January 25, 2024 • 41 mins
Are you ready to revolutionize your approach to weight loss? Join Maria and Tammie for an informative exploration where they reveal the truth about weight management and debunk the myths surrounding it. They share their professional and personal insight into the role of bariatric surgery, dispelling common fears and misconceptions. They emphasize that surgery isn't a quick fix, instead, it's a potent tool that aids in long-term weight loss and boosts overall health.
Maria and Tammie present a detailed discussion on GLP-1 analogs that not only regulate blood sugar but also curb your appetite, making weight management a less daunting task. They also shed light on other medications and their effects, emphasizing the importance of understanding these treatments to find the one that suits you best.
From exercise routines to the options of diet, medications, and surgery, they present a holistic picture of weight management options. Maria encourages you to explore and find a balance that works best for your individual needs. Maria and Tammie round off the discussion by highlighting the importance of long-term maintenance and addressing the mental aspects of weight management. Let's embark on this weight loss journey, equipped with the right knowledge and tools, and remember, your victories extend beyond the scale. Tune in and let's transform your weight loss journey together.
Citations:
1. Benaiges D, Goday A, Pedro-Botet J, Más A, Chillarón JJ, Flores-Le Roux JA. Bariatric surgery: to whom and when? Minerva Endocrinol. 2015 Jun;40(2):119-28. Epub 2015 Feb 10. PMID: 25665592.
2. Christoffersen BØ, Sanchez-Delgado G, John LM, Ryan DH, Raun K, Ravussin E. Beyond appetite regulation: Targeting energy expenditure, fat oxidation, and lean mass preservation for sustainable weight loss. Obesity (Silver Spring). 2022 Apr;30(4):841-857. doi: 10.1002/oby.23374. PMID: 35333444; PMCID: PMC9310705.
3. Eisenberg D, Shikora SA, Aarts E, Aminian A, Angrisani L, Cohen RV, de Luca M, Faria SL, Goodpaster KPS, Haddad A, Himpens JM, Kow L, Kurian M, Loi K, Mahawar K, Nimeri A, O'Kane M, Papasavas PK, Ponce J, Pratt JSA, Rogers AM, Steele KE, Suter M, Kothari SN. 2022 American Society of Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) Indications for Metabolic and Bariatric Surgery. Obes Surg. 2023 Jan;33(1):3-14. doi: 10.1007/s11695-022-06332-1. Erratum in: Obes Surg. 2022 Nov 29;: PMID: 36336720; PMCID: PMC9834364.
4. Freedhoff, Y. (2014). No, 95 percent of people don't fail their diets. Retrieved from https://health.usnews.com/health-news/blogs/eat-run/2014/11/17/no-95-percent-of-people-dont-fail-their-diets
5. Fuentes Artiles R, Staub K, Aldakak L, Eppenberger P, Rühli F, Bender N. Mindful eating and common diet programs lower body weight similarly: Systematic review and meta-analysis. Obes Rev. 2019 Nov;20(11):1619-1627. doi: 10.1111/obr.12918. Epub 2019 Aug 1. PMID: 31368631.
6. MacEwan JP, Chiu K, Ahmad NN, Sacks N, Shinde S, Poon JL, Kan H. Clinical, economic, and health-related quality of life outcomes in patients with overweight or obesity in the United States: 2016-2018. Obes Sci Pract. 2023 Dec 13;10(1):e726. doi: 10.1002/osp4.726. PMID: 38263999; PMCID: PMC10804324.
7. Mann T, Tomiyama AJ, Westling E, Lew AM, Samuels B, Chatman J. Medicare's search for effective obesity treatments: diets are not the answer. Am Psychol. 2007 Apr;62(3):220-33. doi: 10.1037/0003-066X.62.3.220. PMID: 17469900.
8. Martínez-Gómez MG, Roberts BM. Metabolic Adaptations to Weight Loss: A Brief Review. J Strength Cond Res. 2022 Oct 1;36(10):2970-2981. doi: 10.1519/JSC.000000
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Tammie Lakose (00:00):
Welcome to Core Bariatrics podcast, hosted by
bariatric surgeon Dr MariaIliakova and Tammi e Lakose,
bariatric coordinator and apatient herself.
Our goal is building andelevating our community.
The Core Bariatric podcast doesnot offer medical advice,
diagnosis or treatment.
On this podcast, we aim toshare stories, support and
(00:22):
insight into the world beyondthe clinic.
Let's get into it.
All right, Maria, the sun isfinally shining.
It's been how many days ofcloudiness.
Maria Iliakova (00:33):
Oh goodness, Our patients have been cranky.
Tammie Lakose (00:35):
Our patients have been cranky, I know.
Maria Iliakova (00:37):
I've been cranky , sorry Me too.
Me too, don't worry.
Don't worry, sad has alreadystarted, and it's only.
Yeah, we're not even intowinter yet.
So, this is.
This is how it is.
Tammie Lakose (00:47):
Sometimes the sun is shining, it's a good day, so
today we are going to dig intoall of the options, whether it
be surgical, whether it benon-surgical, whether it just be
diet and exercise.
But we're going to talk about,like the success rates, if the
limitations, expectations, howpeople or if they gain weight
(01:09):
afterwards.
Right Right, Because that ishuge.
Maria Iliakova (01:11):
That's a big one .
You know, when we're talkingabout weight loss strategies, I
almost think of it in terms ofyou had a really good point
recently of like how do we end,how do we, what's the goal,
what's the end game here?
I think that's a really goodway to think of it, because you
can lose weight a milliondifferent ways, but are you
losing weight just to loseweight for now, or are you
(01:33):
losing weight to lose weight fora lifetime?
Because maintaining weight lossis really the name of the game
and that's the hard part.
Tammie Lakose (01:39):
That's the hardest part.
I feel like we always need tohave a goal, yeah, exactly,
whether it even not be weightloss.
Maria Iliakova (01:46):
That's such a good point, because weight, you
know, I kind of think of weightas the gateway drug in a lot of
ways, like that's the way thatwe hook people to start a
conversation about health andgoals and all those things, and
weight it's a number so peoplecan kind of wrap their minds
around it.
Insurance companies can wraptheir minds around it, all that
stuff.
I know it's kind of a pain, butweight is really just the
beginning of a conversation.
(02:06):
Yes, right, the very firstquestion out of my mouth when I
meet someone in a visit is whatare your goals?
What would you like toaccomplish?
Because when we're talkingabout weight, we're really
talking about all of these otherthings that people want to be
able to do in their lives.
Tammie Lakose (02:20):
Yes, and that's where I have wanted to highlight
things with our program is sure, I want to know what your
weight is like, what yourstarting weight is, what your
end weight is, but I really trynot to bring up weight at all,
because weight, you know, it isthe big picture, but I want to
know the other things, thenon-scale victories.
(02:40):
These are the things we need tobe really looking at and so,
again, that'll probably beanother episode of, just like
you know, really talking aboutjust not focusing, just on
weight, Right?
Maria Iliakova (02:54):
Yeah Well, and so you know to kind of beat a
dead horse a tiny bit, but we'reactually going to focus on
weight today and how weaccomplish weight loss and
weight loss maintenance, so likehow you accomplish that for a
long time.
But again, I want to emphasizethat while we're talking about
weight, we're really talkingabout the big picture of how you
live a healthier life, how youlive the life you want to and
(03:15):
how you're able to use your bodythe way that you were to do
that.
So, we're going to touch on,just like Tammie said, diet and
exercise, medications, surgeryand kind of beyond, because a
lot of times these things arenot one or the other, it's
combinations.
It's combinations what we wantto accomplish.
So let me just talk about realquick surgery.
(03:36):
I think surgery is the elephantin the ring a lot of times and
I am a surgeon, so you know I ambiased.
Obviously, I wouldn't havebecome a very anti-ex surgeon if
I didn't believe in it very,very strongly.
But here's why it works andwhat does it work for?
Well, that's a really goodquestion.
And it works to help peoplelose weight and keep weight off.
Tammie Lakose (04:00):
Keep it off.
That is your main factor there.
Maria Iliakova (04:02):
Exactly.
Tammie Lakose (04:03):
That's something I need to wrap my head around,
exactly Like for me.
Losing weight was difficult attimes, but I mean I could drop
30 pounds in a month, but it'skeeping it off.
Maria Iliakova (04:16):
Exactly, yeah, exactly.
And that's not to say that youcan't regain weight after
bariatric surgery.
In fact, we now have data thatshows like one in three patients
almost regain weight aftersurgery.
So that's definitely possibleand we'll talk about that in
another episode for sure, butit's the most likely way that
you're actually going to be ableto come off of medications for
(04:38):
things like diabetes and highblood pressure.
It's the most likely way thatwe're going to be able to treat
joint pain for people who havearthritis and other joint issues
, and it's the most likely wayto get to your goals and stay
there whether they're weight orwhether they're lifestyle or
whether they're both.
So surgery really should beconsidered more like sooner than
(04:59):
you think, and it should beconsidered even if you're also
working on diet, exercise andeven medications yeah, it's
surprising.
Tammie Lakose (05:08):
So patients come in here thinking that surgery is
the key.
Right, I don't have to doanything.
Right, you're going to do,you're going to reroute things
or cut things out, and I don'thave to do anything.
Maria Iliakova (05:21):
So, Tammie, tell me, has it been a journey where
you had to do nothing for you?
Tammie Lakose (05:23):
I wish Right, right.
No, you still got to do all thethings.
You still got to focus on whatyou're eating and moving your
body.
Exactly.
The tool just makes it a little, a little easier.
Exactly.
Maria Iliakova (05:41):
And so bariatric surgery, I think a lot of
people think a number of thingsabout.
They think it's the easy wayout, they think it's a shortcut,
they are scared of it becauseit is surgical and it's going to
change your lifestyle.
There's so many differentviewpoints and it goes.
It's so funny because this isone of the things in our lives
where people hate it for all ofthe reasons, 100%.
(06:02):
People are scared of it for allof the reasons and as a surgeon
, I totally get it, because ifsomebody was excited to go to
the OR and didn't have someanxiety about it or didn't give
it a second thought, I would benervous, right, right, yeah,
because for me, this is my dailylife, but for most people,
you're going through surgeryonce, maybe twice in your life
(06:23):
for this purpose.
So, honestly, I think the wholeprocess is exciting and the
whole outcome can be reallyexciting.
But I totally understand thatthe idea of surgery itself can
be scary, 100%, and that's fair,yeah, and even in our field,
even with other physicians,other doctors, other people in
(06:44):
the industry, you do see a lotof fear and misunderstanding.
So, I do want to mention, withsurgery, what are the
expectations?
Yes, right, Because, Tammie, Ithink we even discussed through
your process what thoseexpectations could be.
Tammie Lakose (06:56):
Yes, yes, I'm going to look like a supermodel,
right, yeah?
I'm going to say it in yourword, all of it.
Maria Iliakova (07:01):
Hey, I love it.
No, okay, first of all, you canbe a supermodel any size, okay,
so let's say that, and I wishmore supermodels actually looked
a little bigger, because Ithink that's beautiful, but
anyway.
But expectations after surgeryis not all of the weight loss
that some people expect.
Correct, right?
So typically you're losingbetween 50 and 80% of extra
(07:25):
weight as opposed to all of yourweight, right?
So that's the type of peoplethat's not going to bring them
into a weight that is their highschool weight or that is, like
you said, a supermodel on abillboard weight, but at the
same time, like that's notreally the purpose either, right
, right, the point of thesesurgeries is to help you get up
and off the ground easier.
Yes, help you keep up withother people in your life easier
(07:48):
.
Tammie Lakose (07:48):
Yes, like my three little kids running around
like crazy.
Yeah, I've stopped weighingmyself for the most part.
Yeah.
Maria Iliakova (07:56):
And I think that's a super healthy thing.
Like I encourage people toweigh themselves at most once a
week.
Yes, because otherwise it canbecome really obsessive.
Yes, in a negative way and alsoweight fluctuates.
Tammie Lakose (08:06):
Yeah, especially women.
Oh gosh, Especially women.
Yeah, you're on your period.
Maria Iliakova (08:10):
You happen to eat something a little too salty
.
You're right you know like thatcatches up with everyone.
So you know weight.
Actually, did you know thatweight can fluctuate up to five
pounds in a day?
Tammie Lakose (08:20):
In a day In a day .
So that's why your scale istelling me that I'm five pounds
heavier than when I'm at home,butt naked after I've done all
my business.
Maria Iliakova (08:29):
There you go.
Yeah, there you go.
We all know that the wintertimein Iowa people are at least
wearing like five pounds ofclothes too, so there's that.
So, unless you're juststripping naked in your doctor's
office, which you know, that'sup to you, but there's going to
be a couple of extra poundsthere anyway, yes, so, anyway.
So that's surgery, and we willdefinitely have another episode
that goes more into the nittygritty of what kind of surgeries
(08:50):
are out there and what they'refor and what the differences are
.
But I just want you to knowthat surgery is something to
consider, and even convertingfrom one surgery to another is
an option for a lot of patients.
So if you're in the position,had a surgery and you've
regained weight or you've hadother things like reflux or
other things pop up along theway, that might be a
(09:12):
conversation to have withsomeone who does surgery and
think about maybe taking thenext step with a different
surgery or yeah.
Tammie Lakose (09:20):
So we also want to change mindset of or you've
said you want to change otherproviders' mindset of.
This is your last ditch effort,this is your extreme.
We need to look at thatdifferently.
Why do we have to wait until wehave diabetes and high blood
pressure and all of that stuffbefore we look into surgery?
(09:43):
Why aren't we looking at peoplethat, oh, their BMI or their
weight has gone up a little bitin the past six months Exactly,
for no significant reason?
Let's battle this now.
Oh yeah, absolutely.
Maria Iliakova (09:55):
And it's this whole idea of an ounce of cures
worth a pound of prevention kindof thing.
But what it means basically iswe plan ahead for everything.
We plan ahead for Thanksgiving,for Christmas, for our kids to
go kids' games and things likethat.
For your vacation.
You plan ahead, but we don'treally plan ahead for our health
(10:16):
the same way.
Tammie Lakose (10:18):
We just dig around and see what happens.
Yeah, we kind of dig around andsee what happens, and then I
will say.
Maria Iliakova (10:22):
Insurance companies, for the most part,
are not helpful in this 100% notBecause surgical care or just
in general weight care eventhough it's really, really
important is very limited, sothere are restrictions that are
placed on access to these things.
That I mean, I even talked to apatient today, actually, who is
a person who has med weightloss on board, but her access is
(10:46):
very, very limited because it'sexpensive and she doesn't have
health insurance coverage for itand she's desperate and I
really, really want to be ableto help her, but we don't have
policies in place that reallyallow people to get help before
it gets worse.
In fact, that's kind of crazy.
But she's not a diabetic.
Being a diabetic can help youqualify for some of these meds,
(11:07):
like you've seen.
And she literally said well, Iwish I were a diabetic.
Tammie Lakose (11:12):
Right.
How crazy is that A lot of herpatients have said that because
Right.
Maria Iliakova (11:16):
Yeah, yeah, and this is exactly like the
probably 40th time I'm hearingthis now from a patient which is
messed up.
Tammie Lakose (11:22):
Yeah, because we got to wait until now.
We have this diagnosis beforewe start thinking about it,
right, so?
Maria Iliakova (11:28):
And that applies yeah, that applies across the
board for access here.
Tammie Lakose (11:30):
So, yeah, so let's talk about the diet and
exercise that should work foreverybody.
Maria Iliakova (11:35):
Right, yeah, tell her in, tell her out, guys.
Hello.
Tammie Lakose (11:37):
Obviously, all of our providers, our primary care
doctors, are telling us youbetter move more Right and not
getting down on them because Iam in the health field and
health care field and understandthat we're sitting at a desk,
most, but most of our providersDon't yeah, don't necessarily
know, and that's true.
Maria Iliakova (11:58):
So the way that I think of it is diet and
exercise are essential, right.
And when I say diet I don'tmean like eating no carbs.
In fact, when I say diet I meanlike making sure that you eat a
good diet that's full of carbsand proteins and fat and fiber
and lots of fluids, and I meanjust overall eating stuff like
you would if you lived 150 yearsago and you lived on a farm,
(12:22):
like if you ate healthy and atewhat you needed to that, yeah,
not over limiting yourself, notoverdoing it pretty moderate.
I know that's really boring,but no, no, that kind of
approach to food, right, yes,not food as fuel.
You can enjoy food, but alsounderstanding that food is there
to serve you, not the other wayaround.
(12:44):
That's unfair.
Yeah, 100%.
And then exercise is kind ofthe same right.
Moving your body can be awesomeif you find something you like
to do.
Tammie Lakose (12:53):
That you enjoy Exactly and like.
Maria Iliakova (12:54):
Tammy, what do you enjoy to?
Tammie Lakose (12:56):
do I enjoy like HIIT training High
Maria Iliakova (12:59):
Identity training.
I love that too.
Tammie Lakose (13:03):
And I love not being able to breathe for a hot
second.
Honestly, most of my workoutscome stem from when I'm angry
and I just go balls to the wall.
Is that appropriate?
Maria Iliakova (13:16):
Oh, I mean it is now.
It is now.
No, that's great.
Tammie Lakose (13:20):
That's what I enjoy.
I really do enjoy feeling orhaving that sweat.
Maria Iliakova (13:25):
Yeah, having the sweat on, and there's so many
ways to move your body right.
So when we were puttingtogether some of our materials,
I was looking online and I kindof felt like an idiot because I
was like, ok, give me activities, google or chat, gpt, give me
activities.
And it was like walking andrunning and volleyball and I was
like, yes, I know these things,but it's kind of hard sometimes
(13:46):
to wrap your head around whatyou're going to pick because,
it's almost like if you'restarting from somewhere.
it can be intimidating to getstarted with anything and it can
be overwhelming to choosesomething.
Has there been something thatyou recommend in terms of making
a choice or?
Tammie Lakose (14:03):
getting started.
Be comfortable with beinguncomfortable.
Honestly, that's a good one.
My first time into a gym.
I was lucky enough that theyhad a promotion going that you
would get five free sessionswith a personal trainer.
Actually, I think it was moreso that they could cover their
(14:26):
butt and teaching me how to usethe equipment.
Maria Iliakova (14:29):
And not get injured.
That's great.
Tammie Lakose (14:33):
But that gained confidence for me.
I mean, people are going into agym and being like I'm just
gonna do the treadmill or theelliptical.
Why?
Because it's easy, because youcan't make fool yourself and oh,
let me tell you fool yourself.
Maria Iliakova (14:51):
So I have fallen off of an elliptical broken
iPad doing that Yep.
So you can make it foolyourself even on an elliptical.
Tammie Lakose (14:57):
Where is?
Maria Iliakova (14:58):
that video clip.
It is sealed.
It is sealed.
It's not boxy old, no, but Ihave also fallen off of a
Stairmaster and oh man, sothere's, that is talent
something like that.
No, there's ways to injureyourself doing anything.
Tammie Lakose (15:12):
And that's actually an important part here
too.
Maria Iliakova (15:14):
So overdoing it with exercise and not actually
starting somewhere and kind oftaking it low and slow first is
a great way to get injured andthen sideline yourself for a
whole lot of time.
Tammie Lakose (15:26):
I do question sometimes because you know we
will preach you need to exerciseand move your body every day.
But I'll be open and honest.
I'm not exercising every day.
I do need to.
Maria Iliakova (15:39):
I am moving my body obviously You're moving
your body and I think there's adifference between moving your
body and exercising.
Yes, there is I think therecommendation really should be
moving your body a little morethan you would normally, for 30
minutes a day.
Tammie Lakose (15:52):
I think I just go a little too extreme and
honestly I should not Like whenI told you I was angry and I
went home and ran a 16 minutemile.
I should not have.
Like my heart probably did notappreciate that.
So I think I need to find Ineed to work out to that.
Maria Iliakova (16:11):
There's a lot of rage exercising that happens.
Tammie Lakose (16:13):
We've all done it .
Maria Iliakova (16:15):
I used to box and I understand.
Tammie Lakose (16:16):
That's a great way to get some aggression out.
Maria Iliakova (16:19):
That's not to say that that's wrong.
Whatever approach works for you, that's great, but the whole
idea behind like moving yourbody is do anything.
If it's jamming to a TikTokvideo, if it is yoga, if it is
walking your dog, if it is doingHIIT, high intensity interval
things, if it's golfing, playingwith your kids.
Tammie Lakose (16:41):
Absolutely, throwing a 30 pound toddler in
the air is intense.
But it's not something that youthink, oh, I worked out today
because I was playing with mykids, exactly, and it is.
Maria Iliakova (16:54):
And like there's actually a lot of studies that
show that continuous movementand engagement, even if it's low
intensity, can be very helpfulover time Because it's doable,
you're not gonna injure yourselfas likely.
So really finding things andthen, like you said I love that
you said this of just doing itand not being afraid to kind of
(17:14):
look new or not be good atsomething, Lord knows.
When I first tried highintensity interval stuff, I mean
you look like a fool in a hat.
Tammie Lakose (17:22):
Oh 100%.
I am not saying I lookbeautiful and I ain't about to
do it in front of a whole bunchof people.
Oh no, oh no, no, no no, andthen actually.
Maria Iliakova (17:30):
so I got to the point that I liked it so much I
actually started teachingclasses about a year, year and a
half after that.
So you absolutely do not knowwhat your limits are, you don't
know what your possibilities are, until you get started doing
something.
Tammie Lakose (17:43):
Right, and don't hesitate.
Yet Don't hesitate to ask forhelp.
I mean, that young buff guy atthe gym would probably like
enjoy teaching you.
He's going to the gym every day.
He would probably enjoyteaching you how to do it
correctly, right?
So put yourself out there alittle bit too.
Maria Iliakova (18:04):
Absolutely.
I would totally do that now,Absolutely.
And if he hits on you don'twant that, then move along.
Tammie Lakose (18:10):
Right, or even a woman.
There's a lot of women outthere.
There's a lot of women.
There's way more women.
Maria Iliakova (18:15):
weight training, absolutely, and I remember I
actually took a high schoolclass in weight training, which
can you believe my high schoolhad.
Weight training is so cool.
But it set me up to haveanother skill that I could use
to move my body anywhere anytime, to the point where now I have
those things at home and I'mable to create a workout for
myself anytime that I'm at homeand it's kind of it's cool.
(18:37):
So I think anytime you'rethinking about fitness activity,
moving your body, just trysomething, do anything Something
.
Physical therapy counts.
Oh yes, getting walking aroundthe mall counts, everything
counts.
Tammie Lakose (18:52):
If you are doing absolutely anything, you are
passing the person that's stillsitting on the couch.
Maria Iliakova (18:57):
That's so true.
Laps around the couch.
I love it.
Tammie Lakose (18:59):
You can run laps around the couch.
Maria Iliakova (19:01):
I remember when I was a kid, and it was really
bad weather outside.
My mom would be like run aroundthe dining table and I did my
boys do that often.
Tammie Lakose (19:08):
Yeah, I remember that.
Maria Iliakova (19:09):
Anyway.
Tammie Lakose (19:10):
But what is the success of diet and exercise?
Because, let's be honest, I'vebeen on a lot of diets.
Maria Iliakova (19:16):
Yes, and they always fail.
Who hasn't?
I mean, I've been on a milliondiets too.
So diet and exercise alone forweight loss.
What do you think is the rate?
How often do you think thatworks Long term?
Tammie Lakose (19:28):
5%, you're right.
Maria Iliakova (19:30):
Really yes, oh, isn't that crazy.
Tammie Lakose (19:32):
Yeah, ok, that is it.
Maria Iliakova (19:34):
It literally is the statistics are it works less
than 5% of the time.
That's crazy, isn't that wild?
So 95% of people, 95% who trydiet and exercise alone, will
regain the weight and most ofthem will regain more.
Tammie Lakose (19:49):
But it's just you .
Maria Iliakova (19:51):
It's just that you're not a problem, not eating
well and moving.
That's the mentality we'regetting out of here, like we are
getting out of here that if itworked, we would all do it and
be successful.
Yeah, if it all worked, thenall the 60% of people who have
an extra pound or something ontheir body wouldn't have it.
But that's okay, so, yeah, sodiet and exercise alone do not
(20:14):
work for weight loss theyabsolutely.
It does work really really well, though, for maintaining 100.
Yes, yes, keeping your bodyactive.
Tammie Lakose (20:23):
Yes.
Maria Iliakova (20:23):
Keeping your body healthy, keeping your gut
happy and working.
Tammie Lakose (20:27):
Yes.
Maria Iliakova (20:28):
Your mind happy and working.
So for those reasons, having agood, healthy diet and staying
active every day, those arethat's really important, just
for overall wellness.
Tammie Lakose (20:37):
Yes, and maintaining and just feeling
good, exactly so.
Okay, that doesn't work,doesn't work.
I'm coming into your officeRight and I'm telling you
surgery, ain't it for me.
Yeah, that's fair, okay.
So what's?
What can we look at now?
Maria Iliakova (20:51):
What else is out there?
Well, I'm sorry, Tammie, you'regoing to have to leave now.
Tammie Lakose (20:53):
No, I'm kidding, no, no, no, no, I'm totally
kidding, I'm totally kidding.
Maria Iliakova (20:56):
So luckily there's actually a lot of other
options.
So one thing is we definitelylook at mental health too as
part of the picture and we willhave another episode about
mental health and bariatricsurgery and things definitely.
But you know, you have toremember this is not mind versus
body.
This is mind and body whenwe're talking about weight,
because oftentimes the way thatwe move our bodies, the way we
(21:18):
think about what to eat, the waywe kind of the whole picture,
is also how we feel.
Tammie Lakose (21:25):
Yes, a lot, because when I I'm not feeling
good, I want all the junk food.
Maria Iliakova (21:29):
That's right, that's right.
So, surprisingly, pretty muchevery visit we also talk about
mental health.
Yes, Right, and that's scary.
I get it Not.
Nobody wants to be told oh, youneed to.
Tammie Lakose (21:40):
You know, go see someone and figure things out
Right and work on yourselves andall of that.
Maria Iliakova (21:45):
But actually, you know, I've gone through
mental health like therapymyself.
I've gone through things and Ithink the only thing that
happened was either it was nothelpful, that can happen or it
was helpful, right yeah, and Ifelt better and I felt more
empowered and I felt morecapable and I didn't feel like
the problems in my life werescary anymore.
(22:06):
Yes, I mean okay.
So those are pretty decentoutcomes.
I really have yet to hearsomebody going through therapy
and it making things worse.
Right, but anyway.
So something to consider.
Definitely, if you already havesomeone that's helping you with
mental health, that's great,but if not, I would actually say
consider.
Tammie Lakose (22:23):
Yeah, and if you do have somebody and it's just
not working, break up with them,that's okay, yeah.
Maria Iliakova (22:27):
That's true.
Well, throughout all of this,breakups are part of the
equation sometimes yes, oh yeah,and you can break up with your
yeah with anybody providing youcare.
Yes, yeah, that's that is inyour yeah, that's in your balls
in your court on that one, yesit is For sure, so, but okay,
but also, I think it's reallyimportant to think about med
weight loss, so medications thatcan help you lose weight or
(22:48):
help you maintain weight, andthat topic has exploded lately.
Tammie Lakose (22:52):
Yes.
Maria Iliakova (22:52):
Right Like you cannot go on Facebook or
Instagram or TikTok and not hearabout Mozambique and Wagovie
and Wajarro and all of these.
Yes.
Tammie Lakose (23:01):
Yes.
And let's just start here, withus here in a provider's office.
Yes, we want to give it to allof you, I promise.
Yeah, like, if it obviouslyfits for you, put it in the
water.
But it's not that easy.
Yes, but if we could, we would,because it works.
Maria Iliakova (23:18):
It does work, and that's the thing.
And let me caution that bysaying, though, it doesn't work
for everyone Right, because, tobe honest with you, none of
these sort of things work foreveryone, right To be.
Yeah, weight is pretty.
It's a customizable approachfor everyone, yes, and it's a
lifelong approach for everyone,but with medications, you know
these GLP ones, which isglucagon, like peptide one,
(23:39):
analogs, which is what thecategory of medications that
these all fit into, theseSaxenda, Mounjaro, Ozempic,
Wegovy medications.
They are also diabetesmedications, yes, so they help
with insulin resistance, ifyou've heard of that.
They help your body basicallyregulate blood sugar better, but
they also help your stomachslow down and how it processes
(24:00):
food.
Yeah, and so it's really,really it works very well at
decreasing appetite, helpingpeople lose weight, helping
people overall their metabolicfunction get better.
So, yeah, like Tammie said, Iwould love to be able to give
this medication to many morepeople than we currently do Now
appetite, appetite with thesemedications oh yeah, like, is it
(24:23):
working like Phentermine ofjust shutting off your hunger,
or why does it make you lesshungry?
So, to be honest with you, wedon't fully understand why a lot
of these medications work theway that they do in terms of
appetite.
Appetite is complicated, very,yeah, and I mean that not just
because we don't know, like theone pathway that affects that,
(24:44):
but probably because there'ssomething like five to 10
different pathways that actuallyimpact appetite.
Yeah, because think about evenlike okay, what's your favorite
food?
What's your favorite food?
Mexican, mexican.
So think about Mexican food,think about the best place you
like to eat.
Tammie Lakose (24:58):
Oh, now you're taking me to lunch, yeah right.
Maria Iliakova (25:01):
So that's what I mean is just by talking about
food that you like.
Tammie Lakose (25:05):
My mouth is watering.
Maria Iliakova (25:06):
We got Tammie mouth watering right, we got
Tammie fantasizing over here andthat's very powerful, and I
didn't do anything in terms ofmedications.
I didn't do anything in termsof showing you a picture.
There was no smell involved.
That's your mind.
That's your mind at work, rightthere, right.
But that, what we just did,probably has started to activate
(25:26):
some of your stomach enzymes,some of your digestive enzymes
in the rest of your gutcertainly made things work in
your brain and you're probablyfeeling your tongue get a little
, a little more saliva than ithad before in that wild, so
appetite is very complicated.
Tammie Lakose (25:43):
But you made a good point where and educate me
here, where these injectables?
Yeah, yeah, they slow down.
Maria Iliakova (25:54):
Yeah, they slow down basically how the stomach
processes food Right and thinkof it as and that keeps you
fuller longer.
That's right Now something likePhentermine.
That's right, Phenterminedoesn't it's really just an
appetite suppressant.
It's an appetite suppressantbecause it stimulates your
nervous system.
Tammie Lakose (26:09):
Ok, so it is a different function, but that's
something I want people to knowis that these injectables are
not just an appetite suppressant.
There's more going on.
No, people don't understandthis.
It makes me frustrated.
Maria Iliakova (26:20):
It may be bad.
Tammie Lakose (26:20):
There's more going on.
Maria Iliakova (26:22):
There's more going on behind the scenes.
Tammie Lakose (26:25):
Like the empty of the stomach.
It's slowed down.
Also the insulin resistance.
There's more going on than justappetite suppressant, and
that's what I want people toknow.
Maria Iliakova (26:39):
Yeah, absolutely , and I think an approach to
medications that help withweight is unfortunately nuanced.
There's not one size fits allsolution at any of these
strategies, and certainly notwith medications, because right
now so there's nine medicationsthat are approved by the FDA to
help people with weightmanagement.
Like specifically approved forobesity and weight and things
(26:59):
like that, and they all workdifferently.
They're in multiple categories,but they all work differently.
And then the other thing thatwe really have to think about
here, too, is they're expensive.
So Phentermine, not expensive,a lot of side effects, a lot of
side effects, and we can talkabout some of those.
But like Contrave, a little bitmore expensive, less side
effects, but some that arereally severe.
(27:21):
And then Ally or Orlistat, samething, less expensive, lots of
side effects.
And then these GLP-1, Saxenda,Mounjaro, Wegovy, also a very
expensive medication if you'repaying out of pocket and still
have side effects.
Tammie Lakose (27:35):
Yeah, and then the other side effects are less,
though I have been on a lot.
I've been on the Phentermine soI've also tried Saxenda too.
Maria Iliakova (27:44):
I feel like Phentermine just made me crazy,
but I mean I did have sideeffects with Sexenda but I just
feel like they were a littleless little less mental wise.
Oh, absolutely.
Tammie Lakose (27:55):
Because that's the thing is.
Maria Iliakova (27:56):
So these the GLP-1s Mounjaro, Ozempic, Wegovy
they don't really have a lot ofmental side effects that we've
noticed at least.
They don't really have a bigimpact on anxiety or depression
or any of those things, or sleepPhentermine definitely does.
Oh yes, so Phentermine cancause or make worse things like
anxiety, insomnia, your heartfeeling like it's racing and, to
(28:20):
be fair, that's also part ofhow it works, because you're
constantly adding a little bitof stimulation to your nervous
system, so you're addingstimulation to all those
functions too, and in fact, oneof the other side effects people
don't necessarily know aboutPhentermine is that with some
medications it can increase yourrisk of seizures.
So, like I said, these are notone size fits all approaches.
If you're on medications foranxiety and depression.
(28:41):
Phentermine may be a dangerousmedication that you take and
then, no matter what,phentermine also affects your
heart muscles and can causeheart arrhythmias or
palpitations, which means thatyour heart rhythm can get
knocked off normal or even heartattacks down the road.
I know people have heard oflike Fen Fen, probably right
From like the 90s and thingslike that and that was yanked
(29:03):
off the shelves.
Phentermine is safer than FenFen, but Phentermine is actually
one of the components of FenFen and so long term use of
Phentermine definitely canincrease risk of heart problems
and for some people can increaseheart problems off the bat if
they already have them, sodefinitely not appropriate for
everyone.
Contrave I actually use a lotof Contrave and it's a
combination of medicationscalled bupropion and naltrexone,
(29:26):
so bupropion you probably haveheard Wellbutrin as .
I take it.
There you go, A lot of peopletake it right, yes, they do.
So the funny thing about thismedication is actually started
as something that helped peoplestop smoking.
Tammie Lakose (29:38):
Yep, I come from a pulmonary clinic and alot of
Wellbutrin of was given out forsmoking cessation and it did
help a lot, absolutely, and sothe other interesting thing
about this is it's a medicationthat's used to help with anxiety
and depression.
Maria Iliakova (29:52):
Yes A bunch of other mental health conditions
too, and it's like the only onethat they noticed helped people
lose weight, right.
And so you know, obviously,this drug company decided oh hey
, people are losing weight,let's get it approved for weight
loss too.
And it works, yeah.
So the results between, by theway, all these different
medications can be about thesame in terms of overall weight
(30:14):
loss and overall what you canachieve.
Contrave does still have sideeffects though, yes, right, and
you can still have some of thenausea, some of the GI symptoms,
and then a lot of peopleactually have improved sleep by
taking it.
Less anxiety, less anxiety.
So two birds one stone for somefolks.
But you know, with better sleepor more calm, sometimes people
(30:37):
can get a little too sleepy,yeah, right, right.
And a little too sedated, right.
And then there's actually ablack box warning on this
medication of suicidal thoughts.
Oh, okay, so rare, but Iactually did have a patient who
that applied to, and we had totake her off of this medication
and switch to something else.
So there is no free lunch here.
That is bottom line.
(30:57):
No, none of these medicationsare qualified for any of that.
Yeah, and then the other one totalk about is Orlistat, or Ally
, which some folks will knowbecause it made its way to a
bunch of late night talk showhosts, like monologues, back in
like the early 2000s, because itstops your body from absorbing
some of the fat that you'reeating, so guess where that fat
(31:18):
goes To the right places youpoop it out, oh, okay, okay, and
sometimes, when you don'texpect it, oh snap, oh snap is
right.
So folks can have really baddiarrhea with this medication,
or even something worse calledanal leakage, which is about as
fun as it sounds Certainly noteverybody has these side effects
(31:39):
but but because you're also notabsorbing fat, the same way,
you're also leaching your bodyof some fat soluble vitamins,
like vitamin A and D and E and Kand we were talking about the
weather earlier, right, and thesunshine not being out in the
wintertime and everythingvitamin D, for instance, which
your body absorbs from food butalso comes from sun activation.
(32:01):
A lot of people are already lowon some of these vitamins,
right?
So adding another medication tothe mix that makes these
vitamins even lower not alwaysthe safest option not always a
good option.
So then and we've alreadytalked about the injectable
medications to there's options.
Tammie Lakose (32:17):
There's options, they're good.
They're good.
What if my insurance stopscovering it?
What if I stop?
Maria Iliakova (32:22):
taking it.
Yeah well, it stops workingBecause, just like any other
medication you take, if you'renot taking it, it don't work.
Tammie Lakose (32:29):
What is the?
Maria Iliakova (32:29):
percentage of people gaining that weight back?
Yeah, pretty much everyone.
So when you stop taking thesemedications, you gain the weight
back Because there's no longlasting effect of these
medications.
If you stop taking yourmedications for your blood
pressure, guess what your bloodpressure is going to?
Tammie Lakose (32:45):
go back up again, especially if you're doing all
the same things.
So, I feel like we see a lot ofpatients using these
medications but not seeingdietary and really making those
changes.
So once you get that, take thataway, yeah, then people can
regain weight.
Maria Iliakova (33:04):
So you're right, Because sometimes people can
use these medications to helppeople change their habits and
to have better access to mentalhealth and sort things out for
themselves.
They're really effective forpeople who are going through
life changes, whether job orfamily or other, or even age
changes like menopause, thingslike that, Because it kind of
(33:26):
helps to take away the edge offof some of these more difficult
situations in life.
But ultimately you're right Ifpeople are not really taking a
look at the bigger picture,changing some of their habits,
guess what?
You go back to the same habits.
You start regaining the weightback.
Tammie Lakose (33:40):
And I want to throw this out there that when
people talk about medical weightloss or surgery, well, we're
not really talking about themanyways.
People are not going up to eachother.
Be like, I'm on no zimp becauseI want to lose weight.
But something that really stuckwith me is that even myself
(34:01):
before surgery, I always thoughtwhat am I having for breakfast?
Ok, I ate breakfast.
What am I having for lunch?
Oh, I can't wait to have dinner.
So there's a lot of food noiseand these medications help with
that food noise of being able tofocus on making good choices.
And when all you're thinkingabout is food, of course, all
(34:25):
you're thinking about is the badfood, absolutely so that's
something I just wanted to putout there, that, though medical
weight loss and surgery peoplesay it's the easy way out, it's
just a tool to help quiet thatfood noise amongst other things?
Maria Iliakova (34:42):
Exactly.
Tammie Lakose (34:42):
Food noise is a.
Thing.
Maria Iliakova (34:44):
Oh, food noise is definitely a thing.
Oh, my goodness, food noise isa thing so having.
I think it's difficult for somefolks to relate to that because
they may not have experiencedit, but if you have and I have
experienced food noise in mylife too it can overwhelm
everything in your life 100%.
Tammie Lakose (35:01):
That's all you're thinking about.
Maria Iliakova (35:02):
That's all you're thinking about, meaning
your family obligations, yourwork obligations, your anything
else that's in your life.
It all revolves around yourthoughts, around food.
If you have food noise going on, so you're obviously right.
These medications can help cutthat back or help to eliminate
it entirely, with the kind offreedom that you can experience
(35:23):
as a result, either throughmedications or even through
surgery, of that food noise canbe a life changer.
That completely for people.
Tammie Lakose (35:33):
And so I personally have ADHD just found
out in my adult life, actuallyafter or right before surgery, I
found out.
And so I like to compare it towhen an unmedicated ADHD person
100 tabs are open 100 tabs areopen, so when I'm able to take
(35:55):
my medication usually only takeit at work, but I'm able to
focus on one thing, so againit's the noise of being able to
focus on the important thingsExactly.
Maria Iliakova (36:06):
And as somebody who's guilty of having 100 tabs
open all the time, I understand,because it's really difficult
to focus on the things you wantto when you have something
that's taking all your attention.
And food and weight and thesekinds of topics can do that and
do that for a lot of people, andso acknowledging that and
trying to find ways to deal withit is really important.
(36:28):
So just to kind of tie it alltogether, because I know we've
talked about surgery and dietand exercise and medications the
other thing I really reallywant people to know is that it's
not either or.
When we deal with weight it isnot the same as dealing with a
cocaine problem or an alcoholissue or anything like that.
(36:50):
It's a lot more like dealingwith diabetes or dealing with a
mental health issue or somethinglike that.
Tammie Lakose (36:58):
It's a lifelong approach.
The thing is with drugs andalcohol you can eliminate those.
Maria Iliakova (37:03):
Exactly, guess what.
You got to eat, food you got toeat right, and you've got to
attack that mental aspectExactly.
It's all about maintenance.
It really is.
It's all about long term,because sometimes people think
of these things as a one timefix.
Oh, I'm going to get somemedications, I'm going to take
them for some months and it'sgoing to fix everything.
Or oh, I'm going to get surgeryand it's going to fix
(37:24):
everything, and then I'm goingto move on and my life can be
great.
That's not how it works at all.
All of these approaches requiremaintenance.
They also sometimes combinewith each other.
So we're sometimes usingmedications before or after
surgery.
We're sometimes moving on frommedications to surgery.
We're sometimes not able tohave medications because of cost
(37:47):
, or we're not able to havesurgery because of insurance
restriction.
There's all kinds of things atplay here.
So I just want to make sureeveryone kind of knows that
there's a lot of options thereand that there's a lot of work
being done to develop moreoptions but also ways to combine
them.
Tammie Lakose (38:06):
Yeah, ultimately, there is a choice for everybody
or there's an option foreverybody, and don't hesitate to
bring it up to your provider,and if that provider is not
listening, break up with them.
Maria Iliakova (38:19):
That's fine, sorry, yeah, it's so easy to
find another one.
By the way, it's really not.
It's really not, but yes.
Tammie Lakose (38:26):
But.
But you're onto somethingEverybody deserves a Provider
that is listening to them, is ontheir side.
At that, I agree with yeah, andwait, it's not an easy topic.
Maria Iliakova (38:36):
It's not an easy topic and I will say you know.
As a provider myself, I willsay that I have been very
undereducated on this topicUntil I started doing it myself
every day, in and out, and evennow I realize I don't know very
much About these topics.
Yeah because there's so much tolearn, right, there's so much
(38:57):
we don't understand and we'vegot a long way to go to figuring
out solutions to these issues,and then not even just like the
solutions, but how do people getto them right?
Tammie Lakose (39:07):
and don't hesitate to Reach out to a
bariatric program.
Maria Iliakova (39:11):
Oh yeah, this is something I learned that
bariatrics does not mean Surgeryright, right, and a lot of
programs are now offering a morecomprehensive approach.
Right, that's more of aspectrum of like diet and
exercise and mental health andmedications and surgery and all
kind of fine Bariatrics for me,oh yeah.
(39:32):
Yeah, yeah, yeah for sure.
So bariatrics actually comesfrom the word Barry Bari, which
means weight.
Okay, so the whole idea isbariatrics is the study or the
field of weight.
All right right not justsurgery, not just surgery.
So bariatrics is just referringto weight and we talk again.
We talk about weight becauseit's the easiest way for us to
(39:54):
all kind of have the samelanguage, right, but when we're
talking about bariatrics orweight or any of these things,
it's about a much bigger picture, right, right?
Tammie Lakose (40:03):
right and that's why I chose core bariatrics, the
core of it all.
Very at you got, you did getcaught up on the bariatrics,
part part of people don'tunderstand what bariatrics mean
right so for those that keeplistening, I'm, I'm, I feel like
I'm gonna bring it up.
Continue to bring it up, justso that, if people miss an
episode, that they understandthat bariatrics is more than
(40:25):
just bariatric surgery.
Maria Iliakova (40:26):
Absolutely, absolutely Well.
Thanks so much for joining us.
I would love to hear your storyabout your journey in Trying
these different things yet, cuzI've done it all.
Tammie Lakose (40:35):
Yeah, and just like.
Maria Iliakova (40:37):
Tami, a lot of people who, who, who get to One
stage have tried a lot of otherthings before they got there and
probably will try other thingsafter they, after whatever stage
they're at now.
So in our comments, pleasedon't hesitate to tell us about
your experience and how you'vegone through either med, weight
loss or surgery, or diet andexercise, how things are working
(40:58):
for you.
Tammie Lakose (40:59):
I would love to hear about or even how they're
not working for you, oh, evenbetter, yeah, we want it as much
as all you know.
All of this is good, positivestuff.
We also want to get down to theNot so great stuff, absolutely.
So, yeah, don't forget tofollow us to get notified for
another episode and thanks forhanging out with us.
Thank you, you.
Welcome to Core Bariatrics podcast, hosted by
bariatric surgeon Dr MariaIliakova and Tammi e Lakose,
bariatric coordinator and apatient herself.
Our goal is building andelevating our community.
The Core Bariatric podcast doesnot offer medical advice,
diagnosis or treatment.
On this podcast, we aim toshare stories, support and
(00:22):
insight into the world beyondthe clinic.
Let's get into it.
All right, Maria, the sun isfinally shining.
It's been how many days ofcloudiness.
Maria Iliakova (00:33):
Oh goodness, Our patients have been cranky.
Tammie Lakose (00:35):
Our patients have been cranky, I know.
Maria Iliakova (00:37):
I've been cranky , sorry Me too.
Me too, don't worry.
Don't worry, sad has alreadystarted, and it's only.
Yeah, we're not even intowinter yet.
So, this is.
This is how it is.
Tammie Lakose (00:47):
Sometimes the sun is shining, it's a good day, so
today we are going to dig intoall of the options, whether it
be surgical, whether it benon-surgical, whether it just be
diet and exercise.
But we're going to talk about,like the success rates, if the
limitations, expectations, howpeople or if they gain weight
(01:09):
afterwards.
Right Right, Because that ishuge.
Maria Iliakova (01:11):
That's a big one .
You know, when we're talkingabout weight loss strategies, I
almost think of it in terms ofyou had a really good point
recently of like how do we end,how do we, what's the goal,
what's the end game here?
I think that's a really goodway to think of it, because you
can lose weight a milliondifferent ways, but are you
losing weight just to loseweight for now, or are you
(01:33):
losing weight to lose weight fora lifetime?
Because maintaining weight lossis really the name of the game
and that's the hard part.
Tammie Lakose (01:39):
That's the hardest part.
I feel like we always need tohave a goal, yeah, exactly,
whether it even not be weightloss.
Maria Iliakova (01:46):
That's such a good point, because weight, you
know, I kind of think of weightas the gateway drug in a lot of
ways, like that's the way thatwe hook people to start a
conversation about health andgoals and all those things, and
weight it's a number so peoplecan kind of wrap their minds
around it.
Insurance companies can wraptheir minds around it, all that
stuff.
I know it's kind of a pain, butweight is really just the
beginning of a conversation.
(02:06):
Yes, right, the very firstquestion out of my mouth when I
meet someone in a visit is whatare your goals?
What would you like toaccomplish?
Because when we're talkingabout weight, we're really
talking about all of these otherthings that people want to be
able to do in their lives.
Tammie Lakose (02:20):
Yes, and that's where I have wanted to highlight
things with our program is sure, I want to know what your
weight is like, what yourstarting weight is, what your
end weight is, but I really trynot to bring up weight at all,
because weight, you know, it isthe big picture, but I want to
know the other things, thenon-scale victories.
(02:40):
These are the things we need tobe really looking at and so,
again, that'll probably beanother episode of, just like
you know, really talking aboutjust not focusing, just on
weight, Right?
Maria Iliakova (02:54):
Yeah Well, and so you know to kind of beat a
dead horse a tiny bit, but we'reactually going to focus on
weight today and how weaccomplish weight loss and
weight loss maintenance, so likehow you accomplish that for a
long time.
But again, I want to emphasizethat while we're talking about
weight, we're really talkingabout the big picture of how you
live a healthier life, how youlive the life you want to and
(03:15):
how you're able to use your bodythe way that you were to do
that.
So, we're going to touch on,just like Tammie said, diet and
exercise, medications, surgeryand kind of beyond, because a
lot of times these things arenot one or the other, it's
combinations.
It's combinations what we wantto accomplish.
So let me just talk about realquick surgery.
(03:36):
I think surgery is the elephantin the ring a lot of times and
I am a surgeon, so you know I ambiased.
Obviously, I wouldn't havebecome a very anti-ex surgeon if
I didn't believe in it very,very strongly.
But here's why it works andwhat does it work for?
Well, that's a really goodquestion.
And it works to help peoplelose weight and keep weight off.
Tammie Lakose (04:00):
Keep it off.
That is your main factor there.
Maria Iliakova (04:02):
Exactly.
Tammie Lakose (04:03):
That's something I need to wrap my head around,
exactly Like for me.
Losing weight was difficult attimes, but I mean I could drop
30 pounds in a month, but it'skeeping it off.
Maria Iliakova (04:16):
Exactly, yeah, exactly.
And that's not to say that youcan't regain weight after
bariatric surgery.
In fact, we now have data thatshows like one in three patients
almost regain weight aftersurgery.
So that's definitely possibleand we'll talk about that in
another episode for sure, butit's the most likely way that
you're actually going to be ableto come off of medications for
(04:38):
things like diabetes and highblood pressure.
It's the most likely way thatwe're going to be able to treat
joint pain for people who havearthritis and other joint issues
, and it's the most likely wayto get to your goals and stay
there whether they're weight orwhether they're lifestyle or
whether they're both.
So surgery really should beconsidered more like sooner than
(04:59):
you think, and it should beconsidered even if you're also
working on diet, exercise andeven medications yeah, it's
surprising.
Tammie Lakose (05:08):
So patients come in here thinking that surgery is
the key.
Right, I don't have to doanything.
Right, you're going to do,you're going to reroute things
or cut things out, and I don'thave to do anything.
Maria Iliakova (05:21):
So, Tammie, tell me, has it been a journey where
you had to do nothing for you?
Tammie Lakose (05:23):
I wish Right, right.
No, you still got to do all thethings.
You still got to focus on whatyou're eating and moving your
body.
Exactly.
The tool just makes it a little, a little easier.
Exactly.
Maria Iliakova (05:41):
And so bariatric surgery, I think a lot of
people think a number of thingsabout.
They think it's the easy wayout, they think it's a shortcut,
they are scared of it becauseit is surgical and it's going to
change your lifestyle.
There's so many differentviewpoints and it goes.
It's so funny because this isone of the things in our lives
where people hate it for all ofthe reasons, 100%.
(06:02):
People are scared of it for allof the reasons and as a surgeon
, I totally get it, because ifsomebody was excited to go to
the OR and didn't have someanxiety about it or didn't give
it a second thought, I would benervous, right, right, yeah,
because for me, this is my dailylife, but for most people,
you're going through surgeryonce, maybe twice in your life
(06:23):
for this purpose.
So, honestly, I think the wholeprocess is exciting and the
whole outcome can be reallyexciting.
But I totally understand thatthe idea of surgery itself can
be scary, 100%, and that's fair,yeah, and even in our field,
even with other physicians,other doctors, other people in
(06:44):
the industry, you do see a lotof fear and misunderstanding.
So, I do want to mention, withsurgery, what are the
expectations?
Yes, right, Because, Tammie, Ithink we even discussed through
your process what thoseexpectations could be.
Tammie Lakose (06:56):
Yes, yes, I'm going to look like a supermodel,
right, yeah?
I'm going to say it in yourword, all of it.
Maria Iliakova (07:01):
Hey, I love it.
No, okay, first of all, you canbe a supermodel any size, okay,
so let's say that, and I wishmore supermodels actually looked
a little bigger, because Ithink that's beautiful, but
anyway.
But expectations after surgeryis not all of the weight loss
that some people expect.
Correct, right?
So typically you're losingbetween 50 and 80% of extra
(07:25):
weight as opposed to all of yourweight, right?
So that's the type of peoplethat's not going to bring them
into a weight that is their highschool weight or that is, like
you said, a supermodel on abillboard weight, but at the
same time, like that's notreally the purpose either, right
, right, the point of thesesurgeries is to help you get up
and off the ground easier.
Yes, help you keep up withother people in your life easier
(07:48):
.
Tammie Lakose (07:48):
Yes, like my three little kids running around
like crazy.
Yeah, I've stopped weighingmyself for the most part.
Yeah.
Maria Iliakova (07:56):
And I think that's a super healthy thing.
Like I encourage people toweigh themselves at most once a
week.
Yes, because otherwise it canbecome really obsessive.
Yes, in a negative way and alsoweight fluctuates.
Tammie Lakose (08:06):
Yeah, especially women.
Oh gosh, Especially women.
Yeah, you're on your period.
Maria Iliakova (08:10):
You happen to eat something a little too salty
.
You're right you know like thatcatches up with everyone.
So you know weight.
Actually, did you know thatweight can fluctuate up to five
pounds in a day?
Tammie Lakose (08:20):
In a day In a day .
So that's why your scale istelling me that I'm five pounds
heavier than when I'm at home,butt naked after I've done all
my business.
Maria Iliakova (08:29):
There you go.
Yeah, there you go.
We all know that the wintertimein Iowa people are at least
wearing like five pounds ofclothes too, so there's that.
So, unless you're juststripping naked in your doctor's
office, which you know, that'sup to you, but there's going to
be a couple of extra poundsthere anyway, yes, so, anyway.
So that's surgery, and we willdefinitely have another episode
that goes more into the nittygritty of what kind of surgeries
(08:50):
are out there and what they'refor and what the differences are
.
But I just want you to knowthat surgery is something to
consider, and even convertingfrom one surgery to another is
an option for a lot of patients.
So if you're in the position,had a surgery and you've
regained weight or you've hadother things like reflux or
other things pop up along theway, that might be a
(09:12):
conversation to have withsomeone who does surgery and
think about maybe taking thenext step with a different
surgery or yeah.
Tammie Lakose (09:20):
So we also want to change mindset of or you've
said you want to change otherproviders' mindset of.
This is your last ditch effort,this is your extreme.
We need to look at thatdifferently.
Why do we have to wait until wehave diabetes and high blood
pressure and all of that stuffbefore we look into surgery?
(09:43):
Why aren't we looking at peoplethat, oh, their BMI or their
weight has gone up a little bitin the past six months Exactly,
for no significant reason?
Let's battle this now.
Oh yeah, absolutely.
Maria Iliakova (09:55):
And it's this whole idea of an ounce of cures
worth a pound of prevention kindof thing.
But what it means basically iswe plan ahead for everything.
We plan ahead for Thanksgiving,for Christmas, for our kids to
go kids' games and things likethat.
For your vacation.
You plan ahead, but we don'treally plan ahead for our health
(10:16):
the same way.
Tammie Lakose (10:18):
We just dig around and see what happens.
Yeah, we kind of dig around andsee what happens, and then I
will say.
Maria Iliakova (10:22):
Insurance companies, for the most part,
are not helpful in this 100% notBecause surgical care or just
in general weight care eventhough it's really, really
important is very limited, sothere are restrictions that are
placed on access to these things.
That I mean, I even talked to apatient today, actually, who is
a person who has med weightloss on board, but her access is
(10:46):
very, very limited because it'sexpensive and she doesn't have
health insurance coverage for itand she's desperate and I
really, really want to be ableto help her, but we don't have
policies in place that reallyallow people to get help before
it gets worse.
In fact, that's kind of crazy.
But she's not a diabetic.
Being a diabetic can help youqualify for some of these meds,
(11:07):
like you've seen.
And she literally said well, Iwish I were a diabetic.
Tammie Lakose (11:12):
Right.
How crazy is that A lot of herpatients have said that because
Right.
Maria Iliakova (11:16):
Yeah, yeah, and this is exactly like the
probably 40th time I'm hearingthis now from a patient which is
messed up.
Tammie Lakose (11:22):
Yeah, because we got to wait until now.
We have this diagnosis beforewe start thinking about it,
right, so?
Maria Iliakova (11:28):
And that applies yeah, that applies across the
board for access here.
Tammie Lakose (11:30):
So, yeah, so let's talk about the diet and
exercise that should work foreverybody.
Maria Iliakova (11:35):
Right, yeah, tell her in, tell her out, guys.
Hello.
Tammie Lakose (11:37):
Obviously, all of our providers, our primary care
doctors, are telling us youbetter move more Right and not
getting down on them because Iam in the health field and
health care field and understandthat we're sitting at a desk,
most, but most of our providersDon't yeah, don't necessarily
know, and that's true.
Maria Iliakova (11:58):
So the way that I think of it is diet and
exercise are essential, right.
And when I say diet I don'tmean like eating no carbs.
In fact, when I say diet I meanlike making sure that you eat a
good diet that's full of carbsand proteins and fat and fiber
and lots of fluids, and I meanjust overall eating stuff like
you would if you lived 150 yearsago and you lived on a farm,
(12:22):
like if you ate healthy and atewhat you needed to that, yeah,
not over limiting yourself, notoverdoing it pretty moderate.
I know that's really boring,but no, no, that kind of
approach to food, right, yes,not food as fuel.
You can enjoy food, but alsounderstanding that food is there
to serve you, not the other wayaround.
(12:44):
That's unfair.
Yeah, 100%.
And then exercise is kind ofthe same right.
Moving your body can be awesomeif you find something you like
to do.
Tammie Lakose (12:53):
That you enjoy Exactly and like.
Maria Iliakova (12:54):
Tammy, what do you enjoy to?
Tammie Lakose (12:56):
do I enjoy like HIIT training High
Maria Iliakova (12:59):
Identity training.
I love that too.
Tammie Lakose (13:03):
And I love not being able to breathe for a hot
second.
Honestly, most of my workoutscome stem from when I'm angry
and I just go balls to the wall.
Is that appropriate?
Maria Iliakova (13:16):
Oh, I mean it is now.
It is now.
No, that's great.
Tammie Lakose (13:20):
That's what I enjoy.
I really do enjoy feeling orhaving that sweat.
Maria Iliakova (13:25):
Yeah, having the sweat on, and there's so many
ways to move your body right.
So when we were puttingtogether some of our materials,
I was looking online and I kindof felt like an idiot because I
was like, ok, give me activities, google or chat, gpt, give me
activities.
And it was like walking andrunning and volleyball and I was
like, yes, I know these things,but it's kind of hard sometimes
(13:46):
to wrap your head around whatyou're going to pick because,
it's almost like if you'restarting from somewhere.
it can be intimidating to getstarted with anything and it can
be overwhelming to choosesomething.
Has there been something thatyou recommend in terms of making
a choice or?
Tammie Lakose (14:03):
getting started.
Be comfortable with beinguncomfortable.
Honestly, that's a good one.
My first time into a gym.
I was lucky enough that theyhad a promotion going that you
would get five free sessionswith a personal trainer.
Actually, I think it was moreso that they could cover their
(14:26):
butt and teaching me how to usethe equipment.
Maria Iliakova (14:29):
And not get injured.
That's great.
Tammie Lakose (14:33):
But that gained confidence for me.
I mean, people are going into agym and being like I'm just
gonna do the treadmill or theelliptical.
Why?
Because it's easy, because youcan't make fool yourself and oh,
let me tell you fool yourself.
Maria Iliakova (14:51):
So I have fallen off of an elliptical broken
iPad doing that Yep.
So you can make it foolyourself even on an elliptical.
Tammie Lakose (14:57):
Where is?
Maria Iliakova (14:58):
that video clip.
It is sealed.
It is sealed.
It's not boxy old, no, but Ihave also fallen off of a
Stairmaster and oh man, sothere's, that is talent
something like that.
No, there's ways to injureyourself doing anything.
Tammie Lakose (15:12):
And that's actually an important part here
too.
Maria Iliakova (15:14):
So overdoing it with exercise and not actually
starting somewhere and kind oftaking it low and slow first is
a great way to get injured andthen sideline yourself for a
whole lot of time.
Tammie Lakose (15:26):
I do question sometimes because you know we
will preach you need to exerciseand move your body every day.
But I'll be open and honest.
I'm not exercising every day.
I do need to.
Maria Iliakova (15:39):
I am moving my body obviously You're moving
your body and I think there's adifference between moving your
body and exercising.
Yes, there is I think therecommendation really should be
moving your body a little morethan you would normally, for 30
minutes a day.
Tammie Lakose (15:52):
I think I just go a little too extreme and
honestly I should not Like whenI told you I was angry and I
went home and ran a 16 minutemile.
I should not have.
Like my heart probably did notappreciate that.
So I think I need to find Ineed to work out to that.
Maria Iliakova (16:11):
There's a lot of rage exercising that happens.
Tammie Lakose (16:13):
We've all done it .
Maria Iliakova (16:15):
I used to box and I understand.
Tammie Lakose (16:16):
That's a great way to get some aggression out.
Maria Iliakova (16:19):
That's not to say that that's wrong.
Whatever approach works for you, that's great, but the whole
idea behind like moving yourbody is do anything.
If it's jamming to a TikTokvideo, if it is yoga, if it is
walking your dog, if it is doingHIIT, high intensity interval
things, if it's golfing, playingwith your kids.
Tammie Lakose (16:41):
Absolutely, throwing a 30 pound toddler in
the air is intense.
But it's not something that youthink, oh, I worked out today
because I was playing with mykids, exactly, and it is.
Maria Iliakova (16:54):
And like there's actually a lot of studies that
show that continuous movementand engagement, even if it's low
intensity, can be very helpfulover time Because it's doable,
you're not gonna injure yourselfas likely.
So really finding things andthen, like you said I love that
you said this of just doing itand not being afraid to kind of
(17:14):
look new or not be good atsomething, Lord knows.
When I first tried highintensity interval stuff, I mean
you look like a fool in a hat.
Tammie Lakose (17:22):
Oh 100%.
I am not saying I lookbeautiful and I ain't about to
do it in front of a whole bunchof people.
Oh no, oh no, no, no no, andthen actually.
Maria Iliakova (17:30):
so I got to the point that I liked it so much I
actually started teachingclasses about a year, year and a
half after that.
So you absolutely do not knowwhat your limits are, you don't
know what your possibilities are, until you get started doing
something.
Tammie Lakose (17:43):
Right, and don't hesitate.
Yet Don't hesitate to ask forhelp.
I mean, that young buff guy atthe gym would probably like
enjoy teaching you.
He's going to the gym every day.
He would probably enjoyteaching you how to do it
correctly, right?
So put yourself out there alittle bit too.
Maria Iliakova (18:04):
Absolutely.
I would totally do that now,Absolutely.
And if he hits on you don'twant that, then move along.
Tammie Lakose (18:10):
Right, or even a woman.
There's a lot of women outthere.
There's a lot of women.
There's way more women.
Maria Iliakova (18:15):
weight training, absolutely, and I remember I
actually took a high schoolclass in weight training, which
can you believe my high schoolhad.
Weight training is so cool.
But it set me up to haveanother skill that I could use
to move my body anywhere anytime, to the point where now I have
those things at home and I'mable to create a workout for
myself anytime that I'm at homeand it's kind of it's cool.
(18:37):
So I think anytime you'rethinking about fitness activity,
moving your body, just trysomething, do anything Something
.
Physical therapy counts.
Oh yes, getting walking aroundthe mall counts, everything
counts.
Tammie Lakose (18:52):
If you are doing absolutely anything, you are
passing the person that's stillsitting on the couch.
Maria Iliakova (18:57):
That's so true.
Laps around the couch.
I love it.
Tammie Lakose (18:59):
You can run laps around the couch.
Maria Iliakova (19:01):
I remember when I was a kid, and it was really
bad weather outside.
My mom would be like run aroundthe dining table and I did my
boys do that often.
Tammie Lakose (19:08):
Yeah, I remember that.
Maria Iliakova (19:09):
Anyway.
Tammie Lakose (19:10):
But what is the success of diet and exercise?
Because, let's be honest, I'vebeen on a lot of diets.
Maria Iliakova (19:16):
Yes, and they always fail.
Who hasn't?
I mean, I've been on a milliondiets too.
So diet and exercise alone forweight loss.
What do you think is the rate?
How often do you think thatworks Long term?
Tammie Lakose (19:28):
5%, you're right.
Maria Iliakova (19:30):
Really yes, oh, isn't that crazy.
Tammie Lakose (19:32):
Yeah, ok, that is it.
Maria Iliakova (19:34):
It literally is the statistics are it works less
than 5% of the time.
That's crazy, isn't that wild?
So 95% of people, 95% who trydiet and exercise alone, will
regain the weight and most ofthem will regain more.
Tammie Lakose (19:49):
But it's just you .
Maria Iliakova (19:51):
It's just that you're not a problem, not eating
well and moving.
That's the mentality we'regetting out of here, like we are
getting out of here that if itworked, we would all do it and
be successful.
Yeah, if it all worked, thenall the 60% of people who have
an extra pound or something ontheir body wouldn't have it.
But that's okay, so, yeah, sodiet and exercise alone do not
(20:14):
work for weight loss theyabsolutely.
It does work really really well, though, for maintaining 100.
Yes, yes, keeping your bodyactive.
Tammie Lakose (20:23):
Yes.
Maria Iliakova (20:23):
Keeping your body healthy, keeping your gut
happy and working.
Tammie Lakose (20:27):
Yes.
Maria Iliakova (20:28):
Your mind happy and working.
So for those reasons, having agood, healthy diet and staying
active every day, those arethat's really important, just
for overall wellness.
Tammie Lakose (20:37):
Yes, and maintaining and just feeling
good, exactly so.
Okay, that doesn't work,doesn't work.
I'm coming into your officeRight and I'm telling you
surgery, ain't it for me.
Yeah, that's fair, okay.
So what's?
What can we look at now?
Maria Iliakova (20:51):
What else is out there?
Well, I'm sorry, Tammie, you'regoing to have to leave now.
Tammie Lakose (20:53):
No, I'm kidding, no, no, no, no, I'm totally
kidding, I'm totally kidding.
Maria Iliakova (20:56):
So luckily there's actually a lot of other
options.
So one thing is we definitelylook at mental health too as
part of the picture and we willhave another episode about
mental health and bariatricsurgery and things definitely.
But you know, you have toremember this is not mind versus
body.
This is mind and body whenwe're talking about weight,
because oftentimes the way thatwe move our bodies, the way we
(21:18):
think about what to eat, the waywe kind of the whole picture,
is also how we feel.
Tammie Lakose (21:25):
Yes, a lot, because when I I'm not feeling
good, I want all the junk food.
Maria Iliakova (21:29):
That's right, that's right.
So, surprisingly, pretty muchevery visit we also talk about
mental health.
Yes, Right, and that's scary.
I get it Not.
Nobody wants to be told oh, youneed to.
Tammie Lakose (21:40):
You know, go see someone and figure things out
Right and work on yourselves andall of that.
Maria Iliakova (21:45):
But actually, you know, I've gone through
mental health like therapymyself.
I've gone through things and Ithink the only thing that
happened was either it was nothelpful, that can happen or it
was helpful, right yeah, and Ifelt better and I felt more
empowered and I felt morecapable and I didn't feel like
the problems in my life werescary anymore.
(22:06):
Yes, I mean okay.
So those are pretty decentoutcomes.
I really have yet to hearsomebody going through therapy
and it making things worse.
Right, but anyway.
So something to consider.
Definitely, if you already havesomeone that's helping you with
mental health, that's great,but if not, I would actually say
consider.
Tammie Lakose (22:23):
Yeah, and if you do have somebody and it's just
not working, break up with them,that's okay, yeah.
Maria Iliakova (22:27):
That's true.
Well, throughout all of this,breakups are part of the
equation sometimes yes, oh yeah,and you can break up with your
yeah with anybody providing youcare.
Yes, yeah, that's that is inyour yeah, that's in your balls
in your court on that one, yesit is For sure, so, but okay,
but also, I think it's reallyimportant to think about med
weight loss, so medications thatcan help you lose weight or
(22:48):
help you maintain weight, andthat topic has exploded lately.
Tammie Lakose (22:52):
Yes.
Maria Iliakova (22:52):
Right Like you cannot go on Facebook or
Instagram or TikTok and not hearabout Mozambique and Wagovie
and Wajarro and all of these.
Yes.
Tammie Lakose (23:01):
Yes.
And let's just start here, withus here in a provider's office.
Yes, we want to give it to allof you, I promise.
Yeah, like, if it obviouslyfits for you, put it in the
water.
But it's not that easy.
Yes, but if we could, we would,because it works.
Maria Iliakova (23:18):
It does work, and that's the thing.
And let me caution that bysaying, though, it doesn't work
for everyone Right, because, tobe honest with you, none of
these sort of things work foreveryone, right To be.
Yeah, weight is pretty.
It's a customizable approachfor everyone, yes, and it's a
lifelong approach for everyone,but with medications, you know
these GLP ones, which isglucagon, like peptide one,
(23:39):
analogs, which is what thecategory of medications that
these all fit into, theseSaxenda, Mounjaro, Ozempic,
Wegovy medications.
They are also diabetesmedications, yes, so they help
with insulin resistance, ifyou've heard of that.
They help your body basicallyregulate blood sugar better, but
they also help your stomachslow down and how it processes
(24:00):
food.
Yeah, and so it's really,really it works very well at
decreasing appetite, helpingpeople lose weight, helping
people overall their metabolicfunction get better.
So, yeah, like Tammie said, Iwould love to be able to give
this medication to many morepeople than we currently do Now
appetite, appetite with thesemedications oh yeah, like, is it
(24:23):
working like Phentermine ofjust shutting off your hunger,
or why does it make you lesshungry?
So, to be honest with you, wedon't fully understand why a lot
of these medications work theway that they do in terms of
appetite.
Appetite is complicated, very,yeah, and I mean that not just
because we don't know, like theone pathway that affects that,
(24:44):
but probably because there'ssomething like five to 10
different pathways that actuallyimpact appetite.
Yeah, because think about evenlike okay, what's your favorite
food?
What's your favorite food?
Mexican, mexican.
So think about Mexican food,think about the best place you
like to eat.
Tammie Lakose (24:58):
Oh, now you're taking me to lunch, yeah right.
Maria Iliakova (25:01):
So that's what I mean is just by talking about
food that you like.
Tammie Lakose (25:05):
My mouth is watering.
Maria Iliakova (25:06):
We got Tammie mouth watering right, we got
Tammie fantasizing over here andthat's very powerful, and I
didn't do anything in terms ofmedications.
I didn't do anything in termsof showing you a picture.
There was no smell involved.
That's your mind.
That's your mind at work, rightthere, right.
But that, what we just did,probably has started to activate
(25:26):
some of your stomach enzymes,some of your digestive enzymes
in the rest of your gutcertainly made things work in
your brain and you're probablyfeeling your tongue get a little
, a little more saliva than ithad before in that wild, so
appetite is very complicated.
Tammie Lakose (25:43):
But you made a good point where and educate me
here, where these injectables?
Yeah, yeah, they slow down.
Maria Iliakova (25:54):
Yeah, they slow down basically how the stomach
processes food Right and thinkof it as and that keeps you
fuller longer.
That's right Now something likePhentermine.
That's right, Phenterminedoesn't it's really just an
appetite suppressant.
It's an appetite suppressantbecause it stimulates your
nervous system.
Tammie Lakose (26:09):
Ok, so it is a different function, but that's
something I want people to knowis that these injectables are
not just an appetite suppressant.
There's more going on.
No, people don't understandthis.
It makes me frustrated.
Maria Iliakova (26:20):
It may be bad.
Tammie Lakose (26:20):
There's more going on.
Maria Iliakova (26:22):
There's more going on behind the scenes.
Tammie Lakose (26:25):
Like the empty of the stomach.
It's slowed down.
Also the insulin resistance.
There's more going on than justappetite suppressant, and
that's what I want people toknow.
Maria Iliakova (26:39):
Yeah, absolutely , and I think an approach to
medications that help withweight is unfortunately nuanced.
There's not one size fits allsolution at any of these
strategies, and certainly notwith medications, because right
now so there's nine medicationsthat are approved by the FDA to
help people with weightmanagement.
Like specifically approved forobesity and weight and things
(26:59):
like that, and they all workdifferently.
They're in multiple categories,but they all work differently.
And then the other thing thatwe really have to think about
here, too, is they're expensive.
So Phentermine, not expensive,a lot of side effects, a lot of
side effects, and we can talkabout some of those.
But like Contrave, a little bitmore expensive, less side
effects, but some that arereally severe.
(27:21):
And then Ally or Orlistat, samething, less expensive, lots of
side effects.
And then these GLP-1, Saxenda,Mounjaro, Wegovy, also a very
expensive medication if you'repaying out of pocket and still
have side effects.
Tammie Lakose (27:35):
Yeah, and then the other side effects are less,
though I have been on a lot.
I've been on the Phentermine soI've also tried Saxenda too.
Maria Iliakova (27:44):
I feel like Phentermine just made me crazy,
but I mean I did have sideeffects with Sexenda but I just
feel like they were a littleless little less mental wise.
Oh, absolutely.
Tammie Lakose (27:55):
Because that's the thing is.
Maria Iliakova (27:56):
So these the GLP-1s Mounjaro, Ozempic, Wegovy
they don't really have a lot ofmental side effects that we've
noticed at least.
They don't really have a bigimpact on anxiety or depression
or any of those things, or sleepPhentermine definitely does.
Oh yes, so Phentermine cancause or make worse things like
anxiety, insomnia, your heartfeeling like it's racing and, to
(28:20):
be fair, that's also part ofhow it works, because you're
constantly adding a little bitof stimulation to your nervous
system, so you're addingstimulation to all those
functions too, and in fact, oneof the other side effects people
don't necessarily know aboutPhentermine is that with some
medications it can increase yourrisk of seizures.
So, like I said, these are notone size fits all approaches.
If you're on medications foranxiety and depression.
(28:41):
Phentermine may be a dangerousmedication that you take and
then, no matter what,phentermine also affects your
heart muscles and can causeheart arrhythmias or
palpitations, which means thatyour heart rhythm can get
knocked off normal or even heartattacks down the road.
I know people have heard oflike Fen Fen, probably right
From like the 90s and thingslike that and that was yanked
(29:03):
off the shelves.
Phentermine is safer than FenFen, but Phentermine is actually
one of the components of FenFen and so long term use of
Phentermine definitely canincrease risk of heart problems
and for some people can increaseheart problems off the bat if
they already have them, sodefinitely not appropriate for
everyone.
Contrave I actually use a lotof Contrave and it's a
combination of medicationscalled bupropion and naltrexone,
(29:26):
so bupropion you probably haveheard Wellbutrin as .
I take it.
There you go, A lot of peopletake it right, yes, they do.
So the funny thing about thismedication is actually started
as something that helped peoplestop smoking.
Tammie Lakose (29:38):
Yep, I come from a pulmonary clinic and alot of
Wellbutrin of was given out forsmoking cessation and it did
help a lot, absolutely, and sothe other interesting thing
about this is it's a medicationthat's used to help with anxiety
and depression.
Maria Iliakova (29:52):
Yes A bunch of other mental health conditions
too, and it's like the only onethat they noticed helped people
lose weight, right.
And so you know, obviously,this drug company decided oh hey
, people are losing weight,let's get it approved for weight
loss too.
And it works, yeah.
So the results between, by theway, all these different
medications can be about thesame in terms of overall weight
(30:14):
loss and overall what you canachieve.
Contrave does still have sideeffects though, yes, right, and
you can still have some of thenausea, some of the GI symptoms,
and then a lot of peopleactually have improved sleep by
taking it.
Less anxiety, less anxiety.
So two birds one stone for somefolks.
But you know, with better sleepor more calm, sometimes people
(30:37):
can get a little too sleepy,yeah, right, right.
And a little too sedated, right.
And then there's actually ablack box warning on this
medication of suicidal thoughts.
Oh, okay, so rare, but Iactually did have a patient who
that applied to, and we had totake her off of this medication
and switch to something else.
So there is no free lunch here.
That is bottom line.
(30:57):
No, none of these medicationsare qualified for any of that.
Yeah, and then the other one totalk about is Orlistat, or Ally
, which some folks will knowbecause it made its way to a
bunch of late night talk showhosts, like monologues, back in
like the early 2000s, because itstops your body from absorbing
some of the fat that you'reeating, so guess where that fat
(31:18):
goes To the right places youpoop it out, oh, okay, okay, and
sometimes, when you don'texpect it, oh snap, oh snap is
right.
So folks can have really baddiarrhea with this medication,
or even something worse calledanal leakage, which is about as
fun as it sounds Certainly noteverybody has these side effects
(31:39):
but but because you're also notabsorbing fat, the same way,
you're also leaching your bodyof some fat soluble vitamins,
like vitamin A and D and E and Kand we were talking about the
weather earlier, right, and thesunshine not being out in the
wintertime and everythingvitamin D, for instance, which
your body absorbs from food butalso comes from sun activation.
(32:01):
A lot of people are already lowon some of these vitamins,
right?
So adding another medication tothe mix that makes these
vitamins even lower not alwaysthe safest option not always a
good option.
So then and we've alreadytalked about the injectable
medications to there's options.
Tammie Lakose (32:17):
There's options, they're good.
They're good.
What if my insurance stopscovering it?
What if I stop?
Maria Iliakova (32:22):
taking it.
Yeah well, it stops workingBecause, just like any other
medication you take, if you'renot taking it, it don't work.
Tammie Lakose (32:29):
What is the?
Maria Iliakova (32:29):
percentage of people gaining that weight back?
Yeah, pretty much everyone.
So when you stop taking thesemedications, you gain the weight
back Because there's no longlasting effect of these
medications.
If you stop taking yourmedications for your blood
pressure, guess what your bloodpressure is going to?
Tammie Lakose (32:45):
go back up again, especially if you're doing all
the same things.
So, I feel like we see a lot ofpatients using these
medications but not seeingdietary and really making those
changes.
So once you get that, take thataway, yeah, then people can
regain weight.
Maria Iliakova (33:04):
So you're right, Because sometimes people can
use these medications to helppeople change their habits and
to have better access to mentalhealth and sort things out for
themselves.
They're really effective forpeople who are going through
life changes, whether job orfamily or other, or even age
changes like menopause, thingslike that, Because it kind of
(33:26):
helps to take away the edge offof some of these more difficult
situations in life.
But ultimately you're right Ifpeople are not really taking a
look at the bigger picture,changing some of their habits,
guess what?
You go back to the same habits.
You start regaining the weightback.
Tammie Lakose (33:40):
And I want to throw this out there that when
people talk about medical weightloss or surgery, well, we're
not really talking about themanyways.
People are not going up to eachother.
Be like, I'm on no zimp becauseI want to lose weight.
But something that really stuckwith me is that even myself
(34:01):
before surgery, I always thoughtwhat am I having for breakfast?
Ok, I ate breakfast.
What am I having for lunch?
Oh, I can't wait to have dinner.
So there's a lot of food noiseand these medications help with
that food noise of being able tofocus on making good choices.
And when all you're thinkingabout is food, of course, all
(34:25):
you're thinking about is the badfood, absolutely so that's
something I just wanted to putout there, that, though medical
weight loss and surgery peoplesay it's the easy way out, it's
just a tool to help quiet thatfood noise amongst other things?
Maria Iliakova (34:42):
Exactly.
Tammie Lakose (34:42):
Food noise is a.
Thing.
Maria Iliakova (34:44):
Oh, food noise is definitely a thing.
Oh, my goodness, food noise isa thing so having.
I think it's difficult for somefolks to relate to that because
they may not have experiencedit, but if you have and I have
experienced food noise in mylife too it can overwhelm
everything in your life 100%.
Tammie Lakose (35:01):
That's all you're thinking about.
Maria Iliakova (35:02):
That's all you're thinking about, meaning
your family obligations, yourwork obligations, your anything
else that's in your life.
It all revolves around yourthoughts, around food.
If you have food noise going on, so you're obviously right.
These medications can help cutthat back or help to eliminate
it entirely, with the kind offreedom that you can experience
(35:23):
as a result, either throughmedications or even through
surgery, of that food noise canbe a life changer.
That completely for people.
Tammie Lakose (35:33):
And so I personally have ADHD just found
out in my adult life, actuallyafter or right before surgery, I
found out.
And so I like to compare it towhen an unmedicated ADHD person
100 tabs are open 100 tabs areopen, so when I'm able to take
(35:55):
my medication usually only takeit at work, but I'm able to
focus on one thing, so againit's the noise of being able to
focus on the important thingsExactly.
Maria Iliakova (36:06):
And as somebody who's guilty of having 100 tabs
open all the time, I understand,because it's really difficult
to focus on the things you wantto when you have something
that's taking all your attention.
And food and weight and thesekinds of topics can do that and
do that for a lot of people, andso acknowledging that and
trying to find ways to deal withit is really important.
(36:28):
So just to kind of tie it alltogether, because I know we've
talked about surgery and dietand exercise and medications the
other thing I really reallywant people to know is that it's
not either or.
When we deal with weight it isnot the same as dealing with a
cocaine problem or an alcoholissue or anything like that.
(36:50):
It's a lot more like dealingwith diabetes or dealing with a
mental health issue or somethinglike that.
Tammie Lakose (36:58):
It's a lifelong approach.
The thing is with drugs andalcohol you can eliminate those.
Maria Iliakova (37:03):
Exactly, guess what.
You got to eat, food you got toeat right, and you've got to
attack that mental aspectExactly.
It's all about maintenance.
It really is.
It's all about long term,because sometimes people think
of these things as a one timefix.
Oh, I'm going to get somemedications, I'm going to take
them for some months and it'sgoing to fix everything.
Or oh, I'm going to get surgeryand it's going to fix
(37:24):
everything, and then I'm goingto move on and my life can be
great.
That's not how it works at all.
All of these approaches requiremaintenance.
They also sometimes combinewith each other.
So we're sometimes usingmedications before or after
surgery.
We're sometimes moving on frommedications to surgery.
We're sometimes not able tohave medications because of cost
(37:47):
, or we're not able to havesurgery because of insurance
restriction.
There's all kinds of things atplay here.
So I just want to make sureeveryone kind of knows that
there's a lot of options thereand that there's a lot of work
being done to develop moreoptions but also ways to combine
them.
Tammie Lakose (38:06):
Yeah, ultimately, there is a choice for everybody
or there's an option foreverybody, and don't hesitate to
bring it up to your provider,and if that provider is not
listening, break up with them.
Maria Iliakova (38:19):
That's fine, sorry, yeah, it's so easy to
find another one.
By the way, it's really not.
It's really not, but yes.
Tammie Lakose (38:26):
But.
But you're onto somethingEverybody deserves a Provider
that is listening to them, is ontheir side.
At that, I agree with yeah, andwait, it's not an easy topic.
Maria Iliakova (38:36):
It's not an easy topic and I will say you know.
As a provider myself, I willsay that I have been very
undereducated on this topicUntil I started doing it myself
every day, in and out, and evennow I realize I don't know very
much About these topics.
Yeah because there's so much tolearn, right, there's so much
(38:57):
we don't understand and we'vegot a long way to go to figuring
out solutions to these issues,and then not even just like the
solutions, but how do people getto them right?
Tammie Lakose (39:07):
and don't hesitate to Reach out to a
bariatric program.
Maria Iliakova (39:11):
Oh yeah, this is something I learned that
bariatrics does not mean Surgeryright, right, and a lot of
programs are now offering a morecomprehensive approach.
Right, that's more of aspectrum of like diet and
exercise and mental health andmedications and surgery and all
kind of fine Bariatrics for me,oh yeah.
(39:32):
Yeah, yeah, yeah for sure.
So bariatrics actually comesfrom the word Barry Bari, which
means weight.
Okay, so the whole idea isbariatrics is the study or the
field of weight.
All right right not justsurgery, not just surgery.
So bariatrics is just referringto weight and we talk again.
We talk about weight becauseit's the easiest way for us to
(39:54):
all kind of have the samelanguage, right, but when we're
talking about bariatrics orweight or any of these things,
it's about a much bigger picture, right, right?
Tammie Lakose (40:03):
right and that's why I chose core bariatrics, the
core of it all.
Very at you got, you did getcaught up on the bariatrics,
part part of people don'tunderstand what bariatrics mean
right so for those that keeplistening, I'm, I'm, I feel like
I'm gonna bring it up.
Continue to bring it up, justso that, if people miss an
episode, that they understandthat bariatrics is more than
(40:25):
just bariatric surgery.
Maria Iliakova (40:26):
Absolutely, absolutely Well.
Thanks so much for joining us.
I would love to hear your storyabout your journey in Trying
these different things yet, cuzI've done it all.
Tammie Lakose (40:35):
Yeah, and just like.
Maria Iliakova (40:37):
Tami, a lot of people who, who, who get to One
stage have tried a lot of otherthings before they got there and
probably will try other thingsafter they, after whatever stage
they're at now.
So in our comments, pleasedon't hesitate to tell us about
your experience and how you'vegone through either med, weight
loss or surgery, or diet andexercise, how things are working
(40:58):
for you.
Tammie Lakose (40:59):
I would love to hear about or even how they're
not working for you, oh, evenbetter, yeah, we want it as much
as all you know.
All of this is good, positivestuff.
We also want to get down to theNot so great stuff, absolutely.
So, yeah, don't forget tofollow us to get notified for
another episode and thanks forhanging out with us.
Thank you, you.
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