Transcription of Episode 4: Overweight and Nothing Works?

Overweight and nothing works, welcome to SBH Bronx health
talk, produced by SBH health system and broadcast from the
beautiful studios at St. Barnabas Hospital in the Bronx. I’m
Stephen Clark. Obesity is a huge problem in America but it’s
especially bad in the Bronx where an estimated forty percent of
adults are considered obese, with me today is Dr. Nissan
Nahmias Director of the weight loss surgery center at SBH
health center. Welcome Dr. Nahmias.Thank you for having me.

So why is obesity such an issue in the Bronx?

Well obesity is a multifactorial problem. It stems from all the
way from genetic factors to you know the way we eat, our
reality, the foods that we are exposed to and it has taken a lot
of roles and changed over generations as well. I would I think
it’s fair to say that it’s a multi-determined problem.

Now in the Bronx we have a lot of Spanish people here, is their
diet conducive to becoming overweight or obese?

You know I think we associate, culturally, food with a lot of
events that are important and different cultures eat different
things but I would like to think that we can shy away from
pointing the finger or blaming a particular group and start
looking at the population in the Bronx as an heterogeneous
group of people that eat in bodegas, that don’t cook much at
home, that need a lot of guidance towards the healthier and
more conducing ways of life, that we would like to have

Well I guess there’s a problem, it’s a lot of fast food in the
Bronx,, a lot of people drink soft drinks and I guess that
certainly doesn’t help, right?

Well overeating is definitely a big thing and you know we are a
very hard-working group of people so we are basically are
eating and walking. We get fast food delivered to us via our cell
phone. We don’t even have to talk to an individual, we just click
on an app and then a delivery person drops the food in our lap
so our overeating has become prevalent because we have all
these things that just a generation ago were not there.

It’s too easy, it’s too easy to order the wrong food.

It’s incredibly easy and it’s incredibly everywhere. We don’t
have to get out of the hospital to walk across to the to the
corner store to get a sandwich when the sandwich can come to
you at your office.

Right! now you’re a bariatric surgeon who is the best candidate
for weight loss surgery?

So when we think about the the ideal candidates I would have
to to make emphasis to it’s not necessarily the biggest patient.
It is that patient that has realized that obesity is taking a toll in
their life. It’s making it harder for for them to tie their shoelaces,
to get around to do their daily activities and have realized that
they don’t want to live this way anymore. If we think about
qualifications for surgery, we use something called a body
mass index which is a measure of our height and our weight.
You have a smartphone, you click BMI and it will give you a
method so you can calculate it. Basically you plot in your height
and your weight and it tells you a number. If it’s thirty five and
you have medical problems like diabetes, high blood pressure
or other medical problems like asthma then definitely with 35 or
more you qualify. If the number plots over 40 then that’s all you

I guess a lot of people need to get to a certain point in their life
when they say you know what, I’ve tried all these weight-loss
programs, I’ve tried exercising, nothing seems to work, would
you say that’s the case?

I would say on average, patients have tried fat diets, they have
gone to the gym, they have done their due diligence and they
have thought about this surgery intervention for at least two
years prior to coming to my office and they see me as a last

I know I spoke to one of your patients, a bus driver from the
Bronx and she said that she’d spent again, two years her
weight had yo-yoed back and forth nothing seemed to work
and she just said you know what time’s now.

Steve I’ve been going to the gym for four months in a row I
have lost about five pounds and I’m really working out three
times a week, it’s not an easy an thing to accomplish, it
requires consistency, it requires a lot of time investment and
and if you think about it, most people don’t have the privilege
to just shut everything in their life down and then go, I don’t
know, to a camp for a month. You know those are things that
are not realistic.

Now again, weight-loss surgery is not going to be a mecca for
everyone. There are people who it’s not right for, right?

That is correct and I’m glad you brought that up. At SBH we
are very very focused on a high quality and a good result
program. We don’t want to do a very large volume program.
We don’t want to operate in the entire Bronx. We want to make
sure that the people that we help and assist with this
interventions are gonna benefit the maximum out of it. They’re
gonna have preoperative workup that will include somebody
being evaluated by a heart doctor, that’s gonna make sure that
the heart is in good condition. They’re gonna be screened for
sleep apnea. They’re also gonna have a psychological,
psychosocial evaluation to make sure this is a tool that will
impact them positively and that they are mentally ready to get
this intervention. To give you an example of a person that
would not be a good candidate from that perspective, it would
be somebody who has no family support, somebody that has
an addiction to drugs. Being depressed doesn’t disqualify you
for this, but being depressed and ignoring treatment is a red

Okay so once someone is cleared and you’ve decided they’re
a good candidate for the surgery what surgery options are

So the process takes about between four and six months and
during this time interval the patient has seen the dietitian and
sees me at an initial encounter and we kind of put together
what are the patient’s goals for weight loss and what do they
have in mind as a surgery. I know how to do an extensive
number of bariatric operations but I do know that I’m not the
one living with the operation and I have to make sure that
whatever intervention we do is, A, long-lasting, B, non-experimental
and C, performed in a way that’s going to help
this patient achieve their goals.

So for those patients who are familiar with bariatric surgery
what are the surgeries that you do?

The surgeries that we do at SBH are the vertical sleeve
gastrectomy, which entails removing approximately 75 to 80%
of the stomach, the part that distends the most and we leave a
muscular tube of stomach. If you think about, you know
colloquial terms, if you think of a bottle of 2-liter bottle that’s
how much your stomach gets distended. If you make it so that
it only can hold about 120 ml, like a half a can of soda. Half a
can is about the size that this stomach ends up being with the
sleeve gastrectomy. So it is a smaller stomach and because
the portion that is removed also produces some hormones that
make you hungry, so that helps a lot.

And the gastric bypass is the other surgery?

The other surgery that we we offer is a laparoscopic roux-en-y
gastric bypass. In this operation, we create a small pouch out
of the upper part of the stomach about the size of a of a fist
and we then measure the intestine and divided at a point in
which one of the two ends goes up to this new new smaller
stomach and the other one connects to the intestine itself.

How do you determine which one is right for a certain patient?

So in our initial encounter we discuss the medical problems. I
tend to recommend for patients that are diabetic, especially
those with difficult control and insulin dependence, the gastric
bypass is proven to be a better and longer-lasting intervention.
In addition, people with the gastric bypass can lose more
weight on average than those with the sleeve gastrectomy. The
caveat to that is if you have the gastric bypass you must take
vitamins for the rest of your life and we need someone that is
fully aware that they need to take care of themselves in this
way forever and that is a big commitment.

Now again, I I know you have a a full-time registered dietitian
working within your program. I guess she gets involved during
the preoperative stage?

Yes, so we have several consultants and our dietician is not
like a skinny mini know-it-all that’s gonna tell you, you are
doing everything wrong and shame you in a way that a lot of
dietitians do without really focusing on the patient’s best
interest and and all the struggles that the patient’s going
through. She is a dedicated dietician for bariatric patients. She
understands the struggles, goes through them and tries to
really get into the position to understand you completely so that
then she can figure out a best plan to help you and this plan is
deployed over about six months. After the intervention is done,
we don’t stop there, we follow up with the patients forever but
the first year is critical and the dietitian plays a big role. They
also can reach us by phone at any point.

I know one thing that you told me when the program first began
is that for your patients it’s a transformative change. They
change their lives and so that just means not just having the
surgery but changing who they really are.

Right, who they really are comes out and sometimes their
insecurities need to be dealt with and having our patients
plugged into our psychological evaluation department helps
them a lot to deal with the changes in the way they perceive
themselves, the changes and the emotions they feel about
people’s perceptions of them. How come they never looked at
me before and now that I lost the weight they look at me, so I
feel angry about it, to give you an example or I feel so good
about myself I feel like I want to run a marathon and do
everything I didn’t do before but wait everything takes a
process we need to pace ourselves and be ready so that every
challenge is met with a successful outcome and not a failure
because failure defines all the times that they try to lose weight
before they couldn’t so.

It’s really a marathon not a sprint?

That’s right. It’s a lifelong journey that will have slip and falls
and we’re gonna be there to help.

If someone wants more information?

So they can reach us at the bariatric center. They can reach us
directly at 718-960-3871 and they can also reach out through
our clinics at Bronx Park and that would be 718-863-8695 and
another number in case they get stuck with those two is

Okay great. Thank you Dr. Nahmias for joining us on SBH
Bronx health talk.

Thank you very much for having me Steve, I really appreciate

Okay you’ve heard another episode of SBH Bronx health talk.
Thanks for joining us.