Lose Weight…Find Health at the Lakeland Weight Loss Center
Well welcome and welcome in joining us
with Lakeland Comprehensive Weight Loss Center's new virtual seminar. New times,
new changes and we're gonna adapt to them and work with you, teaching a little
bit about the disease of obesity. I am Dr. Michael Schuhknecht, I am the Medical
Director here at Weight Loss Center and I've been doing bariatric surgery for 25
years plus, also been in this institution here for the last 13 years. And I'm Dr.
Seth Miller, I'm a general surgeon in a minimally invasive robotic surgeon and I
also do weight-loss surgery. I was a surgeon in the Army for about 12 years before
getting out of the military and about January 2019 and joined the team here. So
between Dr. Schuhknecht and myself we do all of bariatric surgery for Lakeland,
and between the two of us have about 40 years of experience and about 5,000
bariatric cases.
Well thank you Seth. What we want to do today is talk about the
disease of obesity, I'm gonna go through the medical side of it, the behavioral
side of it, the lifestyle changes we need to occur to make it ourselves healthy
and well, and then Seth will talk about what the procedures we are specifically doing. Why we do them and how we do things. We hope we answer all your questions going forward.
So what is the problem with this country now with our weights, Well, I keep it
quite simple we're not tall enough. We gauge our weights in the medical
world on a term called a body mass index, and it's basically a ratio of your
weight to your height, we formulate it.
In American right now
we about 75% overweight and about 1/3 of us are morbidly obese or obese, so
the problem is growing and no pun intended. We have a big problem at hand.
So how we live, how we eat, how we don't exercise, or we don't exercise well and how we basically live. We want to teach you how to get back into good shape and good
health and good wellness. How do you calculate your BMI, if you're interested
you do need this to calculate you for surgery and aftercare. The easiest way is to go online or on your cell phone, look up a BMI calculator. Put your height, put
your weight and you'll get the exact number.
This will tell you the weight or
the levels of obesity that you're in and that time. This is the real problem with
obesity it carries a lot of bad baggage with it.
There are 64 what we call co-morbid diseases, diseases that go along with that
lifestyle, the diet, the lack of exercise, that causes obesity causes other things.
High blood pressure, diabetes, metabolic disorders, PCOS, even higher risk for
things like cancer, sleep apnea, a really big killer of Americans, a silent
disease-related almost exclusively to obesity, 64 diseases. And the good news of
all this is folks, when you get better when you eat well, when you live well,
they go away just like the weight goes away. There's are really four things that
we do, why we are so heavy in this country today and we are really a heavy
again, seventy-five percent us are overweight or obese, that's a large
number. We can be better, we've just learned bad behaviors, we've
learned bad lifestyles, we've learned bad ways of living and there are four basic rules of
life in a sense that we violate, that we break.
You can break one of them and still
have a problem, we can break all of them have a really big problem. So we try to
teach our patients your individual prescription for wellness, by fixing
those things that you do poorly. So first and foremost we eat too much. We've all
been trained to eat till we're full, we love to eat till we're full. We see in America
a portion size is way too big. We overeat every time we sit down. We're not
supposed to eat until we are full, we supposed to eat we're no longer hungry,
that takes us away from eating excess. When your appetites questor, you have
satiety, we stop eating, we don't do that America. When should we step eating? When we are no longer hungry. Learn to eat slowly, enjoy your food, it's the most
important part of life. We need to enjoy and be happy and healthy in our eating
habits.
So small meals and eat them more often. Portion sizes are getting bigger,
very large. When I was born in 1964 average size soda was six ounces and
the average American had one a month. Now, the average size soda is 24 ounces and
the average American has two a day, all bad calories on top of it.
Everything's super-sized, biggy sized, oversized portions, and we indulge
ourselves every day. Learn to eat until you are no longer hungry,
learn just stop eating when you have satiety, not when you're full.
Number two,
is we don't eat often enough, when we say if you don't eat enough, we don't eat
often enough. You ask the average American how many times a day they eat, I
ask the question at the open seminars we had, the public seminars we had, most Americans eat once or twice a day and the answer is 1.2 times a day.
We
weren't designed to eat once or twice a day. Every animal on Earth eats almost six
times a day, as should we. We should never skip meals. When you skip meals where you eat infrequently, your just telling your body's metabolism just slow down. We want to speed back up, to burn more calories, even while we're not eating. So small
meals, and eat frequently. Three meals a day, never ever skip a meal, breakfast, lunch, or supper. Or load your calories in your
day, if you're a regular daytime awake, nighttime I'm asleep person.
Or load your calories first part of the day that way a bigger breakfast, that way you have
more time during the day to burn those calories up. But don't miss those snacks
either and snacks aren't things like Little Debbie's and pops and candies.
Snacks are just smaller portions of healthy foods. So small meals and eat
frequently. Number three and this is probably where most of us get wrong in
our life. We're gullible and we fall off the track quite easily. We are what
we eat that's an old saying from the dietary schools of America, and we truly
are. The most potent drug in our life is the food we eat and we need to learn to
eat healthy.
We in America have learned to eat nothing what I would call a horse
or a pig fodder, animal fodder. We love our starches and our sugars,
these are energy dense foods, lots and lots of calories, but nutritionally empty
foods and those are really two groups of foods. Sugars or sweets, pops, cookies,
candies, cakes and then the starch in the bread, the rice, the pasta and the potato.
Only one natural and that's the potato and I think God buried it so we wouldn't
find it, but we did. We love them, America loves its french fries. Those are foods that are just energy dense and nutritionally empty foods. So
not only are you just gaining calories which, when we eat energy dense foods we're going to store them we store them as fat or adipose tissue
we saw them as cholesterol and triglycerides within our bloodstream and
we also store some in our liver as liver glycogen. Stored energy, we don't really
get fat from eating fat that was an old wives tale in a sense, not proven ever. We
get heavy and overweight and obese from eating too many calories, we also
become malnourished.
It's almost hard to believe that you can be 600 pounds of
being malnourished, but anyone who is 600 pound is malnourished. They ate too many
energy dense foods not enough nutrition foods. What should we help you god-given
foods, fruits, vegetables, meat and dairy and there are very few within those that
aren't good for us most of them are good for us. Because in those fruits and
vegetables, we carry most of our vitamins and minerals.
Within our dairy and our
meats we carry most of our proteins and good essential fats in our diet. So we
need to eat well, we need to eat often and we need to eat appropriate sizes of foods
and fat. And last and finally we need to be active. We become a very sedentary
society, we learn to slow down to the point we don't take walks, we don't ride
our bikes, we rely on public transportation. We get it around really
quick and we go a lot of places but we don't do it on our own two feet anymore.
We don't do it to burn excess calories off. Every calorie we eat, we have to burn.
If we don't burn them, we're going to store them. An exercise has two very, very
important functions to us. It number one does help us burn those calories we eat
and number two it helps with stimulate our metabolism. And there's a biochemical
process for all these things, we're not talking just in fear, we were talking
improving facts.
Scientific facts, medical evidence says what we say is truthful,
I'll give you my own personal experience. I've been doing this job for thirty
years almost. In the last three months I was off, I took off 50 pounds by
exercising, eating frequently, eating healthy natural foods. Some people think
I had surgery, I didn't, not yet and I don't want the surgery at any time.
Not that I don't approve of it, it's what we do for a living, but eating and living
the right way. So what Dr. Miller is going to tell you is why do we add
surgery to the practice. But the truthful basis of all of our practices to help
you change your behavior. To help you change how you eat, how much you eat, what you eat and what you're doing when you're not eating, and as far as exercise.
So Seth I'll let you take the floor from here. Yeah, thanks
Mike. So as you probably can understand by this point, there's a there's a common
misconception that there's diet and exercise in one corner and surgery in
the other and what we're saying is kind of like that's completely wrong. We
heavily emphasize healthy diet and exercise and healthy lifestyle and we're
adding surgery as a tool to help patients achieve that. You know trying to
achieve that on your own without surgery is extremely difficult and surgery is
what if that it's that impetus, that fresh start, that clean slate that helps
make all those changes that you need to make in your diet and exercise habits
possible and the goal is that you make those behavioral changes for long enough
that they become healthy habits, ok. It's always gonna be a struggle to keep at a
healthy weight, the surgery just makes it a manageable struggle that you can
overcome. So there are a few requirements for the surgery. First of all we look at
by mass indexes Mike described.
So a BMI of 40 or greater makes you a candidate
or BMI of 35 or greater with some medically related weight problem. Things
like high blood pressure, diabetes and sleep apnea are one of those common
medical problems. So we essentially do two types of bariatric surgery.
One's called a sleeve gastrectomy, It's considered a restrictive procedure and we're basically just making the stomach smaller and we also do what's called the
Roux-enY gastric bypass, which is a little bit more complicated we'll show
you a picture in a second. But both of these surgeries are effective, but
they're both stood the test of time, but both of them are just
tools and they're tools that are very effective to help you make those changes,
but they do they don't do the work for you and that's why we have a
comprehensive weight loss center here. So in addition to our bariatric surgeries
we do offer a full spectrum of general surgery and minimally invasive
surgery, things like reflux surgery that can be related to your weight loss
surgery which is important because when we're looking at a whole patient and all
their surgical problems haven't that wide array of capabilities
we can take care of different issues.
For instance, when you lose weight you might
be prone to develop gallstones, well we also do gallbladder surgery, so any
surgical needs that you that you may have we can certainly take care of as
you proceed through this process. So are the first procedure that is the most
common operation that we do it's the most common operation that's done the
United States is the sleeve gastrectomy. Essentially what we do is we remove
somewhere between sixty to eighty five percent of the stomach and what's left
looks like a sleeve, which is why it's called the sleeve gastrectomy. So it's
conceptually pretty simple we just remove most of your stomach and your
stomach is small and so when you eat you get full quickly. So it makes a lot of
sense and a lot of people feel more comfortable with this option because
it's more easily understood and what we found doing some of the
scientific studies is that it probably works better than expected for a couple
of reasons.
The portion of the stomach that we remove, is also the portion that
stretches when you eat large meals so with that gone you can't eat quite as
much food. It's also the portion that secretes a hormone called ghrelin which
stimulates appetite, so by removing that in addition to feeling full quickly with
meals, it probably helps in being less hungry in between meals as well. So the
other operation that we do is the what's called the Roux-en Y Gastric Bypass,
this is kind of the tried-and-true gold standard of bariatric surgery it's been
around for decades, and essentially it's a combined procedure. So it's what we
call a combined restrictive and malabsorptive procedure. So basically
what we do is we create a pouch, it's about an egg sized pouch
out of your stomach that becomes your new stomach and we bring up a limb of small intestine connected to that pouch. And so in doing that, when you eat food, food
goes into this pouch you get full quickly and then it travels down your
intestine, but it doesn't meet digestive enzymes from your liver or your pancreas
until further downstream when it connects with your intestine lower.
So
that's the malabsorptive component to it. So with this procedure patients lose on
average 75 to 80% of your excess weight. So if
you're gonna ask me what's my excess weight, what you can do is take your
weight at your heaviest and then subtract that at your ideal weight and
your ideal weight would be something like what you'd weigh as a senior in
high school if you were a thin kid, okay. And so of that excess weight most
patients lose and keep off somewhere around 75 – 80 percent of their excess
weight. It's very durable with both these procedures, it's done minimally invasive
with small incisions and it's an overnight stay in the hospital,
typically home the next day. With every surgery there's potential complications
and in this case it's no different.
However, I would say because we are
involved in it at a national and a statewide level, all of our data is
collected and we have a safety profile that we can be proud of.
But with any surgery there's potential complications, and in this case leaks from
the staple line or from the a stenosis, developing blood clots, those are the
sorts of things that we are concerned about possibly at the time of surgery.
In
the long term there's some concern for malnutrition, which is why it's important
to take multivitamins on a daily basis after these surgeries. So this slide kind
of depicts the process that you go through and as you can see it's a long
process that is very intensive both before in the after surgery. Okay, so the
before the surgery is kind of like the training for the main event, so I often
say this is like the Olympic athlete who's running with a parachute on their
back, okay. So we have you come to our weight
loss program and we make you go through a lot of steps and do a lot of education
with this with a single goal in mind that we want you to be successful and we
don't want just you to just be successful in the short term we want you
to be successful in the long term, so that five years from now ten years from
now you don't have diabetes, you've kept the weight off, your sleep
apnea is gone, you're able to take a hike with your grandkids, both of the kind of
the goals that we have in mind.
So as you can see from this chart, there's once a
month visits for about six months prior to the operation and then we continue to
see you after the surgery to make sure that you
continue to have success in progress as you lose your weight. So we'll see you
immediately one week after surgery and then one
month after surgery and then we continue to see you for three months, six months,
and every year thereafter, to make sure that you have continued success and that
you're being appropriately nourished. So your responsibility in coming through
this program is basically to meet with us once a month, to kind of go through
the process and to make all the benchmarks that we set out. So that
involves attending what we call shared medical appointments and these are
appointments where you come in and you'll have individual time where you're
meet with the nurse practitioner and with the dietician, but you also have
time in a group setting where it's a safe environment, where well we'll go over
educational topics that are designed to bring you through the process, so that by
the time you get to the surgery you feel comfortable that you're making the right
decision, that you're making appropriate changes and that you'll be successful
with the surgery.
So we also ask that you maintain food diaries, we ask that you
engage in exercise activities, to your ability, and to your level and that
we aim to get you working towards that healthy diet the Dr. Schuhknecht was
talking about, those five to six healthy meals a day. We're training on making
those changes before the surgery so that after the surgery you have that clean
slate, you can engage and initiate those changes and make those changes new
habits that you can sustain in the long term. So again with these with these
shared medical appointments you will meet with the nurse practitioner, a
dietician and there it takes some time, it's a it's a bit of a commitment, so
it's approximately 90 minutes once a month. So it's important to realize that
everything that's done is designed to make you successful
and as much of a time commitment as it is, it's worth it in the long run.
So
what's next? So, ask yourself do I qualify for surgery
and most people who are interested in seeing these seminars based on their BMI,
would qualify for surgery, okay, and
most insurance cover insurance carriers will cover it. So basically the next
steps that you proceed are to complete the evaluation and there's a quiz to
complete at the conclusion of this just to prove that you saw this video and you
were paying attention. I just wanted one more bit of thanks to you for joining us
you are the most important part of this team and as Seth mentioned it several
times, this is a team that care for you. We have a wonderful staff of providers
here of doctors, nurse practitioners, advanced practitioners, dietitians,
MA's, Manager, we've even count her in that group, very good group of people.
We
do follow several guidelines of MBSC, Michigan Bariatric Surgery Collaborative,
we follow the guidelines of MBS A Quip, which is our certification
here at the Lakeland Weight Loss Center, and but again the most important
part of this team is you. It's a big commitment on your part, it's about
loving and respecting and caring for yourself. So thank you again for sharing
your time with us and we hope it can be a future help to you.
