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Melanie Cole: If you’ve tried to lose weight, you’ve probably tried so many diets and medications over the years and you probably haven't had very much long-term success. It’s really difficult to lose a large amount of weight. My guest is Dr. Stelios Rekkas. He's a bariatric surgeon and the medical director of the weight loss program at Manatee Memorial Hospital. If people have been trying so hard to lose weight, there are so many diets out, there are so many things going on, what do you recommend is the first thing people should try when they are starting to see the weight creep up and even if they are severely overweight?

Dr. Stelios Rekkas, MD, FACS: What we really recommend to our patients is start by talking to your local doctor. It's a great way to get the conversation going. A lot of patients, like you said, have tried numerous diets, weight loss programs, over the counter pills, so their primary care doctor should be the one that starts the conversation, and then after they figure out whether or not they're a candidate and whether they want to try and look into other options, we're happy to take over and educate our patients and we have a lot to offer them.

Melanie: Are there any diets and/or things out there you want people to know about or to stay away from? People have tried Atkins and there are so many fad diets out there. What do you want people to know about being wary of what they read and see?

Dr. Rekkas:  We always see these diets pop up from Atkins to cabbage soup; I've seen everything including ice creams. There's really not one perfect diet out there and that’s really the take-home point. Where we really want to focus on is it’s got to be a comprehensive way to approach weight loss. That means that any program that doesn't have diet and exercise and you're not really focusing on working directly with the patient, it’s probably going to fail long-term. The important thing is talking about a well-rounded program and attack the things from all angles; that means diet, activity, exercise and also helping people fundamentally understand that their psychological support is very important. We really work on getting our patients empowered pushing them and helping them through every aspect to weight loss.

Melanie: Psychological support is so important because when you're trying to lose weight, your mind is everything because it’s telling you whether you're hungry or whether you're bored or whether you're stressed, and sometimes we eat just because of whatever it is that’s going on in our minds. If someone is looking at bariatric surgery and they're hearing this in the media, what is bariatric surgery and what are the parameters because not everybody’s a candidate?

Dr. Rekkas:  You're right. Bariatric surgery is surgery that we do specifically to help patients lose weight. It’s a whole specialty in itself and it’s not just a surgical aspect that we really focus on, but we focus on getting that patient in and we work with a comprehensive team of dieticians, psychologists, psychiatrists, medical doctors, so we really as surgeons focus on helping our patients lose weight and we find that when people lose weight, their medical problems get better, including curing their diabetes, high blood pressure, and sleep apnea. My job is to get a patient, get them motivated and see how we can help them not only with just surgery, we have other tools as well, but to get them as healthy and as happy as we can.

Melanie: If they are a candidate for bariatric surgery, are there things that they should also be doing? People think ‘I'm going to have bariatric surgery, now I don’t have to worry about this until I've had the surgery,’ but that’s not really the case. Do you still want them to try and be losing weight or to exercise or to get some psychological counseling while they're waiting for this procedure?

Dr. Rekkas: Absolutely. We really don’t focus on the surgery in our program; we focus on the journey of it. We tell our patients the same thing. It’s a tool that they get. Our patients have to get motivated, our patients are really taking through a whole journey of preoperative clearances, getting them ready, dietician meetings, we have bariatric seminars. Surgery is a tool that they use and we teach them how to get optimized before surgery so they do the things that keep that weight off after surgery. There's really nothing else that we can offer for our patients that works as well as surgery, and we're talking about losing over 75% of their extra body weight, but you're right. It's a comprehensive program and it's a tool that they get and we educate them, we put them together with other patients and the whole thing is really a journey from beginning to end.

Melanie: Before we talk about those types of surgery, you said you put them together with other patients. I assume there are some support groups that go along with it. Do you encourage family members to be involved in this as well? You don’t tell too many people you're losing weight because maybe then they’ll start judging you, keeping an eye on you, but the support group is a different deal. Do you want family members involved in this?

Dr. Rekkas:  Yes. The family is a very important tool, but the thing that I've seen through the years is no one can really relate to our bariatric patients like another bariatric patient. We have monthly seminars, we have support groups, we even have an online support for our patients where they can get on their 24 hours a day and they can ask questions with other patients privately and get their answer out there and talk about what they're going through, what works and what doesn't work. That kind of comradery and that support from other patients in the program I think really sets us apart and helps our patients take it to the next level.

Melanie: What are the types of surgery you offer? Just tell us a little bit about them.

Dr. Rekkas: There are multiple things that are out there for weight loss surgery. Two of the most popular is something called the gastric sleeve surgery and the gastric bypass surgery. The gastric sleeve surgery is a surgery that we basically go in with a camera and five small incisions and we remove about 75% of the stomach. When we do that, patients tend to eat less, their cravings tend to change or hormones that change that they actually crave less sweets. That surgery as a tool with a little bit of moderate activity with some good coaching with a proper diet, you see amazing results. A lot of our patients are losing over 100 pounds and completely turning their lifestyle. Their diabetes is going away. Their sleep apnea is getting cured. They're getting off their high blood pressure medications, so it's a very rewarding thing for me as a surgeon to watch. Those are the two main surgeries that are offered now.

Melanie: It really is incredible, especially for you when you see these results and the people's lives are changed. What's life like for them afterward? Is it difficult to go out to restaurants? Is it difficult to be out at social events depending on which of the surgeries they had?

Dr. Rekkas:  For the most part, no. Most of my patients, when they go through the surgery and after surgery, they go through a very specific diet, and that usually involves having a liquid diet for a few days before surgery. After surgery, they're on a diet that starts off with liquids and slowly advances, but after about two or three months, they're eating like everyone else. They're just eating good quality food, they're eating small portions, but no one can really tell that they’ve had anything done. That’s a beautiful thing because there's this slow transition afterward and most of the patients lose their weight within the first nine to twelve months. That transformation is incredible, but no one can really see it. It’s just teaching the healthy quality lifestyle that most of these patients did not have an opportunity to have beforehand. It keeps them honest, it restricts what they can eat, but that change and watching patients go through that, you see them change mentally, they're stronger, they're happier and healthier. As a bariatric surgeon, that’s a very fulfilling thing and I love my job for that.

Melanie: What a wonderful description and what great work you're doing. Tell us about your team at Manatee.

Dr. Rekkas:  We do have a lot of people here and we're all patient-centered. We really want our patients to feel very welcome the first time they call, going through the program and afterward. We have a dietician in-house that basically starts the patient off. We figure out what the problems are. Some patients come to us and they really have no idea what a calorie is, what's good or bad food, so our dietician starts the process off by educating them and we're very big about educating. We have bariatric coordinators here at the hospital and our office that basically take the patients through all the steps of the procedure, getting through insurance and really motivating that patient to stay in the program and to take things through. We work with different physicians in the area, including psychiatrists, psychologists, gastroenterologists, and cardiologists.

Our job is to get a patient in, make it easy for them, we deal with their insurance, we help them, we give them options and it's all about that multidisciplinary approach where we're optimizing the patient beforehand, keeping them very active in the program, encouraging them, and all the way until after surgery, it continues. We keep seeing our patients for years afterward and that support and the groups that we have I think have been really instrumental in having our results last and having our patients really stay active and motivated.

Melanie: Thank you so much. What great information. You're listening to Manatee Talk Radio with Manatee Memorial Hospital. For more information, please visit manateememorial.com. That’s manateememorial.com. Physicians are independent practitioners who are not employees or agents of Manatee Memorial Hospital. The hospital shall not be liable for actions or treatments provided by physicians. Individual results may vary. There are risks associated with any surgical procedure. Speak with your physician about these risks to find out if bariatric surgery might be right for you. This is Melanie Cole. Thanks so much for listening.