Caitlin Whyte (Host): Welcome to Jamaica Hospital Med Talk.
I'm Caitlin White.
Joining me today is Dr.
Darshak Shaw, the Director of Bariatric Surgery from Meis Health Network,
Jamaica Hospital Medical Center.
Together we'll be exploring the important topic of weight loss
versus weight loss surgery.
Now, doctor, is obesity or being overweight a major health
problem in the US would you say?
Dr.Darshak Shah:
Yes.
So currently obesity is one of the greatest disease of our
public health crisis right now.
the latest statistics says that 40.3%
of adults, which translates to close to a hundred million adults
are obese in United States.
Which is a rise of 2.3%
in last decade.
In last 10 years, the rate of obesity has grown 2.3%.
Now, when, the data was split up to see what age group is particularly
affected, it was surprising to see that pretty much every age group is
affected and even the children and.
teenagers are now becoming more and more overweight and obese compared
to in the past, but by, numbers, the age group of 40 to 60 years is
the one That is affected the most with the obesity rate being 46.4%.
Caitlin Whyte (Host): Well, when is someone considered overweight or obese?
And when should they then seek help from a doctor to manage their weight?
Dr.Darshak Shah:
there are many different criteria by which.
One can be classified, depending on their weight, but the one That
is most commonly used is called the BMI or the Body Mass Index.
It's a number that we derive by dividing the weight in
kilograms by height in meter.
Squared.
So when we get that number, it's easy to find that online
calculators to find one's BMIA.
Normal BMI is 18.5
to 25.
Anyone from 25 to 30 PMI is considered overweight.
Over 30 is obesity, And then over 35 is more B obesity.
These are the numbers that we use when we try to tailor our management, and
That is something that the insurances use as well, about whose coverage,
they will include, based on their BMI.
Caitlin Whyte (Host): Well, for those who are considered obese or overweight, what
health complications are they at-risk for?
Dr.Darshak Shah:
So obesity has been shown to affect every, single organ in our body.
The one That is most affected that we commonly see in clinical practice, in
real-world that we see when patient's come to seek help for obesity, a lot of times
they have already incurred one of them.
So studies have shown that there is a five to 10 times more risk of
diabetes, where the glucose is higher and difficult to control in the
blood, high blood pressure requiring medication, sleep apnea, where the.
The spectrum includes snoring to all the way where they are not breathing
adequately or their breathing stops while they are sleeping.
Osteoarthritis where they have knee or back or other shoulders, pain.
Related to extra weight that the body has to carry or the knees have to
carry, an increased risk of cancer.
Specifically breast GYN or, colon cancer has been shown to
be increased rate with obesity,
Caitlin Whyte (Host): Hmm.
Well, what are the weight loss options that a Dr.
May recommend to a person facing these problems?
Dr.Darshak Shah:
In general, anytime we look at weight loss, we broadly classify into three
different kind of management options.
the first and foremost And the most important one is
the lifestyle modification.
So any patient we see, the first thing we do is we ask what they have
done And we offer them what options they have for lifestyle modification.
The first and foremost is gonna be diet.
So.
We counsel them along with the help of a nutritionist where they discuss and
understand what their dietary preferences are, And then counsel them about what they
should be eating, how much they should be eating, and when they should be eating.
There are many different kind of diet options where, The calories,
depending on their activity, their genetic makeup is recommended.
Intermittent fasting has been shown to help with weight loss.
It's scientifically proven.
So diet is number one.
The second form of lifestyle modification is exercise.
So there is enough data in, scientific literature that shows that the typical
recommendation for most patient's is 150 minutes of exercise per week.
That exercise can be broadly divided into.
Either cardio or muscle or hit exercise that we call it high
intensity interval training.
And That is something that we counsel about spreading over the week where
they can either do 30 minutes a day for five days a week, or 40
minutes a day for four days a week.
So the recommendation is 150 minutes of exercise per week.
So those two are basically lifestyle modification.
Then we move on to medication.
That's the second option.
For a very long time, the only medication we had for weight loss were all pills.
phentermine is one popular one that was used.
Contra is another one.
So there are a bunch of, medical options that we have, but none
of them have been shown to have adequate, sustained long-term weight
loss without any side effects.
So they never became very popular till the recent uptake of injections when ozempic.
Was introduced in the market for management of diabetes.
we noticed that patient's are also having significant weight loss
and slowly it started becoming a mainstream injection for obesity
more than the diabetic control.
And that's when, the medical.
weight loss with injection started becoming more and more popular.
So currently we have a bunch of options.
I'm gonna go over it in a second, what options we have about medical weight loss.
And the third is surgery.
with surgery it's been the gold standard of weight loss for decades.
Before the surgery used to be done with open approach And that used to lead to a
fair amount of morbidity or complications.
Over the last 50 years, it has shifted from open approach to laparoscopic
or robotic approach where the surgeon uses minimally invasive approach to
perform these weight loss surgeries.
Caitlin Whyte (Host): Well, doctor, clear up some terminology for us.
What is the difference between weight loss surgery And then medical weight loss?
Dr.Darshak Shah:
Sure.
So the second And the third option that I just spoke about in terms
of, options for weight loss.
So medical weight loss does not involve any procedures.
It is basically giving medicine or injection, a pill or an
injection to help with weight loss.
Now.
There are two different kind of injections, that are more commonly
prescribed these days for weight loss.
So the first one is a GLP one receptor agonist, which means
it's, it promotes the GLP one named receptors, and Ozempic is one of them.
It's a semaglutide that helps with diabetes along with.
Having patient's to lose weight, and hence it became popular as a
weight loss medication as well.
And in the same drug line we have Liraglutide, which
is Victoza and Trulicity.
So these all work as a GLP one receptor agonist.
They come as a.
Tiny injection that patient's self-administer once a week, And we
start off with a very low-dose and slowly progress to a higher dose.
The second category of injectables that we have presently is a combination of both
GP one agonist and a GIP receptor agonist.
Now these have become more popular and.
Mainstream for injectable weight loss medications, the Zep Bound and Mounjaro.
These are tirzepatide and these help with more weight loss than seen
by the other group of medications.
So when we talk about numbers, with these injectables, the clinical
trials showed that 15 to 20%, of weight, over the course of a year.
Was lost by the patient's.
And in real-world when we actually prescribe them, we see
patient's typically losing 10 to 15% of their weight in a year.
So if someone comes in and they're 300 pounds, typically we end up seeing they
lose 30 to 45 pounds, in real-world.
so there's a term called excess weight loss.
So that's the weight that the patient has compared to what they
should have for their height.
And gender and, the excess weight loss we see is close to
20 to 30% with these injections.
And now the second is the surgical weight loss surgery, which is the
bariatric surgery that we talk about.
with the bariatric surgery, we have multiple different kind of operations.
The most popular of those is the sleeve gastrectomy.
The laparoscopic sleeve gastrectomy where we.
Make tiny incisions on the abdominal wall.
We go in using a laparoscope or laparoscopic instruments or robotic
instruments, And we free up the stomach and make it significantly smaller.
And with that, the patient's eat less to feel full.
And also certain hormones called ghrelin are secreted in much less quantity.
That leads to decreased appetite, and with that patient's lose.
Weight.
so when we compare the weight loss, compared to the medical weight loss in
surgery, we see 30 to 33% of weight loss.
with medical we spoke about 10 to 15%, so it's more than double the
weight loss we see with surgery.
and with excess weight loss, we see 60 to 70% of that excess
weight being lost with the surgery.
Caitlin Whyte (Host): Well, let's break these down even a little more.
Who is a good candidate for weight loss surgery?
Dr.Darshak Shah:
any patient we see, there is no, one-size-fits-all approach we.
Speak to the patient.
We understand their history, we understand their expectation.
we see medically how much weight they need, to lose, whether they qualify
for surgery or not, whether the insurance covers injections or not.
So there is no clear answer to what fits best for everyone.
It's always more individualized, customized plan that we
make with the patient.
depending on their coverage And what they need, But when we look at, who
is covered for surgery, the revised guidelines from the A-S-M-B-S, which is
the Society for Metabolic and Bariatric Surgery, which, most of the insurances
follow, is anyone with BMI over 30 with a medical problem like high blood pressure,
diabetes, sleep apnea, osteoarthritis.
They would qualify for surgery as long as they are cleared by the
specialist that they need to see.
Caitlin Whyte (Host): And on the other side, who then makes a good
candidate for medical weight loss.
Dr.Darshak Shah:
same thing.
So if the BMI is 27.5,
with a medical problem And the insurance does cover their, management
with injectables, then we would offer that to the patient with the
clear understanding, an expectation of what the injectables would.
Bring forth in terms of side effects And the outcomes, And then along with
that discussion with the patient, we decide if we should offer them injections
or we should offer them surgery.
Caitlin Whyte (Host): Well, we've covered a ton of information today, doctor, and
to wrap it all up for us, how can I work with my doctor to determine the best path
for my own weight loss and health goals?
Dr.Darshak Shah:
Excellent question.
So in terms of discussion with your medical doctor, you should.
Discuss your weight and calculate your BMI, to understand where you are
categorized and whether you would qualify for, weight loss medication or a surgery.
Understand the risk of the procedure And the side effects of the
injections, and you can start the conversation with the doctor and go
ahead with the weight loss journey.
Caitlin Whyte (Host): Thank you so much for joining us, Dr.
Shaw.
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I'm Caitlin White, and This is Jamaica Hospital Med Talk.
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