Jamie Monacelli: This is Med Talk presented by HCA Midwest Health. I'm Jamie Monacelli with Dr. Stephen Scott, MD, board certified surgeon at the Surgical Weight Loss Institute of Kansas City at Lee's Summit Medical Center and HCA Midwest Health.

Jamie Monacelli: Whether you made resolutions for this year or not, the year or the new decade, every January feels like a fresh beginning. How do you seize that inspiration and take sustainable steps toward the life you want to lead and how do you keep the promises to eat right and put your body in your health first.

Jamie Monacelli: A report came out in September of last year that says America is at an historic high for obesity. One in three Americans, or 100 million people of all ages have obesity. How can obesity seriously affect your quality of life and longterm health?

Dr. Scott: Obesity is actually now the number one health problem in the western world, not even in just the United States, but in the entire western world. Obesity is related to many, many different diseases that many people know about. Things like diabetes, high blood pressure, sleep apnea, and in the longterm, it increases your risk for cancer, increases your risk for joint problems, can cause infertility, and many, many other things that a lot of people may not even consider when they look at their weight and if they are overweight and how it can affect their health.

Jamie Monacelli: Why do you recommend a lifestyle change for patients as part of a successful way to keep the weight off?

Dr. Scott: Well, we know that it's very difficult to lose weight and keep it off. That's because now we understand a lot of the different chemicals that come from our stomach come from our brain that are telling us that we're hungry and that we need to eat, especially when we try to go on a diet. If all you do is cut your calories back, your brain is telling you, hey, I'm hungry. You need to eat. It continues to do that. Unfortunately even when you go off the diet, it will continue to tell you to do that, which is why you'll gain the weight back and plus more. That's why it's important to have a comprehensive plan that includes a healthy diet, increased activity, things like increasing your water intake, regular meals like breakfast especially. All those things can add up and help you lose weight and keep it off.

Jamie Monacelli: As the Kansas City area's most experienced, robotics, bariatric surgeon, having done more than a thousand robotics procedures, can you explain some of the advantage of doing a surgery like that when it comes to successful weight loss?

Dr. Scott: What the robot helps me do, it helps me see things better, and it helps me control those instruments better, in order to do the operations that we offer to people who suffer from this disease of morbid obesity. What the robot does, is it is a stable platform, allows me to see into places I couldn't normally see, to see in a 3D vision, and it even allows me to do things and see things that I can't do with my eyes and my hands normally.

Jamie Monacelli: Let's talk about some of the other benefits of it being also minimally invasive and you being in control.

Dr. Scott: The key thing that has happened in weight loss surgery is that our techniques have gotten better. The technology has gotten better, and by us also improving because of the number of cases we do specializing only in weight loss surgery, it really has allowed this surgery to become one of the safest operations we can do. It's actually safer to have weight loss surgery than it is to have your gallbladder taken out.

Jamie Monacelli: What are some of the procedures available for people who need to lose weight?

Dr. Scott: We have several different operations. I actually do seven different procedures for weight loss. The three most common ones that we do are called the sleeve gastrectomy, or the gastric sleeve. The gastric bypass, which is an operation that's been around for a long time and we still do it because it works very well. An operation that's a little bit newer and has changed some and improved a lot over the last few years, called the duodenal switch, for people who suffer from diabetes or people who are heavier. It really has become an operation that allows people to have a very, very normal lifestyle and still lose and maintain their weight loss.

Jamie Monacelli: You are one of the only bariatric surgeons in the area doing an endoscopic procedure called ESG, or Endoscopic Sleeve Gastroplasty. What is it?

Dr. Scott: This is a new concept. We've always had sort of diet and exercise, and then way up here we've had weight loss surgery, but not very much in between for those patients that maybe are only anywhere from maybe 40 to 80 pounds over their ideal body weight, well now we have some endoscopic procedures. The ESG or Endoscopic Sleeve Gastroplasty, I think is the most exciting of those procedures. It allows us to go down through the throat, down through the mouth, down your throat, into the stomach, and we actually have a little sewing device on our endoscope that allows us to change the size and the shape of the stomach, which makes people feel full faster and stay full longer and allows them to lose weight.

Jamie Monacelli: Tell me about some of the other recent advances in weight loss that you're hearing about?

Dr. Scott: There's several things that I think are very, very fascinating. One of the most fascinating things from a nonsurgical point of view is this whole idea of intermittent fasting. What we've seen with intermittent fasting is that we get actually even more health benefits than we do weight loss with it. While the weight loss is moderate, the health benefits actually seem to be pretty extensive with intermittent fasting. Then of course the other things that are happening are more and more of the things that we can do for patients after surgery to help them maintain that weight loss. The most difficult thing about any weight loss program is maintenance, maintaining that weight loss. We now have interventions, we have medications, and we have programs that we can put people in that help them maintain that weight loss.

Jamie Monacelli: Can you come back to the intermittent fasting for just a second, because it is a real buzz term that we're hearing a lot about, especially at this time of year. How much of a fast does it need to be to make a difference? Can you talk about some of the health benefits?

Dr. Scott: The health benefits first of all have to do with just losing weight. When you lose weight, your blood pressure goes down, your blood sugar is better, you sleep better, your joints feel better. All of those things happen.

Dr. Scott: With intermittent fasting, we seem to have an even greater effect on, for example, your cholesterol. If you suffer from high cholesterol, it has an even greater impact than just the weight loss that you would expect from it. As far as how to do it, there's a lot of different ways to do it, and they all seem to work pretty well.

Dr. Scott: Some people do what we call the five and two, so they fast two days a week where they'll take in very, very few calories and the other five days a week, they just eat what they want to eat. Another way of doing it is some people call the 20 and four, so there's a four hour window during the day where you're going to consume all of your calories and then the other 20 hours you're not going to really consume any significant calories.

Jamie Monacelli: Is there any danger in that you overcompensate on the days that you're not fasting and then you lose the benefit?

Dr. Scott: Well, that's the interesting thing because most people would think that, well man, I'm going to be so hungry after I've done the fast that I'm going to make up for all those calories that I didn't take in. Actually that's not what happens. We don't really understand that.

Jamie Monacelli: This has been Med Talk presented by HCA Midwest Health. I'm Jamie Monacelli.