Bringing Balance to Obesity | On Call with the Prairie Doc | April 6, 2017

Bringing Balance to Obesity | On Call with the Prairie Doc | April 6, 2017


>>WE DIET, EXERCISE, OR HAVE SURGICAL PROCEDURES, BUT HOW WELL DO THEY WORK? HOW CAN WE KEEP WEIGHT OFF THAT WE HAVE LOST? BRINGING BALANCE TO OBESITY, TONIGHT, “ON CALL WITH THE PRAIRIE DOC.”>>GOOD EVENING AND WELCOME TO “ON CALL WITH THE PRAIRIE DOC.” WHEN WE WERE GROWING UP, THERE WERE USUALLY ONE OR TWO KIDS IN OUR CLASS WHO WERE OVERWEIGHT. TODAY, ACCORDING TO THE CENTERS FOR DISEASE CONTROL, CHILDHOOD OBESITY HAS MORE THAN DOUBLED IN CHILDREN AND QUADRUPLED IN ADOLESCENTS IN THE PAST 30 YEARS. THE PERCENTAGE OF CHILDREN AGED 6-11 YEARS IN THE UNITED STATES WHO WERE OBESE INCREASED FROM 7% IN 1980 TO NEARLY 18% IN 2012. AND THE OVERALL PERCENTAGE OF ADULTS WHO ARE OVERWEIGHT, INCLUDING OBESITY: 70.7%. WE WILL ADDRESS THIS EPIDEMIC AND YOUR QUESTIONS. FIRST, LET’S TAKE A LOOK AT THIS WEEK’S PRAIRIE DOC QUIZ QUESTION. TRUE OR FALSE? PEOPLE WHO HAVE LOST WEIGHT THROUGH WEIGHT WATCHERS, JENNY CRAIG, TOPS, OR OTHER WEIGHT LOSS PROGRAMS WILL USUALLY KEEP 30% OF THAT WEIGHT OFF AFTER FIVE YEARS. TRUE OR FALSE? VIEWERS WHO CALL IN THE CORRECT ANSWER WILL BE ENTERED INTO A DRAWING TO WIN A SIGNED COPY OF OUR BOOK, “THE PICTURE OF HEALTH.” EACH OF MY ESSAYS, ORIGINALLY WRITTEN FOR THIS SHOW, COMES WITH A WONDERFUL ACCOMPANYING PHOTOGRAPH BY DR. JUDITH PETERSON. WE WILL ANNOUNCE THE ANSWER AND THE WINNER AT THE END OF THE SHOW. REMEMBER, YOU ONLY HAVE 10 MINUTES TO GET YOUR ANSWER IN! BUT YOU’VE GOT AN HOUR TO CALL IN ANY MEDICAL QUESTION ABOUT OBESITY. AND WE WILL TAKE THEM AS THEY’RE CALLED IN OR SENT TO US VIA Facebook OR E-MAIL. CALL IN QUESTIONS TO 1-888-376-6225 OR SEND US AN EMAIL TO THE ADDRESS ON THE SCREEN. JOINING US TONIGHT ARE DR. MIKE DAVIES, SENIOR MEDICAL ADVISOR IN THE OFFICE OF VETERANS ACCESS TO CARE OF THE DEPARTMENT OF VETERANS AFFAIRS IN THE BLACK HILLS AND WASHINGTON, D.C. THROUGHOUT THE UNITED STATES. IS THAT THE CORRECT NAME?>>THAT’S CORRECT, YES.>>AND D,R DAVID FROMM OF THE RAPID CITY MEDICAL CENTER LLP. GENERAL SURGEON AND A SURGEON WHO ADDRESSES THE ISSUE OF SURGERY FOR OBESITY. SO LET’S START WITH YOU, DAVID. WHAT GOT YOU INTO SURGERY FOR OBESITY?>>YOU KNOW, IT’S AN INTERESTING FIELD. WHEN I CAME OUT OF MY TRAINING AT THE UNIVERSITY OF IOWA, I HAD AN INTEREST IN DOING ADVANCED MINIMALLY INVASIVE SURGERY, LAPAROSCOPIC, I LOVED TO DO PROCEDURES OF THE ESOPHAGUS AND THE STOMACH.>>FOREGUT. UPPER G.I.>>NATURALLY, THERE’S A NEED. AND IN RAPID CITY, I WAS ASKED, WOULD YOU CHAMPION THIS? I SAID, WELL, LET ME GIVE IT SOME TIME AND, YES. IT IS VERY ADDICTING, IT’S A PRACTICE. I LOVE THE PRACTICE. PEOPLE ARE EXCITED TO COME SEE YOU, THEY’RE EXCITED TO COME SEE YOU WHEN WE’RE DONE.>>AND COMMONLY THEY HAVE A GOOD RESULT?>>YES.>>IT’S HOW MUCH OF YOUR PRACTICE?>>30 TO 40% OF MY PRACTICE.>>YOU’RE ORIGINALLY FROM WHERE?>>RAPID CITY.>>RAPID CITY ORIGINALLY. YOU’RE STILL IN RAPID CITY?>>STILL IN RAPID CITY.>>YOUR DAD WAS A GENERAL SURGEON AS WELL?>>HE WAS, YES.>>THEY TALK ABOUT GENERAL SURGERY BEING ONE OF THOSE MOST-SOUGHT-AFTER AND NEEDED SPECIALTIES THAT PEOPLE ARE NOT GENERALLY DOING ANYMORE. AND WE NEED MORE GENERAL SURGEONS. WHAT’S YOUR COMMENT ON THAT?>>PEOPLE ALWAYS SAY, IF YOU’RE ON A DESERTED ISLAND, PICK ONE MEDICAL SPECIALTY TO BE WITH YOU, IT WOULD PROBABLY BE A GENERAL SURGEON.>>I WOULD SAY AN INTERNIST. WHO HAPPENS TO KNOW HOW TO CUT.>>YEAH.>>INSTRUMENTS, RIGHT?>>I WOULD SAY THAT THE VERY BEST GENERAL SURGEON IS AN INTERNIST WHO REALLY, BY HEART, KNOWS THE PHYSIOLOGY AND THE METABOLISM AND ALL OF THE MEDICAL PROBLEMS THAT CAN GO WRONG WHEN YOU DO SURGERY.>>YOU’RE RIGHT. YOU HAVE TO HAVE A GOOD UNDERSTANDING OF THE PHYSIOLOGY OF THE BODY, AND YOU HAVE TO BE ABLE TO APPLY SURGICAL SCIENCE TO THAT.>>I OFTEN THOUGHT, IF I HAD DONE IT DIFFERENT, I MIGHT HAVE DONE A GENERAL SURGERY, IT’S A WONDERFUL FIELD. SO, MIKE, YOU AND I HAVE KNOWN EACH OTHER FOR 30 YEARS.>>AT LEAST. YEAH. IT’S BEEN A WONDERFUL TIME.>>IT’S BEEN A GREAT — WATCHING YOU GO THROUGH THIS. AND NOW YOU ARE — YOU’RE THE HEAD OF OUTPATIENT V.A. SYSTEM THROUGHOUT THE UNITED STATES.>>THAT’S A LITTLE GRANDIOSE, NOT REALLY, THERE’S A LOT OF PEOPLE IN THE TOP BUREAUCRACY IN V.A.>>YOU’RE PART OF THAT?>>I’M PART OF THAT NOW, YEAH. AND I WOULD HAVE — WE WERE TALKING EARLIER, I NEVER WOULD HAVE GUESSED V.A. WOULD HAVE BEEN THIS EXCITING OF A CAREER. I STARTED OUT AS A HOSPITALIST AT V.A. BLACK HILLS FOR SIX YEARS, AND THEN KIND OF WENT IN THROUGH THE LEADERSHIP AND ADMINISTRATIVE TRACK THROUGH THE REST OF MY CAREER, WAS THE CHIEF OF STAFF THERE, FORT MEADE, HOT SPRINGS, AND CBOCs FOR 14 YEARS, AND THEN KIND OF MOVED INTO NATIONAL ROLE FOR THE LAST TEN.>>I PICKED YOU BECAUSE YOU’RE SUCH A MEAN GUY. I THINK THAT’S IT, ISN’T IT?>>YEAH, RIGHT.>>SO, AS AN INTERNIST, OBESITY IS A PROBLEM THAT YOU SEE OFTEN?>>I’M ALSO A PRIMARY CARE PROVIDER. AND, SO, ACTUALLY, THROUGH THE YEARS, AS WE’VE SEEN WITH THIS EPIDEMIC OF OBESITY, YOU KNOW, ALL OF OUR PATIENTS ARE GETTING HEAVIER OVER TIME. CERTAINLY AS I LOOK BACK. AND I HAVE TO SAY THAT I HAVE AN INTERESTING FAMILY. MY WIFE, WHO ACTUALLY WORKS WITH DR. FROMM IN HIS PRACTICE HAS TWO DOCTORATE DEGREES IN NUTRITION, AND WE TALK ABOUT THIS STUFF ALL THE TIME. AND THEN I HAVE — WE HAVE A SON, WHO’S ALSO A BARIATRIC SURGEON.>>IS THAT RIGHT? I DIDN’T KNOW THAT.>>YEAH, YEAH, YEAH. SO THERE’S LOTS OF TALK ABOUT THE LATEST DEVELOPMENTS IN OUR WORLD.>>SO, IT’S INTERESTING THAT THE REASON THAT THIS PARTICULAR CIRCLE OF PEOPLE CAME TOGETHER ON THIS TOPIC WAS BECAUSE YOUR WIFE INVITED THE THREE OF US TO BE ON A PANEL.>>RIGHT.>>TELL THEM A LITTLE BIT ABOUT THAT STORY.>>YEAH. SO SHE TOOK A STINT AS THE PRESIDENT OF THE DIETETIC ASSOCIATION IN SOUTH DAKOTA, AND ARRANGED, YOU KNOW, INTERESTING, THE MEETING AROUND THE TOPIC OF OVERWEIGHT AND OBESITY, WHICH IS, AS YOU SAID, SUCH AN EPIDEMIC AND OF COMMON AND WE’VE GOT TO FIGURE OUT WHAT WE’RE GOING DO ABOUT THIS, RIGHT, AS A SOCIETY. AND, SO, TRYING TO GET SOME MORE EXPOSURE, I THINK, TO THE ISSUE.>>AND, SO, WE EACH HAD A CHANCE TO GIVE OUR SPIEL.>>YEAH, OUR SPIEL.>>WHICH IS KIND OF INTERESTING. AND I THOUGHT, REALLY, CHANGED MY THINKING A BIT. I DID WRITE A CHAPTER IN A SURGICAL TEXT. IT’S INTERNAL MEDICINE FOR THE SURGEONS. OUT OF EMORY. LED BY MICHAEL LUBIN, AN OLD FRIEND OF MINE. AND THEN WE DID IT A SECOND TIME, AND THE CHAPTER I HAD WAS MEDICAL PROBLEMS IN THE OBESE. IN SURGICAL PROBLEMS IN THE OBESE. AND ACTUALLY THE END OF THE CHAPTER WAS, AT THE TIME, 35 YEARS AGO, WAS TO SAY, IT’S TOO EARLY TO START RECOMMENDING GENERAL SURGERY FOR OBESITY.>>RIGHT.>>BECAUSE WE DIDN’T KNOW WHAT WE WERE DOING AND PEOPLE WERE DYING AND THERE WAS A LOT OF PROBLEMS WITH IT.>>RIGHT.>>BUT BEFORE WE GO INTO THAT, I WANT TO START WITH, WHY DO WE CARE ABOUT OBESITY? I KNOW, OKAY, THERE’S AN EPIDEMIC, BIG DEAL. WHY DOES IT MATTER? DAVE?>>WELL, IF YOU LOOK AT ALL THE THINGS THAT ARE ASSOCIATED WITH OBESITY, YOU KNOW, YOU HAVE HIGH RISK FOR HEART DISEASE, STROKE, KIDNEY DISEASE, CERTAIN TYPES OF CANCERS, EARLIER AGE ASSOCIATED DEMENTIA, JUST CHRONIC PAIN, YOU KNOW, PEOPLE COME IN WITH ACHY JOINTS, ACHY BACKS. IF YOU THINK ABOUT IT AS A SOCIETY –>>SLEEP APNEA.>>WE’RE ALWAYS TREATING THINGS AFTER THE FACT. WITH THE COMPLICATION, WE’RE TREATING YOU THEN. AND THE IDEA FOR TREATING OBESITY, THIS COULD BE SOMETHING THAT WE COULD MODIFY BEFORE PEOPLE EVER GET TO THAT POINT.>>YOU LOOK AT THE DIABETICS, IN PARTICULAR, WHO ARE VERY VERY OVERWEIGHT, IF YOU CAN GET THEM TO LOSE WEIGHT, THE DIABETES GOES AWAY. JUST AMAZING.>>YEAH. FROM AN INTERNAL MEDICINE STANDPOINT, WE ALWAYS USED TO LOOK AT, I THINK, I WOULD GUESS, OUR DISEASES THROUGH THE EYES OF HYPERTENSION, OH, AND BY THE WAY, YOU NEED TO LOSE WEIGHT, RIGHT?>>YEAH.>>OR DIABETES, AND IF YOU LOSE WEIGHT, THEN YOUR DIABETES WILL GET BETTER. BUT, YOU KNOW, IT’S INTERESTING, ONE OF THE AH-HA MOMENTS FOR ME IN THIS WHOLE WORLD OF OBESITY IS, WE PROBABLY NEED TO FLIP IT. AND WE PROBABLY NEED TO SAY, OBESITY IS PROBABLY THE CORE ISSUE. AND THEN THERE ARE A NUMBER OF ASSOCIATED, YOU KNOW, CO-MORBIDITIES, IF YOU WILL, OR DISEASES THAT COME WITH OBESITY. AND THE INTERESTING THING IS, YOU CAN PICK A MEDICINE TO TREAT ANY ONE OF THOSE DISEASES THAT WILL MAKE YOUR WEIGHT HIGHER OR LOWER. SO, US PROVIDERS HAVE TO BE THINKING ABOUT WHAT THE OPTIONS OR FOR MEDS AND PICK THE ONE THAT’S NOT GOING TO MAKE THE CORE PROBLEM WORSE.>>RIGHT. I MEAN, THERE’S CERTAINLY SOME MEDICINES FOR DIABETES, IN PARTICULAR, THAT ENHANCE THE WEIGHT GAIN.>>RIGHT.>>INSULIN BEING ONE.>>RIGHT. AND HYPERTENSION AND CONTRACEPTION AND PSYCHIATRIC ISSUES AND SEIZURES, IT GOES DOWN –>>IT GOES ON AND ON AND ON.>>YEAH, IT’S A BIG DEAL.>>SO THERE IS NO QUESTION ABOUT IT, IT’S A GOOD IDEA TO TRY TO GET PEOPLE TO A NORMAL WEIGHT. OR TRY FOR INDIVIDUALS TO GET THEMSELVES TO A CORRECT WEIGHT. THE PROBLEM IS, IT’S A DIFFICULT CHALLENGE. IT’S MUCH MORE DIFFICULT THAN WE REALLY UNDERSTAND. BUT HOW DO WE KNOW — OR WHAT IS THE DEFINITION OF OBESITY? I MEAN, FOR EXAMPLE, YOU NEED TO HAVE A CERTAIN WEIGHT BEFORE YOU’RE GOING TO TAKE A PERSON TO SURGERY.>>YEAH.>>THERE’S SOME PEOPLE WHO ARE RELATIVELY THIN, AND, YET, THEY WANT TO BE THINNER YET.>>YEAH. SO THERE’S TWO WAYS TO THINK ABOUT IT. THERE’S A CRITERIA THAT WAS ESTABLISHED IN THE NATIONAL INSTITUTES OF HEALTH, SO THEY LOOK AT FACTORS SUCH AS YOUR BMI.>>BMI IS?>>LOOKING AT YOUR WEIGHT IN KILOGRAMS, WHICH IS 2.2 POUNDS IS ONE KILOGRAM, AND THEN YOU DIVIDE THAT BY YOUR HEIGHT IN METERS SQUARED. IT’S A WAY TO COMPARE APPLES TO APPLES, YOU MAY BE 250 POUNDS, 6’5″, AND THAT’S VASTLY DIFFERENT IF YOU’RE 5’2″ AND 250 POUNDS.>>YEAH. SO.>>SO, YOU KNOW TALK ABOUT A BMI, IF IT’S GREATER THAN 39, YOU’RE OBESE, 35 TO 40, YOU’RE MORBIDLY OBESE. WE SAY, 40 PLUS, YOU’RE GROSSLY MORBIDLY OBESE OR SEVERELY MORBIDLY OBESE. OBESITY CAN BE PHILOSOPHICALLY MORE THAN THAT. YOU KNOW, PEOPLE QUESTION THE WHOLE IDEA THE NATIONAL INSTITUTES OF HEALTH CRITERIA. OBESITY COULD BE EXCESS ADIPOSE TISSUE PLUS THE EFFECT THAT THAT HAS UPON YOUR SYSTEM.>>RIGHT. I MEAN, WE’RE TALKING THAT DEFINITION OF BMI, BUT I KNOW FOR A FACT THAT MEN OR ANYBODY SHAPED LIKE AN APPLE, A DUNLAP DISEASE, HUGE ABDOMEN FAT, ARE AT HIGHER RISK FOR HEART DISEASE, VASCULAR DISEASE, A LOT OF THE PROBLEMS ASSOCIATED WITH OBESITY THAN THE PEOPLE, CLASSICALLY A WOMAN, WHO’S PEAR SHAPED, AND THEY’RE ALL IN THE LEGS AND, IN FACT, THOSE PEOPLE WHO ARE PEAR SHAPED, THE ONLY WAY THEY’LL EVER LOSE WEIGHT IS TO MAKE THEM PRETTY SICK AS A RULE. AND THAT’S BEEN MY — ANY RESPONSE TO THAT?>>WELL, I THINK THERE’S — IT’S NOT AS SIMPLE AS LOOKING AT SOMEBODY OFTEN, RIGHT? YOU CAN LOOK AT SOMEBODY AND THINK THAT THEY MEET THE CRITERIA FOR OBESITY, BUT THEY MAY BE BIG BONED, THEY MAY BE TALL, SHORT, ET CETERA. THEY MAY BE DIFFERENT SHAPED. SO, WE CAN STEP ON THE SCALE AND GET MORE INFORMATION AND SEE WHAT YOUR WEIGHT IS. OR YOU COULD DO YOUR BODY MASS INDEX LIKE DR. FROMM JUST MENTIONED, WHICH GIVES YOU A BETTER UNDERSTANDING OF IT, OR THERE’S EVEN MORE SOPHISTICATED TESTS NOWADAYS. YOU COULD DO THE DEXA SCAN.>>SEE WHAT PERCENTAGE OF FAT.>>SEE WHAT PERCENTAGE OF FAT, YOU MIGHT HAVE A LEAN BODY THAT’S ALL MUSCLE BUT BE TECHNICALLY OVERWEIGHT. AND, SO, YOU GOT TO BE THOUGHTFUL ABOUT MAKING THAT DIAGNOSIS.>>RIGHT.>>BECAUSE ONCE YOU MAKE THE DIAGNOSIS, THE NEW THINKING IS THAT THIS IS A DISEASE. WE USED TO THINK, RIGHT, THAT THIS IS A PROBLEM WITH BEHAVIOR, MAYBE. OR AN UNLUCKY GENETICS THAT YOU GOT. BUT OBESITY NOW IS THOUGHT OF AS A DISEASE IN ITSELF. WHICH IS KIND OF A NEW MODEL. I WOULD SAY, THAN I GREW UP WITH ANYWAY.>>WELL, THE MANIFESTATIONS OF THIS DISEASE ARE ALL THESE OTHER CHRONIC CONDITIONS THAT ARE CERTAINLY LIFE-THREATENING.>>POTENTIALLY, YES.>>SO, LET’S TALK ABOUT THE CAUSES. YOU TOUCHED ON THAT. I THINK THERE’S — THAT’S THE MAGICAL QUESTION. WHAT ARE THE CAUSES OF OBESITY? IT’S YOUR TURN.>>MULTITUDE. YOU KNOW, PEOPLE WOULD ASK ABOUT IT, AND I HEARD SOMEBODY DISCUSS IT THIS WAY THEY SAID, WHAT IS THE CAUSE OF OBESITY, IS IT YOUR GENETICS? YES. IS IT OVEREATING, MAYBE. COMPARED TO THE SAME WAY, HOW DO YOU SAY THAT YOU’RE AT RISK FOR HEART ATTACK, IS IT HIGH BLOOD PRESSURE, IS IT SMOKING HISTORY, GENETICS, YES, IT’S ALL OF THE ABOVE AND EACH ONE OF THOSE. SO FOR OBESITY, YOU CAN’T SAY IT’S JUST ONE THING, IT’S A COMBINATION OF A LOT OF DIFFERENT THINGS.>>I JUST GOT A NUDGE, WE NEED TO GO IN THIS DIRECTION. LOSING WEIGHT IS A DIFFICULT PROCESS, BUT KEEPING IT OFF IS A MOVING TARGET.>>I’VE BEEN FIGHTING WEIGHT SINCE LITERALLY YOUNG ADULTHOOD. I’VE GONE THROUGH A NUMBER OF WEIGHT LOSS PROGRAMS. I’VE ALWAYS BEEN SUCCESSFUL IN TERMS OF LOSING WEIGHT. I’VE HAD MUCH MORE DIFFICULT TIME MAINTAINING THAT WEIGHT LOSS FOR ANY REASONABLE PERIOD OF TIME. SO, KEEPING IT OFF FOR A YEAR HAS SOMETIMES BEEN POSSIBLE BUT MAINTAINING A WEIGHT LOSS FOR MORE THAN A YEAR, YEAR AND A HALF, TWO YEARS HAS BEEN VERY DIFFICULT. I’VE ALSO UNDERGONE GASTRIC BYPASS SURGERY, AND THAT WAS REALLY SOMETHING I DID ABOUT TEN YEARS AGO. BUT I WAS AT A POINT HEALTHWISE, WHERE I NEEDED TO DO SOMETHING OR THE QUALITY OF MY LIFE WAS GOING TO CONTINUE TO DETERIORATE WITH RESPECT TO THOSE ASSOCIATED HEALTH RISKS THAT GO WITH BEING OVERWEIGHT. FOR ME, IT WAS A GOOD DECISION. SOME OF THE CO-MORBIDITY ISSUES, LIKE DIABETES AND HIGH CHOLESTEROL, SLEEP APNEA, GENERAL FATIGUE, GROWING JOINT ISSUES, ALL OF THOSE LITERALLY DISAPPEARED AS A RESULT OF THE SURGERY. SO, FOR ME, THAT WAS NOT SOMETHING I DID FOR COSMETIC REASONS. IT WAS SOMETHING I DID FOR HEALTH AND WELLNESS. BUT I CONTINUE, EVEN HAVING HAD THAT SURGERY, IT WAS VERY SUCCESSFUL IN TERMS OF ACHIEVING A WEIGHT LOSS. BUT OVER THE INTERVENING EIGHT YEARS, YOU KNOW, MY WEIGHT HAS SLOWLY CREPT AND, SO, I STILL NEED TO BE MINDFUL, TO BE CONSCIOUS ABOUT THAT. BUT, FOR ME, THE SURGERY HELPED ME BECOME MORE CONSCIOUS AND MORE INTENTIONAL IN MY DECISION MAKING. THE FOCUS TODAY IS MUCH MORE ON THE PURSUIT OF WELLNESS AND HEALTH AND FITNESS THAN ON WEIGHT PER SE. AND, SO, YOU KNOW, YOU’RE STARTING TO SEE CONCEPTS LIKE MINDFULNESS, YOU’RE STARTING TO SEE CONCEPTS LIKE SELF-COMPASSION, SO THAT LOSING WEIGHT, HITTING A TARGET ON A SCALE IS NOT NECESSARILY THE PREFERRED GOAL. >>THANK YOU, DR. PAPINI, WHAT A WONDERFUL GENTLEMAN, HEAD OF OUR ARTS AND SCIENCES HERE IN BROOKINGS, SDSU.>>THIS IS YOUR SHOW AND YOUR QUESTIONS ARE KEY TO OUR SHOW DISCUSSION. CALL IN YOUR QUESTIONS ABOUT OBESITY TO 1-888-376-6225 OR SEND US AN EMAIL TO [email protected] SO, PLEASE, GIVE US YOUR QUESTIONS. SO, THAT WAS AN INTERESTING INTERVIEW. WHAT’S YOUR RESPONSE?>>WELL, YOU KNOW, THIS IS THE NEW MOST EFFECTIVE TREATMENT FOR OBESITY IS WHAT DR. PAPINI HAD. THAT SURGERY HAS DRAMATICALLY IMPROVED SINCE THE 35 YEARS AGO WHEN YOU WROTE THAT BOOKCHAPTER.>>YES.>>AND IT IS PROBABLY GOING TO BE MORE AND MORE SOUGHT AFTER BECAUSE IT WORKS. AND IT WORKS BECAUSE ITINTERVENES IN A WAY THAT OTHER TREATMENTS WE TRIED OVER THE YEARS HAVE NEVER WORKED. DIET AND EXERCISE AS WE STARTED THE SHOW WITH, WHICH I’M SURE WE’LL COME BACK WITH, IS, YOU KNOW, SORT OF A STARTING POINT, THAT’S FOUNDATIONAL, RIGHT? BUT WHEN YOU GET TO A CERTAIN POINT, THE SURGERY CHANGES THE WAY YOUR BODY FUNCTIONS, AND IT REALLY DOES WORK.>>WE TALKED ABOUT THE CAUSES, YOU SAID IT’S MYRIAD, RIGHT? BUT I KNOW THAT PEOPLE, THERE’S SOMETHING THAT HAPPENS AT DOLL HE IS LENS AND SOMETIMES PEOPLE GAIN WEIGHT THEN. ADOLESCENCE. THERE’S SOMETHING THAT HAPPENS WHEN A WOMAN HAS THEIR FIRST BABY, THEY SEEM TO GAIN AFTER THAT FIRST BABY, AND THEN THEY MAY GAIN AGAIN AT THE NEXT BABY AND THEY GAIN AT THE NEXT BABY. AND THEN THERE ARE THOSE PEOPLE WHO WILL GAIN WEIGHT FIVE POUNDS A YEAR, THREE POUNDS A YEAR. BUT IT’S YEAR AFTER YEAR AFTER YEAR AFTER YEAR AFTER YEAR AFTER YEAR. SO, I MEAN, YOU CAN SEE IT, AND IT SEEMS TO ME THAT, WHEN YOU GAIN WEIGHT, YOUR BODY RESETS ITSELF TO THAT WEIGHT AND IT SAYS, THIS IS WHAT I’M GOING TO DO, EVERYTHING I CAN TO MAINTAIN THAT WEIGHT AT THAT LEVEL. DO YOU AGREE WITH THAT?>>YEAH, SO I WANT TO TALK ABOUT THAT BECAUSE THE WAY WE USED TO THINK ABOUT OBESITY WAS LIKE A BANK, RIGHT? >>YES.>>I REMEMBER DOCTORS, MENTORS OF MINE, PROBABLY ME, TOO, YOU GO IN THE ROOM, YOU WOULD SAY, WELL, IT’S LIKE A BANK, YOU KNOW, EVERY TIME YOU EAT, YOU MAKE DEPOSITS IN THIS BANK. AND YOU GAIN, YOU KNOW, ENERGY THAT’S STORED RIGHT IN YOUR BODY AS FAT. AND THEN WHEN YOU EXERCISE, YOU TAKE WITHDRAWALS. SO, THE IDEA IS TO BALANCE YOUR DEPOSITS AND WITHDRAWALS. BUT IT TURNS OUT, IT’S NOT LIKE THAT AT ALL. IT’S REALLY MORE LIKE A SET POINT LIKE A THERMOSTAT. YOU SET THE THERMOSTAT IN YOUR HOUSE AT 70, IF A STORM COMES THROUGH, AND IT COOLS OFF, AND YOUR HOUSE COOLS OFF, YOUR FURNACE HEATS UP, BRINGS IT UP TO 70, RIGHT? IF YOU HAVE A HEAT WAVE THAT COMES DOWN, THEN YOUR AIRCONDITIONER KICKS ON AND BRINGS IT DOWN TO 70. YOU HAVE A SET POINT. AND IT TURNS OUT, OUR BODIES PROBABLY WORK MORE LIKE THAT SET POINT AND DEFENDING THAT SET POINT, TRYING TO GET BACK TO THAT SET POINT, THAN THEY DO LIKE THE BANK MODEL. >>YEAH. THE QUESTION IS, WHY DOES IT ALLOW ITSELF TO GAIN BUT DOESN’T ALLOW ITSELF TO LOSE AND WHY DOES THAT SET POINT OCCUR?>>THAT’S A GOOD QUESTION. I HEARD IT TALKED ABOUT IT THIS WAY, SOME PEOPLE DISPUTE THIS, PEOPLE SAY THE HUMAN BODY IS EVOLVED FOR MILLENIA FOR THE ABILITY TO SURVIVE FAMINE AND STARVATION, SO OUR BODY IS DESIGNED TO KEEP WHATEVER WEIGHT, WHATEVER ENERGY, TALK ABOUT ADIPOSE TISSUE, ADIPOSE TISSUE IS STORED ENERGY, THE BODY IS SAVING IT FOR THAT TIME THAT WILL NEVER HAPPEN. SO YOUR BODY IS DESIGNED TO MAINTAIN THAT. AS SOON AS YOU LOSE WEIGHT, YOUR BODY WILL DO THINGS TO BRING IT BACK UP. YOU KNOW, PEOPLE TALK ABOUT, YOU KNOW, THE WILL POWER ISSUE, WHY DO DIET AND EXERCISES NOT WORK? WELL, YOU WOULD SAY, WELL, IT’S THE WILL POWER OF THE PERSON, YOU KNOW, YOU LOST WEIGHT BUT YOU DIDN’T STICKWITH IT, YOU WENT BACK TO OLD HABITS, IT’S THE FOOD ADDICTION.>>BLAME, GUILT, BLAME, GUILT, WE ALL DO IT. SHAME, GUILT. WHAT DO WE SAY TO A PERSON WHO’S HEAVY?>>MAKE FUN OF THEM.>>NEGATIVE NEGATIVE NEGATIVE NEGATIVE COMMENTS.>>YEAH, IT’S ROUGH.>>OH, YOU’RE SHAMEFUL, I MEAN, YOU KNOW, HOW CAN YOU EAT SO MUCH? THERE’S SOME DATA THAT SAYS THAT HEAVY PEOPLE EAT LESS THAN THIN PEOPLE.>>PEOPLE COME IN MY OFFICE, THEY HAVE THINGS DOWN, THEY HAVE A CHART, THEY WILL TELL ME EXACTLY WHEN THEY EAT, HOW MANY CALORIES, THEY WENT TO THE GYM, BURNED OFF THIS MANY CALORIES, THEY’RE FRUSTRATED, BECAUSE, THEY’RE, LIKE, I’M DOING ALL THE RIGHT THINGS, I CAN’T LOSE ANY WEIGHT, WHY IS THAT?>>IT’S COMPLEX. I LIKE THE WAY YOU STARTED WITH THIS, IF YOU LOOK AT SOMEBODY’S CHART OVER THEIR LIFETIME, YOU KNOW, YOU’LL SEE YOU GAIN WEIGHT DURING ADOLESCENCE AND ADULTHOOD, YOU HAVE DIFFERENT LIFE EVENTS, DIFFERENT SOCIAL THINGS THAT WE THINK MUST CHANGE THAT SET POINT. THE THERMOSTAT.>>YEAH.>>AND, SO, ONE OF THEM IS AGE. YOU KNOW, YOU TEND TO MAKE YOUR SET POINT GO UP A BIT WITH AGE. WE KNOW THAT, RIGHT? BUT ONE MIGHT BE SOMETHING LIKE EATING A BUNCH OF CALORIE-DENSE HIGH PRESERVATIVE FOODS, MORE THAN YOU NEED, MAYBE YOUR BODY SENSES THAT AS A WAY TO RESET THE SET POINT. MAYBE YOU HAVE A TRAUMATIC EVENT AND MAYBE YOUR BODY SENSES THAT. MAYBE YOU’RE AROUND A BUNCH OF PEOPLE, YOU KNOW, WHOSE WEIGHT IS MUCH HIGHER THAN YOURS, MAYBE THAT HAS SOMETHING TO DO WITH OUR BRAINS IN RESETTING THAT SET POINT. YOU KNOW, THERE’S A WHOLE BUNCH OF THINGS, WE’RE JUST STARTING TO UNDERSTAND, I THINK.>>BACK IN THE ’70s, THERE WAS SOME SOLID STUDIES WHERE THEY PAID COLLEGE KIDS, YOU KNOW, TO OVEREAT. AND THEY FOUND THAT THEY DIDN’T LIKE IT. THEY DIDN’T WANT TO STAY THERE. THEY DIDN’T WANT TO CONTINUE. THEY GOT UNCOMFORTABLE. AND THEN WHEN THEY WERE NO LONGER PAID TO OVEREAT, THEY CAME RIGHT BACK TO THE SAME SET WEIGHT. ISN’T THAT AMAZING? >>YEAH.>>OF COURSE, YOU KNOW, IN MY CASE, BUT IT WAS FIVE POUNDS MORE THAN. WHEN I WENT BEFORE.>>THE SAME THING WITH THE BIGGEST LOSER, RIGHT?>>WHAT’S HAPPENED WITH THOSE?>>THE BIGGEST LOSER IN 2009, IT WAS A DRAMATIC FINDING, REALLY, THAT WE HAD PEOPLE THAT LOST ON AVERAGE 120 POUNDS, SEASON 9, 2009, IN THE BIGGEST LOSER, 14 OF THE 16 PEOPLE WHO WERE STUDIED HAD LOST, ON AN AVERAGE, 120 POUNDS, BUT AFTER THE SHOW WAS OVER, THEY WENT BACK UP TO WHERE THEY WERE BEFORE. AMAZING.>>THAT’S RIGHT. SO WE DON’T UNDERSTAND THE CAUSE, REALLY. I KNOW THAT WE WEIGH AS A RULE, WE WEIGH WHAT OUR BIOLOGIC PARENT, YOU KNOW, THE TWIN STUDIES AND THE ADOPTING STUDIES FROM THE NETHERLANDS SHOW YOU DON’T WEIGH WHAT YOUR ADOPTED PARENTS WEIGH, YOUR ENVIRONMENT, YOU WERE RAISEDTHE WHOLE TIME WITH ALL THESE OTHER KIDS, YOU WEIGH WHAT YOUR BIOLOGIC PARENTS WEIGHED.>>YEAH. SO THERE’S A HUGE GENETIC THING. BUT IF THAT WAS ALL THERE WAS, WHY ARE WE GAINING WEIGHT? PEOPLE BLAME THE FAST FOOD. WHAT’S YOUR TAKE ON THE FAST FOOD?>>YOU KNOW, I THINK THAT THERE HAS TO BE SOME COMPONENT OF THAT. IF YOU LOOK AT THE HISTORY OF THE U.S., THEY TALK ABOUT IN THE ’50s, WHEN AMERICAN HEART ASSOCIATION CAME OUT, CAME OUT WITH THE DIET, LOW-FAT, HIGH-CARBOHYDRATE DIET, THEY SAID IT DIDN’T DO ANYTHING, YOU CAN SEE FROM THE’70s THAT OBESITY BALLOONED FROM THAT POINT. PEOPLE TALKED ABOUT IT, SAID, MAYBE FAT ISN’T MAKING US FAT, MAYBE IT IS CARBOHYDRATES, MAYBE IT IS SUGAR, MAYBE IT’S THIS CRAVING FOR THINGS THAT ARE SWEET, THEN WITHIN OUR DIET THAT WE GET USED TO THAT. I TOLD MIKE, WHEN I WAS A COLLEGE STUDENT, I WAS LUCKY, I TRAVELED TO CHINA, I WAS IN CHINA FOR I ASHORT PERIOD OF TIME, BACK IN THE EARLY ’90s, IT WAS PROBABLY A NOVELTY TO SEE SOMEBODY FROM THE UNITED STATES, AND I WAS STUDYING ECONOMICS AT THE TIME, WE’D GO TO ALL THESE FACTORIES, PEOPLE WOULD BE, OH, THESE AMERICANS ARE HERE, THIS IS SPECIAL, THEY’D MAKE US A CAKE. AND IT WAS THIS BEAUTIFUL, TASTY CAKE. AND YOU TOOK A BITE OF IT, AND IT WAS DISGUSTING, IT DID NOT TASTE SWEET AT ALL. [ Laughter ] IT WAS NOT SWEET. WHAT WAS WEIRD, WE WERE OVER THERE FOR A MONTH AND A HALF, FROM THE TIME YOU WERE THERE, YOU GOT USED TO IT, WE CAME BACK TO THE STATES, WE WENT TO L.A., WENT TO McDONALD’S, I HADN’T HAD A BIG MAC FOR A WHILE, THE FIRST BITE, THIS IS WAY TOO MUCH. THERE WAS SORT OF A PERCEIVED TASTE. AND MAYBE IN THE UNITED STATES, MAYBE WE GOT USED TO THINGS TASTING TOO SWEET.>>THERE’S NO QUESTION ABOUT IT. THE BIG DEAL WAS THE REALIZATION THAT IT ISN’T THEFAT IN OUR DIET THAT HAS CAUSED OBESITY, IT’S REALLY THE CARBOHYDRATES, OR AT LEAST WHAT THEY’VE DONE, THEY DID A COMPARISON BETWEEN LOW-FAT DIET AND A LOW-CARBOHYDRATE DIET AND THE PEOPLE WHO WERE ON THE LOW-CARB, LOST MORE, FELT BETTER, CHOLESTEROL DROPPED LOWER, EVERYTHING WAS HAPPIER. THEY WERE MORE SUCCESSFUL THAN THE LOW-FAT. BUT THEN AFTER A YEAR, IT WAS THE SAME, AND, SO, THEY SAID, WELL, NEITHER ONE WORKS.>>YEAH.>>YOU KNOW, THERE’S BEEN SO MANY BOOKS AND SO MANY DIETS, AND THE BOTTOM LINE IS, THEY ALL WORK ABOUT THE SAME.>>YEAH.>>THEY WORK FOR A WHILE. AND THEN YOU KIND OF BOUNCE BACK TO YOUR SET POINT.>>RIGHT.>>FOR MOST OF — OR MOST OF THE WEIGHT OF THE SET POINT, NOT ALL THE WAY. I DON’T WANT TO SAY THAT THERE’S NO BENEFIT TO DIET AND EXERCISE BECAUSE THERE IS SOME. RIGHT? IT’S JUST NOT AS MUCH AS WE WANT.>>I THINK THE KEY IS, WITH EXERCISE. BUT LET’S TALK ABOUT SURGERY. BECAUSE, I MEAN, RIGHT NOW, YOU’VE GOT A VIDEO, WE’D LIKE TO KIND OF SHOW RIGHT NOW, AND THEN HAVE YOU TALK THROUGH IT AS WE DO THIS QUICK LITTLE VIDEO OF WHAT SURGERY IS THIS GOING TO BE?>>SO THIS IS A SLEEVE — IT’S BEEN AROUND FOR A WHILE, PROBABLY BECOME MORE POPULAR FROM 2008 AND BEYOND.>>YOU CAN START IT ANY TIME IF YOU’VE GOT IT UP. OKAY. SO WHAT’S GOING ON THERE, DAVE?>>SO WHAT YOU’RE SEEING IS PROBABLY, WORKING FROM THE BELLY BUTTON UP TOWARDS YOUR CHEST.>>THAT’S THE LIVER.>>THE LIVER THERE, THAT WE’RE ELEVATING. PUT A LITTLE DEVICE, AND, SO, THE RIGHT YOU’RE SEEING A FAT PAD, PROBABLY THE BOTTOM PART OF THE ESOPHAGUS, TOP PART OF THE STOMACH. BELLVY’S FAT PAD, NAMED AFTER DR. BELLVY, THE REASON WE LOOK HERE, TO LOOK FOR A HERNIA, WHERE THE STOMACH GETS PULLED UP INTO YOUR CHEST AND IF WE SEE THOSE, WE LIKE TO FIX THOSE. GET IT OUT OF THE WAY. AND WE’RE LOOKING AT THE STOMACH. WHAT YOU’RE SEEING IS THE PYLORIC VALVE, THE ONE-WAY VALVE AT THE BOTTOM OF THE STOMACH. WE PUT A MARK ON, THERE WHAT’S CALLED THE GREATER CURVATURE. THE FATTY AREA HERE IS CALLED THE GASTROHALLIC LIGAMENT. WE NEED TO MOVE THAT TO DO THE SECOND PART OF THE OPERATION. ESSENTIALLY OPEN IT ALL THE WAY UP ALL THE WAY UP TO THE TOP OF THE STOMACH.>>THE STOMACH IS SO TIED TO ALL THAT ADIPOSE ISSUE.>>YEAH.>>IF YOU SEE THAT MUCH FAT TISSUE NORMALLY? IN THINNER PEOPLE WHEN YOU’RE DOING GENERAL SURGEON?>>YOU CAN. IT’S SURPRISING, THAT THERE ARE PEOPLE THAT ARE FAIRLY THIN THAT STILL HAVE A LOT OF, IT’S CALLED VISCERAL FAT, FAT AROUND THE ORGANS. AND THERE ARE PEOPLE THAT ARE QUITE LARGE AND THEY MAY NOT HAVE THAT MUCH. AVERAGE PEOPLE, OVERWEIGHT, THEY TEND TO HAVE MORE VISCERAL FAT.>>WHAT ARE YOU DOING, RELEASING THE STOMACH FROM THE VISCERAL FAT?>>YEAH. YOU DON’T SEE IN THIS PICTURE, THE SPLEEN, THESE ARE CALLED THE SHORT GASTRIC VESSELS IN BETWEEN. AND, SO, THIS IS THE TOP PART OF THE STOMACH, WHICH IS CALLED THE FUNDUS.>>YOU DON’T HURT THE SPLEEN OR ANYTHING BY CUTTING OFF –>>NO.>>– THE MUSCLES THAT RUN BETWEEN THE STOMACH –>>YOU COME THROUGH HERE. YOU START TO SEE BEHIND THE STOMACH, THERE’S THE PANCREAS. IT WILL COME INTO VIEW HERE. RIGHT HERE. HERE’S THE PANCREAS RIGHT UNDERNEATH THAT. AND YOU’LL START TO SEE KIND OF THE PART OF THE STOMACH THAT’S HERE. SO, WHAT WE’LL START TO SEE, THERE’S A TUBE, WE CALL A BOUGIE, CERTAIN DIAMETER. THAT’S WHAT YOU USE TO CALIBRATE THE PART OF THE STOMACH THAT WE’RE GOING TO REMOVE. THIS IS CALLED A –>>SO THE BOUGIE IS GOING DOWN THE THROAT, RIGHT?>>DOWN THE THROAT.>>INTO THE STOMACH.>>INTO THE STOMACH, RIGHT.>>SO THERE’S A BOUGIE ON THE RIGHT, INSIDE THE STOMACH.>>THE BOUGIE WOULD BE JUST TO THE LEFT. WE USE THAT TO CALIBRATE THE SIZE OF THE STOMACH THAT WE WANT TO LEAVE BEHIND.>>OKAY.>>AND, SO, THE PART OF THE STOMACH WE’RE REMOVING IS THE PART THAT WILL STRETCH. SO THE SIMPLE WAY TO UNDERSTAND THIS, WHICH I DON’T THINK IS NECESSARILY CORRECT, THE SIMPLE WAY TO UNDERSTAND IT, YOU’RE MOVING THE PART OF THE STOMACH THAT WOULD TYPICALLY STRETCH TO ACCOMMODATE A MEAL. IN REALITY WHAT WE’RE DOING, WE’RE CREATING A CERTAIN AMOUNT OF PRESSURE WITHIN THAT PORTION OF THE STOMACH AND THAT WILL HAVE AN EFFECT. YOU KNOW, PEOPLE ALSO TALK ABOUT ALL THESE HORMONES WITHIN THE G.I. TRACT AND –>>GHRELIN.>>GHRELIN. IF YOU LOOK ON THE RIGHT SIDE OF THAT, THAT’S CALLED THE FUNDUS, WE THINK THAT THAT PART OF THE STOMACH IS THE PART THAT PRODUCES THAT HORMONE. AND THAT HORMONE IS HIGH LEVEL, TYPICALLY REPORT THAT THEY FEEL HUNGRY. SO WHEN YOU’RE MOVING THIS PORTION, A LOT OF TIMES WHEN PEOPLE HAVE THIS PROCEDURE, THEY USUALLY WILL SAY, I JUST DON’T FEEL HUNGRY, I KNOW I NEED TO EAT BUT I DON’T FEEL LIKE I HAVE TO EAT.>>SO THE LITTLE KNOWN FACT IS, THIS REALLY MAY BE A METABOLIC SURGERY.>>YES.>>YOU MAY BE REMOVING PHYSICALLY THE STRETCHING PART OF THE STOMACH BUT YOU MAY BE JUST REMOVING THE PART THAT MAKES THE HORMONE THAT DRIVES HUNGER.>>THAT DRIVES HUNGER, ABSOLUTELY.>>GHRELIN. WHAT’S THE COUNTER OF IT?>>WELL, THE COUNTER OF GHRELIN. THERE’S A LOT OF DIFFERENT HORMONES IN THE G.I. TRACT, IT’S JUST ONE OF THEM.>>NOW, WHAT ARE WE DOING UP HERE NOW?>>SO, –>>WE’RE NOT ON THE CAMERA. [ Laughter ]>>SO THAT PART, ONCE WE REMOVE THAT PORTION OF THE STOMACH, THAT WILL COME OUT. PEOPLE ASK, IS THAT PART OF THE PROCEDURE PERMANENT? IT IS. THAT PART OF THE STOMACH DOES NOT GROW BACK. BY REMOVING THAT PART OF THE STOMACH, I ALWAYS TELL MY PATIENTS, IT DOES THREE THINGS. ONE IS THAT IT DECREASES GHRELIN LEVELS WHICH DOES TYPICALLY LEAD TO LOSS OF HUNGER. THAT’S A BIG THING FOR PEOPLE, THEY SAY, I FEEL HUNGRY ALL THE TIME. IT’S GREAT, I DON’T FEEL HUNGRY ANYMORE. THE SECOND THING THAT IT DOES, IT CREATES, IN MY OPINION, CERTAIN AMOUNT OF STRETCH ON THAT PART OF THE STOMACH, IT’S NOT A VOLUME THING PER SE, PROBABLY A STRETCH THING. MECHANIC RECEPTORS AMONG THE STOMACH THAT HAVE FEEDBACK TO THE VAGUS NERVE, THAT GOES TO THE BRAIN STEM, THAT INTERACT WITH A PORTION OF THE BRAIN CALLED THE HYPOTHALAMUS, REGULATORY CONTROL OVER OUR BODY. SO I SEE A LOT OF PATIENTS THAT COME BACK, THEY SAY, YOU KNOW WHAT, SWEET STUFF JUST DOESN’T TASTE THE SAME, THIS DOESN’T TASTE THE SAME. I HAD A LADY I SAW FOR A ONE-MONTH FOLLOW-UP, I ASKED, HOW ARE YOU DOING, I HAD A DING DONG, I KNOW YOU’RE NOT SUPPOSED TO BE EATING IT, I ATE HALF OF IT, IT DIDN’T TASTE GOOD, I THREW IT AWAY.>>IT DIDN’T HAPPEN IT BEFORE.>>IT CHANGED. THE LAST THING WE TALK ABOUT THIS, YOU KNOW, IT IS A METABOLIC PROCEDURE IN THAT IT WILL CHANGE OTHER THINGS, TOO. SINCE THERE’S LESS STOMACH TO STRETCH, THE AMOUNT OF TIME THAT FOOD STAYS IN THE STOMACH IS LESS. SO FOOD IS KICKED OUT IN THE SMALL INTESTINE AT A FASTER RATE. AND THERE IS THE SECOND COMPONENT, I’D SAY THE THIRD COMPONENT, THIS PROCEDURE, IN THAT IF YOU DECREASED THE INTESTINAL TRANSIT TIME, THE AMOUNT OF TIME THE FOOD STAYS IN THE SMALL INTESTINE, THAT WILL CHANGE HORMONES, PROBABLY 20 DIFFERENT HORMONES THAT CHANGE. PEPTIDE ONE, CCK. MOTILIN.>>PYY.>>LEPTIN. WHAT DOES THE LEPTIN DO?>>IT COMES FROM THE FAT CELLS, AND THAT ALSO INFLUENCES YOUR HUNGER, RIGHT?>>YEAH. SO, NOW, WE’RE NOT GOING TO SHOW ANY MORE OF THAT FUN LITTLE ROMP THROUGH THE INSIDE OF YOUR GUT. I LOVE THAT PICTURE. THAT WAS WONDERFUL. THANK YOU FOR DOING THAT FOR US. BUT THE QUESTION IS, DO YOU PUT A SLEEVE OVER THE STOMACH SO IT DOESN’T GET OVEREXPAND OR WHAT’S THE SLEEVE THING? >>SO, THE SLEEVE IS REMOVING THE PART OF THE STOMACH THAT WILL STRETCH. SO, THE PART OF THE STOMACH THAT WILL ACCOMMODATE A MEAL IS THAT PORTION THAT’S REMOVED. AND YOU WOULD SAY, WELL, THE STOMACH CAN HOLD ANYWHERE BETWEEN 1,500 TO 2,000 CCs OR CUBIC CENTIMETERS AND YOU’RE REDUCING THAT DOWN TO 250, LET’S JUST SAY, ON AVERAGE.>>SO YOU’RE NOT PUTTING A DEVICE OR ANYTHING, THERE’S NOT A BAND ANYWHERE.>>NO.>>THIS IS NOT THE BAND PROCEDURE?>>NO. SO YOUR BODY’S OWN NATURAL TISSUE IS THERE. BUT THE IDEA BEHIND IT, YOU’RE NOT NECESSARILY RESTRICTING THE PATIENT. A LOT OF TIMES IN SURGERY, THERE’S ALWAYS THIS IDEA OF RESTRICTING. I WANT TO EAT BUT I CAN’T BECAUSE I CAN’T GET ENOUGH FOOD IN MY SYSTEM. THE IDEA IS WE’RE NOT RESTRICTING, WE’RE CHANGING YOUR PERCEPTION OF HUNGER, YOUR HUNGER DRIVE IS LESS, YOUR BODY IS LOSING WEIGHT THROUGH A WAY YOU DON’T QUITE UNDERSTAND.>>GO AHEAD.>>I WAS GOING TO ASK YOU, IS THAT THE ONE PROCEDURE YOU DO? OR WHAT OTHER PROCEDURES DO YOU DO FOR OBESITY?>>NO. WE DO MULTITUDE. THE SIMPLEST THING IS GASTRIC BALLOON.>>WHICH YOU BLOW UP.>>SO YOU PUT A BALLOON INSIDE THE STOMACH. YOU KNOW, THERE’S BEEN SOME POPULARITY WITH THAT. PEOPLE LIKE IT BECAUSE THEY SAY IT’S NONSURGICAL PROCEDURE. MORE PROVIDERS THAT CAN DO IT. REALITY IS, THERE’S PROBABLY A VERY SLIM PORTION OF THE PATIENT POPULATION THAT I CONSIDER A GOOD CANDIDATE FOR THAT. THERE’S THE GASTRIC BAND, WHICH IS REALLY POPULAR. I THINK THE GASTRIC BAND STILL HAS A ROLE. BUT THE GASTRIC BAND IS POPULAR FOR REASONS THAT IT PROBABLY SHOULD NOT HAVE BEEN POPULAR. AND IT’S PLACED IN PATIENTS OF ALL DIFFERENT SIZES. YOU KNOW, IT’S PROBABLY BETTER FOR LOWER BMI PATIENTS.>>PEOPLE WHO AREN’T SO HEAVY?>>YES. THERE’S THE GASTRIC BYPASS, THE DUODENAL SWITCH, WHICH IS ESSENTIALLY WHAT WE JUST SHOWED, THE SLEEVE WITH THE BYPASS DOWN THROUGH THE STOMACH.>>OKAY. AND YOU DO THEM ALL?>>YES.>>ALL RIGHT. LET’S JUST JUMP INTO QUESTIONS BECAUSE WE’VE GOT A NUMBER. HOW VIGOROUSLY CAN A PERSON OVER 65 EXERCISE? MIKE?>>WELL, THEY CAN EXERCISE ASVIG RUSSLY AS THEIR BODY WILL ALLOW. I MEAN, THEY SHOULD, IF THEY HAVEN’T BEEN EXERCISING FOR A WHILE SEE THEIR DOCTOR AND MAKE SURE THAT THEY ARE UP TO IT. YOU KNOW? BUT YOU CAN GET YOUR HEART RATE UP TO 120, PROBABLY. AS LONG AS IT’S SAFE. NOW IF YOU’RE HAVING SYMPTOMS, IF YOU’RE HAVING JOINT PAIN, THAT MIGHT HOLD YOU BACK. CERTAINLY IF YOU’RE HAVING CHEST PAIN, YOU WANT TO GET CHECKED OUT BEFORE YOU DO THIS, IF YOU’RE SHORT OF BREATH, GET CHECKED OUT. BUT ONCE YOU’RE CHECKED OUT, I MEAN, START SLOW AND DON’T JUMP RIGHT INTO IT. START SLOW AND THEN GET TO IT. BECAUSE THAT REALLY HELPS YOUR MIND FEEL BETTER, IT HELPS BURN SOME CALORIES, AND IT IS — IT’S A VERY HEALTHY THING TO DO.>>ARE YOU STILL JOGGING?>>NO. I HAVE TO SAY –>>YOU AND I HAVE JOGGED TOGETHER MANY TIMES.>>YES, WE HAVE. YEAH. WALKING, I WOULD SAY.>>THERE IT IS. I LIKE THE IDEA OF — THERE’S SOME STUDIES THAT SAY THAT IF THIS PERSON CAN WALK 30 MINUTES A DAY, JUST AT THE RATE THEY’RE COMFORTABLE, THAT YOU GET MUCH OF THE BENEFIT THAT YOU GET FROM –>>YEAH. WHATEVER EXERCISE YOU CAN DO AND STILL TALK TO YOUR BUDDY.>>YEAH.>>SO WHAT’S RECOMMEND.>>DON’T OVERDO IT AND BRING ON A PROBLEM. DON’T IGNORE PROBLEMS, IF YOU’RE STARTING TO GET INTO TROUBLE, BE CAREFUL, BACK OFF, GIVE YOUR KNEE A CHANCE TO REHEAL, WHATEVER IT MIGHT BE, THAT’S RUNNING INTO IT. DOES OBESITY, IS IT RELATED TO THE HIGH CONSUMPTION OF FRUCTOSE CORN SYRUP?>>WOW.>>I MEAN, THAT’S — THAT’S THE BIG — YOU KNOW, PEOPLE LOVE TO BLAME COCA-COLA.>>WELL, I MEAN, PICK SOMETHING TO BLAME, RIGHT?>>YEAH.>>POLYUNSATURATED FATS, RIGHT. CORN SYRUP. I DON’T KNOW. SOMETIMES CARBOHYDRATES, RIGHT?>>YEAH.>>AND THERE’S A MILLION DIFFERENT KINDS OF DIETS OUT THERE THAT ELIMINATE EVERYTHING. AND GO BACK TO THE CAVE MAN DIET, RIGHT? THE PALEO DIET AND ELIMINATE EVERYTHING ELSE. THE BOTTOM LINE IS, IT’S CALORIES, YOU KNOW.>>IT’S CALORIES, ISN’T IT?>>IT’S CALORIES.>>I REALLY LIKE THE IDEA OF TEACHING PEOPLE TO COUNT CALORIES.>>I WOULD DISAGREE WITH YOU. I’M GOING TO SAY THAT THERE MAY BE SOME VALIDITY TO THAT. THINK ABOUT IT — [ OVERLAPPING CONVERSATION ]>>YOU KNOW, IT IS PROBABLY THE PERCEIVED SWEETNESS OF FOOD. IT IS THE AMOUNT OF SUGAR THAT WE PROBABLY HAVE WITHIN OUR DIET. YOU KIND OF WONDER WHY IS FRUCTOSE CORN SYRUP IN EVERYTHING, BUT IT MAY NOT JUST BE THAT, BUT IT IS AN EASY FILLER THAT CAN BE PLACED INTO THAT. WE’RE USED TO THINGS BEING SO SWEET. WE HAVE TO HAVE EVERYTHING TASTE A CERTAIN WAY.>>YEAH. [ OVERLAPPING CONVERSATION ]>>MAYBE YOU DON’T MAKE YOUR OWN FOOD AT HOME. YOU KNOW? YOU GO TO THE FAST-FOOD PLACE THAT PACKS FOOD WITH THINGS THAT END UP WITH MORE CALORIES, RIGHT?>>YEAH. >>AND, OF COURSE, YOU SELL MORE FAST FOOD IF IT TASTES GOOD.>>YEAH.>>I KNOW THAT THERE’S HIGH FRUCTOSE CORN SYRUP IN EVERYTHING, IN CAMPBELL’S TOMATO SOUP. IT’S THE SWEETNER THAT THE GOVERNMENT HAS ENCOURAGED US TO DO BECAUSE MANIPULATED FARMERS TO RAISE CORN AND BLAH BLAH BLAH.>>MAYBE. [ Laughter ]>>SO, GOOD QUESTIONS. AND THE ANSWER IS, YOU AND I BOTH THINK THAT CARBOHYDRATE AND FRUCTOSE CORN SYRUP ARE BAD BUT I THINK THE BOTTOM LINE IS, CALORIES IS WHAT MATTERS.>>IT TURNS INTO ENERGY, THAT ENERGY –>>ONE OF THE THINGS I TELL PEOPLE, IT’S KIND OF LIKE THE IDEA OF THE PRINGLES POTATO CHIPS. YOU SAY, WHAT’S DIFFERENT THAN A PRINGLE POTATO CHIP? A LOT OF STUFF ADDED TO IT. CANDY, WATCH KIDS OR SOMETHING THAT’S SWEET, KNOW THERE’S A BAG OF IT, EAT ONE, SEE IF YOU CAN RESIST EATING MORE. THE NATURAL HORMONES INSIDE THE GUT, YOU THINK ABOUT IT, CHOLESCYSTOKININ BEING ONE, SECRETED BY THE DUODENUM. IT RESPONDS TO FAT, PROTEIN, THERE’S NO RESPONSE TO CARBOHYDRATES. VERY INTERESTING. IT COULD BE THAT JUST HAVING FAT, HAVING A LITTLE BIT OF PROTEIN IN YOUR DIET, WHICH IS ESSENTIALLY THE PALEO DIET, DOES TEND TO EAT LESS CALORIES OR LESS FOOD INTAKE BECAUSE YOU TEND TO FEEL FOOL.>>THERE’S THESE WEIGHT LOSS PROGRAMS WHERE YOU EAT THEIR PRODUCT. AND THERE’S A PROFILE DIET THAT’S AVAILABLE RIGHT NOW. FOR EXAMPLE, PEOPLE LOSE WEIGHT VERY READILY ON IT. IT’S NO CARBOHYDRATE, IT’S PROTEIN AND FAT AND THEN YOUR BODY HAS TO TAKE THE FAT AND BREAK IT DOWN INTO CARBOHYDRATE BECAUSE WE HAVE TO HAVE CARBOHYDRATE TO FEED THE BRAIN TO KEEP GOING. AND, SO, BUT YOU CAN’T SUSTAIN THAT FOREVER.>>RIGHT. SO THE DIETITIANS WOULD I SAW, I THINK, AND I CAN HEAR MY WIFE IN MY HEAD –>>SHE’S SCREAMING RIGHT NOW.>>YOU DON’T LEARN ANYTHING FROM THAT. RIGHT? YOU BUY SOMETHING, YOU DO THE EASY FIX, YOU EAT THE MEAL BECAUSE YOU DON’T HAVE TO THINK, YOU DON’T LEARN ANYTHING. PART OF THIS IS BECOMING MINDFUL ABOUT NOT ONLY WHAT YOU’RE EATING AND HOW MANY CALORIES ARE IN THERE AND MAYBE WHERE IS THE HIDDEN, YOU KNOW, FRUCTOSE AND CORN SYRUP IN THERE, BUT, ALSO, WHAT ARE THE PORTION SIZES, ARE YOU COOKING, ARE YOU GOING TO THE GROCERY STORE. IS THERE, YOU KNOW, FIBER IN THIS DIET. I THINK WE’VE GOT TO GET BACK TO THE BASICS WHEN IT COMES TO EATING.>>WHAT’S DIFFERENCE BETWEEN THAT AND ATKINS DIET?>>IT’S THE SAME THING. AND, SO, IF YOU’VE ALREADY SHOWN THE ATKINS DIE LET LEAD TO THAT WEIGHT LOSS, BUT IT LOSES ITS EFFECT AFTER A YEAR, WHY REINVENT THE WHEEL. IT SEEMS LIKE THERE’S SO MANY GIMMICK CAN I THINGS THAT ARE PUT OUT THERE, TO GIVE PEOPLE A SENSE OF FALSE HOPE, IF I DO THIS DIET, IF I DO THIS, THIS IS GOING TO BE THE MAGIC THING THAT’S GOING TO LEAD TO THIS WEIGHT LOSS, IT DOESN’T. SO WHY DO WE PROMOTE THIS? YOU KNOW, YOU SEE A LOT OF PATIENTS, I SEE A LOT OF PATIENTS IN MY PRACTICE THAT COME BACK, YOU SAY, WHAT DIET HAVE YOU HAD? THEY HAD 20 DIFFERENT THINGS THAT THEY SOMETIMES HAVE TRIED. I TRIED THIS, TRIED THAT. DID IT WORK, YEAH, IT WORKED FOR A PERIOD OF TIME AND THEN IT CAME BACK. AGAIN, IT GOES BACK BEHIND THE SCIENCE BEHIND OBESITY. YOU HAVE THE THERMAL REGULATORY SET POINT, AND YOU CAN’T, YOUR BODY — YOU WILL LOSE BUT YOU CAN’T LOSE WITH DIET AND EXERCISE. IT COMES RIGHT BACK.>>RIGHT. YOU KNOW, I THINK, THIS IS A QUESTION, WHAT DO YOU THINK ABOUT THE VEGAN DIET FOR SOMEONE TRYING TO LOSE WEIGHT, SPECIFICALLY, FORKS AND KNIVES DOCUMENTARY? AND I DON’T KNOW WHAT THE FORKS AND KNIVES DOCUMENTARY IS. DO ONE OF YOU?>>I DON’T KNOW EITHER MYSELF. BUT I KNOW DIET RESULTS IN WEIGHT LOSS BUT IT DOES COME BACK. NOW, I WOULD HAVE — I WANT TO THROW IN HERE, THOUGH, THAT THERE’S ONE OTHER NEW DEVELOPMENT, ESPECIALLY SINCE 2012, AND THAT’S DRUGS. RIGHT? FOR THOSE OF US THAT HAVE BEEN EXPERIMENTING OVER THE YEARS WITH DIFFERENT PILLS FOR WEIGHT LOSS, QUESTION KNOW THAT DIET AND EXERCISE IS FOUNDATIONAL. WE KNOW SURGERY KIND OF AT THE OTHER END OF THE SPECTRUM TAKES YOUR APPETITE AWAY PROBABLY BECAUSE OF INFLUENCING HORMONES. THERE ARE DEVELOPING GROUP OF MEDICATIONS NOW THAT CAN POTENTIATE THE EFFECTS OF DIET AND EXERCISE AND CAN HELP PEOPLE LOSE WEIGHT FASTER AND KEEP IT OFF LONGER, IF YOU TAKE PILLS THAT HELP INFLUENCE YOUR BRAIN’S HORMONES IN TERMS OF REACTING TO SOME OF THESE STIMULI.>>I WILL SAY THIS, THAT CARRIE HEGBERG, THE NURSE PRACTITIONER WHO WORKED WITH ME FOR YEARS, BROUGHT THIS UP TO ME, I NOTICE PEOPLE WHO ARE ON PROZAC SEEM TO DO BETTER. WHENEVER WE START THAT ON PEOPLE. WHEN THEY HAVE DIABETES, PUT THEM ON METFORMIN THEY SEEM TO DO BETTER AND LOSE WEIGHT.>>PRETTY INSIGHTFUL.>>SO I’VE BEEN PUTTING PEOPLE ON, EVEN WHEN THEY’RE NOT DEPRESSED, ON PROZAC AND EVEN WHEN THEY DON’T HAVE DIABETES ON METFORMIN AND I’LL PUT THE TWO TOGETHER AND IT SEEMS TO HELP. WE HAD A NUMBER OF PEOPLE WHO HAD GASTRIC BYPASS SURGERY AND AFTER YEARS THEY’RE ABOUT HALFWAY BACK TO WHERE THEY WERE BEFORE. HIT THEM WITH FLUOXETINE AND METFORMIN AND THEY STOPPED. I MEAN, THEY WENT DOWN A BIT AND MAINTAIN NOW. NOW, THAT’S A CHEAP OPTION. THOSE ARE CHEAP OPTIONS, BOTH OF THEM ARE AVAILABLE GENERICALLY AND CHEAP. THERE ARE NEW THINGS THAT ARE MORE EXPENSIVE.>>PHENTERMINE COMES TO MIND.>>PHENTERMINE.>>HOWEVER YOU WANT TO SAY IT, IS CHEAP, $36 A MONTH, RIGHT, WELL STUDIED IN TERMS OF THE SIDE EFFECTS AND IT’S ALSO VERY EFFECTIVE, JUST LIKE THOSE. THERE ARE SOME NEWER DRUGS, YOU GOT TO BE CAREFUL, SOME OF THEM ARE VERY EXPENSIVE, BUT THERE ARE SOME NEW DRUGS THAT ARE OPTIONS, TOO.>>OKAY. SO, VEGAN DIET, PEOPLE WHO GO ON A VEGETARIAN DIET, VEGAN DIET, THAT MEANS THAT THEY DON’T EAT EGGS AND THEY DON’T DRINK MILK, MILK PRODUCTS, RIGHT?>>RIGHT. SO LET ME STOP RIGHT THERE. THE WAY I REACT TO THAT IS, THE WORD DIET, RIGHT? WE’VE GOT TO ADOPT AN EATING HABIT THAT’S MINDFUL FOR THE REST OF OUR LIVES. DIET, TO ME, MEANS TEMPORARY. WE’RE GOING TO DO SOMETHING FOR A WHILE, FIX IT, AND THEN WE’RE GOING TO — CAN –>>GO BACK TO WHAT WE DID BEFORE.>>– GO BACK TO THE PREDIET PHASE. I THINK THE REAL ISSUE IS, START TO LEARN WHAT IS IT THAT WE’RE EATING, WHAT ARE OUR HABITS, WHAT STIMULATES ME, DO WE GET UP AND EAT IN THE MIDDLE OF THE NIGHT, ARE WE EATING FOR A EMOTIONAL DRIVE, ARE THERE MEDICATIONS, AND START TO ADDRESS SOME OF THOSE FACTORS AND LEARN HOW TO DO IT. ONE OTHER THING I’D LIKE TO SAY IS, THIS APP THAT YOU CAN DOWNLOAD FROM THE INTERNET, THE NAME ESCAPES ME AT THE MOMENT.>>WEIGHT LOSS?>>WEIGHT LOSS APP, GOOGLE THEM, GET THEM ANYWHERE. AND THEY WILL HELP YOU KEEP TRACK OF HOW MANY — WHEN YOU’RE EATING AND HOW MUCH YOU’RE EATING AND HOW MUCH YOU’RE EXERCISING. AND I THINK THOSE HELP A LOT. MY FITNESS.>>THERE’S A LOT OF THEM. YEAH.>>I HAD A GROUP OF 70 PLUS YEARS OF AGE AND I’M TEACHIN’ THEM DIET AND EXERCISE PROGRAM.>>YEAH.>>TRYING TO DO THAT. AND THE GOVERNMENT, BY THE WAY, WON’T PAY A DOCTOR TO LEAD A GROUP. I DID IT FOR FREE. I MEAN, THAT’S JUST THE WAY IT IS. THEY WON’T PAY GROUP THERAPY. BUT THIS GROUP GOT THE ENERGY TO STAY ACTIVE AND DO PHYSICAL THINGS AND EAT CORRECTLY. BUT ONE OF THE THINGS WE WERE TALKING ABOUT IS WEIGHT — DIET, CALORIE COUNTING. JUST TAKE THE DIET DIARY FOR A WEEK AND — OR EVEN THREE DAYS AND MEASURE HOW MANY CALORIES YOU ATE EACH DAY. AND IT’S AMAZING HOW WELL THEY DID. THEY REALLY DID PRETTY WELL. BUT THE EASIEST WAY TO DO IT, GET SIRI, HOW MANY CALORIES IN, YOU KNOW, THIS CANDY BAR OR THAT BOWL OF CEREAL OR THIS AMOUNT OF STEAK, AND, YOU KNOW, MOST FOODS IN ALL OF THE RESTAURANTS, HAVE A CALORIE COUNT ON THEM. AND, BOY, IT’S AMAZING THE CALORIES –>>I HAVE TO SAY, I DOWNLOADED MY FITNESS PAL ONE TIME AND TRIED IT ON MY CELL FOR TWO WEEKS, I’M NOT OVERWEIGHT, BUT I WANTED TO LEARN, YOU KNOW, SORT OF WHAT CALORIES WERE, AND IT WAS A VERY ENLIGHTENING EXPERIENCE. IT WAS LIKE, WOW, THAT’S TWO PORTION SIZES, NOT ONE.>>I DIDN’T REALIZE HOW MANY CALORIES WAS IN THAT — YOU KNOW, I HAD AN APPLEBEE’S STEAK, 400 OR LESS CALORIES, RIGHT, MY DAUGHTER, TINY LITTLE PERSON, HAD A CRISPY CHICKEN SALAD, RIGHT? HERS WAS 1,300 CALORIES, MINE WAS — WE REALLY SHOULD COUNT CALORIES. WE’VE GOT NO TIME LEFT. WE GOT TO RUN THROUGH THESE QUESTIONS. LET’S BE REAL QUICK. MAN FROM HENDRICKS, MINNESOTA, WANTS TO KNOW, HOW MUCH DOES WEIGHT GAIN AFFECT A HIATAL HERNIA?>>AT THE BEGINNING OF THE FILM, I WAS LOOKING FOR HERNIAS, I PROBABLY SAY 50% OF THE PEOPLE THAT I OPERATE ON WILL HAVE SOME HIATAL HERNIA.>>YEAH. AND CERTAINLY REFLUX ESOPHAGITIS IS A SYMPTOM THAT’S TROUBLESOME.>>YOU. I CAN’T.>>THE PRESSURE INSIDE YOUR ABDOMEN.>>YEAH.>>THINK ABOUT IT, IT’S A CAVITY, IF YOU HAVE EXTRA PRESSURE, IT’S GOT TO GO SOMEWHERE, NATURAL HOLES, THAT’S BEING ONE.>>WOMAN FROM PIERRE HAS HEARD DRINKING WATER WITH A LEMON BEFORE A MEAL CAN HELP YOU FEEL FULL, IS THAT TRUE?>>GOOD STRATEGY. COMMONLY SUGGESTED ONE. AND IT’S SOMETHING THAT ANYBODY CAN DO IT. IT HELPS FILL UP YOUR STOMACH.>>DOES PREDNISONE HELP CAUSE INCREASED APPETITE AND WEIGHT GAIN?>>YEAH.>>IT DEFINITELY DOES. AND THAT’S AN UNDERLYING CAUSE. ANOTHER THING WE DIDN’T TOUCH ON MUCH IS STRESS. ANOTHER THING, STRESS, NATURAL PREDNISONE AND CORTISONE, YOU TEND TO EAT MORE AND RESPOND 0 THAT. LOWER STRESS, GOOD EATING HABITS.>>ONE QUESTION, ABERDEEN, CHOLESTEROL 242, MY CHOLESTEROL, AND BEGAN EXERCISE AND TAKING NIACIN AND NINE DAYS, CHOLESTEROL IS 180 IS THIS NORMAL? HOW ABOUT NIACIN.>>FABULOUS RESPONSE TO THE NIACIN AND THE EXERCISE, I WOULD SAY, CONGRATULATIONS, KEEP IT UP.>>SO, VERY GOOD. AND NOW, FOR THE WINNER OF TONIGHT’S PRAIRIE DOC QUIZ QUESTION. TRUE OR FALSE? PEOPLE WHO HAVE LOST WEIGHT THROUGH WEIGHT WATCHERS, JENNY CRAIG, TOPS, OR OTHER WEIGHT LOSS PROGRAMS WILL USUALLY KEEP 30% OF THAT WEIGHT OFF AFTER FIVE YEARS. TRUE OR FALSE?>>FALSE.>>THE ANSWER IS: FALSE. AFTER FIVE YEARS THOSE WHO HAVE REGAINED THEIR ORIGINAL WEIGHT IS ALMOST 100%. THAT IS: 0% HAVE KEPT IT OFF. IT WAS RICHARD JERGENSEN OF WATERTOWN, SOUTH DAKOTA, WHO ANSWERED THE QUESTION CORRECTLY. THANK YOU, RICHARD, FOR PARTICIPATING AND A BOOK WILL BE IN THE MAIL TO YOU SOON. ANY QUESTIONS OR COMMENTS? VERY QUICKLY.>>WELL, I WOULD SAY THAT WAS A YES OR NO ANSWER, BUT DIET AND WEIGHT LOSS DOES WORK IN HELPING TO DECREASE THE SECONDARY EFFECTS OF OBESITY. RIGHT. SO IF YOU GET HIGH BLOOD PRESSURE FROM IT, DIABETES FROM IT, THAT DOES — THERE’S PROOF THAT THAT DOES WORK.>>I MEAN, I THINK EATING LESS, WHETHER YOU LOSE WEIGHT OR NOT IS THE RIGHT THING TO DO FOR YOUR OVERALL HEALTH.>>IT IS.>>ALONG WITH EXERCISE.>>YEAH.>>FORGET THE WEIGHT, EXERCISE, EAT RIGHT, –>>YOU’LL FEEL BETTER, YOU’LL SLEEP BETTER.>>YOU’LL FEEL BETTER, YOU’LL SLEEP BETTER. NIACIN, I’M NOT A REAL FAN OF, IT CAN CAUSE SYMPTOMS, NO DATA HAS EVER SAID THAT IT REDUCED HEART ATTACK OR ANYTHING, BUT IT WORKED FOR THIS PERSON. WE’LL BE RIGHT BACK AFTER THIS.>>ALL AROUND TOWN, FROM STORES TO PLAYGROUNDS, BABIES ARE ON THE MOVE. AND THERE ARE DISEASES THAT ARE ON THE MOVE, TOO. AND SOME OF THESE SPREAD EASILY. TO BEST PROTECT HIM FROM 14 SERIOUS DISEASES BY THE TIME HE TURNS 2 YEARS OLD, VACCINATE HIM ACCORDING TO THE RECOMMENDED SCHEDULE. SO, HE CAN GO ON ABOUT HIS BUSINESS AND YOU CAN HAVE PEACE OF MIND. FOR MORE REASONS TO VACCINATE, TALK TO YOUR CHILD’S DOCTOR OR GO TO CDC.GOV/VACCINE.>>ISN’T IT STRANGE THAT IN THIS ERA WHEN THERE IS AN EPIDEMIC OF OBESITY, OUR SOCIETY SEEMS TO DEFINE BEAUTY AS THIN? WHEN THERE IS SUCH A DIFFERENCE BETWEEN WHAT’S EXPECTED AND WHAT’S REAL, IT LEAVES PEOPLE DESPERATELY IN SEARCH FOR A SOLUTION TO THEIR PROBLEM. ADD TO THE PERCEIVED BEAUTY ISSUE, SEVERAL SEVERE MEDICAL PROBLEMS RESULT OR WORSEN FROM OBESITY, INCLUDING DIABETES MELLITUS, SLEEP APNEA, WEAKNESS, AND IMMOBILITY, MAKING WEIGHT LOSS AS AN IMPORTANT GOAL TO ENHANCE HEALTH NOT JUST FOR COSMETIC REASONS. THERE SEEMS NO EASY SOLUTION, NOT FOR ANY INDIVIDUAL, AND NOT FOR SOCIETY AS A WHOLE. MULTIPLE STUDIES SHOW WEIGHT LOSS, EVEN IN HIGHLY MOTIVATED PEOPLE, HAPPENS IN ABOUT 30 OUT OF 100. AFTER ONE YEAR, ONLY TEN HAVE KEPT IT OFF, AND IN FIVE YEARS, ONLY ONE. I KNOW THERE ARE EXCEPTIONS TO THIS RULE, BUT IN GENERAL LOSING WEIGHT AND KEEPING IT OFF IS A VERY DIFFICULT TASK. REPEATED STUDIES SHOW THAT FOR THE MOST PART ADOPTED ADULTS WEIGH WHAT THEIR BIOLOGIC PARENTS WEIGH, NOT THEIR ADOPTED PARENTS. IN THE CASE OF BODY SHAPE, NATURE WINS OVER NURTURE, AS IT SEEMS WE ARE DESTINED TO LOOK A LOT LIKE OUR PARENTS. IN ADDITION, IT’S HUMAN NATURE TO EAT MORE THAN WE NEED AND TO REST WHENEVER WE ARE NOT REQUIRED TO MOVE. THAT’S OLD-WORLD SURVIVAL BEHAVIOR THAT COMES ALREADY SET INTO OUR HARD DRIVES. HOWEVER, IT’S A NEW WORLD WHERE TOO MUCH FOOD COMES WITH TOO LITTLE EFFORT. WHAT’S MORE, OUR HORMONAL AND METABOLIC SYSTEMS SEEM TO MANIPULATE HUNGER, METABOLISM, AND ACTIVITY IN ORDER TO MAINTAIN OR EVEN GRADUALLY GAIN WEIGHT, BUT NOT TO ALLOW WEIGHT LOSS. IS THIS OVERWEIGHT DESTINY COMPLETELY OUT OF OUR HANDS? DOES OUR HUNGER HAVE TO DRIVE US TO THE FAST-FOOD RESTAURANT, OR COULD WE SERVE OUR FAMILY SMALLER PORTIONS OF A HEALTHIER FARE, ESPECIALLY WITH NON-STARCHY VEGETABLES? DOES GENETICS CHAIN US TO THAT COUCH OR ARE WE STILL FREE TO GET UP AND GET MOVING WITH A DAILY 30-MINUTE WALK? STUDIES SHOW THAT A HEAVY PERSON, IN CONDITION AND EATING RIGHT, LIVES AS WELL, AND LONG, AND HEALTHY AS A THIN PERSON. BOTTOM LINE: WE SHOULD NOT SET OUR EXPECTATIONS TOWARD LOOKING LIKE SOMEONE WE ARE NOT, RATHER, TOWARD LIVING A HEALTHIER LIFESTYLE. WE SHOULD DO OUR BEST TO AVOID THE UP AND DOWN AND UP AGAIN WEIGHT ROLLERCOASTER, WHICH CAN BE HARMFUL PHYSICALLY WHILE WORSENING SELF-IMAGE. WE CAN CHOOSE TO REALIZE THAT BEAUTY IS NOT DEFINED BY WEIGHT OR SIZE. BEAUTY IS HEALTH, WHICH COMES FROM EXERCISING WELL, EATING RIGHT, AND THEN LOVING OURSELVES FOR IT. >>A BIG THANK YOU TO OUR GUESTS, DR. MIKE DAVIES, AND DR. DAVID FROMM. THANK YOU, GENTLEMEN.>>THANK YOU FOR INVITING US.>>WE COULDN’T HAVE DONE THE SHOW WITHOUT OUR EXPERTS. HERE AT “ON CALL WITH THE PRAIRIE DOC” OUR STAFF AND CREW WORK TO PROVIDE HONEST, SCIENCE-BASED INFORMATION AIMED TO HELP YOU MAKE GOOD HEALTH CARE DECISIONS. IF YOU BELIEVE IN OUR EFFORTS PROVIDING GOOD INFORMATION IN A WORLD OF MISINFORMATION AND WOULD LIKE TO HELP CONTINUE THIS QUEST FOR TRUSTWORTHY, REAL INFORMATION, PLEASE GO TO PRAIRIEDOC.ORG AND CLICK ON THE ‘DONATE’ BUTTON. ANY HELP YOU CAN GIVE WILL BE PUT TOWARDS PROVIDING AUTHENTIC INFORMATION TO THOUSANDS OF VIEWERS. THANK YOU. THAT DOES IT FOR TONIGHT. FROM ALL OF US HERE AT “ON CALL WITH THE PRAIRIE DOC,” UNTIL NEXT TIME, STAY HEALTHY OUT THERE, PEOPLE.

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