Understanding obesity and how bariatric surgery supports lasting weight loss

We want to get to our guest, who has been gracious enough to join us in studio. We love company. We really do. We are so excited to have with us in ongoing conversations Dr. Vanessa Buie. She's an MD, MBA, assistant professor of surgery and bariatric at the University of Chicago. Welcome to the afternoon show. How are you? 

Thank you so much for having me. As we were just talking, this is my first time on the radio. And it's a whole different environment for me here. 

Oh. You sound like a pro, though. 

She does. 

Right? Listen, today, we are discussing an important healthcare topic that affects millions of Americans, bariatric care and weight management. And with me again, Dr. Vanessa Buie, assistant professor — welcome to the show. We are so happy to have you. And I know our listeners are happy to hear all about this. Tell us a little bit about yourself. 

Yeah. So I was raised in West Des Moines, Iowa, but my family is originally from Mississippi. And my parents still live down there now, Mississippi, as well as Slidell, Louisiana. And I have been on this journey of figuring out what I want to do, what my purpose is in life. And I came to medicine, then I came to surgery. And then I really found that a way in which I can help people and using my skills and my gifts is through bariatric surgery, which is helping people who look like us really get to a place that they can live a quality life in the way that they want to and be around their children and do everything that they want to be able to do. And I really enjoy helping people do that.

Yeah. How common is obesity today? 

I think that's a really important question and something that I really want your listeners to understand the scope of. So if you picture a room with 10 adults in it, four of those people are actually obese.

The latest CDC numbers show roughly 40% of the US adults have a body mass index in the obesity range. And that's about 100 million people in the United States. 

That doesn't surprise me at all, which is roughly a third of the population, a little bit less —

It's more than a third. 

Yeah, absolutely. 

Yeah, especially with these super sizes that are at the drive-through. 

That's always the option, right? I love when I order something from the drive-through and they're like, do you want the small? And they make it sound like —

Like it's so tiny.

Right. I'll be like, yes, the one that's $9.99.

[LAUGHTER]

I'm cheap. I don't want the upcharge. All right. So, Doctor, let's talk about this. Let's talk about obesity rates amongst ethnic groups.

Yeah. I'm thinking about my cards because I'm a cue card person. But there are a lot of differences. And especially in Chicago, Black adults — both nationwide and in Chicago — see some of the highest numbers, in terms of obesity rates. Across Cook County, it's about four in 10 Black adults live with obesity. Latino communities, that's the same, in the 40% range.

And then we have white adults, which are more close to one in three. And Asian-American adults have —

I'm sorry. What are ours again?

— the lowest prevalence.

What is African-American again?

Four in 10, around 40%. Yep. And then I think the other thing — I don't treat children, but I think it's something that we really have to think about, because the children are our future. And when we look at our kids, that gap widens even more. Black and Latino children in Chicago are about four times more likely to have obesity as their white counterparts. These differences aren't about individual willpower, either. They reflect what's available in our neighborhoods — safe places to move, affordable fresh food. Just like we talked about, the drive-through is a problem.

Quality health care and freedom from chronic stress — on the south and the west sides, for example, it's tougher to find a full-service grocery store than a corner store loaded with junk food.

I agree.

Let's talk about reframing obesity as an actual medical condition. Why is that important?

It's super important because obesity is a real medical condition. It's influenced by your brain, your hormones, your genetics, and the environment that you live in. If you think about, in terms of asthma, hypertension, depression, those are all medical conditions. Obesity is also a medical condition that we have to treat. And we have to think of it like that when we're treating it. You would never tell someone to, oh, just go work out more and eat less if they have asthma, would you? 

Oh, no. 

I love that. Again, I'm a man of a certain age, and I've lived through certain decades. And I can remember, when I was a child, I was actively bike riding outside with my friends, playing Johnny Come Across. It appeared that we were much more active. 

What is Johnny Come Across? I'm sorry —

Yeah, I don't what that is. Like Red Rover, Red Rover? 

It's just another version of tag, you're it. 

Oh, OK. OK. 

It's a more complicated version. You have to play it on a big field. But that being said — I didn't mean to throw you all off. 

No, you did. I was like, what is Johnny Come Across? 

We're here to learn everything. 

Absolutely. But that said, the video games had just started in the early '80s. And even when we did play them at home, that was kind of a treat, something that we did rarely, because not everybody could even afford them. They weren't as accessible as they are today. And we certainly didn't have smartphones. And so now we see a generation of children that are much more sedentary. We have a generation of parents that don't really cook at home. 

Again, fast food for us was a rarity, not the norm. And so now we see kids that are raised on McNuggets, raised on fast food — no shame to McDonald's. It just is what it is. And they live a more sedentary life because of technology. Are all of these recipes for what we're seeing in our children being more obese at earlier and earlier ages? 

I think there's an aspect of environment that plays into this. And we have to acknowledge that. We have to acknowledge the environment. But I think it's really important — what I want to drive home here is that it's not just about the environment. It's not just about willpower. There are many things. Your brain, in and of itself, helps control when you feel hungry. 

And for some folks, those signals to your brain aren't working properly. On top of that, you have your hormones, like insulin. I'm sure people have maybe heard leptin. Those play a big role in how your body stores fat and how much you eat. On top of that, then you add stress. Stress is also a hormone that adds fuel to the fire. And then in our Black communities —

Is that the cortisol? 

Exactly. 

Come on, come on. 

Yes, I love it. 

Keeping up, baby. 

You know it. That stress hits harder in our Black communities, whether it's from money struggles, racism, food deserts, or just trying to stay safe in your own neighborhood. That also adds a level to the brain chemistry and how our body is processing and handling fat. And then, to your point, the environment — if you don't have a grocery store, healthy food, a safe place to walk, or easy access to healthcare, it's going to be harder for you to maintain that weight. 

Well, you know what? I know sometimes when I think I'm hungry, I'm really thirsty. But we'll talk about some of that on the other side of the break, guys. We're in studio. We have Dr. Vanessa Buie, MD, MBA, assistant professor, but she's also a bariatric surgeon. And she's talking to us about this weight loss thing that you all are looking at when the summer hits. Everybody wants to be in the gym, or they want to get some work done. 

But we're talking about it from a perspective from someone who knows how to guide us when it comes to bariatric surgery. 

And as a matter of health, not just a matter of — 

Fix. Right, yeah, absolutely. 

Not aesthetics. 

It's important. So let's move to bariatric surgery and what it looks like. If we talk about bariatric surgery, when should someone even feel that they are a candidate of getting something that extreme? 

Yeah. So number one, we're going to reframe. We're not going to call it extreme, because it's not extreme. It's actually a very safe operation. But I think we have to start thinking about it when your life or your health is starting to get at risk, when diet and exercise alone just aren't enough, and you're not able to get your health in control. 

You feel like high blood pressure, diabetes, acid reflux, sleep apnea, joint pain. You're not able to run around with your kids as much as you would like to. You're not able to potentially stand at your job for as long as you would like to. At any point in time that you're feeling like, I need some extra help, I think that's the opportunity that we have to actually start talking about bariatric surgery. 

In terms of numbers, anyone with a BMI over 40 qualifies for bariatric surgery. Anyone with a BMI over 35 with one of those obesity-related diseases also qualifies for bariatric surgery. 

Excellent, excellent. Many people might be hesitant because they think it's risky, right? What's the reality, though? What makes this so safe now compared to years ago? 

Yeah, so that's a really common fear. And I'm happy you asked the question because today, bariatric surgery is safer than it has ever been. It's safer than having your gallbladder or your appendix out or having a knee replacement. I think the best way to do it is to compare this to the risk of doing nothing for someone with a BMI over 40. 

If you're living with a BMI over 35, your risk of having a cardiovascular event, including a heart attack or a stroke, in the next 10 years is actually, for men, as high as 65% and, for women, as high as 48%, doing nothing. So if you think of it like this, in terms of — you're staying on the road with severe obesity. It's like driving a car with bad brakes on the highway. It feels familiar. It's comfortable. But it is dangerous. 

Bariatric surgery is like pulling over to get your brakes fixed. It's safe. It's well studied, procedure that gives your body the help it needs to prevent something worse from happening later. So, yes, it is real surgery. But the bigger risk is often not doing anything at all. 

Yeah. And there's some attachments that go along with this as well. You and I were speaking during the break. And I want to be transparent that one of my concerns was about the behavioral sense when it comes to having a procedure like this. Can you talk to us about that? 

Yeah. So we talk about medications and surgery. Both are out there. There is a lot more support around bariatric surgery, in terms of the quality of it, in terms of the regulation, and what's required to do bariatric surgery. And what's required is having a multidisciplinary team. So my team includes nurse practitioners, who also do medication management. I have a nurse, a bariatric nurse. We have nutritionists and dietitians who work with our patients, as well as behavioral health counselors. 

Because I tell my patients, I can give you medicine. I can reroute and change your GI anatomy so that you eat less. But if we're dealing with something — if you're eating because of an emotional problem, because of something that you're avoiding, surgery, medication will not change that. Those are behavior changes that we have to change. And we have to address that in order to move forward and really get to the life that you want. 

Excellent. I got two for you this time, two for one. How much weight can someone expect to lose? And then are there other benefits that they'll see, like improved blood pressure and so forth? 

Yeah. So I tell my patients about 25% to 35% of your total body weight loss is what people can typically expect to see with weight loss surgery. That's — 

So if you're 300 pounds, you can expect to be 200. 

Mm-hmm. 

60 to 100 or over 100 pounds is what people see. Some people see less. Some people see more. It really depends in terms of your commitment to the program. And it's a lifelong program. I tell my patients, we're getting married. When I operate on you, this isn't like my other surgeries, like hernia surgery or gallbladder surgery, where I see you, do your surgery, and then I never see you again. This is a commitment that we're making to each other. You see our nutritionists, our dietitians, all of our team frequently after the surgery and for the rest of your life. 

In terms of chronic medical diseases, yes. Many of my patients actually are off of their diabetes medications and their high-blood-pressure medications within a month after surgery. 

Well, you know what? We have a caller. 

Oh, OK. Perfect. 

All right. Here we go. Hey, Lee. Lee —

Hey. So — uh-huh. 

We're expecting you to be on the topic. How are you doing this afternoon? 

I'm doing fabulous. Thank you very much for taking my call. So I wanted to ask — first thing I wanted to say is — it's great that she's speaking about this. Because it took a family member to help me understand that we don't view people with addictions the way we should sometimes. And there are people who just are addicted to food. 

And it's the same way an alcoholic would tell you one drink is too many and a thousand is never enough. For people who have that chemical imbalance in the brain when it comes to food, food is — when it's comfort, when it's sadness. And so I wanted to ask the doctor, even though you help them when it comes to the bariatric surgery, is there counseling that goes along? Because if they have a real serious issue when it comes to eating, giving them the surgery and helping them reduce the weight through that way, does that help them deal with their cravings? 

Thank you, Lee. We got you. You begin to touch on that in the last answer. 

Yeah, I think it's really important. At University of Chicago, we've committed to having a multidisciplinary team. And so I actually have bariatric psychiatrists and licensed social workers who actually screen. And I can't do surgery until they feel that the patient is ready. So it's not just me deciding, hey, we're going to do surgery. I'm not a cog in a wheel. We've got multiple teammates on the team that all have to say, yes, we're good to go in order to get surgery. 

And sometimes it's a matter of, look, we've got something we need to deal with. I have patients that are dealing with homelessness. I have patients who are dealing with addiction. And it's not saying that, no, you can't ever have surgery. But it's like, hey, you and I are working together with the team to get these under control so that you can live the life that you want to live. 

And once again —

That sounds like underwriting. 

— that's making the distinction between this — if this was cosmetic, it'd be one — but it's not. This is, again, medical. So there's going to be a different preparation for this than if it was —

Correct. 

Simply cosmetic. 

And we don't have a lot of time left. What do our listeners need to know about where they can get more information? 

Yeah. So in terms of more information, they can follow me @drvanessabuie on Instagram. You can come see us at University of Chicago Medical Weight. They can find us online. Or they can call our bariatric intake coordinators at 773-702-1618. 

All right. We'll make sure we put that number in the chat. We appreciate it. Dr. Buie, it has been an absolute pleasure. 

Thank you so much. 

And you're welcome to come back. 

I know we could do this — 

I love it. 

We could have done this for easily an hour, right? 

Absolutely. 

Absolutely. 

Easily. So that's fine. That just means you get to come back. 

Yes, I love it. 

And she said this was her first time. No way. You did great.

Thank you. Thank you. I really appreciate it. 

I'm scared to see her play pool. She'd be like, how do you hold the stick? 

Right, and then she beats you. Exactly, exactly. Thank you so much for opening up this conversation. 

Absolutely. 

It's definitely well needed in our community and to our listeners. And those of you that are listening, go to Facebook Live, and we'll put every information that you need in the chat.