>> IF YOU ARE ONE OF THE MANY WHO STRUGGLE WITH EXCESSIVE AND UNWANTED WEIGHT GAIN, DON'T LOSE HOPE BECAUSE THERE ARE NEW OPTIONS AVAILABLE FOR YOU.

PLEASE STAY WITH US AS WE TALK WITH BARIATRIC SURGEON PAIGE QUINTERO NEXT.

>> "KENTUCKY HEALTH" ITSELF FUNDED IN PART BY A GRANT FROM THE FOUNDATION FOR A HEALTHY KENTUCKY.

>> IT IS ESTIMATED THAT TWO OUT OF FIVE AMERICANS ARE OBESE.

SOME POPULATION GROUPS HAVE EVEN HIGHER INCIDENTS.

THERE ARE MANY FACTORS CONTRIBUTED TO THE INCREASE INCIDENTS OF OBESITY AND THESE INCLUDE GENETICS, DECREASE IN EXERCISE, INCREASE IN HIGH CALORIC FOODS AND DRINKS AND LIFESTYLES THAT FAVOR THE QUICK FAST FOOD MEAL OVER HIGH NIGHT YENT LOWER CALORIC BALANCED MEAL.

BEING OVERWEIGHT IS NOT INDICATIVE OF A CHARACTER FLAW, MORAL WEAKNESS OR SLOTH OR NEGATIVE CONNOTATIONS THAT HAVE BEEN INFERRED BY EXCESSIVE WEIGHT.

OBESITY IS CONSIDERED A CHRONIC ILLNESS, AND CONDITIONS SUCH AS DIABETES, HEART DISEASE, CANCER, SLEEPING DISORDERS AND OSTEOARTHRITIS.

THOSE INDIVIDUALS WHO ARE OVERWEIGHT AND HAVE CONCURRENT MEDICAL PROBLEMS MAY BENEFIT FROM INTERVENTION.

THERE IS NO ONE TREATMENT THAT MEETS THE NEED FOR ALL PATIENTS.

RATHER, TREATMENT REGIMENTS WHETHER YOU BEHAVIOR AND DIETARY MODIFICATIONS, MEDICAL TREATMENT AND SURGERY ALONE OR IN COMBINATION WILL NEED TO BE TAILORED FOR THE PATIENT'S NEEDS AND TOLERANCES.

TO GUIDE US THROUGH THE SURGICAL OPTIONS WE HAVE AS OUR GUEST Dr. PAIGE QUINTERO.

Dr. Dr. QUINTERO FOLLOWED BY A FELLOWSHIP IN ADVANCED GASTROINTESTINAL MINIMALLY INVASIVE SURGERY AT THE UNIVERSITY OF MISSOURI SCHOOL IN SHE IS EMPLOYED BY THE GROUP BARIATRIC SURGERY.

THANK YOU VERY MUCH FOR BEING WITH US TODAY.

>> THANK YOU, SIR.

>> TELL ME.

I GUESS THE OLD QUESTION, WHAT IS A NICE PERSON LIKE YOU DOING IN A NEIGHBORHOOD LIKE THIS?

BUT LET'S JUST SAY WHAT IS A NICE PERSON LIKE YOU DOING BARIATRIC SURGERY?

>> I DO HAVE THE WRONG PERSONALITY TO BE A SURGEON.

THEY TELL ME I'M TOO NICE.

I KNEW I LOVED SURGERY.

THAT'S UNDERSTANDABLE BECAUSE IT'S AWESOME.

BUT THEN I HAD TO DECIDE WHAT TYPE OF SURGEON I WAS GOING TO BE.

AT FIRST I THOUGHT MAYBE CANCER SURGERY, MAYBE PERIPHERAL VASCULAR SURGERY BUT THEN I DISCOVERED BARIATRIC SURGERY AND I UNDERSTOOD THIS FIELD.

I HAVE NEVER HAD A VASCULAR SURGERY PROCEDURE.

HAVE I NEVER HAD CANCER.

BUT I HAVE BEEN OBESE AND I UNDERSTAND THAT.

AND SO THIS IS SOMETHING THAT I FELT LIKE I COULD HELP PATIENTS WITH BECAUSE I HAD PERSONAL UNDERSTANDING AND KNOWLEDGE OF IT.

>> WHAT DOES THAT ADD TO THE DISCUSSION?

WHEN YOU COME IN WITH A PATIENT AND THEY REALIZE THAT YOU HAVE BEEN SITTING IN THE CHAIR THAT THEY'RE NOW SITTING IN?

>> I THINK PATIENTS CAN FEEL THAT I'M NOT JUDGING THEM.

I'M NOT TELLING THEM THEY'VE DONE SOMETHING WRONG.

I'M TRYING TO HELP THEM.

AND THEY DO ASK ME QUESTIONS.

WELL, WHEN YOU WENT THROUGH THIS, HOW WAS IT OR, YOU KNOW, WHAT DID IT FEEL LIKE TO YOU WHEN THIS HAPPENED OR WHAT WAS IT LIKE WHEN YOU LOST WEIGHT?

IT'S VERY HELPFUL.

>> YOU CAN'T TELL THEM WHAT IT'S LIKE HAVING THE BEST PERSON DOING THE PROCEDURE.

>> MY PARTNER DID MY PROCEDURE.

I THOUGHT HE DID A GREAT JOB.

>> WE WON'T TALK ABOUT THAT NOW.

AM I WRONG IN USING THE TERM OBESE AND OBESITY OR THERE IS A BETTER TERM WE SHOULD BE USING?

>> I THINK THAT'S SCRIPTIVE OF THE BMI CLASS THAT A PATIENT MAY HAVE.

I THINK IT'S PROBABLY MORE SENSITIVE TO SAY A PERSON WHO IS SUFFERING FROM OBESITY OR WHO HAS OBESITY OR STRUGGLING WITH OBESITY.

I PROBABLY DON'T WANT TO SAY YOU ARE AN OBESE PERSON.

I DESCRIBE IT AS THE DISEASE THAT THEY HAVE.

BECAUSE IT'S NOT THE ONLY THING THAT DEFINES A PATIENT.

SO WE WANT PATIENTS TO FEEL COMFORTABLE IN THAT WE ARE NEVER ATTACKING THEM.

WE ARE JUST TRYING TO HELP THEM IMPROVE HEALTH.

>> SO IT'S LIKE YOU DON'T SAY SOMEONE IS HEART ATTACK BUT YOU ARE SOMEONE WHO HAS HAD A HEART ATTACK.

>> EXACTLY.

EXACTLY THE SAME.

>> SO OBESITY NOW IS A DISEASE UNTO ITSELF?

>> IT IS.

WHEN I WAS TRAINING WHEN I WAS YOUNGER, IT WAS NOT ACTUALLY CONSIDERED A DISEASE.

AND IT IS NOW.

WE KNOW THAT IS ABSOLUTELY ACCURATE.

THERE IS A DISEASE PROCESS GOING ON.

IT NEEDS MEDICINE.

IT NEEDS SURGERY.

IT'S CAUSING HEALTH PROBLEMS.

IT'S NOT, AS YOU SAID, A MORAL FAILING.

IT'S NOT SOMEONE JUST, YOU KNOW,NEEDS TO HAVE THEIR MOUTH WIRED SHUT.

WE HAVE HEARD SO MANY HORRIBLE THINGS.

IF THEY JUST HAD MORE WILLPOWER.

NO THERE ARE METABOLIC THINGS GOING ON IN OUR BODIES THAT ARE MAKING IT HARD FOR TO US LOSE WEIGHT, THAT ARE MAKING IT EASY TO HOLD ON TO EXCESS WEIGHT.

>> I HAVE HEARD ABOUT THE METABOLIC SYNDROME AND YOU JUST USED SOMETHING GOING ON IN TERMS OF METABOLISM.

SO WHAT IS THE DIFFERENCE BETWEEN OBESITY AND METABOLIC SYNDROME?

>> I WOULD SAY A METABOLIC SYNDROME CAN PREDISPOSE TO OBESITY AND MAYBE A PERSON WHO DOES NOT HAVE METABOLIC SYNDROME STARTS TO HAVE WEIGHT GAIN, IT COULD THROW THEM IN METABOLIC SYNDROME.

METABOLIC SYNDROME IS A NON-SPECIFIC TERM BUT IT DESCRIBES THE STATE OF WHEN A PATIENT IS EATING SOMETHING THEY DON'T METABOLIZE IT APPROPRIATELY.

THEY'RE MORE LIKELY TO SEND IT OVER TO FAT WHICH IS A DOWNHILL EFFECT BECAUSE IF WE HAVE MORE BODY FAT, MAYBE WE HAVE MORE VISCERAL FAT AROUND OUR ORGANS OR MORE FAT STORED IN INAPPROPRIATE PLACES LIKE OUR LIVER, IT IS GOING TO LEAD TO INSULIN RESISTANCE AND CAUSE MORE INAPPROPRIATE METABOLISM.

IT'S VERY TOUGH.

IF A PERSON NEEDS TO LOSE WEIGHT, THERE ARE THINGS FIGHTING AGAINST THEM.

>> WOW.

YOU USED THE TERM BMI A MOMENT AGO.

WHAT DOES BMI STAND FOR AND YOU SEEM TO INFER THAT THAT IS NOT USED AS A DETERMINATION OF OBESITY.

>> IT IS.

IT IS.

BUT THERE ARE OTHER THINGS THAT GO INTO IT.

SO FIRST OF ALL, WEIGHT IS NOTHING MORE THAN THE EARTH'S GRAVITATIONAL PULL ON OUR BODIES.

THAT'S IT.

IT HAS SOME STRONG EMOTIONAL CONNOTATIONS.

WE FEEL A CERTAIN WAY ABOUT OUR WEIGHT.

BUT THAT'S ALL IT IS.

NOW TO SAY SOMEONE IS OVERWEIGHT, THAT MIGHT NOT BE A VERY SPECIFIC TERM.

WELL, WHAT IS THEIR LIGHT.

IF YOU TAKE WAIT OVER HEIGHT SQUARED IN METRIC, THAT'S BODY MASS INDEX.

SO THIS IS A WAY FOR US TO MAKE A RATIO OF A PERSON'S WEIGHT TO THEIR LIGHT.

THIS NUMBER, IT'S NOT SPECIFICALLY FOR GENDER, ETHNIC BACKGROUND, WE DON'T KNOW HOW MUCH MUSCLE MASS THE PERSON HAS OR DOESN'T HAVE.

SO BMI IS A NUMBER, BUT WE DO HAVE BMI CLASSES.

ANY BODY MASS INDEX GREATER THAN 30 IS CONSIDERED OBESE.

AND WE HAVE DIFFERENT CLASSES.

AND IN SOME WAYS WE CAN USE THESE TO TELL WHICH PATIENTS WOULD BENEFIT FROM SAY BARIATRIC SURGERY.

SO BMI 35 TO 39.9 IF YOU'VE GOT A SILLNESS ILLNESS LIKE DIABETES OR HIGH BLOOD PRESSURE OR SLEEP APNEA, YOU MAY BE ABLE TO GET YOUR INSURANCE TO COVER THE SURGERY AND BMI GREATER THAN 40, WE FEEL A LOT OF THOSE PATIENTS WOULD BENEFIT FROM BARIATRIC SURGERY.

>> BUT AGAIN, THERE ARE A LOT OF PEOPLE WE WATCH EVERY DAY WHO ARE CLASSIFIED AS OBESE BUT THEY ARE RUNNING UP AND DOWN THE FIELD.

>> GREATER THAN 50% OF KENTUCKIANS ARE CONSIDERED OBESE.

>> BUT THEY'RE NOT RUNNING UP AND DOWN THE FOOTBALL FIELD EITHER.

>> I WILL SOMETIMES GET PATIENTS WHO SAY WELL I'M MOSTLY MUSCLE AND I'VE GOT MY BODY COMP, WELL THATS DETERMINED THAT IS NOT TRUE BUT WE HAVE DIFFERENT BODY COMPOSITIONS.

IF YOU LOOK AT SOME REALLY, REALLY MUSCULAR ATHLETES, SHAQUILLE O'NEILL, YOU KNOW, HE MAY HAVE A B 34 I THAT IS CONSIDERED OBESE BUT HE IS VERY MUSCULAR.

SO I THINK BODY COMPETITION-- COMPOSITION CAN TELL US THINGS.

IT TELLS US HOW MUCH PERCENTAGE IS FAT.

HOW MUCH IS LEAN BODY MASS AND WE CAN GET INFORMATION FROM THAT AS WELL.

BUT BMI IS A EASY NUMBER TO CALCULATE, DOESN'T TAKE MORE THAN YOUR WEIGHT OR HEIGHT TO FIGURE IT OUT.

>> IS ALL BODY FAT THE SAME OR DOES IT MATTER WHERE IT'S LOCATED?

>> LOCATION IS IMPORTANT.

YOU KNOW, SOME PEOPLE ARE PEAR SHAPED, THEY CARRY WEIGHT ON THE LOWER HALF OF THEIR BODY, HIPS, BOTTOMS, LEGS.

THAT'S NOT BAD.

IF A PERSON IS AN APPLE SHAPE AND CARRY MOST OF THEIR BODY WEIGHT AROUND THEIR MIDDLE, THIS IS MUCH MORE UNFAVORABLE.

THIS IS THE TYPE OF BODY SHAPE IN A PERSON WHO MIGHT HAVE METABOLIC SYNDROME WITH MORE INSULIN RESISTANCE.

IT IS HARD HARDER FOR THIS PERSON TO LOSE WEIGHT.

THEY WILL HAVE WORSE DIABETES AND HIGH BLUEPRINT AND MORE REFRACTORY DISEASE.

>> IS DIET DIRECTLY RELATED TO OBESITY AND WHAT KIND OF DIETS ARE WE TALKING ABOUT?

>> I WOULD SIMPLIFY THIS BY SAYING IN AMERICA, WE SEEM TO HAVE AN IMBALANCE BETWEEN CALORIE INPUT AND CALORIE OUTPUT.

OUR ENERGY EXPENDITURE IS NOT IN BALANCE.

I CAME FROM A FAMILY THAT OWNED A TOBACCO FARM.

AND MY GRANDMA USED TO MAKE THE BIG COUNTRY BREAKFAST.

AND I WOULD EAT THE BIG COUNTRY BREAKFAST BUT I HAVE NEVER BEEN IN A TOBACCO PATCH OR HOED A ROW.

I DRIVE TO WORK AND SIT DOWN OR STAND UP OR OPERATE.

I DON'T EAT A BIG COUNTRY BREAKFAST.

I DON'T BURN THAT MUCH ENERGY.

SOMETIMES IN OUR CULTURE IN KENTUCKY, THIS IS THE KIND OF FOOD THAT WE LIKE.

IN AMERICA WE DO HAVE A LITTLE BIT OF AN IMBALANCE.

HIGHER CARB DIETS SEEM TO PREDISPOSE TO HIGHER BODY FAT.

CARBS ARE FAST ENERGY.

IF WE DON'T USE THEM, IT GOES AWAY FOR STORAGE IN FAT.

THAT'S A LOT OF THE PROBLEM.

THE CALORIES ARE HIGHER THAN THEY NEED TO BE.

PORTIONS ARE BIGGER IN AMERICA THAN THEY NEED TO BE.

>> SURE.

THAT'S FOR SURE.

WHAT OTHER RISK FACTORS ARE THERE FOR DEVELOPING OBESITY?

>> I THINK THAT GENETICS DEFINITELY PLAY A LOWELL EXAMPLE WE THINK THAT ABOUT-- PLAY A ROLE.

50% OF THE DETERMINANT ADULT WEIGHT IS GENETIC BUT THERE IS ALSO ENVIRONMENT AND LIFESTYLE.

WE DO SEE SOME MENTAL HEALTH DISORDERS LIKE ANXIETY OR DEPRESSION, SOME PEOPLE EAT TO BUFFER THEIR EMOTIONS.

WHETHER THEY'RE AWARE OF THAT OR NOT, WE SEE THAT AS WELL.

WE SEE THIS ABSOLUTELY RUNNING IN FAMILIES.

GENETIC COMPONENT.

WHAT IF EVERYONE AROUND YOU, IF YOU ARE LIKE ME, YOU LIVE IN A GO OUT TO EAT CULTURE.

I DON'T HAVE A LOT OF VICES BUT I LOVE TO GO OUT TO EAT.

THE CULTURE AROUND YOU, EVERYBODY IS EATING BIGGER PORTIONS THAN THEY NEED TO SO MAYBE YOU DO IT AS WELL.

>> OKAY.

WE ALL SEE AND DO WHAT OUR FRIENDS ARE DOING.

IT'S HARDER TO LOSE IT ONCE YOU GET IT, ISN'T IT?

>> IT'S SO HARD.

>> EASY TO GET ON, HARD TO GET RID OF.

>> VERY MUCH.

>> WHERE DO YOU STAND WITH SOME OF THESE COMMERCIAL WEIGHT LOSS PROGRAMS?

WE SEE THEM ON TV.

JUST TO SAY THE JENNY CRAIG, WEIGHT LOSS, NUTRI-SYSTEMS.

ARE THEY HELPING US, BY THE GENERIC COMPANY?

>> I THINK THERE CAN BE SOME GOOD AND SOME BAD.

I AM IN FAVOR OF ANY PROGRAM THAT HELPS PATIENTS LEARN WHAT IS A GOOD DIET.

ANY PROGRAM THAT IS EMPHASIZING HIGHER PROTEIN, LOWER SIMPLE SUGARS, HIGHER FIBER TYPE FOODS, EATING FOODS THAT MAKE YOU FEEL FOOD, HAVE I NO PROBLEMS WITH WEIGHT WATCHER.

I'M A WEIGHT WATCHER ALUM FOR MANY, MANY YEARS.

THEY'RE GREAT AND I DO THINK THEY DO A GOOD JOB WITH WORKING ON BEHAVIORAL MOD IF I DAYS-- MODIFICATION.

LIKE WHEN YOU HAVE THE URGE TO HAVE THIS, TRY THIS INSTEAD.

THAT'S REALLY GOOD.

THE DOWNSIDE OF THEM IS SOME OF THEM CAN VEER INTO THE CRASH DIET TYPE OF SITUATION WHERE PATIENTS, YES, YOU CAN LOSE THAT WEIGHT, BUT YOU MAY NOT HAVE THE TOOLS THAT YOU NEED TO KEEP IT OFF BECAUSE, UNFORTUNATELY, WHATEVER WE DO TO LOSE WEIGHT, WE HAVE TO CONTINUE TO KEEP IT OFF.

THE FIRST TIME I HEARD THAT, I WAS VERY UPSET ABOUT IT.

BUT YOU KNOW, FINDING A WAY TO MODIFY OUR DIETS THAT IS HEALTHIER, BETTER PHYSICAL ACTIVITY THAT WE CAN SUSTAIN WAS WE NEED.

>> BUT IT SEEMS THAT THERE IS ANOTHER PROBLEM.

WE TELL PEOPLE TO EAT A HEALTHY DIET, BUT IT'S COSTLY.

SO HOW DO-- YOU HAVE THE BALANCE THAT'S GOING ON HERE.

YEAH, YOU MIGHT WANT TO GET ON THESE PROGRAMS BUT IS THAT REALITY THAT YOU HEAR FROM YOUR PATIENTS?

I WANT TO DO RIGHT, BUT BOY, I CAN'T AFFORD IT?

>> ABSOLUTELY.

WE DEFINITELY SERVE PATIENTS FROM ALL WALKS OF LIFE, SOCIOECONOMIC BACKGROUNDS.

AND I DO THINK IT'S POSSIBLE TO EAT PROPERLY EVEN IF YOU ARE TRYING TO HAVE A MORE ECONOMICAL FOOD BUDGET.

I LIKE TO SHOP AT ALDI AND I'M A HUGE SALE SHOPPER.

I WOULD WIN THE PRICE IS RIGHTED.

I NO KNOW WHAT FOOD COSTS AND HOW TO GET IT THE CHEAPEST.

I WILL SAY I'M NOT GOING TO SHOP AT WHOLE FOODS.

I'M GOING TO SHOP AT KROGER AND ALID AND FIND DEALS AND I COMMUNICATE TO PATIENTS LIKE THAT.

YOU CAN DEFINITELY GET THIS HIGH PROTEIN HERE AND THIS HERE.

THIS IS THE BEST PRICE FOR IT.

I DON'T TELL ALL THE PATIENTS THAT THEY HAVE TO EAT ORGANIC FOOD.

IF THAT'S WHAT YOU LIKE AND YOU PREFER IT, THAT'S OKAY BUT THAT'S NOT WHAT WE ARE GOING TO HAVE TO HAVE TO WIN THE FIGHT AGAINST OBESITY.

>> WE WILL BE SENDING YOUR ADDRESS TO THE FOLKS AT WHOLE FOOD.

>> THANK YOU.

>> THE BIGGEST CHANGE HAS BEEN IN SOME OF THE MEDICATIONS FOR DIABETES, THE SO CALLED GLP-1 RECEPTOR AND ANTAGONIST.

SO WHAT ARE THE GLP-1.

WHAT IS IT DOING AND IS IT REALLY-- SINCE THEY SEEM TO SHOW WEIGHT LOSS WITH THIS, WHAT IS THE STORY?

>> THESE WERE ORIGINALLY DIABETIC DRUGS THAT HAD A SIDE EFFECT AND IT WAS WEIGHT LOSS AND IT WAS ONE OF THE WAYS THAT THEY HELPED PEOPLE IMPROVE THEIR DIABETES AND INSULIN RESISTANCE.

THE PEP SIDE 1 ARE AN EXPLOSIVELY FANTASTIC GROUP OF DRUGS.

THEY DECREASE INSULIN RESISTANCE, WHICH, I MENTIONED EARLIER, IS ONE OF THE THINGS THAT MAKES IT SO HARD TO LOSE WEIGHT.

THEY DECREASE THAT.

THEY MAKE YOUR STOMACH EMPTY MORE SLOWLY SO THAT THE FOOD STAYS IN THERE LONGER, YOU FEEL FULLER LONGER.

MAYBE YOU ATE BREAKFAST BUT COULDN'T MAKE IT TO LUNCH FOR A NEEDED SNACK.

NOW YOU ARE NOT GOING TO BE HUNGRY UNTIL LUNCH BECAUSE THE FOOD IS GOING TO BE IN THERE.

IT IS A SIDE EFFECT BUT AN EFFECT THAT HELPS.

THEY WERE GOOD FOR DIABETES AND VERY GOOD FOR WEIGHT LOSS.

AND I THINK THEY'RE TRYING TO GET THE BALANCE RIGHT WITH THE SUPPLY AND DEMAND BECAUSE THEY MAKE THEM FOR DIABETICS BUT WE HAVE SO MANY PEOPLE TAKING ADVANTAGE OF IT FOR THE INDICATION OF WEIGHT LOSS.

ORIGINALLY IT WAS OFF LABEL USAGE BUT SOME OF THE DRUGS HAVE BEEN REBRANDED AND HAVE AN INDICATION NOW.

SO OZEMPIC IS THE SAME, MONJARO IS THE SAME AS JETBOUND.

WE HAVE THE INDICATION NOW FOR WEIGHT LOSS AND THIS DOES HELP US HAVE MORE INSURANCE COVERAGE OF THOSE DRUGS.

>> AGAIN, YOU STILL NEED TO MAKE SOME CHANGES IN DIETARY BEHAVIOR SO THAT THESE ARE PERMANENT WEIGHT LOSS CHANGES, CORRECT?

>> ABSOLUTELY.

SO, TO ME WEIGHT LOSS HAS TWO COMPONENTS.

THERE IS THE PART THAT WE CAN BRING IN MEDICALLY SURGICALLY, TO HELP PEOPLE FEEL FULLER, TO HELP PEOPLE NOT HAVE HUNGER, CAN'T EAT AS MUCH, DECREASE THEIR INSULIN RESISTANCE.

WE BRING THAT TO THE PATIENT AND THE PATIENT BRINGS TO THE SITUATION GETTING EDUCATED, GETTING FOCUSED, GETTING SERIOUS ABOUT DOING THIS.

ELIMINATING THE DISTRACTIONS, CHANGING THEIR LIFESTYLE AROUND SO THEY CAN DO IT.

AS A PERSON WHO HAS BEEN ON A DIET ONCE OR TWICE, ONE OF THE HARDEST THINGS IS YOU CAN'T STICK WITH IT BECAUSE YOU ARE TOO HUNGRY AND YOU ARE CRAVING SOMETHING.

SO WE CAN TURN THAT DOWN.

I HAD A PATIENT TODAY DESCRIBE THE FEELING OF BEING ON ONE OF THESE DRUGS IT TURNED DOWN THE FOOD NOISE IF HER HEAD.

>> INTERESTING.

>> THOSE INTRUSIVE AND PERVASIVE THOUGHTS, I NEED TO EAT SOMETHING.

IT TURNED IT DOWN AND SHE COULD SUCCEED.

>> WOULD THAT KEEP ME FROM GOING PAST CHIP DRAWER AND GRABBING IT IN THE MIDDLE OF THE NIGHT AND GRAZING.

>> IT WOULD HELP A LOT.

IT'S VERY POWERFUL.

>> LET'S GO IT TO THE THING THAT YOU ARE AN EXPERT ON AND THAT IS THE SURGICAL TREATMENT OF OBESITY.

TAKE ME THROUGH WHAT IS THE IDEA BEHIND SURGERY?

WHAT ARE YOU TRYING TO DO?

>> SURGERY MAY HAVE, AT LEAST ONE OR TWO OBJECTIVES.

ONE WOULD BE TO DECREASE THE SIZE OF THE STOMACH SO THAT WE DECREASE THE AMOUNT OF FOOD PEOPLE CAN EAT.

SO IN AMERICA WE ARE LIVING IN THE LAND OF THE PLENTY AND WE HAVE TOO LARGE A PORTION.

IF SOMEONE HAS A BARIATRIC SURGERY, THEY CAN'T EAT THAT PORTION.

THEY FEEL SICK IF THEY OVEREAT SO WE DECREASE THE SIZE OF THE STOMACH.

SOME SURGERIES REROUTE THE INTESTINES SO WE HAVE AN ELEMENT OF MAL ABSORPTION.

YOU EAT THE CALORIES BUT CAN'T ABSORB ALL OF THEM SO THAT'S ANOTHER WAY WE LOSE WEIGHT.

AND ALSO, WE FORGET ABOUT THE METABOLIC PORTION.

BARIATRIC SURGEONS WE CALL OURSELVES BARIATRIC AND METABOLIC SURGEON IS BECAUSE EVEN A SLEEP GAS TRECT MI BY REMOVING PART OF THE STOMACH, WE DECREASE THE CIRCULATING LEVELS OF HUNGER HORMONE.

TAKE OUT THE PART THAT MANUFACTURES HUNGER HORMONE.

SO IT'S METABOLIC SURGERY.

WE ARE INTERFERING IN SOME OF THE PATHWAYS THAT CAUSE HUNGER AND INSULIN RESISTANCE AND MAKING FAT.

>> A LONG TIME AGO THERE WAS THE PROCEDURE, THE LAP BAND VERY POPULAR AND USED BY ALLOT OF PEOPLE BUT IT DID NOT ALWAYS TAKE CARE OF THE PROBLEM.

WHERE ARE WE WITH THE LAP BAND?

IS THAT ONE OF THOSE THINGS WHERE YOU ARE SHRINKING DOWN.

>> ONE OF THE MOST ATTRACTIVE THINGS ABOUT THE LAP BAND IT IS 100% REVERSIBLE.

IN THE WAY YOU PUT A WATCH BAND AROUND YOUR WRIST, A LAP BAND IS A BAND AROUND THE STOMACH.

IT'S TIGHT.

YOU HAVE THE ENTIRE STOMACH BUT THE PART THAT CAN HOLD FOOD IS VERY SMALL SO FOOD GETS BOTTLE NECKED AND SLOWED DOWN GOING THROUGH THE BAND AND GIVES YOU TIME TO FEEL FULL.

THE BAND HAS BEEN AROUND FOR MANY YEARS, MANY FAYE FAMILY MEMBERS WITH BANDS AND I TREAT A LOT OF PATIENTS WITH THEM.

FOR SOME PATIENTS IT HAS BEEN GREAT, BUT FOR OTHERS THEY'VE STRUGGLED WITH VOMITING OR REFLUX OR FOOD GETTING STUCK AND THAT HAS MADE IT HARD FOR THEM TO EAT GOOD THINGS.

YOU KNOW, WE LOVE SOLID PROTEIN.

MAKES PEOPLE FEEL FULL.

REGULATES THE BLOOD SUGAR, IT'S GOOD BUT IF IT IS TOO HARD TO EAT MEAT BECAUSE YOUR BAND IS TOO TIGHT, YOU MIGHT EAT SOMETHING SQUISHY LIKE A MILK SHAKE.

SOME PEOPLE HAVE HAD A HARDER TIME WITH IT AND WE KNOW THAT 25 TO 50% OF PATIENTS WITH LAP BAND WILL HAVE IT REMOVED AT SOME POINT IN THEIR LIFETIME SO THERE COULD BE AN ISSUE LIKE THE BAND SLIPS OR ERODES INTO THE STOM OKAY OR HORRIBLE REFLUX OR THEY WANT A DIFFERENT BARIATRIC SURGERY.

WE DO REMOVE QUITE A FEW OF THEM.

I DON'T MEAN TO SAY IT'S NOT GOOD FOR ANYBODY BUT FOR A LOT OF FOLKS, IT WASN'T THE RIGHT THING FOR THEM.

>> BRIEFLY, THE NAME WHICH IS A GREAT NAME, RURAL WIDE BYPASS.

YOU JUST, THIS IS ONE WHERE YOU LITERALLY BYPASS THE STOMACH?

>> YEAH, WE ARE GOING TO, THIS IS AN OLD PROCEDURE THAT WE STILL DO.

STILL PRETTY GOOD.

WE CUT THE STOMACH AND MAKE A LITTLE POUCH.

YOUR OLD STOMACH IS THERE BUT IT'S BYPASSED.

THE FOOD DOESN'T GO THAT WAY ANYMORE.

THE FOOD EXITS YOUR LITTLE STOMACH THROUGH A PIECE OF BOWEL THAT WE PULLED UP AND HOOKED UP.

WHEN THAT HAPPENS, YOU HAVE BYPASSED A LENGTH OF SMALL VALVE WHICH IS WAS INSTRUMENTAL IN ABSORBING NUTRIENTS AND CALORIES.

THE MALABSORPTION PROCEDURE AND RESTRICTIVE PROCEDURE BUT WE CONSIDER IT A METABOLIC PROCEDURE BECAUSE THERE ARE 134 FAVORABLE CHANGES IN THE HORMONES WHEN THE FOOD IS NOT GOING THROUGH THE NORMAL WAY.

>> WHAT ARE THE THINGS THAT FASCINATES ME IS THE GASTRIC SLEEVE PROCEDURE.

NOW, WHY IS IT CALLED A SLEEVE?

GASTRIC OBVIOUSLY BECAUSE IT'S THE STOMACH.

>> WHEN YOU ARE DONE REMOVING PART OF IT, IT LOOKS LIKE THE SLEEVE OF YOUR SHIRT OR JACKET.

THE GASTRIC SLEEVE HAS BEEN A VERY IMPORTANT PROCEDURE.

IT'S VERY POPULAR.

THIS IS THE NUMBER ONE BARIATRIC SURGERY IN AMERICA.

>> REALLY?

>> THE REASONS BECAUSE IT DOES HAVE A LOWER RISK; ESPECIALLY IN THE EARLY OPEN RATIVE PERIOD.

ONCE YOU FINISH THAT, WE SEE VERY LOW MAINTENANCE TYPE OF SURGERY.

IF A PERSON HAS A GASTRIC BYPASS OR ONE OF THE OTHER MALABSORPTION PROCEDURES, THEY HAVE A FEW MORE RULES TO FOLLOW.

THEY HAVE TO TAKE MORE VITAMINS FOREVER.

THEY MAY STRUGGLE WITH MALABSORPTION BUT SLEEVE PATIENTS DON'T HAVE THAT.

THEY JUST HAVE A SMALL STOMACH BUT IT'S GENIUS, THE PART OF THE STOMACH WE REMOVE IS THE PART THAT MAKES THE HUNGER HORMONE SO THEY HAVE LESS HUNGER THAN JUST REDUCING THE VOLUME OF THE STOM GLAK WE HAVE THE STOMACH THAT WE ARE LOOKING AT.

AND THEN I GUESS YOU PUT A LITTLE DEVICE INTO THE STOMACH, WHAT DOES THAT DO FOR YOU?

WE WANT TO HAVE A TEMPLATE.

SO WE DON'T WANT TO MAKE IT TOO NARROW.

THE WAY THIS IS DONE.

WE INSERT SOMETHING THE SIZE OF MY THUMB AND INSERT IT DOWN THE MOUTH WHILE THE PATIENT IS ASLEEP AND POSITION IT ON THE LESSER CURVE TER OF THE STOMACH AND WE PUT OUR STAPLER UP TO IT AND FASHION A STOMACH THAT IS NOT TOO NARROW BUT THAT IS NARROW ENOUGH.

SO IT'S A PLACE HOLDER.

>> THIS STAPLER IS LITERALLY JUST FIRING A ROW OF STAPLES AND YOU ARE NOW CUTTING THE STOMACH?

>> YEAH, SO THE STAPLE WILL LAY DOWN THREE INTERLOCKING ROWS OF STAPLES ON THE PATIENT SIDE AND THREE ON THE SPECIMEN SIDE THAT'S GOING TO COME OUT AND THERE IS A KNIFE IN THE MIDDLE.

IT FIRES AND THEN THE KNIFE COMES BACK UP AND DIVIDES AND WE HAVE OUR SPECIMEN THAT WE ARE GOING TO TAKE OUT.

>> YOU TAKE THAT PORTION OF THE STOMACH OUT?

>> WE HAVE TO BECAUSE IT'S NOT HOOKED UP TO BLOOD SUPPLY AND IT WOULD BE AN ORGAN WITH NO BLOOD SUPPLY.

WE TAKE IT OUT.

WE TAKE OUT THE OLD STOMACH THROUGH A LITTLE HOLE.

>> AND YOU'VE GOT THIS THING THAT IS LEFT OVER FOR YOU.

THIS SLEEVE.

I ASSUME YOU TAKE OUT THE LITTLE THING.

>> THAT IS TAKEN OUT.

YES.

>> JUST WANT TO MAKE SURE.

SO THAT'S A BIG STAPLER THAT YOU ARE GOING TO-- I THINK I REMEMBER APPROPRIATEDLY NAMED.

TITAN BECAUSE IT LOOKS LIKE ONE OF THE TITANS-- IT'S A BIG STAPLER.

>> IS THAT DIFFERENT.

YOU WOULD HAVE TO TAKE MULTIPLE BITES OR SOMETHING.

>> YEAH, BEFORE WE HAD THE TITAN STAPLER, WE HAD A STAPLE THAT HAD A MUCH SHORTER JAWS AND SO WE WOULD STAPLE, RELOAD, STAPLE RELOAD AND IT TOOK, DID A LITTLE LONGER TO DO IT.

BUT THE TITAN HAS BEEN A FANTASTIC PRODUCT.

WE LOVE THE WAY THAT THE SLEEVE LOOKS AFTER THE TITAN.

IT'S NICE AND STRAIGHT.

>> I REMEMBER USING STAPLERS WE WOULD HAVE TO STAPLE ACROSS A STAPLE LINE AND I ALWAYS WORRIED ABOUT COMPLICATIONS THAT SO THAT IS GORN?

>> WE USE A TITAN STAPLER, THERE IS NO CROSSING OF THE STAPLE LINES.

>> I LIKE THAT.

WHAT AGE DO WE CONSIDER OPERATING ON PEOPLE FOR OBESITY.

>> I PERSONALLY AM AN ADULT SURGEON.

I DON'T OPERATE ON ANY PATIENTS YOUNGER THAN 18.

THERE ARE PEDIATRIC BARIATRIC PROGRAMS IN AMERICA AND I HAVE COLLEAGUE WHO DO THIS TYPE OF SURGERY AND I RESPECT THEM VERY MUCH.

ME PERSONALLY, I AM AN ADULT SURGEON SO I AM ACTUALLY NOT JUST LOOKING AT AGE I AM LOOKING AT THE MATURITY LEVEL OF THE YOUNG PERSON AND SOME PEOPLE AT 18 ARE READY TO BUY A HOUSE AND GET MARRIED AND WORK A JOB AND SOME PEOPLE AT 18 ARE NOT REALLY READY FOR THAT WE WANTED TO CHOOSE THE RIGHT PATIENT, THE RIGHT PROCEDURE AT THE RIGHT TIME.

BUT WE DO HAVE SOME PEOPLE THAT ARE REALLY READY TO DO THIS.

I THINK ANY PATIENT WHO IS CONSIDERING BARIATRIC SURGERY, I WOULD LIKE TO THINK THAT THEY'RE AUTONOMOUS, ABLE TO CHOOSE THEIR OWN FOODS, THEY'RE ABLE TO PREPARE THEIR OWN FOODS, ABLE TO HAVE CONTROL OF THAT.

AND IF THEY'RE NOT, IT MAY NOT BE QUITE THE RIGHT TIME TO DO IT.

>> YOU ARE SUGGESTING THEY SHOULD NOT BE LIVING AT HOME WITH THEIR PARENTS.

>> I MEAN IF THEY CAN DO THAT AND THEY CAN STICK WITH IT, THAT'S FINE.

WE HAVE A LOT OF COLLEGE STUDENTS AND I TALK TO THEM DO YOU HAVE A MEAL PLAN ON CAMPUS?

WHAT IS THE STRATEGY?

CAN YOU GO FOR THE MEET AND THE VEGETABLES?

IS THAT POSSIBLE FOR YOU.

>> WHEN YOU THINK ABOUT OPERATING ON A PERSON, THEY COME IN TO SEE YOU AND WANT AN OPINION ABOUT HAVING BARIATRIC SURGERY, DO YOU SIT DOWN AND SAY HERE ARE THE THINGS WE NEED TO DO FIRST AND WHAT ARE THEY?

>> WE WANT TO MAKE SURE THAT PATIENTS ARE SAFE TO HAVE SURGERY.

ALL OF MY PATIENT, ALMOST ALL OF MY PATIENT, HAVE A COMORBIDITY, RELATED TO THEIR OBESITY AND ALL OF THESE ARE INDEPENDENT RISK FACTORS FOR HAVING A HEART ATTACK OR STROKE.

A LOT OF OUR PATIENTS GET CARD YACK CLEARANCE.

SOME OF THEM MAY SEE A LUNG DOCTOR.

HOW RISKY TO HAVE SURGERY.

ONCE WE HAVE THAT FOX, WE MAY NEED TO WORK UP A FEW OTHER THINGS.

YOU MAY HAVE TO HAVE A SCOPE TO CHECK OUT YOUR STOMACH AND ESOPHAGUS BUT THOSE ARE THE WORKUPS WE DO BEFORE.

>> DO YOU SAY YOU WANT TO TRY DIETARY MODIFICATIONS OR CONSIDER MEDICATIONS?

>> THAT IS DRIVEN BY INSURANCE.

SO A LOT OF INSURANCES DO REQUIRE THAT PATIENTS HAVE A TIME PERIOD OF DIETARY MODIFICATION.

NOW THIS IS A BIG POINT OF DISCUSSION RIGHT NOW IN OUR SOCIETY AND IN INSURANCE COMPANIES BECAUSE THE DATA THAT WAS USED TO RECOMMEND THAT PATIENTS DO SIX MONTHS OF MEDICALLY SUPERVISED DIET IS FROM 1991.

IT'S 2023.

THIS IS 30-YEAR-OLD DATA.

SO I THINK A LOT OF OUR RESEARCH NOW IS GEARED TOWARDS SHOWING THAT IT REALLY MAY NOT BENEFIT A PATIENT TO WASTE TIME BEFORE GETTING TO THE THING THAT IS GOING TO HELP THEM LOSE WEIGHT.

FOR EVERY SIX MONTHS THAT YOU ARE HYPERTENSIVE, IT MIGHT BE A CHANCE YOU MAY NOT GET OFF YOUR MEDS AFTER SURGERY.

WE'RE NOT IN FAVOR OF LONG WAITS BEFORE SURGERY BUT WE DO HAVE SOME CONSTRAINTS BECAUSE WE WANT INSURANCE TO PAY FOR THE SURGERY.

>> I WANT TO THANK YOU FOR BRINGING ME A PICTURE OF THAT GIANT STAPLE.

I CAN'T GET OVER THAT.

THAT'S JUST AMAZING.

BUT THANK YOU VERY MUCH FOR DISCUSSING THESE THINGS.

I THINK YOU HAVE GIVEN US A LOT OF INFORMATION.

THANK YOU FOR BEING WITH US TODAY.

BECAUSE OF THE MULTIPLE MEDICAL PROBLEMS ASSOCIATED WITH OBESITY, WE HAVE TO RETHINK OBESITY AS NOT JUST A WEIGHT PROBLEM BUT A CHRONIC ILLNESS UNTO ITSELF.

AS SUCH, WE MUST CONSIDER THE TREATMENT OPTIONS DISCUSSED TODAY INCLUDING SURGERY.

PLEASE TALK TO YOUR HEALTHCARE PROVIDER.

IF YOU HAVE ANY QUESTIONS OR CONCERNS ABOUT THE NEED FOR TREATMENT OF EXCESSIVE WEIGHT GAIN.

IF YOU WITH ISSUE TO WATCH THIS SHOW AGAIN OR WATCH AN ARCHIVED VERSION OF PAST SHOWS PLEASE GO TO WWW.ket.org/HEALTH.

IF YOU HAVE A QUESTION OR COMMENT ABOUT THIS OR OTHER SHOWS, WE CAN BE REACHED AT KYHEALTH@ket.org.

I LOOK FORWARD TO SEEING YOU ON THE NEXT KENTUCKY HEALTH AND PLEASE BE VERY CAREFUL WITH YOUR DIET.

HIGH NUTRIENTS, LOW CALORIC DIET.

GET A LITTLE EXERCISE AND MAYBE WE CAN KEEP YOU AWAY FROM Dr. Dr. QUINTERO.

IF NOT, THAT'S THE WAY TO GO.

THANK YOU FOR BEING WITH US TODAY.

>> "KENTUCKY HEALTH" IS FUNDED IN PART BY A GRANT FROM THE FOUNDATION FOR A HEALTHY KENTUCKY.