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Bill Klaproth (host): UPMCs central PA weight management services are experts in helping you achieve your healthiest weight, whether that be non-surgical options or surgical options. So let's talk with Dr. Justin Rosenberger, a bariatric and general surgeon with UPMC Central, Pennsylvania surgical associates. And UPMCs central PA weight management services and Samantha Hionis a certified family, nurse practitioner and obesity medicine association, certified clinician.

This is Healthier You a podcast from UPFC I'm Bill Klaproth. Samantha and Dr. Rosenberger, thank you so much for your time. Samantha, let me start with you. So first off, what are the benefits of weight reduction in losing weight? And then what tools and resources do you offer at UPMCs central PA weight management services to help people achieve that healthier weight?

Samantha Hionis: Benefits to achieving that weight would be improving your quality of life, reducing your risk for type two diabetes, cardiovascular disease, sleep apnea, and other medical complications. We offer our patients a wide range of tools, information, and support to achieve and maintain a healthy weight. You do not have to face those challenges alone. our medical group offers comprehensive medical management to help you achieve weight loss, you work with a provider, nutrition services, exercise, behavioral support, and we also have medication options that can help.

Bill Klaproth (host): Okay, that sounds great. So can you tell us about the non-surgical weight loss options that are available at UPMC?

Samantha Hionis: Sure. So we offer a wide array of non-surgical weight loss resources. We have support groups, weight loss medications, diet counseling. We're here to support you on your journey to a healthy weight through the entire process. We can also help control or reverse any weight related diseases you may have, such as type two diabetes, high blood or sleep apnea and other breathing issues.

Bill Klaproth (host): So when it's all said and done, how do you help patients achieve their weight loss needs?

Samantha Hionis: So we do that through office visits with our nurse practitioners, our physician assistants and our doctors, as well as diet nutrition plans. sometimes working with a registered dietician. But, our physician assistants and our nurse practitioners and doctors also have nutrition information, exercise guide. Lifestyle change and mental health support, as well as weight loss drug options. Our weight loss care team includes a doctor, nurse practitioners, physician assistants, and registered dieticians who will work with you.

Bill Klaproth (host): So Samantha, when people come to you, obviously they've tried, most likely they've tried several weight loss options and it's just not working. Is that right?

Samantha Hionis: Yes.

Bill Klaproth (host): So you're really able to get them to the point of going, I know you've probably tried every diet, there is known to man at this point, it's just not working for you. So generally people are probably thankful and when you're able to go in and really take a look at what they need and the options that they have, and discuss this with them and come up with a plan that's best for them, is that right?

Samantha Hionis: Yes, each plan is personalized per patient. what I tell my patients is medical weight loss isn't an exact science. A lot of it is trial and error, especially trying to find the right diet plan. Finances are a little bit difficult for people at this moment, so trying to figure out how to. Who have food security as well as promoting weight loss and weight loss drug options that can also help with that as well.

Bill Klaproth (host): I bet people often wonder how long is this gonna take? Right. Is there a general. Rule of thumb when you start working with people, I know this is probably a tough question to answer, but for the programs that you offer, are they usually months long programs?

Samantha Hionis: Yeah, usually what it depends is we don't really go off of a number of, months. It can be insurance driven, in terms of how long they'll cover it. Usually we go by how effective the medication is, measuring that about every 12 weeks. You know, and they can be, we've seen patients for years. Some patients Reach their goal weight and they leave the program. Others stay with us just to remain accountable and maintain their weight loss.

Bill Klaproth (host): Absolutely. And it's nice that you're there to help them through their weight loss journey and beyond that follow up, I would imagine is crucial as well, that they have someone to check in and, maybe somewhat that, that kinda holds them accountable to keeping up with their weight loss management. Is that right?

Samantha Hionis: Yeah, sustained weight loss is hard. Our medical weight management team, has a commitment to, your personal journey, and it lasts a lifetime. We try and set you up for success. So far more than 80% of our patients have lost weight, and some have lost as much as a hundred pounds. So if they're struggling to lose weight, they can always reach out and let us help them. And like I said, each, program is, personalized to the patient. So none of it's cookie cutter.

Bill Klaproth (host): That's really important. So thank you for that, Samantha. We really appreciate it. Dr. Rosenberger, I'm gonna bring you in on this and so now let's turn to surgical options. Sometimes people can really work so hard to, do this on their own and use. Programs like Samantha is talking about, sometimes it just doesn't work. Right? And then it's, they come to you going, I've tried everything, doc. I need help. So can you talk to us about that and the benefits of actual weight loss surgery?

Dr. Justin Rosenberger: Yeah, most of the patients that come to our office have did multiple diet attempts medically wise and failed. And some of them, don't go through the medical weight loss. They just tried on their own and that's fine. But once they come to us, we talk about surgery a lot of the times. The first surgery we do, which is probably the most popular, is the sleeve gastrectomy where we take part of the stomach, about 70 to 80% of it and take it out of the body. So you're left with a small little tube of stomach. It looks like a banana almost. And then that gives you a lot of restriction when you eat.

So you feel full after a little bit of food, and that helps you lose a good bit of weight. In the other surgery we do, a good bit of the time is the gastric bypass. The gastric bypass is a separate surgery. It adds both restriction and a portion of malabsorption. So we create a small little pouch out of the top part of the stomach, about the size of a golf ball. Then we reroute the small intestine and bringing some of that up to the pouch, and then that gives you the addition of malabsorption in addition to restriction to lose weight.

They're both equal in weight loss afterwards, and it's usually patient choice. each of the surgeries have their own specific benefits, and I won't talk to them right now, but a lot of the times the patients can choose which surgery they want with our guidance.

Bill Klaproth (host): Absolutely, and you help guide the patient. When you talk about these two options, which one would be right for that specific patient?

Dr. Justin Rosenberger: Correct. There's lots of things with each surgery that can cause problems afterwards, such as, just to give you one example with the sleeve, if you had significant reflux disease, you'd be a better candidate for the bypass. Sometimes patients with, severe type two diabetes will do better with the bypass. And then other patients do better with the sleeve. Like sometimes, we do make everybody quit smoking and using nicotine, but nicotine's a big, big problem with bypasses. So those would be geared towards sleeve or sometimes younger patients would do better with the sleeve.

Bill Klaproth (host): So this is all part of that evaluation when somebody comes in to see you? Is that right?

Dr. Justin Rosenberger: Correct. There's multiple providers in our office. We have nurse practitioners, PAs, and then a bunch of other medical personnel that'll help guide them through to which surgery they want. And then once they meet the surgeon, we'll also go over all the options and then try to guide their experience to, benefit their weight loss the best.

Bill Klaproth (host): Right. And can you talk about the success of this? You know, in general, 90% of bariatric patients are able to maintain a long-term weight loss, so bariatric surgery in general really works. Is that right? Is that what you found?

Dr. Justin Rosenberger: Yeah, so I mean, the weight loss is one thing, but I think the more beneficial, outcomes after surgery is getting rid of the hypertension, the diabetes, the sleep apnea, a myriad of other comorbidities. The patients do well, medically, in addition to feeling better and keeping the weight off.

Bill Klaproth (host): Yeah, I mean, that's such a great point about the comorbidities, the weight is off, so you feel better about yourself, number one. Number two, You're healthier, which is really good, but some of the things that we're ailing you because of that extra weight, most likely are gonna be missing as well, the high blood pressure and other things that you talked about. So can you spend just a little bit more time about how bariatric surgery really does, remove these comorbidities really leading to a much better quality of life?

Dr. Justin Rosenberger: Yeah, so I mean the two big ones are diabetes and high blood pressure. Just when patients get surgery, sometimes they stay overnight in the hospital. By the next day they're getting their medications decreased before they even go home. So, I mean, that's just a great thing to, encourage them.

Bill Klaproth (host): Absolutely. After the surgery is over, you follow up then as well. Right, because then usually comes a combination of dietary and lifestyle changes combined with the surgery. That's really the perfect mix of someone managing their weight and keeping this weight off, throughout the rest of their life. Is that right?

Dr. Justin Rosenberger: Yeah, so I mean, these patients are lifetime followers with us. They're usually with us, six months before surgery and then you know, Three to six months every, three to six months after surgery and then yearly after that, they get nutrition Labs checked every three to six months and then yearly. And they're really kind of our patients for Lifetime. And it's a great, friendship we build with these patients for Lifetime.

Bill Klaproth (host): So you are with them every step of the way. You said, I think you said six months before and then it's a lifetime afterwards. You're with them on this journey then, is that correct?

Dr. Justin Rosenberger: Correct.

Bill Klaproth (host): So I did want to ask you one other thing. I know you do another surgery, revisional bariatric surgery. Maybe people have heard that phrase. Can you tell us what that is?

Dr. Justin Rosenberger: Yeah, so a revisional bariatric surgery would be any second surgery. So once you have a sleeve or a bypass or a gastric band in the past, any surgery after that would be considered, a revisional bariatric surgery. Some of them are due to problems such as increasing reflux. Or ulcer disease or problems like that. And then some of them are due to failed weight loss. Sometimes people lose a little bit of weight and then gain it back, and then they just need a little bit of encouragement to get a little more weight off with another little surgery. So there's a myriad of reasons why you can have revisional bariatric surgery, but we do them all.

Bill Klaproth (host): Yeah. So again, that follow up is really important. After that surgery is done, and then like you said, you are able to go in and understand what's going on and, and make an adjustment if you have to do that. Is there anything else you want to add, Dr. Rosenberger, when it comes to the surgical options for weight loss?

Dr. Justin Rosenberger: I mean, surgery is definitely not the end all, be all, and that's why we work closely with our medical management arm of the program. But surgery is a great, option for patients that have more than a hundred pounds to lose. A lot of times it's hard to do that just medically on your own. Patients that think they, they don't want surgery, they should at least come in and hear what we have to offer. And I think between the medical management team and our team, we can get the weight off them.

Bill Klaproth (host): For sure. Well, thank you so much Dr. Rosenberger, we appreciate it. And Samantha, one last question for you as well. Any thoughts you wanna add about the nonsurgical options available for someone to lose weight?

Samantha Hionis: Not really. We've covered a good myriad of the program. We have patients that come in and they're hesitant about surgery, so they come to us first and we work with them with medical weight loss. And we can easily, get them in with surgical if eventually they do change their mind, and vice versa. We work really well together to help the community and help the patients as best we can.

Bill Klaproth (host): Absolutely. Well, Dr. Rosenberger, thank you so much for your time. We appreciate it. And Samantha, thank you for your time. This has really been a great conversation. Thank you for your time.

Samantha Hionis: Yeah. Thank you so much.

Bill Klaproth (host): And once again, that's Dr. Justin Rosenberger and Samantha high owners. For more information, please visit upmc.com/centralPAweightloss. That's upmc.com/centralPAweightloss. 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 I'm Bill Klaproth. Thanks for listening.