Danielle: Good evening Jacksonville and happy Saturday. I’m Danielli 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 Kasraeian: I am good, how are you?
Danielle: I am good, I’m glad that it’s not raining anymore, hopefully.
Dr. Ali Kasraeian: I’m glad I made it over here. People seem to have a thing, not to get on a rant before we start the show. People in Jacksonville, I don’t know if it’s America or people don’t know how to drive in two circumstances, it seems that if a drop of rain hits, everyone seems like just … “Stopping and driving at five miles an hour makes me safer,” which I don’t think that’s probably the case.
The other thing is, and I’ll open 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.
Speaker 3: Forever and ever.
Dr. Ali Kasraeian: 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 and I just don’t understand that and I gotta 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’s an event going on downtown it seems like-
Danielle: -We have been closed a lot lately downtown.
Dr. Ali Kasraeian: When the people are going into downtown, is the perfect time to close the inward lanes toward downtown and when the concerts and the events end, it’s a perfect time to close the outward lanes. And I live downtown and it’s very nice to watch this happen. I digress, and so it took me a very, very long time to get here for a very short trip, so I’m glad I made it.
Danielle: Me too.
Dr. Ali Kasraeian: So that’s how my entrance to your show went, but I’m very excited about today’s show. It’s a long time in the making, which is very surprising because it’s a topic that’s medically always in the news, and to join us to talk about this topic is Dr. Kara Wanchick who is a husband of a guest at the [inaudible 00:02:12] Aaron Moore who will be silently in the corner of the studio here with us-
Dr. Kara Wanchi: For a little while, maybe.
Dr. Ali Kasraeian: We’ll see. I’ll be counting 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 going to talk about obesity in the totality of care, but something new we haven’t talked about on this show, and I think 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 Wanchi: Nobody wants to admit to me-
Dr. Ali Kasraeian: Nobody wants to talk about it. You know, you do the great work, but no one wants to admit that it was done. First, thank you both for being here and thank you especially for joining us on the show today.
Dr. Kara Wanchi: Absolutely. Happy to be here.
Dr. Ali Kasraeian: So let me ask you, I always ask people how they got into medicine, and we can talk about that, but first I want to thank you for your military service. So 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. 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. So 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 Wanchi: Oh, it was a long process. I was kind of all over map. I was going to 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. 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 think 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 Kasraeian: That’s interesting, growing up, one of my parents’ friends was a bariatric surgeon, and he would always ask me what I was going to do, and he would always tell me every decision I was making was a mistake, because bariatric surgery was the one operation that took care of 13 diseases at once, and it’s absolutely true, and one thing I was always curious about was what bariatrics meant. So bariatrics is actually the branch of medicine that deals with the study and treatment of obesity, so that’s prevention and treatment, if you were talking about the surgical aspect, and it’s actually 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 here.
Dr. Kara Wanchi: 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 like a bad word, and people think, “Well, 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 Kasraeian: 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 percent of us are overweight, 37.9 percent of Americans greater than 20 are obese, and that’s a BMI. It’s actually 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 percent of them are in this category. These translate into life long diseases that have impact where they cause mortality down the line and surgery puts bandaids on it. Medicines cannot turn the corner of it once you’ve gone too far. 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 Wanchi: So 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 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 Kasraeian: So getting back to the question of when you’re beginning to look at as a surgeon, 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 we see it all the time.
Dr. Kara Wanchi: Even in a morbidly obese patient, an operation that we literally do every day, a gall bladder, is so much harder in a morbidly obese patient because they invariably have fatty liver. A fatty liver is not very pliable, so to get exposure to the gall bladder is really difficult.
Dr. Ali Kasraeian: Everything becomes harder in every aspect of medicine, so you can imagine that it makes everything in your day-to-day life more difficult. As a surgeon, when did you kind of look at the world of things I can do and say that I can make such an impact in changing people’s lives for the better?
Dr. Kara Wanchi: 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 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 Kasraeian: So that’s interesting, because you’d think in the military people would not have issues with obesity.
Dr. Kara Wanchi: People everywhere have problems with obesity, and even in the military. In the military you were 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 Kasraeian: That’s the key for this, is it’s not something you should be ashamed of if you begin having issues with obesity, because it’s something that I think the preventative aspect, like you’ve 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 then 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 going to change the health of our people and 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 that 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 Wanchi: It will, because we know your body finds a set point. Everybody who’s ever tried to diet knows that you can get away from this certain