and cheap and people buy those much more readily than good food. So good food is expensive. Cheap food is cheap but it’s not really that good for you. And that is a huge problem unfortunately. And then of course, the lack of movement. As you know we don’t move as much as we used to in the past. There are remotes and there’s emails and internets and cars and everything else that minimize our walking and minimize our daily activity.

So, most of us have a sit down job, present company a sit down job and that requires very little energy expenditure by the body. So, you have an increase in the caloric content, decrease in movement and increase in genetic predisposition and then a lot of medications that unfortunately physicians well some, obviously to help us with our daily problems but medications do help with water retention and help with caloric intake, so people tend to retain more calories and retain more fluid and gain weight. All these things factor in. And unfortunately, on the average they say that every decade of life you gain ten pounds. I don’t know if that is true. And then by the time you reach the 50s and 60s range, well you really are way above where you should be. And that seems to be the national trend and that’s the problem.

Host:  Well that is a perfect explanation for it. Too much processed, sugary food, not enough movement and then you say medications as people get older, they have more health problems and are on medications. So, all of these things factor into this obesity epidemic.

Dr. DiMarco:  And it’s a vicious cycle, yeah, it’s a vicious cycle.

Host:  it is a vicious cycle. I mean just think of the sugary Starbucks stuff that we drink every day. It’s crazy.

Dr. DiMarco:  Easy with Starbucks, I like it.

Host:  Well I do too so too much of it though, that gets to be a problem. So speaking of the problems, what are the associated medical risks of obesity?

Dr. DiMarco:  So, if it starts at a very young age; when you start to develop overweight problems, it starts with initially joints, okay. Your joints start to have aches and pains and they start to have ligament problems at a very young age. And then on top of that, it continues with blood pressure and then sleep apnea. And once you develop blood pressure and sleep apnea, you are really down a very fast spiral of damage that your body is going to go through. And then of course, diabetes starts. So, for every point or every BMI above 30, there is a significant increase in incidence of diabetes. So, what happens is we gain weight, and you get the high blood pressure then the medications come in. and then that unfortunately makes you gain more weight. Then you get the sleep apnea which then creates more of a blood pressure problem and more pulmonary hypertension that occurs.

So, obesity really is a problem that’s associated with blood pressure, sleep apnea and back problems, diabetes is a huge problem associated with obesity, increase in cancer risks. Every type of cancer you can imagine is increased with diabetes. So, the list goes on and on. But pretty much pick any organ system and if you are morbidly obese, it’s going to affect it in some manner. And that of course cardiovascular disease, you know heart disease, heart attacks and that is a huge problem with obesity.

Host:  So, this sounds like a cascading snowballing effect. First you get the joint pain, then high blood pressure, then sleep apnea, and then diabetes.

Dr. DiMarco:  And that creates all kinds of problems.

Host:  So, then for someone listening who may be obese, who may have these comorbidities; what are the indications or how does someone know if weightloss surgery is right for them?

Dr. DiMarco:  Right so BMI, body mass index is a height to weight ratio okay so, people who are seven feet tall don’t really have a lot of morbid obesity problems. But most of us are not. So, it ‘s a height to weight ratio. And what happens is as the central obesity starts to occur; then you get the problem with the hypertension and cholesterol issues and heat disease. Central obesity means the fat is stored inside your belly. That creates a lot of problems. So, our goal is to get patient’s BMI less than 30. We found that if your BMI is less than 30, then you don’t develop the diabetes and the joint problems, and the sleep apnea goes away and everything else. So, when we look at a patient, that comes into the office with BMI is 32, 34, we say well you need to go to a medical management such as work with our dieticians. We have two dieticians in the office. Work with our dieticians and see how you can change your diet, change your lifestyle and get your BMI less than 30.

But if you come in the office with a BMI of 40 or greater, that means you need to lose about 80 pounds or more. Well 80 pounds is a lot of weight to lose by going on a diet. And most folks, some folks are successful, but most folks just cannot achieve those goals. So, now we enter into the surgical aspect and that’s where surgery comes in. So, BMI greater than 35 with associated morbidities, comorbid conditions like diabetes, and hypertension and sleep apnea. So, 35 or great with those or 40 or greater and if you haven’t developed diabetes yet, you will, but 40 or greater we still provide surgical intervention.

Host:  So, over 40 BMI, that’s –

Dr. DiMarco:  That’s a real danger zone.

Host:  That’s the danger zone. So, then what are the current surgical options for someone? How do they – I know there are several different types of bariatric weightloss surgery. How does someone understand what is right for them?

Dr. DiMarco:  Right so, there are many surgical options out there and the most common one that we do nowadays is called a sleeve gastrectomy. A sleeve gastrectomy – first of all, all these surgeries nowadays are done laparoscopically or robotically. So laparoscopically means very little tiny incisions, robotically, same way very little tiny incisions that really are more of an outpatient surgery. You come in, you have it done, you stay overnight at the most and then you go home the next day. So, the surgery has been significantly improved and really simplified since the 80s and 90s when I started doing these, which I’m dating myself now. So, the surgeries have come a long way and have gotten much better. But we start with the most simple surgery, the sleeve gastrectomy, by far the least complicated surgery, the easiest to tolerate for most patients and that is by far the first one we look at.

Then we do the gastric bypass and then of course something called a biliopancreatic diversion, otherwise known as a SIPS procedure and these procedures are a bit more complicated. So, we start initially with the basic one which is called the sleeve gastrectomy and people oftentimes fear surgery because they say oh my God, I’m going to have an operation, but really the sleeve gastrectomy has less complications than a simple gallbladder surgery. It’s really very, very simple, very uncomplicated, outpatient type procedure that can be tolerated by anybody, just about anybody in any age group and it works really, really, really well and that’s the one that I’m really excited about because it’s the least complicated surgery that we do and still extremely effective in weight control.

Host:  All right so number one, the sleeve gastrectomy. Number two the gastric bypass. Number three the SIPS procedure. So, then after bariatric weightloss surgery, and after someone loses all of the weight; in general then, the high blood pressure, the sleep apnea, the diabetes; these types of conditions generally go away.

Dr. DiMarco:  Correct.

Host:  So, then with bariatric weightloss surgery, you can change your weight and change your life.

Dr. DiMarco:  Correct. It is very true. So, what happens is, we start with let’s say the sleeve, that’s the most common one. We start with doing a sleeve procedure. So the first month after this procedure, we expect about a 20 to 30 pound weightloss. Which is a dramatic change in weight. Then after that, we expect about five to ten pounds a month. So, over the course of a year, you are looking at a 80 to 100 pound weightloss. Which is a dramatic change in a person’s ability to move around and get back to what normal lifestyle, get more mobile. But associated with that, the diabetes, 85% resolution. That means it goes away, 85% of the time it goes away. It goes away, right. Gone. Never to be seen. And the ones that they – the other 15% are under much better control.

The high blood pressure, same thing about 80 to 90% resolution. Sleep apnea, most of the time goes away. All these things just go away, disappear. People lose their sleep apnea machine. They don’t want to deal with it anymore. They are gone. The beauty of that is phenomenal and so those are – those things are just gone and then what happens that people don’t realize is they get taken off the blood pressure medications and the cholesterol medications because the cholesterol goes away. And all of the sudden, your cardiac risks become much lower and you don’t have the heart attacks, you don’t have the diabetic problems associated with the ability to not walk when you are a diabetic and you have all these foot problems and ankle problems and people lose toes when their diabetes get’s really bad. Those things go away. They get better.

And people come in with these ulcers, chronic ulcers in the lower extremities and lower legs because diabetes prevents the healing process from occurring. Diabetes goes away, the ulcer goes away.

Host:  Well it’s easy to see how that could be life changing. So, change your weight and change your life. So, earlier, you were mentioning how far bariatric weightloss surgery has come since you first started doing it. So, if you could, look into your crystal ball. What is on the horizon for bariatric weightloss surgery?

Dr. DiMarco:  Right. So, there’s always ways to make the procedures better and less invasive. So, now we’re dealing with instead of doing a laparoscopic surgery where we put holes inside the abdomen; we actually do it endoscopically where we go down in the stomach, and follow the return of food, we go down in the stomach with a scope and actually make the stomach smaller from the inside. Again, less surgery, less complications, less problems. There are these things called space occupying balloons that we put inside the abdomen to resemble a constant food source inside your abdomen. So, now you feel full all the time and you eat less. These are things that we are looking it and developing and hopefully in the horizon we can see the procedures being done even less invasively than they are right now.

Host:  Well less invasive and more commonplace. That’s what we certainly would hope for. Dr. DiMarco, thank you for your time. This has been fascinating.

Dr. DiMarco:  It’s a pleasure talking with you and if I can be of any help please let me know.

Host:  That’s Dr. Luciano DiMarco and to learn more or to book an appointment just call 717-909-0290, that’s 717-909-0290 or visit www.upmcpinnacle.com/weightloss, that’s www.upmcpinnacle.com/weightloss. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is Healthier You, a podcast from UPMC Pinnacle. I’m Bill Klaproth. Thanks for listening.