The 27th Degree

The 27th Degree – Episode 22: Obesity and Bariatric Surgery with Dr. Lamaitre

By June 11, 2021August 17th, 2021No Comments
https://www.youtube.com/watch?v=ZAvP0GLolcI

Join us as we discuss obesity and bariatric surgery with Dr. Matthew Lemaitre. We’ll discuss the causes of obesity, strategies to lose weight, and if surgery is the right treatment plan for you.


Transcription

Dr. Christopher Joncas:

Well, welcome everyone to the 27th degree with Chris and Nancy from 27 Degrees Consulting. We’re really excited today to have Dr. Matt Lemaitre with us, and Dr. Lemaitre’s going to talk to us about obesity, and we’ll have a really thorough, and I think really exciting discussion about obesity and treatment and whatnot. But before we get into that, I just want to mention our sponsor of course, BayCoast Bank, just right for all of your financial needs. Visit baycoastbank.com or call 508-678-7641 to learn more. Now before we get going, Nancy, do you want to mention a few things? Some housekeeping things?

Nancy Medeiros:

Yes, not so much housekeeping, but we have our new button to click if you want to support our podcast. You can become one of our Patreon supporters and our platform is you are able to listen to us now on multiple platforms. So we have iHeart, iTunes, Alexa, Google Play, FM Player, Pandora.

Dr Christopher Joncas:

That’s really exciting.

Dr. Christopher Joncas:

So why don’t we start, maybe Dr. Lemaitre, you can tell us a little bit about yourself, your background, and then we’ll get right into it.

Dr Matthew Lemaitre:

Great, all right. Well, Nancy and Chris, first of all, thank you so much for having me.

Dr Christopher Joncas:

That’s a pleasure.

Dr Matthew Lemaitre:

It’s a pleasure to come and share what I think is an important message about obesity. And I really want to applaud you guys for the health messages that you guys are getting out every day.

Dr Christopher Joncas:

Thank you.

Dr Matthew Lemaitre:

I hope that your viewers can make this sort of part of their routine in the morning as part of their health routine to really make sure that they’re mindful about it over a lifetime. So thank you.

Dr Christopher Joncas:

Thank you.

Dr Matthew Lemaitre:

I’ve been working in obesity and bariatrics for quite some time now, over 15 years, I graduated from Tufts Medical School in Boston. I did my residency at UMass, and though I’m a Massachusetts boy, I went and worked in New Jersey for quite some time.

Dr Christopher Joncas:

I was at UMass also by the way.

Dr Matthew Lemaitre:

Oh you were?

Dr Christopher Joncas:

You got a good school there and residence.

Dr Matthew Lemaitre:

I loved it, fantastic education and really great community medically wise and great pathology. So I thought it was a super education. And then I moved to New Jersey where I worked for the Hackensack Meridian system down there. And more recently I’ve moved back here four years ago to work with Steward. And so I’ve been working in the Fall River, New Bedford area since that time, as well as Boston and Eastern Massachusetts, but my primary home and my primary focus is the Fall River, New Bedford area, Prima CARE at St. Anne’s.

Dr Christopher Joncas:

That’s great. Yeah, excellent, excellent. Well, why don’t we start talking just to maybe we can just discuss obesity in general? And I know you have a lot that you wanted to say in regards to that.

Dr Matthew Lemaitre:

Sure, yeah. I think it’s a super important issue to discuss and it affects all of us. Okay, so I love talking about it on any level. I love reeducating my patients about what I think obesity is and how I think we should view it as far as how it affects our health and how important it is to our health. So I guess I might want to ask you guys just a simple question and for your viewers as well. Did you have that cup of coffee in the morning this morning when you came in? Did you drink a cup of coffee or did you get one? Are you guys coffee drinkers?

Nancy Medeiros:

So I’m a tea drinker.

Dr Matthew Lemaitre:

Excellent, all right.

Dr Christopher Joncas:

I’m caffeine free. So I do not drink coffee.

Dr Matthew Lemaitre:

All right, perfect. As you know, as a society, we’re sort of addicted to coffee now, and I tell my patients, tea drinkers are the only thin people left out there. It really does help because when we drink coffee, we’re really not drinking coffee now anymore. We’re drinking sugar water. And so I try and educate that we’ve only got a certain amount of calories that we can use during the day. And here, all of us are driving through the various fast food places to get our cup of coffee in the morning, which by the way, as you know, in the 1970s, it was in that little blue cup about this big.

Dr Christopher Joncas:

Tea cup initially.

Dr Matthew Lemaitre:

Yeah, and now watch how it’s grown. And then I started asking my patients, “Well, what are you putting in that? Or have you ever peeked behind the counter and seen those two big scoops of sugar go into the coffee?”

Dr Matthew Lemaitre:

So if you start thinking about coffee, not as a coffee bean with something, with caffeine to wake you up in the morning, but start thinking of it as a sugar drink, then things can rapidly change in how we tackle our weight problems. And I think that’s the fastest, simplest way to look at it. I mean, you drive up to some of these places and even, I won’t mention anybody by name, but some of them have striped awnings up front, like a candy store, and you go in and everything is a carbohydrate. I think the only thing that’s healthy in some of these places is the banana on the counter and then everything else, and it very quickly adds up. A simple cup of coffee nowadays will minimum starts at about 60 calories. But more often, we aren’t walking out of that store without spending about 500 to 1,200 calories on a cup of coffee.

Dr Christopher Joncas:

I mean, if you were to get a donut or a bagel, you’re adding probably what? 400 or so calories?

Dr Matthew Lemaitre:

Which we frequently do, out of convenience. And because we really got to get to work or get on with our lives. This convenience though is costing us dearly. And it seems cheap on the surface, but it really isn’t.

Dr Christopher Joncas:

I mean, I see not infrequently when I’m at work, I see some of the staff come in with the big coffee from the place we won’t mention, they have written on it what they put in and it’s like five, seven sugars.

Dr Matthew Lemaitre:

Well, have you noticed nowadays that it’s not even a real bean that’s dropping into your cup? They’ve got the little bar dispensers and they’re putting syrup in and right there, that’s 100 calories. So I think the simplest way that if you’re going to drink coffee, then okay, it’s black and espresso, like an Italian drinks it and then okay, I’ll give it a pass. But I think that’s the first place to start because it does boil down to the calories. And if we’re waking up in the morning and we’re spending 1,000 calories getting cup of coffee, then we’ve already defeated our whole day. So no amount of proportion control, portion control or diet is going to help at that point.

Dr Christopher Joncas:

Interesting.

Nancy Medeiros:

So one of the things that I’ve heard in the past, and I’ve struggled with my weight off and on, and someone had told me once, make sure you don’t drink your calories. And that’s kind of like, that’s always stuck in my mind, because it’s quick, you can gobble it down.

Dr Matthew Lemaitre:

Yes, and this is a perfect example of that. So we all have in our minds the notion of how many calories we should be doing, and it averages out somewhere between 2,000 and 2,500 calories per day. At least that’s what our government tells us. In reality, the calories that the human body needs to do well and survive and thrive and had done so for millions of years before we invented fast food is about 1,000 calories, and that’s shocking for people to know. So here’s the next concept that I like to sort of change people’s minds about obesity, and it’s what if we called obesity by a different name? Because most of us, when we look at the extra weight that’s on our belly, we think oh, that’s not important. I’ll get to it sometime. But I’ve got more important things to do, like do stuff for the boss and stuff like that.

Dr Matthew Lemaitre:

But that weight that’s on our waist, it really is a factor in our health. And so what I tell my patients is let’s relabel obesity and let’s just call it malnutrition. Now most of us, most of us, what do you think of when we grew up, what were we taught? Who was the person who suffers from malnutrition?

Nancy Medeiros:

Third World countries.

Dr Matthew Lemaitre:

Yes. So we’re all worried about the person in the Third World who’s not getting enough calories a day, they’re starving. And so we’re supposed to be worried about them. It turns out that’s 10% of the world’s population. So should we be worried about them? Absolutely. Now, what if malnutrition though just means bad nutrition? It doesn’t tell you how you get that bad nutrition. It just means bad nutrition. And instead of few calories, it turns out that we can have too many calories and that can lead to malnutrition and that can shorten our lives.

Dr Christopher Joncas:

So mal meaning bad, it can be on either end of the spectrum.

Dr Matthew Lemaitre:

Exactly.

Dr Christopher Joncas:

Right. And then there’s just this kind of sweet spot in between that we’re trying to hit.

Dr Matthew Lemaitre:

Yes, and so the optimal calories for a human being for millions of years was about 1,000 calories, and it still is okay. But now we’re all doing about 4,000 to 5,000 calories a day, really depending on who you are, what you’re doing, it’s up in that range. And so is it any wonder that all of us are being affected by obesity? It’s literally everybody. Now you look at it and the statistics just keep growing year after year. And it’s only in the span of the last 35 years, we’ve gone from a nation that was by and large a body mass index, which we can get into of about 25 or relatively thin to a body mass index where we’re all in the obesity range or the overweight range. So when I look at obesity, I call it malnutrition. And then I say, “Well, geez, 75% of Americans fall into that camp.”

Dr Matthew Lemaitre:

And so who are we supposed to be worried about? Who should we have the commercials for and send the checks to? Shouldn’t we be worried about our own malnutrition first and foremost. And an interesting thing, if you go on the website to look at when you give money to UNICEF or something like that for malnutrition, nowadays, they actually have the whole scale and they’re sending money to Africa and they’re sending money right back to America. So they’ve actually figured it out more so than I think most of us who assume that this is normal.

Nancy Medeiros:

I love the way that you think about that. I think it captures it so much better.

Dr Matthew Lemaitre:

And then I have one other thought that I like to tell patients about obesity is fat cells. Are these good cells or bad cells? Because they know what the vast majority of my patients will answer.

Nancy Medeiros:

All right. So this is a trick question. I was going to say bad, but just the way you asked it. I think they have a good side.

Dr Matthew Lemaitre:

Is there a good side? Yes. In fact, they’re very, very good cells and they’re central to us doing well as humans, as individuals, as a species. So if you were to boil down the species to two functions, and I know this is an oversimplification, you might say it’s to reproduce and to survive. So our ovaries are our best cells in the body because that allows us to reproduce. Our fat cells, they allow us to survive. So what is the primary role of a fat cell other than to slow us down and make us look heavy? What’s the primary role of a fat cell?

Dr Christopher Joncas:

It is to release energy when we need it.

Dr Matthew Lemaitre:

Yes. So we’re storing energy and then whenever we need it, we can do the work. I don’t see plugs on us. We’re not plugging ourselves in. So just like our cellphones and our laptops, we walk around without a cord, and it’s because we have these fat cells. So what do we put in our cellphones and our laptops that allow us to not plug them in?

Dr Christopher Joncas:

Like batteries, and it’s like our batteries, right?

Dr Matthew Lemaitre:

Yes, these are batteries. And they were designed over millions of years and they’re fantastic. And they’re really good at their job. And by the way, some families developed really good battery packs. I’m going to call those the Teslas of the world and then other families, not such good battery packs. And then I’m going to call those the Nissan Leaf, sorry, Nissan. They’re not as fun.

Dr Matthew Lemaitre:

This is one way that I want people to feel good about what’s happening is we have these fat cells and we’re doing exactly what they were designed to do, get us through the famine. And some people have better fat cells than others. So this is not a disease that anybody should put some shame and stigma on. This is, we designed ourselves over millions of years of evolution to conserve energy. It’s only in this era that we have so much energy and I mean food energy, because that’s where we get our energy from unlike electricity for a product. We get food energy, and it’s so abundant that we actually can’t get rid of the energy anymore. And it builds up on us. And so, whereas the system worked great for millions of years and the people who developed the best fat cells, they were king of the hill for millions of years, now unfortunately it’s crippling us.

Dr Christopher Joncas:

It’s a great way to look at it though. And it’s amazing, when you look at society in general, I mean we are all, everywhere you go, do you want the largest size? Do you want to supersize it? Go out for drink. Do you want for 10 cents or 20 cents extra, the bigger, the portions are out of control in our society. I mean these are not normal portions that we get in restaurants or anywhere. Now, I guess in our homes also.

Dr Matthew Lemaitre:

Yes. We’re just so used to eating so much. It’s really, and it’s so ever-present that think back to now for all of us who are of that age, if you think back to the 1970s, that dinner plate that we’re all eating off of all of a sudden it got a lot bigger, just like those cup of coffees got a lot bigger. And so the portions nowadays are not appropriate portions. And so if we work back to, we only have 1,000 to 1,500 calories a day to spend, the portions now that we get when we go to school and we go to the lunch counter, they are inappropriate portions. And the portions that we get at these fast food places are inappropriate and they’re calorie dense and they are not nutritious. So we’re doing ourselves a disservice on both fronts, more of poor quality food.

Nancy Medeiros:

And the type of calories matter too, right? I can’t just be going along in my little diet and think, oh, I’m going to eat those two cookies. I’m going to go get on a treadmill. And I know they’re like 300 calories. I’m going to see that 300 calories pop up on my treadmill and done. It’s like, I never eat those cookies.

Dr Matthew Lemaitre:

Yes. And that brings in, obviously there’s a large literature on what are the appropriate calories. And my patients come to me all the time and ask, “Well, what’s the appropriate diet?” And all of my patients have been on diets their entire lives. They do not come to, as you know, I’m a surgeon. So by the time somebody comes to me, they’ve had a very thoughtful journey about weight loss and they know that they’ve struggled with it their entire lives. So they’ve been on every program and every diet aid and even medications. And then they eventually come to me if they can’t get the weight off that way. What I would argue, and you’ve heard this sort of statement before is that the very word diet is inappropriate because it assumes that you’re going to go down to a certain weight and then you’re going to stop and then you’re off the hook and then you can essentially do whatever you want.

Dr Matthew Lemaitre:

And I’ve seen it time and time again, that if people have goals of a certain weight, they get down to that weight and then the wheels fall off. And all of a sudden we’re going back up the scale. And that’s true for myself as well too. There are periods where I will use a food calorie counter app on the phone, which by the way, I would suggest is one of the best ways to lose weight is just be honest with yourself. It’s called the observer effect. If we observe a thing, we actually get better at doing it. So as far as diets, it’s very hard because there are fads and there are diets that come and go. Is it carbohydrates this year? Or fat is bad? Or is it protein? Protein is the latest hero of the story, but is it appropriate to eat up on protein?

Dr Matthew Lemaitre:

I mean, the extreme of that is something like the Atkins Diet, and I would argue that, just keep it simple. And I want my patients to always have sort of just a general goal in mind and on the diet side of the street, what I call the guy on the farm in the 1920s. And so if you’re ever going to eat something, buy something, cook something, ask yourself what the guy on the farm in the 1920s could do. By and large. If he could do it, you can do it. So nothing in a package, there’s no stores outside the home. If you didn’t put it in your lunch bag and bring it with you, it’s not happening. Other than like a glass of tea or something during the day, he didn’t have anything outside the farm to eat. And by and large, his plate was mostly vegetables. So he was getting that three quarters of a plate of vegetables and then one quarter of a plate of protein. And back in the day in the 1920s, he couldn’t eat all the chickens he wanted because he needed to sell them and he needed to sell the cows and the milk. And so his intake of protein was not as much as what we’re doing today. It was on that order of four ounces, not what we’re doing.

Nancy Medeiros:

Sometimes that’s what I struggle with a little bit too, because I see like we’re so fast paced, running from one place to another to another. And if you don’t think and prepare things and have something in the queue next up, you’re like, “I’m starving. It’s like 2:00 now, I’ve missed lunch. And all I see is McDonald’s on the road ahead of me.”

Dr Matthew Lemaitre:

We’ve become a hyper efficient society. Whether it’s the cellphone, all the demands and the stresses that we don’t have time to stop and obviously be our own chefs. That’s not possible. We have very little time in the week. And so if it’s going to be done correctly, yes it has to be done on a Sunday where you’re planning out. And I know I’m most successful when I line everything out on a Sunday. And if it’s all in the fridge and I just grab my little lunch bag, I’m good. The moment I walk into the cafeteria, I’ve blown it. The moment, yes the bariatric surgeon drives through a fast food joint to get a cup of coffee, he’s blown it. We’re human and we need sustenance to keep up with this modern life that we’ve created for ourselves. You know what I mean?

Dr Christopher Joncas:

You brought up kind of, sorry, Nancy, you brought up a really interesting point directly. I’ve noticed this with my patients over my career is the patients who, which is really a majority who struggle with weight issues, because it’s just a societal issue really. A lot of them have the sense that they can fix this with exercise, and clearly exercise is good and it’s important for us to do, but I’ve never really seen anyone without modifying their food intake, been able to lose weight with just exercise alone.

Dr Matthew Lemaitre:

Yeah. So you brought up just a fascinating, there are a bunch of points there, which is, is this a societal disease or is this an individual disease? And we’re all Americans. We like to take individual responsibility seriously. And we all blame ourselves. And we say, “Oh, this is my fault because I drove through the fast food place today. I wasn’t good.” I would argue that this is very much a societal disease, a genetic disease. And the minor portion of it is our calorie intake and our calorie expenditure. Okay, so there’s diet and exercise and we really can’t make inroads unless we’re working on both those sides. So yes, that’s the individual responsibility of it. But I would say 80% of this is a societal problem because when you look around and see that everybody’s mother, brother, uncle, everybody has this disease, and yet we’re taking the responsibility on ourself and the shame and the stigma on ourself of obesity. It’s not appropriate and it’s not fair. Our patients need access to care. Our population needs access to care. And we’re denying them that if everybody thinks this is their own disease and they need to tackle it on their own. They don’t, we need to tackle it as a society, but you know what? There aren’t a lot of messages like that out there today.

Nancy Medeiros:

So what are the first couple of steps someone can take? I mean, when they’re seeing you, like they’ve done the whole yo-yo thing and they come to a point where I just need something more. So what are the first things and what are the first steps you are telling them? And what’s your conversation with them like?

Dr Matthew Lemaitre:

Sure. I think It’s all about education. It’s all about how we become educated and we become our own best defenders of our good health. So it really does take some work. We need to become our own best nutritionist. We need to become our own best physical therapists and trainers. And it’s really about a support system and it’s about coping. So when we get down to it, I have my bias that obesity is the disease and everything else might just be a symptom of it. And if we got that disease, we would get everything. But in reality, the disease also springs from coping and all of us have to try and cope with the stresses of modern day life. And we do so to a better or worse extent at different times in our lives and depending on who we are.

Dr Matthew Lemaitre:

And so it’s really about getting a support network. And so if you get education through support groups, online groups, I mean think about it, nowadays, we can go online and get information like this that you guys are providing just in this format. But there’s also the participatory element when your viewers write us in and ask questions that we can answer, but then even more. So it’s about getting an army of friends that can just work with you and they can share their secrets with you and they can share their failures with you as well. And what you get from that is, well, now you can avoid the pitfalls. But you also get energy and motivation. I mean, all of us, sometimes we are super energized and we’re really good about our diet and we’re really good about our physical activity, and there are times when we’re just not.

Dr Matthew Lemaitre:

So my thought process for my patients is go to a support group and steal their energy. They’ve got it. They’re willing to give it to you and motivate you. And that’s how you really get started is just having an army of friends so you know that the decisions that you’re making are the ones for you and that they’re lifetime. They’re not just about one and done. So this is not about a diet. It’s not about exercising for a couple of months and then that’s it. And it’s not about a surgery and then that’s it. This is a lifelong endeavor, and it’s affecting all of us. In fact, I used to give a talk to high school students called obesity is a skinny person’s disease too. And the idea behind that is we all have fat cells. We’re all eating the same inappropriate foods and we’re all not exercising enough. And so we’re all subject to obesity.

Dr Christopher Joncas:

You brought up an interesting point. You said that you look at obesity as kind of the major cause of I think, many diseases. And it’s so true. I mean, if you think about it, diabetes, heart disease, many cancers, all of this is related. So it’s really a huge issue. Even beyond obesity itself, it leads to so many other diseases.

Dr Matthew Lemaitre:

Diseases, that’s correct. And it actually does take a toll on us and it does shorten our lives. So the way that I explain it, and this is an oversimplification, but I think it’s a nice visual is yes, the fat cells aren’t just, or the fat isn’t just on our belly. It’s parking itself elsewhere in our bodies. So one day it decides to park it around the arteries. Well, now we’ve got high blood pressure and we’re at risk for a stroke. One day, it decides to park it in the artery is high cholesterol. And now we’re at risk for a heart attack. Obstructive sleep apnea is just the obstruction in the airway. Fatty liver is what it is. It says its name, right? And then the knees, we all are familiar with arthritis and the stress and the strain the body just wasn’t designed to carry this much weight for this long, a period of time.

Dr Matthew Lemaitre:

I heard from one of your other physicians who had mentioned that maybe they should recall, we call it pathology by its real name. And so it reminded me that when I’m in the hospital, I go in, I get called to people’s bedsides all the time. And they will come in with various things like a heart attack or pneumonia, respiratory failure. And I remind my nurses, my patients, my residents, I remind them, they didn’t come in with pneumonia. They came in with an obesity attack as manifested by a pneumonia, or they came in with an obesity attack as manifested as the heart attack. And so it’s inappropriate for us as a healthcare institution to not recognize that be an obesity friendly zone, which St Anne’s and Prima CARE are. So it’s amazing how much they’ve embraced the whole issue and to really tackle it as a topic, because when a patient comes in at a certain BMI, you have to recognize that maybe it wasn’t just the thing that was on the piece of paper that said heart attack. It might have been something else.

Dr Christopher Joncas:

Sure, that’s a great point.

Nancy Medeiros:

What kind of education and support do the patients get? So you just talked about that hospital setting. So someone who’s obese had a heart attack and they’re, I’m just thinking of discharge instructions to the patients. Okay, here’s your new diet. Don’t have any salt and watch your calorie intake. So what are you saying to you patients when-

Dr Matthew Lemaitre:

Yeah, and it is hard because obviously we’re limited in our resources. We are not, and I can’t mention them by names, but the big diet organizations and stuff, I like to look at it as a holistic approach. And I’m giving what I can with the resources that I can. So our patients are seeing nutritionists before, during and after the whole process. They’re always plugged into the support group. We run a support group walking group. So we’re walking with our patients. We’re trying to envelop them and encourage them to then develop more of that type of a support and educational infrastructure. But as you know, the discharge instructions say essentially, eat better. Well, what does that mean? It’s hard. It’s hard. We’re sort of pushing us stone up a very big hill.

Nancy Medeiros:

So you talked about something important, the support leading up to the surgery. So what other things, what is on that checklist? If I know I want bariatric surgery, what am I expecting when I go in and see you? And what’s that timeline look like?

Dr Matthew Lemaitre:

So that’s good, and the timeline has changed dramatically. I mean, just a few years ago, it took one or two years to get to weight loss surgery if you could get through our program at all. Now that’s been refined down to three months. As we get rid of the shame and stigma around obesity, and we start to treat it like other diseases, there’s no other disease where you get a diagnosis and somebody says, “Well, wait in line for two years.” So now we’ve tried to look at it differently and say, “Well, if you’ve got a cancer diagnosis, you would get your chemotherapy immediately.” If your gallbladder was sick, you would get your gallbladder out immediately. And so we’re trying to look at it like that, which is maybe the fruits of weight loss surgery are after, and not as much before as they were, but the truth lies in between. It is before, it is the mindset that the patient comes in with.

Dr Matthew Lemaitre:

So we’re always looking for how engaged our patients are and that’s part of the process. So we do support them beforehand with the nutritional visits. The insurance company requires a psychology visit prior to the procedure. And then I’m looking at it from a physician’s perspective. I want to make sure that the day that the patient goes to surgery is safe. So I liken it to an obstetrician is watching her patient for nine months before she gives birth. And the one role is to make sure that day she gives birth is a good one. And so I want to make sure that that day that we do surgery is a good one. So for the three to four months that we’re following you prior to the procedure, I am basically making sure that this is safe on all levels.

Dr Matthew Lemaitre:

So I tell my patients complications happen here and now when we’re talking, not in my operating room and did I know something about your health that I was supposed to know? And it turns out in surgery, everything is always important. So we go through a thorough history and physical, and we do it several times each time they come in, because we want to make sure that we haven’t missed anything that every stone’s been touched. And if we need to send you to a cardiologist, to a pulmonologist, and we also include Dr. Yacoub and the medical weight loss aspect, because we want the patient to be embraced all around to make sure that they have different options because maybe surgery isn’t for everybody. There are four ways to lose weight, diet, exercise, medications, and surgery. So maybe Dr. Yacoub is where you want to be, and that’s right for you. Or maybe you’re at the stage where weight loss surgery is what’s right for you now.

Dr Christopher Joncas:

And patients can go to you if they’re unsure, just to get information too. I mean, they don’t have to have decided I want to have weight loss surgery. Maybe I want to learn more about it. I’m a bit on the fence, but I’m interested in it. They can go to you for that?

Dr Matthew Lemaitre:

Yeah, absolutely. As you can see, I have no shortage of love about talking about obesity. So if you want to come in and just get an educational information, that happens all the time. In fact, I speak to my patients as if they haven’t decided on going to weight loss surgery, because I don’t know at that time, when I initially meet them, if they really are going to weight loss surgery, and my theory is, is this might be the one and only opportunity that they get to learn about obesity, and so I’m going to use it. So it is an educational visit, the initial one.

Nancy Medeiros:

What are the qualifications for insurance to cover this?

Dr Matthew Lemaitre:

Sure. So insurance qualifications actually surprisingly are fairly minimal nowadays.

Dr Christopher Joncas:

It’s gotten better.

Dr Matthew Lemaitre:

Yes, much better. In fact, it’s just a nutritional referral, a psychology referral, some labs, and really that’s about it. And sometimes the support group, they have really pared down what they require beforehand. Some insurance companies do require four months in the program. And for those insurance companies, we do want the patient in the program for four months. It’s more sort of what we require and we’re doing the difficult balance of are we discriminating? If we block somebody from surgery on the other hand, I also want to see some engagement before, because I want to make sure, and how you judge that is very difficult. Do you judge it just by the scale? It’s sort of putting a whole gestalt around the patient as to how energized they are about it.

Nancy Medeiros:

I wasn’t going to say anything. I thought you made up that word, gestalt, like stop looking at words.

Dr Christopher Joncas:

She did not, Nancy did not believe it was a real word.

Dr Matthew Lemaitre:

Yes, it’s the whole world view. I want to know that my patient is as excited about it.

Dr Christopher Joncas:

That’s funny. You can just put translations down at the bottom of your screen.

Nancy Medeiros:

The transcript’s going to be fun to edit that.

Dr Christopher Joncas:

Right, I’m sure you will, I’m sure you will.

Nancy Medeiros:

So is there a certain BMI you have to hit to qualify?

Dr Matthew Lemaitre:

Yes, so good point.

Nancy Medeiros:

And I guess we should explain what a BMI is.

Dr Matthew Lemaitre:

Yes. All right, so body mass index is the imperfect way of how we put everybody on the same scale, and it’s basically height and weight, and it’s a calculation, and we can all get online and look up body mass index calculator, and figure out what our body mass index is. And I do like it in the sense that you can never tackle a problem until you know where you stand and you’re honest with yourself. It’s like Suze Orman with finances. You got to stand where you live. Well, you got to stand where you live and your body mass index is essentially that. So anyone who has a body mass index of 35 and above with two health issues related to obesity is a candidate for surgery. Anyone whose body mass index is 40 and above is a candidate for surgery with or without health issues. So if you’re 40 and above, the insurance company essentially will authorize you. If you’re at 35, you need two health issues.

Dr Christopher Joncas:

And what would be some of those health issues you’d look at just for our audience so they’re aware?

Dr Matthew Lemaitre:

Sure. So, so they’re the big ones that all of us Americans have, high blood pressure, usually on medications or treated with medications, high cholesterol, obstructive sleep apnea, asthma, acid reflux, infertility for young women. And as I mentioned earlier, before we started erectile dysfunction for men. Those are big ones that are affected by obesity. So there. So they’re looking for, and diabetes obviously is the big one and arthritis sometimes.

Dr Christopher Joncas:

There’s a lot that I wouldn’t have thought about, so that’s interesting. I would have thought of diabetes and hypertension, heart disease, but I never would have thought of knee arthritis or erectile dysfunction or some of those other issues. So that’s great that that can help people to have the insurance cover. This procedure can be so necessary.

Dr Matthew Lemaitre:

I think things are coming along and we’re realizing, and maybe it’s ethical change from the insurance companies, or maybe it’s a financial change from the insurance companies, but they’re recognizing that this is a big problem for all of us, right. And maybe the more expedient route for them cost wise is to approve this earlier.

Dr Christopher Joncas:

So it probably saves them money down the road. If they can have healthier clients down the road. They’re not going to spend the money on diabetes and the complications of heart disease, et cetera.

Dr Matthew Lemaitre:

Yes.

Nancy Medeiros:

What is the actual procedure that you do now?

Dr Matthew Lemaitre:

All right. So that’s also a good question because these change all the time. So we used to do three procedures, and the three procedures were the band, the sleeve and the bypass. In fact, back 10, 15 years ago, it was just the band and the bypass. And so when patients would come in, I would describe to them that there are three surgeries and I would call it the baby bear surgery, the mama bear surgery and the papa bear surgery. The papa bear surgery, okay, sure it’s a big cut by the surgeon, but big results. The baby bear surgery, the band is we throw a belt buckle around your stomach and you can’t eat as much. It’s small cut by the surgeons, small results. And so I would present them evenly. But then what I found out was that patients were sitting in my waiting room and they’re all having a virtual, basically a support group in my waiting room. And they’re talking about the different surgeries. And by and large, nowadays, most people are coming to the sleeve. There are certain categories that I still do the bypass for, but the dynamics has changed at least for now. I think that those will change in the future, but for now, by and large, it’s the sleeve gastrectomy, which is a very small surgery with relatively big results.

Nancy Medeiros:

So what are you doing surgically, like you’re just saying a sleeve, and I’m sure some viewers are just picturing like this tight constriction around.

Dr Matthew Lemaitre:

Yes. And in fact, and that’s a very appropriate question because I have physicians who will ask me what is a sleeve, and it’s the name that the gentleman who invented the surgery gave to it. And basically what we’re doing is if you imagine that the stomach is a big storage container, let’s just call it a shopping bag. And instead of a big storage container, I’m going to trim your stomach so that it’s a small storage container. So now it’s long and narrow, like the rest of your intestines. If you hold your thumb up, it’s about the size of your thumb visually, and so you can’t eat as much and you can’t eat as fast. And because of that, you lose weight. Now, there are technical other reasons why you lose weight. There’s this appetite stimulant called ghrelin that is diminished after the surgery. I call it the munchie hormone.

Dr Matthew Lemaitre:

You lose weight because of that. But in essence, what I’m doing is I’m tailoring a narrower stomach so you can’t eat as much or as fast. And because of that, you lose weight. Unlike the bypass, which is a bigger surgery, the bypass is both restrictive, meaning I’m restricting how much you can eat and how fast you can eat. So I’m giving you a smaller stomach, but I am also bypassing some of the intestines and the role of the intestines is to absorb any meals we have. So if I bypass it, literally like the HOV lane on the highway, the two lanes of traffic can’t meet, well, the food can’t meet the digestive juices, and now you can’t absorb the calories.

Nancy Medeiros:

You have such a good way of explaining things like the analogies, great. It’s like, oh yeah, that makes perfect sense. So now if I’m understanding correctly, I’m overweight. I’ve been struggling yo-yoing. I meet these certain requirements and now I have like maybe a three month lead up to the surgery if that’s the way I’m going. So now I have the surgery. What am I expecting afterwards? Am I in pain? How long do I stay out of work for? And what’s the diet look like?

Dr Matthew Lemaitre:

Sure, okay. So first of all, yeah, I think that getting to surgery is a big moment in people’s lives because it’s been building for a long time. I’d say the only barrier to surgery right now is more ourselves and coming to the decision that this is appropriate for me. And again, that means friends and support groups and really making that decision. The surgery itself is the small part. It’s a 45 minute surgery now, which is the same as a gallbladder.

Dr Christopher Joncas:

That’s great. I didn’t know it was so brief.

Dr Matthew Lemaitre:

Yeah, very brief. I tell my patients, I say, “Tell your family members it’s three hours.” Because for you, it’s five minutes, you take a nap. For me, it’s 45 minutes. For them, it’s an eternity. So I just said three hours, but it’s actually 45 minutes, like a gallbladder. And it’s four small little incisions. I do it laparoscopically, which is the small little incisions or I do it robotically, same thing for small little incisions. And 45 minutes, you are up and walking around on the hospital floor an hour after the procedure. I do still keep people one night. So I want to see how people are doing with the diet, their vitals, their exam, make sure they’re safe and that they’re doing well. And then we send them home the next morning on a liquid diet.

Dr Matthew Lemaitre:

And so here’s the rub. We keep people on a very strict diet for the first two months. I tell people they’re in my penalty box. And it’s while the stomach is healing, because in order to fashion a new stomach, a smaller stomach, it has to heal. So we close the stomach with a long staple line. And in reality, even though that staple line is made of titanium, the strongest metal ever, it’s not what keeps your stomach together. What keeps your stomach together is your tissues healing. I mean, imagine if you cut yourself on your hand and you watch it close, that’s what I’m doing in my mind’s eye for your stomach on the inside is I’m watching it close, and then I’m releasing you onto a regular diet.

Dr Matthew Lemaitre:

So you’re on liquids for two weeks, essentially. And then you’re on what I call the baby food diet after that, which is puree for two weeks, then soft solids. And then by about a month and a half, I graduate you on to a regular diet, but by regular diet, I mean, I’ve operated on your stomach and I’ve made it smaller, but I have not operated on our eyes or our brain. So it’s a lot, it’s a new day. It’s a lot smaller than most of my patients expect. And to give it sort of a volume size that maybe people can relate to, I tell them it’s like a large egg for breakfast, lunch, dinner and a snack. And that’s it, that’s 1,000 calories for the whole day now until forever. So it’s a much smaller.

Dr Christopher Joncas:

So we have to change our whole, after the surgery and hopefully before a lot has gone on to change our perception, the whole perception around food has to change.

Dr Matthew Lemaitre:

Yes. And that’s where it can be shocking. I find the younger patients, so I have advantages and disadvantages of my older and younger patients. Younger patients can change on a dime. They can get an idea in their head and they can become a vegan or vegetarian overnight and do tremendous success with it. We, on the other end of the spectrum, it’s harder to change us. We all think we know better and we’ve determined how we’re going to live our lives. So it can be a shocker for the older patients. However, where I love my older patients, is that we all know after a certain age that the warranty kind of wore off. And now we’ve got to protect our body and we’re serious about it. And so we take it a lot more seriously, whereas the younger patient may not take it as seriously over the course of a lifetime.

Dr Christopher Joncas:

I’m interested in how people change their relationship with food. Because I think back to myself growing up, somewhat of an ethnic family, food was, we had food when we celebrated, we had food when we were sad and it was usually large quantity. It’s hard to break that relationship.

Dr Matthew Lemaitre:

It really is. It’s integral. I mean, you know, if you have a problem in any other area of your life, you might be able to get rid of that habit. But food is what we humans have socialized around and we’ve done it for millions of years. I mean, to get right down to it, we were celebrating that we made it from year to year. Wow we’re all making it from year to year. But we can’t afford to celebrate every coworker’s birthday party with a cake. So it is integral to how we view ourselves, how we view our socialization in our society and it’s very hard to change.

Dr Christopher Joncas:

You know, a lot of times, and this may seem like maybe an odd association, maybe it’s not, but I take care of patients who have addiction. So I’m not an addiction specialist, but in primary care, many of my patients come in, they have problems with drug addiction or maybe alcoholism or whatever it may be. And particularly with drug addiction, it can be really hard because the whole group that they surround themselves with are often people who enable their use. So one of the pieces of advice I’d give them is if they are really serious and they’re going to a program, when they get out, they have to really almost find a new social structure, a new group. So with food, it seems like you have to also in a way do that too.

Dr Matthew Lemaitre:

Absolutely.

Dr Christopher Joncas:

You have to like, so I’m just going to drive by McDonald’s and make believe it doesn’t exist anymore.

Dr Matthew Lemaitre:

Yes, you have to write things out of your life. And that’s where the support group and the walking group come in handy, is I’m trying to replace addictions. As you know, obesity is multifactorial. There’s genetic, behavioral, societal, and then there’s also an addictive portion of it. And I see it all the time. My patients go through a little bit of sugar withdrawal over the first 21 days after surgery because of how sugar-laden the American diet is. So now they have to replace that addiction with something else. And my hope is that they will replace it with yes, no enablers. So join the support group. Families who do the surgery together, or any kind of weight loss together, any kind of health activity together do better. So right there, you don’t want to surround yourself with enablers. So you either got to convert them or get new friends.

Dr Matthew Lemaitre:

And it really does make a difference. And I have people who switch addictions after surgery, and that can be a good thing or a bad thing. You mentioned one, which is alcohol and people after these surgeries have to be very careful with alcohol. However, another addiction that I have all the time is exercise. And it’s a great one, and I have patients all the time who get addicted to the point where I’m jealous of them. I stopped losing weight because I have one gentleman who walks nine miles every single day. He’s clearly addicted to it and he’s doing fantastic.

Dr Christopher Joncas:

That’s great.

Dr Matthew Lemaitre:

Is that everybody? No, and it’s very hard for me to predict how people will do after surgery and what’s the magic key, just as it is for all of us to predict when we’re doing well in our lives and when we’re not. It’s hard to predict.

Nancy Medeiros:

So when you get back to your regular diet, there’s foods though that you’re still, you’re just not eating anymore, so like breads and things like that.

Dr Matthew Lemaitre:

Yes, well, some of them, we actually like that you can’t get back to them as easily. So breads, pastas and rices, which expand in your stomach and are carbohydrates, which is what the food pyramid was developed on in the 1970s, that’s what got us all obese in the first place. Thank you, American food industry, so I’m okay with those ones not coming back as easily into the person’s diet. And it really depends on what surgery you had. If you had the bypass, then carbohydrates are extremely poorly tolerated. That can be a good or bad thing. And then if you had the band, you want to be careful because it is a restrictive device that doesn’t have any give. So you don’t want to be eating things like hotdogs with skin on them or grapes with skin on them that might get lodged. That could be an issue. That’s why the band sort of fell out of favor is that it’s a little too severe and then it wasn’t getting the weight loss that people wanted. The nice thing about the sleeve is it’s your own stomach and it stretches and has give and so things move through and because the food is moving in the way that it was originally designed, I guess to do. You don’t get dumping syndrome with the sleeve. So that can be a good and a bad thing. You can do carbohydrates for the sleeve.

Dr Christopher Joncas:

Can you just mention what dumping syndrome is to our audience?

Dr Matthew Lemaitre:

Oh, yes sure, and that’s a hard topic to describe, but when we do the gastric bypass, we are bypassing part of the intestine. So the stomach goes right to the small intestine. So anything you eat, if it’s a simple sugar, it goes right to the small intestine. Now the small intestine is not used to seeing the concentrated sugar all in one bolus. And when it sees it, it doesn’t know what to do with it. And it basically sends a lot of fluid right into the intestinal lumen and you know where that fluid’s going, right out the other end. So it can be quite a fast trip to the bathroom.

Dr Christopher Joncas:

The appropriate term for the condition.

Dr Matthew Lemaitre:

Yes, I think they nailed it over that one.

Nancy Medeiros:

So now, what is the followup with you like after surgery? And suppose like I’m two years out and I’m maybe doing some things or I’ve really pushed the envelope to see, well, what exactly will happen if I eat this?

Dr Matthew Lemaitre:

Yes, and by the way, that’s a great topic. What exactly will happen? Because we are all humans, we’re all going there someday at some point, which is how do I test the system? And the way that I describe it to my patients is, is we’re all great saboteurs of ourselves. Is that another word we can add to the list.

Nancy Medeiros:

I know that one

Dr Christopher Joncas:

Nancy’s okay with saboteur.

Dr Matthew Lemaitre:

But we’re very intelligent. We know right where the Achilles heel is on anything and we’re going to go for it. And so this is where yes, we have to realize that the warranty did wear off and we can’t be saboteurs of ourselves. We really do have to not test the limits, but all my patients will at some point, and then it’s a matter of where they’re going from there. So that’s where the aftercare comes in. So I believe that it’s a lifelong aftercare network that we need to build. And so at varying points in my career, I’ve called it the alumni association, or if I had ultimate resources to be the Jenny Craigs of the world, not to mention anybody or I would have a whole 360 element of my patients, but I don’t.

Dr Matthew Lemaitre:

So the followup typically is several visits with us afterwards. We also send you back to Dr. Yacoub’s office for visits afterwards. And I look at it as endless. I want my patients always following up with me. I get patients from other weight loss surgeons, and they say, “Oh well, I was dismissed after the two years.” And I was like, “Well, obesity, doesn’t go away after the two years. This is a lifelong struggle. And if anything, the first two years were the happy days. That’s when you were losing weight. And now, what’s going to go on with the rest of your life?” So I look at it as a lifelong project. In fact, when I did talk about physical activity and what to do afterwards, I call the 80 year old Zumba lady, which is all of us in our lives, whatever age we’re at, we have to suddenly become the 80 year old Zumba lady.

Dr Matthew Lemaitre:

We look at what she’s doing and how she got there and how she got there was she put the caretaker first. Before she took care of other people in her life, she decided, “You know what? Five days a week in the gym, and I’m going to make my friends there. I’m an endurance athlete and I’m going to do it for 40 years.” And because of that, she avoided the obesity epidemic. She always put herself first, which is a little selfish. But for gain. Now she’s 80 years old, she’s jumping around like a 13 year old girl. She’s taking care of her grandchildren. And she’s the cool grandmother on the dance floor at the wedding. That’s the way the world’s supposed to be. It isn’t supposed to be the inverse where we aren’t making it there or our family’s taking care of us in later years. It’s not where the world is supposed to go. So I think that that’s also something that people have to be mindful of is look around you and see what you want to make on a day to day basis decision-wise to make sure you become the 80 year old Zumba lady.

Dr Christopher Joncas:

That’s a great way to look at. I mean, it’s interesting you brought up this kind of timetable. So when someone has surgery, it seems to me in the first year or so, they’re getting a lot of positive reinforcement. They’re losing weight, their friends, their family are saying, “You look great. You’re doing so well.” And then they reach a plateau and that’s probably where it gets a little hard.

Dr Matthew Lemaitre:

And the attention goes away. You can’t do the Facebook posts anymore.

Nancy Medeiros:

[inaudible 00:49:42] the sizes, so you’re excited and you’re shopping.

Dr Matthew Lemaitre:

Yes, yep, you got addicted to the fast part of the weight loss curve. And now this is the quieter curve. This is where expectations are important. And I try and set expectations even before the patient has surgery or has decided on surgery, that it is lifelong. Any diet is wrong because it’s not lifelong. Any exercise program where you quit two weeks later, two months later is not, no, I’m talking 40 years. That’s when I’ll let you quit, if at all, but you won’t want to, because you’ll realize that that was the key to the success was that daily exercise, and all the studies show that the more you get the cardiovascular system moving, the longer our lives are. And that’s what the daily exercise is, that’s what my walk group is, is to get people out there and know that yes, obesity surgery is one part of it, and it’s a very small part of it. It’s like for lack of a better metaphor, it’s like a reboot for your computer.

Dr Matthew Lemaitre:

Your computer started working slow because it got a virus one day. And I cleaned it up. Your computer is working fast, but if you go to the same websites mentally or food-wise, then your computer’s going to slow up again. So it’s only one facet, just like high blood pressure medications will help, but it’s not curing it. Surgery is a tremendous help, but it’s not curing it, but there are some big wins with surgery, like diabetes. I send my patients home routinely on half their diabetic meds or none right out of the hospital. So that’s one day they were on their diabetic meds, the next day they weren’t, that’s one of the biggest joys.

Dr Matthew Lemaitre:

High blood pressure, the next couple of weeks, usually they’re off their high blood pressure medications within a matter of weeks after surgery. High cholesterol, it’s usually only a couple of months. Obstructive sleep apnea, the patient knows that immediately because they come into my office and they’re tapping their foot and they have more energy than they know what to do with. And I’m like that person, I wouldn’t have even needed the diagnosis of obstructive sleep apnea. I know they had it because now they’re getting oxygen to the brain and they’ve got energy, but we usually don’t get the CPAP machine off until a couple months later. So one way that I get thrilled about my job is I look at it as I’m one of the few doctors that gets to take away medications, not add them on but again, this is not a cure, and you get to a point where the weight loss stalls or there’s weight regained, and that’s a whole other topic too.

Nancy Medeiros:

I want to visit that too, but I had two questions for you. One for the younger women, where do babies fit in?

Dr Matthew Lemaitre:

Oh yeah. All right, that’s a great question. So first of all, I used to push younger women away in their 20s and stuff, and my main bias and it’s my bias was this, is you’re young. Go do it the old fashioned way, which is our bias. Diet and exercise and surgery is easy. So I would spend an hour long lecture with them, basically designed to sort of push them away and say, “Go change your mind.” And then I got scolded by a patient one day, she came in and she was in her mid 30s. And I told her my theory. And she said, “I missed out on my 20s because I was obese. The only thing I want about this surgery is I wish I had done it when I was 20, so that I could have gone out on dates, enjoyed life, felt good about myself. That’s part of life too. And I missed out on 10 years.”

Dr Matthew Lemaitre:

And that was the first time that I realized, oh, maybe my bias is not the important bias as here, and maybe it’s someone else’s bias. Now, as far as pregnancy, here’s the fascinating thing. And this is also difficult to understand. If optimal nutrition is at 1,000 calories, then you are optimally prepared for pregnancy at 1,000 calories. So people with a BMI that is down the scale have a much, much healthier pregnancy and delivery than those who are up the scale. So it’s actually a great thing beforehand. And I wish that all my gynecologist and obstetrician friends of which my sister and brother-in-law are, I wish they would send people with infertility to me much, much sooner because I see people struggling with infertility for five years. Their ovulatory cycles are not on mark. And with the weight loss comes, hormonal changes and the ovulations come right back and they become much more regular as far as periods. And it helps resolve things like PCOS and stuff. But fertility does jump up.

Dr Matthew Lemaitre:

Now, do I want you getting pregnant in the first year after surgery? Absolutely not. So we ask people to not do anything that way. I mean, yes, but just not get pregnant for the first year after surgery so that your body is at a steady state, but theoretically speaking, you are now eating the appropriate amount of nutrition. You are maximally nourished, not malnourished because you’re eating less.

Nancy Medeiros:

So you’re positioning yourself great for a healthy pregnancy.

Dr Matthew Lemaitre:

Yes. Not only to get pregnant, but to have a healthy pregnancy.

Nancy Medeiros:

Now I know with the bypass, the meds, you still have to take like the B12, the calcium and the multivitamins. Are we taking meds forever with the sleeve?

Dr Matthew Lemaitre:

Good question, and I’m very slow to change. Conservatives are very, I mean, surgeons are very conservative when it comes to change because we want to see that things work and that they’re safe. And so with the bypass, because we’re bypassing part of the intestines, the medicines are being absorbed in the same way. So we are always checking vitamins and we want to make sure that we are on top of all that and that the patient is taking their daily vitamins. With the sleeve, we do the exact same thing. Now do my patients need to take vitamins every single day who have the sleeve? Not necessarily because they’re absorbing medications in a similar fashion. And oftentimes they don’t have to change their medications from long-acting to short acting medications. They stay on the same medicine regimens if they need medicines at all. So we still follow them, eh, but do we need to as strictly? No. I think it’s a good exercise because now I get to point to my patients a year later, I get to tell them these were your labs when we first met and these are your labs now. And look at the difference.

Dr Matthew Lemaitre:

And even I’ve noticed as a surgeon, when I look at the labs, even if I didn’t look at the patient’s name, I know if the labs are from somebody before surgery or after surgery. And that’s kind of a neat game that I play in my head is did this patient have surgery? And by and large, if things cleared up, they did. So that’s kind of fun.

Nancy Medeiros:

So let’s spend the last couple of minutes talking about, so someone’s like three or four or five or 10 years out now, and they were putting weight back on. What’s going on there? What can be done? And what do you recommend?

Dr Matthew Lemaitre:

Yep, so as we were discussing, it’s multifactorial. So surgery isn’t going to be the cure all. There is no magic pill right now, although there’s the new diet pill that just came out semaglutide. So because it’s multifactorial, then you have to go back and address each one of those issues and where that might be. Is it on the diet front and the nutritional front? And I think their calorie counter apps are quite amazing. I mean, if you really treat it the right way, those calorie counter apps can really bring people down the scale of 20 to 30 pounds. I tell my patients that they have one rule with those apps is it goes in your phone before it ever goes in your mouth. And if you can keep that one rule, you can keep a calorie counter app. And it actually works very well.

Dr Christopher Joncas:

A lot of my patients using them successfully. It’s really interesting.

Dr Matthew Lemaitre:

They’re a wonderful reset. I do it twice a year for one month and then it gets me in line and then I know, okay, maybe I’m doing, and then six months later, I’m bad again. And then I have to go back to school for dieting. But so there’s the diet element. What is the expander of energy? Did somebody adopt lifestyle modifications? A walking regimen is great.

Dr Christopher Joncas:

And that’s another good point. I mean, you don’t have to do high level exercise. It’s just walking. I walk every day at lunch. I made it part of my routine for years. I’d probably be much heavier if I didn’t, but I enjoy it. And I know it’s good for my health, but that’s all you really need to do, right?

Dr Matthew Lemaitre:

Yes, and those apps now can count your steps so you can get a certain amount of steps. And I know 10,000 is the number that people quote, but actually all the studies show that the cardiovascular effects at 4,000 steps is really what you need to get the blood flowing. So even as few as 4,000 steps a day, so walking is the perfect exercise. It’s also the perfect exercise because unless you have very bad arthritis, we can do it for 90 years. You’re not going to run a marathon for 90 years. But walking is something we can all do casually. You can do with a family member. You can do while you’re doing your to do list on your phone. You can multitask and walk, but I do suggest a dedicated walking regimen. I find that people who say, “Well, I walk a lot for work.”

Dr Matthew Lemaitre:

It doesn’t count. That’s a freebie. Now I want you to go out and walk afterwards. So the weight regain, which is an issue for some and a certain percentage, there’s on that side. And then there’s on the medicine side. Are they a candidate for medicines? And these medicines work great with patients who are already prone to lose weight. So we’ve given you a smaller stomach and your stomach, so you’re not able to eat as many calories as other people. And then you add on a medication and it can actually be what the tipping point is to get you down on the scale. And so that brings up semaglutide, which recently just got approved by the FDA. It’s been in the news. It gets about 15% weight loss over a year and a half period, which is twice as effective as what prior weight loss medicines were. And the way they discovered is it’s actually a diabetes med, [inaudible 00:59:45].

Dr Christopher Joncas:

I’ve got a few patients over the years on it for weight loss, it’s kind of off label. It does work.

Dr Matthew Lemaitre:

And that’s why people were using it because they realized it was very effective on that front. Now it does have side effects like nausea and vomiting and GI side effects. But taken consistently with lifestyle modification changes, it can lead to pretty consistent, 15% weight loss. Then add on top of that, that you already had the sleeve or the bypass. And now you’re talking a significant difference. So I think that’s always an avenue for somebody who’s struggling with a weight regain. Surgery is sometimes an avenue for people with weight regain. So sometimes we can revise things. That’s called revisional surgery. And I always encourage people to come in, talk to me. Typically, I’ll get some tests to see what your bypass looks like, what your sleeve looks like. And to see if there’s, I call it room to play. Can I do something for you?

Dr Matthew Lemaitre:

And sometimes I can easily. And sometimes I can’t and that’s disappointing. And then because it’s multifactorial, it’s right back in the support group. This is not a disease of the 1940s, where you go home as an individual and you struggle with it and don’t tell anybody about it. This is everybody’s disease, and I think it starts right with getting the right support because the right support will help on all the other aspects where medicines or surgery don’t, because they are only part of the equation and nobody is pretending otherwise, you know what I mean?

Dr Christopher Joncas:

If you had one message you wanted to leave our viewers with, since we’re about ready to wrap up, what would you tell everyone out there who are listening?

Dr Matthew Lemaitre:

I think it’s, I’m going to borrow that message from Suze Orman, which is stand where we live. Admit where we live. It is good to know our BMI and it’s not everything. It is good to use these calorie counter apps and really know how much we’re eating. And it’s really good to be mindful of this every single day of every single week. If I were going to give prescription pads to somebody, I probably wouldn’t give them to us doctors that you see once a month, I would give it to the person cooking your meal every few days. Are you cooking an appropriate meal? Are you planning in advance? So it’s really about the daily decisions we make every day, because we can’t change our genes. And unless you’re the president, you can’t change the society we live in overnight, so we got to change what we can and that’s what’s whatever in our hands. And I think what’s in our hands is our mind. We can be mindful about it.

Nancy Medeiros:

That’s great. Thank you so much.

Dr Christopher Joncas:

That’s an excellent message. Thank you.

Dr Matthew Lemaitre:

Thank you.

Dr Christopher Joncas:

I want to just once again recognize our sponsor BayBoast Bank. You can contact BayCoast Bank at baycoastbank.com or call 508-678-7641. I want to, of course, thank you for coming and delivering this really important message. It was really great.

Nancy Medeiros:

It was a great conversation.

Dr Christopher Joncas:

Incredibly educational, great conversation. How do people reach you?

Dr Matthew Lemaitre:

Well, St. Anne’s Hospital and through Prima CARE. So they can reach out to their primary doctor at Prima CARE, and then they will get directly to me. The physicians at Prima CARE, it’s such an obesity friendly zone that they will put in a referral if that’s what you request, and then they can come to me.

Nancy Medeiros:

And Taylor, you can put those links up on our social media sites too as information.

Dr Matthew Lemaitre:

Excellent. Well, thank you, Nancy and Chris. It’s great to see the Spurgeon and to see it grow.

Dr Christopher Joncas:

Thank you so much for being here and being part of it and educating our viewers. It was really a great conversation, wasn’t it?

Nancy Medeiros:

Absolutely, yeah.

Dr Christopher Joncas:

It was excellent. And thank you everyone for watching the 27th Degree with Chris and Nancy from 27 Degrees Consulting and everyone have a great day. We’ll see you back in a couple of weeks.

Nancy Medeiros:

Yep.

Dr Christopher Joncas:

Excellent.

Nancy Medeiros:

Bye-bye.