Stuff You Should Know - What's up with bariatric surgery?

Episode Date: June 23, 2022

Bariatric surgery can also be called weight loss surgery. Some people think it's a highly underused tool to fight obesity. Others think it's a shortcut. We discuss all the ins and outs in this week's episode.See omnystudio.com/listener for privacy information.

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Should Know. I like that. The joke's so nice. I said it twice. So we should issue a trigger warning before this episode because we are talking about bariatric surgery, which some people refer to as weight loss surgery. And the topic of food and weight loss and obesity and weight loss surgery can be very triggering for people. So if you want to listen to this one, great. We're going to just break it down like we usually do. But if it's something that you don't want to listen to, we totally understand. Yeah. I mean, after researching this, I totally get why like a fat positive or somebody who would be triggered by talk of that could be upset by it because there's a pretty substantial argument to be made that bariatric

surgery is conducted just to make obese and overweight people acceptable to society. That that's basically the upshot of why people get this surgery done. That's not necessarily true for everybody, but there's a whole school of thought that says, you know, this is a medical form of fat shaming for some people at least. Yeah. And there's another school of thought that it's a disease solving surgery. And the evidence plays out that it really does help with things like diabetes and hypertension and can be very successful. The reason I thought of this to begin with was I saw a Vox article called, we're barely using the best tool we have to fight obesity. Yeah. And the sort of crux of that article, which we'll talk about here is that only about

one percent of people who qualify for bariatric surgery use it. And the Vox article was all behind it and basically said, we have this great tool for people that cannot seem to get down to what is a healthy weight for them who are suffering from hypertension and diabetes. And they were saying like, people should use this surgery more. And there's a lot of reasons why people don't, which we're also going to talk about. Yeah. I mean, there's one thing that everybody can agree on. Like bariatric surgery works for weight loss. It's like a spectrum of how much it works, but it definitely works. There's substantial results once it happens. And understandably so, because it is a radical surgical procedure where you're

like really profoundly altering your internal anatomy so that you can in some cases accept less food, in some cases digest food less or have less of a chance to digest food. And we should point out we're talking about 2022 modern bariatric surgery because even 10 years ago results were wildly different. The preferred surgeries were wildly different. And they've come a long, long way in the past even 10 years. Yeah. It definitely has hit its stride in the last 10 years for sure. But there's, as far as the history of this whole idea goes, this is not a new concept. It goes back at least to the end of the 19th century. Some people say it goes back as far as the 10th century.

Which is amazing to think about. And you know what, Olivia helped us with this. And I had a feeling when I said, hey, let's cover the history. I was like, there's got to be some, you know, hundreds and hundreds of year old procedure that somebody did. And if you believe the story in the 10th century, there was a King Sancho of Leon. And Sancho was so big, and this is when Ed McMahon chimes in. How big was he? He was so big that he couldn't ride a horse or walk. Ouch. As the story goes. So the doctor did the most basic form of weight loss surgery at the time, which was to suture King Sancho's lips shut so that King Sancho could only ingest a liquid diet and apparently lost about half his weight and got the throne back. So that's a nutso story.

I find something else that comes later, Chuck, even more nutso. In 1992? No. In the 21st century, there was a push to basically reintroduce jaw wiring. Oh yeah. Yeah. And so this whole thing with King Sancho, one of the original Kings of Leon, like it got picked up like a thousand or so years later, even though it's been shown not to work as we'll see. But the whole like modern bariatric surgery actually was born in the 19th century out of the same kinds of procedures, but for a totally different purpose. A guy named Caesar Rue came up with a surgical technique called the Rue and Why. And it was used in case you had like some sort of like a bowel or gastric obstruction, he figured out how to bypass it and connect your stomach to a different part of your

intestine to get around the obstruction and yet you would still have functioning parts. And that was where the idea of gastric bypass surgery came from or the name of it. Yeah, which all the way back in 1892, which is really hard to believe, but they called it Rue and Why because I believe it sort of forms a Y shape when you're finished. And there was about a 21% mortality rate initially in 1892, no surprise, but they got that down to about 11, which is really great for the time period, I think. And then, you know, things kind of went along as people were experimenting with those obstruction surgeries. There were doctors that started to say, hey, wait a minute, we now have a thing called a scale and humans, we don't just need to put grain on it, humans can stand on it.

So we know how much we weigh and everyone went, what? Hey, that's a great idea. I can't wait to weigh myself every day is what everyone said. I haven't weighed myself in a long time. I kind of quit doing that. Me too. But hard to believe, but yes, humans started weighing themselves and all of a sudden in the 1920s and 30s, doctors started in patients started paying attention to their little literal weight, not just like how they looked and how they felt. Right, weight gain and being overweight, and I'm using scare quotes here, or obese, again, scare quotes, became medicalized at that point. Like it became a medical issue, a problem to be treated. And it just that whole idea and that whole concept has taken off since then. It's just

so fully ingrained in our society that it's really interesting to think like, it's only been around for maybe a hundred or so years. But they basically would give you anything that you wanted to lose weight, like amphetamines, laxatives, just anything. You just go to the doctor and he'd give you whatever. But it wasn't until the 1940s that that whole idea of medicalizing being overweight, like really kind of spread into society at large when the insurance companies got involved. Yeah. And I should point out too, you're using scare quotes when you say things like overweight and obese, because there is so much individual variation in body weight and how people carry it and how healthy they are. And we understand this, I mean, we sort of understand

this now as far as people accepting it, but there's still not a lot of acceptance around it. That's why when you calculate something like a BMI, that is for, you know, to judge a population that does not take into account an individual or their muscle mass or, you know, their body shape. So they kind of throw these tags on overweight and obese and BMI that are useful in a certain sense, but also not useful in a certain sense. Yeah. And the BMI scale was invented in the 19th century by a guy named Adolf Quetelet. He was a sociologist and he based it exclusively on white Western Europeans. Right. So in a way, you could say the BMI scale has created the ideal body form is

a average sized or whatever the BMI says is average sized white European. The problem is, that's a problem in and of itself because you now have a compartment that you're trying to shove everybody in regardless. And if you're not in that compartment that you're supposed to be in, you have a problem, a medical problem even, maybe even a life threatening problem. But more than that, if you're not white and Western European, that scale shouldn't really apply to you, but that hasn't kept humanity or people from plugging all of humanity into that same BMI scale. So there's a lot of questions about the BMI scale itself and especially in recent years. Yeah. And I hope everyone understands when we use those terms,

all of this goes into that. As doctors were looking at still kind of performing these surgeries, they noticed that, hey, you can lose weight. The initial ruin why when you had an obstruction, they were like, wait, this is good for weight loss too, because quite simply your stomach is smaller and your body is not absorbing, you can't eat as much. It's not absorbing as many nutrients. And in 1952, they believe the very first real deal weight loss surgery occurred, again, from a Swedish surgeon named Victor Einriksen, when Victor removed 103 centimeters of small intestine from a woman, a 32 year old woman who didn't lose that much weight, but supposedly it improved her life quality. Yeah. And just the next year,

an American named Dr. Richard Varko created a slightly altered ruin why procedure called the Jejunalial bypass. I practiced that so many times. My brain just says, nope, you're never going to get it right the first time. I think that was probably close. It was close, but there was like a hitch and a stumble in there too. Jejunalial is what I would say. Oh, showing off, eh? Okay. But that may not be right either. And that comes from, I'm sorry, that's what the first time they called it bariatric surgery, right? Yes. And bariatric is from the Greek for weight or heavy.

So they said, I guess this is surgery for heavy people, maybe? I'm not sure, but that's about, the 50s is about when that name became applied to it. And then in the 60s, they were starting to do studies and experimentation with it. And there was a study that found that a temporary procedure where you would have like your stomach move to a different part of your small intestine, temporarily you'd lose the weight and then they go reverse the procedure. They found that patients just basically gained the weight back after the procedure was reversed. And at that point in the early 60s, these surgeries started to become permanent in nature pretty much across the board. Yeah. You know, that was my first surprise in this research. I thought even modern bariatric

bypasses and stuff, I thought that was all a temporary thing and that like you don't live with an egg sized stomach for the rest of your life. And that's not true. You live with an egg sized stomach the rest of your life. Yeah. They, as we'll see, they remove a significant portion of your stomach in either one of the surgeries that you get. And that when they do that, that's irreversible. That part of your stomach is gone. What's amazing to me is that they've gotten good enough at it that it has tremendous results and the complications have kind of died down over the years to where the risk of death is now down to about 0.1% in the 2020s. It's gotten that low. But just around 2000, 20 years ago, it was still up at 1%, which is really high

for a surgical procedure in the Western world in the 20th century. But they've whittled it down 10 times lower than it was 20 years before because they started using laposcopic surgery. That's right. And Livia points out that 0.1% is less than knee replacement surgery just to kind of put that, you know, to frame that. Yeah. And also I want to correct myself. It wasn't in the 21st century. It was in the mid 20th century that they tried to bring back jaw wiring, but it just doesn't work. That's right. And as a result of the success rate and obviously whittling that death rate down to 0.1, surgeries now are crunching up toward 300,000 per year. I think 256,000 was the last year that we have a number for and that was in 2019, as opposed to

about 20,000 a year in the 90s and about 150,000 in change in the mid 2000s. Yeah. Because they said, hey, everybody, we don't kill nearly as many of you as we used to. Come and get it. Should we take a break? Sure. All right. That was a good setup. So let's take a break and we'll be right back. Hey, I'm Lance Bass, host of the new iHeart podcast, Frosted Tips with Lance Bass. The hardest thing can be knowing who to turn to when questions arise or times get tough or you're at the end of the road. Okay. I see what you're doing. Do you ever think to yourself, what advice would Lance Bass and my favorite boy bands give me in this situation? If you do, you've come to the right place because I'm here to help. This, I promise you. Oh, God.

Seriously, I swear. And you won't have to send an SOS because I'll be there for you. Oh, man. And so my husband, Michael, um, hey, that's me. Yeah, we know that Michael and a different hot, sexy teen crush boy band are each week to guide you through life step by step. Not another one. Uh-huh. Kids, relationships, life in general can get messy. You may be thinking, this is the story of my life. Oh, just stop now. If so, tell everybody, everybody about my new podcast and make sure to listen so we'll never, ever have to say bye, bye, bye. Listen to Frosted Tips with Lance Bass on the iHeart radio app, Apple podcast or wherever you listen to podcasts. I'm Mangesha Tickler and to be honest, I don't believe in astrology,

but from the moment I was born, it's been a part of my life. In India, it's like smoking. You might not smoke, but you're going to get second-hand astrology. And lately, I've been wondering if the universe has been trying to tell me to stop running and pay attention because maybe there is magic in the stars if you're willing to look for it. So I rounded up some friends and we dove in and let me tell you, it got weird fast. Tantric curses, Major League Baseball teams, canceled marriages, K-pop. But just when I thought I had to handle on this sweet and curious show about astrology, my whole world can crash down. Situation doesn't look good. There is risk to father. And my whole view on astrology, it changed. Whether you're a

skeptic or a believer, I think your ideas are going to change too. Listen to Skyline Drive and the I Heart Radio app, Apple Podcast, or wherever you get your podcasts. Okay Chuck, so we're back and I think it's high time that we actually talked about how a bariatric surgery goes. And there's a couple of different ways you can go. Some are more popular than others it seems like one that used to be more popular, the ruin Y, the bypass has become less popular in favor of one called sleeve gastrectomy. See, I can never get it the first time. You want to say gastronomy? I did. I wanted to say gastropub. Yeah, this is easily the most common performed today. This is the one that's very, very popular

right now. They remove about 80% of your stomach. And basically the stomach instead of being a large pouch becomes a narrow sleeve. That's why it's called sleeve gastrectomy. And it's very, very simple in that you have a much, much, much, much smaller stomach. So you can't eat as much. You will feel full more quickly. But what also happens is, and I'm not sure if they had a hunch this would happen or if they knew this would happen, but it also tricks the body into releasing fewer of those hormones that say that you're hungry. So it's not like, oh, I'm still hungry all the time. Like you just have a smaller stomach, you eat less and you're satisfied. Yeah, you eat less and you have the desire to eat less on top of that. So I mean, you can imagine that this has

tremendous results. And I think that they did know that that hormone effect was going to happen because they specifically remove a part of the stomach called the fundus. And that's the portion that expands when you eat a lot of food. So your stomach can't expand when you eat food. You got to keep that in mind. And then also the fundus is where ghrelin is largely made. And that's that hunger hormone. So you're producing less ghrelin and you just can't physically fit that much food into your stomach anymore. Right. And like I said, it's the most popular form today. I think in the mid 2000s, it was about 18% of bariatric surgeries now or in 2019, it was 59%. It's even more than that in 2022. I just don't have the most recent number. I was

just got back from vacation in Mexico. And one of the two families that we kind of hung out with and buddies up with, I was chatting with the guy and I was like, so what do you do? And he said, I'm a bariatric surgeon. And I'm no kidding. And I was like, we're about to do a podcast episode on that. And he said, what's a podcast? Well, what's a bariatric surgery? No, he didn't ask that because we had already talked a little bit, but he, a very nice guy from Texas and he talked a little, I didn't like want to bother him too much about it. Although he really, really enjoyed talking about it because he's not only a bariatric surgeon, but he's very much a wellness doctor. And he believes that it's just part of a wellness plan for your life. Not just like, all right, we'll

do it. And then have fun in the world. So he was a good guy to talk to, but he talked about sleeve gastropub here. There I went again. Sleeve gastropub being the most popular gastropub. Yeah, it is the most popular gastropub of all time. So how does that surgery go though? It's pretty quick for one. Yeah, I think it's like 40 to 70 minutes, not that long. You stay in the hospital for a couple of nights, they keep an eye on you. And one of the reasons they're keeping an eye on you is because for two weeks afterward, you can have nothing but a liquid diet. Because if you go look up sleeve gastrectomy videos, there's a lot of computer animations out there that show you what they're doing. So you can imagine that if you remove probably, I think maybe 80%

of your stomach, it needs to heal. And the way that you help it heal over the first two weeks is by just drinking like broth, water, maybe some Gatorade, if you're feeling spicy. But again, remember, like you're not sitting there going bonkers wanting food. Most people who have a sleeve gastrectomy report having to make themselves eat. They have to keep a strict schedule because they don't want to eat like they used to. Like most people want to eat. Yeah. And I mean, we'll talk a little bit about maintenance later. But I think in the end, they recommend you eat like, you know, four to six very small meals a day. Like there's no way around it. You're going to change your eating habits and your lifestyle in a big, big way

if you have this surgery. And I read a lot of first person accounts of like, you know, can you ever go out to eat again and sit down with your family and enjoy a meal? Because if you're filling something the size of an egg, it's like, can you even order a meal? And, you know, everyone that I read was, it's like, yeah, you know, you, you get used to it. You go to the restaurant, you order an appetizer, maybe, and you don't even eat half of the appetizer. And you take the rest home, you do a lot more talking at dinner. And you don't drink alcohol, you can't drink liquids while you eat at all. They're saying, you know, you drink liquids no more than like 30 minutes before you have a meal because there's so little room. I did see some people say they

could drink a little alcohol, but it's really recommended you basically quit drinking. Certainly you don't want to drink beer when you have a tiny egg stomach. Oh my God. Oh my God, that sounds terrible. It does. But you, there's no way around it. You are changing your lifestyle. But across the board, when I read all these first person accounts, everyone was like, you get used to it. And the trade off is for them, that they are much healthier and happier and generally didn't have the regrets. I'm sure you could find some people that had regrets and were like, I miss sitting down and eating big meals with my friends and family. But I mean, most of the people that I read were pretty satisfied with the surgery. So after you get surgery too, and I can imagine

they're satisfied because when you get a sleeve gastrectomy, the doctors who perform these kind of procedures, they use something called excess weight to qualify the success of the surgery. And excess weight is the difference between your ideal weight and what you weighed before the surgery. And 18 months after the procedure, patients typically have lost about 70% of their, of their body weight after the surgery, within a year and a half. They're excess weight, right? Yes, they're excess weight. Yeah. And you know, generally, it's not like the days of your with gastric banding,

which has really gone out of favor. A lot of complications, the weight generally did not stay off. But with sleeve gastrectomy, and then as we'll see with gastric bypass, the weight does tend to stay off for years. Although people do gain some of the weight back. One study saw after 12 years, about 40% of patients had maintained a 30% weight loss or more compared to their original total weight and 93% were at least 10% lighter than they'd been. So 60% of people gain back more than 30% of their weight. Is that a way to say it? Yeah. I have to admit, you just made my brain do a somersault. But yes, that's the converse, I guess, huh? Yeah. So 60% of people gain back more than that 30%. But

it doesn't mean they gained all the weight back. That could have been 32%, 35%. No, because again, like you said, 93% or at least 10% lighter than they've been before. There's a lot of percentage just flying around here. Yeah. So, but the upshot is, is that you are definitely going to lose weight. If you're a physician, especially if you're a bariatric surgeon, you consider bariatric surgery the gold standard for rapid and sustained weight loss. If you have a patient who is, again, obese to maybe say 300, 400 pounds or more, you would say, look, you really need this surgery and it's going to change your life. You would probably also tell them it's going to save their

life too. Again, it's questionable, but that's the medical stance. That's right. Then we have the gastric bypass, the original Rue On-Y or RyGB surgery. They staple off part of your stomach. They reduce that remaining part to, again, about the size of an egg and then they attach it to that Rue limb of the small intestine. And you're, you know, most of that stomach in the upper small intestine is now bypassed. That's why I call it bypass surgery. And this one is, I think there are a few more complications now and that's why this one's fallen out of favor a little bit compared to sleeve gastrectomy, right? Yeah. The impression I have is that sleeve gastrectomy is much more or much less complicated afterward because you're not

messing with the original plumbing. All you're doing is removing a large section of the stomach. Everything else remains as is. Right. So you still have a risk of developing an infection or leakage in your stomach or all sorts of stuff. But you're not bypassing, you're not detaching the stomach and then reattaching it elsewhere, which adds an entirely different dimension to that surgery. And that's what Rue On-Y is. And when you're doing that, Chuck, the reason why you're doing that is because you're basically keeping the small intestine from being able to digest as much like fats, carbohydrates, all that stuff from the food you eat. So you're eating less, but you're also digesting less of it or absorbing less of it. So that leads to rapid weight loss

as well. That's right. So like we said, as far as this being an effective thing, you know, losing weight for some people is really, really, really hard. So for some people, it is a mountain that they cannot overcome. Diets, you know, I think the verdict is in across the board on diets, which is diets are a quick fix and it's very hard to keep that maintenance. Everybody basically agrees that long-term weight loss involves life, complete lifestyle change and not some kind of crazy diet that you're doing or even not crazy diet that you're doing. Exercise we've talked about on the podcast is great for your body, but you cannot exercise the weight off if you don't change the food and drink portion of your life. Right. Precisely. And even when you do diet,

like you may actually change your body so that you aren't able to lose weight after a point. And when you stop dieting, you may gain back more weight than before. So that could be dangerous. For sure. You don't want to mess with your metabolism too much. And I would direct people to our intuitive eating episode. We talked a lot about that. Yeah. But that, like you said, the verdict being in on dieting has really kind of supported the idea of bariatric surgery as not only the gold standard, but really the only real option you have if you want to lose a serious amount of weight. And so a lot of people have been studying just how effective it is. And like you said, there's lots of percentages flying around and how many people kept how much weight

off. But there was this one study that looked at people who have gastric bypass surgery and contestants on the biggest loser, which is a weight loss competition that's been on TV forever. And they use them because it's hard to find a group of people who lose about as much weight as you would lose with the gastric bypass surgery, but without using gastric bypass surgery. So they made like an ideal control group. That's right. And what they found is really super interesting. Both groups lost about the same amount of weight, or at least similar amounts. But the biggest loser group, I hate even saying that, I hate that dumb title, the biggest loser group experience what's called metabolic adaptation, which is to say that their metabolism slowed down and it made it harder

to keep that weight off. So six years on down the road, that control group with the biggest loser bunch had regained a lot of that weight. But their metabolism was still really low, and slower than it was to begin with. So it kind of permanently altered, it seems like, I don't know about permanently, but at least six years later had altered their metabolism. It's not permanent, no, but they will have to go through the process of retraining their body to not store as much fat or burn energy slower in order to get back to normal. But that's what dieting can really do to you. But what happened with the other group? Well, the other group, the bariatric surgery patients, their metabolism stabilized. So there's a lot of rapid weight

loss just because you're taking in less, but also because your body is not producing hunger hormones like ghrelin. And it may actually produce more of the satiated, is that right? Satiated? Satiated? Sure. Sitcom? Satiated. Satiated hormone leptin. So their metabolism actually, it just stabilized. So eventually they stopped losing weight, maybe gained a little bit back, but typically kind of hold what's referred to as a baseline weight, basically the weight that your body and your metabolism says, this is how much you should weigh. Try, as you will, we're always going to try to get back to this. And if you mess with us, we're going to make it harder on you than ever. Right. Which I mean, that study really makes a pretty good case for bariatric surgery as an

option for people. Right. So does this. There was a meta analysis in 2021 that saw, we talked earlier about, you know, health complications from carrying too much weight, that bariatric surgery reduces the risk to develop type two diabetes by 61% and hypertension by 64%. And if you already had those conditions going in, which can be one of the criteria to get the surgery to begin with, the surgery was associated with remission even. So just to take a little sidebar, I didn't understand how people can say, okay, if you're faced with data like that, how can you possibly say that obesity is not necessarily linked with poor health or that there's a concept called healthy at any size, which I want to do an episode on eventually.

And the thing that I saw, the explanation is, yes, these things are associated with obesity, with being overweight. But it's, the point is, is if you're obese or overweight, you're not automatically going to get type two diabetes. Right. You're not automatically going to develop hypertension. And in much the same way that smokers may or may not develop lung cancer, people who are overweight or obese may or may not develop type two diabetes or hypertension or some of the other maladies, I guess, associated with being overweight by the medical establishment. Yeah. Yeah. That's a good way to look at it. Yeah. I just wanted to add that. Sure. But Chuck, the thing is, it is, it is evident that yes, if you do have those maladies,

yeah, gastric bypass surgery, bariatric surgery will definitely help your health outcomes as a result. Yeah. Or headed toward those. And it's not like, if you get regular physicals, you know, when you're headed toward those, toward type two diabetes and hypertension, it's not like a switch is just flicked. And you're like, all right, I've got those two conditions now, like, you know, the blood tests that they give you. And trust me, I've been, I go every year now, like I want to know about my body. I'm not one of these guys who is overweight and like just buries my head in the sand. I probably to my detriment want to get too many tests done and things like that. Because I want to know what's up. But, you know, I've seen my own health like

creep up toward those numbers to levels that I don't like. So then I have to work to like get those numbers back down. And it's all, it's all data driven. And it's all from blood tests. And I just encourage people to go get their physicals every year. There's no, I know people that bury their head in the sand and are just like, I just don't want to know about that stuff. And I just think people should really be advocate for their own health. And what's the word I'm looking for when you are just sort of preemptively sort of getting tests to find out where you stand, you know, taking action. Yeah. Well, taking action on the medical side. So you can take action, you know, at home. Yeah. Also, you know, you don't have to go to a doctor to get blood tests.

You can order your own basically and just go to like Quest or Labcorp or something. Oh yeah. Just like do your own blood panel. Yeah. Yeah. And they have, you know, the results show if you're in like a normal range or whatever for everything. Yeah. Or if you cut yourself, squeeze a little bit on a piece of white paper and just look at it for a while. That's right. What does it look like? It's like reading tea leaves or chicken guts. What was I going to say? Oh, they did, as far as the meta analysis, another study with that analysis, they found about half the people with type 2 diabetes that had the surgery had enough improvement that they could get off their medication. And that's what remission

basically is. It's sort of like you're always an alcoholic even though you quit drinking. Like technically, you're still diabetic, but if it's in remission, that means you've gotten your numbers down to a safe level, you can get off the medication and stuff like that. So also, by the way, that's questionable as well as whether you're still an alcoholic after you quit drinking. Well, is it? Yeah. I mean, it's sort of just terminology though, right? No, not necessarily. I think there's definitely a school of thought that's once an addict, always an addict. Like you will always be addicted even if you go for the rest of your life, 50, 60, 70 years without ever taking another drink, you'll always be an alcoholic. Other people say,

no, that's not true. And that's a whole mindset that keeps people trapped in this idea that they're addicted or an alcoholic when they aren't any longer. And it produces a lot of unnecessary shame and hardship. You know, I'm glad to hear that because I always thought that was weird when someone who like quit drinking 20 years ago says, I'm still an alcoholic. And I just thought that's not for me to judge like that's their terminology that they need to use. But I always thought that was a strange way to think about it. So I'm glad to know that. I think that does apply for some people. I'm not saying it may be for all people. Yeah, it's just the opposite is true as well. Just because you're an alcoholic, it doesn't mean you're always going to be an alcoholic for

everybody. Okay, I got you. So Chuck, Chuck, Chuck. Yes. I say we take a break. All right, let's do it. I'm going to go into remission and use the restroom. Hey, I'm Lance Bass, host of the new iHeart podcast Frosted Tips with Lance Bass. The hardest thing can be knowing who to turn to when questions arise or times get tough, or you're at the end of the road. Okay, I see what you're doing. Do you ever think to yourself, what advice would Lance Bass and my favorite boy bands give me in this situation? If you do, you've come to the right place because I'm here to help. This I promise you. Oh, God. Seriously, I swear. And you won't have to send an SOS because I'll be there for you. Oh, man. And so my husband, Michael. Um, hey, that's me. Yeah, we know that Michael and

a different hot sexy teen crush boy band are each week to guide you through life step by step. Oh, not another one. Kids, relationships, life in general can get messy. You may be thinking, this is the story of my life. Just stop now. If so, tell everybody, everybody about my new podcast and make sure to listen so we'll never ever have to say bye bye bye. Listen to Frosted Tips with Lance Bass on the iHeart radio app, Apple podcast or wherever you listen to podcasts. I'm Mangesh Atikular and to be honest, I don't believe in astrology, but from the moment I was born, it's been a part of my life in India. It's like smoking. You might not smoke, but you're going to get secondhand astrology. And lately, I've been wondering if the universe has been trying to

tell me to stop running and pay attention because maybe there is magic in the stars if you're willing to look for it. So I rounded up some friends and we dove in and let me tell you, it got weird. It got weird fast. Tantric curses, major league baseball teams, canceled marriages, K-pop. But just when I thought I had to handle on this sweet and curious show about astrology, my whole world came crashing down. Situation doesn't look good. There is risk to father. And my whole view on astrology, it changed. Whether you're a skeptic or a believer, I think your ideas are going to change too. Listen to Skyline Drive and the iHeart Radio app, Apple Podcast, or wherever you get your podcasts.

All right, we're back. I'm glad we cleared that up about alcoholism. I didn't know that that was going to pop up. I didn't either. No, I'm glad you said something though. That's good information. Yeah. So I might say it's stuff you should know. I just use the line that I hate that everyone else uses when you first meet them and tell them what you do. Oh, yeah. At some point when you meet someone new and you tell them what you do in the name of the show,

at some point they say, oh, that sounds like stuff you should know, right? Yeah, they definitely do. Or they'll hit you with, so tell me something I should know. Yeah. Yeah. I also realized just this week, Chuck, why some people who write in abbreviate the show S-U-S-K, I've never understood what they were doing. I finally noticed the why and the you are next to each other on the keyboard, on a QWERTY keyboard. Oh, you think that's what it is?

It's got to be. I just figured people were doing the Prince thing. Or just, you know, internet shorthand for you as you. Right. But it doesn't make, oh, yeah, I guess it does. It does. Stuff you should know. Okay. Well, I'm back in the wilderness as much as I was before. Let's talk about some risk factors. You did talk about leakage.

Always is, you know, just with any kind of abdominal surgery you might get, there's a risk of infection and clotting, hernia ulcer, gallstones, bowel obstructions. I think most, I think you find more of those specific ones in the gastric bypass rather than the sleeve. And then explain to everyone what these two great words together mean, dumping syndrome. One of the most unfortunately named medical conditions that has ever been put forward. I think so. Dumping syndrome is where you basically, when you're eating after gastric bypass surgery

or bariatric surgery, the food just moves out of your stomach too quick. It's not, it's not predigested enough. So when it hits your guts, it causes cramps. It can cause diarrhea. There's another variation called late dumping syndrome where if you eat an overly sugary meal or snack or whatever, it can drop your blood sugar precipitously because so much insulin gets released because again, it wasn't predigested or pre-absorbed in any way. It just kind of shows up in your gut like, here I am, I'm a bite of steak.

Let's see what we can do. Yeah. The other thing you're going to have to do is potentially take supplements, you know, just because you're eating so little, you're also getting fewer good things into your body. And, you know, hopefully you're eating good things. If you continue to eat just very small amounts of bad stuff, and again, we're using scare quotes, but, you know, if, if I get this and I continue just to eat fried chicken and mashed potatoes, then I'm not giving my body the nutrients that it needs. And you might need to take supplements.

One thing you definitely have to do is eat really, really slow and chew like you've never chewed before. Yeah. You got to chew like Dr. Kellogg. Yeah. I mean, I think you're essentially trying to trick your body into thinking you're on sort of a liquid diet still. Yeah. But I think also your body is sending you signals like, please, please stop. Yeah. The three bites of steak is too much, you know, like it's sending you those signals. So you're, you, yeah. And I think it's, from what I understand, it takes some,

some working out and figuring out how to eat under this new, under these new circumstances. Yeah. It's a little bit of trial and error, but that people, you know, work it out over time. I bet you really appreciate food. Yeah. I could see that being an effect of it. I could also see becoming totally neutral toward food being an effect of it as well. Yeah. I mean, there are definitely psychological impacts and that is played out with another interesting side effect, which is, and I saw this in a few places,

is that you are more likely to get divorced than if you didn't have the surgery. And I think there was one study, there have been plenty of studies, but there was one in 2018 that found 9% got divorced after the surgery compared to 6% of the control group. And there are a lot of ways to look at that. One certainly is it, maybe you have the increased confidence to leave a relationship. You didn't have the confidence to leave before that you should have leave like a bad relationship. Yeah. Apparently you get married or in a relationship more if after you get the surgery, which also could make a lot of sense. Yeah. Which is nice. I like that one. That's the silver lining to the

other cloud, you know? Yeah. So if you said, okay, what about me? How do I know if I qualify for bariatric surgery? Because I don't know if we said or not, Chuck, insurance will cover it. Medicaid, Medicare and private insurance will cover it under certain circumstances because, again, obesity has been medicalized and is seen as a disease or a syndrome or symptom of disease, right? Or associated with disease, if not a disease itself. So they've said, okay, we'll cover this if you have a BMI of at least 40 or you're more than 100 pounds overweight. I was surprised it was just 100 pounds. I would have thought it'd be more than that. Yeah. Or if you have a BMI of 35 and you also have type 2 diabetes or sleep apnea or hypertension or fatty liver

disease, it's not from alcohol, osteoarthritis, lipid abnormalities, heart disease or gastrointestinal disorders. Gastropub disorders. Along with that 35% BMI or if you have tried to lose weight with several multiple efforts and are unable to, and I think that's included with the BMI, right? Yes. Yeah. And that's actually, I mean, they, insurance companies will make you jump through a lot of hoops and one of them is you need to try to lose weight and show that you can't before they'll ensure you in some cases. There's a lot of meanness to it really if you step back and think like that you're treating somebody like that not because of any medical condition, but because they're overweight. But that's what insurance companies do to get to pay for it.

And if you pay for it yourself, Roxanne Gay got it done and wrote an essay about it. And she said that she paid out of pocket because she didn't want to have to jump through any hoops or red tape. And she said that the cost was breathtaking as she put it. Oh, really? So yes, I would get the impression that the average person would not be able to afford it out of pocket. So there are hoops you're going to have to jump through. Apparently, according to a 2020 paper by Boston Medical Center, fewer than 1% of patients, like we said, get the surgery that qualify. And one of the big reasons is a lot of physicians, PCPs still do not recommend it. Apparently, you're five times more likely to get it if it is recommended by your primary care physician.

But it just doesn't happen as much. Yeah. And I think a lot of the PCPs aren't up on the advances that have been made in things like mortality rates and the fact that it's moved over to laparoscopic. So if you get like a kind of old and said in their ways, primary care physician, they might not know that bariatric surgery is much safer than it used to be. And, you know, much less invasive. They're like, here, just have a soda pop and it'll be fine. Exactly. Have a diet coke. So if you do get bariatric surgery, there's a chance, an 80% chance that you are a woman, right? That's right. Even though obesity rates are the same for men and women, women are way more likely to get the surgery. Also, when women get the surgery,

compared to men, they are younger than their male counterparts. And I think that it's more like referrals. You're more likely to get the surgery because you've been referred by someone who got it rather than coming from your doctor. And it also shows that women, and this is sad and not surprising at all, that 84% of women listed psychosocial concerns as one of their biggest motivations, even over health-related concerns. Yes, but infertility has also been strongly linked, as far as I understand, to being overweight or obese. So it's possible that some of the increase in women who get it or the disproportion of women who get it could be because they're seeking to have a family or have an easier pregnancy too. Right. And again, on the

sort of general shaming outlook of this surgery, there was a survey about five years ago in 2017, a poll, I guess, that in the U.S., almost 40% of people responded that bariatric surgery was the easy way out, rather than just losing weight the old-fashioned way. Yeah, and that's such a crock because it's like, hey, you should really lose a bunch of weight. Oh, you're getting bariatric surgery. That's the easy way out. And that really underscores how much people look at being overweight as an individual moral failing, that there is something wrong with you, yeah, or a choice, or that you're just lazy or you just can't help yourself, whatever. So much so that just people who are overweight or obese are just looked down upon. They're not treated with the same kind of

dignity that an average-sized person would be. And this actually shows up in medical settings too. Apparently doctors will not pay as much attention to health indicators like cholesterol level or glucose levels or whatever. And instead, just pay attention to the appearance of an overweight or obese patient when they recommend gastric bypass or bariatric surgery. So they're not saying it's because you're hyper tense or because you have diabetes. They're essentially saying it's strictly because you're overweight. Yeah, and sort of the one thing that's obvious to me is everything that I've seen about the surgery, the recovery, your lifestyle, afterward for the rest of your life, there's nothing easy about it. Yeah. It is not the easy way out. It's not like,

no, it's a 40-minute surgery, then you're good to go. It's not an easy thing. And it is a not something to go into lightly. It is a major surgery that will completely alter the way you eat. And a lot of people, the way they eat is a big part of their lifestyle in their life. And it will alter that forever. And it's a big, huge monumental change. And there's nothing easy about it. But it is your decision. It's up to you. From what I've seen about the fat positive activist community, they would probably recommend that you reflect on exactly why you want the surgery. Right. Is it because you are being pressured by family, friends, society? Or is it just for whatever reason? And whatever reason you have, it's your, again,

it's your decision. No one can tell you that it's right or wrong, but you should definitely educate yourself on the risks and the benefits and everything about it. And then just make your decision and feel good about it either way. Yeah, I agree. I think this is like one of those topics that people might research late at night, even feeling ashamed to even look into this kind of procedure. And hopefully we could clear up some of this stuff. And if some people feel good about, then they can own it and move forward with their head held high. Very nice. You got anything else? I got nothing else. Well, since Chuck says got nothing else, that of course means it's time for a listener mail. I'm going to call this just a new listener from Canada. Okay. I don't think

that's how they say it. I'm a new listener. Just want to say how much I enjoy the show. My husband told me about stuff you should know. And I kind of brushed them off thinking this was just another boring podcast, trying to teach me boring things. But I finally gave it a shot and was hooked after the very first show I listened to. You guys have great chemistry. I heard another listener call you Burt and Ernie type, a Burton Ernie type. I feel that. I'll take that. Sure. You have a great mix of random knowledge and important knowledge. And I love your true crime episodes too. Hope you keep going forever. And you should know my husband is not letting me live this down, that he is the greatest podcast taste. That is from Autumn in Thunder Bay, Ontario, Canada,

North America, planet Earth. Very nice, Autumn. Thank you very much. And we're glad that you're with us, even though it was your husband who made you do it. That's right. If you want to be like Autumn and get in touch with us, we would love that. You can send us an email. It's the best way to do it. Just wrap it up, spank it on the bottom lightly and send it off to Stuff Podcasts at iHeartRadio.com. Stuff you should know is a production of iHeart Radio. For more podcasts, my heart radio, visit the iHeart Radio app, Apple podcasts, or wherever you listen to your favorite shows. Hey, I'm Lance Bass, host of the new iHeart podcast, Frosted Tips with Lance Bass. Do you ever think to yourself, what advice would Lance Bass and my favorite boy bands give me in this

situation? If you do, you've come to the right place because I'm here to help and a different hot, sexy teen crush boy bander each week to guide you through life. Tell everybody, everybody about my new podcast and make sure to listen so we'll never, ever have to say bye, bye, bye. Listen to Frosted Tips with Lance Bass on the iHeart Radio app, Apple podcast, or wherever you listen to podcasts. I'm Munga Chauticular and it turns out astrology is way more widespread than any of us want to believe. You can find it in Major League Baseball, international banks, K-pop groups, even the White House. But just when I thought I had a handle on this subject, something completely unbelievable happened to me and my whole view on astrology changed. Whether you're a skeptic or a

believer, give me a few minutes because I think your ideas are about to change too. Listen to Skyline Drive on the iHeart Radio app, Apple podcast, or wherever you get your podcasts. with Caroline Hobby every Monday on the Nashville Podcast Network available on iHeart Radio app, Apple podcast, or wherever you listen to podcast.