New Approach to Obesity is Changing Bariatric Surgery

Steve Adubato goes one-on-one with Dr. James McGinty, Chief of Surgery and Surgical Services at Englewood Hospital and Medical Center, to discuss how the new understanding of obesity has changed the bariatric surgery field.

11/28/17 #2088






"We are pleased to welcome Doctor Jim McGinty, who is Chief of Surgery and Surgical Services at Englewood Hospital and Medical Center. Good to see you doctor. Thank you for having me. Let's talk about weight loss surgery and how it's changed, just in the last five to ten years. Well... That's one of your areas of expertise? That's correct. So weight loss surgery has changed... really, the way we think about the disease of obesity has changed over time. Weight loss, or... I'm sorry, obesity, is a chronic condition and it's a growing problem in our country. What we now understand about it is that once you reach a certain weight over your ideal body weight, eighty to a hundred pounds, for example, or more, you're really locked into that weight. What do you mean locked in? Well, there's a center in your brain, the hypothalamus, that actually is the set point that controls your weight, sort of like a thermostat would in a... in an apartment, and that weight is set, and for whatever reason we don't understand the mechanism, but for whatever reason, in patients who reach about 80 pounds over their ideal body weight, that becomes their set point, and really everything they do to try to lose weight is undermined by that part of the brain. So for instance, many times patients will come to us and say, "I've tried everything. I've dieted. I've lost about 30 pounds or so. And after about six months, I'm still... They come back? ...eating the same thing..." They come back six months later and they're starting to gain weight again. So research has now shown that it's this set point that is driving that mechanism. Hmm. And really what happens is that as you start to lose weight and come down off of that set point, your body thinks you're starving. And so it slows your metabolism down. It increases your hunger and your appetite, and by the end of six to twelve months, you're back to where you started. Different types of options? Describe them. For weight loss. So really the most popular one now is called the vertical sleeve gastrectomy. All of these surgeries, now, are done standardly through small incisions, what's termed as laparoscopic surgery. So the sleeve gastrectomy is an operation where we remove the baggy part of the stomach. If you think of your stomach as a bag, we're really just removing the part of the stomach that holds extra food. And we create a tube out of the stomach. And the way that works actually, is to remove a part of the stomach that makes a hormone that is an appetite stimulant. It's called ghrelin. And..."