[MUSIC PLAYING] Hello, and welcome to the University of Chicago Medicine At the Forefront live. The purpose of our program is to allow you to interact with our doctors live on Facebook. So get your questions ready, and we'll answer as many as we possibly can over the next half hour. Now, we want to remind our viewers that our program today is not designed to take the place of a medical consultation with your physician. Joining us today is Dr. Edwin McDonald and Dr. Christopher Chapman. They'll be speaking with us about healthy weight loss options available here at UChicago Medicine. I'll start off with the two of you introducing yourselves. Kind of tell us a little bit about your areas of specialty. Absolutely. So I'm one of the advanced endoscopists here at the University of Chicago. There's three of us here. So I do a lot of procedures that deal with pancreatic cancer, other diseases like that. And one of my focuses is on endoscopic treatments for obesity. And that's what I like to do. Great. Dr. McDonald? So I'm also one of the gastroenterologists here. I specialize in nutrition. So that means I basically see people who suffer from malnutrition. So people with short bowel syndrome who need alternative ways to get nutrients in. And I also do weight management. So I also do some of the procedures that Chris mentioned, but also focus on medical weight loss, which is essentially talking about diet, exercise, and then people who qualify maybe even using medications. And you're also a chef. We're going to talk a little bit more about that later. I'm also a trained chef. That's pretty exciting. That's great stuff. It is. I love doing it. I haven't had his food yet, though. Really? Well, I should have you over sometime. I think so. I think so. I think that's an official invitation. Yeah, that was an invite. We have a witness here, so that's great. You heard it here now. Absolutely. Well, many people have had their lives changed the healthy weight loss options available at UChicago Medicine. Let's hear from one of our patients, who had a wonderful outcome. I walked from my apartment to the lake and back. And that was something like 6,000 steps. And you know, it's not something I could have done a year ago. So I'm really happy about that. I'm happy. My wife's happy. Everybody's happy. Gregory Fulham is doing things he hasn't been able to do in years. The success has been dramatic. Gregory had a procedure performed by Dr. Christopher Chapman called endoscopic sleeve gastroplasty. The procedure is quick, and the results can change lives dramatically. The advantages of the endoscopic sleeve gastroplasty are that it's an outpatient procedure. There are no incisions, so there is no scarring. And the healing time is drastically reduced. The endoscopic sleeve gastroplasty is a noninvasive procedure designed to reduce gastric volume. Sutures are put in the stomach, reducing the size of the stomach. Stomach volume is reduced by 50% or more. Patients eat less, because they become full more quickly, and are satisfied with smaller portions. You feel full sooner. And that's a good thing. The University of Chicago Medicine provides a full range of bariatric services. For some patients, this is the perfect solution. Others, though, will require surgical procedures, also available at the University of Chicago Medicine. We're happy to see any patient who would be interested in procedures or other methods for weight loss. However, for this particular endoscopic sleeve gastroplasty procedure, we're looking for patients who are really in need for that jump start to lose about 30 to Patients go through a process before the procedure to make sure they're ready for this step. After the procedure, they will be expected to change their lifestyle, eating less and exercising more. At University of Chicago Medicine, we pride ourselves on our multi-disciplinary evaluation. That includes seeing a psychologist, an endocrinologist, a dietitian, as well as a gastroenterologist. We have the patients see all these providers before we even do the procedure. Gregory says the procedure went very well, and the changes to his lifestyle have been surprisingly easy to make. I eat the same stuff that I have been eating forever. I just eat less. The procedure had Gregory in and out of the hospital in a day. He says the care has been great. It's really a privilege to be in a neighborhood that has an institution like this so handy and so ready to assist. It's wonderful. See, that was I think pretty interesting, because it really showed what a difference that made in Gregory's life. I mean, he was talking about these changes, and the fact that he can walk and get around now. Which is really neat to see. Absolutely. He's had a remarkable journey. And you know, he keeps telling me-- I see him where he is employed-- and he tells me how much of a difference it's made for him. Great. And Dr. McDonald, I imagine you see a lot of patients that are in the same situation, where their lives are literally transformed. Oh, definitely. I mean, I've seen people-- I think the most weight loss I've seen in our clinic so far maybe went probably close to 150 pounds or so. So that makes a huge difference in people's lives, as far as mobility, as far as happiness, as far as just day-to-day, everyday interactions. So I know both of you are-- what you preach to your patients is healthy weight loss, and healthy is the important aspect of that. Let's just start off talking about what exactly that means. What's the difference between healthy weight loss versus non-healthy weight loss? So for me, I think it's better to define what unhealthy weight loss is. And that's a good place to start. So unhealthy weight loss-- you know, I see a lot of people who try these starvation diets. So these different fasts, where people are just drinking water for days on end. And a lot of those diets, it's really just not sustainable. So I think healthy weight loss is something that is going to have a sustained effect over time. And it is a pattern of eating that someone can actually stick to and continue with, as opposed to something that is going to lead to issues over a certain period of time. So there's a lot of different very, very low calorie diets out there that for the most part will lead to weight loss. But you can really only do those for about a month or so. And eventually, most people, all the weight is going to come back. So what we tend to focus on is really a way of eating that people can carry out throughout their entire life, as opposed to just one month or just a couple of months. Because again, like I said, we want the weight loss to be sustainable. It's a lifestyle change. Yeah. I agree. And as Ed and I were talking together-- we work very closely together-- that this is not just a single moment of change. This is a lifestyle change that we want to do. And that's why the multi-disciplinary approach that we see with Ed working on some of the medications and the procedures that we do together, where the focus is more about providing durability for those patients that yo-yo up and down with their weights. Because they do a fad diet. They crash. And they get down, but then it's ultimately unsustainable. And then they end up having these problems again. So we're trying to find these ways to build not only a medical relationship, but a personal relationship that allows us to make long term changes. And when people yo-yo like that, it's not only hard on them physically, but emotionally as well, I would imagine. Yeah. And it's actually harder to maintain the weight loss when you go up and down. Primarily, every time you go up and down, that's associated with hormonal changes. And that can impact your long term weight loss overall. So the way I view weight loss, it's almost like a pyramid. And you have to have the foundation. Without the foundation, the whole pyramid is going to fall apart. But there will be maybe multiple rungs on the pyramid or rungs on the ladder. So lifestyle modification is really the foundation. But for a lot of people-- for most people-- studies show that lifestyle modification on its own may not be as effective. And that's why we provide these adjuncts. And so you have medications. You have bariatric and endoscopic therapy. Then we also have bariatric surgery. And each of them can play an important role, depending on what the individual patient is going through. Full continuum of care here. A full continuum of care. Great. I do want to remind our viewers that if you have questions for either one of our physicians, just type him in on Facebook, and we'll get to him as quickly as we can. We have our first question from a viewer. And that is, is BMI the best way to gauge a healthy weight? So BMI is the way that we use commonly primarily because for research purposes, we do have to have some sort of classification, and also to decide whether or not people would benefit from bariatric surgery or medications. We need some sort of marker to make those decisions, and BMI based upon studies has become that marker. But there are a lot of limitations when it comes to BMI. So BMI is not a reflection of your muscle mass, nor is it a reflection on differences in terms of ethnicity. So certain ethnicities may just in general carry a higher BMI or a lower BMI. So for instance, according to research studies, people of Asian descent may have a lower BMI to begin with. But that does not necessarily mean that they don't have obesity. So someone may not have a BMI that puts them in overweight category. But if you actually look at their fat mass, technically they're functionally over weight. And BMI is not capturing that population. So BMI is just one metric that we use. But it's not the sole metric, by no means. We look at other things, like waist circumference. Things like that. Or also we really look for like kind of visceral adiposity, or fat volume we're talking about. So I agree with Ed that BMI in itself is not the only tool that we use and should be using to assess someone's weight status. Great. We have another question from a viewer that asks, how do you know if you should be considering bariatric surgery or endoscopic procedure or something else like medical weight loss? And I'm going to throw that one to you first. Sure. So since we have the wide spectrum of care here going all the way from lifestyle management to medications to bariatric endoscopy all the way up to bariatric surgery, what we try to do is work very closely with the whole group to decide what's the best for the patient individualized. And so our general guidelines are based on a BMI. So if you have a BMI between 30 and 40, that might make you a good candidate for endoscopic bariatric therapy. However, if you have a BMI greater than 40, oftentimes bariatric surgery is the most effective option to treat your obesity issue, as well some of the complications that arise from the weight issues. And so either a BMI greater than with co-morbidities should be considered for surgery. However, if you look at medications, even a BMI of 27 would be an indication to consider medical management to help with weight. So we can use the BMI as a starting point. But then we do tailor it to individuals. So if someone has a BMI in a higher class that is more interested in endoscopic procedure, that may be better than nothing at all. it really depends on the patient. But we kind of use the BMI as a first starting point. And Ed, how do you feel? Yeah, I totally agree And what Dr. Chapman here means by co-morbidities is really the other conditions that may be associated with gaining extra weight, or just other conditions in general. So say someone has severe lung disease. That may put them at risk for complications from bariatric surgery. We may have to consider alternate options that aren't as invasive. Or if someone has severe diabetes and we know they need to lose weight immediately, bariatric surgery may be the better option, just because we know it's a little bit more effective, especially with a BMI over 40. And I think Ed brings up a great point about the timing and the need. So we deal at University of Chicago with a lot of patients with significant health problems in addition to weight issues. And so we're in constant communication with our transplant surgeons, our orthopedic surgeons, our OBGYNs. We deal with fertility issues. These are patients who, if they're struggling with these conditions, sometimes helping them lose a little bit body weight-- even 10%-- can make a significant difference for their outcomes for other procedures or their plans for their families. I've got to get to a couple of things, because we have some props here that you brought that I'm fascinated by. And so if you could kind of explain to us what we're seeing here. And we were talking a little bit during the video that aired a few moments ago, and there was an animation that showed one of the procedures you do. And you brought in some things. Right. So currently, there are about three procedures that are FDA-approved, or the device is FDA-approved for use. And these are endoscopic procedures, meaning that we use a flexible tube with a camera on it to go down through the mouth and do interventions on the stomach. So there's no cuts or no incisions. The wound healing is not really there, because it's all internal. It's very discreet. And so these are the options that we're kind of employing from the endoscopic side. And there's the intragastric balloon here. You see it's a silicone balloon. There are about three that are FDA-approved on the market. They're fluid-filled or gas-filled. They're about the size of a grapefruit. They stay in your stomach for a period about six months, and then we take it out. So this is a very nice option for those patients who are looking for a very reversible option. Because once you remove the balloon, you're completely back to yourself. The other option that we do is the endoscopic sleeve gastroplasty. This is a where we use a suturing device here that allows us to actually take full thickness bites through and through the stomach wall to tighten the stomach. And we kind of call this the accordion procedure, because you're basically folding it and closing it on itself. And this is the one that Gregory had and had such a great response. So you can see that you use this device and a handle that allows you to close and basically pass a suture and take bites of tissue. And then I'll let Ed here finish and talk about aspiration therapy. Because we both do this therapy here. Yeah. So there is aspiration therapy, which is basically where we place a small tube in the stomach. And the tube allows people to empty out at least 30% of their calories that they take in a given meal. So you know, it's actually just a variation of a common procedure that we do all the time as gastroenterologists, which is a Percutaneous Endoscopic Gastrostomy tube, also known as a PEG tube. So typically historically, we do the PEG tube for people who can't eat. They have swallowing issues or issues with their esophagus, and we have to feed them directly in the stomach. But with this tube, It's a little bit different. So this allows people to basically empty out their stomach just a little bit. But one, you have to chew your food very carefully. So you just can't empty out everything you're eating. Two, it's always done in a context of lifestyle change. So it's not a tool that people can use and just eat whatever they want and empty whatever they want. Doesn't work exactly like that. So people are seen by myself and our dietitians, and even we have psychologists involved that help us out with the whole process. You know, that to me is I think critical. Because this isn't just a procedure. When you both do your work, you involve a lot of folks in the process. And it is about a lifestyle change. It's really from beginning to end with them. Right. You need a full evaluation for this. Because it is such a drastic change. A lot of time, people are battling 30-40 years of habit that they've built up that they're trying to suddenly change. And kudos to them for coming in and starting that process. But because it is so challenging, we acknowledge that we have to ask our patients to meet with a dietitian and a psychologist to make sure that we're moving in the right direction and it's going to be safe. Great. Now we have a question from one of our viewers. Stephanie is asking, she sees every one or two years there's a new fad diet that comes out. I think keto, Whole30, paleo, there's a bunch of them. Are these realistic for patients to do diets like this? Does it help? Is this more of a hindrance? What are your thoughts? I mean, everyone's a little bit different. And I think whenever we see someone in clinic, we don't automatically tell them just to do Keto, or tell them just to do x diet. We really have to take an individual approach to understand what people's taste preferences are, what their ability to afford certain foods, where they live at. So access is an issue. So we take all these different things in consideration. But what a lot of these diets have in common, ultimately you're avoiding ultra-processed foods. So there's no diet that really tells you to eat a whole bunch of potato chips. Or other foods. Or other ultra-processed foods. And then most of the diets really involve some sort of calorie restriction. So there's a lot of debate out there in terms of where we should place those calories. Should those calories be mostly protein? Should those calories be less fat or less carbohydrates? But when you look at a lot of different studies, ultimately when people decrease their caloric intake-- their calorie intake-- people tend to lose weight. And if you add exercise to the mix, you're even going to lose even more weight. So fundamentally, just eating less and eating more healthier foods that aren't processed is going to be the foundation to any of these diet programs. Now, there are some diets out there that are just unsafe. And most of those diets are really where you're doing like for extended periods of time, where you're putting yourself at risk for starvation and also protein loss. So you know, I tend to tell people to be careful with those, and also be careful with things that sound like it's too miraculous to be true. So if there's a diet that says the miracle diet, the miracle diet really does not exist. And if the diets really just focus on supplements, typically a lot of supplements don't really lead to a lot of weight loss. So case in point, there's like the HCG diet out there, where people are taking a lot of HCG, which is a hormone associated with pregnancy. You know, that diet has been-- it's out there in the literature. But the diet has been studied, and it's not as effective as what people claim to be. So ultimately, what I tell people with these diets, you really have to do your research. And a lot of research should include talking to a registered dietitian. Not necessarily a nutritionist. If they are a nutritionist, you really have to find someone who's certified, as opposed to someone who is online claiming to be a nutritionist. Which that happens. We have another viewer who-- there's a procedure that they had done called the roux-en-Y. Is that correct? Roux-en-Y. Gastric bypass. Yeah, it didn't maintain. But they want a new beginning. What would you tell someone like that? Right. We see a lot of patients who have had bariatric surgery, and then unfortunately have regained weight. So I think when we bring them into our clinic to discuss, we actually just try to find the underlying reason why they've had weight regain. Is it something behavioral? Or is it something mechanical? And if it's mechanical, sometimes we can actually try to repair those things. The repair could be surgical. So bariatric surgery definitely has a role, like a revision bariatric surgery. But also we're using this endoscopic suturing device to do certain things as well. So a lot of times, we find that the opening of the stomach to the small intestine is dilated. So it's stretched out in size over time. And this typically happens anywhere from five to eight years post-operative. And you can actually use this device to suture down that opening to make it tight again to provide that level of restriction. So one of the key questions I ask my patients when they come in with this problem is, do you feel any restriction? Or can you eat more food than you could before? And so those are different things that we want to try to get at to try to see if maybe there's a mechanical component that can be doing this. And even sometimes people may form what we call a gastrogastric fistula, where there's actually an abnormal connection from their pouch into their old excluded stomach. Because with a bypass, your old stomach is still there. So there's a chance, actually, when you eat, the food you're going is back down the original path. And so we kind of do a full range of evaluation to see is there's something mechanical, or is there something behavioral? And we go from there. Dr. McDonald, can we talk about coffee a minute? I'm pointing at your UChicago Medicine mug. I've got to get the plug in there. But talk a little bit about coffee, because we were discussing this a little bit before the program began, and some of the benefits of black coffee. So lead us down that path, if you will. I mean, for me, I'm probably a coffee addict since years ago when I became a resident and had my first kid-- my wife and I first kid-- when I was an intern. So coffee became mandatory. And since then, I just have not stopped. Overall, coffee is pretty healthy. So there's a lot of concerns. A lot of times people come in to me and in my clinic and say things like, I stopped coffee, I stop spicy foods. And I'm like, wait a minute, where did all this negative connotation come from when it comes to coffee and spicy foods and stuff like that? Because ultimately, a lot of these foods are healthy. So black coffee by itself has been associated with decreased risk of liver cancer, and maybe even decreased risk of heart disease. Now, when you add a lot of sugar and a lot of cream some of the fancy lattes and everything that have a lot of calories, that can be associated with weight loss. And also, those aren't very healthy, because it's again simple sugars. And that's probably more along the lines of the processed food category. So there are some recent concerns about coffee and cancer. Specifically in the state of California, at least at Starbucks and other coffee stores, they have to put a label explaining the risk of cancer with certain types of coffee. So a lot of that risk or a lot of those concerns comes from studies on mice, but not necessarily studies in humans. So most of the studies in humans, again, show that coffee decreases the risk of cancers. But the concern really comes from the fact that coffee, especially when it's roasted-- so like our darker roast coffee-- may have higher amounts of a carcinogen-- a cancer causing agent-- called [? acro ?] aromatase. But that's also found in potatoes. It's also found in bread. It's also found in a lot of foods that we roast in the oven. Now ultimately, how much does it take? You know, how much exposure to [? acro ?] aromatase does it take to cause cancer? I don't think anyone really knows that, because to set that up to answer that question, you'd have to do an unethical study, where you're just giving people [? acro ?] aromatase for many years and then seeing what happens. So we don't know. But ultimately, I drink coffee. I probably drink maybe a little bit less dark roast. But I don't really have any concerns about it, for my own well-being. One of the questions too that's coming in kind of along the same lines, and it deals with cancer. But the link between obesity and cancer. Would either one of you care to comment there? Right. I mean, so there's definitely a link between obesity and cancer as well as outcomes related to cancer therapies. If you look at breast cancer, for example, that there have been plenty of literature published and well-done studies suggesting that if you have obesity and are undergoing treatment for breast cancer, that your outcomes are less favorable. So we know that there is definitely a link not only to the development of cancer, but also to the outcomes related to therapy. So this is another reason why I think some of these options should be on the table for patients, even when they're battling some of those very strenuous conditions. Interesting. So another question. Many of these popular diets or high protein diets. And the concern is, is there a correlation between all that protein and possibly having kidney stones? Not necessarily. So it depends on one, someone's personal history with kidney stones. Because there's multiple different types of kidney stones. Most of the stones are really based upon calcium, not necessarily protein intake. Now in the past, especially like in the '90s, everyone was concerned about eating too much protein and that causing kidney failure. So I remember years ago when I was playing football and sports, and people were trying to do protein shakes. And all the coaches were like, don't do too much, or else you're going to get kidney failure. That is not true. So that has all been debunked. And a lot of people-- even people with kidney disease-- actually need protein, up until a certain point where they need dialysis. Then you really just need to talk to a dietitian and make sure you're not overdoing it. But for the most part, the protein concerns and kidney disease, you really don't have to be concerned too much. Because most people aren't going super crazy with the protein. Another one of our viewers says, I have a PCOS and a slightly high A1C. Would an endoscopic weight management procedure be beneficial to helping me lower my A1C? Yeah, I think that's a great question. Unfortunately, one of the common presentations of PCOS is weight-related challenges in addition to menstrual cycle irregularities or having irregular periods. And so the treatment of PCOS or using an endoscopic management, it really gets to the bottom line is, does it also help with treatment of those conditions that are associated with weight, such as diabetes or high blood pressure? And there are literature out there that suggests that these endoscopic procedures, when they're capable to lose that can improve hemoglobin A1C, can improve people with fatty liver disease, can improve people with blood pressure or cholesterol problems. So yes, for that person out there, I would say that if you do have PCOS and you're struggling with weight, this could be a viable option to help you get over that hump and get you out of that. We see a lot of patients who are in that pre-diabetes phase, and they say their numbers are borderline. If they're trying to correct that issue, weight loss will help try to get them back down out of that range. So people with that borderline diabetes, that's a signal. That's an alarm sign that's just going off saying that we need probably to do something more aggressive. Whether that's lifestyle, whether that's endoscopic, whether that surgery is very tailored to the person. But that's an alarm sign for people. Because these things can help. Can I answer that? Yeah, absolutely. So also, PCOS can be very complicated. And it's something that really requires a multi-disciplinary team to manage. So here at the University of Chicago, we have people seeing endocrinologists. We work with the gynecologists. And then we also work with ourselves as weight loss specialist and endoscopist. So I think that approach is going to be individualized. But it's probably going to take input from a lot of different doctors to decide what's the best overall approach. Absolutely. Because there are medications that are great treatments for PCOS too. Like a lot of patients are on metformin, which also is an a blood sugar control medicine. So that may be enough to help this person get out of that range with a mildly elevated A1C. So as Ed mentioned, we work very closely with the endocrinologist to make sure that they're in the right approach. We don't just offer one thing and say that this is what we do. But you have to look at the whole picture. And sometimes, procedures aren't the right option. Sometimes medications are. But we do tailor it individually, I would say. Another viewer question. I've heard that women's hormones make it more difficult to lose weight. Would you approach a woman's weight loss treatment differently than you would a man? No. I mean, for the most part, yes. So women can have a harder time to lose weight. But at the end of the day, really, lifestyle modification is the foundation. And those changes are the same. Reducing calories, trying to exercise, sleeping, not trying to sleep too little, not sleeping too much. And then from there, we decide based upon other conditions people may have whether or not they're a candidate for bariatric surgery, medications, or endoscopy. But ultimately, the equation, if you will, is relatively similar. It just so happens to be a little bit more difficult, especially in women who are post-menopausal. Yeah. We see a lot of women patients actually come in who are interested in endoscopic therapies. And in fact, our most frequent patient are really those patients that have had their second child, and they just can't shake the weight after their second or third child. And so there is definitely a gender difference that I've seen in my practice in terms of how people do. But men do well with the procedures and with lifestyle changes as well. But I think it is something that we do try to tailor. And we look at other things that they're going through. Women may be more likely to have thyroid disease than a man. So we have to ask those kinds of questions and make sure those conditions are ascertained or assessed as well. And so there are other things that we look at same time. Another question from a viewer. Vegan diet, yes or no? Yeah. I mean, it depends on your taste preferences and what you're really into. So if you want to do fruits and vegetables and be a vegan, you can do that in a healthy way. But you really have to be a healthy vegan. So I've seen unhealthy vegans where, they're just eating potato chips, and they're calling themselves a vegan. And technically, you can be on a potato chip diet and be a vegan. But that is an unhealthy diet. Or you could just eat pasta all day and be a vegan, but you're not eating fruits and vegetables. So I remember I was giving a community lecture, and someone came up to me and said they're a vegan. And I asked them like, oh, what's your favorite fruits and vegetables? And they said, they hate fruits and vegetables. And I'm like, how can you be a vegan and you hate fruits and vegetables? So that is an example of being an unhealthy began. But vegan as a whole, a lot of studies show that people may live a little bit longer, if you look at some of the Seventh Day Adventist studies. They may potentially have a decreased risk of cancer. So for some people, that is a very viable option. People who are interested in becoming a vegan, you have to be aware of the possibility of B12 deficiency. So that's something that definitely occurs in the vegan population. But outside of that, you really just have to make sure you're a healthy, which applies to any diet. And I would imagine you just have to watch your intake of-- Yeah, the macronutrients. Making sure you get a protein. What are the protein sources that are vegan-compatible. Those are why you see a registered dietitian or someone like Dr. McDonald who can help you understand what those macronutrients-- What is a good protein source for a vegan, just out of curiosity? So you'd have to have multiple protein sources. Primarily because there are a few plant-based proteins that have all your essential amino acids. So the only ones I can think of offhand, quinoa is a complete protein that's plant-based. And I believe amaranth is also. But everything else, you're going to have a combination of different seeds, different nuts, and different beans. And using that combination will get you all those essential amino acids, which are kind of the building blocks of protein. We're about out of time, but we do have one more question from one of our viewers. Keto diet, good or bad? It can be good if done appropriately. So a lot of studies show that the keto died for people who have seizures can decrease the risk of seizures. It plays a role in it, especially in people who have epilepsy. It may help out with people who have migraines. And people can lose weight with a ketogenic diet. Now, the ketogenic diet is still a relatively recent phenomenon, so in terms of long term effects, I think we need to do a little bit further studies. In terms of how it affects our gut bacteria, those studies also need to be done and are actively being done. And I think some of our researchers, specifically Jane Chang is looking at some of those, trying to answer some of those questions. But from a weight loss perspective purely, people can lose weight with a ketogenic diet. But at the end of the day, most of these diets are really restricting your calories, and really cutting back on some of these ultra-processed foods. Dr. Chapman, any parting words for us? No. I think this was fantastic. I hope everyone learned a lot. And you know, I hope you got a taste of how Ed and I work very closely together, and that we are here to help people. And if you have any questions, we're always happy to reach out. Definitely. Perfect. And we want to stress the continuum of care. Because there are a lot of services that are available here at UChicago Medicine for folks that want to lose weight and change your lifestyle in a safe manner. Yeah, absolutely. So I see people with a bariatric surgeons. For people who are candidates for bariatric surgery, I tend to at least recommend they have a conversation with a bariatric surgeon, just so they can see what their options are. Absolutely. Great. If you want more information about UChicago Medicine's weight management program, please visit our website site at UChicagoMedicine.org/weight management. It's there at the bottom of the screen. Or you can call 888-824-0200. Thanks for watching At the Forefront live, and have a great week.