Discover the transformative power of bariatric surgery with Cleveland Clinic's Dr. Sara Monfared in a conversation that could forever alter your view of obesity and its treatment. Dr. Monfared passionately articulates her path to specializing in this life-changing field, emphasizing the urgent need to reframe obesity as a chronic disease rather than a personal failing. By intertwining her personal motivations with professional expertise, she illuminates how bariatric surgery isn't just about weight loss—it's a proactive strike against cancer, heart disease, and more. Our talk sheds light on the imperative for medical care to evolve, placing preventive obesity treatments alongside routine health screenings.
Peek behind the curtain of bariatric surgery with us as we scrutinize the intricacies of various procedures tailored to individual needs. Dr. Monfared walks us through the cutting-edge, such as endoscopic outlet reduction, while addressing the challenges post-surgery patients face, such as weight regain. Her insights aim to dispel the stigma that shrouds this topic, reinforcing the message that setbacks are not reflective of personal failings but rather a call for innovative, minimally invasive solutions that cater to each unique journey.
As our episode reaches its conclusion, we rally for the cause of broadening bariatric surgery access and delve into the necessity of persistent research to secure insurance coverage for state-of-the-art treatments. Dr. Monfared's analysis of the shifting perceptions around endoscopic sleeve procedures, along with the evolution of gastric bypass surgery, offers a beacon of hope for those navigating these waters. We wrap up by inviting listeners to join our vibrant online community, where shared experiences and knowledge merge to support and enlighten anyone touched by the topic of bariatric surgery.
Discover the transformative power of bariatric surgery with Cleveland Clinic's Dr. Sara Monfared in a conversation that could forever alter your view of obesity and its treatment. Dr. Monfared passionately articulates her path to specializing in this life-changing field, emphasizing the urgent need to reframe obesity as a chronic disease rather than a personal failing. By intertwining her personal motivations with professional expertise, she illuminates how bariatric surgery isn't just about weight loss—it's a proactive strike against cancer, heart disease, and more. Our talk sheds light on the imperative for medical care to evolve, placing preventive obesity treatments alongside routine health screenings.
Peek behind the curtain of bariatric surgery with us as we scrutinize the intricacies of various procedures tailored to individual needs. Dr. Monfared walks us through the cutting-edge, such as endoscopic outlet reduction, while addressing the challenges post-surgery patients face, such as weight regain. Her insights aim to dispel the stigma that shrouds this topic, reinforcing the message that setbacks are not reflective of personal failings but rather a call for innovative, minimally invasive solutions that cater to each unique journey.
As our episode reaches its conclusion, we rally for the cause of broadening bariatric surgery access and delve into the necessity of persistent research to secure insurance coverage for state-of-the-art treatments. Dr. Monfared's analysis of the shifting perceptions around endoscopic sleeve procedures, along with the evolution of gastric bypass surgery, offers a beacon of hope for those navigating these waters. We wrap up by inviting listeners to join our vibrant online community, where shared experiences and knowledge merge to support and enlighten anyone touched by the topic of bariatric surgery.
Welcome to Core Bariatrics Podcast hosted by Bariatric Surgeon Dr Maria Iliakova and TMA LaCose, 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:
Today we have with us a personal friend of mine who did medical school at UMKC my Stopping Grounds 2, residency at Indiana University, fellowship at the University of Texas Health Science Center at Houston and is now a Bariatric Surgeon at Cleveland Clinic. Let's please welcome with me Dr Sarah Monfred.
Speaker 1:
Hello, sarah, hi, thanks for being here.
Speaker 3:
Thank you for having me.
Speaker 1:
All right. So let's just jump right into it why you got into Bariatric Surgery and how you got there and just dive right in.
Speaker 3:
Yeah. So from medical school I just had an idea I wanted to do surgery and general surgery was my path. But then when I was in residency it's interesting, we all like love to operate and you're like, how do I pick which type of career? So I am a little bit like, oh, I went with things that annoyed me a little bit less than like other surgeries, like positioning. I hated difficult positioning in the operating room and I was like, oh, this is nice Arms out. So a lot of it was just like technical, like this is the kind of career I want to do, this is the surgery. But then the other half of it was the patients I like to treat obesity because I think it deals with a million other things like cancer and heart disease and lung diseases. During COVID we realized that was a cause of a lot of things. So I was like, all right, this is something preventative medicine essentially. And then just my own experience with weight up and down and I was like, okay, I can relate to my patients. So those kind of were the reasons I headed towards bariatrics.
Speaker 2:
You mentioned preventative medicine and I really am curious about that, because I think that one of the things people don't necessarily realize is this is one of the only surgeries that can serve to prevent the worsening of disease or the development of disease. Can you talk a little bit more about why that resonated for you?
Speaker 3:
Yeah, absolutely. We talk about colonoscopies and how they're like top reason of decreasing colon cancer and everything else smoking, all this stuff that we're like, oh, we got to get ahead of it, get your mammos. And so, like I was like, why is treating obesity? This is, in my opinion, the number one preventative medicine. It causes increased risk for breast and colon cancer. Obesity does so. Treating that will help treat the cancer and then treating obesity is going to help you have less heart attacks, less stroke, all this stuff. So to me I was like it's, in my opinion, the number one preventative medicine. And so, yeah, it was like, whether it's surgery or whatever it might be, we have to treat this disease and it is a chronic disease, so it's not one of those where you can just be like, oh it's one and done. It's something people live with lifelong.
Speaker 2:
In that preventative medicine vein. Do you think that there's enough public awareness of that or there's enough awareness amongst other healthcare providers that that can actually occur through these surgeries?
Speaker 3:
I think there is some awareness in most primary cares and I think most physicians when they see someone who you know, they tell them like oh, losing weight helps with whatever they see a cardiologist. Or like losing weight helps, but as far as still getting the referrals and still sending them to bariatric surgery, I do think we do struggle a little bit because you guys have mentioned this before we're still telling people or you don't have enough willpower. So even amongst providers, we're still going. Oh, if you just have a little bit more willpower, you'll lose weight, as opposed to actually referring them to an obesity medicine or bariatric center.
Speaker 2:
Yeah, I'm always shocked by that. It's oh, of course. This person hasn't been trying for their entire life to do this themselves and hasn't been struggling with it forever.
Speaker 3:
And you would think, like I said, if you have your 40 and a female and you get your mammogram, why not? Hey, your BMI is above 35. Why not see the specialist? Whether you get anything surgery, medications, anything why not? Why is that not part of the preventative things that should be checkmarked?
Speaker 2:
Okay, that's pretty interesting. So talk a little bit more about what that would look like. And let's say you could wave a magic wand and you can make that happen. What would that look like at 40 for every woman?
Speaker 3:
Yeah, I think that would be. I don't want to put an age on it because that would be difficult, but definitely, like we tell everyone now 45, you've hit 45, you're due for a colonoscopy or colagard, and whoever the physician is or the provider is goes. This is a checkbox you got to do. This is preventative. Same thing, like I said, with mammogram. So, yeah, I don't know what age, but in my opinion there should be in the primary care setting. So I would say, like your BMI is above 35. I would like to refer you to a physician. You can discuss this and it's. It doesn't. Again, does not have to be like, oh, you have to have surgery or even those discussions beforehand, but your BMI is 35. Just have those discussions and it might mean like just an office visit or a virtual visit, and I think that would be, and most of these are also covered by insurance, like we don't have issues covering office visits.
Speaker 1:
I think that would be such a good idea and I think if people learned. I think education around bariatric surgery and just medications and stuff like that is limited, because I think a lot of this is newer than, obviously, colonoscopies and stuff. So I do think that education is huge. So if someone just went into, if my primary care doctor told me to go to a bariatric surgeon's office just to discuss things sooner in life, I would have been more educated and maybe could have had surgery earlier or been able to battle things earlier. So then it wasn't such I need to do this now. It's a. I want to do this now to prevent my high blood pressure. I want to do this now to prevent complications with my pregnancy. Yeah, I like the way you look at that for sure, and I think that's where we should go for sure.
Speaker 2:
Yeah, I think that's a pretty neat approach. I agree, because when we talk about preventative medicine, we're really trying to fix the problem before it happens. So make sure people, like Tany said, have healthier pregnancies before they get preeclampsia or gestational diabetes. Make sure people never develop diabetes in the first place or develop the high blood pressure which people are much, much earlier now in the past couple of decades. So that's really interesting to me. To just consider obesity care like screenings, just like colonoscopies or mammograms, that's a pretty, I think, innovative approach. Sarah, that's really cool.
Speaker 3:
Yeah, I wish it. Yeah, it's definitely a dream of mine. And I think the other thing is, like Maria will know, I hate when I get a patient who's already has so many comorbidities and they're such a high risk and it's like we could have done this 10 years ago. And so that's the other key thing. I think, especially with our younger patients and their 20s, they're like oh, you're just in your 20s, you can do it and I think in your 20s and stuff like for me, I think changing those lifestyle habits definitely are easy.
Speaker 1:
Or before kids, before your crazy career, I feel like it might be just a little bit easier to change those lifestyle habits, too, before you find your spouse for the rest of your life, because once you got those habits in place of eating healthier, you're going to find a spouse and stuff that are is on the same page as you as well. I'm struggling just right now of my husband is he's very supportive meat and potatoes finish your plate, like so. It's both of us getting out of the mentality where, as if I was to have that lifestyle years ago, I would have found someone probably that had the same type of lifestyle as well. So, yeah, earlier, I think, is, but so much that would be so much better.
Speaker 2:
And you've talked about. I think, sarah, you've mentioned also on something which, when people have surgery, they sometimes don't necessarily get the weight loss that they expect, or over time, they may regain weight or have other things that crop up, like reflux, which we all see in our practices too. Tell me a little bit about how you approach that situation, where people are maybe being told you can do this on your own or it's all about willpower or something else. What is your approach to to folks having had surgery and maybe not being where they want to be afterwards?
Speaker 3:
Yeah. So I think that's just. That's one of the hardest thing I feel like as bariatric surgeons we deal with. So for one thing, before they even get their first surgery, I think we all say this is a tool, this is not like some magic pill. You're not going to have surgery in the next day, eat what you want and just weight comes off. For the most part, everyone does lose weight and we quote 60 to 70 percent of their excess body weight. But I tell everyone, the majority of patients gain about 15 percent back. It's that curve that comes back up. But then again I do say it's still the most successful because about two thirds of patients keep that weight off. But we still have that one third. We have one third of sleeves like I read a study that was 40 percent of sleeves that gained 50 percent of their weight back or more, which is quite substantial and even bypass. about 20 percent of those patients gained a significant amount of weight, not just small amount of weight. So then we get to this point where we're seeing these patients who've had it 10, 15, 20 years ago. And what do we do? It's a lot more approach. I tell them the process is a lot more rigorous. I do have every single one of them see our bariatrician, our medical professionals, where they can help with medications. I don't, I don't prescribe them, but they do and they're great in our office I say look, you got to start their program. We got to see if there's medications that can help with this weight loss. I always tell them most of the time they've actually fall. They haven't seen somebody in years to follow up. I say you got to go back to our bariatric dieticians. We start food logging, all the good learning, the good habits. And then the other part of my process is I do anoscopy. I do go back in there and measure their sleeve or their bypass to see with their size of their stomachs and whatnot. That it's again. It's a little bit more rigorous. I usually takes a little bit longer if they've gained weight and we're either headed towards surgery or just trying to get the weight back off. But most of the time I do recommend especially to go see our bariatricians, our medical specialists.
Speaker 1:
And what is Surgeons? Sorry Maria, but surgeons do Sleeves and stuff stretch out, quote-unquote. Do they stretch out? No, no.
Speaker 3:
There's one study. They did these contrasted. They had people drink the contrast that like shows Stomachs are and they found maybe 10% of the stomach stretches. But it's not Verified really and I think from experience I've gone back in there and scoped patients and the sleep. The stomach doesn't stretch If it's big. It was always big to begin with, like they had made this. Yeah, so if I go and scope someone who had a sleeve, maybe 15 years ago they used to use a bigger measuring device, what we usually they used to be like 5660 French, which is just very much wider and so the stomachs were just made bigger back then because they, for whatever reason, that's what it was, and so now we make the stomachs a lot smaller. So if I go in there and the sleeves really big or really wide, it's not because it's stretched. It was most likely made wide to begin with and same with a bypass. If I go in there and find a big stomach pouch, it was because it was always made big. So the stretching at that is truly a myth. We don't stretch the stomachs out and At the most it's 10% and just not significant to this and for weight gain.
Speaker 1:
Yeah, so in that case, if you went in, someone had a sleeve. 10 years ago you found out the sleeve was just big. Can you re sleeve it?
Speaker 3:
Yes, you can, yeah, you can do you. I say, yes, I in fellowship we definitely did. I personally haven't done it in my practice yet because I haven't come across it, but we have. And there again, there is there you can find any kind of study for this. But there is a study we presented at a journal club Resleaving a patient can cause weight loss, but it really has to be the patient. You go in there and you're like, wow, this sleeve was made very large and we can actually get stomach tissue out. Because you don't want to, you go, we put our bougie in and you go in there. If you can't staple along it, then you can't get enough tissue out. But I have seen it done. I did a handful of them and fellowship, and so it's not a procedure that we, that's not. We do it, but I'm very selective.
Speaker 2:
Patients, yes, yes you do mention patient selection, which I think is a really interesting concept, because I think a lot of folks when they have these surgeries, they won. The approach has been one and done. That's been the mantra for a very long time for this kind of these procedures, mostly driven by insurance, more than anything else than that, than my data. But you're bringing up a really good point, which is that there's not a one-size-fits-all approach, especially once people have gone through surgery already, just because you've regained weight or just because something else has happened Doesn't automatically buy you another surgery, doesn't automatically buy you a specific kind of surgery. So how do you approach those kinds of maybe Misconceptions, or even encourage people to come in for a visit when they may have some of those beliefs ahead of time?
Speaker 3:
You said it's not one-size-fits-all. I Always put encourage, encouragement that look, there's surgical options. So I don't want anybody and I tell people you don't have to have surgery, because some people are like I've already had one, I don't want to have another and that's fine, that's totally okay. But I will say, most of the people when they come see me they're like those are another surgery option and I'm like we always have options, but I do want you to again, most of the time I'd like them to try medications first before going to a second surgery. But there's a wide array of options. Even for a gastric bypass. We thought we do an endoscopic Outlet reduction, which is pretty least invasive, or sometimes go back in there and make their Bowels longer and if for sleeve, there's plenty of options converting them to a duodenal switch. I think it's just not a one-size-fits-all and the key thing is to not believe everything you read online. So I can't tell you how many people exactly.
Speaker 1:
I see.
Speaker 3:
Come in who've had a sleeve and they gain weight and they're like, okay, I should have had a bypass. Or like, yeah, or okay, I've read online if you gain the weight back, you can convert it now to a button. You're like, okay, I, let's step back and have a conversation, because that's not simply true. There's plenty that we see that people don't lose more weight, converting them to a bypass, so that so, for weight gain alone, conversion to a bypass or whatever another surgery may not be the answer.
Speaker 2:
There's been some pretty interesting research lately, especially that there's people who just don't respond to bariatric surgery, whether it's a sleeve or a bypass or a seedy or whatever it may be, and that's really an unclear. We don't really understand why and we don't have any predictive capability to find out which people that affects. What do you do when there's a person who maybe has had a surgery before, seems like they're doing everything right, maybe even a revision to another surgery, and they're still having problems with weight or other comorbidities related to weight?
Speaker 3:
Yeah, that's a really hard case. So I think the key thing is now they have the genetic studies to do genetic studies and I can't tell you that I know much about that. But I know when I talk to my bariatricians they're like, yeah, we send them for their genes. We actually, a main Cleveland Clinic has a bunch of practitioners who go in depth with that. But I think that's the next step is to send them for blood work and whatnot and see where they can help.
Speaker 2:
Yeah.
Speaker 1:
I think the biggest takeaway there is if any of our listeners are that patient, there's nothing wrong with you, you're not doing necessarily anything wrong. The biggest reason for starting this podcast is because if any of those patients went onto a Facebook group and said I'm struggling, they would all be attacked saying you're eating too much, you're not moving enough, this, that and so. That's where I really wanted this education for those patients that if you are regaining a little bit or if you haven't lost anything, there's nothing wrong with you, that it's not necessarily what you're doing, it's just your body.
Speaker 3:
Yeah, and everyone's weight loss trajectory is different. Like we have to compare it to babies on that growth chart.
Speaker 1:
Oh, they're like on that globe, yeah.
Speaker 3:
And you're like okay, you could be above or below the slope, that doesn't mean anything's wrong with the baby.
Speaker 1:
And I like that.
Speaker 3:
But it does keep us accountable too. So if you're not on the right trajectory, again, that your body could be different, but we also. That's time to pay review. Let's see what are your dietary habits, what is the exercise? What is your lifestyle Like? Are you sleeping enough? Stuff like that. And again, it's just like the scale. I think you guys said it keeps you accountable, but it shouldn't be a burden.
Speaker 2:
Absolutely yeah, because there's so much. There is so much that affects weight and so many things that we depends on it's not. It's not one size fits all by any means of any approach. So I'm curious, you had mentioned some, a pretty creative procedure which I don't think a lot of places are doing, which is using a scope to actually do a revision specifically on bypass patients. Can you talk a little bit about what you're excited about in kind of innovation in surgery in this space and what kinds of things you're working on or you're excited about other people working on in the future to help with complex situations for people?
Speaker 3:
Yeah, so I was lucky enough to go to a fellowship where my mentor really believed in minimally invasive or incisionless surgery and he's a great guy, so he, we tried a lot of things endoscopically and one of the ones that has been successful and actually quite a few gastroenterologists will quite a few of them do this- but, essentially go without any cuts on the belly at all. They go. We go through the mouth and do it with an endoscope and a camera and we can suture stomachs a little bit tighter. If you've had a gastric bypass, essentially we take your opening and just make it pinpoint, like it'll be two centimeters, we'll make it like half a millimeter or half a centimeter, or even the sleeve. We do the endoscopic sleeves. I don't personally do them, but there's plenty of places around the country. So again, you don't get cuts on your abdomen. I think the field is still. There's got to be a lot more studies on it. I know there's plenty of. There is research out there. So I don't want to say there isn't, but I think it's cool. I don't think we should just put it down Like if I truly believe no, there, because there's quite a few surgeons around the country who are like oh, endoscopic sleeve is fake or doesn't work or whatever. And I, you know I don't like that mentality. Just because it's innovative, it doesn't mean it hasn't, it has to be perfected. So yeah. So I think it's cool, I think we got to keep doing it and do research on it. And then the other key part about it is eventually, when we have good, successful data, which there's, some out there try to get insurance companies to approve it, which is always the last and hardest step, that is the hardest step?
Speaker 2:
Yeah, Because the hard part is there's. There is so much innovation in this field, which is really exciting from both the medical standpoint and the surgical standpoint, and the spectrum of care that's developing out of this, thankfully. But what do you do about the insurance lack? Because even if you're in a really innovative program where you did fellowship, for instance, right Cleveland Clinic, which really is cutting edge in a lot of ways, how do you handle being able to do much more but not necessarily being allowed to buy insurance or for reimbursement purposes?
Speaker 3:
It is such a hard field. There is a little bit roundabouts of it. We always all the codes were always for open surgeries but we use them for laparoscopic, so some of those codes can translate for endoscopic and insurances will pay. And I know they're working on the procedure. I was talking about outlet reduction. They're working on getting a code for that. So part of it is just advocacy too. I know Maria works a lot on this. But try to go and be like we need a CPT code, like you guys have to get us a code and I believe, for is it Sadi or a single gastric bypass? They've been fighting it and they finally got one. So we got to keep advocating. That's one end and then the other end for the patients. We're just, I'm honest with them. I say, hey, this is one of those procedures that may get denied. We'll give it a try to get approval for you, but and we'll fight it Like we'll do appeals and peer to peers and all this others. I am very upfront. I'm say I do say paid to the patients that it may not get approved and then cash pay options. I know plenty of centers who have cash pay options that are reasonably priced. Yeah, yeah.
Speaker 2:
So a lot of options but still a lot of barriers to potentially yeah.
Speaker 3:
And this is another thing I want to plug in there is that we have a lot of patients who go overseas, or not even overseas that other places- in the country to get a gastric sleeve or whatever surgery and I understand a lot of them don't have benefits. They go seek it somewhere else because they're like I want to have it here but I can't pay for it. So if you ever have that, seek a bariatric center and we can refer you to somewhere in the country that has very reasonable prices and but you don't have to go somewhere else outside the country. So I do want to put a plug out there for that, that there's plenty of places in the United States.
Speaker 2:
Yeah, I love that.
Speaker 3:
I love that, Sarah.
Speaker 2:
I think that's really important for people to know that just because you go to one bariatric surgery program or one center something doesn't mean that you're going to be excluded from care If you can't join them or if your insurance isn't accepted, you're not just going to be thrown to the wolves. We all do this because we really care about this field and there are way more ways to make money than this industry for doctors and for people in our field. So there's a lot of compassion, I think, out there for people who don't have insurance coverage potentially or can't afford certain approaches. So I love that you said that. I think that is so important for people to hear that they can expect help and referrals even if the place that they initially start doesn't work for them.
Speaker 1:
I want to ask you surgeons something, because this came up with one of my friends. A lot of people research the sleeve and just want the sleeve. The sleeve is not necessarily for everybody, but sometimes people are afraid of the bypass. So explain why they might be afraid of it and why they shouldn't be afraid of it.
Speaker 3:
Maria, you want to take this one to start.
Speaker 2:
Oh sure, but I will defer to you, sarah. But basically, like I said earlier, there's a lot of misconception because this field is fairly new. But a lot of surgeries used to be done open and a lot of folks had much more intense surgeries, much more intense recoveries afterwards and also had higher complication rates afterwards, especially after bypasses and do-it-all switches, which is another form of rearranging things on the inside, and that legacy unfortunately still haunts us pretty intensely. Would you say, sarah, that's true, go ahead. No, I was going to say.
Speaker 3:
So, as far as a gastric bypass goes, I want to say it's been around 40 years now. It's the one surgery that's held true, We've had the band have a rise and a fall, and even the sleeve. It's successful and it was. We think it's peaked and now a little bit less. So the truth is the gastric bypass has been around for such a long time and they did do it open and they used to have complications and they were figuring it out and that's so. Now we've we have really almost perfected it. It's such a good surgery and we've come such a long way from what it was 20, 30, 40 years ago. Yeah, I agree with haunting us a little bit from what surgeons and they were doing their best too. So the complications, the ICU care, all that stuff. But that's how I reassure the patients. I tell them first that surgery again has held. True, A bypass has shown weight loss for decades, so it is a good surgery. And then the complications. Now that we do it with advanced technology is down to what a sleeve is. So I now leak rates when we're comparing sleeves and bypasses. They're almost the same. So I tell them, as far as short-term complications, short-term recovery, it's exactly the same.
Speaker 1:
What about long-term, like malnutrition and?
Speaker 3:
Yeah, so long-term it's again a pretty rare like malnutrition vitamins. Yes, definitely the sleeve is more forgiving if you stop taking your vitamins all together versus a gastric bypass or a duodenal switch.
Speaker 1:
She's mean mugging me, and I'm doing better, maria, I'm doing better. I love it.
Speaker 3:
Yeah, it's true, it's as far as not so much malnourishment because we do the bowel limbs again. We come a long way. It's very rare to get malnourished with a gastric bypass and even a duodenal switch. But as far as vitamin deficiencies, definitely Like you can probably I don't recommend it, but you can go weeks and months and not take vitamins with a sleeve when you're out and then you're probably not going to have too much consequences versus if you don't take your vitamins, for gastric bypass or a duodenal switch especially. But the other thing I got to say long-term is ulcers with a gastric bypass and I deal with this because I feel like half of accurate smoke cigarettes.
Speaker 2:
You're after their surgery. Sometimes it's so bonkers to me, but people do.
Speaker 3:
They're just. I have so many smokers. I've never dealt with this many smokers in all my training and my career so far. So I will. I always tell everybody it's. If they're having problems with a gastric bypass, most of the time it's because they're having an ulcer. And so unless you're doing something you're not supposed to. People do really well with a gastric bypass.
Speaker 2:
Noted Sounds good, yeah, yeah. So that's a great question though, tammy, because it's a lot of folks don't want to, don't even know how to ask the question. Necessarily, they just feel afraid, and hopefully this is starting to break down some of that. So, absolutely.
Speaker 3:
That's great. I'll tell you, my older nurses are the ones who've seen the bypasses from 20 years ago. They come to me and they're like I don't want to bypass, I've seen what it can do, right, and how do you explain it to them? That it's better. That's the same way I say that technology has advanced. If you remember, in the ICU they had an open abdomen and things like that. I'm like they come around. But I will say I've had quite a few older nurses who are like I've seen what the bypass is.
Speaker 2:
Yeah absolutely yeah, and they're definitely not wrong about the past, but hopefully, with technology, we are making things better and a lot more knowledge about this. Sarah, I'm really grateful that you spoke with us today. I think you're really fighting a great fight in terms of re-shifting the focus to bariatric surgery as preventive medicine, and really I think I would love to be one of your patients because you seem so compassionate and so thorough. It's just been a real joy to watch your career so far and I'm so grateful that people like you are contributing to this field, because it couldn't be better as a result. So thank you for taking time to be with us today.
Speaker 3:
Yeah, absolutely. I just want to say this podcast is great. I'm so glad you guys are doing this. I was listening to it and I was like this is what I say to my patients and what a great way to have a lot of people hear it and all these myths that you guys are debunking and it's great. I love it. I'm referring my patients to this podcast and you guys are doing a lot of good work.
Speaker 1:
I thank you so much for that. That's why I do it. Obviously, Maria and I still have full-time jobs. We're just doing this. In some days it is a lot, but stuff like that and patients reaching out to me on Instagram and stuff and just saying this is what I needed, is why we are doing it 100%. So thank you so much for saying that. Thank you everybody for listening. Don't forget to go over to Instagram and follow us and send us a message if you have anything you want us to talk about. We also did open up a Facebook group, so Core Bariatrics Community. It'll just ask you questions of where you heard about the group and what you want out of it and whatnot. So, yeah, head over there and request to join. Otherwise, thank you for listening. Thank you, Sarah, for being here and until next time, thank you. Thank you, guys.