Online Weight Loss Surgery Seminar

(peaceful music) – I’d like to welcome all
of you to a discussion of bariatric surgery. Sometimes, it’s helpful
to look back at history to figure out really
where we are as a result of where we used to be,
and maybe to project in terms of what we
might be in the future. The bariatric surgery idea
didn’t really even begin until the early 1950s. And at that time, there
were a few brave surgeons who decided to try to help people with severe clinical obesity
using intestinal bypasses for shortening the
intestine so that the food and nutrient would not be absorbed. And therefore, the patient could use their own stored-up body
mass and the fat stores to generate energy for life. This was a hotly debated idea. And it did work very
well for some patients. However, by the early 1970s,
the surgical profession was seeing some serious
problems with malabsorption and with malnutrition
as a result of this kind of severe interruption
of the normal anatomy of the human body. As a result, some new
ideas came to the fore as this old idea began to disappear. Not completely, because there
were some adaptive ideas that still used the
concept of malabsorption. That is the nutrients go through, but don’t stay in the body. They pass on through. So we started to see the
invention of some new ideas, including Dr. Ed Mason’s gastric bypass which actually was designed
and tried in the early 1960s. And then we saw a whole
series of operations that moved away from
the malabsorptive idea toward purely restrictive
ideas in concept. These included stapling the stomach either horizontally or vertically, the use of bands both
adjustable and nonadjustable, or placing a balloon in the
stomach to try to create a sense of satiety in
trying to help patients to diminish their appetite and their drive to eat more than they really needed to. So keep that in mind as we
discuss these various operations, why you’re here in the first place, why you’d want to talk about it. Also realize that
surgeons have become more and more expert at what
they do: training themselves and training each other
to become very proficient at these various surgical procedures. Throwing into the mix as well the benefits of minimally invasive surgery
to do most of these operations which makes recovery
quicker, and complications with respect to the abdominal
wall so far far diminished from what they were before. So pay attention. You’re gonna hear some exciting ideas and some thrusts and intent, and learn what you think
might work for you. And we’ll help you make the right choice. – I’ve been asked today
to discuss a little bit about the causes of obesity,
and also the impact of obesity. Obesity is a disease. It is not just a condition. It’s not a behavioral disorder. It is a disease. And we know that because of
all the different problems that we call comorbidities. Comorbidities are conditions that are either directly caused by obesity or significantly aggravated by obesity. When we’re talking about
medical comorbidities, there are over 65 medical conditions that are considered weight
related comorbidities. For example, type 2 diabetes
really leads the list. High blood pressure, heart
disease, sleep apnea, joint problems, reflux, cancer. Many people don’t realize that obesity is a huge risk factor for cancer, that the 14 most common
cancers that we treat in our society are
increased in obese patients over non-obese patients anywhere
from double to 15 times. There are other comorbidities
that are not medical though. Things like clothing selection,
being able to be seated in restaurants, at theaters, on airplanes. Sanitation, these are restrictions due to your physical state. You can’t go out to any
store and buy clothes. And when you do, there’s
a limited selection and often increased cost. It’s true that, for instance,
when it comes to a job, that you’re less likely to get the job if you’re morbidly obese. If you get the job, you’re
less likely to be promoted. When it comes to professional schools: medical school, dental school, law school, studies show that any school that you have to either show a photograph or have a interview with
that you’re less likely to be accepted even though
you may be equally qualified. Even within the medical
profession, many doctors have biases against obese
patients, many nurses. It’s very difficult to take care of a morbidly obese patient. Now the real problem is the cause. The controversy, everything
in obesity is controversial even though we have plenty
of science to support it. Why is it so controversial? And it’s because of the
misunderstanding of the cause. We’re told that the cause of obesity is a behavioral abnormality, that you simply eat too much
and exercise too little. So another issue with obesity
is the treatments of obesity. And we’re told that medical
therapy is the gold standard by which the treatment of
obesity should be undertaken. And I have no problem with people attempting medical therapy. The average person on that
regimen will lose about 10% of their excess body weight
which is about 10 pounds at six months. But at one year, many of ’em
have already regained it. And studies would show
as soon as they go off the medication, the
weight tends to come back. So not very satisfactory. Diet and exercise, we all
should try diet and exercise and become a lifetime goal. But again, studies are not
very promising in that regard. But it’s worth trying. How about behavioral modification? I personally like journaling. But again, journaling has, admittedly, not been shown to really help. At least I look at what I’m doing wrong and try to work on it. How do I know that this doesn’t work? ‘Cause that’s what you hear. Well in 1991, the Centers
for Disease Control did a what they call a meta-analysis. And what you do in a
meta-analysis is you collect all the research data on a
subject and compile that data and see if you can come
up with conclusions. And the conclusion that
they came up with is that less than 5% of patients
could lose 10% or more of their excess body weight, and that’s, again, if you’re
100 pounds overweight, that’s equivalent of losing 10 pounds, and keep it off for two years or longer. Now that’s pretty dismal. The Centers for Disease
Control actually comes up with obesity data about every two years. Last time they published their
data was three years ago. And they found that only
about 2% of patients with significant weight problems were able to control them and get them under control with medical weight loss. So unfortunately, the
results are pretty dismal. We just don’t have the
medical tools to attack ’em. And that’s why surgical weight loss is the most effective
way of dealing with this. Morbid obesity is a chronic illness that is difficult to
treat with medical therapy and exercise therapy alone. Again, they found that
surgery, in that case they were talking primarily
gastric bypass surgery, was the best long-term treatment. In fact, in that same
document they point out that it was the only
reliable long-term treatment that they found at that time. – A brief discussion in terms of who should think about bariatric surgery and who should actually
avail him or herself of it, these are important decisions to make. Because any time you try
a surgical procedure, you’re going to have to
add in the risk package with that particular procedure. So it’s important to
understand what the risk and the particular benefit
of any given procedure is and what you can expect in the long term. Patients, in general, who are interested in bariatric surgery
should probably be looking at a severely overweight condition. That means they should
weigh at least 75 pounds over their ideal body weight
and/or have a body mass index greater than 35. These are somewhat arbitrary numbers. There would be exceptions to these rules, particularly when it comes
to diabetes mellitus type 2, which may respond to a gastric bypass, for example, in a dramatic way with return to normal
blood sugar regulation without the use of medications
in the great majority of patients even if these
patients aren’t obese. So there’s something happening
with the intestinal hormones which modulates the diabetes problem. And so you might be
willing to accept a lower body mass index and a
lower overweight condition to agree to take the risk of
that particular procedure. So in general, if your body mass index is above 35, particularly
if you have what we call a comorbid condition such
as diabetes, or sleep apnea, or hypercholesterolemia, or severe venous insufficiency, or congestive heart failure, or poorly controlled hypertension, all these things might
make a person think, or the caregivers for these people think, that maybe surgery would be a good option since nothing else seems
to have been working. You should also be fairly
stable in the management of whatever medical condition you have. We aren’t going to take
someone who’s in the middle of a severe hypertensive crisis or in poorly controlled diabetes or with congestive heart failure that hasn’t been
compensated and offer them a surgery which could
accelerate that condition, and even lead to a higher risk. And we don’t want to take any
more risk than we have to. We do agree that we’re taking
a risk in doing the surgery in the first place, but we
want to keep it minimal. We want to keep it to
where we get a good outcome and the patients can enjoy
not only a longer life but a higher quality of life
while they’re allowed to live. So a body mass index over 35
if you have a comorbidity. And a body mass index over 40, we don’t really look
for those comorbidities. And these are guidelines
that were published in 1991 by the National
Institutes of Health here in the United States. And again, they are somewhat arbitrary. There are reasonable
exceptions to these guidelines. But they at least ought
to be thought about before you jump into surgery. Probably it would be
helpful to prove to yourself that you can’t lose
weight in some other way and maintain it. While the great majority of
severely overweight patients cannot maintain weight
loss over the long term, a few of them can: perhaps 3% to 5% in the best studies long term. But that 3% to 5% ought not
to take the risk of surgery if they can handle it in some other way. We look for psycho-emotional stability, whether it’s with the help of psychiatry and psychological counseling
and/or medication. We do need to have a patient who’s stable and committed to long-term life. Otherwise, there’s no point in doing it. And we would have to avoid
patients who are suffering life-threatening illnesses such as cancers that are incurable or have a low or an unreasonable life expectation. So those are the patients
that could consider weight loss surgery. We do have to admit that the
American Diabetes Association, which group of physicians for a long time avoided recommending bariatric surgery, has for the past four years
now very resolutely recommended that bariatric surgery be considered, especially in their diabetic population. So those are the general guidelines. And if you fit, then you
can help refine it further by talking to a physician or
provider who knows the details. – Here at St. Mark’s Hospital, we have a variety of surgical options. We offer the Lap Band,
or the gastric band, the sleeve gastrectomy,
the gastric bypass, and the biliopancreatic
diversion with duodenal switch, which we oftentimes will
abbreviate, or shorten, to just duodenal switch. So those are four different operations. The three most common
surgeries we do are the sleeve, the bypass, and the duodenal switch. And they range in
aggressiveness, if you will, or degree of invasiveness. All of them involve some
surgery on the stomach. And two of the three, the
bypass and the duodenal switch, also involve some work on
the small intestine as well. I’ll start off by talking
about the lesser invasive ones and then proceed. We’ll start by talking about
the Lap Band, or gastric band. Now this was a very popular option. It became FDA approved in the year 2001, and probably reached a
peak of popularity about somewhere between 2004 and 2010. And at that time, we were
putting some Lap Bands in. And basically the way the surgery works is it is a ring, a plastic
ring, medical grade plastic that goes around the
top part of the stomach and it acts as a brake on the food. And so it’s a portion
control device if you will. The band is adjustable. It’s connected. The little ring that goes around
the top part of the stomach it’s connected by some
tubing that goes to a port which sits underneath
the skin of the abdomen and is sewn onto the muscle. And we can use that port to adjust the tightness of the band. So it’s been very helpful for a lot of people to lose weight. One thing we know about the band though, and the reason it has
diminished in popularity over the last three to four years, is that it doesn’t affect
the body hormones as much in terms of appetite
suppression or control. It typically works more
by a pressure phenomenon. So if someone is eating and
they have a small amount of food, that band will
put some pressure there where they’ll feel some feedback
where they will feel full and not want to eat further. The other potential issue
with the band could be heartburn, not necessarily
immediately after the surgery, but maybe two or three years later when food may have a
tougher time going through. And we might have to loosen the band. So for several reasons, it’s become a little bit less popular,
but we do still offer it. And it has been a helpful adjunct in terms of getting more
weight off for people. Regarding weight loss with the Lap Band, we typically see about 40%
to 50% excess weight loss, which means that if you’re
100 pounds overweight, you’d lose about 40 to
50 pounds on average. Some patients are gonna
lose more than that, and some probably a little bit less. And it will depend on coming back for regular follow up visits to make sure that your band is appropriately tightened. There are some risks with
the Lab Band as well. Heartburn is one. Nausea or vomiting could be other risks, especially if you’re not taking time to chew your food thoroughly. And an additional risk,
which is really quite rare with the band, would be an erosion where the band could actually
erode into the stomach which would require its removal. Another surgery that
works only in the stomach, like the band, is the sleeve gastrectomy. This surgery has become more
popular in recent years. It now rivals gastric bypass
as one of the more common weight loss surgeries in the
country and in our practice. With the sleeve gastrectomy,
we create a small tube out of the stomach. So the stomach is normally
shaped like a sphere. And by using a stapling device,
we are actually removing about three quarters of the stomach fashioning it into a tube or a cylinder. And this way, there’s a
little bit more pressure, a little bit more
resistance into the stomach so that when you’re eating,
you feel full more quickly. It also actually impacts
the hormones of the body with regard to appetite and fullness so that you’re feeling less
hungry even before you eat and more full after you
eat a small amount of food. So the weight loss results with the sleeve are, generally speaking,
higher than with the Lap Band. They would average between 50%
and 70% excess weight loss. And like the band, it does
have some complications. All the weight loss procedures do. One of the potential
complications with the sleeve would be heartburn. And there would be a very small
risk of a staple line leak. That would be about 1% to 2%. So a very rare occurrence. But if it does occur,
that would be significant and would have to be dealt
with either surgically or through drains. Someone would be a good
candidate for a sleeve who wants to lose a
significant amount of weight and who also may have had
lower abdominal surgery or surgery on other parts of their abdomen like the small intestine or the colon, or if they’ve had a hernia
repair in the lower abdomen which was more significant. Because the sleeve will then
avoid any of that scar tissue by focusing mainly on the
upper part of the abdomen. It’s just on the stomach. So sometimes we also think
of it as a good procedure for someone who may be more medically ill. That the other two surgeries
that are more aggressive, the bypass and the duodenal switch, might be a little bit too much for them. And the sleeve is very
helpful in that situation. The sleeve gastrectomy
appeals to a lot of people because it is more simple
than the gastric bypass and the duodenal switch. It also does not affect
the small intestine. And therefore, there are very few, if any, absorption problems with
the sleeve gastrectomy. So this would be very helpful if someone already has difficulty
with iron absorption, or a vitamin deficiency. Of course we’re going to recommend that for all of these surgeries,
that you take your vitamins carefully and completely
after the surgery. The sleeve though really is focused exclusively on the stomach. We don’t see any problems
with bowel obstruction, or any kinking or twisting
of the small intestine, because we are simply not operating on that part of the body. It also tends to appeal to people who are looking for the surgery that will have the lowest
surgical complication risk but still get them at least
50% excess body weight loss. – The next procedure that
we will discuss in detail is the Roux-en-Y gastric bypass. We like to put the word
laparoscopic on the front of that because most of these
operations can be performed with a minimally invasive approach. And in fact, that particular
innovation in surgery over the last 15, 20 years now with respect to complex
surgical procedures has revolutionized not only
the access to the procedure but also has lowered the substantial risk that people face when
they’re looking at getting a hernia through a big incision, or the wounding that
could lead to infection. That’s pretty much
disappeared when we can do these procedures with a
minimally invasive technique. So the laparoscopic
Roux-en-Y gastric bypass. So what on earth does Roux-en-Y mean? Well, it’s a French word. It means the Y after Dr. Roux. Dr. Roux, for your historical
background, was a surgeon who lived well over 100
years ago in Switzerland. And he used an adaptive technique of dividing the intestine,
and then reconnecting it to itself creating a Y
appearance so that he could use a single limb of intestine to
connect to the upper stomach in the cases of severe
cancer problems in that era and/or difficult to manage
peptic ulcer disease surgeries where gastrectomy was involved. So his innovation was popular in its own
right for short term. It kind of lost its
application for a few decades. It was resurrected when we saw
a lot of peptic ulcer disease in this country in the 1950s and 1960s. And it was adapted to
the bariatric population at Ohio State University in 1973 at a time when the
gastric bypass was looking a little bit suspect because
people suffered so much from bile reflux problems of not having the bile diverted away
from their little pouches, their little stomachs. But in essence, just
to review first of all, the gastric bypass has
been with us the longest. It’s the most proven. We understand its risks and benefits. You can generally expect
an excess body weight loss in the range of 70% to 80% in
the first five to 10 years. You can probably count on
fewer than one in six patients actually regaining unacceptable
amounts of weight over time. But that will happen to some for reasons that we’re
still trying to understand. You can see a resolution of comorbidities such as diabetes as often as 80% to 85%. Hypertension, probably
more like 40% to 50%. Obstructive sleep apnea, again, 80% plus. Hypercholesterolemia without medication, in the 80% range again. So these comorbid conditions will go away with the gastric bypass. Interestingly, with the type 2 diabetes, it will disappear within
days of the operation, well before a patient’s lost enough weight to really account for the
fact that their blood sugar is returning to normal. And we, again, think this
has to do with the hormones in the intestine which have
an effect on the pancreas and on the liver and on the muscle and on the fat organ
itself to modulate it. In fact, maybe type 2
diabetes is a gut disease. And the problem is there rather
than in the pancreas itself as opposed to the type 1 diabetes where there is an insulin insufficiency. So the gastric bypass anatomically involves creation of a little pouch approximately one ounce to maybe two, in some cases, capacity. And this pouch will be
connected to the limb that Dr. Roux taught us how to use. And then it was further elucidated by Dr. Ward Griffen at
Ohio State back in the 70s. Connect the small pouch to
a bypassing or feeding limb that takes the food away from the stomach and away from the duodenum,
and then reconnects it with the enzymes that
came out of the pancreas and the liver at some distance downstream. There will be a common channel. It will have significant length sufficient to allow normal fat absorption and normal absorption
of fat-soluble vitamins. This rearrangement will not take care of the vitamin B12 issue. And you’ll have to take supplemental B12 and other B vitamins to be sure that you don’t see a deficiency. If you have a pre-existing
vitamin D deficiency, you’ll have to continue the vitamin D even after that operation. But this operation per se will not cause a vitamin D deficiency. Calcium is recommended to
be taken by all patients. And some pre-menopausal women will also have to take supplemental iron. So returning then to the diagram, we see that we have a little pouch. We have the bypassing limb. We have the food coming down
and joining the enzyme stream. And then, normal digestion taking place from that point forward usually involving somewhere around 3/4 of the intestine. There are three ways that that
operation works nonetheless. There is restriction. You have the little pouch and
you have a controlled outlet to that little pouch
which is not as generous as the normal esophagal
gastric connection. You have some malabsorption because some of these nutrients don’t join and mix with the food stream the way Mother Nature had intended her to do in the first place. And as a result, there’s a
little bit of malabsorption. However, we can’t explain weight losses on the basis of the malabsorption alone, or even to a significant degree. It might perhaps explain 10% to 15% of the body weight loss,
but that’s about it. And then the third way
that this operation works is through a metabolic pathway
or a physiologic pathway, which involves the
interaction between our brains in the neuroendocrine
system and the gut hormones as the feedback being
very complex as it is to suppress our appetite and
make us less interested in food and able to function quite
normally with far fewer calories than we were used to before the operation and to stay that way for
the rest of our lives. And that’s essentially the gastric bypass. Been with us the longest. We can predict the risks involved. And we’re comfortable with
the mechanisms of action, although I’m sure we
have more to learn too. But it remains a premier operation. And one should at least
think about that procedure before discussing, or
pursuing, some other option because of its preeminence and acceptance by surgical professionals the world over for such a long time. – But the most powerful
operation is the duodenal switch. What we do is we amputate. We start by amputating
the greater curvature of the stomach turning
the stomach into a tube. That’s that vertical gastrectomy that’s also called a
vertical sleeve gastrectomy. And that has several different effects. First of all, we realize that that alone has metabolic effect. Not only does it reduce your
stomach so you eat less. But more importantly,
it alters metabolism. The stomach is more complicated. There’s different types of
cells in the upper part, the fundus, than are in
the body of the stomach, or in the antrum which is the distal part. And when those cells either
come in contact with food or don’t come in contact with
food, it affects metabolism. And so when you take them
out of the circulation. Then we go down below the stomach onto the duodenum about an inch, the duodenum is the first
portion of the small intestine, and we divide that. And then we go down to the
colon and measure the bowel, develop what we call a Roux-en-Y limb which brings part of the bowel up to that we can bring up
to the stomach to sew. And we measure that from
the colon backwards. So that the food comes down from one side. The digestive enzymes
come down from another. And again, they mix where you’ve sewn the bowel back together. And then the digestion, most
of the absorption occurs in that common channel which
is the most distal portion. In the duodenal switch, that
common channel is short. It’s only about three feet long. Now for 35 years, we
thought about this operation in terms of behavior, and said it works because the stomach is made small. But that doesn’t really work because everybody can eat more with time and that doesn’t correlate
with weight gain. So we’ve said, “Well we’re bypassing 90% “of the intestinal tract; so therefore, “there’s substantial malabsorption. “You’re not absorbing as many nutrients.” In theory, you’re only
absorbing 10% of your nutrients. Right? Well the answer is wrong. The bowel has tremendous
absorptive capacity. It also has tremendous adaptive capacity. With time, the bowel adapts. It becomes more absorptive. And so, what we find is that you absorb carbohydrates fairly normally. Protein absorption is decreased maybe 10%; but in some patients, probably not at all. Fat absorption is decreased
anywhere between 30% to 80%. And again, we’ve said, “Well that works “’cause not absorbing fat
will give you less calories.” Fat’s not really a big problem
when it comes to obesity. When you look at the
metabolism of fat deposition in obesity, it’s really related
to carbohydrates, not fats. But what it does do is if
you have undigested fat that gets into the large intestine, that can cause gas and diarrhea. So for those patients that have
DS, that’s a good incentive for them to avoid high-fat foods. So again, it’s very very powerful. We see that patients on
average lose greater than 80% of their excess body weight. On average, less than 10% are regaining their weight at 10 years. So, very powerful weight
loss, very durable operation. And again, to demonstrate
its metabolic effect, we see that over 95%, anywhere
from 95% in our experience, 98% of our type 2
diabetics go into remission meaning that the disease goes away. That’s compared to a gastric bypass which is about 80% to
85% which is excellent versus a sleeve which is about 70%. Most of ’em go into remission within the first two or
three days after surgery, definitely within the first two weeks. So very very powerful metabolic operation. Downside: increased complications, okay. It is more complex and
therefore, there are more risks, such as leaks to occur. Nutritionally, you have to pay
attention a little bit more. Not a lot, but a little bit more because you can get into
some nutritional problems. – With any surgical procedure,
there is a risk of bleeding, and there is a risk of abnormal clotting. Abnormal clotting can lead
to blood clots in the leg and/or the pelvis which
could then propagate and go to the chest. And then we call it a pulmonary embolus. This isn’t a frequent
problem, but if someone has already had these
complications as a result of some other form of surgery
or just out of the clear blue after taking an airplane
ride to New York City, then we know that we’re dealing with a hypercoagulable
person who is at risk for having one of these
blood clot phenomena again. So in terms of would somebody die from this sort of operation? They don’t die very often. The risk of death is somewhere in the .2%, or one in 500, range in the
first 30 post-operative days. And most of those deaths
are as a consequence of the pulmonary embolus. Now if you compare gastric
bypass to total knee surgery, for example, or pelvic surgery,
or even gallbladder surgery, it competes favorably. In fact, far safer than any
kind of orthopedic procedure in terms of that particular risk. So you have to keep that in mind. These are nationwide kinds of numbers. And they’re far better than most people would have predicted 15 or 20 years ago. And maybe it’s because
surgeons are better. We’re more careful at looking at the data. And we have as a premier
interest keeping a patient alive, healthy, and living happy for a long time. So other risks can involve infection. When we do stapling, or we do suturing, there can be the
possibility of an infection. Sometimes, these
infections are as a result of a failure of tissue to heal properly leading to an intestinal
or gastrointestinal leak. As it turns out, if these
leaks are dealt with properly and aggressively, they needn’t lead to serious complications and/or death. But left untreated, and
neglected of course, you can see one of the
rare causes of death would be an infection. Pneumonia is possible with any operation. Recovery of normal activity
and using the lungs is critical early after
surgery along with walking and being able to be up and about. We rarely see these kinds
of complications in people who don’t smoke and people who
are walking quite regularly before they even have their surgeries. Those patients, you can almost put ’em in a totally different category. They’re probably gonna do just fine, even with respect to the infections. Some people will develop
a bowel obstruction. We have rearranged the intestinal anatomy. And this can either cause scar tissue, or not cause sufficient scar
tissue where it needs to. So bowel obstruction is a possibility. And I think the lifetime
risk after gastric bypass is probably in the one
in 20, or 5%, range, much as it would be after a hysterectomy or after an appendectomy where
they have a similar number. But the first year, 1% or 2% of patients will develop a bowel obstruction. There can be vitamin deficiencies. We mentioned already the B12 issue. You have to take supplemental B12. If acutely you’re unable to
eat for more than several days, you can develop an acute vitamin B1, or thiamine, deficiency. And in some cases, people will
get low calciums, perhaps. We’re still studying that and trying to investigate whether it’s really because of the surgery or other issues. But we know that the calcium
absorption is impaired with a gastric bypass. Iron deficiency anemia,
rarely seen in males or menopausal women, is
sometimes seen in young women in their reproductive years. So we have to watch for that. And usually, we’d recommend
that those young ladies take supplemental iron every day just in case. All of these vitamin deficiency issues also have to be monitored long term. Because if you don’t look
at what the numbers are in the bloodstream, you won’t know whether you’re deficient or not. And usually we can correct a problem if we know about it in advance. We rarely see heart attacks or strokes. Usually, we won’t operate on
people where we’re worried that that’s an impending disaster. We rarely see poor control of some severe
psychological conditions like bipolar personality or depression. But we do have to be sure that if a patient’s on an
antidepressant going into surgery that that patient as quickly
as possible after the operation then continues the same treatment so that we don’t interrupt that flow to keep things as smooth as possible. So those are the major issues. We’re talking about
something that’s not quite so disruptive to life
and/or threatening to life as maybe all of the other
frequently performed procedures are, like the gynecologic
stuff, the urologic procedures, and the orthopedic procedures. – So when we think about
these surgeries as a tool, like anything else,
there’s two parts to it. One is actually having the
surgery and making sure it’s done well, effectively, and safely. And that’s where we obviously
are here to help with that. The second part is the partnership of you making the right decisions: deciding to eat the right kinds of foods, the ones that are rich in nutrition, high in protein. Obviously, we’re gonna want to avoid foods that are high in carbohydrates,
sugars, and fats. And keeping that portion size down, drinking lots of water,
not liquid calories. So there’s a real
partnership that goes there: having a well done surgery along with good compliance afterwards. And when we see those two
things going together, really amazing results can happen. – We’re here to give you information, information that you can use
to make an informed decision about what’s best for you. We’re not here to talk
anybody into anything. We want you to continue
to do your homework. Talk to people who’ve had these surgeries. Talk to people who’ve done well. Talk to people who’ve had problems. But I counsel you to
talk to the individuals. The choice is yours
whether weight loss surgery is for you or not. If you tell me that it’s not, that’s fine. If surgery is for you,
it’s up to you to determine which procedure that you want. We’re not gonna tell you. We’re gonna help you make that decision by answering your questions. Now there are a number
of obstacles to surgery. So many times I hear from patients, “Well, you know, everybody tells me “this is the easy way out.” This is not the easy way out. Unfortunately, it’s the only way out for many of our patients. So we want you to really
talk to your family, talk to people and understand. Help them understand. Insurance can be an issue. We understand that. But bariatric surgery is a
very unique area in medicine. It is one of the only areas of medicine that is actually cost effective. We actually save the
healthcare system money. Other obstacles is just
the fear of surgery. And as I’ve said in
other portions of this, the risk is there. But the risk compared to other operations is not as high. We’ve tended to inflate the risk and the fear that goes along with it. On the other side, we tend to diminish, or tend to underestimate what
the damage of obesity’s done. Obesity is now one of the
world’s largest problems. And yet we tend to treat
it as nothing more than a personal body image issue
rather than a real health issue when it is really a major health issue. So you need to look at
yourself and what you really what problems you really
have, and what you’re really trying to accomplish. And what risks you’re
really willing to take in order to get this done. And then, take a consideration
of which operation is best for you. – You may be thinking,
“What do I do next,” after viewing this online seminar. In this case, you’re gonna want
to take the online post test to make sure that you’ve
captured the information that we’ve talked about here. And then, you’ll proceed
to submit your application so that you can come in for a consultation so that we can talk
more in detail with you about your health, your
medical conditions, which surgery is right for you, and to make sure that
you’re a good candidate for weight loss surgery. (peaceful music)

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