Drs. Williams, Guthrie, and Greene continue their conversation with Dr. Shani Belgrave, MD, FACS, FASMBS, Atlanta’s Bariatric Surgeon and founder of Oneka Bariatrics and Wellness.
Transcript
Dr. Deanna Guthrie:
Welcome to Take Good Care Podcast. An endeavor that grew out of our love for obstetrics and gynecology.
Dr. Karen Greene:
Our aim and mission is to serve as a source of vital information for women of all races, ages, and walks in life.
Dr. Mironda Williams:
I am Dr. Mironda Williams.
Dr. Deanna Guthrie:
I am Dr. Deanna Guthrie.
Dr. Karen Greene:
And I am Dr. Karen Greene.
Dr. Mironda Williams:
Welcome to our show.
Welcome to this episode of Take Good Care Podcast. I’m Dr. Mironda Williams.
Dr. Deanna Guthrie:
I’m Dr. Deanna Guthrie.
Dr. Karen Greene:
And I am Dr. Karen Greene.
Dr. Mironda Williams:
And before I get us back to our wonderful guest who’s in the virtual space with us today, Dr. Shawnee Belgrave, I need to remind everyone that we are live and on the air. We’re picking up a wonderful conversation that we started with Dr. Belgrave on obesity management, bariatric surgery, and just some of the other issues that may come with that. Just want everyone, Dr. Shani Belgrave, if you could please remind our audience again of your name, the name and location of your practice and how they can reach out to you.
Dr. Shani Belgrave:
Oh, thanks so much. My name is Shani Belgrave and my practice is Oneka Bariatrics and Wellness. We are located in Sandy Springs, Georgia. And you can always reach out to us online at www.onekabariatrics.com.
Dr. Mironda Williams:
Awesome. When we left off with the previous episode, we were starting to get into some more specifics about bariatric surgery and some of the different kinds of procedures that can be done. But again, before we continue this conversation, I really just want to put out a disclaimer. Our platform, Take Good Care Podcast, is here to open conversations and to provide you access to experts in various fields, but we always want to encourage you to speak with your own providers specifically about any questions you may have about your own health journey, your own weight loss journey. And if you have specific questions that Dr. Belgrave can answer, please feel free to reach out to her on her website. She has online options that she can reach out to you and then she can answer some more specific detailed questions that you may have more directly.
Let’s see. Can you tell us a little bit about how you got into bariatrics and wellness? How did you decide to go down this path as your field of expertise?
Dr. Shani Belgrave:
Sure. I did my general surgery residency because I knew that I wanted to be a surgeon, but I wasn’t for sure what kind of surgeon I wanted to be. It took some time. And then when I did my fellowship training in minimally invasive surgery and bariatrics, that’s when it really clicked that, yeah, focusing on bariatric surgery is the way to go for me because I saw the transformation that patients were having. And so it’s one of those fields in medicine where you can do a procedure and then you can see right before your eyes an amazing transformation unfold. And I really could not think of anything else like that in medicine.
As a surgeon, I like doing an operation and seeing a result. So if I take out someone’s gallbladder and they feel better, you get that gratification like, “Wow, okay, we’ve done something here.” But with weight loss surgery, I feel that impact more because it’s like, “Wow, I couldn’t take my kids to the amusement park because I couldn’t walk. I couldn’t…” And then a year later, for people to be like, “Oh my gosh, we went to six flags.” I mean, those are stories that I still remember and that’s why I’m really happy I chose bariatric surgery.
Dr. Mironda Williams:
That’s great. In the last episode, you started to give us some information about the different kinds of the two procedures that are currently being done most often. And that’s the gastric sleeve versus gastric bypass. Can you go into a little bit more the differences about those two procedures and why they are different?
Dr. Shani Belgrave:
Sure. With weight loss surgery, it’s bariatric and metabolic surgery. And so these operations, they work a couple of different ways. It’s not purely because the stomach is smaller. While there are some anatomic changes, there’s also changes in the hormones that also aid in the weight loss. So with the sleeve gastrectomy… And all these procedures are done using minimally invasive techniques, which means small incisions in a camera, and that can be laparoscopic or robotic.
So with the sleeve gastrectomy, the way that one works is we are surgically removing about 80% of your stomach. So we take you from about a football size stomach to a banana-sized stomach. And so some of the ways that operation works is because the stomach is smaller, you get those cues of being full. So it helps with eating less. The stomach also makes a hormone called ghrelin, which is the appetite hormone. And so when a large part of the stomach is removed, the ghrelin level decreases. And so people have appetite suppression. Those are some of the main ways that the sleeve gastrectomy works.
The gastric bypass… I always explain to patients that one of the main differences between a sleeve and a bypass is that in the case of a sleeve, we are only operating on the stomach. With the gastric bypass, we are operating on both the stomach and the intestines. And so with the bypass, we make a pouch out of the stomach. The larger part of the stomach remains inside the abdominal cavity. It’s just bypass. Food no longer goes to the larger part of the stomach. So food is held in a pouch and the part of the stomach that’s been stapled off to create the pouch and then we connect your intestines to the pouch. And so with the way that that rerouting of the intestines is done, because the intestines job is to absorb, when we do that rerouting, less is absorbed, and so by definition, it’s also malabsorptive. And so that’s the way that the gastric bypass works. And still with the gastric bypass, you have shifts in the hormones as well. So decreased ghrelin as well as increased GLP-1. So those are some of the ways that the operations work for weight loss.
Dr. Mironda Williams:
Awesome.
Dr. Karen Greene:
Interesting. We often see, as gynecologist, patients that have had bypass surgery and sometimes they’re not really sure what kind of surgery they have. We also see patients who want to have bypass surgery. And so how do you decide when you’re counseling a patient which procedure works best for which patient?
Dr. Shani Belgrave:
Yeah. I’m so happy you mentioned that because sometimes patients will come in and they’ll have an idea, “So-and-so had this or I saw that, that’s what I want.” And sometimes it can be patient preference, but I always tell patients that there’s some things that have to be factored in. For example, patients who have significant acid reflux that have to be on medication daily, those patients, I would say more likely than not would do better with a gastric bypass than a sleeve because sleeve gastrectomy does come with the risk of reflux, whereas gastric bypass is more of an anti-reflux operation, but that’s not a definite, but it’s just something when I’m counseling patients one way or the other.
Another is patients that need to be on a lot of nonsteroidals, the NSAIDs, ibuprofen, Motrin. Those kinds of patients, I’d say probably the sleeve is going to be the better way to go because with the bypass, bypass patients really should not take those drugs on an ongoing basis because of the risk of ulcers where we’ve done the connection between the pouch and the intestine. So there are some unique things depending on the patient’s history and what’s going on, and also sometimes depending on how much weight they need to lose because there are some differences with the weight loss between different procedures.
Dr. Karen Greene:
So in that entrance, in those instances, have you ever counseled a patient and had to tell them you’re not a candidate? And how do you make that decision? Patients, for them, it’s a big decision to even think about it. How do you ever counsel a patient to say, “his may not be the best idea for you”?
Dr. Shani Belgrave:
Yeah. The way I like to have this conversation with patients is I always tell patients, “My goal as your surgeon is to make you better. So everything is risk benefit.” So if I’m ever in a situation where I’m looking at their history and there’s certain medical things they have going on or certain prior surgeries that they’ve had where I think we’re probably taking more risk than we’re going to get benefit, and so for those reasons, I think maybe for use surgery or this particular surgery, it really is not the way to go. And I try to offer them alternatives because I think sometimes people really just want to get better. And so it’s like, “Well, I had that in my mind, but if you’re saying there are other ways I can get better, then let’s talk about that.”
Dr. Mironda Williams:
That’s great.
Dr. Deanna Guthrie:
So in the process of having these surgeries done, are there any things that have to be done preoperatively before they have the surgery, like requirements that need to be completed?
Dr. Shani Belgrave:
Absolutely. I’m so glad we’re talking about that because this whole weight loss journey is a process and it’s a lifelong journey even after surgery. So I always try to let patients know, “There’s some things we need to do to get you to surgery and then you’re going to have lifelong follow-up.” But to get patients to surgery, typically we’ll do a consultation, then they’re going to also receive nutrition counseling. There’ll be a psychological evaluation just to screen for anything that might be an issue like binge-eating disorders or substance abuse problems, because we really want to set people up for success and also too so that someone can evaluate them to make sure they understand that this is a lifelong journey, that they’re going to have to take lifelong vitamins, things like that. Depending on their health, they may need additional tests. Sometimes patients will need a sleep study if there’s a concern that they may have sleep apnea. We’ll get some labs, EKG. So those are some of the things that we do before surgery.
Dr. Deanna Guthrie:
And then because for a lot of people, they see the transformation, what are some of the things that they have to give up when they have this surgery? Are there certain foods and things they cannot have after surgery? Because in their mind, when I get to where I want to be, I want to be the typical normal person and do whatever everybody else does.
Dr. Shani Belgrave:
Yes. What I tell everyone is that surgery is an amazing tool. However, it’s only a tool. It’s not a quick fix. And so when you get the results, you are going to have to do certain things to maintain the results. And so there’s certain things like soda that cause the weight to come back, drinking sugary beverages, things that are high in sugar. And so lifelong patients really are going to have to be mindful that they are choosing the right foods because even though the surgeries are very effective, you can regain your weight if you’re not committed to maintaining the lifestyle changes that we are making along the way, which is really reducing sugars and healthier eating. I try to educate patients to really focus on protein and produce and minimizing processed foods.
Dr. Karen Greene:
Which is good advice for everybody.
Dr. Mironda Williams:
Everybody. I appreciate when you said it’s a tool because I’ve had either friends and/or patients who will come in and they’ll ask us about our opinions about GLP-1 medications, surgery, those kinds of things. And I think all of us tend to say they’re all wonderful tools, but there’s no magic. There’s not a magic button that they push to make you not want pizza or potato chips, or in my case, ice cream. It doesn’t make that go away, but it’s a tool to help you learn how to manage to develop those portion control and just selection options in terms of what you should be eating and drinking on a regular basis, surgery or no surgery.
Dr. Shani Belgrave:
Absolutely. And that’s something I really focus on and emphasize is mindset because I had mentioned that in the last episode about life advice in general was mindset, and it applies to the weight loss journey, just making sure that you’re keeping the right mindset, this is a tool and you’re going to use your tool to get the best possible results.
Dr. Deanna Guthrie:
What kind of post-op support do you have for patients? Do you have an online community that they can encourage each other? What tools can you give them postoperatively to keep them on the journey?
Dr. Shani Belgrave:
Absolutely. I do a few things. Number one, the hospital has support groups that they are encouraged to participate in. And then from the practice standpoint, I like to do a lot of follow-ups. I’ll see my patients two weeks after surgery, then one month after surgery, and then three months post-op, six months, nine months, 12 months, and then annually at least once a year. And then in addition to that, I’m very active on social media, on my Instagram, Facebook, and I also host a bimonthly podcast as a way of staying connected and engaged with patients as well. And I have a dedicated weight loss management section of the podcast.
Dr. Karen Greene:
Wonderful. Wonderful. So you take this journey along with them?
Dr. Shani Belgrave:
Yes. I feel like you get it. Yes. Oneka Bariatrics is all about partnering with patients on their journey. This practice isn’t about just doing the procedure because the procedure is a moment in time. It’s about walking with patients through their journey.
Dr. Mironda Williams:
Absolutely. Anything else, Dr. Guthrie?
Dr. Deanna Guthrie:
I was going to say, because I was going to just reiterate that because a lot of people get lost. Like you said, they go in and they think the surgery’s going to take care of everything-
Dr. Mironda Williams:
It’s a magic pill.
Dr. Deanna Guthrie:
… and it’s the magic pill, but that whole what happens afterwards and how do I deal with this and how do I manage this travel, eating when I travel, cooking for my kids, that sort of thing. So it really does help when there is somebody alongside them to keep them.
Dr. Mironda Williams:
And my partners actually met Dr. Belgrave at a gathering of sister physicians, sisters in medicine that happens periodically. And I think hearing this conversation is just a reminder of why we were so excited to introduce our patients and our audience to her, but also just to continue to partner because we’re looking for like-minded individuals who believe in… We’re a gynecologist, yes, but that doesn’t mean we don’t care about other aspects of your life as a woman in our case because we deal with women patients, but we really want to take a very holistic view of our patients. And so to hear you say that as a surgeon is great that it’s not just get you through 90 days post-op and then good luck with that.
Dr. Karen Greene:
It’s nice just to follow up.
Dr. Mironda Williams:
We appreciate that you are dedicated to staying connected and you’ve operationalized that in your practice in terms of how you make sure that your patients stay engaged.
Now, there was one… We’re a gynecologist, so we assume all you take care of is women, but do you operate on both men and women as a part of your practice focus or how does that typically proceed?
Dr. Shani Belgrave:
Absolutely. I operate on men and women. Statistically, more women get weight loss surgery than men. So more of my patients are women, but I love taking care of the fellas as well.
Dr. Mironda Williams:
Awesome. Awesome. And again, we began this episode with a disclaimer about making sure you check in with your own healthcare providers if you have specific questions, but with any surgery, there can sometimes be possible complications. So can you just give some of our audience some of just the general complication things that may come with this kind of surgery that always have to be kept in mind?
Dr. Shani Belgrave:
Absolutely. Complications, that’s one of the things that I like talking about because with bariatric surgery, only 1% of eligible patients end up getting weight loss surgery. And I think that’s because there’s been a myth that these operations are very risky. And so I’m very passionate about debunking that myth. While all operations come with risk, the safety profiles for the operations are excellent.
There are a few kind of things that can happen in the acute immediate perioperative period that can be bleeding, infection. One of the more serious ones would be a leak or blood clots. Other things that can happen either at the time of surgery or at some point down the line would be bowel obstructions if you’ve had any kind of rerouting done. Other things that people lifelong should keep in mind is they can have vitamin deficiencies. And so that’s why it’s really important to have at least annual follow-up so someone’s checking your vitamin levels. But those are the main things that can happen that you should be aware of. It’s very important to be having follow-up with your surgeon so that if you have any complication, it can really be promptly diagnosed and treated.
Dr. Mironda Williams:
Absolutely. That speaks to what we say as well with hysterectomy, is they’re very safe. The safety profile for surgeries now with the minimally invasive techniques and some of the advances in technology have really improved that safety profile, but sometimes things can happen, but staying in touch with your doctor, your surgeon and making sure that anything that is needed to be addressed is addressed properly can help minimize any long-term effects with any of that.
Any other myths, any other things out there that you’re want to just bust up today while we got an audience, some more obesity myth busting going on here?
Dr. Shani Belgrave:
Sure. I’m going to reiterate the one that we talked about on the first episode, which is that obesity is somehow a moral failure and that’s something that people need to be ashamed of. It’s actually a chronic disease and we kind of touched on it briefly that it’s multifactorial. While there is a behavioral component, there’s also genetic component, environmental. There are different things that lead to the problem of obesity. So that would be myth number one is that obesity is not a matter of willpower. It’s more than that. That was the first one.
The second one that I like to dispel is the one we just talked about with surgery being very risky. Some patients have not told friends and family they were having the surgery because they were afraid of being told, “Don’t do that. It’s dangerous,” or I guess they had heard things from them that let them knew that they weren’t going to be supportive. And so I think it’s so important to do podcasts and things like this so that friends and family can be informed and can know that these surgeries are safe and they really are life-changing. So I think just trying to dispel that myth.
Then the third myth is that weight loss surgery is a cosmetic procedure. Sometimes there’s people thinking that a sleeve or bypass is like a tummy tuck or something like that and they’re completely different procedures. With metabolic and bariatric surgery, we are actually operating on your gastrointestinal system as opposed to body contouring. So I think sometimes there’s a little bit of confusion out there as to what these operations are. So just a chance to say that these are not the same as a tummy tuck. They’re different.
Dr. Mironda Williams:
Absolutely. I know our audience has been intrigued and this has just been great conversations we’ve been able to have. Dr. Belgrave is just an amazing person, as well as physician and surgeon. So please remind our audience again about the name of your practice and how they can reach you and all of your social media platforms if they can find you.
Dr. Shani Belgrave:
Thank you so much for the opportunity to come on the podcast. I am Shani Belgrave, Atlanta Bariatric Surgeon and founder of Oneka Bariatrics and Wellness. Our website is www.onekabariatrics.com. That’s O-N-E-K-A bariatrics.com. On Instagram, you can find me there. I’m active on Instagram. My handle is Dr. Shani Belgrave. I am also on YouTube as Dr. Shani Belgrave.
Dr. Mironda Williams:
Awesome. Amazing. Anything else before we get ready to wrap up this episode?
Dr. Deanna Guthrie:
That was so great talking with you and learning.
Dr. Shani Belgrave:
Thank you so much. It was wonderful to talk to you all.
Dr. Mironda Williams:
Yes, yes.
Dr. Karen Greene:
Yes, thank you again.
Dr. Mironda Williams:
Our tribe and our community is just amazing.
Dr. Karen Greene:
It’s growing.
Dr. Mironda Williams:
Yes. And we love having the technology that allows us to be together even when we can’t physically be in the room.
So once again, we want to thank all of our audience members, friends, family, patients for watching us again or listening to us if you’re listening on an audio platform of Take Good Care Podcast. Please continue to share us with your friends and family, especially this wonderful information that Dr. Belgrave has shared with us so that you can let your friends and family know about the wonderful, safe opportunities and an amazing physician in the Metropolitan Atlanta area who is available. So you can always find this episode and all of our previous episodes on our website at rosagynecology.com. That’s rosagynecology.com. And until we meet again for another episode of Take Good Care Podcast, I’m Dr. Mironda Williams.
Dr. Deanna Guthrie:
I’m Dr. Deanna Guthrie.
Dr. Karen Greene:
And I am Dr. Karen Greene. Take good care.