On May 10th, in another Wednesday live, Pop Recovery Systems held an amazing informative live session with two experienced bariatric surgeons, Dr. Erick Smith and Dr. Michael Choi, accompanied by Katlyn Foster, one of Pop Recovery Systems’ ambassadors, who all talked about bariatric surgery and the importance of efforts we put into battling one of the most widespread modern epidemics – obesity.
Dr. Erick Smith and Dr. Michael Choi shared their professional experiences and insights about this type of surgery, potential benefits that people can expect, but also things that you should consult your doctor about before deciding to opt for bariatric surgery.
Katlyn Foster, as a person who underwent bariatric surgery, gladly shared her valuable personal experiences regarding weight loss medication and later the surgery itself.
Katlyn’s Experience
Host: “Katie, why don’t you talk about your experience? I know it’s been a while, but why don’t you talk about your experience with the GLP?”
Katlyn: “Absolutely, so when I first decided to take control of my health, I went to my regular doctor, and they had sent me a referral to a weight loss specialist, and I met with him and, at the time insurance wasn’t covering anything, whether it was the injections or the weight loss surgery, and he said that he was able to get samples of, at the time, the first one I did, was Ozempic ,so basically we were going that route and not jumping to surgery and I end up being on weight loss injections for, I want to say, a total of 10 months before I decided to have bariatric surgery and for me personally it was just the financial aspect, because when it came down to it, my insurance didn’t cover bariatric surgery or the weight loss injections, and for me personally the weight loss injections weren’t helping so I had to figure out what my next step was.“
Dr. Choi’s Introduction
Host: “Thank you so much for that perspective, and hello Dr. Choi, you made it!”
Dr. Choi: “Sorry about that. Hi Dr. Smith, hi guys. How are you, man? Good. Good to see you.”
Host: “We’re so glad that you’re here, and I know that this subject is very close to your heart, so just to kind of like let everyone know, a quick, don’t give us the long version, give us the short version, about your background, and who you are, where you practice is, so they can know that you’re not just some person, you know, speaking not from experience but you’re an actual expert.”
Dr. Choi: “Okay, all jokes aside, so I did my fellowship at UC Davis, with bariatrics MIS in 2005, 2006, and I’ve been very fortunate to practice here in Miami Florida for about 20 years. And it’s been a great great road traveling down this journey to help uh people who are fighting obesity and it’s a pleasure to be part of Poprecovery Systems and, I would do everything to help uh you and Dr. Smith and everyone else that’s collaborating with me to fight obesity.”
A Few Words from Dr. Smith
Host: “I love that and that’s a big thing that’s near to your heart too, right doctor Smith? Fighting obesity is, that’s like your number one mission it seems like.”
Dr. Smith: “Yeah I mean it’s what we do, just like he said. Somebody the other day said something about my response to, it might have been a post or something, about a patient that had bariatric surgery, and they said I didn’t know that you did their surgery, and I said, I didn’t do their surgery, they said well you almost were like defending them, and I’m like, because I feel like I’m an advocate for everybody who battles this, whether they’re my patient or not, it’s not well unless you’re my patient I’m not an advocate for you, I’m an advocate for anybody who deals with the disease that we try to treat the best that we can every single day, and so I think many of us are like that.Those are the kind of people that we want to partner with, with Pop, it’s not just about hey how many patients do I have, what can we do to make an impact in this epidemic that we have of obesity, regardless of what treatment option that they need, and regardless of who ends up being the physician that gives them a medication or surgery or the support system for the rest of their life.”
Surgery vs Weight Loss Medication?
Host: “Awesome, now I have a question from the doctor’s side, we heard from Katie’s side that she was taking it, when she added up the cost it was much more, you know, just basically based on results on finances, it’s better to have the surgery. I have taken Ozempic and the first time I took it a little bit of guidance, I guess from a doctor, I lost more weight right, but then when I was like okay I get it now I’ll just take it myself because you can just buy it now, I’ll just take it myself, you know, I didn’t really see those results. So you think that or from your experience is it the guidance from a doctor that helps with the weight loss so you have to take like a certain amount and all of that like, how does that come into play? Because now people are like oh I got a prescription I’m just going to go to Costco and buy it, and they’re just taking it on their own and like you know. It was really crazy because it wasn’t until I started working with the new nutrition coach and mixing that with my fitness that I started to see more results, but at the same time with the constipation and stuff like that, I was like, is this worth it, like how much I have to pay to do this? So those are just like my own personal experiences, but I’d love to hear why does it seem like it works sometimes and it doesn’t other times?”
Dr. Smith: “I’ll let you go first Dr. Choi and then I’ll chime in.”
Dr. Choi: “Thank you Dr. Smith. So basically as you know that GLP or semaglutide is a GLP agonist so it mimics one of the hormones that’s in the body, so it can affect the brain, the the pancreas, and the intestine, so what you were feeling miss Alexis was because it slows down the motility of the GI tract, meaning from the stomach all the way, so you would get constipated. And so sometimes also by taking these medications, we really don’t know what dose you know to start off with, you might have not hit your sweet spot so, therefore, you hadn’t met that sweet spot of milligrams to affect you properly. But that’s my little tidbit of what the GLP agonist is and I’ll let Dr. Smith go and take the take the baton from here.”
Dr. Smith: “I think it’s a good overview of how it works because a lot of people are on the drug and they don’t understand how it works, and I think, from a surgical standpoint I always tell patients, I want you to understand how your surgery works because if you understand how your surgery works, you have a better chance of being compliant. If you don’t know how your surgery works and you just say well I trust you just do whatever you need to do to me to help me lose weight, then when you have what you think are side effects, you don’t realize that they’re actually secondary to the fact that you’ve had this surgery, that they will pass and there may be some behaviors that you’re doing that can control those, what you think are side effects, but are normal based on the surgery that you’ve had. So I think it’s really important that people understand how does this work, and oh gosh I’m nauseated, because my stomach’s not emptying very well. I think the reference that you made about the cost it’s true, if you look at the average cost of bariatric surgery in about a year and a half of what you would pay for the GLPs, you’ve paid for your bariatric surgery. I think the other concern that we have for the GLPs is how they’ve got into the hands of anyone who has prescription writing privileges. The studies on the GLPs were done when there were lifestyle changes and regular followup and monitoring performed and so, for example, something like Zepbound, which is the Mounjaro that has the indiciation for weight loss, it’s the one that’s posted the highest percentage of weight loss. Possibly as high as 18 months. Now it was, or excuse me 18%, that was a 78 months. But what the studies are very clear is as soon as they went on placebo, they went back on basically saline injections, but they didn’t know they weren’t getting the medicine, the majority, 85% or greater of those patients gain the majority of their weight back. Now the only way they did lose weight was if they had dietary education, mental health support, overall, let’s just generically call it lifestyle changes in place. So when people hear those statistics all they hear is 18%, and they say okay so give me the drug just like I take my blood pressure pill I’m going to have 18%. Early on, you will have weight loss because you’re going to be so nauseous and you’re going to have some of those, whether you call them side effects or actual effects of the drug. But those patients, long term, statistically have been shown to fail with they don’t have that support with it. So it’s not to say that myself or Dr. Choi are smarter than everybody else and we’re the only ones that should be giving these drugs that’s not the case. But if a primary care physician is giving these drugs, they have to be providing that support long term for the patient. They’re called lifestyle changes for a reason, for the rest of your life. Just like on the flip side, me as a bariatric surgeon, if I’m just handing out the script once a month and we’re not providing that support we’re setting our patients for failure as well. So these are all the things that you have to talk to a patient about when they come in. You have to say, you need to know what you’re signing up for, and here’s the things that we always make sure we make clear about GLPs. Number one do you know for sure you’ll keep the job that you have for the rest of your life. If you have insurance that is paying for them and no one know knows that, right, so if you switch jobs and you no longer have medical weight loss benefits you may go from paying $100 a month to $1,200 a month, versus if you change jobs two years from now and now your new insurance doesn’t provide bariatric benefits, they can’t go in and reverse your surgery. Your surgery is already there, your tools already there permanently. So we need to make sure, do you understand the ramifications of what cost may be moving forward. Number two, do you know that you’re signing up to take this for the rest of your life, if you want to achieve the results that the studies are posting and the drug companies are showing? And if people understand that, and if they’re a good candidate for a GLP then that’s the direction that we’ll proceed.”
Katlyn’s Experience with Weight Loss Medication
Host: “And I think that’s really important to know the different options, so that you know which one is best for you. I would love to ask Katie because I know that you went, you had, you took the drug for like 10 months, right, through that process did you feel some of the side effects, did you go through some of the side effects? Could you explain what, and like I said, I know it’s been a while but to be honest with you I doubt that the chemistry of the drug changed, so Ozempic is Ozempic, but I could be wrong, could you talk about that, your experience with that?”
Katyln: “In the beginning, I was on Ozempic, and then halfway through they switched me, I always pronounce it wrong, is it Wegovy, so then I was on that one as well. Why did they switch? Honestly I think it was because of how accessible it was at the time, because I was doing samples, so my doctor was able to give me a sample for I don’t however many months, and then it stopped, and he’s like oh well now I can do this, here’s this, and then I think I did like a discounted program where it was like $25 a month, but then that stopped, and then they’re like oh it’s going to be $1,400 a month now, if you want to continue it. Well before it had gotten to that point, I was experiencing a lot of nausea, I was wanting to throw up all the time, I couldn’t hardly eat, I was having severe stomach issues, going, running to the bathroom, and then brain fog. I don’t know if that’s a side effect of it or not but I was in some sort of fog at all times. And then, at one point, I can’t even honestly remember what it was, but I landed in the emergency room and the only thing that had changed was my weight loss injection. And I was getting ready to have to administer my next dose, like the following day, and with it being on a weekend, the emergency doctor looked at me and was like honestly I know nothing about those drugs so I would just go ahead and do your injection if it’s scheduled tomorrow and then call your doctor when they open on Monday. And I was like well I just think I’m not going to take it and I took myself off of it, I didn’t give myself the next dose, and then I called my doctor the next day when they reopened, and that’s when we had the discussion of hey is this something I’m going to continue doing or what are my next options, because I was tired of feeling, I was sick and tired of being sick and tired. And over that 10 months, I hate the word only, but over that 10 months I had lost 20 pounds, and they had even expected me to lose more, so yeah, it just, it wasn’t for me. I know it works for some people but I wanted more of that long-term solution, and thankfully because I did go through a weight loss specialist at the time, they did have that nutritional support, I still met with a dietitian every couple of weeks and had that followup, but I know like you were saying Dr. Smith, if you go through your primary care they don’t always have that support and you have to have that support to continue on your journey or you’re left with no information and it’s just setting you up for failure, it really is.”
The Best Treatment for Obesity
Host: “Yes, and I think that people need to be careful of how much they learn about these drugs on social media, because just because I’m taking them, like I have a box of Ozempic in my refrigerator right now, I could start a live and be like okay everybody we’re gonna talk about why you should buy, and I could like wear a doctor’s coat, and sound super smart, go on Chat GPT, give me six points about Ozempic, repeat them to you, and I sound like an expert, and how do we not know that that’s not what these people are doing. I really believe that if you guys are going to suggest these kinds of drug or if you’re going to explore these kinds of drugs, that you’re going to put into your body, don’t just talk to your PCP, who may not know too much, find a weight loss specialist, find a bariatric surgeon in your area, not to have surgery, but I’m sure he knows about it. Would you say, doctors, that it’s safe to say that most bariatric surgeons know about this drug and of it?”
Dr. Smith: “I would and I think the best example I can give you to reiterate the point that you just made, which is very good is, so people who are wanting treatment for their obesity, I mean think about how, Katlyn think about how many times you got so tired of people just assuming that you eat more than them, than they do, and that’s why you were obese, or that you were lazy or that you didn’t put in the work, it’s nauseating, so most people who battle with obesity they’re looking for somebody to stand up for them and fight for them and say this is a disease and I think we’re starting to realize and see more people understand this truly is a disease. Sure there’s things about our behavior that we could change to make our disease more treatable, but it’s a disease. But you can’t be one of those patients that says I’m tired of doctors not looking at this problem of obesity as a disease, but yet want to wing it and do it on their own with medication. Because if a patient says I have the disease of hypertension they would never go somewhere and get a compounded hypertensive pill for cheaper, because they can get it cheaper that way, and wing it on their own, take the medication, no one’s checking their kidneys, no one’s checking their blood pressure, no one’s checking what’s happening to them, they would never do that. Well then you can’t have your, this is a terrible pun, but I’m going to say it anyway, you can’t have your cake and eat it too. You can’t say I want you to treat this like it’s a disease but yet I want to treat it like it’s not disease, and I want to wing it on my own and be my own doctor. You can’t do that. And so if we’re going to say this is a disease, let’s treat it like a disease, let’s get you in the hands of someone who’s a specialist with your disease and, don’t get me wrong, there are plenty of PCPs out there that are very good obesity medicine specialists, that they focus on this, they do this and they understand the importance of all this, and there’s some bariatric surgeons who don’t want to fool with it and that’s okay they don’t have to, but you can’t halfway do it. So that’s why I think it’s so important that if you’re going to say this is a disease, which it is, treat it just like any other disease you would and it has to be done the right way, monitored by specialist who knows about it.”
Dr. Choi: “Well, if I can just chime in, also I just wanted to tell you that Dr. Smith brought up a great point, the treatment for obesity, in my opinion and through the NIH, is surgery. The prevention are these drugs, yes, I understand that if you’re unable to get into or unable to pay for a bariatric surgery, I get it, you’re doing something to help you, but hopefully that Pop Recovery Systems will allow us to help those people and get into those, as what Dr. Smith is saying, the treatment for obesity is surgery. Because, as he said, there’s an 85% recidivism meaning that you will gain all your weight back and even more once you stop these drugs. Or you’re unable to get those drugs due to your changes and economic changes that you’re going to see.”
Dr. Smith: “So there was an interesting study, we just talked about this the other night, my CEO of my hospital brought it to me a few weeks ago, no a couple months ago I guess, but up in the state of Michigan there is a large insurance company that did not currently cover bariatric surgery benefits, and they, but they were providing medical weight loss benefits, and they sat down and they looked at the amount of money they were spending on medical weight loss since the GLPs came out, because we just went from people spending money on maybe Phentermine which is dirt cheap, to GLPs which is extremely expensive, and none of these drugs are anywhere close to patent running out. So they’re going to be expensive for a really long time. And what happened is they looked at it and they said we now need to start providing bariatric surgery benefits to our patients because we are spending so much money on these drugs, we can, in a much more cost-effective way, give them the actual treatment of obesity, just like Dr. Choi says, accomplish a significant amount more weight loss and long-term weight loss that’s been proven, not over 78 weeks, but over 10 years plus. and so they’ve shifted, and so it’s been very educational for some of these insurance companies to say wait a second, this opened our eyes to the problem but there’s been a solution right under our noses for years, and we assumed that it wasn’t the ideal one and now they’re realizing that.”
From Weight Loss Medication to Bariatric Surgery
Host: “And I want everyone to know that you can put your questions in the little question box just please put Katie, question, and then or Dr. Smith, question or Dr. Choi, question, so I know who to ask. But one thing that I want to jump to, Dr. Choi, you just tapped into my personality like you just said what I was I’ve been thinking, but I don’t feel like I can say it because I’m not a doctor, you know what I’m saying so, but you just said it and I kind of want to talk to Katie, because she’s the patient on here, she’s been through both you know. How did you feel when you were making that decision to switch from the medication to the surgery? What were some of the thoughts that you had, was there a fear that you would only have like, girl be honest, but I know you will girl, that’s why I love you, so for those 10 months, you know, lost 20 lbs, and I’m not saying that the number is so important but it’s like, that is one thing that’s measurable, that you can say is this working or not, how did that compare in your first 10 months of bariatric surgery and what were some of the thoughts in that transition because you tried one and then you switched to the other?”
Katlyn: “Yes, absolutely, so for me personally surgery’s terrifying. I don’t care what kind of surgery it is, it’s terrifying, and I wasn’t mentally ready to go through that route that’s why I decided to go with the injections first. But see for me personally, I had Insurance who didn’t look at obesity as a disease, I called them and I was asking about my benefits, seeing if weight loss injections or bariatric surgery was going to be covered and they said no, we don’t cover anything weight loss related because obesity is not a disease. It is a self-driven disease and I was like okay. I said more than that but I’m not going to say that on here. So that’s why I did that. Well then the samples, I’m like okay well it’s free like I’m going to try this I’m going to run with it and see if it works because in the moment financially I didn’t think that I could afford to have bariatric surgery. So I went that route and then going through the path that I went through and just feeling overall like complete, I was like I can’t do this long term. So for me, I said well you have two options, well maybe more than two. You do the injections and you pay $1400 a month and you maybe get results or you maybe don’t, you take out a loan and get bariatric surgery and go that route, or you just give up, you just stop. Because for me, when I was doing the injections I was doing everything right I was meeting with a nutritionist I was doing all of the things right and not seeing the results and I felt defeated. I thought I was going to stay obese the rest of my life. Well I went and applied for a personal loan and it was, literally I was waiting by the phone, if I get approved for this loan I’m going to have the surgery, if I don’t get approved for the loan I’m done. Thankfully I got approved and that’s how I paid for my bariatric surgery. And I mean we know it’s all about results right but it’s that long-term thing too. I mean I was fortunate I did lose my weight pretty quick, some people are slower losers which is completely fine, like I say all the time you didn’t gain all your weight overnight, you’re not going to lose all of your weight overnight. It’s not a race to the finish line. This is a lifetime commitment and thankfully I’ve been successful but that’s a summary. That’s that’s my story.”
Why Do Weight Loss Medication Stop Working When You Stop Taking Them?
Host: “I appreciate that so much. Dr. Choi I have a question for you okay, why do in injections stop working after you stop taking them? Was it about them that, what is it about them that makes them set up for short-term success versus long-term success?”
Dr. Choi: “So that’s a great question miss Alexis, so as you said, the semaglutide is a GLP agonist so basically it mimics a hormone that’s in the body that prevents you from feeling hunger, and slows everything down, so once, if I get your question right is, once you stop taking it guess what it goes away, and so your old natural body just starts going back to where it was because everyone’s, as I said to my patients, everyone has their own little air conditioned thermostat in their brain and that’s where they’re set no matter what, and so basically when you stop that miss Alexis that’s when everyone goes back to their natural ranges. And that’s when you start gaining all your weight back.”
Dr. Smith: “I think the easiest way to think about it is just there’s no other drug that anybody would take for blood pressure or diabetes and take it for three months and then decide to stop taking it but their problems fixed for good. It’s really no different than any medicine we take for anything. I think there’s also something that you have to consider is that you have, there’s a thing that many people don’t know is, if you have bariatric surgery, it mimics as if you’re on a GLP. There have been studies we’ve known before the GLPs came out that people who have bariatric surgery, and specific surgeries more so than others, we see increased sensitivity of those GLP receptors and GLP levels. So it’s almost like, and there was a great post a few months ago of an obesity medicine specialist who focuses on GLP administration of the medications who admitted, yes surgery is almost like mimicking GLPs um but when you stimulate a receptor over and over and over and over and over again with a medication your body many times says maybe I should down-regulate these receptors because this seems abnormal. Just like if you block a receptor it will upregulate those receptors to try to override the system. So now you’ve downregulated the receptors from being on the GLP, now you take the GLP away and you’re less sensitive to that hormone that your body makes of inhibiting your hunger and things like that. So it’s a lot of science that some people may not want, but it just think of it this way, there’s no other drug that you can take and just stop and your problem stays gone.”
Why Is Post Surgery Care so Important?
Host: “There is one question for you Katie, which surgery did you have?”
Katlyn: “I have the gastric sleeve.”
Host: “All right, so the gastric sleeve, and I want everyone to understand that we support your transformation journey no matter where you are, but there is a right and wrong way to use these tools. So for example the way I was doing it, just doing it myself, okay Google says start with 0.25 for four weeks, then go up to 0.5, then go up 0.75. This isn’t working, I’m gonna skip to two you know. That’s not the way to do it. And whether you have, I mean at that time I have my
nutritionist, I have my mental health, but I don’t have my surgeon right, so none of it was working because I wasn’t doing it right. And same thing with bariatric surgery, and 50% of that is finding, I mean anyone can be successful with the tool, but like a huge huge percentage of that is finding the right surgeon and the right practice who has comprehensive support to be able to give you the tools from the beginning to help you get the most out of that. And one of the reasons that Dr. Choi is here with us today is that he has, after 20 years of all this experience seeing so many patients decided that, yes this Pop Recovery Systems and putting it into his practice and giving his patients this comprehensive support this made sense to give them the best results. And so because I have two amazing surgeons on this call I wanted each of you to answer me what is the difference between having bariatric surgery and Katie you’re going to go after them what is the difference between having bariatric surgery and having the normal, not calling it good or bad, type of support program and going through bariatric surgery and having more an in depth individualized support program like we have here at Pop, from the surgeon’s perspective?”
Dr. Choi: “What I would think is that, honestly, when I first was introduced to Pop Recovery System and I knew that Dr. Smith was the director and I’m not trying to kiss his butt or anything I just knew that he was just, I understood his practice from long time before, and then I understood what you guys wanted to do and and there’s been so many times where I can’t do it. I can’t be the the nutritionist. I can’t be the psychologist. I can’t do it. I want to but there’s no way there’s not enough time in the practice to do that. And I think that what you guys and what you’re dreaming and what you’re setting for in the journey, I think is just very important because it’s going to help a lot of people. Because we always get questions that say hey what do I eat now or what, can I do this when can I exercise, when and all these questions and and if you multiply that by so many patients there’s no way on God’s good Earth that you’re going to be able to answer all those questions. And that’s why I believe in this system and what you and Dr. Smith and Katie are all trying to do.”
Dr. Smith: “Yes, I would say that you’ll not meet an experenceed bariatric surgeon who has a comprehensive program that would not admit to you that multimodality approach of mental health, dietary education, lifestyle changes, and good surgical care, is not mandatory for good results. And if you ever met one that says that they aren’t then, no offense, they’re not a good bariatric surgeon. But you won’t, you really won’t, whether they want whether they’re utilizing Pop right now or not they will always admit that. They will, number two, always admit that they wish they had more resources to do those things, but whether it be the limit, the cost of carrying that overhead, whether it having access to people around them that do a good job, or not knowing maybe some people who are specializing in that. And I think what something that I have really tried to follow over my career especially as I’ve progressed through my career is the key to success is to surround yourself with people who are passionate and very good at what they do and there is none of us in this world that are good at everything. And sometimes as physicians we tend to think because we’re the physicians that we’re the buck stops everywhere. And I think earlier in my career, years ago when I learned that as long as I help the patient, it doesn’t have to come from me, it can come from someone else in my office or someone else, because I want the best of the best at their specialty, want the best of the best at something that they love that they’re passionate about. I’m really passionate about what I do and that’s part of why I’m good at it but other people are nutrition coaches, are mental health specialists, are concierge people, are ambassadors who have been through this like Katlyn, who have been through this and is so passionate about wanting everybody else to experience the success that they have and to get through those tough times when they have them to and know that it’s normal. They all get to focus at what they do really well. And we just become a team and it doesn’t matter that I did everything or Laura did everything or Katlyn did everything or Dr. Choi did everything. We did our part but we know when a patient uses this program they are surrounded by people who are experts and very passionate about what they do and we’re covering all those categories that are mandatory that all those surgeons will admit are necessary for people to be successful.”
Katlyn: “Absolutely. I will tell you firsthand support has been probably the only reason why I have been successful. I can’t tell you how many times that I just wanted to stop that I wanted to give up we say this all the time and I mean it from the bottom of my heart this surgery is a tool and if you don’t do, if you don’t use your tool the way that you should you can potentially not be successful. You can gain it all back. What is so different and I say this all the time, you need food to survive, unlike any other addiction, you don’t need alcohol to survive you don’t need drugs to survive but you need food and changing your relationship with food is not easy. I’m a recovering food addict. There are still days that I struggle but having that help with a nutritionist, having that help with a mental therapist to find out other ways to not use food for therapy, has been so helpful in this journey. Because without it, I can’t say I would be standing here saying that I am a successful story because I don’t know that I would be if I didn’t have that support .
I love that, thank you for being so honest.“
Bariatric Surgery and Menopause
Host: “So I do have a question for Dr. Smith, what advice can you give for women who are going through menopause after having the sleeve? Basically the weight loss has stopped.”
Dr. Smith: “What what you have to understand with conditions like menopause for example or we’ll say hypothyroidism, there are some other things too that many people will associate with weight gain or plateauing of weight loss, is those things will impact the way your body breaks down calories in your metabolism, but those things will not directly cause you to gain weight. Let me explain, I wish I could eat what I did when I was 40, but I can’t get away with it. And when now that I’m gonna be 50 this year and Laura’s never going to let me forget that, she calls me old every day, I can’t get away with it because my body is changed and it’s different. If I don’t change my activity level if I don’t change the types of foods that I eat if I don’t change my calorie number then I may be staying the same on what I’m taking in but I may be gaining weight because I’m breaking food down differently and I’m burning calories differently. It’s also really important that we focus on our body composition maintaining muscle mass, and so as we get older we struggle to maintain our muscle mass and as your muscle mass drops, the number of calories your body burns drops. So if someone is slowly losing muscle mass their calorie number slowly drops down and you’re still eating the calories that you worked for you five years ago or premenopausal and now they’re not working anymore. So there’s I’m not an OBGYN and I don’t pretend to be but I can tell you that you can overcome it, it’s not a hindrance to weight loss but you need to sit down with somebody and really dig deep and make sure your hormones are maximized, make sure your body composition is maximized and let someone help you with
it.”
Pre-Surgery Advice from Katyln
Host: “Thank you so much. Katie what advice would you give to someone who’s getting ready to have surgery on May 29th?”
Katyln: “Where should I start? Take pictures, take videos, remember it’s not a race to the finish
line, you’re gonna have good days, and you’re gonna have really bad days, that’s just the reality of it. Do not compare your journey to other people, listen to your doctor because you’re, what you’re going to find out, especially if you’re on the internet, is everyone’s doctor will tell you something different. Some doctors tell you no caffeine, some doctors tell you no straws, you just got to make sure you’re following your plan because everyone is going to be on a different plan. Stay off the scale, your measurements, I can go on and go on and go on but I’m gonna stop right there.”
Bariatric Surgery Benefits
Host: “Awesome, question for Dr. Choi, what are the bariatric surgery benefits? Can you give an explanation on what we should be looking or asking for?”
Dr. Choi: “In what aspect? Meaning what each surgery does?”
Host: “That’s what I suppose, when they’re going, what should they be looking for like and okay so the first part of the question was what are the benefits of bariatric surgery?”
Dr. Choi: “So the benefits of bariatric surgery are, as you see, if you have hypertension, diabetes, cholesterol levels, you have a 70 to 80% chance that your hypertension and type two diabetes will resolve. You also have a 70 or 80% chance that you have if you have a CPAP machine or sleep apnea machine you might throw away in the garbage six to nine months later on down the road. In addition to that, there are good things about having, each surgery is different. I like to do the gastric sleeve as Dr. Smith had said, because it does affect you hormonally. Because when you cut and remove 70-80% of the gastric sleeve or the greater portion of the stomach you also remove this hormone called ghrelin, so we also know that ghrelin and leptin are these circadium rhythms that go up and down that make you get hungry. So sometimes, what my patients tell me after a gastric sleeve, is that I’m not hungry anymore Dr. Choi, so that I forget to eat, so that’s a good sign that for me, that I’ve been successful, that I’ve done a good surgery for the patient. So that makes me feel well. The other thing about the bypass really quick it also does a great job but it’s also twofold because it is malabsorption and restrictive, meaning the pouch is the restricted portion and the bypass is the malabsorption portion so some people like to do that, but each doctor, as you said, Dr. Smith might want to choose one or the other but I preferably like to choose the sleeve first because then, God forbid, down the road there’s more options to switch it into, a bypass or SDS or do a switch. But not saying that the bypass shouldn’t be done in the first place, but that is just my feeling as a surgeon. And other surgeons might have different values and beliefs on what surgery they like.”
Is Roux-en-Y a Cure for Obesity?
Host: “Thank you and Dr. Smith does Roux-en-Y treat the disease of obesity?”
Dr. Smith: “Yes, yes absolutely, Roux-en-Y gastric bypass, we have as much data of any of the surgeries out there long-term data. Roux-en-Y gastric bypass is a great procedure if it’s done on the right patient. There’s no perfect procedure but Roux-en-Y gastric bypass has been shown to have significant weight loss over long term, and so all of these surgeries we’re talking about DS or switch, gastric bypass, sleeve all of these are surgeries that treat the disease of obesity. But I always like to tell patients, you may on your history in the chart, it may say that you have hypertension, but when we check your blood pressure it’s normal, the diffence is you take a medication for your blood pressure that’s why it’s normal but you still have the disease of hypertension. Well I like to tell people is mentally, you always have the disease of obesity but it’s now permanently controlled and what that does is it keeps you on guard not only of behaviors but it keeps you on guard of follow-up and having long-term plans to keep you on track. People who’ had cancer they’re cured of their cancer, hopefully, but they’re still going to follow up with their oncologist to make sure that there’s no evidence of the disease coming back. And obesity really is isn’t any different of that long-term follow-u,p that long-term plan to make sure that you keep your disease at bay.”
Continue Losing Weight After the Surgery
Host: “Thank you so much. Dr. Choi how can I continue to lose weight after one and a half year, like she’s not losing weight it’s been one year and a half, she stopped losing weight is there a way to continue to lose weight after a year and a half by changing things around?”
Dr. Choi: “Yes, so depending on what surgery, but there are some times that what we need to do is you need to get a good x-ray history of what’s happening depending on what surgery he or she has had. But then we also got to see if she’s been following up with a dietitian, if she’s having support as we’re discussing with all these things, because that’s what we’re trying to hit upon that it’s so important without support, maybe you fell off the wagon, so what you need to do is you need to go and have have an examination or have a brief medical history and surgical history redone, get a studies, maybe you stretcedh the pouch out, maybe you know there’s other factors. Maybe as you said, you’ve hit menopause, you know, when women who hit menopause, 40 and after you lose 1% of muscle mass every year after 40, so those are certain things that we need to understand. But it could be simply that, listen I’ve been eating a lot but I don’t go and walk after dinner as I usually did, so those are simple fixes but it should be a whole practical support of what we need to figure out why what was the main reason why you’ve stopped losing weight. So that’s why this pop recovery system is so important.”
Changing Your Habits Is Important!
Host: “And I think that this is a great comment for Kaitlyn, because you’ve probably gone through this, talking about how the food noise comes back even after the surgery right. Why is that if your stomach’s gone, then where did the food noise come from? What is it, I know but I want you to say it.”
Katyln: “Girl I’m not kidding you and I struggle with it, but I think what makes it different now is that I can recognize that there’s that problem, whereas before I didn’t recognize it and I was just like oh okay whatever, i can do this. But,I don’t know times are different and sometimes I’ll be
stressed and when you walk by that pantry door it’s like eat me, eat me, eat me, and I have to slam the door and walk straight past. Whereas in the past I was just like, okay what you got in there? Iit’s what I like to say and you guys can correct me if I’m wrong, but I feel like that first year, you’re like in a honeymoon stage, and then after that first year it’s you having to put that work in. You have to continue the dieting and the exercising and staying on plan because if not you can easily go back to the bad habits and gain your weight back. I know people personally and I think that’s why I was so scared at first to do the surgery is I know people personally who have failed and have gained all their weight back and then had to go have a revision done. Because people don’t realize, they think it’s a quick simple fix, and it’s not, it’s not at all.”
Is It Ever Too Late for a Revision?
Host: “Dr. Smith, last question, is it ever too late for a revision?”
Dr. Smith: “No, if a revision is necessary, it’s never too late. I’ve revised patients who had their surgery so long ago it was done open, I had a lady not too long ago, I did a revision of a lady, who had surgery in the 80s. Now there’s some doctors that are going to feel comfortable doing that and some that aren’t and that’s oka,y but it’s never too late. It’s like life, it’s never too late for a fresh start. It’s also never too late if you feel like my only option is a revision, to get to a specialist and find out you may not even need a revision. You may just need some education and support. We don’t look to do revisions, we do them when they’re necessary, but it it’s never too late. Today is the best day to start all over. And it’s never too late, you’ve not ruined your tool, you’ve not ruined your chance, you’ve not missed your window of opportunity, and it’s gone forever. Get with somebody, get support system in place, have Pop support you for those of you out there that had surgery years ago and you’re like gosh it’s a lot of trouble to go find a surgeon to sit down with, don’t worry about that. Go to Pop first, sit down with Pop, because you may just need Pop for long-term support to get you back on track from a dietary standpoin,t mental health standpoint, psychological standpoint, but Pop can also get you in the hands of an experienced surgeon who can provide those options for you if, ultimately that’s what you need.”
It’s Okay to Search for Support
Katyln: “And please know that just because someone does your surgery, if they’re not giving you that continued support that you need to be successful, there is nothing wrong with going and
having that continued follow-up care with another bariatric doctor. I personally do not see the surgeon that did my sleeve, I am now going to another bariatric doctor because I wasn’t getting the support that I needed and that’s okay. You have to advocate for your health because you want to be successful and I one of my first questions to that new surgeon was how often do you see people even though I’m now over two years posttop. He said I still will continue to see you every six months to a year, I will still do your blood work I will still do X Y and Z, if you need nutritionist I’ve got you. It is okay to continue to seek out help even though it’s not your surgeon.
Yes, be your number one advocate, I tell patients that every week, you have to be your number one advocate and everybody else will fall in line and other people will see you advocating for yourself and they’ll gravitate towards that and they will want to advocate for you as well but you have to take responsibility to be your number one advocate.”
Be Your Own No. 1 Health Advocate!
Host: “Yes, Dr. Choi, do you have any last words for our audience?”
Dr. Choi: “I think that whichever way that people want to choose to lose weight, if it’s financially or economically, meaning that if you can’t afford to get weight loss surgery now don’t be afraid to use these semaglutides these weight loss drugs but however just know for the fact that once you stop that you will gain your weight back. The most important thing is hopefully Pop Recovery System can help you get your financing also, to have the surgery done, so don’t be scared, as Dr. Smith said every day is a new day to change your life. And we’re trying to help you guys to get a new lifestyle and change your life so that you can become more healthy for your future.”
Host: “Love that! Katie, Dr Smith, last words for the peeps?”
Dr. Smith: “Great seeing you guys, I think it was a great conversation, I look forward to seeing you guys next week.“
Katyln: “Just remember guys, you are worth the investment whether insurance covers it or not, you have to invest in your health, invest in you first and then you can invest in all those fun things that you want to do but invest in you first you can enjoy.”
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