Published on February 03, 2022

The Weight Is Over

Explaining obesity

Obesity is a serious chronic disease that affects millions of Americans. While eating a healthy diet and exercising regularly can help some people achieve — and maintain — a healthy weight, others need medical help.

Learn more from surgeon Erik Simchuk, M.D. He’ll go over obesity, why dieting and exercise don’t always work, the benefits of bariatric surgery, and more.

Suzie Lawry-Hall, podcast host: Obesity is a serious chronic disease that affects millions of Americans. One in three adults struggle with this condition, according to the CDC. This puts them at an increased risk for Type 2 diabetes, heart disease and cancer. While eating a healthy diet and exercising regularly will help, others need medical support. If you’re among them the idea of weight loss surgery may have entered your mind.

Hello, everyone. I’m Suzie Lowry Hall, Enloe’s Community Outreach Manager, and today we’re here with Dr. Eric Simchuk. Dr. Simchuk is a surgeon and part of Enloe’s Bariatric Program. He has performed countless bariatric procedure and says these surgeries can be life-changing and life-saving and with that let’s get started. Thank you, Dr. Simchuk, for being here.

Erik Simchuk, Surgeon: Oh, you’re welcome.

SLH: Yeah. So my first question is, when is someone considered to be obese?

ES: Well, that is an excellent question and really is in the mind of the beholder. Now we can define obesity as having a body mass index, or a BMI, of 30 or above. One gets your body mass index by dividing your weight by your height squared is really your body surface area. The interesting thing about it is that we, over time as a society, have begun to think of obesity as really the new normal. They’ve done those studies in which they’ll take people in a room, and they’ll walk people by them. They’ll ask them to point out those with a normal weight and routinely now people will point out people who are actually obese as having a normal weight status.

SLH: So what are some of the health conditions associated with obesity?

ES: Well, there are many, and the list is very long. But more commonly, people will think and know about Type 2 diabetes mellitus, really (it) begins to occur when a person reaches a body mass index of 30, high blood pressure or what we call “hypertension,” all the variations of high cholesterol. Elevated liver function tests that your primary doctor may say you have a “fatty liver” is actually the liver being damaged by the excess fat. But you can end up with anatomic problems as well, such as obstructive sleep apnea, stress urinary incontinence, gastroesophageal reflux disease, and the list goes on and on.

SLH: So why is it that when you’re obese losing weight can be so hard?

ES: That is an excellent question. I think a question that so many of our patients and patients currently and patients in the future they struggle with on a daily basis: Why can’t I do this on my own? I’ve tried so many diets. I’ve tried so many exercise programs, and, yeah, I can go and lose the 40 or 50 pounds that I wanted to lose, but then in the course of the next year I gain it all back. Why can’t I do this on my own?

The reason is biology is not on the patient’s side, it’s not on the human being side. Our body defends itself against weight loss through neurological and hormonal mechanisms. Your body doesn’t think of weight loss as a good thing because all it knows is that it’s energy reservoir, which is our fat stores, are going away. See our body thinks it’s, all it knows is that the calorie source has grown scarce, the energy reservoir is diminishing and what does your body think? Your body thinks it’s dying because it’s not getting the calorie stores that it needs. So it’s going to defend itself in every way it can against that and put the weight right back on. It’s that good and it is that difficult to stop. That is where surgery comes in and that’s why surgery is different because we remove the neurological and hormonal defense mechanisms against weight loss.

SLH: So what types of bariatric surgeries are performed at Enloe?

ES: The majority of what we do currently is called the Sleeve Gastrectomy, originally referred to as the Vertical Sleeve Gastrectomy. We still do an operation called the Ruin Y Gastric Bypass, although the Sleeve Gastrectomy really has taken the world by storm after it began to be approved by insurance companies in 2010. We do a lot of our operations laparoscopically, which is working through little incisions, most of which are really just 5 millimeters, which is about the width of a pencil. The vast majority of our patients stay one night only with us in the hospital now and are able to go home the next day.

SLH: That’s amazing. So Dr. Simchuk, a common misconception is that people have to pay for this bariatric surgery out of their pocket, but that’s not the case. Can you tell us more?

ES: Yes, Suzie, that’s an excellent question. I think you’re right. I mean, it is a very common misconception. People think that weight loss surgery, whether it’s the Sleeve Gastrectomy or the Rune Y Gastric Bypass, that these are what we call “aesthetic surgeries” or elective surgeries. When, in fact, you might even consider these surgeries urgent or emergent when it comes to many of our patients who because of all of their medical conditions related to the weight, their life may be shortened quite a bit. So, no the medical insurance companies have covered these operations for years. It actually is uncommon now to find a patient with an insurance plan that doesn’t cover weight loss surgery. So the out of pocket for you know beginning to end is minimal to non for most of our patients now.

SLH: That’s amazing.

ES: Right.

SLH: Yeah. Would you say that most people who have bariatric surgery end up getting back to their ideal weight?

ES: In regard to the term “ideal body weight,” it’s actually a term or it’s a term that’s defined by insurance companies. And insurance companies look at life table analyses and determine that a person at their ideal body weight just tends to live longer. So, it actually might surprise you to find out that ideal body weight for a person of any height, you might think of them as really skinny, somewhat unhealthily skinny. So, our goal is obviously not to get a person to their “ideal body weight.” What we want to do is get them to into a normal weight category, which gives them a body mass index of around 25.

SLH: Can you tell us about the support services?

ES: Yeah, so we are a Center of Excellence with the American College of Surgeons in the American Society of Metabolic and Bariatric Surgery. And as a Center of Excellence, we provide a tremendous amount of pre-operative and post-operative education and support services. Most of our patients undergo four months of pre-operative, that’s before surgery, educational class work, learning about nutrition, learning about diet, learning about exercise programs, etc.

SLH: So what does it look like life after bariatric surgery? What does that look like for patients?

ES: I can tell you that the life is beautiful. It’s a very gratifying thing that I do that part of my surgical practice is bariatric surgery. Because really when you say what does life look like, really we’re giving them a life back. In that one year out from surgery, their body really isn’t deciding for them what they can and cannot do in their lives, such as walk again even farther than 250 yards, go hiking, go biking, go to the amusement park and actually get on a ride and ride that ride with their family, instead of being the one that has to sit on the bench and watch everybody else have fun. It’s really all about re-engaging in life and being able to partake in those things that they couldn’t before surgery.

SLH: Thank you for being here, Dr. Simchuk, and thank you all for joining us. We hope you found this information helpful. If you’re interested in bariatric surgery or just want to know more visit www.enloe.org/weight. Take care.