WEBVTT - What's up with bariatric surgery? 0:00:01.440 --> 0:00:04.240 Welcome to Stuff You Should Know, a production of I 0:00:04.360 --> 0:00:13.200 Heart Radio. Hey, and welcome to the podcast. I'm Josh, 0:00:13.240 --> 0:00:15.600 and there's Chuck and Jerry's lurking around here like a 0:00:15.640 --> 0:00:18.799 creeper weirdo who takes pictures of people without their permission. 0:00:19.200 --> 0:00:23.079 And this is stuff you should know. I like that. 0:00:24.000 --> 0:00:27.680 The joke is so nice. I said it twice. Uh 0:00:27.720 --> 0:00:30.240 So we should issue a trigger warning before this episode 0:00:30.320 --> 0:00:34.840 because we are talking about bariatric surgery, which some people 0:00:34.920 --> 0:00:38.000 refer to as weight loss surgery, and the topic of 0:00:38.040 --> 0:00:42.120 food and weight and weight loss and obesity and weight 0:00:42.159 --> 0:00:45.680 loss surgery could be very triggering for people. So if 0:00:45.680 --> 0:00:47.920 you want to listen to this one, great, we're gonna 0:00:48.000 --> 0:00:50.279 just break it down like we usually do. But if 0:00:50.320 --> 0:00:51.680 it's something that you don't want to listen to, we 0:00:51.720 --> 0:00:55.840 totally understand. Yeah. I mean, after researching this, I totally 0:00:55.880 --> 0:00:59.560 get why, like a fat positive or somebody who would 0:00:59.600 --> 0:01:02.520 be triggered by talk of that could be upset by 0:01:02.520 --> 0:01:06.720 it because there's a there's a pretty substantial argument to 0:01:06.760 --> 0:01:10.800 be made that bariatric surgery is conducted just to make 0:01:11.319 --> 0:01:17.119 obese and overweight people acceptable to society. That that's basically 0:01:17.160 --> 0:01:20.559 the upshot of of why people get this surgery done. 0:01:20.760 --> 0:01:23.480 That's not necessarily true for everybody, but there's a whole 0:01:23.520 --> 0:01:25.960 there's a whole school of thought that says, you know, 0:01:26.560 --> 0:01:29.560 this is this is a medical form of fat shaming 0:01:30.200 --> 0:01:33.479 for some people at least. Yeah. And there's another school 0:01:33.480 --> 0:01:41.119 of thought that it's uh, you know, uh, disease solving surgery. Uh. 0:01:41.120 --> 0:01:44.080 And the evidence plays out that it really does help 0:01:44.120 --> 0:01:48.960 with things like diabetes and hypertension and can be very successful. 0:01:49.240 --> 0:01:51.760 The reason I thought of this to begin with was 0:01:52.240 --> 0:01:56.160 I saw a Box article called We're barely using the 0:01:56.200 --> 0:02:00.080 best tool we have to fight obesity, uh. And this 0:02:00.200 --> 0:02:03.320 sort of cruxt of that article, which we'll talk about here, 0:02:03.440 --> 0:02:06.840 is that only about one percent of people who qualify 0:02:06.920 --> 0:02:10.560 for bariatric surgery use it. And the Vox article was 0:02:10.680 --> 0:02:13.720 all behind it and basically said, we have this great tool, 0:02:14.480 --> 0:02:18.080 uh for people that cannot seem to get down to 0:02:18.120 --> 0:02:20.880 what is a healthy weight for them who are suffering 0:02:20.880 --> 0:02:24.240 from hypertension diabetes, And they were saying, like, people should 0:02:24.320 --> 0:02:26.280 use the surgery more. And there's a lot of reasons 0:02:26.520 --> 0:02:29.280 why people don't, which we're also going to talk about. Yeah, 0:02:29.280 --> 0:02:31.400 I mean, there's one thing that everybody can agree on, 0:02:32.240 --> 0:02:36.679 like bariatric surgery works for weight loss to to it's 0:02:36.680 --> 0:02:38.680 like a spectrum of how much it works, but it 0:02:38.800 --> 0:02:43.200 definitely works. There's substantial results once it happens, and understandably so, 0:02:43.280 --> 0:02:48.880 because it is a radical surgical procedure where you're like 0:02:49.280 --> 0:02:53.359 really profoundly altering your internal anatomy so that you can, 0:02:53.400 --> 0:02:56.200 in some cases except less food, in some cases digest 0:02:56.400 --> 0:02:58.880 food less or have less of a chance to digest food. 0:02:59.040 --> 0:03:03.600 And we should point out we're talking about modern bariatric 0:03:03.680 --> 0:03:08.120 surgery because even ten years ago, results were wildly different. 0:03:08.720 --> 0:03:12.880 The preferred surgeries were wildly different. And uh, they've come 0:03:12.919 --> 0:03:15.720 a long long way in the past even ten years. Yeah, 0:03:15.720 --> 0:03:17.880 it definitely has hit its stride in the last ten 0:03:17.960 --> 0:03:21.920 years for sure. Um, but there's uh, as far as 0:03:21.960 --> 0:03:24.040 the history of this whole idea goes, it's not a 0:03:24.080 --> 0:03:28.320 new concept. Um. It goes back at least to the 0:03:28.440 --> 0:03:31.639 end of the nineteenth century. Some people say it goes 0:03:31.680 --> 0:03:35.280 back as far as the tenth century, which is amazing 0:03:35.320 --> 0:03:38.000 to think about. And you know what, Olivia helped us 0:03:38.000 --> 0:03:40.600 with this, and I had a feeling when I said, hey, 0:03:40.720 --> 0:03:42.520 let's cover the history I was like, there's got to 0:03:42.560 --> 0:03:45.600 be some you know, hundreds and hundreds of year old 0:03:46.000 --> 0:03:49.360 procedure that somebody did. And if you believe the story, 0:03:49.400 --> 0:03:51.440 in the tenth century, there was a King Sancho of 0:03:51.520 --> 0:03:55.280 Leon and Sancho was so big. And this is when 0:03:56.440 --> 0:03:59.800 Ed McMahon chimes in, how big was he? He was, 0:04:00.000 --> 0:04:02.560 oh big that he couldn't ride a horse or walk 0:04:03.680 --> 0:04:08.920 ouch as the story. As the story goes, so the 0:04:09.040 --> 0:04:13.120 doctor did the most basic form of weight loss surgery 0:04:13.120 --> 0:04:16.400 at the time, which was the suture King Sancho's lips 0:04:16.720 --> 0:04:19.920 shut so that King Sancho could only ingest a liquid 0:04:19.960 --> 0:04:23.680 diet and apparently lost about half his weight and got 0:04:23.720 --> 0:04:28.200 the thrown back. So that's a nuts so story. I 0:04:28.279 --> 0:04:35.840 find something else that comes later chuck even more nuts so. No. Um, 0:04:35.880 --> 0:04:40.440 In the twenty one century, there was a push um 0:04:40.560 --> 0:04:45.200 to basically reintroduce jaw wiring. Oh yeah, yeah, it's so 0:04:45.400 --> 0:04:47.640 this whole thing with King Sancho, one of the original 0:04:47.720 --> 0:04:51.560 kings of Leon. Um Like it got picked up like 0:04:51.600 --> 0:04:55.000 a thousand or so years later. Um, even though it's 0:04:55.080 --> 0:04:57.400 been shown nut to work, as we'll see, But the 0:04:57.440 --> 0:05:01.320 whole like modern bariatric surgery um actually was born in 0:05:01.360 --> 0:05:04.760 the nineteenth century out of um uh the same kinds 0:05:04.760 --> 0:05:07.960 of procedures, but for a totally different purpose. UM. A 0:05:08.000 --> 0:05:11.120 guy named Caesar rue came up with a surgical technique 0:05:11.120 --> 0:05:15.160 called the ruin why and UM. It was used in 0:05:15.200 --> 0:05:18.400 case you had like some sort of like um bowel 0:05:18.560 --> 0:05:22.599 or gastric obstruction. He figured out how to bypass it 0:05:23.000 --> 0:05:26.760 um and and connect your stomach to a different part 0:05:26.800 --> 0:05:29.480 of your intestine to get around the obstruction and yet 0:05:29.480 --> 0:05:32.839 you would still have functioning parts UM. And that was 0:05:32.880 --> 0:05:37.120 where the idea of um of gastric bypass surgery came from, 0:05:37.160 --> 0:05:39.120 or the name of it, yeah, which all the way 0:05:39.160 --> 0:05:41.159 back in nine two, which is really hard to believe, 0:05:41.240 --> 0:05:44.720 but it uh. They called it ruin why because I 0:05:44.760 --> 0:05:48.360 believe it's sort of forms y shape when you're finished. 0:05:48.520 --> 0:05:56.719 And that was about mortality rate initially in no surprise, 0:05:56.839 --> 0:05:59.359 but they got that down to about eleven, which is 0:05:59.400 --> 0:06:02.840 really great for the time period, I think. And then 0:06:03.400 --> 0:06:06.120 you know, things kind of went along as people were 0:06:06.560 --> 0:06:11.520 experimenting with those obstruction UH surgeries. There were doctors that 0:06:11.680 --> 0:06:14.200 started to say, hey, wait a minute, we now have 0:06:14.240 --> 0:06:17.240 a thing called a scale and humans we don't just 0:06:17.279 --> 0:06:20.320 need to put grain on it. Humans can stand on 0:06:20.400 --> 0:06:23.800 it so we know how much we weigh. And everyone went, 0:06:23.960 --> 0:06:26.960 what hey, that's a great idea. I can't wait to 0:06:26.960 --> 0:06:30.200 weigh myself every day, is what everyone said. I haven't 0:06:30.200 --> 0:06:31.720 weighed myself in a long time. I kind of quit 0:06:32.360 --> 0:06:36.120 me either, me too, But hard to believe, but yes, 0:06:36.279 --> 0:06:38.920 humans started weighing themselves, and all of a sudden in 0:06:38.920 --> 0:06:43.000 the nineteen twenties and thirties, doctors started in patients started 0:06:43.000 --> 0:06:46.360 paying attention to their you know, to their little literal weight, 0:06:46.440 --> 0:06:48.400 not just like how they looked and how they felt 0:06:49.160 --> 0:06:53.760 right weight gain and um being overweight and I'm using 0:06:53.800 --> 0:06:57.320 scare quotes here, um or obese again, scare scare quotes. 0:06:57.440 --> 0:07:01.920 Um became medicalized at point, like it became a medical issue, 0:07:01.920 --> 0:07:05.599 a problem to be treated. And it's just that whole idea, 0:07:05.600 --> 0:07:08.080 and that whole concept has has taken off since then. 0:07:08.120 --> 0:07:12.080 It's just so so fully ingrained in our our society 0:07:12.120 --> 0:07:14.640 that it's really interesting to think, like it's only been 0:07:14.640 --> 0:07:18.040 around for maybe a hundred or so years. But um, 0:07:18.160 --> 0:07:22.680 they basically would give you anything that you wanted to 0:07:22.840 --> 0:07:27.720 lose weight, like amphetamines, laxatives, UM, just anything. You just 0:07:27.720 --> 0:07:30.080 go to the doctor and he give you whatever. UM. 0:07:30.120 --> 0:07:34.360 But it wasn't until the nineteen forties that that whole 0:07:34.840 --> 0:07:39.800 idea of medicalizing um being overweight, uh like, really kind 0:07:39.840 --> 0:07:43.040 of spread into society at large, when the insurance companies 0:07:43.080 --> 0:07:45.720 got involved. Yeah, and I should point out to you 0:07:45.720 --> 0:07:48.160 you're using scare quotes when you say things like overweight 0:07:48.200 --> 0:07:52.160 and obese because there is so much individual variation in 0:07:53.160 --> 0:07:55.600 in body weight and how people carry it and how 0:07:55.640 --> 0:07:59.880 healthy they are. And we understand this, I mean, we 0:08:00.080 --> 0:08:02.640 sort of understand this now as far as people accepting it, 0:08:02.680 --> 0:08:05.040 but there's still not a lot of acceptance around it. 0:08:05.560 --> 0:08:07.920 That's why when you calculate something like a b M 0:08:07.960 --> 0:08:10.880 I that is for you know, to judge a population 0:08:10.920 --> 0:08:14.400 that does not take into an account take into account 0:08:14.400 --> 0:08:18.200 of an individual or their muscle mass or you know, 0:08:18.560 --> 0:08:21.720 their body shape. So they kind of throw these tags 0:08:22.720 --> 0:08:25.440 on overweight and obese and b M I that are 0:08:27.120 --> 0:08:29.200 useful in a certain sense, but also not useful in 0:08:29.200 --> 0:08:32.199 a certain sense. Yeah. And the b M I scale 0:08:32.280 --> 0:08:34.560 was invented in the nineteenth century by a guy named 0:08:34.559 --> 0:08:39.120 Adolf quite Alet. He was a sociologist and he based 0:08:39.240 --> 0:08:44.800 exclusively on white Western Europeans. So in a way, you 0:08:44.840 --> 0:08:47.240 could say the b m I scale has created the 0:08:47.360 --> 0:08:52.040 ideal body form is a average sized or whatever the 0:08:52.040 --> 0:08:55.120 b m I says, the average size white European. The 0:08:55.200 --> 0:08:58.000 problem is that's that's a problem in and of itself, 0:08:58.040 --> 0:09:00.240 because you now have a compartment that you're trying to 0:09:00.240 --> 0:09:02.679 shove everybody in regardless, and if you're not in that 0:09:02.720 --> 0:09:06.800 compartment that you're supposed to be in, you have a problem, um, 0:09:07.040 --> 0:09:10.600 a medical problem even maybe even a life threatening problem. Um. 0:09:10.640 --> 0:09:14.120 But more than that, if you're not white and Western European, 0:09:14.760 --> 0:09:17.199 that scales shouldn't really apply to you. But that hasn't 0:09:17.360 --> 0:09:21.959 kept humanity or people from plugging all of humanity into 0:09:22.040 --> 0:09:23.920 that same b m I scale. So there's a lot 0:09:23.920 --> 0:09:27.959 of questions about the bm I scale itself, and especially 0:09:28.040 --> 0:09:31.240 in recent years. Yeah, and I hope everyone understands when 0:09:31.240 --> 0:09:35.959 we use those terms. All of this goes into that. UM. 0:09:36.160 --> 0:09:39.719 As doctors were looking at uh, you know, still kind 0:09:39.720 --> 0:09:43.280 of performing these surgeries, they noticed that, hey, you can 0:09:43.320 --> 0:09:46.080 lose weight, you know the initial ruin why when you 0:09:46.120 --> 0:09:48.440 had an obstruction, They were like, wait, this is good 0:09:48.440 --> 0:09:52.200 for weight loss? Too, because quite simply, your stomach is 0:09:52.240 --> 0:09:55.439 smaller and your body is not absorbing. You can't eat 0:09:55.440 --> 0:09:58.720 as much and it's not absorbing as many nutrients and 0:09:58.920 --> 0:10:04.080 in you, they believe. The very first real deal weight 0:10:04.120 --> 0:10:08.360 loss surgery occurred again from a Swedish surgeon named Victor 0:10:09.000 --> 0:10:13.439 ein Rickson, when Victor removed a hundred hundred three centimeters 0:10:13.800 --> 0:10:15.800 of small intestine from a woman, a thirty two year 0:10:15.800 --> 0:10:19.360 old woman who didn't lose that much weight, but supposedly 0:10:19.440 --> 0:10:23.199 it improved her life quality. Yeah, and just the next 0:10:23.320 --> 0:10:27.920 year UH an American named Dr Richard Varco created a 0:10:28.200 --> 0:10:33.880 slightly altered, ruined why procedure called the j juno ilio bypass. 0:10:34.720 --> 0:10:38.280 I practiced that so many times. My brain just says, Nope, 0:10:38.320 --> 0:10:41.080 you're never gonna get it right. The first time, I 0:10:41.080 --> 0:10:43.640 think that was probably close. It was close, but there 0:10:43.679 --> 0:10:45.920 was like a hitch and a stumble in there too. 0:10:46.320 --> 0:10:49.200 Ju Juna lial is what I would say, oh, showing 0:10:49.240 --> 0:10:53.160 off a but then may not be right either, and 0:10:53.200 --> 0:10:56.120 that comes from I'm sorry, that's that's what the first time. 0:10:56.160 --> 0:10:59.600 They called it bariatric surgery, right, yes, And bariatric is 0:10:59.640 --> 0:11:04.280 from the Greek for weight or heavy UM. So they said, 0:11:04.320 --> 0:11:06.960 I guess this is surgery for heavy people. Maybe I'm 0:11:06.960 --> 0:11:10.440 not sure, but that's where that's that's about. The fifties 0:11:10.480 --> 0:11:13.839 is about when that that name became applied to it UM. 0:11:13.920 --> 0:11:17.720 And then in the sixties UM they were starting to 0:11:17.720 --> 0:11:20.800 do studies and experimentation with it. And there was a 0:11:20.800 --> 0:11:24.840 study that found that UM a temporary procedure where you 0:11:24.840 --> 0:11:28.280 would have like your stomach moved to a different part 0:11:28.280 --> 0:11:32.200 of your small intestine. Temporarily you lose the weight and 0:11:32.200 --> 0:11:35.120 then they go reverse the procedure. They found that patients 0:11:35.200 --> 0:11:38.600 just basically gained the weight back after the procedure was reversed. 0:11:38.840 --> 0:11:41.600 And at that point in the early sixties, these surgeries 0:11:41.600 --> 0:11:45.400 started to become permanent in nature pretty much across the board. Yeah, 0:11:45.400 --> 0:11:48.320 you know, that was my first surprise in this research. 0:11:49.559 --> 0:11:53.680 I thought, even modern bariatric bypasses and stuff, I thought 0:11:53.760 --> 0:11:57.360 that was all a temporary thing, and that like, you 0:11:57.440 --> 0:11:59.720 don't live with an egg sized stomach for the rest 0:11:59.720 --> 0:12:02.360 of your life, and that's not true. You live with 0:12:02.400 --> 0:12:05.160 an excized stomach the rest of your life. Yeah. They 0:12:05.200 --> 0:12:08.440 as we'll see, they remove a significant portion of your 0:12:08.480 --> 0:12:11.320 stomach in either one of the surgeries that you get, 0:12:11.800 --> 0:12:14.760 and that when they do that, that's that's irreversible, that 0:12:14.840 --> 0:12:17.560 part of your stomach is gone. What's amazing to me 0:12:17.679 --> 0:12:19.920 is that they've gotten good enough at it that it 0:12:20.000 --> 0:12:24.959 has tremendous results, and the complications have kind of died 0:12:25.000 --> 0:12:28.280 down over the years to where the risk of death 0:12:28.360 --> 0:12:32.400 is now down to about point one percent. Uh. In 0:12:32.440 --> 0:12:37.360 the twenties, it's gotten that low, but just around two thousand, 0:12:37.440 --> 0:12:39.480 twenty years ago, it was still up at one percent, 0:12:39.600 --> 0:12:42.560 which is really high for a surgical procedure in the 0:12:42.559 --> 0:12:46.679 Western world in the twentieth century, but they've they've whittled 0:12:46.679 --> 0:12:49.640 it down ten times lower than it was twenty years 0:12:49.640 --> 0:12:53.319 before because they started using lap of scopic surgery. That's right. 0:12:53.360 --> 0:12:57.480 Olivia points out that point one percent is less than 0:12:57.520 --> 0:13:00.400 knee replacement surgery, just to kind of put that, you know, 0:13:00.480 --> 0:13:03.280 to frame that. Yeah, and also I want to correct myself. 0:13:03.320 --> 0:13:05.000 It wasn't in the twenty first century. It was in 0:13:05.040 --> 0:13:07.360 the mid twentieth century that they tried to bring back 0:13:07.400 --> 0:13:10.320 jaw wiring, but it just doesn't work, that's right. And 0:13:10.559 --> 0:13:15.800 as a result of the success rate and the obviously 0:13:15.840 --> 0:13:19.439 whittling that death rate down to point one. UM surgeries 0:13:19.520 --> 0:13:24.000 now are crunching up towards a three hundred thousand per year. 0:13:24.040 --> 0:13:27.240 I think two hundred and fifty six thousand was the 0:13:27.320 --> 0:13:29.400 last year that we have a number four, and that 0:13:29.440 --> 0:13:33.600 was in twenty nineteen, as opposed to about twenty thousand 0:13:33.600 --> 0:13:35.240 a year in the nineties and about a hundred and 0:13:35.320 --> 0:13:40.559 fifty thousand and change in the mid two thousand's because 0:13:40.559 --> 0:13:43.240 they said, hey, everybody, we don't killed nearly as many 0:13:43.320 --> 0:13:45.160 of you as we used to come and get it. 0:13:46.360 --> 0:13:48.520 Should we take a break? Sure? All right, that was 0:13:48.559 --> 0:13:50.559 a good setup. So let's take a break and we'll 0:13:50.600 --> 0:14:17.760 be right back. Okay, Chuck, So we're back, and I 0:14:17.800 --> 0:14:20.560 think it's high time that we actually talked about how 0:14:20.720 --> 0:14:24.320 a bariatric surgery goes UM. And there's a couple of 0:14:24.360 --> 0:14:27.840 different ways you can go UM. Some are more popular 0:14:27.880 --> 0:14:29.760 than others. It seems like one that used to be 0:14:29.800 --> 0:14:33.280 more popular than ruin why the bypass has become less 0:14:33.320 --> 0:14:37.160 popular in favor of one called sleeve. Guests Guests direct 0:14:37.200 --> 0:14:39.640 to me, See, I can never get it. The first 0:14:39.680 --> 0:14:43.240 time you want to say gastronomy, I did. I wanted 0:14:43.280 --> 0:14:47.880 to say gastro pub Uh yeah, this is easily the 0:14:47.920 --> 0:14:51.800 most common um performed today. This is the one that's 0:14:51.880 --> 0:14:54.960 very very popular right now. They remove about eight of 0:14:55.000 --> 0:14:59.560 your stomach and basically the stomach, instead of being a 0:14:59.680 --> 0:15:03.400 large pouch, becomes a narrow sleeve. That's why it's called sleeve. 0:15:03.720 --> 0:15:07.560 Gets struck to me, and it's it's very very simple, 0:15:07.680 --> 0:15:10.880 and that you have a much, much, much much smaller stomach, 0:15:11.400 --> 0:15:13.520 so you can't eat as much. You will feel full 0:15:13.560 --> 0:15:17.440 more quickly. But what also happens is and I'm not 0:15:17.480 --> 0:15:19.320 sure if they had a hunch this would happen, or 0:15:19.320 --> 0:15:22.000 if they knew this would happen, but it also tricks 0:15:22.040 --> 0:15:25.800 the body into releasing a few of those hormones that 0:15:25.880 --> 0:15:29.240 say that you're hungry. So it's not like, oh, I'm 0:15:29.280 --> 0:15:31.680 still hungry all the time. Like you just have a 0:15:31.680 --> 0:15:35.680 smaller stomach. You eat less and you're satisfied. Yeah, you 0:15:35.720 --> 0:15:38.720 eat less and you have the desire to eat less 0:15:38.760 --> 0:15:41.160 on top of that. So, I mean you can imagine 0:15:41.160 --> 0:15:44.240 that this has tremendous results. And I think that they 0:15:44.280 --> 0:15:47.000 did know that that hormone um effect was going to 0:15:47.120 --> 0:15:50.400 happen because they specifically remove a part of the stomach 0:15:50.440 --> 0:15:53.920 called the fundest and that's the portion that expands when 0:15:53.920 --> 0:15:56.400 you eat a lot of food, So your stomach can't 0:15:56.440 --> 0:15:58.760 expand when you eat food. You got to keep that 0:15:58.840 --> 0:16:01.800 in mind. And then also the funnest is where grellan 0:16:02.160 --> 0:16:05.400 is largely made, and that's that hunger hormone. So you're 0:16:05.440 --> 0:16:09.120 producing less grillan and you just can't physically fit that 0:16:09.200 --> 0:16:13.920 much food into your stomach anymore. Right, And like I said, 0:16:13.920 --> 0:16:16.600 it's the most popular form today. I think in the 0:16:16.640 --> 0:16:20.880 mid two thousand's it was about eight bariatric surgeries. Now 0:16:21.280 --> 0:16:23.840 or in twenty nineteen it was it's even more than 0:16:23.880 --> 0:16:27.240 that two. I just don't have the most recent number. 0:16:27.280 --> 0:16:30.680 I was, um, I just got back from vacation in 0:16:30.760 --> 0:16:34.640 Mexico and one of the two families that we kind 0:16:34.640 --> 0:16:36.600 of hung out with him buddied up with. I was 0:16:36.680 --> 0:16:38.040 chatting with the guy and I was like, so, what 0:16:38.040 --> 0:16:40.400 do you do and he said, I'm a bariatric surgeon 0:16:40.480 --> 0:16:43.880 and no kidding. And I was like, what, We're about 0:16:43.920 --> 0:16:46.040 to do a podcast episode on that, and he said, 0:16:46.080 --> 0:16:51.360 what's a podcast. I'm just said, well, what's a bariatric surgery? Now? 0:16:51.400 --> 0:16:52.920 He didn't ask that because we had already talked a 0:16:52.960 --> 0:16:56.440 little bit, but he uh, very nice guy from Texas 0:16:56.600 --> 0:16:59.920 and he um talked a little bit. I didn't like 0:17:00.000 --> 0:17:02.360 want to bother him too much about it, although he 0:17:02.440 --> 0:17:05.000 really really enjoyed talking about it because he's not only 0:17:05.520 --> 0:17:09.879 a bariatric surgeon, but he's very much a wellness doctor 0:17:09.920 --> 0:17:12.720 and he believes that it's just part of a wellness 0:17:12.760 --> 0:17:15.640 plan for your life. Um, not just like all right, 0:17:15.680 --> 0:17:19.000 we'll do it and then have fun in the world. Um. 0:17:19.119 --> 0:17:20.399 So he was a good guy to talk to you. 0:17:20.400 --> 0:17:23.840 But he talked about sleeve gast direct Uh here there 0:17:23.840 --> 0:17:27.240 I went again, sleeve gastro pub being the most popular 0:17:27.280 --> 0:17:30.520 gastro pub. Yeah, it is the most popular gastro pub 0:17:30.560 --> 0:17:33.840 of all time. So what how does that surgery go? Though? Um, 0:17:33.880 --> 0:17:37.760 it's pretty quick for one Yeah, I think it's like 0:17:37.840 --> 0:17:40.679 forty to seventy minutes, not that long. You stay in 0:17:40.680 --> 0:17:42.639 the hospital for a couple of nights. They keep an 0:17:42.640 --> 0:17:44.320 eye on you. And one of the reasons they're keeping 0:17:44.359 --> 0:17:47.040 an eye on you is because for two weeks afterward, 0:17:47.600 --> 0:17:50.479 you can have nothing but a liquid diet. Because if 0:17:50.560 --> 0:17:54.320 you go look up sleeve gastrectomy videos, Um, there's a 0:17:54.359 --> 0:17:56.639 lot of computer animations out there that show you what 0:17:56.680 --> 0:17:59.200 they're doing, so you can imagine that if you remove 0:17:59.680 --> 0:18:05.040 probably doably, I think maybe of your stomach um, it 0:18:05.080 --> 0:18:07.240 needs to heal. And the way that you help at 0:18:07.240 --> 0:18:10.240 heal over the first two weeks is by just drinking 0:18:10.320 --> 0:18:16.359 like broth, water, um, maybe some gatorade if you're feeling spicy. Um. 0:18:16.400 --> 0:18:20.040 But again, remember like you're not sitting there going bonkers 0:18:20.080 --> 0:18:23.280 wanting food. Um. Most people who have a sleeve gets 0:18:23.359 --> 0:18:27.920 tructomy report having to make themselves eat. They have to 0:18:28.040 --> 0:18:31.120 keep a strict schedule because they don't want to eat 0:18:31.280 --> 0:18:35.240 like they used to, like most people want to eat. Yeah, 0:18:35.240 --> 0:18:38.760 And I mean we'll talk a little bit about maintenance later, 0:18:38.800 --> 0:18:42.280 but I think in the end they recommend you eat like, 0:18:42.640 --> 0:18:45.040 you know, four to six very small meals a day, 0:18:45.760 --> 0:18:47.800 Like there's no way around it. You're you're going to 0:18:47.920 --> 0:18:52.040 change you're eating habits in your lifestyle in a big, 0:18:52.080 --> 0:18:55.120 big way if you have this surgery. And I read 0:18:55.160 --> 0:18:58.359 a lot of first person accounts of like, you know, 0:18:58.440 --> 0:18:59.960 can you ever go out to eat again and said 0:19:00.000 --> 0:19:02.480 down with your family and enjoy a meal, because if 0:19:02.480 --> 0:19:05.000 you're filling something the size of an egg, it's like 0:19:05.000 --> 0:19:07.640 can you even order a meal? And you know, everyone 0:19:07.760 --> 0:19:10.359 that I read was it's like, yeah, you know, you 0:19:10.359 --> 0:19:12.840 you get used to it. You go to the restaurant, 0:19:13.320 --> 0:19:16.800 you order an appetizer maybe, and you don't even eat 0:19:16.800 --> 0:19:18.840 half of the appetizer and you take the rest home. 0:19:19.240 --> 0:19:22.119 You do a lot more talking at dinner, and you 0:19:22.240 --> 0:19:25.400 don't drink alcohol. You can't drink liquids while you eat 0:19:25.440 --> 0:19:28.920 at all. Um, they're saying, you know, you drink liquids 0:19:29.359 --> 0:19:31.840 no more than thirty minutes before you have a meal 0:19:32.119 --> 0:19:35.199 because there's so little room. Uh. I did see some 0:19:35.240 --> 0:19:37.880 people say they could drink a little alcohol, but it's 0:19:38.000 --> 0:19:41.840 really recommended you basically quit drinking. Certainly, you don't want 0:19:41.880 --> 0:19:44.480 to drink beer when you have a tiny egg stomach. God, 0:19:45.040 --> 0:19:47.919 oh my god, that sounds terrible. It does, um, but 0:19:48.080 --> 0:19:51.399 you there's no way around it. You are changing your lifestyle. 0:19:51.480 --> 0:19:54.080 But across the board, when I read all these first 0:19:54.080 --> 0:19:56.480 person accounts, everyone was like, you get used to it, 0:19:56.880 --> 0:20:00.360 and the trade off is for them the they are 0:20:00.440 --> 0:20:04.360 much healthier and happier and generally didn't have the regrets. 0:20:04.359 --> 0:20:07.640 I'm sure you could find some people that had regrets 0:20:07.640 --> 0:20:09.720 and were like, I missed sitting down and eating big 0:20:09.760 --> 0:20:13.120 meals with my friends and family. But I mean, most 0:20:13.200 --> 0:20:15.040 of the people that I read were pretty satisfied with 0:20:15.040 --> 0:20:18.800 the surgery. So um, after you get surgery too, and 0:20:18.840 --> 0:20:21.320 I can imagine they're satisfied because when you get a 0:20:21.359 --> 0:20:25.080 sleeve guests trick to me UM, the doctors who performed 0:20:25.160 --> 0:20:28.240 this these kind of procedures they use as something called 0:20:28.240 --> 0:20:31.840 excess weight to qualify the success of the surgery. And 0:20:31.960 --> 0:20:35.159 excess weight is the difference between your ideal weight and 0:20:35.480 --> 0:20:39.639 what you weighed before the surgery and eighteen months after 0:20:39.960 --> 0:20:46.199 the procedure, patients typically have lost about seventy percent of 0:20:46.600 --> 0:20:51.040 their of their body weight after after the surgery. Within 0:20:51.080 --> 0:20:53.639 a year and a half, their excess weight, right, Yes, 0:20:53.680 --> 0:20:57.200 they're excess weight. Yeah, And you know, generally it's not 0:20:57.280 --> 0:21:01.879 like uh, the days of your with gastric banding, which 0:21:01.920 --> 0:21:06.200 has really gone out of favor, UM a lot of complications, 0:21:06.240 --> 0:21:09.080 the weight generally did not stay off. But with sleeve 0:21:09.119 --> 0:21:12.720 gastrectomy and then as we'll see with gastric bypass, the 0:21:12.760 --> 0:21:17.960 weight does tend to stay off for years, although people 0:21:18.000 --> 0:21:21.040 do gain some of the weight back. UM. One study 0:21:21.040 --> 0:21:24.400 saw after twelve years about forty percent of patients had 0:21:24.480 --> 0:21:28.359 maintained a thirty percent weight loss or more compared to 0:21:28.359 --> 0:21:32.280 their original total weight, and where at least ten percent 0:21:32.359 --> 0:21:37.040 lighter than they'd been. So sixty percent of people gain 0:21:37.119 --> 0:21:41.359 back more than thirty percent of their weight. Is that 0:21:41.359 --> 0:21:43.800 a way to say it? Yeah, I have to admit 0:21:43.840 --> 0:21:47.080 you just made my brain do a somersault. But yes, 0:21:47.160 --> 0:21:50.200 that's the that's the that's the converse, I guess. Huh. Yes, 0:21:50.240 --> 0:21:52.280 So sixty percent of people gain back more than that 0:21:52.320 --> 0:21:55.040 thirty percent, But it doesn't mean they gained all the 0:21:55.040 --> 0:21:58.919 weight back that could have been. No, because again, like 0:21:58.960 --> 0:22:01.920 you said, sent or at least ten percent lighter than 0:22:01.920 --> 0:22:05.800 they've been before a lot of percentages flying around here. Yeah. So, 0:22:05.880 --> 0:22:08.840 but the upshot is is that you are definitely going 0:22:08.880 --> 0:22:13.159 to lose weight if you're a physician, UM, especially if 0:22:13.160 --> 0:22:16.919 you're a bariatric surgeon. You consider bariatric surgery the gold 0:22:17.000 --> 0:22:23.200 standard for rapid and sustained weight loss. That like, that's 0:22:23.560 --> 0:22:27.040 if if you have a patient who is um like 0:22:27.359 --> 0:22:32.359 again obese UM to a to like maybe say three 0:22:32.440 --> 0:22:36.280 hundred four hundred pounds or more UM, you would say, look, 0:22:36.640 --> 0:22:39.359 you really need the surgery and it's going to change 0:22:39.359 --> 0:22:41.600 your life. It's you would probably also tell them it's 0:22:41.640 --> 0:22:44.280 going to save their life too. Again, it's questionable, but 0:22:44.320 --> 0:22:47.639 that's the medical stance, that's right. Uh. Then we have 0:22:47.720 --> 0:22:51.359 the gastric bypass, the original rue on y or r 0:22:51.520 --> 0:22:55.880 y GB surgery. Uh. They staple off part of your stomach. 0:22:56.400 --> 0:23:00.119 They reduce that remaining part too. Again about this as 0:23:00.160 --> 0:23:02.720 an egg, and then they attach it to that rue 0:23:02.800 --> 0:23:06.400 lamb of the small intestine and you're you know, most 0:23:06.440 --> 0:23:09.040 of that stomach and the upper small intestine is now bypass. 0:23:09.119 --> 0:23:12.400 That's why they call it bypass surgery. And this one 0:23:12.520 --> 0:23:16.320 is I think there are a few more complications now 0:23:17.560 --> 0:23:19.320 and that's why this one's fallen out of favor a 0:23:19.320 --> 0:23:21.960 little bit. Compared to sleeve guest struck to me, right, Yeah, 0:23:22.040 --> 0:23:24.199 the impression I have is that sleeve gets struck to me, 0:23:24.320 --> 0:23:29.000 is much more um or much less complicated afterward, because 0:23:29.560 --> 0:23:32.119 you're not messing with the original plumbing. All you're doing 0:23:32.200 --> 0:23:35.400