Metabolism and WLS by Dr. Nowzaradan, My 600lb Life DoctorNovember 3, 2017
This is a continuation of the first article with information discussed by Dr. Nowzaradan, My 600lb Life Doctor at the 2016 ObesityHelp National Conference as the Keynote and Fireside Chat Speaker.
Dr. Now discussed metabolism before and after weight loss surgery. Dr. Nowzaradan, My 600lb Life Doctor explained metabolism as it relates to anyone that struggles with obesity, what happens to our metabolism after WLS, and importantly, living as a post-op five years plus and how our metabolism will impact our weight loss and maintenance.
This is the second article in the three article series from the Keynote Presentation and Fireside Chat by Dr. Nowzaradan. Stay tuned for the third article.
It is important for patients to understand their metabolism before surgery and how weight loss surgery impacts their metabolism for a limited amount of time after their surgery as to compared to their metabolism five years out.
The metabolic difference between someone that is healthy and weighs 150 pounds is totally different than a person that weighs 600 pounds. For that reason, when you operate on these higher-risk patients, and if you look at the beginning of the My 600lb Life television show, I said that our success rate is 5%. You'll learn about the difference in the 5% success rate and the other 95% in the next article.
Metabolism Changes from Weight Loss Surgery
If you look at success in five years for these patients when we operate on them, what happens is that we change their metabolism and they lose weight. And their weight goes down, down, down, the goal for the faulty metabolism that created the problem in the first place would repair itself. Usually what happens is when we operate on these patients, we change all the gastric intestinal hormones that drive their metabolism. The insulin resistance goes down to zero.
It isn't only the size of patients' stomachs that are changed that affects how much they eat but actually changing their metabolism. I’ll explain why. When we operate on the patients, their metabolism changes because we manipulate one of the gastrointestinal hormones that control their appetite, the insulin resistance. About a year after surgery, that hormone starts decreasing from other sources and the gastrointestinal system, and the five years becomes the same level as the patient had before their surgery.
When these patients have bariatric surgery, they are going to have the same drop in weight, the same metabolism. If they continue to eat the same amount they ate in the first year after surgery, in five years, they are going to start gaining weight.
About 20 years ago, patients that I saw after five years were gaining weight. So, I thought their pouch was getting bigger so we'll do a revision to get your pouch back to the small size. We operated on the patients, thought their pouch was bigger so we made it smaller. What happened is they lost weight for about a year, and then five years later down the road, they’re back to the same bigger pouch size. Our original success in five years was the same.
We found that it was not the size of the pouch that was causing this problem, it was the metabolic repair. These patients reverted to the same pathological genetic disposition that they had in the beginning.
This is one reason that having a revision is really something that patients hope that is going to change their situation and they'll start losing weight again. But the revision is going to have only a temporary effect.
Because after around five years, patients can start to regain and it isn’t necessarily their fault. Patients’ metabolism has regenerated at the same strength it was before surgery.
Everyone Has A Different Metabolism, Not A One-Size-Fits-All
The surgery comes down to the metabolic changes. Everybody has a different metabolism. Your weight is like a bank account. The money you put in is just like the food that you eat. The bill is what you spend, write the check, and that is like the energy you spend to live. So, everybody has a different budget. Everybody has a different metabolism. You can’t take everyone and tell them that 1,200 calories are going to be good for them. You have to figure out what their metabolism is, how many calories they need, and what we need to do to get to that. The 1,200 calorie standard for isn’t a standard for everybody.
Some people live on $8,000,000 and other people live on $20,000. We want more money in our account. We all want more calories to spend.
The same with your metabolism. Everyone is different but here’s the issue that everybody misses. You have to understand there are two components at work. Your metabolism can change with surgery and some medications. In my book, I call it an "endogenous factor." That’s a metabolic and genetic disposition that people have.
Obesity Isn’t A Patient’s Choice
We need to spread the message that obesity is not a patient’s choice. That it is a metabolic and genetic disposition that people have, and this is a disease and needs to be treated as a disease. When it comes to my patient process, I don’t have a selection process like most doctors have. I don’t have any selection process. Everybody comes and we take care of them.
(Article was created from the transcripts of the videos of Dr. Nowzaradan)