New Highland Hospital weight loss doctor motivated to get in the field because mom, brother faced obesity
By Chris Motola
Q: Bariatric surgery has been around for a few decades now. I’m assuming we have good information on the long-term efficacy of it in combating obesity. Are patients keeping the weight off?
A: It depends. I would say there is a percentage of weight regain that we see that’s significant. And all patients do gain some weight back when you look at them long-term. What I tell patients is that their BMI will drop between 12 and 17 points within the first year. And you’ll usually regain three points back. So five to 10 years out, patients will typically be about 10 points less than before the surgery. So if you had a BMI of 45, you’ll probably level out around 35. I think it’s important to let patients know this upfront so they can set their expectations. I do see patients with severe obesity with BMIs greater than 50 or 60 — even with surgery their BMI is probably going to level out in the 40s. So some patients look at that as weight regain or inability to lose weight. These tools that we have to treat obesity are only so effective, and patients need to understand that.
Q: How common is major weight regain?
A: Overall about 30% of patients will gain a significant portion of their weight back over the course of 10 years.
Q: What can you do for those patients to help them control their obesity?
A: Obesity affects multiple aspects of people’s lives, and there are different severities of the disease. To simplify it, we use BMI but each level of the disease requires increasing levels of therapy, surgery being the most effective. Patients post-surgery, who are still struggling with obesity, should know that surgery isn’t the only option. What I typically do is reinstate good nutrition and active lifestyle, but also weight loss medications. Behavioral therapy can also help for maintenance of weight loss and continued weight loss. But I think, really, to treat patients with obesity you need to incorporate all of these things and weigh the risks and benefits of each.
Q: So bariatric surgery can’t necessarily be viewed as a cure?
A: The truth is bariatric surgery isn’t a cure for obesity, it’s just a very effective treatment for it. So even though they may lose weight and do very well, they’re always at risk of recurrence of the disease. I really think it exemplifies the fact that patients need to have long-term follow-up. It’s usually much easier to intervene with a patient who is struggling when they’re first starting to have issues.
Q: The COVID-19 pandemic has really destabilized people’s lifestyles and added massive stressors to people’s lives. What kinds of effects are you seeing that have on people struggling to control their weight?
A: I would say the pandemic has had negative effects on a lot of things. In terms of mental health it’s created a lot of stress, which can lead to increased eating and decreased activity. So we’ve definitely seen a lot of patients gain weight. There have been some positive effects in getting people to be more active by being outside more because you can’t really go to social gatherings like you did before. But overall I think it’s made patients more conscious of the need to watch what they eat and exercising. I don’t know if it’s really helped, but it has highlighted the obesity epidemic in some ways.
Q: What got you interested in bariatric surgery and obesity?
A: Before I started medical school my mom had a sleeve gastrectomy when she was in her mid-50s. She struggled with her weight after having children. She was a teacher, she worked all the time. She really just didn’t have the energy level I think she wanted. She did every weight loss program you could think of, every diet. The truth is, for patients who have obesity where their BMI is more than 35, diet and exercise doesn’t really work. There’s really no evidence that suggests diet and exercise works, but there’s this blame that occurs by society, and patients blame themselves. We try to practice evidence-based medicine, but patients still get told things that there’s no evidence for. But yes, my mom ended up having the procedure. She did really well with it. It really changed her life. She has tons of energy now and is probably going to live to 100. I think that’s part of the reason I got into bariatric surgery. Also my brother had a gastric bypass. He did very well with that as well, but he did have some weight regain. But I think his level of disease was more than what my mom had. He’s struggled with obesity his whole life, which is a little different than what my mom dealt with. But in the end I think it’s given me some respect for what patients have to go through, not just in the physical sense but the social as well.
Q: Do we yet have a clear understanding of why, sometime in the ’70s, our obesity rates started to skyrocket?
A: It’s obviously multifactorial. We didn’t have to deal with this stuff when we were cavemen. We’re not running from saber-toothed tigers anymore. Part of it is the work most of us do now is more sedentary. We have addictive, very available foods. I think our evolution has made us susceptible to it. There’s the assumption that it’s a lifestyle choice and that patients who develop it are just lazy and lack willpower. It’s really a dysfunction of how the body interprets energy. Patients who benefit from bariatric surgery or weight loss medications, when you really talk to them, they have increased hunger or difficulty reaching fullness or satiation. People who are normal weight usually eat when they’re hungry, but their body isn’t usually telling them to be hungry all the time. Patients who are obese usually are hungry all the time. What we see after surgery is this hunger and satiation are improved. There’s some kind of disregulation between the GI tract and the brain that makes a lot of humans susceptible to obesity.
Lifelines
Name: Aaron Sabbota, M.D.
Position: General surgeon at Highland Hospital
Hometown: West Bloomfield, Michigan
Education: Wayne State University School of Medicine
Affiliations: Highland Hospital, Strong Memorial
Organizations: American College of Surgeons, Society of American Gastrointestinal and Endoscopic Surgeons; Association for Metabolic and Bariatric Surgery
Family: Wife (Stephanie), son, twin girls
Hobbies: Hockey, video games