Danielle: Good evening Jacksonville and happy Saturday. I’m [Danielle 00:00:12] and welcome to The Conversation with Dr. Ali Kasraeian. You too can join the conversation; give us a call 340-1045. Dr. Ali, how are you today?
Dr. Ali K: I am good. How are you?
Danielle: I am good. I am glad that it’s not raining anymore, hopefully.
Dr. Ali K: I’m glad I made it over here. People seem to have, I think, not to get on a rant before we even start the show. People in Jacksonville, and I don’t know if it’s America, people don’t know how to drive in two circumstances. It seems if a drop of rain hits everyone seems like just stopping and driving at 5 miles an hour makes it safer, which I don’t think that’s probably the case. The other thing is, and I’ll open it to the audience here in the studio. I was under the impression, and I’m by no means a NASCAR or Formula One driver by any stretch of the imagination, but I always thought the left lane was for passing.
Danielle: They stay there. They’ll just stay there forever. Why?
Dr. Ali K: And it just seems like the slowest person with the least interest in getting somewhere seems to pick the left lane as the place to stay and block all traffic. I just don’t understand that and I try to go to my internal Zen place to not get onto the side of the road. And the other thing, not to get on a Jacksonville rant, but I’d really like to meet the people that have gone through the plans of designing the Jacksonville restructuring process and how the bridges seem to be closed all the time and anytime there is an event going on downtown it seems like-
Danielle: They have been closed a lot lately downtown.
Dr. Ali K: … when the people are going into downtown is the perfect time to close the inward lanes towards downtown and when the concerts and the event end it’s a perfect time to close the outward lanes. And I live downtown and it’s very nice to watch this happen. So, I digress. It took me a very, very long time to get here for a very short trip. So, I’m glad I made it. So that’s how my entrance to the show is. But, I’m very excited about today’s show. It’s a long time in the making, which is very surprising because this is a topic that is medically always in the news. To join us to talk about this topic is Dr. Kara Wanchick who is a husband of a guest to The Conversation, Dr. Erin Moore, who will be silently in the corner of the studio here with us-
Danielle: For a little while maybe.
Dr. Ali K: We’ll see, we’ll see. I’ll be kind of like the Barbara Walters. Hopefully we don’t make him cry but maybe we can engage him in conversation. He’s a vascular surgeon at Baptist, and Dr. Wanchick is actually a bariatric surgeon, so a general surgeon who specializes in the surgery of obesity, with North Florida Surgeons. And we’re gonna talk about obesity and the totality of care, but it’s something that we haven’t talked about on the show and I think it’s something that is very much under-discussed in the world of medicine, is the surgical management of obesity. Because it’s almost like the plastic surgery of obesity.
Dr. Kara W: Nobody wants to admit it to me.
Dr. Ali K: No one wants to talk about it. You do the great work, but no one wants to admit that it was done.
Dr. Kara W: Mm-hmm (affirmative).
Dr. Ali K: So, first, thank you both for being here. And thank you especially for joining on the show today.
Dr. Kara W: Absolutely. Happy to be here.
Dr. Ali K: So let me ask you. I always kind of ask people how they got into medicine and things like that, and we can talk about that. But first I want to thank you for your military service. Both of you have really helped us be here and in the insanity that’s going on in our country right now the reason that we can do the things that we can do and have nonsense like we have going on is because we have the freedom to do those things. And that’s because of people like you, so thank you for doing that.
Dr. Kara W: Absolutely. Thank you.
Dr. Ali K: And as a surgeon that’s a very difficult thing to do because you see things that a lot of us don’t want to see.
Dr. Kara W: Mm-hmm (affirmative).
Dr. Ali K: In doing all of those things, how does one enter the world of deciding as a surgeon, you know, I want to grow up to be a bariatric surgeon.
Dr. Kara W: Oh, it was a long process. I was kind of all over the map. I was gonna be a gynecologist for a while. Then I decided the only thing in my operating room that’s allowed to scream is me, so no babies. And being a general surgeon is great. I love doing general surgery. I still do a lot of general surgery. But once I became more exposed long-term to the bariatric patients and you see people regain their lives, you see people regain their mobility, you see people able to chase their kids, or even something people don’t about like cross their legs. It is just wonderful to see that kind of progress for people. So I’m like, this is what I want to do forever.
Dr. Ali K: That’s interesting. Growing up one of my parents’ friends was a bariatric surgeon. He would always ask me what I was gonna do, and he would always tell me every decision I was making was mistake because bariatric surgery was the one operation that took care of 13 diseases at once.
Dr. Kara W: Mm-hmm (affirmative). Yes.
Dr. Ali K: And it was true. It was an absolute truth. And one thing I was always curious about what was bariatrics meant. And bariatrics is actually the branch of medicine that deals with the study and treatment of obesity, so that’s prevention and treatment, and here we’re talking about the surgical aspect. And it actually is derived from the Greek root for baro which means heavy or large. So, I was curious about that, so I looked it up. So, I’ll share that, one of the reasons I was probably a little bit later getting there.
Dr. Kara W: I would like to get people to think more of it as metabolic surgery. Because I think we’ve gotten to this place where bariatric surgery is a bad word and people think, well, then they’re just telling me that I’m fat. But truthfully what we’re trying to do with this surgery is cure your diseases. So, we are curing your metabolic syndrome. We are resetting your body’s metabolism and set point. So we’re curing diabetes, we’re curing sleep apnea. I want us to think more in terms of metabolic surgery than just the weight loss itself.
Dr. Ali K: So in a world where we have just had data coming out that shows that a third of the world’s population is overweight, now in the United States 70% of us are overweight, 37.9% of Americans greater than 20 are obese. And that’s a BMI, which is essentially a calculation of your weight and your height, being greater than 30. Between 25 and 29 is overweight. So above 30, that’s fairly significant. And in the United States we led the world in that. And also our children and young adults, 13% of them are in this category. And these translate into lifelong diseases that have impact where they cause mortality down the line. And surgery puts band-aids on it. Medicines cannot turn the corner of it once you’ve too far. So how does one get to a point where they have to think about a surgical management to their difficulties with not being able to lose weight?
Dr. Kara W: I think the biggest thing we can do as physicians is try to address this early. As we start to approach a BMI of 30, where you’re starting to be classified as obese, that’s where we need to start talking to people about this. Qualifications for surgery are still the 1991 NIH criteria, so it’s a BMI of 35 with an obesity related comorbidity, or 40 without. We know that the closer people get to 50 and especially above a BMI of 50, the ability to get them to a normal BMI diminishes rapidly without some pretty large operations. So, early management I think is the key for us, and it’s lifestyle changes.
Dr. Ali K: So, getting back to the question of when you were beginning to look at it as a surgeon-
Dr. Kara W: Mm-hmm (affirmative).
Dr. Ali K: … where, you know, what we’re exposed to early on in our training is not this. But obesity impacts all of us in the world of medicine and it also impacts all of us in the world of surgery, because operating when people have difficulties with obesity impacts all the diseases that impact surgical outcomes. So you see it all the time.
Dr. Kara W: Even in a morbidly obese patient, and operation that we literally do every day, a gallbladder, is so much harder in a morbidly obese patient because they invariably had fatty liver. A fatty liver is not very pliable, so to get exposure to the gallbladder is really difficult.
Dr. Ali K: So everything becomes harder-
Dr. Kara W: Everything.
Dr. Ali K: … in every aspect of medicine. So you can imagine that it makes everything in your day-to-day more difficult.
Dr. Kara W: Mm-hmm (affirmative).
Dr. Ali K: So, as a surgeon when do you kind of look at the world of things I can do and see that I can make such an impact in changing people’s lives for the better?
Dr. Kara W: It was probably when I became a surgeon down at the Naval Hospital, because during residency your exposure is a little bit limited and you’re mainly covering the ER. So your view can be a little skewed. But it was once I was at the Naval Hospital and started doing these operations myself and following these patients long-term. Because even as a general surgeon I counseled people about, “Hey. Let’s look at your weight. Let’s talk about things we can do to help you lose weight.” You’re not very successful. But when I started doing surgery and seeing these guys really change their lives, I was motivated.
Dr. Ali K: And so, that’s interesting, because you’d think in the Military people would not have issues with obesity.
Dr. Kara W: People everywhere have problems with obesity and even in the Military. In the Military you are not allowed to operate on active-duty members. So we would mostly be doing family members. But we still, everybody has a problem now.
Dr. Ali K: And that’s the key for this. This is not something that you should be ashamed of if you begin having issues with obesity because it’s something that I think the preventative aspect like you mentioned is a key aspect and especially with children. People talk about healthcare reform and healthcare changes, and everyone thinks magically by changing something in a four-year presidency and if healthcare reform passes, and let’s say we come up with the most magnificent healthcare plan that both parties agree on and the hospitals like and the physicians like and the insurance companies like. It’s not gonna change the health of our people in our population in one lifetime necessarily. This is something that we have to engage from children to adolescents to young adults and their parents so we can change the health of our community over time. And obesity is a problem that is going to take a lifetime to change.
Dr. Kara W: It will, because we know your body finds a set point and everybody who has every tried to diet know-