WEBVTT Kind: captions Language: en 00:00:00.000 --> 00:00:02.867 [Calm music] 00:00:05.433 --> 00:00:08.633 - Folks will gain weight slowly over time, 00:00:09.267 --> 00:00:12.233 and it may start early on in life or it may start later in life. 00:00:12.833 --> 00:00:14.532 They finally get to a weight 00:00:14.533 --> 00:00:15.899 that their body, 00:00:15.900 --> 00:00:18.299 although it is unhealthy at that weight, 00:00:18.300 --> 00:00:19.732 is comfortable at that weight 00:00:19.733 --> 00:00:22.232 and to try to drive their weight down 00:00:22.233 --> 00:00:24.066 with diet and exercise doesn't work, 00:00:24.067 --> 00:00:25.033 the body fights it 00:00:25.567 --> 00:00:26.699 and at that point, 00:00:26.700 --> 00:00:28.167 we're dealing with a disease, 00:00:28.567 --> 00:00:30.233 the disease of obesity. 00:00:31.533 --> 00:00:33.732 Our basic primitive drives are, 00:00:33.733 --> 00:00:36.466 when faced with high-calorie food to consume it, 00:00:36.467 --> 00:00:38.632 even if at that particular time, 00:00:38.633 --> 00:00:40.333 we don't need the calories. 00:00:40.800 --> 00:00:43.599 The willpower is really not useful 00:00:43.600 --> 00:00:45.532 when you try and use it to curtail basic instincts. 00:00:45.533 --> 00:00:46.932 It just doesn't work. 00:00:46.933 --> 00:00:47.966 - It's really a disease. 00:00:47.967 --> 00:00:51.332 We know that this is mediated by hormones in the body, 00:00:51.333 --> 00:00:53.866 which promote weight gain in some people 00:00:53.867 --> 00:00:55.999 and don't allow for weight loss. 00:00:56.000 --> 00:00:57.399 - We all have a certain spectrum, 00:00:57.400 --> 00:00:59.099 a range where we fall in 00:00:59.100 --> 00:01:00.366 and you can affect that range. 00:01:00.367 --> 00:01:01.932 You can be above and below that range, 00:01:01.933 --> 00:01:04.699 but you are set in a certain precondition 00:01:04.700 --> 00:01:06.832 that's based on your own body history, 00:01:06.833 --> 00:01:09.366 your family history, your own physiology. 00:01:09.367 --> 00:01:13.433 - To treat obesity, you need to treat it like a disease with medical therapy. 00:01:16.333 --> 00:01:18.233 - I never gave a second thought to what I was eating. 00:01:19.467 --> 00:01:21.299 I was pretty skinny my whole life, 00:01:21.300 --> 00:01:23.467 and it just gradually crept up on me. 00:01:24.800 --> 00:01:26.799 - Even as a teen, I never really had 00:01:26.800 --> 00:01:28.599 a good image of myself 00:01:28.600 --> 00:01:30.066 and when I started gaining weight 00:01:30.067 --> 00:01:32.233 it just really made that a lot worse. 00:01:33.433 --> 00:01:35.132 - Clearly nutrition is very important but 00:01:35.133 --> 00:01:38.433 people become obese through a combination of many different factors. 00:01:39.467 --> 00:01:41.566 - [Laurie] Your body gets comfortable at a certain weight 00:01:41.567 --> 00:01:45.466 and my body was comfortable at 240 pounds. 00:01:45.467 --> 00:01:47.499 - [John] People would refer to me as Big John. 00:01:47.500 --> 00:01:49.832 I'd never thought of myself in those terms, 00:01:49.833 --> 00:01:51.732 but that was kind of sobering. 00:01:51.733 --> 00:01:53.832 - [Laurie] I didn't realize how big I was, 00:01:53.833 --> 00:01:55.099 'cause I didn't feel that big, 00:01:55.100 --> 00:01:56.732 but when I saw pictures, 00:01:56.733 --> 00:01:59.132 I just didn't recognize myself 00:01:59.133 --> 00:02:01.732 and I'm like, I really need to do something about it 00:02:01.733 --> 00:02:04.366 because I'm heading into my 40s soon, 00:02:04.367 --> 00:02:07.099 and I really want to just be healthy. 00:02:07.100 --> 00:02:10.132 - At my heaviest, I still took the stairs two at a time, 00:02:10.133 --> 00:02:11.099 but the difference was, 00:02:11.100 --> 00:02:13.266 when I got to the top of the stairs, 00:02:13.267 --> 00:02:15.467 I was winded, my heart was pounding. 00:02:16.233 --> 00:02:18.567 My doctor said I was pre-diabetic. 00:02:19.100 --> 00:02:20.999 That really scared me. 00:02:21.000 --> 00:02:23.499 That was the catalyst that really 00:02:23.500 --> 00:02:25.033 spurred me into action. 00:02:26.800 --> 00:02:28.866 - [Dr. Mehal] There are a multitude of health risks, 00:02:28.867 --> 00:02:31.166 heart disease, diabetes, 00:02:31.167 --> 00:02:32.432 high blood pressure, 00:02:32.433 --> 00:02:33.766 fatty liver disease 00:02:33.767 --> 00:02:34.832 and, at the end of the day, 00:02:34.833 --> 00:02:36.200 it affects mortality. 00:02:37.167 --> 00:02:39.633 People become obese through a multitude of different routes, 00:02:40.333 --> 00:02:42.567 and they lose weight through a multitude of different routes. 00:02:42.967 --> 00:02:46.032 It's a question of identifying very early on for patients 00:02:46.033 --> 00:02:47.932 what might be the best intervention. 00:02:47.933 --> 00:02:49.999 - [Dr. Hubbard] We know that many people are trying, 00:02:50.000 --> 00:02:51.599 and they lose weight and they gain it back. 00:02:51.600 --> 00:02:53.566 They yo-yo up and down. 00:02:53.567 --> 00:02:57.132 If I could take that same effort and apply it after surgery, 00:02:57.133 --> 00:02:59.666 when we know we've changed those hormones, 00:02:59.667 --> 00:03:04.100 it gives the patient a tool to use their hard work to achieve their weight loss goals. 00:03:06.133 --> 00:03:08.132 - [Dr. Nadzam] Bariatric surgery is a broad term. 00:03:08.133 --> 00:03:12.966 In essence, it is any operation that helps surgically reduce weight. 00:03:12.967 --> 00:03:16.566 There are two main bariatric surgeries performed. 00:03:16.567 --> 00:03:19.766 That would be a gastric sleeve or a gastric bypass. 00:03:19.767 --> 00:03:21.666 We do them laparoscopically 00:03:21.667 --> 00:03:24.166 with small incisions and long instruments. 00:03:24.167 --> 00:03:29.999 With surgery we are able to drive the weight down for long enough 00:03:30.000 --> 00:03:33.833 that now their body is comfortable back at a weight that is more reasonable. 00:03:34.533 --> 00:03:36.599 This is a disease that we treat surgically, 00:03:36.600 --> 00:03:40.967 but that afterward is treated in a multi-disciplinary approach. 00:03:41.733 --> 00:03:43.899 It's part surgery and part patient 00:03:43.900 --> 00:03:46.132 and I tell patients that all the time. 00:03:46.133 --> 00:03:47.266 - [Laurie] It's not a free pass. 00:03:47.267 --> 00:03:50.200 You really have to work on it to maintain your weight. 00:03:50.733 --> 00:03:53.166 - [Dr. Nadzam] Patients will lose more than half 00:03:53.167 --> 00:03:55.066 of all of the weight they're gonna lose 00:03:55.067 --> 00:03:57.100 in the first three months after surgery. 00:03:57.733 --> 00:03:59.899 - We would like to wait until at least a year, 00:03:59.900 --> 00:04:03.166 when a patient is close to their new low weight 00:04:03.167 --> 00:04:06.200 before we'd approach skin removal surgery. 00:04:07.000 --> 00:04:08.666 - [Dr. Alperovich] When you go through these operations, 00:04:08.667 --> 00:04:09.999 your body transforms. 00:04:10.000 --> 00:04:12.233 You are a different person at the end of the surgery. 00:04:12.833 --> 00:04:16.199 So it's hard to take on this new, healthier persona 00:04:16.200 --> 00:04:19.399 when you have this daily reminder of how you used to look. 00:04:19.400 --> 00:04:22.732 Part of it is aesthetic, but a lot of it is just quality of life. 00:04:22.733 --> 00:04:24.832 So a lot of the people who seek body contouring 00:04:24.833 --> 00:04:26.300 just want to return to normalcy. 00:04:29.533 --> 00:04:33.199 - [John] My highest weight loss was 145 pounds 00:04:33.200 --> 00:04:35.033 in eight or nine months. 00:04:36.367 --> 00:04:38.066 - It is nice to see them now, 00:04:38.067 --> 00:04:40.266 two-and-a-half years out from their surgeries, 00:04:40.267 --> 00:04:42.400 maintaining phenomenal weight loss. 00:04:42.933 --> 00:04:44.166 - [John] When I look at us now, 00:04:44.167 --> 00:04:47.332 we just seem so much happier and full of life 00:04:47.333 --> 00:04:49.032 and I don't think you can put a price on 00:04:49.033 --> 00:04:50.632 feeling wonderful about yourself 00:04:50.633 --> 00:04:52.032 and looking at yourself and saying, 00:04:52.033 --> 00:04:53.300 yeah, I look good. 00:04:54.467 --> 00:04:55.632 - [Dr. Nadzam] With weight loss surgery, 00:04:55.633 --> 00:04:57.199 we know that we're adding 00:04:57.200 --> 00:04:59.466 years back onto people's lives 00:04:59.467 --> 00:05:00.966 and that's very rewarding. 00:05:00.967 --> 00:05:03.866 - [Dr. Alperovich] It's a privilege, it's something we're very lucky that we get to do. 00:05:03.867 --> 00:05:06.899 You have these bonds with patients that last years 00:05:06.900 --> 00:05:07.999 and there's a gratefulness there 00:05:08.000 --> 00:05:09.532 and an appreciation there from them, 00:05:09.533 --> 00:05:10.766 and for me, there's an honor 00:05:10.767 --> 00:05:12.199 that I get to be a small part of 00:05:12.200 --> 00:05:14.032 something in their life that gets them 00:05:14.033 --> 00:05:15.699 to feeling good about themselves. 00:05:15.700 --> 00:05:18.599 - I don't think you can be a successful bariatric surgeon 00:05:18.600 --> 00:05:20.899 if you don't have empathy for your patients, 00:05:20.900 --> 00:05:24.466 and with that empathy comes a lot of reward 00:05:24.467 --> 00:05:25.433 when they've done well. 00:05:26.067 --> 00:05:28.432 Every time I see folks in the office, 00:05:28.433 --> 00:05:30.099 there is positive reinforcement 00:05:30.100 --> 00:05:32.267 that what I'm doing makes a difference. 00:05:33.000 --> 00:05:34.566 There may come a time 00:05:34.567 --> 00:05:37.632 when we find a neurotransmitter, 00:05:37.633 --> 00:05:40.766 a gut hormone or a non-invasive treatment. 00:05:40.767 --> 00:05:42.466 If that's the case, 00:05:42.467 --> 00:05:44.366 then I don't do bariatric surgery anymore, 00:05:44.367 --> 00:05:45.832 but that will be a happy time for me 00:05:45.833 --> 00:05:46.632 'cause it means 00:05:46.633 --> 00:05:49.633 we have cured the disease of obesity.