July 4, 2024 • 30 mins
Discover the profound insights of Dr. Shauna Levy, the trailblazing Chief of Minimally Invasive and Bariatric Surgery at Tulane University, as she joins us to discuss the complexities and triumphs in the fight against obesity. In an intimate conversation, Dr. Levy unveils her journey from an aspiring pediatrician to a pioneer in bariatric surgery, her advocacy for insurance coverage for obesity treatments, and her unyielding commitment to educate the medical community about obesity as a multifaceted disease. Our discussion delves into the significance of a multidisciplinary treatment approach, combining the expertise of providers, dietitians, and mental health professionals to craft personalized care plans for those grappling with obesity.
Join us for a powerful episode where we tackle the pervasive misconceptions and discrimination surrounding bariatric surgery and obesity. Dr. Levy passionately dissects the stereotype of bariatric surgery as the "easy way out," instead highlighting its role as an essential lifeline for many individuals. We also celebrate the transformative "losers bench" tradition, where patients commemorate their weight loss milestones. Through Dr. Levy's narrative, we explore the joy and fulfillment that accompany the life-changing impacts of bariatric surgery, and how support groups play a critical role in dismantling obesity stigma. This episode promises not just a deeper understanding of obesity care but also a look at the heartwarming victories that come with it.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Welcome to Core Bariatrics Podcast hosted by
Bariatric Surgeon Dr MariaIliakova and TMA LaCose,
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.
Speaker 2 (00:26):
Hello everybody.
Today we have with us the Chiefof the Division of Minimally
Invasive and Bariatric Surgeryat Tulane University.
She completed her fellowship inMinimally Invasive Surgery,
Forgot and Bariatric Surgery atVanderbilt.
She did residency in medicalschool at UT, Houston and
undergrad at Emory.
She was actually one of thefirst surgeons ever to certify
(00:46):
as a diplomat of the AmericanBoard of Obesity Medicine in
2020.
Let's please welcome Dr ShaunaLevy.
Speaker 3 (00:52):
Hey, good morning.
Speaker 1 (00:53):
Thanks so much for having me.
Hello, thank you for being here, you're here.
Speaker 2 (00:57):
I know you're super busy.
You've got two girls, Iunderstand, who may be running
around today.
One of the things we reallywant to talk about with you is
your incredible advocacy in thestate of Louisiana and also
nationally.
You've been a really greatadvocate for bariatric care and
a really great media presenceeven.
(01:17):
Why is that so important to youand how did you get started
doing that?
Speaker 3 (01:22):
Gosh, it's hard to even remember.
At this point, I feel like thisis just the way I was raised Me
and my brother and sister areall very similar in that way and
that we feel compelled to speakup whenever we see injustice,
big or small.
Actually, I know how it startedis that when I first started
working at Tulane University,they did not offer obesity
(01:45):
coverage for their employees.
I just started writing emailsafter emails and basically was
very persistent and was able toget that overturned.
Now I'm proud to say thatTulane University offers its
employees excellent, verycomprehensive care,
comprehensive insurance forobesity.
I realized that I am very goodat being annoying and persistent
(02:09):
.
Speaker 1 (02:11):
I feel like worried about that too.
Speaker 3 (02:14):
That's a big part of advocacy is just like never
stopping and consistentlypresenting your message to
anyone and everyone that'swilling to not ignore you.
Basically they don't even haveto be willing to listen, just to
not ignore you.
From there, I think it branchedout into being more involved in
(02:37):
my state society, the localLouisiana ASFBS, and getting
some mentors there and realizingthat Louisiana is such a low
access state but at the sametime has such a high rates of
obesity.
If not me, then who?
It's really a question I askmyself all the time and just
(02:59):
continue to figure out ways touse my voice and band with other
like-minded people to spreadthe message.
Obesity is such a prevalentdisease but it's not talked
about enough we just need tocontinue to spread that message
and find people that will screamwith us and make the message
(03:21):
known to those around us.
Speaker 1 (03:23):
basically, I think one big reason why I wanted to
do this podcast too isespecially getting providers and
stuff talking about this is adisease, it's not necessarily
what you're doing, because somany patients continually say I
failed, I'm doing somethingwrong, why can't I lose this
(03:45):
weight?
Why just hearing it frommultiple providers that we're
interviewing saying this is adisease, that I think is just
going to help a lot of peopleunderstand that it's not
necessarily what you're doing,wrong or right or wrong.
It's what your body may not bedoing.
Speaker 3 (04:01):
Yes, we know that in 2013, the AMA declared obesity
as a disease, and that wasreally overdue.
That was really late, but evennow that was over a decade ago
People are still extremely, Ithink, reluctant as part of it,
but just still there's a lack ofknowledge.
(04:22):
I think part of this goes tothe fact that we are not taught
this in medical school anddoctors are supposed to be the
experts at medical diseases,when primary care doctors, who
are really the gatekeepers tohealth, don't know that much
about weight and obesity becausethey were never taught then.
(04:45):
I think that messaging is verydifficult to spread to general
public.
I think that we really need todo a better job with training
doctors.
Speaker 2 (04:57):
You've been on the cutting edge of really
considering obesity as somethingthat can be treated with a
spectrum of different things,including medications and side
and exercise and surgery andmental health and all the
different components of that.
In fact, you were one of thefirst people that really got
that American Board of ObesityMedicine designation.
(05:18):
Why was that so important foryou to do, especially as a
surgeon?
Can you talk a little bit moreabout what kind of insight or
experience that has given youresponsibility with?
Speaker 3 (05:29):
current情況 in your life.
Yeah, originally I saw a holethat needed to be fixed.
My institution.
I went and I approached thefamily practice doctors and
internal medicine doctors andsaid our patients need
anti-obesity medications inorder to provide the best care
and also it's also a gateway tosurgery right to start with
(05:52):
medication.
And none of them wanted to doit.
And again, same question then ifnot me, then he'll.
If nobody's going to do it,then I better step up and do it.
And that's when I decided tosit for the American Board of
Obesity Medicine exam and sincethen, my knowledge about
comprehensive obesity care hasjust grown exponentially and my
(06:13):
interest in everything reallyabout my understanding about how
to treat patients with thedisease of obesity has gotten
better.
And now I understand obesity sodifferently and, like you said
that it is best treated bymultiple different providers
from multiple different angles.
I know that something thatwe've talked about offline is
that cancer I really thinkshould be our guide, because
(06:36):
they really do Cancer care doesreally an excellent job of
drawing from multiple differentproviders to best treat their
patients in a very difficultscenario.
Of course, there are some thatfollow the textbook right and
they respond to chemo and theyrespond to radiation and their
cancer can be treated.
But there are some morecomplicated cases that require
(07:00):
multiple different physiciansand multiple different
specialists to come together andhave difficult conversations
about what is the best pathwayto treat these patients, and
they do something called a tumorboard where they can get
together and have theseconversations.
I don't see why obesity shouldbe any different.
This is an exceedinglydifficult disease to treat.
(07:20):
That we know.
Even with medication, even withbariatric surgery, some people
still have weight recurrence andthey become more and more
difficult to treat, and I thinkthat we need a think tank, if
you will, to best treat patients, and so I think that using
cancer as a model of how totreat a difficult disease should
(07:43):
guide us on our pathway ofcomprehensive care and it sounds
like with a tumor board.
Speaker 2 (07:48):
some of our listeners may not know exactly what a
tumor board is.
Can you describe what thatlooks like in terms of who
participates, why it's done thatway and how that would look in
the setting of obesity care?
Speaker 3 (08:01):
A tumor board is where multiple different
physicians come together, likeradiologists and oncologists and
radiation oncologists andsurgical oncologists Basically
every aspect of somebody's carecome together into a room to
review pathology specimens, toreview radiology, to review
(08:22):
patients' cancer history,certain genetic markers and
anything that may influencetheir care, and then determine,
based on best evidence and bestknowledge, what is the best
pathway for a patient.
The truth is, we cannot all knowthe same things.
We cannot all be experts at thesame things, and that's why
(08:43):
it's good to get together withother experts and put our brains
together to come up with thebest decisions.
And I think that it's hard asphysicians because we're really
all over the place and medicalprofessionals in general, we're
all over the place.
But it's so much easier just tocome together in a room and
have this conversation ratherthan sending 50,000 emails back
(09:06):
and forth I guess it's oldschool because most people
communicate via text these daysbut to actually not only pick a
room and a room together maybeor I guess we have Zoom now too
it's just the best way to all beon the same page and really
guide difficult care.
Speaker 1 (09:22):
We definitely got a pushback from being in person
because, yes, we and I think yousaid you tried to do this model
too of when we have those quoteunquote red flag patients, just
that we want to.
We see risk factors that we wantto address before going to
surgery.
So we would have the provider,me as a coordinator, the
dietitian, the mental healthprovider all be in the same room
(09:46):
and discuss some patients thatwe had concerns about, and me,
as a bariatric patient, I'm ableto put light in a different way
to some patients.
We had a patient that themental health provider was like
I don't know, I see some thingsthat and then the dietitian said
the same thing and I actuallysaw this patient as a star
(10:10):
candidate because she remindedme a lot of myself and so I just
needed that kick in the butt,aka surgery, to really help me.
So that patient they listenedto me that patient went to
surgery and, I think, is doingvery well.
So, yes, everybody's sitting ina room talking to each other
and figuring out the best planof action.
Speaker 3 (10:32):
But I think you bring up an excellent point too is
that support group and peersupport is also incredibly
important when it comes toobesity, and I think it's so
important because of all theshame and discrimination that
exists not only about obesitybut about the treatments of
obesity.
(10:52):
How many times have we heardthat bariatric surgery was quote
the easy way out?
And when I think about that,I'm like first of all, what's
wrong with making the easy wayout, like literally, if you?
were in a traffic jam and therewas a road that just opened up
and said you would reach yourdestination 30 minutes earlier.
There's not a single personthat wouldn't go down that road.
(11:13):
Give me a brick and brick.
But, second of all, we know it'snot the easy way out, so it's
not even a relevant point, butfor goodness sakes, it's a way
out and I think that, just likeyou said, it's that tool, it's
that boost that people need on ahormonal level and on a
(11:34):
psychological level to helptreat their disease.
And so I think that havingsupport group and peer support
and people who have walked inthat shoes to be like no, I
promise you this is not onlygoing to be fine but going to be
great.
That's an important aspect ofobesity care as well.
Speaker 1 (11:53):
But, I like where you said sorry, maria, I like where
you said that if you were ableto get out of traffic jam and
get to your destination 30minutes earlier, you would.
But sometimes, even if you takethat route we take fast ways to
work we end up in out ofstoplight.
We end up oh my gosh, there's adog in the road.
I don't know.
Same thing with bariatricsurgery.
We might be taking that route,but there is still roadblocks
(12:17):
and so, no matter what route wetake, there's roadblocks 100%.
Speaker 3 (12:22):
I always say to patients that, like weight is
never lost, it knows exactlywhere to find you.
This is a chronic disease thatthere's always going to be those
hurdles, there's always goingto be those bumps in the road,
and so it's like a constantlyyou're running from the weight
your whole life.
It's never.
That fight is never going to goaway, but you just need a
little help to be a littlefaster than the weight.
Speaker 2 (12:47):
Definitely, honestly, your analogy.
I do love that analogy of theroad because you're absolutely
right.
It's one of the only, if notthe only, specialty in which we
make a judgment about thetreatment and it's absurd that
we don't.
We wouldn't want people to havean easy way to get treatment.
If that existed, we would alluse it, we would all want it to
be available to ourselves andwe'd want it to be available to
(13:08):
our family members and to ourcommunity members.
Speaker 3 (13:11):
Yeah, and that's what keeps me so fired up, honestly,
is that obesity discriminationextends to every level of
treatment, even if you look atit, if you look at cash pay
price of Osembic, which we know.
So Osembic is what.
I'll take a step back.
Osembic is a GLP one agonistwhich is originally intended to
(13:33):
treat diabetes.
They found as a side effectthat people lost weight.
And then, of course, drugcompanies are smart and then
they created the anti obesitymedications that we have today,
and so Osembic is the genericform, is called somagotide and
of course, that's the same thingas will go be, and so Osembic
is branded for diabetes, will gobe, is branded for obesity.
(13:57):
Osembic cash is around $1,000.
Will go be cash is around$1,400.
That's not obesitydiscrimination, I don't know.
And so when I hear things likethat, I'm like, oh God, like I
need to scream louder.
This is like what is going onhere.
(14:18):
How are they getting us fromevery single angle possible.
Speaker 2 (14:23):
Yes, and you're so right because it's almost seen
as OK once you get care.
Let's say you get surgery.
Let's say you get access to amedication, even if it costs you
a thousand dollars a month, youstill face a world that will
stigmatize you and will judgeyou, no matter what route you
take any route you take and it'sreally overwhelming for people.
(14:44):
So I'm curious, if you couldredraw the landscape, what this
kind of care would look like,especially once people start any
kind of treatment or don't godown any kind of path.
What do you think that wouldlook like?
Speaker 3 (14:56):
I think that number one, at least some component of
care should be approved by allinsurance.
Right, this should be able tobe a conversation with a doctor
and a patient, and then thepatient should have access to at
least some form of treatment.
You know, the fact thatinsurances are allowed to have
(15:18):
complete exclusion on obesitytreatment is preposterous to me.
Like I understand thatinsurance is not going to allow
every medication under the sunand maybe every surgical under
the sun because of costs andwhatever.
You know what exists in otherfields, but at least when it
(15:38):
comes to high blood pressure orcancer, there's some access to
treatments With obesity.
The number one insurer in thestate of Louisiana, which covers
nearly 80% of the insured livesin the state of Louisiana, has
a complete exclusion on obesitycare no medicine, no surgery, no
(16:00):
, nothing.
Okay, and so the first thing weneed to have is access and then,
in order to treat a disease,then it needs to be a
conversation with the doctor andthe patient where they discuss
or medical professional Iunderstand there's nurse
practitioners and PAs, so Idon't want to be like, exclude
them but the medicalprofessional and the patient and
(16:23):
then they have joint decisionmaking where they patient
describes what they want and thedoctor describes what they
think is the best course action,and then together they make a
decision of what's you know bestfor the patient.
I mean, that's obviouslyseparate than the tumor board
aspect, but that should be thefirst step and then the patient
(16:43):
should be able to choose thattreatment because they have
access to that treatment.
I think that on the most basiclevel, that's what needs to
happen.
Speaker 1 (16:50):
Absolutely.
Speaker 2 (16:52):
That's such an important message for people to
hear because there are multiplestates in which the top
insurance company in that stateincluding with Florida, for
instance, Louisiana many of thesouthern states actually applied
to as well where the majorityof people in that state who have
private health insurance do nothave access to any bariatric
care.
That is bonkers to me, becauseit is again like he said, like
(17:15):
the American Medical AssociationDesignated this as a disease
over 10 years ago at this point,yeah.
The data on these kinds oftreatments are is not at all in
question.
There's really great data thatthese things work, and not just
for treating obesity, but evenfor treating things like I have
blood pressure and diabetes andthe structural feedback we do to
medical like disease and it'sjust.
(17:36):
It's actually some of the mosteffective care.
But we still have these hurdles.
So I'm curious you have beenvery effective in Louisiana and
nationally about raisingawareness and changing policy.
What makes what was the needle?
What?
Speaker 3 (17:50):
makes the difference.
I think there's two things.
I think that we've seen this.
Dr Renee Hilton has beenextremely successful in the
state of Georgia.
She's really a hero for a lotof us who follow advocacy, and I
think that one of the messagingthat she Preaches is that
Finding the holdout in politicsthere can be.
(18:13):
Sometimes there's multipleholdouts, but sometimes there's
just one holdout, and when itcomes to obesity, we don't know
people's stories right Likepoliticians, have obesity too
right.
And so if we can find somebodywho's a decision-maker and
understand do they have biasagainst this disease and meet
one-on-one with them and explainthe data and explain the story,
(18:35):
and if we can reach thosepeople, then we can maybe make
change.
We in the state of LouisianaSenator Barrows is a huge
advocate for treating obesityand I know it's because she has
a personal history with thedisease and so we, if we can
find those allies in Politics,the people, either help them
understand the disease, helpthem understand the stigma or
(18:57):
Touch on their personalexperiences.
I think we can make change.
But the other thing is Helpingunderstand, helping the budget
office, which unfortunatelyguides a lot, understand that we
can have cost savings a lot ofpeople see Bariatric surgery and
especially obesity medicine isjust dollar bills.
They don't see it as patients,they see it as dollar bills and
(19:20):
if we can help explain thatactually obesity is expensive
and it's very costly to oursystems and that if we can just
help people get care, it'swallets and maybe an upfront
expense.
It's a long-term savings andthat's the conversation of
course we're having in weightloss surgery is that Long-term
(19:41):
it's actually much morecost-effective than anti obesity
medications, especially inyounger people, knowing that
they have to take it for therest of their life.
I think that those are areasthat we need to Adjust, but the
other big thing is policy right,like Obesity is not considered
one of the essential healthbenefits, and that's another
(20:02):
area that we need to change.
That's why people can excludeobesity, because it's not
considered one of the essentialhealth benefits.
So they're all big targets.
Speaker 2 (20:12):
I love it.
It sounds like the holdoutswe're coming for you and
advocates.
We're gonna sing your praisesbecause it's so important to
have both allies and also justtarget folks who May have some
bias against this or may notfully understand.
You're actually right, though.
I think the stories are sopowerful when you actually hear
the kinds of transformationspeople go through, it really hit
(20:34):
home.
I think for a lot of peoplethat this isn't it is about
numbers, it is about dollarbills.
It is about that too, but italso has it's having a huge
impact on people's quality oflife and ability to be there for
their family, for their workthemselves, when it really
liberates, I think, people toreally Be who they want to be,
which is magnificent.
Speaker 3 (20:53):
It drives me, nanas, when you see those heat maps,
those color maps that just showour obesity rates Getting worse
and worse, and I, and Iguarantee you, most people are
thinking oh god, people are justgetting lazy and lazier In
eating more and more.
Okay, sure, that may be acomponent of it, but also, our
(21:16):
access to treatments are notnecessarily improving.
Yes, we know that this ishappening, but what are we doing
about it?
And so I think when people seethose maps, they forget that Are
especially in a state likeLouisiana.
They're not, they're notimproving access to care.
And so what?
(21:36):
Yes, we know that ourenvironment is poor.
We know that people are havingkids, we know that jobs don't
allow us to go work out or livehelpful life, so supermarkets
are unhealthy, like the foodthat they're offering us.
So we live in the land of ubereats, which is what I call right
now, and Then you're notproviding us treatment.
I was asked a question are thesenot man-made solutions to
(22:00):
man-made problems?
Okay, okay, what if they are?
Does that mean we shouldn'toffer them?
You know what I mean?
The disease exists.
We're not.
We're not gonna fix big foodright now, the job industry
right now, so should we notoffer Treatment?
Speaker 2 (22:21):
absolutely.
Speaker 3 (22:22):
I just it threw me, it made me think a lot, but then
I just I don't understand.
Even if it is a man-madesolution to a man-made problem,
is it not worthy of still givingthe people if it works?
Speaker 2 (22:34):
That's such a great sentiment and such a great
question to ask, because it tome registers is that's the
equivalent of us not treatingtrauma patients.
Speaker 1 (22:43):
Somebody get into a trauma.
Speaker 2 (22:44):
Okay, it's a man-made problem and we're using
man-made solutions to solve it,and that's what is the problem
there?
You're right.
Speaker 3 (22:51):
Yeah, there's.
I want to ask.
Speaker 1 (22:53):
Why bariatric surgery for you?
Maria said that bariatricsurgery was not her go-to right
out of high school or whatever.
She wanted to do transplantstuff.
And even dr Renee Hilton row atthe same thing.
She, our dad, said I thoughtyou would want to cut out cancer
, so why bariatric?
Speaker 3 (23:11):
surgery for you.
Interestingly, my story is verysimilar.
I thought I was gonna be apediatrician and then a medical
school.
I realized, nope, not it.
I don't know the surgery.
And then when I did my surgeryrotation, I wasn't quite sure
because I never thought I wasgoing to do surgery and I
realized I loved everythingduring surgery residency, except
(23:33):
for maybe cardiac.
But when I reflected on it as Igot to my more senior years, I
realized I loved minimallyinvasive surgery techniques.
I loved, like laparoscopiccolon resections and thoracic
chest surgery that was doneminimally, basically.
And then I started and I lovedmy bariatric rotation and so I
started putting it all togetherand then I applied for MIS and
(23:54):
it evolved.
Now, reflecting on it, it waswhere I was always meant to be,
because I suffered or Istruggled with weight pretty
much my whole life, butespecially as a kid, and I think
that my experience as a childand discrimination that I
experienced have influenced me.
I don't know if my mom's goingto listen to this, but she put
me on Weight Watchers when I wasin the sixth grade and you know
(24:15):
that I kind of messes with youwhen you're a little kid.
Speaker 2 (24:18):
Yeah, wow.
Speaker 3 (24:20):
So I just think that this is 100% where I meant to be
.
Like, when you reflect on it,it's like how, what was I else I
was going to do?
But it didn't come as easily asI would have thought.
And then now, as I startedlearning more and more about
obesity and the physiology ofobesity, I'm like I'm even more
energized to learn more.
Speaker 2 (24:38):
So who knows?
Speaker 3 (24:39):
And then it was meant to be a surgeon, so that story
really resonates A lot of people.
Speaker 2 (24:45):
This is a very personal field for them and even
though people find it sometimesbecause of the technicality of
it, and that everyone in theirfirst time seeing a gastric
bypass, I think are just likewow, that's the coolest thing
I've ever seen for a lot of us,or like a revision or something.
But your words about how thisaffected you as a child and that
the passion that has given youto speak on behalf of other
(25:07):
people and really advocate forthis kind of care, I think is
just an incredible testament towho you are and the incredible
things that you're doing withyour talent and with your skill
that are unique to you, and I'mreally grateful you do it
because it's very inspiring.
Speaker 3 (25:22):
Thank you, you're so kind.
I love it, and that's one ofthe other reasons to go into
bariatric surgery.
Right, it's such a happy field,like our.
Patients are over the moon.
We have losers bench in ourclinic.
Patients lose 100 pounds orthey our body mass index drops
below 30, they get to sign thebench and they are just thrilled
(25:48):
, taking pictures, can't wait tocome back to the clinic, even
if they haven't followed up withus like as they should.
They follow up when they get tothat point so they can sign the
bench because they've beenthinking about it for so long.
We're about.
We're in a position where Ithink we need to get a second
bench.
It's so filled up, wow.
So it's just so happy andexciting.
(26:09):
Even when we have complications,people do so well.
They may have a little bit ofbumps in the road.
Speaker 1 (26:14):
And.
Speaker 3 (26:14):
I need that happiness in my life, like I enjoy, like
I couldn't do surgical oncology.
I feel like, even though thereis joy, there's so much sadness
and with obesity, is just happy.
Speaker 1 (26:28):
It is.
We have a non scale victoryboard, so anything not related
to weight.
We had a board and people puton like no longer in plus sizes,
no longer wearing my CPAP, Ican bend over without being out
of breath, yeah, so I love thoselittle things that people can
your loser bench or non scalevictory board.
(26:49):
Those are the things that keeppeople motivated.
Speaker 3 (26:52):
Yes, that gives me a good idea.
We should paint the wall andjust have people write their non
scale victories on the wall,chalkboard wall too, oh my gosh.
Speaker 1 (27:00):
Yes, maria, write that down, you're doing it.
Speaker 2 (27:02):
I love it, I love it, I love it.
But you're actually right,there's so much joy in the field
and that wasn't necessarilysomething that was that I
expected, but it's such ameaningful like that.
I'm not a person who I thoughtliked clinic and then I guess I
do now, because the kinds ofconversations you're having with
people, even in the beginningyou can be a transformative
(27:25):
experience for them.
In healthcare.
A lot of times people come inand they're a little bit beaten
down by the process and bygetting there.
Tammy was kind enough to openup about her experience coming
into the office for the firsttime and what, how not great
that was in the beginning andthen guiding people through in a
way that is uplifting, that isevidence based, that is
supportive and getting them tobe able to reach goals.
(27:47):
But I don't know, it's justincredible how joyful this field
is.
You bring up a really goodpoint there.
Speaker 3 (27:54):
Yeah, patients usually, on average, have tried
to lose weight seven timesbefore they ask for help, before
they even see talk to theirprimary care doctor or a doctor
about losing weight, and then alot of times when they talk to a
doctor, the doctor is oh, haveyou tried eating less and moving
(28:15):
more?
And so I think, by the time,they reach us, people who
actually get it they are just soelated and relieved.
I'm sure your experience isvery similar, but I would say
82% of all new patients I see atsome point in their visit are
crying Because it's such anemotional experience and because
(28:35):
they okay, finally somebodygets it.
Finally I don't have to feelguilty anymore and I just love
it when patients cry, onlybecause I just feel like they
have a release.
Speaker 1 (28:52):
Safe place.
That's what I think about whenit comes to our clinic.
Is their safe place to talkabout the weight, the hardship
of it, the yeah, yeah?
Speaker 2 (29:01):
I agree that's such a I just I'm so glad you said
that, because it really issomething that it's innovative,
it's interesting.
There's always stuff coming out, there's always technique
improvement.
We're learning more every dayabout the field.
But it is also just one that isfilled with joy and I think
that's such a beautiful message.
It's really not one I've heardexpressed that way before, but,
(29:21):
dr Levy, I think that reallymoves me.
Thank you.
Speaker 3 (29:23):
Yeah, that's good.
It's nice to be happy, it'snice to be happy.
Speaker 2 (29:27):
It's nice to be happy On that note we're really
grateful that you chose to spendsome of your Saturday morning
with us.
Hopefully you have a great restof your weekend.
And we're talking today aboutadvocacy, about access to care,
about tumor board applications,even to bariatric care and about
the joy of this field, which issuch a great and delightful
thing to talk about.
(29:47):
Thank you for joining us,expanding our world and sharing
the pieces yourself with ustoday, Dr Levy, Thank you.
Speaker 3 (29:54):
Thank you for having me.
Can't wait to do it again.
Speaker 1 (29:56):
Oh yeah, Thank you so much and for those that are
listening, thank you again fortuning in.
Head over to Instagram and likeour core bariatrics page and
send us a message if you want usto talk about something or want
to be on yourself.
Thank you all for listening.
See you next time.
Bye.
Welcome to Core Bariatrics Podcast hosted by
Bariatric Surgeon Dr MariaIliakova and TMA LaCose,
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.
Speaker 2 (00:26):
Hello everybody.
Today we have with us the Chiefof the Division of Minimally
Invasive and Bariatric Surgeryat Tulane University.
She completed her fellowship inMinimally Invasive Surgery,
Forgot and Bariatric Surgery atVanderbilt.
She did residency in medicalschool at UT, Houston and
undergrad at Emory.
She was actually one of thefirst surgeons ever to certify
(00:46):
as a diplomat of the AmericanBoard of Obesity Medicine in
2020.
Let's please welcome Dr ShaunaLevy.
Speaker 3 (00:52):
Hey, good morning.
Speaker 1 (00:53):
Thanks so much for having me.
Hello, thank you for being here, you're here.
Speaker 2 (00:57):
I know you're super busy.
You've got two girls, Iunderstand, who may be running
around today.
One of the things we reallywant to talk about with you is
your incredible advocacy in thestate of Louisiana and also
nationally.
You've been a really greatadvocate for bariatric care and
a really great media presenceeven.
(01:17):
Why is that so important to youand how did you get started
doing that?
Speaker 3 (01:22):
Gosh, it's hard to even remember.
At this point, I feel like thisis just the way I was raised Me
and my brother and sister areall very similar in that way and
that we feel compelled to speakup whenever we see injustice,
big or small.
Actually, I know how it startedis that when I first started
working at Tulane University,they did not offer obesity
(01:45):
coverage for their employees.
I just started writing emailsafter emails and basically was
very persistent and was able toget that overturned.
Now I'm proud to say thatTulane University offers its
employees excellent, verycomprehensive care,
comprehensive insurance forobesity.
I realized that I am very goodat being annoying and persistent
(02:09):
.
Speaker 1 (02:11):
I feel like worried about that too.
Speaker 3 (02:14):
That's a big part of advocacy is just like never
stopping and consistentlypresenting your message to
anyone and everyone that'swilling to not ignore you.
Basically they don't even haveto be willing to listen, just to
not ignore you.
From there, I think it branchedout into being more involved in
(02:37):
my state society, the localLouisiana ASFBS, and getting
some mentors there and realizingthat Louisiana is such a low
access state but at the sametime has such a high rates of
obesity.
If not me, then who?
It's really a question I askmyself all the time and just
(02:59):
continue to figure out ways touse my voice and band with other
like-minded people to spreadthe message.
Obesity is such a prevalentdisease but it's not talked
about enough we just need tocontinue to spread that message
and find people that will screamwith us and make the message
(03:21):
known to those around us.
Speaker 1 (03:23):
basically, I think one big reason why I wanted to
do this podcast too isespecially getting providers and
stuff talking about this is adisease, it's not necessarily
what you're doing, because somany patients continually say I
failed, I'm doing somethingwrong, why can't I lose this
(03:45):
weight?
Why just hearing it frommultiple providers that we're
interviewing saying this is adisease, that I think is just
going to help a lot of peopleunderstand that it's not
necessarily what you're doing,wrong or right or wrong.
It's what your body may not bedoing.
Speaker 3 (04:01):
Yes, we know that in 2013, the AMA declared obesity
as a disease, and that wasreally overdue.
That was really late, but evennow that was over a decade ago
People are still extremely, Ithink, reluctant as part of it,
but just still there's a lack ofknowledge.
(04:22):
I think part of this goes tothe fact that we are not taught
this in medical school anddoctors are supposed to be the
experts at medical diseases,when primary care doctors, who
are really the gatekeepers tohealth, don't know that much
about weight and obesity becausethey were never taught then.
(04:45):
I think that messaging is verydifficult to spread to general
public.
I think that we really need todo a better job with training
doctors.
Speaker 2 (04:57):
You've been on the cutting edge of really
considering obesity as somethingthat can be treated with a
spectrum of different things,including medications and side
and exercise and surgery andmental health and all the
different components of that.
In fact, you were one of thefirst people that really got
that American Board of ObesityMedicine designation.
(05:18):
Why was that so important foryou to do, especially as a
surgeon?
Can you talk a little bit moreabout what kind of insight or
experience that has given youresponsibility with?
Speaker 3 (05:29):
current情況 in your life.
Yeah, originally I saw a holethat needed to be fixed.
My institution.
I went and I approached thefamily practice doctors and
internal medicine doctors andsaid our patients need
anti-obesity medications inorder to provide the best care
and also it's also a gateway tosurgery right to start with
(05:52):
medication.
And none of them wanted to doit.
And again, same question then ifnot me, then he'll.
If nobody's going to do it,then I better step up and do it.
And that's when I decided tosit for the American Board of
Obesity Medicine exam and sincethen, my knowledge about
comprehensive obesity care hasjust grown exponentially and my
(06:13):
interest in everything reallyabout my understanding about how
to treat patients with thedisease of obesity has gotten
better.
And now I understand obesity sodifferently and, like you said
that it is best treated bymultiple different providers
from multiple different angles.
I know that something thatwe've talked about offline is
that cancer I really thinkshould be our guide, because
(06:36):
they really do Cancer care doesreally an excellent job of
drawing from multiple differentproviders to best treat their
patients in a very difficultscenario.
Of course, there are some thatfollow the textbook right and
they respond to chemo and theyrespond to radiation and their
cancer can be treated.
But there are some morecomplicated cases that require
(07:00):
multiple different physiciansand multiple different
specialists to come together andhave difficult conversations
about what is the best pathwayto treat these patients, and
they do something called a tumorboard where they can get
together and have theseconversations.
I don't see why obesity shouldbe any different.
This is an exceedinglydifficult disease to treat.
(07:20):
That we know.
Even with medication, even withbariatric surgery, some people
still have weight recurrence andthey become more and more
difficult to treat, and I thinkthat we need a think tank, if
you will, to best treat patients, and so I think that using
cancer as a model of how totreat a difficult disease should
(07:43):
guide us on our pathway ofcomprehensive care and it sounds
like with a tumor board.
Speaker 2 (07:48):
some of our listeners may not know exactly what a
tumor board is.
Can you describe what thatlooks like in terms of who
participates, why it's done thatway and how that would look in
the setting of obesity care?
Speaker 3 (08:01):
A tumor board is where multiple different
physicians come together, likeradiologists and oncologists and
radiation oncologists andsurgical oncologists Basically
every aspect of somebody's carecome together into a room to
review pathology specimens, toreview radiology, to review
(08:22):
patients' cancer history,certain genetic markers and
anything that may influencetheir care, and then determine,
based on best evidence and bestknowledge, what is the best
pathway for a patient.
The truth is, we cannot all knowthe same things.
We cannot all be experts at thesame things, and that's why
(08:43):
it's good to get together withother experts and put our brains
together to come up with thebest decisions.
And I think that it's hard asphysicians because we're really
all over the place and medicalprofessionals in general, we're
all over the place.
But it's so much easier just tocome together in a room and
have this conversation ratherthan sending 50,000 emails back
(09:06):
and forth I guess it's oldschool because most people
communicate via text these daysbut to actually not only pick a
room and a room together maybeor I guess we have Zoom now too
it's just the best way to all beon the same page and really
guide difficult care.
Speaker 1 (09:22):
We definitely got a pushback from being in person
because, yes, we and I think yousaid you tried to do this model
too of when we have those quoteunquote red flag patients, just
that we want to.
We see risk factors that we wantto address before going to
surgery.
So we would have the provider,me as a coordinator, the
dietitian, the mental healthprovider all be in the same room
(09:46):
and discuss some patients thatwe had concerns about, and me,
as a bariatric patient, I'm ableto put light in a different way
to some patients.
We had a patient that themental health provider was like
I don't know, I see some thingsthat and then the dietitian said
the same thing and I actuallysaw this patient as a star
(10:10):
candidate because she remindedme a lot of myself and so I just
needed that kick in the butt,aka surgery, to really help me.
So that patient they listenedto me that patient went to
surgery and, I think, is doingvery well.
So, yes, everybody's sitting ina room talking to each other
and figuring out the best planof action.
Speaker 3 (10:32):
But I think you bring up an excellent point too is
that support group and peersupport is also incredibly
important when it comes toobesity, and I think it's so
important because of all theshame and discrimination that
exists not only about obesitybut about the treatments of
obesity.
(10:52):
How many times have we heardthat bariatric surgery was quote
the easy way out?
And when I think about that,I'm like first of all, what's
wrong with making the easy wayout, like literally, if you?
were in a traffic jam and therewas a road that just opened up
and said you would reach yourdestination 30 minutes earlier.
There's not a single personthat wouldn't go down that road.
(11:13):
Give me a brick and brick.
But, second of all, we know it'snot the easy way out, so it's
not even a relevant point, butfor goodness sakes, it's a way
out and I think that, just likeyou said, it's that tool, it's
that boost that people need on ahormonal level and on a
(11:34):
psychological level to helptreat their disease.
And so I think that havingsupport group and peer support
and people who have walked inthat shoes to be like no, I
promise you this is not onlygoing to be fine but going to be
great.
That's an important aspect ofobesity care as well.
Speaker 1 (11:53):
But, I like where you said sorry, maria, I like where
you said that if you were ableto get out of traffic jam and
get to your destination 30minutes earlier, you would.
But sometimes, even if you takethat route we take fast ways to
work we end up in out ofstoplight.
We end up oh my gosh, there's adog in the road.
I don't know.
Same thing with bariatricsurgery.
We might be taking that route,but there is still roadblocks
(12:17):
and so, no matter what route wetake, there's roadblocks 100%.
Speaker 3 (12:22):
I always say to patients that, like weight is
never lost, it knows exactlywhere to find you.
This is a chronic disease thatthere's always going to be those
hurdles, there's always goingto be those bumps in the road,
and so it's like a constantlyyou're running from the weight
your whole life.
It's never.
That fight is never going to goaway, but you just need a
little help to be a littlefaster than the weight.
Speaker 2 (12:47):
Definitely, honestly, your analogy.
I do love that analogy of theroad because you're absolutely
right.
It's one of the only, if notthe only, specialty in which we
make a judgment about thetreatment and it's absurd that
we don't.
We wouldn't want people to havean easy way to get treatment.
If that existed, we would alluse it, we would all want it to
be available to ourselves andwe'd want it to be available to
(13:08):
our family members and to ourcommunity members.
Speaker 3 (13:11):
Yeah, and that's what keeps me so fired up, honestly,
is that obesity discriminationextends to every level of
treatment, even if you look atit, if you look at cash pay
price of Osembic, which we know.
So Osembic is what.
I'll take a step back.
Osembic is a GLP one agonistwhich is originally intended to
(13:33):
treat diabetes.
They found as a side effectthat people lost weight.
And then, of course, drugcompanies are smart and then
they created the anti obesitymedications that we have today,
and so Osembic is the genericform, is called somagotide and
of course, that's the same thingas will go be, and so Osembic
is branded for diabetes, will gobe, is branded for obesity.
(13:57):
Osembic cash is around $1,000.
Will go be cash is around$1,400.
That's not obesitydiscrimination, I don't know.
And so when I hear things likethat, I'm like, oh God, like I
need to scream louder.
This is like what is going onhere.
(14:18):
How are they getting us fromevery single angle possible.
Speaker 2 (14:23):
Yes, and you're so right because it's almost seen
as OK once you get care.
Let's say you get surgery.
Let's say you get access to amedication, even if it costs you
a thousand dollars a month, youstill face a world that will
stigmatize you and will judgeyou, no matter what route you
take any route you take and it'sreally overwhelming for people.
(14:44):
So I'm curious, if you couldredraw the landscape, what this
kind of care would look like,especially once people start any
kind of treatment or don't godown any kind of path.
What do you think that wouldlook like?
Speaker 3 (14:56):
I think that number one, at least some component of
care should be approved by allinsurance.
Right, this should be able tobe a conversation with a doctor
and a patient, and then thepatient should have access to at
least some form of treatment.
You know, the fact thatinsurances are allowed to have
(15:18):
complete exclusion on obesitytreatment is preposterous to me.
Like I understand thatinsurance is not going to allow
every medication under the sunand maybe every surgical under
the sun because of costs andwhatever.
You know what exists in otherfields, but at least when it
(15:38):
comes to high blood pressure orcancer, there's some access to
treatments With obesity.
The number one insurer in thestate of Louisiana, which covers
nearly 80% of the insured livesin the state of Louisiana, has
a complete exclusion on obesitycare no medicine, no surgery, no
(16:00):
, nothing.
Okay, and so the first thing weneed to have is access and then,
in order to treat a disease,then it needs to be a
conversation with the doctor andthe patient where they discuss
or medical professional Iunderstand there's nurse
practitioners and PAs, so Idon't want to be like, exclude
them but the medicalprofessional and the patient and
(16:23):
then they have joint decisionmaking where they patient
describes what they want and thedoctor describes what they
think is the best course action,and then together they make a
decision of what's you know bestfor the patient.
I mean, that's obviouslyseparate than the tumor board
aspect, but that should be thefirst step and then the patient
(16:43):
should be able to choose thattreatment because they have
access to that treatment.
I think that on the most basiclevel, that's what needs to
happen.
Speaker 1 (16:50):
Absolutely.
Speaker 2 (16:52):
That's such an important message for people to
hear because there are multiplestates in which the top
insurance company in that stateincluding with Florida, for
instance, Louisiana many of thesouthern states actually applied
to as well where the majorityof people in that state who have
private health insurance do nothave access to any bariatric
care.
That is bonkers to me, becauseit is again like he said, like
(17:15):
the American Medical AssociationDesignated this as a disease
over 10 years ago at this point,yeah.
The data on these kinds oftreatments are is not at all in
question.
There's really great data thatthese things work, and not just
for treating obesity, but evenfor treating things like I have
blood pressure and diabetes andthe structural feedback we do to
medical like disease and it'sjust.
(17:36):
It's actually some of the mosteffective care.
But we still have these hurdles.
So I'm curious you have beenvery effective in Louisiana and
nationally about raisingawareness and changing policy.
What makes what was the needle?
What?
Speaker 3 (17:50):
makes the difference.
I think there's two things.
I think that we've seen this.
Dr Renee Hilton has beenextremely successful in the
state of Georgia.
She's really a hero for a lotof us who follow advocacy, and I
think that one of the messagingthat she Preaches is that
Finding the holdout in politicsthere can be.
(18:13):
Sometimes there's multipleholdouts, but sometimes there's
just one holdout, and when itcomes to obesity, we don't know
people's stories right Likepoliticians, have obesity too
right.
And so if we can find somebodywho's a decision-maker and
understand do they have biasagainst this disease and meet
one-on-one with them and explainthe data and explain the story,
(18:35):
and if we can reach thosepeople, then we can maybe make
change.
We in the state of LouisianaSenator Barrows is a huge
advocate for treating obesityand I know it's because she has
a personal history with thedisease and so we, if we can
find those allies in Politics,the people, either help them
understand the disease, helpthem understand the stigma or
(18:57):
Touch on their personalexperiences.
I think we can make change.
But the other thing is Helpingunderstand, helping the budget
office, which unfortunatelyguides a lot, understand that we
can have cost savings a lot ofpeople see Bariatric surgery and
especially obesity medicine isjust dollar bills.
They don't see it as patients,they see it as dollar bills and
(19:20):
if we can help explain thatactually obesity is expensive
and it's very costly to oursystems and that if we can just
help people get care, it'swallets and maybe an upfront
expense.
It's a long-term savings andthat's the conversation of
course we're having in weightloss surgery is that Long-term
(19:41):
it's actually much morecost-effective than anti obesity
medications, especially inyounger people, knowing that
they have to take it for therest of their life.
I think that those are areasthat we need to Adjust, but the
other big thing is policy right,like Obesity is not considered
one of the essential healthbenefits, and that's another
(20:02):
area that we need to change.
That's why people can excludeobesity, because it's not
considered one of the essentialhealth benefits.
So they're all big targets.
Speaker 2 (20:12):
I love it.
It sounds like the holdoutswe're coming for you and
advocates.
We're gonna sing your praisesbecause it's so important to
have both allies and also justtarget folks who May have some
bias against this or may notfully understand.
You're actually right, though.
I think the stories are sopowerful when you actually hear
the kinds of transformationspeople go through, it really hit
(20:34):
home.
I think for a lot of peoplethat this isn't it is about
numbers, it is about dollarbills.
It is about that too, but italso has it's having a huge
impact on people's quality oflife and ability to be there for
their family, for their workthemselves, when it really
liberates, I think, people toreally Be who they want to be,
which is magnificent.
Speaker 3 (20:53):
It drives me, nanas, when you see those heat maps,
those color maps that just showour obesity rates Getting worse
and worse, and I, and Iguarantee you, most people are
thinking oh god, people are justgetting lazy and lazier In
eating more and more.
Okay, sure, that may be acomponent of it, but also, our
(21:16):
access to treatments are notnecessarily improving.
Yes, we know that this ishappening, but what are we doing
about it?
And so I think when people seethose maps, they forget that Are
especially in a state likeLouisiana.
They're not, they're notimproving access to care.
And so what?
(21:36):
Yes, we know that ourenvironment is poor.
We know that people are havingkids, we know that jobs don't
allow us to go work out or livehelpful life, so supermarkets
are unhealthy, like the foodthat they're offering us.
So we live in the land of ubereats, which is what I call right
now, and Then you're notproviding us treatment.
I was asked a question are thesenot man-made solutions to
(22:00):
man-made problems?
Okay, okay, what if they are?
Does that mean we shouldn'toffer them?
You know what I mean?
The disease exists.
We're not.
We're not gonna fix big foodright now, the job industry
right now, so should we notoffer Treatment?
Speaker 2 (22:21):
absolutely.
Speaker 3 (22:22):
I just it threw me, it made me think a lot, but then
I just I don't understand.
Even if it is a man-madesolution to a man-made problem,
is it not worthy of still givingthe people if it works?
Speaker 2 (22:34):
That's such a great sentiment and such a great
question to ask, because it tome registers is that's the
equivalent of us not treatingtrauma patients.
Speaker 1 (22:43):
Somebody get into a trauma.
Speaker 2 (22:44):
Okay, it's a man-made problem and we're using
man-made solutions to solve it,and that's what is the problem
there?
You're right.
Speaker 3 (22:51):
Yeah, there's.
I want to ask.
Speaker 1 (22:53):
Why bariatric surgery for you?
Maria said that bariatricsurgery was not her go-to right
out of high school or whatever.
She wanted to do transplantstuff.
And even dr Renee Hilton row atthe same thing.
She, our dad, said I thoughtyou would want to cut out cancer
, so why bariatric?
Speaker 3 (23:11):
surgery for you.
Interestingly, my story is verysimilar.
I thought I was gonna be apediatrician and then a medical
school.
I realized, nope, not it.
I don't know the surgery.
And then when I did my surgeryrotation, I wasn't quite sure
because I never thought I wasgoing to do surgery and I
realized I loved everythingduring surgery residency, except
(23:33):
for maybe cardiac.
But when I reflected on it as Igot to my more senior years, I
realized I loved minimallyinvasive surgery techniques.
I loved, like laparoscopiccolon resections and thoracic
chest surgery that was doneminimally, basically.
And then I started and I lovedmy bariatric rotation and so I
started putting it all togetherand then I applied for MIS and
(23:54):
it evolved.
Now, reflecting on it, it waswhere I was always meant to be,
because I suffered or Istruggled with weight pretty
much my whole life, butespecially as a kid, and I think
that my experience as a childand discrimination that I
experienced have influenced me.
I don't know if my mom's goingto listen to this, but she put
me on Weight Watchers when I wasin the sixth grade and you know
(24:15):
that I kind of messes with youwhen you're a little kid.
Speaker 2 (24:18):
Yeah, wow.
Speaker 3 (24:20):
So I just think that this is 100% where I meant to be
.
Like, when you reflect on it,it's like how, what was I else I
was going to do?
But it didn't come as easily asI would have thought.
And then now, as I startedlearning more and more about
obesity and the physiology ofobesity, I'm like I'm even more
energized to learn more.
Speaker 2 (24:38):
So who knows?
Speaker 3 (24:39):
And then it was meant to be a surgeon, so that story
really resonates A lot of people.
Speaker 2 (24:45):
This is a very personal field for them and even
though people find it sometimesbecause of the technicality of
it, and that everyone in theirfirst time seeing a gastric
bypass, I think are just likewow, that's the coolest thing
I've ever seen for a lot of us,or like a revision or something.
But your words about how thisaffected you as a child and that
the passion that has given youto speak on behalf of other
(25:07):
people and really advocate forthis kind of care, I think is
just an incredible testament towho you are and the incredible
things that you're doing withyour talent and with your skill
that are unique to you, and I'mreally grateful you do it
because it's very inspiring.
Speaker 3 (25:22):
Thank you, you're so kind.
I love it, and that's one ofthe other reasons to go into
bariatric surgery.
Right, it's such a happy field,like our.
Patients are over the moon.
We have losers bench in ourclinic.
Patients lose 100 pounds orthey our body mass index drops
below 30, they get to sign thebench and they are just thrilled
(25:48):
, taking pictures, can't wait tocome back to the clinic, even
if they haven't followed up withus like as they should.
They follow up when they get tothat point so they can sign the
bench because they've beenthinking about it for so long.
We're about.
We're in a position where Ithink we need to get a second
bench.
It's so filled up, wow.
So it's just so happy andexciting.
(26:09):
Even when we have complications,people do so well.
They may have a little bit ofbumps in the road.
Speaker 1 (26:14):
And.
Speaker 3 (26:14):
I need that happiness in my life, like I enjoy, like
I couldn't do surgical oncology.
I feel like, even though thereis joy, there's so much sadness
and with obesity, is just happy.
Speaker 1 (26:28):
It is.
We have a non scale victoryboard, so anything not related
to weight.
We had a board and people puton like no longer in plus sizes,
no longer wearing my CPAP, Ican bend over without being out
of breath, yeah, so I love thoselittle things that people can
your loser bench or non scalevictory board.
(26:49):
Those are the things that keeppeople motivated.
Speaker 3 (26:52):
Yes, that gives me a good idea.
We should paint the wall andjust have people write their non
scale victories on the wall,chalkboard wall too, oh my gosh.
Speaker 1 (27:00):
Yes, maria, write that down, you're doing it.
Speaker 2 (27:02):
I love it, I love it, I love it.
But you're actually right,there's so much joy in the field
and that wasn't necessarilysomething that was that I
expected, but it's such ameaningful like that.
I'm not a person who I thoughtliked clinic and then I guess I
do now, because the kinds ofconversations you're having with
people, even in the beginningyou can be a transformative
(27:25):
experience for them.
In healthcare.
A lot of times people come inand they're a little bit beaten
down by the process and bygetting there.
Tammy was kind enough to openup about her experience coming
into the office for the firsttime and what, how not great
that was in the beginning andthen guiding people through in a
way that is uplifting, that isevidence based, that is
supportive and getting them tobe able to reach goals.
(27:47):
But I don't know, it's justincredible how joyful this field
is.
You bring up a really goodpoint there.
Speaker 3 (27:54):
Yeah, patients usually, on average, have tried
to lose weight seven timesbefore they ask for help, before
they even see talk to theirprimary care doctor or a doctor
about losing weight, and then alot of times when they talk to a
doctor, the doctor is oh, haveyou tried eating less and moving
(28:15):
more?
And so I think, by the time,they reach us, people who
actually get it they are just soelated and relieved.
I'm sure your experience isvery similar, but I would say
82% of all new patients I see atsome point in their visit are
crying Because it's such anemotional experience and because
(28:35):
they okay, finally somebodygets it.
Finally I don't have to feelguilty anymore and I just love
it when patients cry, onlybecause I just feel like they
have a release.
Speaker 1 (28:52):
Safe place.
That's what I think about whenit comes to our clinic.
Is their safe place to talkabout the weight, the hardship
of it, the yeah, yeah?
Speaker 2 (29:01):
I agree that's such a I just I'm so glad you said
that, because it really issomething that it's innovative,
it's interesting.
There's always stuff coming out, there's always technique
improvement.
We're learning more every dayabout the field.
But it is also just one that isfilled with joy and I think
that's such a beautiful message.
It's really not one I've heardexpressed that way before, but,
(29:21):
dr Levy, I think that reallymoves me.
Thank you.
Speaker 3 (29:23):
Yeah, that's good.
It's nice to be happy, it'snice to be happy.
Speaker 2 (29:27):
It's nice to be happy On that note we're really
grateful that you chose to spendsome of your Saturday morning
with us.
Hopefully you have a great restof your weekend.
And we're talking today aboutadvocacy, about access to care,
about tumor board applications,even to bariatric care and about
the joy of this field, which issuch a great and delightful
thing to talk about.
(29:47):
Thank you for joining us,expanding our world and sharing
the pieces yourself with ustoday, Dr Levy, Thank you.
Speaker 3 (29:54):
Thank you for having me.
Can't wait to do it again.
Speaker 1 (29:56):
Oh yeah, Thank you so much and for those that are
listening, thank you again fortuning in.
Head over to Instagram and likeour core bariatrics page and
send us a message if you want usto talk about something or want
to be on yourself.
Thank you all for listening.
See you next time.
Bye.
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