In this episode of Weight Loss by Design, Dr. Michael Feiz and Dr. Sean Rim dive into malabsorptive procedures for weight loss, focusing on the SADI-S operation (Single Anastomosis Duodenoileal Bypass with Sleeve). The discussion covers how SADI-S works, compares it to traditional gastric bypass and sleeve gastrectomy, and explores patient selection and the long-term effectiveness of surgical interventions.

• What is SADI-S?
  Dr. Sean Rim introduces the SADI-S as a newer, unique bariatric surgery that combines the restrictive power of the sleeve gastrectomy with a potent malabsorptive component, limiting calorie absorption for effective weight loss 00:00:16.

• Digestive Physiology Explained
  Dr. Michael Feiz provides a detailed explanation of how digestion and absorption occur in the stomach and small intestine—highlighting why targeting these areas leads to surgical weight loss 00:01:10.

• How SADI-S Compares to Gastric Bypass
  The hosts discuss the fundamental difference in how much and which part of the small intestine is bypassed in SADI-S versus traditional gastric bypass, emphasizing the enhanced malabsorptive effect of SADI-S 00:04:13.

• Restriction vs. Malabsorption
  Dr. Sean Rim discusses the roles of restriction and malabsorption in bariatric procedures and debunks common misconceptions about long-term hunger regulation after surgery 00:05:09.

• Effectiveness and Longevity of Weight Loss Surgery
  Dr. Michael Feiz and Dr. Sean Rim address the long-term results of procedures like sleeve gastrectomy, gastric bypass, and SADI-S, noting high rates of sustainable weight loss relative to diet and exercise alone 00:09:01.

• Choosing the Right Procedure
  The conversation covers how surgeons help patients decide on the best surgical option based on individual factors such as previous surgeries, BMI, eating habits, and patient preferences 00:12:04.

• Revision Surgeries and Super Obesity
  SADI-S is highlighted as a strong option for patients needing revisional surgery after sleeve gastrectomy or for individuals in the "super obese" category, where greater weight loss is necessary 00:19:04.

"No surgery is going to be all and end all of success... surgery or medication without behavioral and psychological modification, without changing your relationship with food, you will ultimately have a higher chance of being unsuccessful."
— Dr. Michael Feiz 00:18:33

"Our job is to provide the facts and what sort of lifestyle changes come with each operation, and I think most patients would agree that in general, less is better."
— Dr. Sean Rim 00:15:31

• SADI-S (Single Anastomosis Duodenoileal Bypass with Sleeve)

• Gastric Bypass

• Sleeve Gastrectomy

• Dumping Syndrome

• The concepts of restrictive and malabsorptive procedures

• SADI-S is an advanced, highly effective bariatric surgery, suitable for both primary and revisional procedures.

• Surgical weight loss delivers far more sustained results than diet and exercise alone, especially for patients with higher BMI or prior weight loss surgery.

• Success with any surgery still depends on lifestyle, behavioral, and psychological changes.

• Tailoring the surgical approach to each patient's unique situation maximizes long-term success.

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Listen & Subscribe

Tune in to "Weight Loss by Design" on your preferred podcast platform. Don't miss future episodes with Dr. Michael Feiz and Dr. Sean Rim as they break down everything you need to know about weight, health, and wellness!

Weight Loss By Design with Dr. Michael Feiz and Dr. Sean Rim, leaders in bariatric surgery, here to guide and inspire you through every stage of your weight loss journey. New episodes biweekly. Learn more at ⁠⁠drfeiz.com⁠⁠. Find us on Instagram at ⁠https://www.instagram.com/drfeiz/

In today's episode of Weight Loss By Design, Dr. Michael Feiz and Dr. Sean Rim dive into the real-world experiences and challenges surrounding the popular weight loss medications semaglutide and tirzepatide. Drawing on over 30 years of bariatric medicine experience, the hosts discuss patient outcomes, misconceptions, and the importance of long-term planning in any weight loss journey.

Key Topics Discussed

Semaglutide & Tirzepatide – Benefits and Limitations

Most new patients have tried semaglutide or similar medications before considering surgical options (00:00:41).

Common side effects include nausea, "sulfur burps", and constipation, which often lead patients to discontinue use (00:01:12).

Some patients experience only marginal weight loss and quickly plateau (00:01:55).

Cost and long-term sustainability are major concerns for most patients (00:02:39).

The Problem of Overprescription

Many prescriptions are given without addressing underlying behavioral or lifestyle factors (00:06:22).

Some prescribers lack expertise in the complexities of weight gain and obesity (00:06:22).

The Pitfall of Viewing Medication as a Quick Fix

Stopping medication often results in rapid weight regain, causing psychological distress (00:04:30).

Without addressing cognitive and behavioral factors, lasting change is unlikely (00:10:21).

Special Populations and Long-Term Concerns

Questioning the safety of these medications during pregnancy and breastfeeding (00:08:47).

The average patient uses these medications for only 6-12 months; weight often returns even faster than it was lost (00:12:09).

Issues such as gastroparesis in rare, but publicized, cases (00:13:46).

Debunking Media Myths

Benefits like improved sleep apnea or reduced cancer risk are attributed to weight loss itself—not the medication specifically (00:14:24).

The concept of "Ozempic face" is no different than changes seen with any significant weight loss (00:17:28).

Takeaways

Weight loss medications can be a helpful tool for some, but are not a long-term solution on their own.

Long-term success requires behavioral modification, nutritional guidance, and a comprehensive care plan.

Be wary of hype and ensure your provider is experienced and addresses all aspects of your health and weight journey.

Stay tuned for future discussions including debunking more myths and exploring the physical effects of weight loss.

Resources & Connect

Schedule a consultation: drphaze.com

Subscribe, share, and leave a review if you found this episode helpful!

Have questions or topics you want addressed? Send them in—your journey matters!

Listen & Subscribe

Tune in to "Weight Loss by Design" on your preferred podcast platform. Don't miss future episodes with Dr. Michael Feiz and Dr. Sean Rim as they break down everything you need to know about weight, health, and wellness!

Weight Loss By Design with Dr. Michael Feiz and Dr. Sean Rim, leaders in bariatric surgery, here to guide and inspire you through every stage of your weight loss journey. New episodes biweekly. Learn more at ⁠⁠drfeiz.com⁠⁠. Find us on Instagram at ⁠https://www.instagram.com/drfeiz/

In this episode of "Weight Loss By Design," Dr. Michael Feiz and Dr. Sean Rim explore the topic of revision bariatric surgery, discussing why some weight loss surgeries may require revision, the most common complications and symptoms, and how patients can achieve optimal outcomes even after a previous surgery.

• Revisional surgery is sometimes needed due to complications or inadequate results from the original weight loss procedure (00:00:46).

• Early complications, such as intolerance to food due to narrowing, stricture, or scar tissue, may require revision (00:01:30).

• Later complications can include the development of severe heartburn or gastroesophageal reflux disease (GERD) (00:04:08).

• The sleeve gastrectomy is currently the most common weight loss surgery worldwide (00:02:33).

• The procedure reduces stomach volume (about 70–75% removed), transforming it into a high-pressure tube (00:02:45), which can occasionally lead to kinking, scar tissue, or reflux (00:03:16).

• Dr. Michael Faiz and Dr. Sean Rim explain the importance of a thorough hiatal hernia repair to prevent post-surgical reflux (00:04:41).

• Heartburn after sleeve gastrectomy can present years after the original surgery and is a leading reason for revision (00:04:08).

• Atypical symptoms of reflux include chronic cough, hoarseness, or recurrent respiratory infections—patients may see several specialists before a correct diagnosis (00:09:36).

• Revisional surgery can effectively resolve these issues in the vast majority of cases (00:10:23).

• Some patients experience early plateau or regain following weight loss surgery, especially if the original procedure left too much of the stomach in place (00:10:58).

• The sleeve gastrectomy works not only by restriction but also by altering hunger-related hormones (00:11:28).

• When anatomical studies (endoscopy, CT volumetrics) reveal a large remaining stomach, a sleeve revision may be warranted (00:15:56).

• If patients have no heartburn but demonstrate little weight loss and a large stomach pouch, revision to a proper sleeve gastrectomy is an option (00:18:18), as well as alternative surgeries such as gastric bypass or SADI (00:19:09).

• Further reduction of stomach can increase risk for heartburn, so careful selection and patient education are crucial (00:20:19).

• Know the signs and symptoms that may require revisional bariatric surgery.

• Early plateaus or persistent hunger after surgery may indicate an incomplete procedure.

• Proper anatomical evaluation and surgical technique are critical for long-term success.

Weight Loss By Design with Dr. Michael Feiz and Dr. Sean Rim, leaders in bariatric surgery, here to guide and inspire you through every stage of your weight loss journey. New episodes biweekly. Learn more at ⁠⁠drfeiz.com⁠⁠. Find us on Instagram at ⁠https://www.instagram.com/drfeiz/