Speaker 1: Welcome to Stuff You Should Know, a production of I
Speaker 1: Heart Radio. Hey, and welcome to the podcast. I'm Josh,
Speaker 1: and there's Chuck and Jerry's lurking around here like a
Speaker 1: creeper weirdo who takes pictures of people without their permission.
Speaker 1: And this is stuff you should know. I like that.
Speaker 1: The joke is so nice. I said it twice. Uh
Speaker 1: So we should issue a trigger warning before this episode
Speaker 1: because we are talking about bariatric surgery, which some people
Speaker 1: refer to as weight loss surgery, and the topic of
Speaker 1: food and weight and weight loss and obesity and weight
Speaker 1: loss surgery could be very triggering for people. So if
Speaker 1: you want to listen to this one, great, we're gonna
Speaker 1: just break it down like we usually do. But if
Speaker 1: it's something that you don't want to listen to, we
Speaker 1: totally understand. Yeah. I mean, after researching this, I totally
Speaker 1: get why, like a fat positive or somebody who would
Speaker 1: be triggered by talk of that could be upset by
Speaker 1: it because there's a there's a pretty substantial argument to
Speaker 1: be made that bariatric surgery is conducted just to make
Speaker 1: obese and overweight people acceptable to society. That that's basically
Speaker 1: the upshot of of why people get this surgery done.
Speaker 1: That's not necessarily true for everybody, but there's a whole
Speaker 1: there's a whole school of thought that says, you know,
Speaker 1: this is this is a medical form of fat shaming
Speaker 1: for some people at least. Yeah. And there's another school
Speaker 1: of thought that it's uh, you know, uh, disease solving surgery. Uh.
Speaker 1: And the evidence plays out that it really does help
Speaker 1: with things like diabetes and hypertension and can be very successful.
Speaker 1: The reason I thought of this to begin with was
Speaker 1: I saw a Box article called We're barely using the
Speaker 1: best tool we have to fight obesity, uh. And this
Speaker 1: sort of cruxt of that article, which we'll talk about here,
Speaker 1: is that only about one percent of people who qualify
Speaker 1: for bariatric surgery use it. And the Vox article was
Speaker 1: all behind it and basically said, we have this great tool,
Speaker 1: uh for people that cannot seem to get down to
Speaker 1: what is a healthy weight for them who are suffering
Speaker 1: from hypertension diabetes, And they were saying, like, people should
Speaker 1: use the surgery more. And there's a lot of reasons
Speaker 1: why people don't, which we're also going to talk about. Yeah,
Speaker 1: I mean, there's one thing that everybody can agree on,
Speaker 1: like bariatric surgery works for weight loss to to it's
Speaker 1: like a spectrum of how much it works, but it
Speaker 1: definitely works. There's substantial results once it happens, and understandably so,
Speaker 1: because it is a radical surgical procedure where you're like
Speaker 1: really profoundly altering your internal anatomy so that you can,
Speaker 1: in some cases except less food, in some cases digest
Speaker 1: food less or have less of a chance to digest food.
Speaker 1: And we should point out we're talking about modern bariatric
Speaker 1: surgery because even ten years ago, results were wildly different.
Speaker 1: The preferred surgeries were wildly different. And uh, they've come
Speaker 1: a long long way in the past even ten years. Yeah,
Speaker 1: it definitely has hit its stride in the last ten
Speaker 1: years for sure. Um, but there's uh, as far as
Speaker 1: the history of this whole idea goes, it's not a
Speaker 1: new concept. Um. It goes back at least to the
Speaker 1: end of the nineteenth century. Some people say it goes
Speaker 1: back as far as the tenth century, which is amazing
Speaker 1: to think about. And you know what, Olivia helped us
Speaker 1: with this, and I had a feeling when I said, hey,
Speaker 1: let's cover the history I was like, there's got to
Speaker 1: be some you know, hundreds and hundreds of year old
Speaker 1: procedure that somebody did. And if you believe the story,
Speaker 1: in the tenth century, there was a King Sancho of
Speaker 1: Leon and Sancho was so big. And this is when
Speaker 1: Ed McMahon chimes in, how big was he? He was,
Speaker 1: oh big that he couldn't ride a horse or walk
Speaker 1: ouch as the story. As the story goes, so the
Speaker 1: doctor did the most basic form of weight loss surgery
Speaker 1: at the time, which was the suture King Sancho's lips
Speaker 1: shut so that King Sancho could only ingest a liquid
Speaker 1: diet and apparently lost about half his weight and got
Speaker 1: the thrown back. So that's a nuts so story. I
Speaker 1: find something else that comes later chuck even more nuts so. No. Um,
Speaker 1: In the twenty one century, there was a push um
Speaker 1: to basically reintroduce jaw wiring. Oh yeah, yeah, it's so
Speaker 1: this whole thing with King Sancho, one of the original
Speaker 1: kings of Leon. Um Like it got picked up like
Speaker 1: a thousand or so years later. Um, even though it's
Speaker 1: been shown nut to work, as we'll see, But the
Speaker 1: whole like modern bariatric surgery um actually was born in
Speaker 1: the nineteenth century out of um uh the same kinds
Speaker 1: of procedures, but for a totally different purpose. UM. A
Speaker 1: guy named Caesar rue came up with a surgical technique
Speaker 1: called the ruin why and UM. It was used in
Speaker 1: case you had like some sort of like um bowel
Speaker 1: or gastric obstruction. He figured out how to bypass it
Speaker 1: um and and connect your stomach to a different part
Speaker 1: of your intestine to get around the obstruction and yet
Speaker 1: you would still have functioning parts UM. And that was
Speaker 1: where the idea of um of gastric bypass surgery came from,
Speaker 1: or the name of it, yeah, which all the way
Speaker 1: back in nine two, which is really hard to believe,
Speaker 1: but it uh. They called it ruin why because I
Speaker 1: believe it's sort of forms y shape when you're finished.
Speaker 1: And that was about mortality rate initially in no surprise,
Speaker 1: but they got that down to about eleven, which is
Speaker 1: really great for the time period, I think. And then
Speaker 1: you know, things kind of went along as people were
Speaker 1: experimenting with those obstruction UH surgeries. There were doctors that
Speaker 1: started to say, hey, wait a minute, we now have
Speaker 1: a thing called a scale and humans we don't just
Speaker 1: need to put grain on it. Humans can stand on
Speaker 1: it so we know how much we weigh. And everyone went,
Speaker 1: what hey, that's a great idea. I can't wait to
Speaker 1: weigh myself every day, is what everyone said. I haven't
Speaker 1: weighed myself in a long time. I kind of quit
Speaker 1: me either, me too, But hard to believe, but yes,
Speaker 1: humans started weighing themselves, and all of a sudden in
Speaker 1: the nineteen twenties and thirties, doctors started in patients started
Speaker 1: paying attention to their you know, to their little literal weight,
Speaker 1: not just like how they looked and how they felt
Speaker 1: right weight gain and um being overweight and I'm using
Speaker 1: scare quotes here, um or obese again, scare scare quotes.
Speaker 1: Um became medicalized at point, like it became a medical issue,
Speaker 1: a problem to be treated. And it's just that whole idea,
Speaker 1: and that whole concept has has taken off since then.
Speaker 1: It's just so so fully ingrained in our our society
Speaker 1: that it's really interesting to think, like it's only been
Speaker 1: around for maybe a hundred or so years. But um,
Speaker 1: they basically would give you anything that you wanted to
Speaker 1: lose weight, like amphetamines, laxatives, UM, just anything. You just
Speaker 1: go to the doctor and he give you whatever. UM.
Speaker 1: But it wasn't until the nineteen forties that that whole
Speaker 1: idea of medicalizing um being overweight, uh like, really kind
Speaker 1: of spread into society at large, when the insurance companies
Speaker 1: got involved. Yeah, and I should point out to you
Speaker 1: you're using scare quotes when you say things like overweight
Speaker 1: and obese because there is so much individual variation in
Speaker 1: in body weight and how people carry it and how
Speaker 1: healthy they are. And we understand this, I mean, we
Speaker 1: sort of understand this now as far as people accepting it,
Speaker 1: but there's still not a lot of acceptance around it.
Speaker 1: That's why when you calculate something like a b M
Speaker 1: I that is for you know, to judge a population
Speaker 1: that does not take into an account take into account
Speaker 1: of an individual or their muscle mass or you know,
Speaker 1: their body shape. So they kind of throw these tags
Speaker 1: on overweight and obese and b M I that are
Speaker 1: useful in a certain sense, but also not useful in
Speaker 1: a certain sense. Yeah. And the b M I scale
Speaker 1: was invented in the nineteenth century by a guy named
Speaker 1: Adolf quite Alet. He was a sociologist and he based
Speaker 1: exclusively on white Western Europeans. So in a way, you
Speaker 1: could say the b m I scale has created the
Speaker 1: ideal body form is a average sized or whatever the
Speaker 1: b m I says, the average size white European. The
Speaker 1: problem is that's that's a problem in and of itself,
Speaker 1: because you now have a compartment that you're trying to
Speaker 1: shove everybody in regardless, and if you're not in that
Speaker 1: compartment that you're supposed to be in, you have a problem, um,
Speaker 1: a medical problem even maybe even a life threatening problem. Um.
Speaker 1: But more than that, if you're not white and Western European,
Speaker 1: that scales shouldn't really apply to you. But that hasn't
Speaker 1: kept humanity or people from plugging all of humanity into
Speaker 1: that same b m I scale. So there's a lot
Speaker 1: of questions about the bm I scale itself, and especially
Speaker 1: in recent years. Yeah, and I hope everyone understands when
Speaker 1: we use those terms. All of this goes into that. UM.
Speaker 1: As doctors were looking at uh, you know, still kind
Speaker 1: of performing these surgeries, they noticed that, hey, you can
Speaker 1: lose weight, you know the initial ruin why when you
Speaker 1: had an obstruction, They were like, wait, this is good
Speaker 1: for weight loss? Too, because quite simply, your stomach is
Speaker 1: smaller and your body is not absorbing. You can't eat
Speaker 1: as much and it's not absorbing as many nutrients and
Speaker 1: in you, they believe. The very first real deal weight
Speaker 1: loss surgery occurred again from a Swedish surgeon named Victor
Speaker 1: ein Rickson, when Victor removed a hundred hundred three centimeters
Speaker 1: of small intestine from a woman, a thirty two year
Speaker 1: old woman who didn't lose that much weight, but supposedly
Speaker 1: it improved her life quality. Yeah, and just the next
Speaker 1: year UH an American named Dr Richard Varco created a
Speaker 1: slightly altered, ruined why procedure called the j juno ilio bypass.
Speaker 1: I practiced that so many times. My brain just says, Nope,
Speaker 1: you're never gonna get it right. The first time, I
Speaker 1: think that was probably close. It was close, but there
Speaker 1: was like a hitch and a stumble in there too.
Speaker 1: Ju Juna lial is what I would say, oh, showing
Speaker 1: off a but then may not be right either, and
Speaker 1: that comes from I'm sorry, that's that's what the first time.
Speaker 1: They called it bariatric surgery, right, yes, And bariatric is
Speaker 1: from the Greek for weight or heavy UM. So they said,
Speaker 1: I guess this is surgery for heavy people. Maybe I'm
Speaker 1: not sure, but that's where that's that's about. The fifties
Speaker 1: is about when that that name became applied to it UM.
Speaker 1: And then in the sixties UM they were starting to
Speaker 1: do studies and experimentation with it. And there was a
Speaker 1: study that found that UM a temporary procedure where you
Speaker 1: would have like your stomach moved to a different part
Speaker 1: of your small intestine. Temporarily you lose the weight and
Speaker 1: then they go reverse the procedure. They found that patients
Speaker 1: just basically gained the weight back after the procedure was reversed.
Speaker 1: And at that point in the early sixties, these surgeries
Speaker 1: started to become permanent in nature pretty much across the board. Yeah,
Speaker 1: you know, that was my first surprise in this research.
Speaker 1: I thought, even modern bariatric bypasses and stuff, I thought
Speaker 1: that was all a temporary thing, and that like, you
Speaker 1: don't live with an egg sized stomach for the rest
Speaker 1: of your life, and that's not true. You live with
Speaker 1: an excized stomach the rest of your life. Yeah. They
Speaker 1: as we'll see, they remove a significant portion of your
Speaker 1: stomach in either one of the surgeries that you get,
Speaker 1: and that when they do that, that's that's irreversible, that
Speaker 1: part of your stomach is gone. What's amazing to me
Speaker 1: is that they've gotten good enough at it that it
Speaker 1: has tremendous results, and the complications have kind of died
Speaker 1: down over the years to where the risk of death
Speaker 1: is now down to about point one percent. Uh. In
Speaker 1: the twenties, it's gotten that low, but just around two thousand,
Speaker 1: twenty years ago, it was still up at one percent,
Speaker 1: which is really high for a surgical procedure in the
Speaker 1: Western world in the twentieth century, but they've they've whittled
Speaker 1: it down ten times lower than it was twenty years
Speaker 1: before because they started using lap of scopic surgery. That's right.
Speaker 1: Olivia points out that point one percent is less than
Speaker 1: knee replacement surgery, just to kind of put that, you know,
Speaker 1: to frame that. Yeah, and also I want to correct myself.
Speaker 1: It wasn't in the twenty first century. It was in
Speaker 1: the mid twentieth century that they tried to bring back
Speaker 1: jaw wiring, but it just doesn't work, that's right. And
Speaker 1: as a result of the success rate and the obviously
Speaker 1: whittling that death rate down to point one. UM surgeries
Speaker 1: now are crunching up towards a three hundred thousand per year.
Speaker 1: I think two hundred and fifty six thousand was the
Speaker 1: last year that we have a number four, and that
Speaker 1: was in twenty nineteen, as opposed to about twenty thousand
Speaker 1: a year in the nineties and about a hundred and
Speaker 1: fifty thousand and change in the mid two thousand's because
Speaker 1: they said, hey, everybody, we don't killed nearly as many
Speaker 1: of you as we used to come and get it.
Speaker 1: Should we take a break? Sure? All right, that was
Speaker 1: a good setup. So let's take a break and we'll
Speaker 1: be right back. Okay, Chuck, So we're back, and I
Speaker 1: think it's high time that we actually talked about how
Speaker 1: a bariatric surgery goes UM. And there's a couple of
Speaker 1: different ways you can go UM. Some are more popular
Speaker 1: than others. It seems like one that used to be
Speaker 1: more popular than ruin why the bypass has become less
Speaker 1: popular in favor of one called sleeve. Guests Guests direct
Speaker 1: to me, See, I can never get it. The first
Speaker 1: time you want to say gastronomy, I did. I wanted
Speaker 1: to say gastro pub Uh yeah, this is easily the
Speaker 1: most common um performed today. This is the one that's
Speaker 1: very very popular right now. They remove about eight of
Speaker 1: your stomach and basically the stomach, instead of being a
Speaker 1: large pouch, becomes a narrow sleeve. That's why it's called sleeve.
Speaker 1: Gets struck to me, and it's it's very very simple,
Speaker 1: and that you have a much, much, much much smaller stomach,
Speaker 1: so you can't eat as much. You will feel full
Speaker 1: more quickly. But what also happens is and I'm not
Speaker 1: sure if they had a hunch this would happen, or
Speaker 1: if they knew this would happen, but it also tricks
Speaker 1: the body into releasing a few of those hormones that
Speaker 1: say that you're hungry. So it's not like, oh, I'm
Speaker 1: still hungry all the time. Like you just have a
Speaker 1: smaller stomach. You eat less and you're satisfied. Yeah, you
Speaker 1: eat less and you have the desire to eat less
Speaker 1: on top of that. So, I mean you can imagine
Speaker 1: that this has tremendous results. And I think that they
Speaker 1: did know that that hormone um effect was going to
Speaker 1: happen because they specifically remove a part of the stomach
Speaker 1: called the fundest and that's the portion that expands when
Speaker 1: you eat a lot of food, So your stomach can't
Speaker 1: expand when you eat food. You got to keep that
Speaker 1: in mind. And then also the funnest is where grellan
Speaker 1: is largely made, and that's that hunger hormone. So you're
Speaker 1: producing less grillan and you just can't physically fit that
Speaker 1: much food into your stomach anymore. Right, And like I said,
Speaker 1: it's the most popular form today. I think in the
Speaker 1: mid two thousand's it was about eight bariatric surgeries. Now
Speaker 1: or in twenty nineteen it was it's even more than
Speaker 1: that two. I just don't have the most recent number.
Speaker 1: I was, um, I just got back from vacation in
Speaker 1: Mexico and one of the two families that we kind
Speaker 1: of hung out with him buddied up with. I was
Speaker 1: chatting with the guy and I was like, so, what
Speaker 1: do you do and he said, I'm a bariatric surgeon
Speaker 1: and no kidding. And I was like, what, We're about
Speaker 1: to do a podcast episode on that, and he said,
Speaker 1: what's a podcast. I'm just said, well, what's a bariatric surgery? Now?
Speaker 1: He didn't ask that because we had already talked a
Speaker 1: little bit, but he uh, very nice guy from Texas
Speaker 1: and he um talked a little bit. I didn't like
Speaker 1: want to bother him too much about it, although he
Speaker 1: really really enjoyed talking about it because he's not only
Speaker 1: a bariatric surgeon, but he's very much a wellness doctor
Speaker 1: and he believes that it's just part of a wellness
Speaker 1: plan for your life. Um, not just like all right,
Speaker 1: we'll do it and then have fun in the world. Um.
Speaker 1: So he was a good guy to talk to you.
Speaker 1: But he talked about sleeve gast direct Uh here there
Speaker 1: I went again, sleeve gastro pub being the most popular
Speaker 1: gastro pub. Yeah, it is the most popular gastro pub
Speaker 1: of all time. So what how does that surgery go? Though? Um,
Speaker 1: it's pretty quick for one Yeah, I think it's like
Speaker 1: forty to seventy minutes, not that long. You stay in
Speaker 1: the hospital for a couple of nights. They keep an
Speaker 1: eye on you. And one of the reasons they're keeping
Speaker 1: an eye on you is because for two weeks afterward,
Speaker 1: you can have nothing but a liquid diet. Because if
Speaker 1: you go look up sleeve gastrectomy videos, Um, there's a
Speaker 1: lot of computer animations out there that show you what
Speaker 1: they're doing, so you can imagine that if you remove
Speaker 1: probably doably, I think maybe of your stomach um, it
Speaker 1: needs to heal. And the way that you help at
Speaker 1: heal over the first two weeks is by just drinking
Speaker 1: like broth, water, um, maybe some gatorade if you're feeling spicy. Um.
Speaker 1: But again, remember like you're not sitting there going bonkers
Speaker 1: wanting food. Um. Most people who have a sleeve gets
Speaker 1: tructomy report having to make themselves eat. They have to
Speaker 1: keep a strict schedule because they don't want to eat
Speaker 1: like they used to, like most people want to eat. Yeah,
Speaker 1: And I mean we'll talk a little bit about maintenance later,
Speaker 1: but I think in the end they recommend you eat like,
Speaker 1: you know, four to six very small meals a day,
Speaker 1: Like there's no way around it. You're you're going to
Speaker 1: change you're eating habits in your lifestyle in a big,
Speaker 1: big way if you have this surgery. And I read
Speaker 1: a lot of first person accounts of like, you know,
Speaker 1: can you ever go out to eat again and said
Speaker 1: down with your family and enjoy a meal, because if
Speaker 1: you're filling something the size of an egg, it's like
Speaker 1: can you even order a meal? And you know, everyone
Speaker 1: that I read was it's like, yeah, you know, you
Speaker 1: you get used to it. You go to the restaurant,
Speaker 1: you order an appetizer maybe, and you don't even eat
Speaker 1: half of the appetizer and you take the rest home.
Speaker 1: You do a lot more talking at dinner, and you
Speaker 1: don't drink alcohol. You can't drink liquids while you eat
Speaker 1: at all. Um, they're saying, you know, you drink liquids
Speaker 1: no more than thirty minutes before you have a meal
Speaker 1: because there's so little room. Uh. I did see some
Speaker 1: people say they could drink a little alcohol, but it's
Speaker 1: really recommended you basically quit drinking. Certainly, you don't want
Speaker 1: to drink beer when you have a tiny egg stomach. God,
Speaker 1: oh my god, that sounds terrible. It does, um, but
Speaker 1: you there's no way around it. You are changing your lifestyle.
Speaker 1: But across the board, when I read all these first
Speaker 1: person accounts, everyone was like, you get used to it,
Speaker 1: and the trade off is for them the they are
Speaker 1: much healthier and happier and generally didn't have the regrets.
Speaker 1: I'm sure you could find some people that had regrets
Speaker 1: and were like, I missed sitting down and eating big
Speaker 1: meals with my friends and family. But I mean, most
Speaker 1: of the people that I read were pretty satisfied with
Speaker 1: the surgery. So um, after you get surgery too, and
Speaker 1: I can imagine they're satisfied because when you get a
Speaker 1: sleeve guests trick to me UM, the doctors who performed
Speaker 1: this these kind of procedures they use as something called
Speaker 1: excess weight to qualify the success of the surgery. And
Speaker 1: excess weight is the difference between your ideal weight and
Speaker 1: what you weighed before the surgery and eighteen months after
Speaker 1: the procedure, patients typically have lost about seventy percent of
Speaker 1: their of their body weight after after the surgery. Within
Speaker 1: a year and a half, their excess weight, right, Yes,
Speaker 1: they're excess weight. Yeah, And you know, generally it's not
Speaker 1: like uh, the days of your with gastric banding, which
Speaker 1: has really gone out of favor, UM a lot of complications,
Speaker 1: the weight generally did not stay off. But with sleeve
Speaker 1: gastrectomy and then as we'll see with gastric bypass, the
Speaker 1: weight does tend to stay off for years, although people
Speaker 1: do gain some of the weight back. UM. One study
Speaker 1: saw after twelve years about forty percent of patients had
Speaker 1: maintained a thirty percent weight loss or more compared to
Speaker 1: their original total weight, and where at least ten percent
Speaker 1: lighter than they'd been. So sixty percent of people gain
Speaker 1: back more than thirty percent of their weight. Is that
Speaker 1: a way to say it? Yeah, I have to admit
Speaker 1: you just made my brain do a somersault. But yes,
Speaker 1: that's the that's the that's the converse, I guess. Huh. Yes,
Speaker 1: So sixty percent of people gain back more than that
Speaker 1: thirty percent, But it doesn't mean they gained all the
Speaker 1: weight back that could have been. No, because again, like
Speaker 1: you said, sent or at least ten percent lighter than
Speaker 1: they've been before a lot of percentages flying around here. Yeah. So,
Speaker 1: but the upshot is is that you are definitely going
Speaker 1: to lose weight if you're a physician, UM, especially if
Speaker 1: you're a bariatric surgeon. You consider bariatric surgery the gold
Speaker 1: standard for rapid and sustained weight loss. That like, that's
Speaker 1: if if you have a patient who is um like
Speaker 1: again obese UM to a to like maybe say three
Speaker 1: hundred four hundred pounds or more UM, you would say, look,
Speaker 1: you really need the surgery and it's going to change
Speaker 1: your life. It's you would probably also tell them it's
Speaker 1: going to save their life too. Again, it's questionable, but
Speaker 1: that's the medical stance, that's right. Uh. Then we have
Speaker 1: the gastric bypass, the original rue on y or r
Speaker 1: y GB surgery. Uh. They staple off part of your stomach.
Speaker 1: They reduce that remaining part too. Again about this as
Speaker 1: an egg, and then they attach it to that rue
Speaker 1: lamb of the small intestine and you're you know, most
Speaker 1: of that stomach and the upper small intestine is now bypass.
Speaker 1: That's why they call it bypass surgery. And this one
Speaker 1: is I think there are a few more complications now
Speaker 1: and that's why this one's fallen out of favor a
Speaker 1: little bit. Compared to sleeve guest struck to me, right, Yeah,
Speaker 1: the impression I have is that sleeve gets struck to me,
Speaker 1: is much more um or much less complicated afterward, because
Speaker 1: you're not messing with the original plumbing. All you're doing
Speaker 1: is removing a large section of the stomach. Everything else
Speaker 1: remains as is, so you still have like a risk
Speaker 1: of developing an infection or leakage in your stomach or
Speaker 1: all sorts of stuff. UM, but you're not like bypassing,
Speaker 1: you're not detaching the stomach and then reattaching it elsewhere,
Speaker 1: which adds an entirely different dimension to that surgery. And
Speaker 1: that's what ruined. Why is and when you're doing that, Chuck,
Speaker 1: The reason why you're doing that, UM is because you're
Speaker 1: you're basically, UM keeping the small intestine from being able
Speaker 1: to digest as much like fats carbohydrates all that stuff
Speaker 1: from the food you eat, so you're eating less, but
Speaker 1: you're also digesting less of it or absorbing less of it,
Speaker 1: so that leads to rapid weight loss as well. That's right. So,
Speaker 1: like we said, as far as this being an effective thing, uh,
Speaker 1: you know, losing weight for some people is really really
Speaker 1: really hard. So for some people it is a mountain
Speaker 1: that they cannot overcome. Uh, diets, you know, I think
Speaker 1: the verdict is in across the board on diets, which
Speaker 1: is diets are a quick fix and it's very hard
Speaker 1: to keep that maintenance. Everybody basically agrees that UM, long
Speaker 1: term weight loss involves life complete lifestyle change and not
Speaker 1: some kind of crazy diet that you're doing, or even
Speaker 1: not crazy diet that you're doing. UM. Exercise we've talked
Speaker 1: about on the podcast is great for your body, but
Speaker 1: you cannot exercise the weight off if you don't change
Speaker 1: the food and drink portion of your life precisely. And
Speaker 1: even even when you do diet like um, you you
Speaker 1: may actually change your body so that you aren't able
Speaker 1: to lose weight after a point, and when you stop dieting,
Speaker 1: you may gain back more weight than before, So that
Speaker 1: could be dangerous for sure. You don't want to mess
Speaker 1: with your metabolism too much. Um and I would direct
Speaker 1: people to our Intuitive Eating episode. We talked a lot
Speaker 1: about that, but um that like that, Like you said,
Speaker 1: the verdict being in on dieting has really kind of
Speaker 1: supported the idea of bariatric surgery is not only the
Speaker 1: gold standard but really the only real option you have
Speaker 1: if you want to lose a serious amount of weight.
Speaker 1: Um and so uh A lot of people have been
Speaker 1: studying like just how how effective it is, and like
Speaker 1: you said, um, you know, there's there's lots of percentages
Speaker 1: flying around and how many people kept how much weight off,
Speaker 1: But there was this one study that looked at people
Speaker 1: who have gastric bypass surgery and contestants on the biggest
Speaker 1: loser UM, which is a weight loss competition that's been
Speaker 1: on TV forever UM and they use them because it's
Speaker 1: hard to find a group of people who lose about
Speaker 1: as much weight as you would lose with the gastric
Speaker 1: bypass surgery UM, but without using gastric bypass surgery, So
Speaker 1: they made like an ideal control group. That's right, uh,
Speaker 1: And what they found is really super interesting. Both groups
Speaker 1: lost about the same amount of weight, or at least
Speaker 1: similar amounts. But the biggest loser group I hate even
Speaker 1: saying that, I hate that dumb title. The biggest loser
Speaker 1: group experience what's called metabolic adaptation, which is to say
Speaker 1: that their metabolism slowed down and it made it harder
Speaker 1: to keep that weight off. So six years on down
Speaker 1: the road, that control group with the biggest loser uh
Speaker 1: bunch had regained a lot of that weight, but their
Speaker 1: metabolism was still really low uh and lower than and
Speaker 1: slower than it was to begin with, So it kind
Speaker 1: of permanently altered. It seems like I don't know about permanently,
Speaker 1: but at least six years later had had altered their metabolism.
Speaker 1: It's not permanent, no, but they will have to go
Speaker 1: through the process of retraining their body to not store
Speaker 1: as much fat or burn energy slower um in order
Speaker 1: to get back to normal. But that's what dieting can
Speaker 1: really do to you. But what happened with the other group, Well,
Speaker 1: the other group, the bariatric surgery patients. They they're metabolism stabilized.
Speaker 1: So there's a lot of rapid weight loss just because
Speaker 1: you're you're taking in less, but also because your body
Speaker 1: is not producing hunger hormones like growing and it may
Speaker 1: actually actually produce more of the satiated um. Is that right?
Speaker 1: Satiated satiety, sure, sitcom um sat safety hormone leapton so um,
Speaker 1: they're metabolism. Actually, it just stabilized. So eventually they stopped
Speaker 1: losing weight, maybe gained a little bit back, but typically
Speaker 1: kind of hold um. What's what's referred to as a
Speaker 1: baseline weight, basically the weight that your body and your
Speaker 1: metabolism says, this is how much you should weigh. Try
Speaker 1: as you will, we're always going to try to get
Speaker 1: back to this, and if you mess with us, we're
Speaker 1: gonna make it harder on you than ever, right, Which
Speaker 1: I mean, that's study really makes a pretty good case
Speaker 1: for bariatric surgery as an option for people. Right, Uh,
Speaker 1: so does this There was a meta analysis in that
Speaker 1: saw certain we talked earlier about, you know, health complications
Speaker 1: from caring too much weight UM, that bariatric surgery reduces
Speaker 1: the risk to develop type two diabetes by h and
Speaker 1: hypertension by six and if you already had those conditions
Speaker 1: going in, which can be one of the criteria to
Speaker 1: get the surgery to begin with. Uh, the surgery was
Speaker 1: associated with remission. Even so, just to take a little sidebar,
Speaker 1: I didn't understand how people can say, okay, if you
Speaker 1: if you have if you're faced with data like that,
Speaker 1: how can you possibly say that obesity um is not
Speaker 1: necessarily linked with poor health, or that there's a concept
Speaker 1: called healthy at any size, which I want to do
Speaker 1: an episode on eventually. UM. And the thing that I
Speaker 1: saw the explanation is, yes, these things are associated with obesity,
Speaker 1: with being overweight. But it's the point is is if
Speaker 1: you're a b obese or overweight, you're not automatically going
Speaker 1: to get type two diabetes, not automatically going to develop hypertension.
Speaker 1: And in much the same way that smokers may or
Speaker 1: may not develop lung cancer. People who are overweight or
Speaker 1: obese may or may not develop type two diabetes or
Speaker 1: hypertension or some of the other um maladies I guess
Speaker 1: associated with being overweight by the medical establishment. Yeah, yeah,
Speaker 1: it's a good way to look at it. Yeah, I
Speaker 1: just wanted to add that. Sure, but Chuck, the thing
Speaker 1: is it is it is evident that yes, if you
Speaker 1: do have those maladies, Yeah, gastric bypass surgery bariatric surgery
Speaker 1: will definitely help your health outcomes as a result. Yeah,
Speaker 1: or headed toward those, And it's not like if you
Speaker 1: get regular physicals, you know when you're headed toward those,
Speaker 1: towards type two diabetes and hypertension. It's not like a
Speaker 1: switch is just flicked and you're like, all right, I've
Speaker 1: got those two conditions now, Like you know the blood
Speaker 1: tests that they give you, and trust me, I've been
Speaker 1: I go every year now, Like I want to know
Speaker 1: about my body. I'm not one of these guys who
Speaker 1: is overweight and like just buries my head in the sand,
Speaker 1: probably to my detriment. Want to get too many tests
Speaker 1: done and things like that, because I want to know
Speaker 1: what's up. But you know, I've seen my own health
Speaker 1: like creep up towards those numbers two levels that I
Speaker 1: don't like, So then I have to work to like
Speaker 1: get those numbers back down. And it's all it's all
Speaker 1: data driven, and it's all from blood tests. And I
Speaker 1: just encourage people to go get their physicals every year.
Speaker 1: There's no I know people that bury their head in
Speaker 1: the sand and are just like, I just don't want
Speaker 1: to know about that stuff. And I just think people
Speaker 1: should really be uh advocate for their own health and
Speaker 1: and uh, what's the word I'm looking for when you
Speaker 1: are just sort of preemptively um, sort of getting tests
Speaker 1: to find out where you stand, you know, um taking action, Yeah,
Speaker 1: well taking action on the medical side. Uh, so you
Speaker 1: can take action you know at home. Yeah. It also
Speaker 1: you know, you don't have to go to a doctor
Speaker 1: to get blood tests. You can you can order your
Speaker 1: own basically and just go to like quest or lab
Speaker 1: Corps or something. Oh yeah, just like do your own
Speaker 1: blood pail. Yeah yeah, and they have you know, the
Speaker 1: results show if you're in like a normal range or
Speaker 1: whatever over for everything. Yeah, or if you cut yourself,
Speaker 1: squeeze a little bit on a piece of white paper
Speaker 1: and just look at it for a while that's right,
Speaker 1: what does it look like? It's like reading tea leaves
Speaker 1: or chicken guts? Uh, what was I gonna say? Oh?
Speaker 1: There they did. As far as the meta analysis another
Speaker 1: study with that analysis, they found about half the people
Speaker 1: with type two diabetes that had the surgery had enough
Speaker 1: improvement that they could get off their medication. And that's
Speaker 1: what remission basically is. It's sort of like you're always
Speaker 1: an alcoholic even though you quit drinking, Like technically you're
Speaker 1: still diabetic, but if it's in remission, that means you've
Speaker 1: gotten your numbers down to a safe level, you can
Speaker 1: get off the medication and stuff like that. So um. Also,
Speaker 1: by the way, there's that's questionable as well as whether
Speaker 1: you're still an alcoholic after you quit drinking. Well is it? Yeah?
Speaker 1: I mean it's sort of just terminology though right, No,
Speaker 1: not necessarily. I think there's a there's definitely a school
Speaker 1: thought that's that's once an addict, always an addict, Like
Speaker 1: you will always be addicted. Even if you for the
Speaker 1: rest of your life fifties sixty seventy years without ever
Speaker 1: taking another drink, you'll always be an alcoholic. Other people say, no,
Speaker 1: that's that's not true, And that's a whole mindset that
Speaker 1: keeps people trapped in this idea that they're addicted or
Speaker 1: an alcoholic when they aren't any longer, and it produces
Speaker 1: a lot of unnecessary shame and hardship. You know. I'm
Speaker 1: glad to hear that because I always thought that was
Speaker 1: weird when someone who like quit drinking twenty years ago says,
Speaker 1: I'm still an alcoholic, And I just thought that's not
Speaker 1: for me to judge, Like that's their terminology that they
Speaker 1: need to use. But I always thought that was a
Speaker 1: strange way to think about it. So, but I think
Speaker 1: that does apply for some people. I'm not saying for
Speaker 1: all people. Yeah, it's just the opposite is true as well. Um,
Speaker 1: just because you're an alcoholic, it doesn't mean you're always
Speaker 1: going to be an alcoholic for everybody. Okay, I got you, so,
Speaker 1: chuck chuck chuck. Yes, I say we take a break.
Speaker 1: All right, let's do it. I'm gonna go into remission
Speaker 1: and use the restroom. All right, we're back. I'm glad
Speaker 1: we cleared that up about alcoholism. Yeah, I didn't know
Speaker 1: that that was going to pop up. I didn't either,
Speaker 1: And I'm glad you said something though, that's that's good information. Yeah,
Speaker 1: I might say it stuff you should know. I just
Speaker 1: used the line that I hate that everyone else uses
Speaker 1: when you first meet them and tell them what you do.
Speaker 1: Oh yeah, at some point when you meet someone new
Speaker 1: and you tell what you do in the name of
Speaker 1: the show, at some point they say, oh, that sounds
Speaker 1: like stuff you should know. Right, Yeah, they definitely do,
Speaker 1: or they'll hit you with So tell me something I
Speaker 1: should know. Yeah. I also realized just this week why
Speaker 1: some people who right in abbreviate the show s U
Speaker 1: s K. I've never understood what they were doing. I
Speaker 1: finally noticed the why and the you are next to
Speaker 1: each other on the keyboard on a querity keyboard. Oh
Speaker 1: you think that's what it is. It's got it's got
Speaker 1: to be. I just figured people were doing the Prince
Speaker 1: thing or just you know, internet shorthand for you as
Speaker 1: you right, But it doesn't make Oh yeah, I guess
Speaker 1: it does. It does. Okay, Well, maybe back in the
Speaker 1: wilderness as much as I was before. Um, let's talk
Speaker 1: about some risk factors. You did talk about leakage always is,
Speaker 1: you know, just with any kind of abdominal surgery, you
Speaker 1: might get there's a risk of infection and clotting, hernia, ulcer, gallstones,
Speaker 1: botwel obstructions. I think most I think you find more
Speaker 1: of those specific ones in the gastric bypass rather than
Speaker 1: the sleep eve and then explain to everyone with these
Speaker 1: two great words together mean dumping syndrome one of the
Speaker 1: most unfortunately named medical conditions that has ever been put.
Speaker 1: I think so dumping syndrome is where you basically um,
Speaker 1: when you're eating after gastric bypass surgery or bariatric surgery. UM,
Speaker 1: the food just moves out of your stomach too quick.
Speaker 1: It's not it's not predigested enough, so when it hits
Speaker 1: your um guts, it causes cramps, it can cause diarrhea.
Speaker 1: There's another variation called late dumping syndrome, where if you
Speaker 1: eat a an overly sugary meal or snack or whatever, um,
Speaker 1: it can drop your blood sugar precipitously because so much
Speaker 1: insulin gets released because again it wasn't predigested or pre
Speaker 1: absorbed in any way. It just kind of shows up
Speaker 1: in your gut like here, I am, I'm a bite
Speaker 1: of steak. Let's see what we can do. Yeah, the
Speaker 1: other thing you're gonna have to do is potentially takes supplements. Uh,
Speaker 1: you know, just because you're eating so little, you're also
Speaker 1: getting a fewer um good things into your body. And
Speaker 1: you know, hopefully you're eating good things if you continue
Speaker 1: to eat just very small amounts of bad stuff. And
Speaker 1: again we're using scare quotes, but you know, if if
Speaker 1: I get this and I continue just to eat fried
Speaker 1: chicken and mashed potatoes, then I'm not giving my body
Speaker 1: the nutrients that it needs, and you might need to
Speaker 1: take supplements. One thing you definitely have to do is
Speaker 1: eat really really slow and chew like you've never chewed before. Yeah,
Speaker 1: you gotta chew like um, Dr Kellogg. Yeah, I mean
Speaker 1: I think you're essentially trying to trick your body into
Speaker 1: thinking you're on sort of a liquid diet. Still. Yeah,
Speaker 1: but I think also your body is sending you signals
Speaker 1: like please please stop. The three bites of steak is
Speaker 1: too much, you know, like it's sending you those signals.
Speaker 1: So you're you, Yeah, And I think it's from what
Speaker 1: I understand, take some um some working out on figuring
Speaker 1: out how to eat under this new under these new circumstances.
Speaker 1: It's a little bit of trial and error, but that
Speaker 1: people you know, work it out over time. I bet
Speaker 1: you really appreciate food. Yeah, I could see that being, uh,
Speaker 1: an effect of it. I could also see becoming totally
Speaker 1: neutral towards food being in effect of it as well. Yeah.
Speaker 1: I mean they're definitely psychological impacts. And that is played
Speaker 1: out with another interesting side effect, which is and I
Speaker 1: saw this in a few places, is that you are
Speaker 1: more likely to get divorced then if you didn't have
Speaker 1: the surgery. And I think there was one study. There's
Speaker 1: been plenty of studies, but there was one that found
Speaker 1: nine got divorced after the surgery compared to six percent
Speaker 1: of the control group. And there are a lot of
Speaker 1: ways to look at that one. Certainly is it it? Uh?
Speaker 1: Maybe you have the increased confidence to leave a relationship
Speaker 1: you didn't have the confidence lead before that you should
Speaker 1: have leaved, like a bad relationship. Apparently you get married
Speaker 1: or in a relationship more if after you get the surgery,
Speaker 1: which also could make a lot of sense. Yeah, which
Speaker 1: is nice. I like that one. That's the silver lining
Speaker 1: to the other cloud. You know. Um so if you
Speaker 1: if you said, okay, what about me, how do I
Speaker 1: know if I qualify for bariatric surgery, because I don't
Speaker 1: know if we said or not, chuck. Um insurance will
Speaker 1: cover it, Medicaid, Medicare, and private insurance will cover under
Speaker 1: certain circumstances. Because again, obesity has been medicalized and is
Speaker 1: this is seen as a disease or um a syndrome
Speaker 1: or symptom of disease right or associated with disease, if
Speaker 1: not a disease itself. So they've said, okay, we'll cover
Speaker 1: this if you have a b m I of at
Speaker 1: least forty or you're more than a hundred pounds overweight.
Speaker 1: I was surprised it was just a hundred pounds. I
Speaker 1: it have thought it would be more than that. Yeah, um,
Speaker 1: Or if you have a b m I of thirty
Speaker 1: five and you also have type two diabetes or sleep
Speaker 1: apnea or hypertension or fatty liver disease, it's not from alcohol,
Speaker 1: uh osteo arthritis, lipid abnormalities, heart disease, or gastro intestinal
Speaker 1: disorders gastro pub disorders along with that thirty b m I.
Speaker 1: Or if you have tried to lose weight with several
Speaker 1: multiple efforts and are unable to UM and I think
Speaker 1: that's included with the b M I right, yes, yeah,
Speaker 1: and that's actually I mean, they'll they insurance companies will
Speaker 1: make you jump through a lot of hoops, and one
Speaker 1: of them is, um, you need to try to lose
Speaker 1: weight and show that you can't before they'll ensure you.
Speaker 1: In some cases, there's a lot of meanness to it.
Speaker 1: Really if you step back and think, like, um, that
Speaker 1: like that you're treating somebody like that, not because of
Speaker 1: any medical condition, but because they're overweight. Um. But that's
Speaker 1: that's what insurance companies do to get to pay for it.
Speaker 1: And if you pay for it yourself. Roxane Gaye got
Speaker 1: it done and wrote an essay about it, and she
Speaker 1: said that she paid out of pocket because she didn't
Speaker 1: want to have to jump through any hoops or red tape,
Speaker 1: and she said that the cost was breathtaking, as she
Speaker 1: put it, really so yes, I would get the impression
Speaker 1: that the average person would not be able to afford
Speaker 1: it out of pockets. So there are hoops you're gonna
Speaker 1: have to jump through. Apparently, according to paper by Boston
Speaker 1: Medical Center, UM, fewer than one percent of patients, like
Speaker 1: we said, get the surgery that qualify and one of
Speaker 1: the big reasons is a lot of physicians PCPs still
Speaker 1: do not recommend it. Apparently you were five times more
Speaker 1: likely to get it if it is recommended by your
Speaker 1: primary care physician, but it just doesn't happen as much. Yeah,
Speaker 1: And I think, um, a lot of the PCPs aren't
Speaker 1: up on the advances that have been made in things
Speaker 1: like mortality rates and the fact that it's moved over
Speaker 1: to laparoscopic. So if you get like kind of old
Speaker 1: and said in their ways a married care physician, they
Speaker 1: might not know that bariatric surgery is much safer than
Speaker 1: it used to be and you know, much less invasive.
Speaker 1: Um like here, just have a sody pop and it'll
Speaker 1: be fine. Exactly, have a diet coke. Um. So if
Speaker 1: you if you do get bariatric surgery, there's a chance,
Speaker 1: an eight percent chance that you are a woman. Right,
Speaker 1: That's right. Even though um obcit rates are the same
Speaker 1: for men and women, women are way more likely to
Speaker 1: get the surgery. Also, when women get the surgery compared
Speaker 1: to men, they are younger than their male counterparts. And
Speaker 1: I think that it's more like referrals. You're more likely
Speaker 1: to get the surgery because you've been referred by someone
Speaker 1: who got it rather than coming from your doctor. Uh.
Speaker 1: And it also shows that women in this is sad
Speaker 1: and and not surprising at all that of women listed
Speaker 1: psychosocial concerns as one of their biggest motivations, even over
Speaker 1: related concerns. Yes, but um uh. Infertility has also been
Speaker 1: strongly linked as far as I understand, to um being
Speaker 1: overweight or obese. So it's possible that some of the
Speaker 1: increase in women who get it, or the disproportion of
Speaker 1: women who get it, could be because they're seeking to
Speaker 1: have a family or have an easier pregnancy too. Right.
Speaker 1: And again on the sort of general shaming outlook of
Speaker 1: this surgery, there was a survey about five years ago
Speaker 1: in a poll I guess that in the US, um
Speaker 1: almost people responded that bariatric surgery was the easy way
Speaker 1: out rather than just like losing weight the old fashioned way. Yeah,
Speaker 1: because that's and that's just so that's such a crock
Speaker 1: because it's like, hey, you should really lose a bunch
Speaker 1: of weight. Oh you're getting bariatric surgery. That's the easy
Speaker 1: way out. And that really underscores how much people look
Speaker 1: at being overweight as an individual moral failing that there
Speaker 1: is ah, there's something wrong with you, yeah, or a
Speaker 1: choice um or um that you just you're just lazy
Speaker 1: or you just can't help yourself, whatever, so much so
Speaker 1: that that just people who are overweight or obese or
Speaker 1: just look down upon. They don't they're not treated with
Speaker 1: the same kind of dignity that an average sized person
Speaker 1: would be. And this actually shows up in medical settings too.
Speaker 1: Apparently doctors um will not pay as much attention to
Speaker 1: health indicators like UM cholesterol level or UM glucost levels
Speaker 1: or whatever um, and instead just pay attention to the
Speaker 1: appearance of an overweight or obese patient when they recommend
Speaker 1: gastric bypass or bariatric surgery. So they're it's they're not
Speaker 1: saying it's because you're hypertense or because you have diabetes.
Speaker 1: They're essentially saying it's strictly because you're overweight. Yeah, and
Speaker 1: sort of. The one thing that's obvious to me is
Speaker 1: everything that I've seen about the surgery, the recovery, your
Speaker 1: lifestyle afterward for the rest of your life. There's nothing
Speaker 1: easy about it. It is not the easy way out.
Speaker 1: It's not like, well, it's a forty minute surgery, then
Speaker 1: you're good to go. It's it's not an easy thing
Speaker 1: and it is a not something to go into lightly.
Speaker 1: It is a major surgery that will completely alter the
Speaker 1: way you eat, and a lot of people the way
Speaker 1: they eat is a big part of their lifestyle in
Speaker 1: their life and it will alter that forever. And it's
Speaker 1: a big, huge, monumental change and there's nothing easy about it.
Speaker 1: But it is your decision. It's up to you. UM.
Speaker 1: From what I've seen about the fat positive activist community, UM,
Speaker 1: they would probably recommend that you reflect on exactly why
Speaker 1: you want the surgery. Is it because you are being
Speaker 1: pressured by family, friends, society, um? Or is it just
Speaker 1: for whatever reason? And whatever reason you have, it's your again,
Speaker 1: it's your decision. No one can tell you that it's
Speaker 1: right or wrong, but you should definitely educate yourself on
Speaker 1: you know, the risks and the benefits and everything about it,
Speaker 1: and then just make your decision and feel good about
Speaker 1: it either way. Yeah. I agree. I hope this. Uh.
Speaker 1: I think this is like one of those topics that
Speaker 1: you know, people might research, you know, late at night
Speaker 1: even and feeling shamed to even look into this kind
Speaker 1: of procedure and hopefully we could clear up some of
Speaker 1: this stuff and if if something people feel good about,
Speaker 1: then they can own it and move forward with their
Speaker 1: head held high. Very nice. You got anything else? I
Speaker 1: got nothing else. Well, since Chuck said he's got nothing else,
Speaker 1: that of course means it's time for a listener mail.
Speaker 1: I'm gonna call this just a new listener from Canada.
Speaker 1: I don't think that's how they see it. I'm a
Speaker 1: new listener. Just want to say how much I enjoy
Speaker 1: the show. My husband told me about stuff you should know,
Speaker 1: and I kind of brushed them off, thinking this was
Speaker 1: just another boring podcast trying to teach me boring thing.
Speaker 1: But I finally gave it a shot and was hooked.
Speaker 1: After the very first show I listened to you guys
Speaker 1: have great chemistry, and I heard another listener call you
Speaker 1: burten Ernie type of burten Ernie type. I feel that
Speaker 1: I'll take that you have a great mix of random
Speaker 1: knowledge and important knowledge, and I'll love your true crime
Speaker 1: episodes to hope you keep going forever. And you should
Speaker 1: know my husband is not letting me live this down
Speaker 1: that he is the greatest podcast taste that is. From
Speaker 1: Autumn in the Thunder Bay, Ontario, Canada, North America. Planet
Speaker 1: Earth very nice thought them. Thank you very much, and
Speaker 1: we're glad that you're with us, even though it was
Speaker 1: your husband who made you do it. That's right. If
Speaker 1: you want to be like Autumn and get in touch
Speaker 1: with us, we would love that you can send us
Speaker 1: an email. That's the best way to do it. Just
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Speaker 1: send it off to Stuff Podcasts at iHeart radio dot com.
Speaker 1: Stuff you Should Know is a production of I heart Radio.
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