- [Jayme] This podcast is presented by HCA Midwest Health. I'm Jayme Monacelli with Dr. Stephen Scott, bariatric surgeon. More than one third of adult (786 million people) are obese. That's according to the Centers for Disease Control and Prevention. If you or a loved one is affected by obesity you know that managing a healthy weight, to improve quality of life is pretty tough and it's often tempting to try diet gimmicks on your social media feed, or buy expensive workout gadgets. But Dr. Scott, why do you recommend lifestyle changes as a part of a successful solution to keeping the weight off. 

- [Dr. Scott] Well, because the data tells us that fad diets, even fad exercise programs, simply don't work. And we've been able to look at this as a disease process rather than, sort of, a social problem. And so, by looking at it as a disease process we've been able to understand the physiology of it and understand why people gain weight and why it's especially difficult to both lose it and keep it off.

- [Jayme] Why is it not just an easy fix? Why can't you just go do a fad diet and not have it work and keep the weight off? 

- [Dr. Scott] Well, what happens when you go on a diet is your rate at which your body burns calories goes down, and the hormone that tells you that you're hungry goes up. So you're burning fewer calories, and your brain is telling you that you're hungry. Now here's the really bad news about that: when you go off the diet, and you start eating more, that hormone that tells you that you're hungry stays elevated for at least a year afterwards. So that's why you have this drive to continue to eat. And the one thing I know about treating this disease for the last 25 years when human beings get hungry, they eat. That's what they do. 

- [Jayme] So what would you recommend as some low-hanging fruit or strategies that would help someone change the way they live?

- [Dr. Scott] Well, there's a few things. Number one, I think that the key to any successful diet is to try to eat more fruits and vegetables. Fruits and vegetables, they satisfy your hunger. They have lots of nutrition in them. They give you lots of the vitamins and minerals that you need, you also need to drink plenty of fluids and we really recommend non-calorie fluids and of course the best non-calorie fluid of all is water, so those are very, very simple things to do.

And then you need to also try to increase your activity, not so much to lose weight but to keep it off. And those simple things are going to help you make small changes that can help you lose enough way to affect your health, and keep it off.

- [Jayme] I want to talk a little more about that. We have new standing desks at the studio, and it got us talking about the fact that a lot of us sit all day and don't have a lot of ways to get up and get the steps in and that kind of thing. How can you work activity more into your daily life?

- [Dr. Scott] So sitting is the new smoking, really, and we know that it is a very unhealthy activity that people do. But they're really, it's simple things. And that's really what you need to think about. Simple everyday things, things like parking at the end of the parking lot so that you have to walk further to get to where you're going to take the stairs instead of taking an elevator or an escalator. Simple things like that. The standing desk that people are using now can be very helpful. These provide what we call non-exercise activity levels could be a helpful in increasing the amount of calories you burn and helping you lose and maintain weight loss.

- [Jayme] I often hear people say that having surgery is just going the easy way out, and you and I know that's not the case, but can you tell us about what patients go through with that kind of surgery?

- [Dr. Scott] Well, first of all, you have to understand that this is a multidisciplinary program, meaning that we have lots of different people who are going to be a part of the team that is going to help that patient. So we have psychologists. We have bariatricians, which are medical doctors who specialize in weight loss. We have nurse coordinators. We have all these different people who are going to be a part of that. The patient's gonna undergo an extensive evaluation, both physically and mentally, to make sure they're ready for this. And then after that, you have to understand that there's a process that the patients are going to go through with supervised weight-loss and evaluation, a psychological evaluation, be seen by a dietitian, before they ever have surgery. So they're gonna be prepared for this.

- [Jayme] Is surgery an option for everyone?

- [Dr. Scott] It's not an option for everyone, but we do know that for patients who have a high what we call body mass index (in other words, if your body mass index, which is an indication of your percent of body fat is elevated, if you is more than 35 and you have a disease associated with OBC or if your BMI more than 40), then surgery is by far the best option and is really the only option, in which you lose enough way to affect your health, and keep it off.

- [Jayme] Let's talk more about the procedures that might be available for people who need to lose weight.

- [Dr. Scott] Yeah, so let me talk for one second about what that means. A body mass index of 35 or body mass index of 40. So if you are, for example, a female and you're five-foot-four, your body mass index of 35 would probably be around 200 pounds. Body mass of 40 would be about 220 pounds. So that's kind of the kind of weight that we're talking about in that category, but we now have procedures for patients who weigh less than that as well. So as we talk about the procedures, I'm going to kind of start there.

So we now have what we call endoscopic procedures, procedures in which we put a TV camera down through your mouth down into your stomach, and we can actually operate by looking at a TV screen where we don't make any incisions on your abdomen, and that is especially helpful for patients who are more in the, say, 150 to 190 pound range. And then we have surgical procedures, but all the surgical procedures that we do now, we do through a lapiscope, meaning is little TV camera that we put inside of you, so you're gonna end up with four or five small incisions a quarter to a half an inch, and most patients are gonna go home from the hospital the following day. The operations that we do, there are three main procedures. One is called the gastric sleeve, in which we simply take the stomach, which is a big bag, and turn it into a long skinny tube, about the size of a banana. With a gastric bypass, we divide the stomach making a small new stomach that's a little bit bigger than an egg and then we bring the piece of the intestine up, so that the food doesn't go through the entire intestine anymore. That has a tremendous impact on diabetes. And then, for larger patients, we have an operation called The duodenal switch, an operation which sort of a combination between the sleeve and the gastric bypass.

- [Jayme] What happens after someone has a major surgery like that and they lose a significant amount of way because of it. First thing comes to mind for me is... Well, if you don't know how to eat in a healthy way, and you don't know how to live a healthy lifestyle, what is your life gonna be like? Are you gonna gain that weight back?

- [Dr. Scott] Sure, so there's a few things about surgery, that are important for people to understand. So remember what I said before, about when you go on a diet that hunger hormone goes up. Well, when you have surgery, that hunger hormone goes down, goes way down. Also, many of the operations we do significantly decrease your cravings for fats and sweets. So what's gonna happen to you after surgery? You can't always tell by your activity and your behavior before surgery.

So by dialing back that hunger dial, by bringing down your cravings for fat and sweet, it's going to be far easier for you to lose the weight and to keep it off.

The second thing is you're gonna have a team of people who are gonna be helping you, encouraging you, checking on you, that are going to hold you accountable in a way. But they're also gonna be there to encourage you and to help you. That is also gonna help you lose the weight and keep it off. 

And then the last thing that happens is positive reinforcement. You lose weight, you feel better, therefore you're more active. Being more active makes you lose more weight, which makes you feel even better, which makes you lose even more active. And so you get into that positive feedback cycle whereas right now, so many people are in a negative feedback cycle.

- [Jayme] And finally, what are some of the other new advances in weight loss? 

- [Dr. Scott] So two really great new advances. One is this idea of endoscopic surgery, where we actually go down with no incisions on your abdomen, go down with a little lighted TV camera and we can actually do procedures inside the stomach by that technique, so that you end up with no incisions on your abdomen.

And then another really exciting technology is DaVinci technology, which is sometimes called the surgical robot. It's really a machine that helps me see things better, helps me control the instruments better and make surgery safer, especially in very complex patients.

- [Jayme] Thanks to Dr. Stephen Scott, bariatric surgeon, for joining us. This hsa been Med Talk, presented by HCA Midwest Health. I'm Jayme Monacelli.