Selected Podcast
Bariatric Surgery
Bariatric surgery provides an alternative weight loss option for patients who just haven't been able to lose weight through diet and exercise. Dr. Louis Fares discusses what the surgery entails, the possible benefits, and more.
Featuring:
Louis Fares, II, MD
Louis Fares, II, MD is the Program Director of Bariatric Surgery at St. Francis Medical Center and Physician with St. Francis Medical Associates.Transcription:
Prakash Chandran: Bariatric surgery is a medical term used to describe a set of surgical procedures that assist in weight loss. It provides an alternative weight loss option for patients who just haven't been able to lose weight through diet and exercise. We're going to learn all about it today with Dr. Louis Fares II The second He's a Program Director of Bariatric Surgery and surgeon with Saint Francis Medical Center. This is the podcast from St. Francis Medical Center. My name is Prakash Chandran. And so Dr. Fares, great to have you here today. I truly appreciate your time. Let's start with the basics. What exactly is bariatric surgery?
Dr Louis Fares II: Well, bariatric surgery simplistically is a treating of obesity. Obesity is a disease in which fat has accumulated to the extent that health is impaired. So we have surgical operations which will correct the ingestion of too much calories, which is food, and limit how much you can take in and therefore help you lose the weight that is very, very difficult to lose on your own.
Prakash Chandran: Okay. And when you say obesity, you say the health is impaired. I'm imagining that there are different levels of obesity. So could you talk maybe objectively about how people should think about obesity and also when it might become an option to consider bariatric surgery?
Dr Louis Fares II: Yes. Well, obesity is defined as BMI, that's body mass index. It's a calculation that we can do taking the height and the weight and coming up with a formula, which helps give us a number. When people are between the BMI of 19 and 25, that's what we consider ideal or normal weight. When they get between 26 and 29, they're considered overweight. And when they get between 30 to 34, they're now considered obese. When they get 35 to 39, they're now considered severely obese. And when you get over the BMI of 40, you are considered morbidly obese. BMI of 40 basically means you're at least a hundred pounds over your ideal weight.
Prakash Chandran: Okay, understood. So I want to go over the different options. But before I do, you know, I know that there are different types of bariatric surgeries out there. Can you talk to them at a high level?
Dr Louis Fares II: Sure. The major operation that was developed a long time ago was the gastric bypass. It's called a Roux-en-Y gastric bypass. Originally, the operation was used primarily for cancer surgery. Today, it's been found that it can work very well for morbid obesity, and help the patients lose the weight and therefore hopefully lose the co-morbidities that are significantly hurting them.
Gastric bypass surgery is basically an operation where the top of the stomach is cut away from the rest of the stomach. And the intestines are rerouted to let the food go downstream, but just not as much. There's an operation called the sleeve, sleeve gastrectomy. And the sleeve is basically where the stomach, which is basically the size of a football, is made into a long tube. So about 75 to 80% of the stomach is removed, again restricting the amount of food that can be taken in.
There's also a device called the Lap-Band, which a lot of people have heard about because it was advertised a lot on TV. And the Lap-Band is a device that is placed around the top of the stomach and can be tightened at times to help stop the amount of food that's going in. But today, most people are not doing the Lap-Band because the success rate with it is not nearly as good as the first two procedures that I talked about. There's also a fourth procedure called the duodenal switch, which is a more complicated operation. And to be honest, it's now being modified. And there are newer operations that are coming out that are not approved yet by insurance companies. But these operations may in the long run be even better than some of the ones we're doing today.
Prakash Chandran: So gastric bypass, sleeve, Lap-Band and duodenal switch. In each one of these surgical procedures, is it dependent on the type of person that comes in or the circumstance? How do you decide which surgical option to use?
Dr Louis Fares II: Very good question. We sit down with our patients all the time and go through a whole process. And it's a comprehensive program that we're dealing with. The first is we also have them see the dietician that we have, so that they can sit down and discuss their actual dietary behavior. We also have them see a pulmonologist, a lung doctor. We have them see a cardiologist, a heart doctor. We have them see a gastroenterology, plus a psychiatrist and we have lab work and various testings, ultrasounds and stuff like that that are done to help the patient understand what's going on. Most of them don't realize that they have a lot of medical conditions that are potentially harmful to them, because first of all, most of them are younger and they don't realize how much the fat tissue is already affecting their lives. So by having all this, we can then sit down with the patient and give them options about what operations to have. We like the patient to make a decision for themselves. We'd like them to pick the operation that's going to help them going forward in the future. I don't like the idea of the surgeon picking the operation. I think the patients should see what's going to be the best way for them to lose the weight and maintain that weight loss going forward.
Prakash Chandran: Yeah, that makes a lot of sense. And it kind of leads me to my next question around when someone makes the decision to even step into the office to consider bariatric surgery, like who is the ideal candidate that undergoes this procedure?
Dr Louis Fares II: Well, the ideal candidate would be somebody who realizes that they have tried everything to lose weight, but can't. And they have now significantly a weight over a BMI of 35. So it means they're at least around 75 pounds over their ideal weight. And they've already started to experience the problems with that weight such as high blood pressure, diabetes, or pre-diabetes, high cholesterol, sleep apnea, joint pains, back pains, shoulder pains, things that occur because of this excess weight. They should have tried and we want them to have tried various weight loss programs. Unfortunately, we know that the overwhelming majority of them do not work or at least not work long-term. So our point is that once they have tried all of these programs, we want them to come in and sit down and get educated about surgery. It's not a cure-all. We have to have patients working with us to work with them to be successful.
Prakash Chandran: Yeah. And you mentioned this like multidisciplinary team that they meet with, everyone from a dietician to a psychiatrist. Like you wouldn't think that going in for surgery, you would meet with all these types of people, but to your point, this is a journey. This is not a fix-all surgery. This is something that mentally the patient has to prepare for, they have to be ready for, and they have to live with modifications for the rest of their lives. Is that correct?
Dr Louis Fares II: That is correct. But we're also there for them. This is not the idea of like you have a hernia operation, hernia's fixed, and you never see the surgeon again hopefully. This operation is something that we're doing and we expect to see the patient at least on a yearly basis to make sure that they are handling things going forward and doing well. We want them seeing the dietician at least on a yearly basis as well. The idea is that with the weight loss will come some challenges for them, especially as they're around society and society is telling everybody to eat, especially in the pandemic. Everybody is supposed to eat more. Well, that's the worst thing that can happen. We all talk about the quarantine 19, the 19 pounds everybody gained over the two-year pandemic and that's something that's a major issue, a major problem for our society, since now we have greater than 60% of our population that is considered obese.
Prakash Chandran: Wow. Over 60% of the population. That's just crazy. I feel like that number just keeps increasing. So if someone meets the criteria that we discussed, that high BMI, 75 pounds potentially overweight, and they decide to move forward with the surgery, how do they go about preparing for it?
Dr Louis Fares II: Well, first of all, you've mentioned that it's a journey and it is a journey, because almost all insurances require a process to be done from anywhere from four to six months. So the patient is coming in, seeing us on a monthly basis for some time, making sure all of these information that we need is done, these evaluations that we want are done, and that the patient then understands where they're going to be going after the operation to follow up and be seen. To prepare for the operation means that the patient is basically making sure the family members are aware of what's going on. We don't want secrets. We want them to be honest to their family. We want them to be honest with us as well. And then there's certain things like not smoking, things that can adversely affect surgery. We don't want that and therefore we encourage them to stop smoking if they are, and to help them in ways to have smoking cessation devices or medications to help.
Prakash Chandran: So there are a number of things that they need to do before they even go in for surgery. One of those things is the smoking cessation. Do they actually have to like lose a little bit of weight on their own before they come in?
Dr Louis Fares II: We work with them from day one, trying to make sure at least that they don't start gaining any more weight. We would like to see that some of the behavioral changes that we're working with them with dieticians as well is going to help them and hopefully they will see some weight loss. Now, obviously they're not going to lose a hundred pounds because if that were so easy, then we'd all do it. The reality is that we want them to lose some weight. And one of the things we do before the operation is we have what's called a preoperative diet. We have them on this diet and they lose a number of pounds before the surgery, because this diet that we put them on is something that there's no way if they follow it that they will gain weight. This is a low-calorie diet. And we expect them to lose a number of pounds before the operation. And as I tell them, when they lose the weight, they're losing the weight in the area while I will be working, it makes it easier for me and it's therefore easier for them.
Prakash Chandran: So one thing that I wanted to talk about before we close is just the mental impacts of being obese and dangerously obese to where it is actually affecting your quality of life. I imagine that someone who is suffering from being obese goes through a lot, right? They have tried everything. It hasn't been working for them, but they might also feel guilted by society around a certain way that they should look. And one of the things in doing research for this conversation that I've seen is that bariatric surgery can actually help you feel better about yourself and, in some cases save, lives over time. Is that something that you can speak to?
Dr Louis Fares II: That's the actual point and absolutely true. Unfortunately in society, the last bastion of being mean to somebody is that you call them fat or they're a big family of fat people. The reality is, as I said, with the majority of our population now becoming significantly obese, they're finding it more difficult to do things. They can't sit on airplanes, so they have to get two seats. They have difficulty to drive because they can't fit behind the steering wheel. They have difficulty in walking. Their joints are slowly being industrial. And they have to have sometimes canes or walkers. Of course, if you're young and you have a young family and you want to play with your children, you can't get down on the floor. You can't do things with them because you get out of breath so quickly. So those are the types of things that the obese patient is suffering from all the time. And then you throw in all the co-morbidities like diabetes, blood pressure, now you're potentially shortening their life.
So what happens with bariatric surgery is with the weight loss, you have now given patients a second chance of life. They find out that the weight loss, the joint pains go away, the diabetes goes away, the blood pressure comes down to a manageable level. They're able to do things again with their kids. They can play on the ground, they can go out with bicycles, they can drive them around. They can do all the things that we expect as normal that they have been stopped from doing because of the weight. So yes, from the standpoint of bariatric affects patients' lives and self-image, a hundred percent for the better.
Prakash Chandran: Dr. Fares, the last question that I wanted to ask you is given all of your experience as a bariatric surgeon, what is one thing that you just know to be true that you wish more people knew before they came in to see you?
Dr Louis Fares II: That bariatric surgery is not the end all, it's not just a magical thing that you're suddenly going to lose a hundred pounds in the next day. This is a process it's important for the patients to understand that they have to work at it. We will support them. We will help. But it's important for them on a daily basis to make sure that they're watching their behavior, what they're eating, not snacking, exercising, doing things that is going to make it easier and better for them in the long run, and make them a healthier person and their lives won't be cut short by these disease processes that they presently have.
Prakash Chandran: Well, Dr. Fares, I think that is the perfect place to end. Thank you so much for your time and the education today.
Dr Louis Fares II: My pleasure. Thank you.
Prakash Chandran: That was Dr. Louis Fares II, The second Program Director of Bariatric Surgery and surgeon with St. Francis Medical Center. For more information about St. Francis Medical Associates or to make an appointment with one of our medical providers, you can call 855-599-SFMC. Once again, that is 855-599-7362. You can also visit stfrancismedical.org. If you found this podcast to be helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. This once again was the podcast from St. Francis Medical Center. My name is Prakash Chandran. Thanks so much and we'll talk soon.
Prakash Chandran: Bariatric surgery is a medical term used to describe a set of surgical procedures that assist in weight loss. It provides an alternative weight loss option for patients who just haven't been able to lose weight through diet and exercise. We're going to learn all about it today with Dr. Louis Fares II The second He's a Program Director of Bariatric Surgery and surgeon with Saint Francis Medical Center. This is the podcast from St. Francis Medical Center. My name is Prakash Chandran. And so Dr. Fares, great to have you here today. I truly appreciate your time. Let's start with the basics. What exactly is bariatric surgery?
Dr Louis Fares II: Well, bariatric surgery simplistically is a treating of obesity. Obesity is a disease in which fat has accumulated to the extent that health is impaired. So we have surgical operations which will correct the ingestion of too much calories, which is food, and limit how much you can take in and therefore help you lose the weight that is very, very difficult to lose on your own.
Prakash Chandran: Okay. And when you say obesity, you say the health is impaired. I'm imagining that there are different levels of obesity. So could you talk maybe objectively about how people should think about obesity and also when it might become an option to consider bariatric surgery?
Dr Louis Fares II: Yes. Well, obesity is defined as BMI, that's body mass index. It's a calculation that we can do taking the height and the weight and coming up with a formula, which helps give us a number. When people are between the BMI of 19 and 25, that's what we consider ideal or normal weight. When they get between 26 and 29, they're considered overweight. And when they get between 30 to 34, they're now considered obese. When they get 35 to 39, they're now considered severely obese. And when you get over the BMI of 40, you are considered morbidly obese. BMI of 40 basically means you're at least a hundred pounds over your ideal weight.
Prakash Chandran: Okay, understood. So I want to go over the different options. But before I do, you know, I know that there are different types of bariatric surgeries out there. Can you talk to them at a high level?
Dr Louis Fares II: Sure. The major operation that was developed a long time ago was the gastric bypass. It's called a Roux-en-Y gastric bypass. Originally, the operation was used primarily for cancer surgery. Today, it's been found that it can work very well for morbid obesity, and help the patients lose the weight and therefore hopefully lose the co-morbidities that are significantly hurting them.
Gastric bypass surgery is basically an operation where the top of the stomach is cut away from the rest of the stomach. And the intestines are rerouted to let the food go downstream, but just not as much. There's an operation called the sleeve, sleeve gastrectomy. And the sleeve is basically where the stomach, which is basically the size of a football, is made into a long tube. So about 75 to 80% of the stomach is removed, again restricting the amount of food that can be taken in.
There's also a device called the Lap-Band, which a lot of people have heard about because it was advertised a lot on TV. And the Lap-Band is a device that is placed around the top of the stomach and can be tightened at times to help stop the amount of food that's going in. But today, most people are not doing the Lap-Band because the success rate with it is not nearly as good as the first two procedures that I talked about. There's also a fourth procedure called the duodenal switch, which is a more complicated operation. And to be honest, it's now being modified. And there are newer operations that are coming out that are not approved yet by insurance companies. But these operations may in the long run be even better than some of the ones we're doing today.
Prakash Chandran: So gastric bypass, sleeve, Lap-Band and duodenal switch. In each one of these surgical procedures, is it dependent on the type of person that comes in or the circumstance? How do you decide which surgical option to use?
Dr Louis Fares II: Very good question. We sit down with our patients all the time and go through a whole process. And it's a comprehensive program that we're dealing with. The first is we also have them see the dietician that we have, so that they can sit down and discuss their actual dietary behavior. We also have them see a pulmonologist, a lung doctor. We have them see a cardiologist, a heart doctor. We have them see a gastroenterology, plus a psychiatrist and we have lab work and various testings, ultrasounds and stuff like that that are done to help the patient understand what's going on. Most of them don't realize that they have a lot of medical conditions that are potentially harmful to them, because first of all, most of them are younger and they don't realize how much the fat tissue is already affecting their lives. So by having all this, we can then sit down with the patient and give them options about what operations to have. We like the patient to make a decision for themselves. We'd like them to pick the operation that's going to help them going forward in the future. I don't like the idea of the surgeon picking the operation. I think the patients should see what's going to be the best way for them to lose the weight and maintain that weight loss going forward.
Prakash Chandran: Yeah, that makes a lot of sense. And it kind of leads me to my next question around when someone makes the decision to even step into the office to consider bariatric surgery, like who is the ideal candidate that undergoes this procedure?
Dr Louis Fares II: Well, the ideal candidate would be somebody who realizes that they have tried everything to lose weight, but can't. And they have now significantly a weight over a BMI of 35. So it means they're at least around 75 pounds over their ideal weight. And they've already started to experience the problems with that weight such as high blood pressure, diabetes, or pre-diabetes, high cholesterol, sleep apnea, joint pains, back pains, shoulder pains, things that occur because of this excess weight. They should have tried and we want them to have tried various weight loss programs. Unfortunately, we know that the overwhelming majority of them do not work or at least not work long-term. So our point is that once they have tried all of these programs, we want them to come in and sit down and get educated about surgery. It's not a cure-all. We have to have patients working with us to work with them to be successful.
Prakash Chandran: Yeah. And you mentioned this like multidisciplinary team that they meet with, everyone from a dietician to a psychiatrist. Like you wouldn't think that going in for surgery, you would meet with all these types of people, but to your point, this is a journey. This is not a fix-all surgery. This is something that mentally the patient has to prepare for, they have to be ready for, and they have to live with modifications for the rest of their lives. Is that correct?
Dr Louis Fares II: That is correct. But we're also there for them. This is not the idea of like you have a hernia operation, hernia's fixed, and you never see the surgeon again hopefully. This operation is something that we're doing and we expect to see the patient at least on a yearly basis to make sure that they are handling things going forward and doing well. We want them seeing the dietician at least on a yearly basis as well. The idea is that with the weight loss will come some challenges for them, especially as they're around society and society is telling everybody to eat, especially in the pandemic. Everybody is supposed to eat more. Well, that's the worst thing that can happen. We all talk about the quarantine 19, the 19 pounds everybody gained over the two-year pandemic and that's something that's a major issue, a major problem for our society, since now we have greater than 60% of our population that is considered obese.
Prakash Chandran: Wow. Over 60% of the population. That's just crazy. I feel like that number just keeps increasing. So if someone meets the criteria that we discussed, that high BMI, 75 pounds potentially overweight, and they decide to move forward with the surgery, how do they go about preparing for it?
Dr Louis Fares II: Well, first of all, you've mentioned that it's a journey and it is a journey, because almost all insurances require a process to be done from anywhere from four to six months. So the patient is coming in, seeing us on a monthly basis for some time, making sure all of these information that we need is done, these evaluations that we want are done, and that the patient then understands where they're going to be going after the operation to follow up and be seen. To prepare for the operation means that the patient is basically making sure the family members are aware of what's going on. We don't want secrets. We want them to be honest to their family. We want them to be honest with us as well. And then there's certain things like not smoking, things that can adversely affect surgery. We don't want that and therefore we encourage them to stop smoking if they are, and to help them in ways to have smoking cessation devices or medications to help.
Prakash Chandran: So there are a number of things that they need to do before they even go in for surgery. One of those things is the smoking cessation. Do they actually have to like lose a little bit of weight on their own before they come in?
Dr Louis Fares II: We work with them from day one, trying to make sure at least that they don't start gaining any more weight. We would like to see that some of the behavioral changes that we're working with them with dieticians as well is going to help them and hopefully they will see some weight loss. Now, obviously they're not going to lose a hundred pounds because if that were so easy, then we'd all do it. The reality is that we want them to lose some weight. And one of the things we do before the operation is we have what's called a preoperative diet. We have them on this diet and they lose a number of pounds before the surgery, because this diet that we put them on is something that there's no way if they follow it that they will gain weight. This is a low-calorie diet. And we expect them to lose a number of pounds before the operation. And as I tell them, when they lose the weight, they're losing the weight in the area while I will be working, it makes it easier for me and it's therefore easier for them.
Prakash Chandran: So one thing that I wanted to talk about before we close is just the mental impacts of being obese and dangerously obese to where it is actually affecting your quality of life. I imagine that someone who is suffering from being obese goes through a lot, right? They have tried everything. It hasn't been working for them, but they might also feel guilted by society around a certain way that they should look. And one of the things in doing research for this conversation that I've seen is that bariatric surgery can actually help you feel better about yourself and, in some cases save, lives over time. Is that something that you can speak to?
Dr Louis Fares II: That's the actual point and absolutely true. Unfortunately in society, the last bastion of being mean to somebody is that you call them fat or they're a big family of fat people. The reality is, as I said, with the majority of our population now becoming significantly obese, they're finding it more difficult to do things. They can't sit on airplanes, so they have to get two seats. They have difficulty to drive because they can't fit behind the steering wheel. They have difficulty in walking. Their joints are slowly being industrial. And they have to have sometimes canes or walkers. Of course, if you're young and you have a young family and you want to play with your children, you can't get down on the floor. You can't do things with them because you get out of breath so quickly. So those are the types of things that the obese patient is suffering from all the time. And then you throw in all the co-morbidities like diabetes, blood pressure, now you're potentially shortening their life.
So what happens with bariatric surgery is with the weight loss, you have now given patients a second chance of life. They find out that the weight loss, the joint pains go away, the diabetes goes away, the blood pressure comes down to a manageable level. They're able to do things again with their kids. They can play on the ground, they can go out with bicycles, they can drive them around. They can do all the things that we expect as normal that they have been stopped from doing because of the weight. So yes, from the standpoint of bariatric affects patients' lives and self-image, a hundred percent for the better.
Prakash Chandran: Dr. Fares, the last question that I wanted to ask you is given all of your experience as a bariatric surgeon, what is one thing that you just know to be true that you wish more people knew before they came in to see you?
Dr Louis Fares II: That bariatric surgery is not the end all, it's not just a magical thing that you're suddenly going to lose a hundred pounds in the next day. This is a process it's important for the patients to understand that they have to work at it. We will support them. We will help. But it's important for them on a daily basis to make sure that they're watching their behavior, what they're eating, not snacking, exercising, doing things that is going to make it easier and better for them in the long run, and make them a healthier person and their lives won't be cut short by these disease processes that they presently have.
Prakash Chandran: Well, Dr. Fares, I think that is the perfect place to end. Thank you so much for your time and the education today.
Dr Louis Fares II: My pleasure. Thank you.
Prakash Chandran: That was Dr. Louis Fares II, The second Program Director of Bariatric Surgery and surgeon with St. Francis Medical Center. For more information about St. Francis Medical Associates or to make an appointment with one of our medical providers, you can call 855-599-SFMC. Once again, that is 855-599-7362. You can also visit stfrancismedical.org. If you found this podcast to be helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. This once again was the podcast from St. Francis Medical Center. My name is Prakash Chandran. Thanks so much and we'll talk soon.
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