Scott Webb (Host): Welcome to Healthy with VCU Health, where experts from VCU Health share their knowledge, cutting edge research and the latest innovations to help you achieve optimal health and wellness. I'm Scott Webb and obesity is a common medical condition, and for many, it's hard to lose weight with lifestyle changes alone. And if you're listening to this podcast, you may very well be on your own weight loss journey. Today, we're joined by Dr. Guilherme Mazzini, a specialist in weight loss surgery at VCU Health, who helps those struggling with obesity.

Doctor, I know you work alongside a multidisciplinary team of specialists, therapists, and consultants to improve a patient's quality of life, which is great. You're a passionate clinical researcher and educator. I just want to thank you for being on the podcast.

Guilherme Mazzini, MD: Thanks, Scott. It's great to be here.

Host: It’s great to have you here. And we're going to talk weight loss surgery and really benefit from your expertise today. So, as we get rolling here, just talk a little bit about the most common treatment options for someone who's overweight. 

Guilherme Mazzini, MD: So just in full disclosure, I just want to say that I am passionate about what I do and that's because we can feel the impact that we have in patients’ lives. So, when a patient is overweight, this is a very generic term, right? We're just talking about weight. We will approach them trying to understand why they gain weight, how that weight interferes with their quality of life, with their health, and then try to individualize; try to find the best option for them.

And it can vary. It always involves some sort of lifestyle changes, try to, reroute things that went wrong when they gained weight, but we need to understand what's going on with those patients. And then we have a spectrum of things that we can offer them from diet and lifestyle changes, physical activity up to surgery.

Host: Yeah, there's many options, of course. And, you know, I think when we talk about bariatric surgery, maybe for some folks, it's the first option, but I feel like for many, it's kind of the last option. And I know obesity is such a problem in America, perhaps worldwide. So just give us a sense when it comes to bariatric surgery, is that the last option for someone with obesity to consider? Do they need to do a bunch of stuff first?

Guilherme Mazzini, MD: No, not really. I agree that most people have this idea, but we have criteria. So, we only offer surgery for patients who have what we call severe obesity. So, when you calculate their BMI, the body mass index, it needs to be above 35. So those are patients who qualify for surgery, but for any patient with the so-called severe obesity, then surgery is one of the options. It could be the first option as long as they are seen by a specialized team, and they understand what are the changes they will need to undergo with the surgery. But it's one option, it's not the last option and it's the most effective option actually for patients with severe obesity.

Host: Yeah, my mom has had bariatric surgery and was quite successful. And it's fun to joke with her about how little she eats now, how little she needs to be full. You know, I'll just put a small little thing and tease her and say, well, here you go, you know, just a couple of bites. She could certainly eat more than that, but a big improvement in her life, in her health and her weight and all of that. And good to know that for some folks it may be the first thing you go to, depending on the criteria and how well they fit into that. And for others, maybe it is a last resort. And I'm sure Doctor, there's several hospitals in the area that offer weight loss surgery. Just wondering, why do you want folks to come to you? Why do you feel like that's the right choice?

Guilherme Mazzini, MD: Well just first of all, thanks for sharing your mom's story with us. That's what we see. And it's important to say that, you know, why? Because some patients, they are afraid that they will still feel the same hunger, but they won't be able to eat because they have a small stomach.

And that's not what happens. They change your appetite and then you eat less because you feel better eating less. So, this is very nice that you shared that. Thank you. But talking about VCU Health and why anyone should come to us. We could spend a whole day here just talking about it. 

The history of bariatric surgery in the world is attached to VCU, right? Because we had pioneers in this field that have been doing this for years here and research developing techniques. So, we have so far, almost 7,000 successful cases done in our hospital, and we have this huge and amazing team that will individualize all the treatment.

We have access to all the best technologies, including not only the laparoscopy, that is the minimum invasive surgery, but we have robotic surgery, we have endoscopic procedures that we can offer, and all that ruled by the very strict scientific view, because we all, as a school, hospital, as researcher, are working there. We will apply the best medical evidence for each patient. So, we try to offer the best option for each patient. We classify as a Center of Excellence, not only for the American College of Surgeons (ACS), for the ASMBS (American Society for Metabolic and Bariatric Surgery), that is the bariatric society, but for all the major insurances. They all classify us as a Center of Excellence because they trust our outcomes, our results.

Host: I mean, as you say, right, leaders in the field, pioneers in the field, nearly 7,000 successful surgeries. It's really amazing. And we touched on a little bit, you know, whether or not bariatric surgery, the surgical options is the first choice or the last choice, but I know there's some medications and that seems to be, doctor, something that's really in the news. I want to have you just talk about weight loss medications and what do we need to know? What are the essentials?

Guilherme Mazzini, MD: Oh, these are amazing medications, right? With the dimension of the problem that we have, we needed something else. We've been waiting for that for years and the new medications, they are called GLP-1s analogs or agonists. It's a very technical term, but basically what they do, they're substances that will inhibit appetite, induce some satiety so patients feel full, and they definitely end up leading to a significant weight loss in most of the patients.

So, we work with those medications alongside surgery as well. We offer them for our patients that need to lose some weight or improve their health before surgery and even after surgery, for some patients that maybe experience some weight regain after the surgery. So, those are complementary treatments. We are very happy that we have these drugs nowadays. They're so powerful because it's a great option for these patients.

Host: Yeah. As you say, so powerful. And you've got this great multidisciplinary team there and it's really this individualized approach. You know, it's not the one size fits all. So, you work with the patients and where they're at and their weights and BMI and all of that. What I have you just kind of go through the surgery as best you can.

You know, this is an audio podcast, so you can't really point to anything or demonstrate so well, but just tell us about the surgery. How does it work?

Guilherme Mazzini, MD: This is amazing. And that's where my excitement comes, because these surgeries, all of them, they started to being designed, so to speak, in the 50's. So, we have, let's say around 70 years of advancements in this field. And as much as they were in the beginning, trying to try to reduce the stomach and make patients eat less and feel full with the research, we, noticed that actually the way they work, they trigger a complete change in how the body reacts to the food, how the hormones signal our brain and our pancreas, and how everything changes when you eat, to the point that nowadays we call this metabolic surgery. It's not only weight loss surgery because with that, we change completely how the body responds to the meal and the metabolism improves through mechanisms that even involve these drugs.

So, the drugs nowadays, these GLP-1s, they are one of the mechanisms that are triggered by surgery, and they could, they could isolate that and develop a drug. And what we do nowadays, we try to study all these mechanisms that are triggered by surgery, because then we could, eventually and hopefully, find more, develop more treatments based on that. But doing everything together, in coordination with the meal and our physiology, only surgery offers. It's amazing what they do.

Host: Yeah. And I mentioned earlier about some of the benefits that my mom has experienced from weight loss surgery. And one of them is, basically sort of treating her diabetes, I don't know that it's an unintended consequence because it sounds like you really do expect folks to benefit, you know, in addition to losing weight, but in a lot of other ways.

So, I want to have you talk about that: how bariatric surgery helps people recover from other illnesses like diabetes.

Guilherme Mazzini, MD: This is where I think the conversation gets really serious, because we have all these diseases that come with obesity. So, when we are trying to say we treat obesity, it's not the weight, it's not the number, but we're treating all what comes with obesity to make patients healthier.

And one of these diseases is the Type 2 diabetes, which has a tremendous negative impact on patient's health, lifespan, and quality of life. So, because these patients, not only they have to live like taking medications and controlling blood sugar, but also they develop heart disease, they can have strokes, they have like vision loss. And the surgery has a huge impact on that, and most patients, they don't know, they are not aware that the bariatric surgery could be an option for that. Because, of course, losing weight, but not only losing weight, triggering all these metabolic pathways that we kind of briefly touched earlier, in very well-designed studies that we call those randomized control trials comparing bariatric surgery, mainly gastric bypass and sleeve gastrectomy, to the best clinical treatment available; bariatric surgery leads to, on average, 70 percent of diabetes remission. That means that those patients, they can stop taking their medications in 70 percent of the cases. And most of these patients will never go back to need medications. Some may need, but it's a much better controlled diabetes that can come back years later. And it is associated with the weight loss, but not only that, also with those other mechanisms.

And that reflects in, in decreasing, and when you compare the diabetic patients treated with surgery versus clinical treatment; the ones with surgery, they have less cardiac disease, they have less heart attacks, they have less strokes, less kidney problems, all related to diabetes, and they die less, so the mortality is decreased. And this is an impact that I wish we could have this word spread out like, because most patients they are not aware of that.

Host: Right. Yeah, we certainly hope podcasts like this help to spread the word, and we definitely want to get the word out and spread the word, and, you know, we've scratched the surface here today, but hopefully this helps folks and helps educate.

Just give you a chance here at the end, when we think about some of the additional benefits of bariatric surgery, maybe that we haven't covered. 

Guilherme Mazzini, MD: You can have individual benefits. So, patients individually, they experience better quality of life. They die less from any other cause, so we have a decrease in patient mortality. There are several diseases that are threatening, and they improve, like the fatty liver disease. That is a problem nowadays and leads to cirrhosis and cancer and it can resolve in almost 90 percent of these patients.

We have improvement in heart diseases, so those are individual benefits, but it can also have populational benefits. When we compare populations that had surgery, they spend less money from the health system, so the surgery is cost effective. There's a very nice paper published recently showing that after five years, the health system spends less money with those patients because they are healthier. They don't need medication. They don't need exams. Again, we could spend like a whole day talking about this. I get excited. This is nice, but it is surgery. So, it is a process. The patient needs to be willing to undergo all these changes.

And we, at VCU, we provide all the support. So, they have like this multidisciplinary team with therapists, with nurse practitioners, with doctors, and with the whole complexity of the health system that we have there to kind of guide them through the process. So, most patients, when they get to us, they don't have an idea of what this process is going to look like we don't want them to get there knowing. We are there to guide them. We are there to show them what are the options and to make it easy for them to understand and make a decision at the end. There is no judgement.

Host: Right. And just want folks to make the best decision they can for themselves and their families. Really good stuff today. Just give you a chance here at the end. Final thoughts, takeaways, whether it's about how rampant obesity is and how weight loss surgery can help, anything else.

Guilherme Mazzini, MD: I think that, I mean, we talk a lot about the problem and the surgery. What I want to ask the listeners now is that they do not hesitate to stop by and talk to us. Do not hesitate on even messaging us, can go to our website, see our info. We are happy to have them in and talk about the surgery, talk about the option. Even if they decide not to go to have surgery. I think we have so much to offer them, just like doing the surgery that I would be glad to see as many patients as I could just to talk to them and explain to them what are the options.

If you have a family member, message us or schedule an appointment, it's very easy to get to get an appointment with us, like within a week or so you can be seen. We want to make it easy for them to have access to us because that's how trust starts. You need to make sure that you have access to your doctor, to your team, because then you can trust them.

Host: Yeah, absolutely. From the words of an expert, right? You know, trust is so key, in our medical professionals and caregivers and so forth. And as we discussed earlier, Doctor, you know, VCU are leaders in the field of weight loss surgery, pioneers, if you will, all good stuff today. Thank you so much.

Guilherme Mazzini, MD: Okay, thank you, thank you so much for the opportunity, Scott. It was a great pleasure.

Host: And for those of you with additional questions, be sure to visit vcuhealth.org/weightlosssurgery or call 804-827-0045. And to listen to other podcasts from VCU Health, visit vcuhealth.org/podcast. This is Healthy from VCU Health. I'm Scott Webb. Thanks for listening.