Core Bariatrics
Episode 16: Talking with Healthcare Professionals
When a fellow physician's offhand remark about obesity struck a nerve, it brought home the reality of the insensitivity that pervades our medical community. It's discussions like this that Tammie and Maria tackle head-on, breaking down the complexities of weight management far beyond the oversimplified calories in versus calories out. Their conversation sheds light on the multifaceted influences of genetics, metabolism, and lifestyle choices on an individual's weight, underscoring the urgent need for a more educated approach within healthcare.
As they peel back the curtain on bariatric care, they're confronted with the stark realities of accessibility, especially in rural areas. The advancements in surgery and evolving outpatient policies come into sharp focus alongside the role of primary care physicians in the referral process. Maria gets personal, sharing her own experience with binge eating disorder, and together, Tammie and Maria expose how few eligible patients receive the care they need. They also explore how telemedicine, a beacon of hope post-COVID, could revolutionize follow-up care and bridge the healthcare divide.
The finale of the episode takes on a proactive stance, stressing the significance of early intervention in weight management. They emphasize the value of a multi-disciplinary approach and the necessity for primary care doctors to be well-versed in weight management. Wrapping up, they extend an open invitation to our listeners to connect with them on social media for further discussions and insights. With Tammie's invaluable perspective, they hope their candid dialogue resonates with listeners and sparks a much-needed transformation in how the healthcare field addresses weight management.
We want to gather with a purposeful intention to explore the world around us. ...
Listen on: Apple Podcasts Spotify
When a fellow physician's offhand remark about obesity struck a nerve, it brought home the reality of the insensitivity that pervades our medical community. It's discussions like this that Tammie and Maria tackle head-on, breaking down the complexities of weight management far beyond the oversimplified calories in versus calories out. Their conversation sheds light on the multifaceted influences of genetics, metabolism, and lifestyle choices on an individual's weight, underscoring the urgent need for a more educated approach within healthcare.
As they peel back the curtain on bariatric care, they're confronted with the stark realities of accessibility, especially in rural areas. The advancements in surgery and evolving outpatient policies come into sharp focus alongside the role of primary care physicians in the referral process. Maria gets personal, sharing her own experience with binge eating disorder, and together, Tammie and Maria expose how few eligible patients receive the care they need. They also explore how telemedicine, a beacon of hope post-COVID, could revolutionize follow-up care and bridge the healthcare divide.
The finale of the episode takes on a proactive stance, stressing the significance of early intervention in weight management. They emphasize the value of a multi-disciplinary approach and the necessity for primary care doctors to be well-versed in weight management. Wrapping up, they extend an open invitation to our listeners to connect with them on social media for further discussions and insights. With Tammie's invaluable perspective, they hope their candid dialogue resonates with listeners and sparks a much-needed transformation in how the healthcare field addresses weight management.
We want to gather with a purposeful intention to explore the world around us. ...
Listen on: Apple Podcasts Spotify
Welcome to Core Bariatrics Podcast hosted by Bariatric Surgeon Dr Maria Iliakova and Tami LaCos, Bariatric Coordinator and a patient herself. Our goal is building and elevating our community. The Core Bariatric Podcast does not offer medical advice, diagnosis or treatment. On this podcast, we aim to share stories, support and insight into the world beyond the clinic. Let's get into it.
Speaker 2:Hi Tami, hello Marie, I wanted to tell you a story today about something that happened to me, actually around a year ago at this point where we were working. So I was in the doctor's lounge hanging out I think I was in between cases or something like that and I remember one of the other docs was in there and we just struck up a conversation and this guy out of the blue I'm not sure exactly what triggered this, but decided to start talking about weight and he basically explained to me me being a Bariatric surgeon and him being not that the problem is very simple, it is ins and outs, and that people should just stop eating and, if they can't, that he has a really good solution for it and that's just to slap duct tape over their mouth to fix the problem.
Speaker 1:What do you think about that? I feel like I could use duct tape in a totally different manner towards him. What's that? Well, that right there is going to send a patient into a binge eating or just like a mental breakdown. Oh my gosh, says that to someone's face, at least.
Speaker 2:Honestly, I couldn't believe he said it to me, because I do this for a living and obviously really care about it, but it was said so casually, I believe, while he was eating whatever his lunch was at the time, just in between bites. Here we go, and I didn't just super catch, super catch. This guy, by the way, has daughters, is married and is around my age, so in his 30s or 40s, maybe younger person. Yeah, I was pretty blown away, honestly, because I think he is saying out loud what a lot of people think.
Speaker 1:Absolutely, because I was actually just going to say there's people out there. I don't want to throw you under the bus because you don't. All the time you can eat, I can pack it away. That's true. And again, you have had your own eating and your own body and all of that. But again, if a calorie was a calorie, we would all be the same size.
Speaker 2:Exactly, or at least a lot of us would be the same size and we wouldn't have 60% of the population having extra weight or what we consider extra weight. Yeah, it's pretty honest that you're absolutely right, because my body has also changed over time, which is interesting because I have had binge eating disorder myself and so whenever you have an eating disorder it's a lifelong thing. I've learned to manage it really well, but I have it, and in the past there were times that, yes, I would go on yo-yo diets, I would do extremes of dieting and exercise, and I'm at a really healthy point in my life right now, so I'm stabilized, but I still have tendencies of in residency. You eat when you can, you sleep when you can, you go to the bathroom when you can. Those are the rules.
Speaker 1:You're still afraid to drink water because you have to go to the bathroom.
Speaker 2:I have to pee and I can't, I know right Even though. So my brain is still there, and so the way that I eat is I eat when I can and I shove it in my face because I might not have time to do it otherwise, even though my lifestyle is pretty different now. Old habits die hard. I'm a good example of that myself, but the thing is I have lucky genes or something. The way that my body works is I'm able to metabolize things pretty well and I can't eat quite a bit without it with being a big issue. But I also do workout.
Speaker 1:I also do try to you do very much. I was hanging out in the pool in Orlando while you were working out, yep.
Speaker 2:But that's the whole point is basically absolutely. Calorie is not a calorie. It's not ins and outs, and if it were, I would probably be a much bigger size than I am myself, people would be much smaller sizes.
Speaker 1:Yes, yes, because I know people that eat so healthy and just struggle to lose weight. Not that they're trying to necessarily lose weight, but like they should be smaller.
Speaker 2:So let's get into it, absolutely so. The one other thing we want to talk about is exactly that. We're leading in perfectly into it. It's an excellent segue into talking with healthcare providers, which is what this episode is all about, and what healthcare providers know about weight management in general is that most healthcare providers don't know more than the general public about this topic.
Speaker 1:No, they do not, or at least not much more. This again if they did, they did. They're not before they are either. As healthcare providers, we be eating all the food when we can too.
Speaker 2:That's right. A lot of healthcare providers, just like the general population, struggle with weight management the same way that the general population does. There's a couple of reasons for that. There's very little weight related or metabolism related training in any healthcare profession, including medicine. There's very little nutrition exercise training. In fact, in my own curricula, what I learned I think it was under three hours total out of the thousands of hours that we learn, which is astounding when you think about what impact it actually has. Absolutely yeah. I think the idea basically being oh, there's dietitians for that. That's just ludicrous, because one dietitians are really hard to find.
Speaker 1:They're not enough for them.
Speaker 2:Your insurance doesn't like paying for them your insurance doesn't pay for dietary visits for most people, unless they're diabetic for the most part, even in bariatric programs, a lot of people have to self-pay their dietary visits, which is bonkers, but true, right. Then the other thing is we absolutely to be well-rounded physicians, to be well-rounded healthcare providers would benefit from understanding something about nutrition and how we eat and how it gets processed, and the fact that when you diet over and over again, you're messing up your metabolism more than you're helping it, which is not publicly known information, even though it's really true.
Speaker 1:I know that until last week Yep.
Speaker 2:Then there is a lot of misinformation in this field that's guided by opinion rather than science, even in healthcare. I think that this person, this doctor in the lounge who said let's just slap duct tape on everyone, he is just saying out loud what a lot of people believe in a kind of maybe extreme way of saying that A little. Yeah, no kidding. I think a lot of people actually have that kind of misconception of people are just out of control and they can't do anything about it. And why can't they control themselves better? That's just super not how it works for the majority of people who have challenges. The other thing about this is the history of medical care in weight management has a really bad rap. Some of it is warranted, Some of it is fair and some of it is not fair. Let me explain that just a little bit. Weight loss surgery is a fairly new field and it dates back to the 90s. Now most and most insurance companies really didn't start covering any kind of procedures, at least for weight loss, until the 2000s and until the 2010s. There's still a lot of plans actually insurance plans that don't cover bariatric surgery at all. Yeah, there are. Yeah, it's still a fairly new field and access is its own problem that we'll talk about too. Back in the 90s and earlier the kinds of surgeries that were being done for weight management were gastric bypasses and duodenal switches. Both of those surgeries can be pretty intense. The follow up for those can be pretty intense and they were being done as big open surgeries. People had lots of complications and they had the hospital. Stays for them would last five to seven days. Sometimes more people would get leaks or would have narrowings or would have obstructions or would have all these nutrition problems afterwards dehydration and that honestly largely is a thing of the past for these kinds of surgeries because now we do them small cuts. We do really good patient selection overall. There's professional organizations that help us be really standardized and make sure quality is good overall. That's not to say that's impossible to have a complication or impossible to do it badly, but it's a way different field than it was in the 90s and 2000s and the insurance is wanting you to do it same day have surgery and get out. Yeah, it literally advanced to the point where the Centers for Medicare and Medicaid last year, in 2023, wanted to push through a new rule that basically made all of these surgeries required to be outpatient, meaning patients could at most only stay overnight, which that's so bonkers, going from where we were required in five to seven days to now, centers for Medicare and Medicaid and insurance companies are trying to push people out the door the same day which that also that's the same as hip replacements and stuff.
Speaker 1:As soon as you are to get up and walk around, you're walking around and then they kick you out the door and you're at physical therapy the next day.
Speaker 2:Exactly, and I think there will be another episode about insurance as one thing and then there's another episode about how we do these surgeries and things like that. But the field has advanced by leaps and bounds in terms of quality and safety and determining who benefits from these surgeries and how we follow up on them and how we prepare them. But I think the perception within the healthcare industry has not really shifted to that approach and so a lot of folks who are not in this world don't necessarily know that it has advanced so much since that time. The other thing that's a really big obstacle, I think, for people is that it's really tough to reach bariatric care and it's really tough to coordinate it. So even if a provider, even if you're a health primary care provider or a cardiologist or whoever you are really think that a person would benefit from this, one, you have to find a bariatric program. Two, you may have to figure out if that person has insurance or something that covers it, which they may or may not. And then, three, you have to do a little bit of that quarterbacking of that person, getting the right referral, making sure they know how to follow up with it, all of that. So it can be a little bit more than what people necessarily want to bite off like, more than what most providers want to choose.
Speaker 1:But really in rural areas. I actually just found out that where I work, the closest bariatric program is at least an hour and a half away, and that's where we're located. People south of that, you're going even further, and so that's why I'm trying to recruit this bariatric surgeon, I know. but you're absolutely right. You have a day of just one appointment and you have to have three to six months worth of those just appointments, not including your other testing and appointments you may need. Yeah, and so I feel like I've even felt that from my primary care doctor in the past that he may have thought it was a good idea. He just didn't know where to start to help me because a bariatric surgery program was so far away.
Speaker 2:Exactly, and I do think that there is this sort of a lot of providers actually feel helpless here and so they're not necessarily trying to not refer people or restrict care or something like that, but, like you said, you don't even know where to get started, sometimes in a realistic way for patients. And something that I think I may have mentioned in some other episodes, but I just I find it such an astounding number, is that, as a result of all these barriers, less than 1% of eligible people ever see a bariatric specialist.
Speaker 1:That's still so shocking to me too.
Speaker 2:Yeah, so less than 1% of people who are eligible for weight related care ever see somebody who can provide them specialized weight related care Like worth repeating. Because if we, if that were happening in heart health or cancer care or diabetes or even mental health, honestly maybe it does happen in mental health, but I actually think at this point mental health is better accessible than this right there Because we've been figured out.
Speaker 1:You have online options for mental health, like better health.
Speaker 2:There is a lot of movement now on telemedicine, especially after COVID, but it does seem like we still have to fight for that year after year, because insurance every year, health care insurance companies reassess and centers for Medicare and Medicaid does too whether or not to make this kind of care available by telehealth. And so far they've told yes for the 2023 year and 2024, but it does still feel like a fight and it feels for a lot of providers, ourselves included. When we were in Iowa City, it was downplayed and made to be not the preferred mechanism even for people who were traveling hours to get to us on a regular basis. So there's a lot of room yeah, there's a lot of room there for programs that are hybrid, programs that can do both in-person care when it's necessary. So far we can't do telemedicine surgery, for instance. So that's a we have to do with this person. Stay tuned, yes, but for now that's the case. But a lot of the other visits, a lot of the other visits could be done. Telehealth for most patients, that's something that we need to.
Speaker 1:I'm still wrapping my head around that. You would say it all the time and I'm always like but they need you in person and you're like they really don't. I'm here for them if they need me but at least they need an appointment.
Speaker 2:Exactly because the difference between what's perfect and what's ideal and what's available is that's the difference is like. I think we rely a lot of times in healthcare on getting it perfect rather than getting it good enough, and I think that is a massive problem, because good enough care, that's quality, that's consistent, that is based on evidence, that's well supported, is what people need. It doesn't have to be perfect and in person and Mayo Clinic every time. If it can be Mayo Clinic quality but not telemedicine, why the heck not? You know what I mean and I don't think there's anything actually stopping us from doing that. I mean there are many things stopping us from doing that, including, like insurance reimbursement and I feel like you're calling me out.
Speaker 1:Hey, I am we don't have to be perfect. It just need I'm fine. Okay, okay, Try to get over it.
Speaker 2:This is perfect as the enemy or sorry, yeah, perfect as the enemy of done that is. I live by that rule. Oh, you're not.
Speaker 1:All right.
Speaker 2:And in healthcare, I think we sometimes get really tripped up over the perfect rather than the done and the good enough.
Speaker 1:And when I say good enough, I'm not saying I am probably super guilty.
Speaker 2:Yeah. And when I say good enough, I just want to be super clear. I do not mean unsafe, I do not mean rushed, I do not mean poor quality, I do not mean unevidence based, I don't mean any of those things. I just mean if you're waiting for an in-person appointment every single time with your bariatric team and you live three hours away from them or even 45 minutes away from them, or you're a busy mom, or you're a busy dad, or you're like 95% of the population that can spend a whole day over and over again in someone's office, face to face, then maybe that's not the best solution for this access in this kind of care. You make a good point, tammy, and then the other thing that I really want to make clear is, as healthcare providers, we're people too, we are human, and so we are vulnerable to the exact same biases that are present in our overall society. So if our overall society is fatphobic and our overall society is the kind that thinks everybody should pull themselves up by their bootstraps and everything that happens to people is their own darn fault, then a lot of healthcare providers will have that mentality too. Yeah, and it's not surprising that a lot of healthcare providers have those judgments seep into how they perceive their own patients and what kind of treatment pathways they recommend or what they're willing to do to have conversations with people or help people. So there's those factors, and then I will say actually one more, yeah, and one more that's a really big one is time and money and the way that is if your primary care doctor, for instance, has one visit with you a year, that's usually best case scenario for most people, right? Is one visit per year? That's maybe, if you're lucky, 30 minutes and if you're like out of this world lucky 45 minutes to talk with that person and address all of the things going on with them that year, whether that's their blood pressure, their weight, their blood sugar, their hair loss, their menopause, their birth control, their whatever it is right, whatever is coming up oh mental health. Ditto, and these are not conversations that are at all amenable to a discussion about weight management, which is complex, which is stigmatized, and allow somebody to actually even form a triage plan in most cases about that topic. So I understand that a lot of people don't necessarily want to open that can of worms in that limited visit where they have pretty defined goals and pretty defined things they already have to do that are on their plate with that patient and then especially, especially as a patient who really I love my primary care doctor.
Speaker 1:I know how cut short he is because he again so he had to stop taking new patients because he birth until you die, though some people keep him as a primary care and so actually never. I talked to him about bariatric surgery one. Otherwise he didn't know. I don't even know if he still knows I've had, even though I work in the same place. I don't know if he knows I've had bariatric surgery because I didn't want to bother him with all of that footwork and his nurse. I absolutely I already bother him enough for my kids, but so I didn't want to bother him with all of that. And same with my mental health stuff is I just did the footwork myself. But not a lot of people have that ability.
Speaker 2:Exactly, and typically in most programs we do require at least a primary care doctor or someone to give an. Okay, do an assessment of someone doing eval for people who have had that in the past you had it recently, I think, so we had some documentation on that. Yeah, and in many programs we do interact at least with primary care or with OB-GYN or cardiology or others. But I again, it's not like we're having super in depth conversations about each person and those are actually the providers that are referring. Those are the providers that are engaged in the process, are making a huge difference in people to reach this kind of care and to help reach surgery when people need it and to help follow up for it. I even I was so appreciative of that where we work together in Iowa City there were primary care doctors that wanted guidelines of how to follow up for people after surgery and how they could be involved in helping and supporting. That was so amazing to me because people were recorders.
Speaker 1:I had messages from those primary care doctor nurses of like what exactly labs do bariatric patients need, and it was nice to be able to be that resource for them because clearly they, those providers, want this resource, have it. So you, if you're allowing them to feel comfortable enough to reach out to ask those things, Thanks.
Speaker 2:And actually, tammy, you were involved in creating some materials that helped literally put this like on a card, on an email, on a broadcast, our entire system wide, where it said exactly what kind of follow up people need at least once a year, what kind of labs people need at least once a year, and made it really accessible to the entire system of providers that we had. Like it was just really incredible to see. Like you said, it's a two way street, right. We have to be willing, as professionals in this space, to be able to share the information and to be able to share why it's important, and then others also need to be willing to receive that information and to participate in the kind of follow up and care that people need long term. So it's yeah. That was, I think, a really great example of how that can go right in a system. Absolutely yeah, absolutely yeah. And there's also some problems within healthcare. So on the flip side of that, where people are very well meaning but offer maybe misguided help and I do want to address some of those things too I see a lot of folks who actually want to provide some management or some care that addresses weight, but that it may not be as helpful as maybe they're thinking it is. And this is where I want to touch on that dieting, that thing that we talked about earlier over dieting and that actually does more damage. So I've seen a lot of very restrictive diets, low, very low calorie diets or intermittent fasting One. I want to say that those diets actually do have some applications, like for things like epilepsy and other kinds of medical conditions In some cases, when they're overseen by a medical professional and dietitian or kidney failure, like there are situations in which those kinds of diets are a treatment plan and are a very valid and good treatment plan for people. But obesity is not one of them. So I just want to say that super out loud and super clearly that very low calorie diets, restricted diets and those that are intermittent fasting are not an appropriate solution for obesity. For x zero carbs.
Speaker 1:I was still afraid of curbsy, probably six months post-op.
Speaker 2:Great. And exactly because not only do they actually damage people's understanding of their own health and their own eating habits, they actually damage people's metabolism in ways that are not reversible. That is something I don't think a lot of health care providers understand. But when people try dieting and exercise alone, more than 95% of people will regain weight and most of those people will regain more than they started with. And if we're doing that over and over again which is really common in the US, especially for women that is setting somebody up for metabolic problems their entire life and the inability to ever lose weight in a healthy way and ever reach a healthy weight.
Speaker 1:So again, I believe that, right like Dr Jessica Smith was saying, she asks women, or we ask women how many diets you've been on, and all of them right, and we wonder why we can never lose weight, especially as we get older. And then you have the men who you ask how many diets they've been on, and usually it's one or none. And then they usually it's a little bit easier for them to lose weight, so it honestly all makes sense to me.
Speaker 2:It was a bit of a moment when Jessica said that and I will say there is, I do think, a misconception too about men and dieting, because a lot of men actually diet and have dieting behavior. It's just perceived as, oh, high protein diet or paleo. For women it would be interpreted as a diet, but for men they see it as a lifestyle. Maybe they don't perceive it as a diet or a dietary change, even though it's the same thing basically, just men versus women and how it's perceived. So men do this kind of restrictive eating too, and the problem with all of these things is, if you're a lab rat and your diet is controlled by a human being and you don't have access to any kind of food other than what they feed you and when that is maybe a sustainable diet for that rat, you are not a rat. You are not being fed by some human being who's put you in a cage and controls your diet. For human beings, for a diet to be sustainable and healthy is very different than what is possible in laboratory experiments, and so even the study that Dr Smith had mentioned was the greatest loser, one where people went through really extreme dieting and really extreme physical activity and they were able to lose over 100 pounds on average and things like that. Really extreme weight loss too. I hate to use the word extreme, I shouldn't use the word extreme A lot of weight people who are able to lose a lot of weight. The problem is that their bodies became so much more efficient at dealing with the calories that they had that, again, a calorie is not a calorie when you change your metabolism in a way that makes it more efficient. So when they started eating a little bit more than that unsustainable diet, they started regaining weight, and a lot of them regained more than they started off. In fact, over 90% of them regained the weight, and so I think a lot of health care providers would be astounded by how many people come into a bariatric program that have BMI over 30 but are eating less than 2,000 calories a day. I have been told by health care providers that is impossible. There are now many studies that document this. You don't have to trust me.
Speaker 1:Yeah, I am one of those. Most of the time I didn't even have enough time in my day to eat 2,000 calories, honestly.
Speaker 2:And I think a lot of us, anecdotally at least, may have experienced this because, again, if we're really busy in residency or really busy in our training programs, we're sometimes not eating 2,000 calories a day either. But we're not necessarily losing weight when we're doing that, because there's so many other factors like stress and your body adapting to that and other factors. But I think that there is this very persistent misconception, even amongst health care providers, that everybody who has excess weight is overeating and is eating more than their allotted number of calories a day based on their basal metabolic rate and their activities above that, and that is simply not true. So that's absolutely not true, not true, and so that's something that I hope over time people will understand more. There's a lot of evidence of that. There's a lot of anecdotal evidence that we see in our lives that, hopefully, will help people recognize that, even if they don't want to logic through it, but they just see it around themselves in their lives, maybe they can connect to it too. Because I think if we understand that excess weight is not necessarily a food addiction because that's another misconception I sometimes hear, even from health care providers it's not necessarily people overeating, it's not necessarily a behavior at all Then maybe we'll start to understand that people don't need to prove anything about their weight, that they don't need to prove that they have a lack, that they have a will to change their habits or that they're trying to do the right thing or they're trying to do whatever the right thing may be. They don't have to deserve care, medical care for weight management, because that is a very prevalent feeling in the health care community.
Speaker 1:Let's be real, any of us that are dealing with obesity. We have all the will and we've given all the efforts. There's a lot of will and even strong. There's so many people that have done all and I feel like I did for quite a while all the right things. Lost a little weight in the beginning, probably the water weight just could not get it off, no matter what I did.
Speaker 2:And there are a lot of metabolic conditions, like we mentioned repetitive dieting is one of them that make it very difficult for people to lose weight down the road and a lot of other medical conditions insulin resistance so not even diabetes, but even pre-diabetes and insulin resistance that's not related to diabetes can cause people to have a really difficult time losing weight. So can liver problems and kidney problems and pancreas problems and endocrine problems related to fertility, for instance, can make it really difficult for people to lose weight, regardless of their will and effort, and we know that as healthcare providers, we have actually been trained medically in this knowledge, but we do not apply it to our patients often, and oftentimes we do hold people accountable for something they can't be held accountable for.
Speaker 1:Something to think about, and I have a question for you. What do you think is when someone asks a group of patients that have had bariatric surgery what is something you wish you would have done differently, what do you think their answer is? Tell me I'm curious it is not doing it sooner. Yeah, exactly, I stepped foot in that office two or three years prior to seeing you and I just didn't do it. Granted, I did end up having a child, but why are we not doing it sooner? Oh my God.
Speaker 2:Yeah, I'm so glad you brought that up because we do now have a lot of evidence that we should be considering these surgeries, potentially not just for weight, but for metabolic problems like diabetes, like PCOS, like NASH or non-alcoholic liver disease and many other conditions too. So it's this idea that it has to be the last resort or it's someone's last option. Instead, it should be considered much, much earlier in people's lives. If we can treat somebody's diabetes in their early 20s, that means that we spare them potentially decades of suffering, decades of cost, decades of disability even related to that, and I just I can't think of a reason to not consider the full spectrum of care for people for a condition, a medical condition. We don't do this for any other medical condition except for obesity and it really I understand the stigma and I understand the general public not agreeing with this somewhat, even though I don't agree with that, but to see it from within the healthcare industry, I think is honestly, I think is unacceptable.
Speaker 1:Actually, now that I know as much as I do, I just went to a dance competition for one of my best friend's daughters, because I don't have any daughters. But I was just thinking to myself like my friend's daughter is dance, she's a competitive dancer. She's been a competitive dancer since she was young. She struggles with weight and I'm just like this girl is dancing like ridiculous amount of six to seven nights a week, 10 months out of the year. There's so much more and I'm thinking what happens after high school? What happens? You're no longer in dance, I get worse and that's where I blew up, or when I gained as much weight as I did high school, because I wasn't a competitive cheerleader anymore. If we just battled this as primary care doctors, looking at these young kids who are so super active and realizing you cannot out eat that much activity. You are a dancer as well, but same competitive cheerleading, I could not out eat.
Speaker 2:No, unless you're Michael Phelps or a wrestling wrestler.
Speaker 1:So, yeah, if primary care doctors looked at that for their pediatric patients of, especially those very active ones, of putting this in their parents' ears, and sooner, that could save them a whole life of issues, and so I think referring when the issue of weight comes up, where somebody says I'm struggling with this or I'd like to do something about it, their actual number on the scale is irrelevant.
Speaker 2:Referring to somebody who can help A bariatric specialist is indicated at that point. And then, in terms of surgery, at least our professional societies recommend the consideration of bariatric surgery at BMI of 30 if they have other medical conditions like diabetes or high blood pressure, or even arthritis is an indication. Pcos, there are many others, and then over 35 for everyone, so over a BMI of 35. And I think I've heard this a lot even in the medical field that people have to be over 100 pounds overweight or they have to be a BMI of 60 or something like that, or they have to be 600 pounds, and that is just not true. In fact, the biggest benefit from these kinds of surgeries is when they're done earlier in life, before the comorbidities are piled on, and before the complications of those comorbidities are piled on, and before people reach a BMI of 40. Like that's the best outcome people can have, and I think that, yeah, if more people knew that, if more healthcare providers internalize that and actually helped people get the care that they need, that they deserve, that they shouldn't have to prove they need and deserve, then maybe we would all be better off and we would be paying less and we would be having fewer complications. We'd be having people who were, yeah, just better able to live lives they want to live.
Speaker 1:I think of this analogy and if this ends up coming out completely wrong, I could delete it out, but I almost think of this as our skin, especially people that have obesity. Yeah, the bigger you get, the more. And even pregnancy, let's be honest, pregnancy the bigger your belly, your skin, gets and stretches out, more it's harder to get back in. So I feel like that's almost like medical conditions of the further you let it get, the harder it is to get it more under control and back to normal Absolutely. So why not Absolutely Do the pre? Yeah?
Speaker 2:100%. Yeah, because it's the whole. Prevention is worth an ounce of prevention is worth a pound of cure, kind of thing. And so you're absolutely right. Instead of us waiting until people have diabetes and high blood pressure and they have kidney problems and they have liver problems and they have joint problems and all these things are spiraling, if we were to consider these kinds of interventions earlier, we would spare people a lot of morbidity and a lot of days off work, a lot of days where they're struggling to do the activities they want to do and participate with their families in the way they want to. So what I do think. I'm just going to end this briefly with a couple of things I really want other healthcare providers to know, and that's to refer. If you're having conversations about weight or considering weight with your patient, refer. Refer them to a barrier specialist. Refer them to somebody who can have that conversation with them. Also, be aware that there's a spectrum of care. That spectrum of care definitely includes surgery as a consideration for some people, but it also includes things like medications and dietary support and mental health and physical activity and a review of overall health and follow-up. It's not one or the other and it's not one is more extreme than the other. It's what's right for this patient and what combination is it right for this person?
Speaker 1:I look at this, even Beatrix is a specialty. I come from, pauline. So many times where primary care doctors have ordered a pulmonary function test, they think they know how to treat it or they feel like, oh yeah, there's some reversibility there, let's give them some albuterol so they know the bare minimum. That's where specialties such as pulmonary or bariatrics come into play. A primary care doctor knows a little bit about everything, them to the specialty that knows that's all they do all day. They know the workarounds with insurance. They know how to help the patient more, because even with respiratory, primary care doctors might not even know that breathing, teaching breathing techniques, can actually save a COPD patient a lot of misery, yeah absolutely.
Speaker 2:I think it's not to say that we're trying to exclude anybody from this process, because if more primary care doctors want to be trained on bariatric care, there's a lot of prepare, absolutely I raise my hand. I am super interested in helping people understand how to use med weight loss and how to incorporate nutrition and mental health and how to follow up after surgery. There are people out there that are really, I think, available resources for including more people in this work.
Speaker 1:And.
Speaker 2:Lord knows, we need more people doing it. So it's not. I hope it's not seen as exclusionary and if anyone.
Speaker 1:No, those primary care doctors just have so much on their plates. We see you, primary care doctors. We see you.
Speaker 2:We're trying to create more work and definitely we're trying to recruit more people into this field, because we need more people doing this. We absolutely do Right, and I also want to make sure that people understand in the healthcare industry that bariatric surgery isn't a last resort. It is a pretty unique approach. That is the only thing that actually accomplishes a metabolic reset. I think you and I coined the term metabolic conversion the other day, which I love that term too, but it really allows people to reset their metabolism like a thermostat, and there really is no other mechanism for doing that. It also has the greatest effect on weight and metabolism versus any other approach. It's the most durable and it's also the best covered by insurance. So, for the right person, surgery should be considered as one of their first options rather than one of their last.
Speaker 1:Yes, yes.
Speaker 2:And that BMI alone is not a health indicator that warrants any kind of treatment. Bmi is a starting point for an evaluation of an individual and that anchors the discussion in the very beginning, and then we go from there to recognize that, just like a calorie is not a calorie, weight is not weight for everyone and there are many people at a BMI of over 40 that can be very healthy and there's many people under a BMI of 40 that can be very unhealthy. So it is just the starting point to an evaluation. The other thing to remember is that weight management requires a village, much like raising a child. I think we need to really forget about blaming individuals and thinking of keeping people isolated and struggling. We need to include people in our community and in our village, basically in terms of supporting people in lifelong weight management.
Speaker 1:Yes, absolutely. And as a patient, I want to tell other patients that if you have a primary care doctor that just isn't listening to you, it's okay to step away from that primary care doctor. It doesn't mean you have anything against that primary care doctor, it's just you need more out of them and that's okay. And if they just aren't listening to you, please reach out and try to find someone that is willing to listen to you. Ask for a referral to a bariatric program if they don't offer you one. See, if that program allows and your insurance allows you, to make yourself a self-referral. But, as Maria has said, a lot of healthcare providers don't understand a lot of this, and so have patience with them. For sure, they are still learning just as much as even the expert Maria here. Or bariatric surgeon. Like their experts in their profession or that specialty, they're still learning. So definitely have patience with your providers as well, but don't hesitate to tell them what you need and go fight for what you need.
Speaker 2:Exactly, and I think it's up to all of us, as individuals, as communities, as healthcare providers too, to take a stand against stigma on this topic. I think that if we're not part of the solution here, we are part of the problem, and it's time for people to own that, for us to say this is not a moral issue, this is not. It makes no sense to exclude people from this care. It makes no sense to make people feel bad about this. It makes all the sense in the world to help people get the care they need.
Speaker 1:Yes, absolutely. So on that note, I think that we can't beat that, so don't forget to follow us. Go over to Instagram or TikTok. I'm still figuring out the TikTok part, but we'll get some videos going. We'll get some anyways, core bariatric, especially Instagram, to let us know if there's anything you want to talk about questions, concerns but don't forget to follow us so that you get notified of when our next episode comes out. I think this was a great one and I'm so excited to have this one come out so people can hear all this. You're right.
Speaker 2:Thank you so much, tammy. Thanks for listening. We'll see you next time. Bye, bye, bye.