And we take turns seeing the patients while they're in the clinic office. And then we discuss and confer amongst ourselves to really formulate a good game plan. So this takes place when patients come in for their initial evaluation. So we identify if there's some particular behaviors or education that we can work on to really get people ready to be successful with surgery.
And we also have the same approach in the aftercare. And all of this is really focused on selecting the patients that we think will have the best chance of success with surgery, and getting the best outcomes that we can have after surgery. So really having that team approach is I think what sets us quite a bit apart. And it really sets the patients up for success in the future.
So we want to remind our viewers that we are taking your questions, so type them in the comments section. We'll try to get to as many as possible. Let's start off talking about the different types of bariatric surgery available.
They were mentioned in the video, but if you could tell us a little bit about what they are, and what they entail. So there are currently four approved bariatric surgeries that are performed nationwide.
We are one of the only centers that actually offers all four types of surgeries. The most common one being performed these days is something called the sleeve gastrectomy, or vertical sleeve gastrectomy.
Some people call it VSG. This is a procedure that's done laparoscopically, which means surgery through very small incisions. And this can be done with general anesthesia, and most people actually wind up leaving the next day. So the sleeve gastrectomy is a procedure which reduces the size of your stomach by permanently removing a portion of it.
So I like to tell people, if you think of your stomach like a big handbag that you can stuff lots of things into, if you were going somewhere over the weekend. By removing a portion of it, you basically are trimming it down to where just the essentials fit in. So some people say it's a banana shape, or I like to say from the big handbag, to maybe just like a small purse you would take to a party, or something like that.
And so that reduces the space where you can fit food, but also we've learned that actually impacts some hormones in your body that affect hunger and how full you feel. So it's not that you feel hungry but can't eat, but it actually changes the relationship that you have with food.
So that's why it's one of the reasons that it actually works better than restricting yourself on a diet. So that's currently the most common procedure. Another procedure that's performed, also laparoscopically, or using the small incisions, is called the gastric bypass. Sometimes call it people call it the Roux-en-Y. This is a procedure that's been performed actually the longest for weight loss, since like the '60s or something like that.
And it has a really excellent track record. Because it's been around, there are some stories out there maybe that it was not safe in the past, et cetera.
But this is actually is not true. It's a very safe procedure, likely as safe as all the other procedures. And it has certain advantages over the sleeve. And sometimes we recommended for people with severe heartburn or reflux. We may also recommend it if you have diabetes on insulin, such as the patient that was highlighted earlier.
And it can be quite effective in getting people off the insulin that they're on. The other procedure is a procedure called the duodenal switch, which is the procedure that we specialize in here at the University of Chicago. Prachand was actually the person to perform it first, using the minimally invasive techniques here in the Midwest. And very few centers around the country perform it. It is a little bit more complex procedure, but also has more rewards.
The duodenal switch is a procedure that affords you the most weight loss, particularly if you're in the category of people who may need to lose around pounds. And that's people whose BMI-- which is body mass index-- is over And also, it's very effective for people who have very severe diabetes, that have been diabetic for greater than 10 years on insulin.
And can be a very powerful way to treat that metabolic disease, that combination of obesity and diabetes. The last procedure is something called the laparoscopic adjustable gastric band.
Technically we do offer it, but it is a procedure that is becoming sort of less popular these days, mainly because it is a device. It is subject to moving and breaking. And also we've seen over the last few years that the weight loss is not as effective as some of the other procedures.
And so it is a procedure that is approved, but we are actually performing it less frequently, these days. Now, we are getting questions from viewers. I want to get to those, and try to answer as many as we possibly can during the program. First question, which you pretty much just answered but we'll go ahead and throw it at you again, anyway, when you were talking about the duodenal switch.
This is somebody who says, do you think a person whose BMI is over 50 should think about surgery? And I guess, the question would be, then, what types of surgery should they should they first consider? And either one of you can field that one. So you mentioned BMI of greater than So again, BMI stands for body mass index. And we get that number by combining height and weight into a formula, and it gives a pretty good estimate of how much extra fat a person has for their height. It's not a perfect number, and you'll see a lot of news stories and a lot of complaining about BMI.
But the reality is that, unless you're an NFL linebacker or a professional athlete, it actually does a pretty decent job of estimating this. So just to quickly review, a normal BMI is between 20 and And a person is considered obese if their BMI is greater than And so we talk about surgery for obesity when the BMI is 40 or higher, or if it's between 35 and 40 and the person has other significant medical problems related to their obesity, as we mentioned earlier.
So when we're talking about BMI of greater than 50, that's typically somebody who's to pounds overweight. And typically, and frequently associated with that are those other obesity-related medical conditions like diabetes, high blood pressure, and so forth.
So in the past, when gastric bypass was the most common operation performed, say 15, 20 years ago, what was seen quite frequently is that patients who had BMIs greater than 50 or 60, they frequently failed to lose enough weight after they had gastric bypass, or they would regain a significant amount of weight. And that's really what prompted our interest in performing the duodenal switch, because historically, it seemed to be associated with a greater amount of weight loss.
But there really had not been any head to head studies comparing the two operations to determine which is actually more effective for this very difficult-to-treat group of patients with a higher BMI. So we did the first study comparing not only the weight loss, but the impact on diabetes, high blood pressure, and high cholesterol. And we were the first to find that there was, in fact, a significant advantage for patients with greater than a BMI of Now, that doesn't mean that every patient with the BMI of greater than 50 should have a duodenal switch.
And I think that one of the key things that we really try to convey to our patients when they come for an evaluation, and what we really take most of their time in our conversations and discussions with patients, is figuring out what the right tool is for you, as an individual.
Because there's not one operation that's the best for everyone in all circumstances. And so it's really about finding the right match between the operation and the patient, taking to account the fact that each person has a different amount of weight that they need to lose, each person has different medical conditions that are related to their obesity, different side effects of the operations, and different effectiveness, in terms of weight loss and impact on these medical conditions.
And so that conversation that we have as the surgeon with the patient is really the key. So we've talked about people with the higher BMI. So we have a question from a viewer, somebody without that level of BMI.
And the question is, for someone struggling to lose 25 pounds, would surgery be an option? Generally, probably not. Again, we don't necessarily go by how much weight you're overweight, but the BMI. So you would have to calculate your BMI. But the minimum BMI is basically 40, which correlates to roughly around pounds for people who are normal height. Or an average height, I should say. Or if you're a BMI is over 35 and you have a medical condition closely related to obesity, such as diabetes, high blood pressure, high cholesterol, or sleep apnea.
Generally, if you're about 25 pounds overweight, you're probably around a BMI of 30, again, if you're an average height individual. And around that BMI, generally, the first recommendation would be intensive lifestyle modification, which is also the first step for anyone who's trying to lose weight. So that's, generally, meaning working with a professional, such as a dietician or a medical specialist that works with obesity medicine.
Or maybe even a therapist or a psychologist that can help you lose weight. But having those regular visits with professionals really been shown to affect success with people trying to lose weight. And that's one of the nice things about UChicago Medicine. We do offer services like that, as well, so we can cover the whole range.
How safe is bariatric surgery? So I think that there is a lot of myths and concerns, when it comes to surgical safety with these operations. And again, this, I think, dates back to 20 years ago, when these operations really were considered to be risky.
And frankly, there as a lot of high-profile cases in the newspapers, and so forth, as the operations initially started to become more popular. But over the years, with modifications and techniques and the management of these patients, using laparoscopic approaches, instead of the traditional open incision, which required a pretty large incision extending from the breastbone down to the belly button.
By using these approaches, and really the management of the team, the safety today in centers of excellence, such as ours, is very similar to patients who have gallbladder surgery. Which is to say that it's a very safe operation. We have more questions coming from our viewers. I've heard hair loss can be a common side effect of bariatric surgery.
Is there a way to avoid this, and does it taper off on its own? This can happen after bariatric surgery, but it can happen also if you're losing weight with any other means. When you do lose a significant amount of weight, particularly quickly, it is the body's natural response to sort of make sure it's not wasting resources, if you will. And not that hair is a waste of a resource, but basically, it does require protein from your body to make hair. So when you're in that initial period of rapid weight loss, your body may say, let's just see what's going on.
Make sure we have enough nutrients for essential functions. So it may shut down new hair growth for a little bit, and that may come off as seeing that you're losing hair. Generally, this is temporary and fully recoverable. And it generally is not significant to a point where others would notice, but you may notice that your hair is thinning.
Our dieticians, who are nutritional specialists that we work with, are very good at counseling our patients through this period, and making sure that they keep up with the appropriate protein and vitamin recommendations that can really limit the amount of hair loss that they experience, and certainly help with the hair regrow period.
We've got a follow-up question to that. Let's talk a little bit about the vitamins and supplements and things that people will take after a surgery like this. How long does that go on, and how significant is that? So with all of the operations that we do, taking vitamins is something that's necessary after surgery forever.
Each of the operations is slightly different, in terms of the way that the body absorbs and handles different nutrients and vitamins, but in all cases, because of that reduction in appetite and because there's less food being taken in, if you don't get enough in and if your body's not absorbing in the way that it had been previously, you're at risk of developing deficiencies.
So taking vitamins every day is an important part of being as successful as you can be after surgery. I like to tell patients, you wouldn't want to get a transplant operation and then not take your immune suppression medication afterwards. And you have to almost look at vitamins in the same way, after you have these operations. And for me, it was like-- I equated to a light switch.
It was like a miracle for me, almost within days of starting the medication, how I react to food totally changed. I wanted to say for the first time in my life, I started eating like a normal person.
I could tell what it meant to be full. Before I never knew when I was full. So I could start separating the behavior component of overeating versus the physical component of it. So now I know what I'm eating because I want to eat, because something tastes good, versus just eating all the time because I am obsessing with food. That's very interesting. And it showed, obviously, the importance and the success that she's had through your program and with some medical-- some help from medicine.
So that's great. Couple more questions for viewers that just came in as we were listening to that little sound bite. What are thoughts on-- your thoughts on intermittent fasting for weight loss?
Again, a lot in the news about intermittent fasting. So the intermittent fasting is that when you fast, at least more than 12 hours, up to 15, 16 hours, there may be what we call a metabolic switch. It means that we switch from using sugar for energy to use fat for energy.
So that fat burning more that may actually favor weight loss. Now, studies in rodents, animals, have shown that intermittent fasting may be more successful in terms of weight loss.
Now, human studies-- and we have a just few studies with a limited number of patients-- are not clearly showing a benefit in terms of weight loss. Again, and the data are limited. But what they're showing that is safe to do intermittent fasting.
And it can be as effective as doing the low everyday low calorie diet. So the idea is-- intermittent fasting can mean two things. Either you do what we do, time restricted feeding. You eat from, let's say, to but then you fast for 16 hours. That's what-- there are two types, I would say, at least. So the idea is, for example in our program, the patient actually may have a preference in skipping breakfast and eating in that the eight hours window.
It works better for lifestyle or they tried before, it worked. And because the data are not against that, if that's the patient preference, then we do support the patient. And we observe and see if that approach works. So it is-- they may be promising. We don't have enough human data. But again, it always shows that we don't have the perfect diet, the same way the low carb, better fat. We yet to know if there is a perfect diet. It's very much an individual approach. And that's why that history at the beginning of the first visit, which tends to be a long visit, history will work for the patient in the past and what not work is a very important piece in designing that plan.
And so we really-- it's a collaborative work between the patient and as it's provider, designing the treatment plan. We agree, on it. Another question from a patient, or a prospective patient. They take Prozac for anxiety, they want to know if they can take medication for weight loss. So we often talk to these patient's psychiatrist with the patient's permission. So there is no contraindications for most of the weight loss medication to be used in concomitance with, for example, antidepressants.
It is very important to monitor the patient response to the medications, closely, in the first few months. Because usually what you see the first few months is what we're going to see over a longer period of time.
So we monitor the patient closely. And remember, most of the weight loss medication do act in the brain, suppressing appetite. So it is very bad because they're acting in brain, they could theoretically affect the mood. Sometimes in a positive way, sometimes in a little bit more negatively. So close monitoring is the key to make this right and really benefit the patient.
Doctor Busby, one of the questions that we received was cravings. How do you deal with cravings? How do you manage cravings? And that's a killer for all of us. I mean, I know I fall in that category where as soon as I get home, I walk through my kitchen and the first thing I do is open my refrigerator. It's the dumbest thing I can do. I realize it. But I do it. How do you break those habits?
Well, I want to preface this by saying that there is no magic bullet for this. I wish there was. I know, I know. But you know, I would say the typical way that I would approach this with a patient is, you know, I would first provide a little bit of education about what is a craving.
You know, how do you distinguish it from true hunger, first of all. You know, talk about how it, in certain ways, cravings are like emotions. They come and they go. They're typically in response to what's going on in your life.
And they come and go naturally without us doing anything about them. You know, want to, of course, normalize the patient's experience that everyone experiences cravings. So they're not unusual or strange or wrong for experiencing that. And then often the next step that I would take is doing what I would call a functional analysis of their cravings, where determining what are the antecedents or the precipitants or triggers of cravings.
And what are the consequences of eating in response to cravings? For me, it's breathing. I'm joking. And it isn't funny. I shouldn't joke about it. But you know, one of the things that I think-- I don't know if it was you that mentioned it to me. Somebody on your team did. That even the setup of a person's house can impact. Like I said, I park my car in my garage, the door enters into the kitchen. So there I am. And it's the first place I see when I go home.
And there are days when I try to kind of just rush through and keep going but it's-- Right, so certainly there can be both external and internal triggers. So external, yes, you know, setup of your house, your workplace, your commute. You know, really anything. And then internal triggers, you know, primarily emotions. And so you know, part of what I do is if, you know, if there's a way to decrease the prevalence of the triggers or decrease exposure to the triggers, we can do some work there.
Or-- and then we also talk about the inevitability of being triggered and then that kind of things that you can do to cope with that experience because inevitably the craving will decrease whether you do anything about it or not. So what is it that you can do in that moment, basically, to tolerate it. And what that might be is really individualized. But that's how I would approach it. I like that. A couple more questions from viewers. This was interesting.
Any studies-- have you seen any studies-- on patients who are post treatment for breast cancer? What is the long term effect on metabolism and weight gain or loss for those folks who have lived through breast cancer? Yeah, so actually what happened is that with new therapies for cancer, we actually see more and more weight gain induced by those treatments.
Some of the new agents may induce increased hunger. Or for example, we had to use what we call steroids, that combine that the chemotherapy-- with chemotherapeutic agent may actually induce weight gain.
So actually, in our program we do see patients referred by an oncologist because of past treatment weight gain. We have-- I can think about a few patients, post breast cancer treatment weight gain. So we approach them in a similar way. But what is different is I like to call that what we call drug-induced weight gain.
So even if you're not seeing a large weight gain, we know that the weight gain is really was due to a medical treatment.
So we want to aggressively to treat that because the patient-- a lifetime was actually to be a normal weight. It was just a cycle. So there is no doubt now, weight gain after cancer treatment, which we didn't know-- used to see when we had the old chemotherapy agent and which induce significant nausea and vomiting.
We have more of this. So I think we need to really be ready to see these patients in our practice. And the problem is that high weight has been associated with 13 types of cancers. So high weight actually may worsen the outcome.
It may favor the recurrence of the cancer. So although there is no strong data, it probably is important to help the patient to go back to a normal weight after all that treatment. So it's probably important for the cancer by itself. I'm going to try to get to one more question. We're about out of time for the program. But a viewer wants to know if there are studies that show a correlation between the gut microbiome and weight loss, or gain. Yeah, there's plenty of studies.
We're looking at that. There's a lot of interest of the relationship between microbiome and weight gain, or difficulty losing weight. The idea is that maybe the current environment is changing our microbiome. That may explain, for example, why it's difficult to lose weight once we have gained weight.
Why our body is sensing the higher weight as being a new normal and is defending that weight. So the microbiome could be one of the reasons why the sensing of energy in our brain changes in this environment and changes after we gain weight. So a big part, a lot of studies, impossible to summarize one statement. But it's very much a hot topic, which may change in the future the way we treat our patients, or maybe even the type of diet that we give to our patients.
I do to hear from Rita one more time. She's exercising now that she's lost all this and it feels great. The weight loss plan has given her a new outlook and really makes a positive difference in her life.
I've struggled with my weight all of my life. And I've lost weight numerous times, only to gain it back. And right before a doctor-- I saw Doctor Pannain, the same thing was happening.
In I'd lost a little-- right around pounds or so. And around , '15, I don't recall exactly when I started seeing her, I was repeating the same pattern. And wanted to try to stop it from happening again. So I would lose the weight and then regain it and gain a little bit more. And I always had done it on my own, never sought any help losing weight. I always thought that weight management was mind over matter. And always blamed myself for gaining weight.
Nice to see that she's doing so well. So congratulations. Do you need a speaker for your event or organization? A UChicago Medicine registered dietitian can present an interactive, informative session on a variety of food and nutrition topics personalized for your group or organization. For more information about Nutrition to Go, call This week weight loss program is designed for adults who want to lose weight, improve their overall health and increase physical activity.
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