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In this episode of Longevity by Design, our hosts, Dr. Gil Blander and Ashley Reaver, MS, RD, CSSD, are joined by Dr. Mitch Roslin, Chief of Bariatric Surgery at Lenox Hill Hospital in New York City. During this conversation with Dr. Mitch Roslin, he talks in detail about the obesity—he touches on taking a preventative, upstream approach, causes, consequences, and everything in between. Dr. Roslin shares his experience as a bariatric surgeon, and the important role this surgery has on obesity treatment and outcomes.
This article is intended to share information on weight management. The subject matter may be distressing, not appropriate, or triggering for some individuals. Please proceed with caution if you continue to read this article.
Mitchell Roslin, MD, FACS, FASMBS, is the Chief of Bariatric Surgery at Lenox Hill hospital in New York City and has dedicated his professional career to the treatment of morbid obesity. Dr. Roslin is the editor of the VideoTextBook of Bariatric Surgery, serves as the major teaching proctor for sleeve gastrectomy and duodenal switch, and is the course director for symposiums on revisional bariatric surgery. Dr. Roslin is an innovator in the search for better treatments and holds several patents in the emerging field of Pacing Technology for the treatment of obesity. Dr. Roslin recently has been selected as one of the best minimally invasive surgeons in New York.
Before discussing obesity, Dr. Roslin defines the term. He notes that while the true definition is "excess adiposity,"—body mass index (BMI) is the proxy typically used to categorize people as "normal weight," "overweight," "obese," or "morbidly obese."
A twin study served as a major breakthrough in understanding obesity. Research findings concluded that when twins were separated at birth and raised in different environments, their concordance in body mass index was over 90%, implying a genetic component.
The rising rates of overweight and obesity since the 1980s, implies an environmental component as well. An estimated 60% of American adults have a BMI that classifies as overweight or obese—up from only 10% of the population forty years ago.
A significant environmental change over this time period? Dr. Roslin points to the increased availability of processed foods and the widespread use of high fructose corn syrup.
When fructose occurs naturally in foods, it's typically accompanied by fiber. However, the sweetener in processed foods—high fructose corn syrup—is stripped of its fiber content. "Fructose stripped of its fiber at high supply acts as an energy sump and actually causes the breakdown of ATP to AMP, forming uric acid and citrate. This seems to be the start of really severe metabolic syndrome," says Dr. Roslin.
Another factor that can impact weight status is the body's ability to process food intake and convert it into energy—known as metabolism. But, Dr. Roslin mentions that our mitochondria handle fuel very differently as we age or gain weight. "As you get older, you lose mitochondria, which oxidize fat. The way that older adults process fuel is different and the way their mitochondria handles glycogen or fat becomes compromised," he says.
Chronic diseases such as heart disease, cancer, and diabetes are among the leading causes of death and disability in the United States. Dr. Roslin points out that obesity is a major risk factor for all chronic diseases and contributes to longevity.
Dr. Roslin argues that while obesity prevention is eminent, there is also great value in treating obesity with bariatric surgery. "We have to wake up and treat obesity because if not, we're going to continue seeing a rise in the epidemic of chronic diseases. Obesity can cause chronic diseases to come earlier in life—as early as late teens or early twenties." And while there are tools for prevention that we'll dive into later, Dr. Roslin's current work is a treatment method for obesity.
When asked for the most effective way to prevent obesity, Dr. Roslin argues for avoiding highly processed foods. A healthy diet is crucial for health maintenance during childhood and as we age. “The amount of processed food and sugar that you receive in infancy and childhood up-regulates the receptors that help you absorb sugar,” explains Dr. Roslin.
Dr. Roslin recommends a food pattern centered around quality protein, fiber, and plant-based foods.
Unsurprisingly, being active also plays a crucial role in obesity prevention. Dr. Roslin says one of the many paradoxes of obesity is that exercise has never been shown as an efficient weight loss tool for people who are already obese, but exercise can prevent weight regain after weight loss.
During bariatric surgery, a patient's stomach or intestines is manipulated. The stomach is a food reservoir that can determine how hungry we are. Food is absorbed in the intestine, making it a determinant for metabolism and fullness. While bariatric surgery creates a mechanical barrier, numerous mechanisms of action come into play with this surgery. "What's really fascinating is that when we change the GI tract, we're changing the gut-brain interaction. By removing some of the stomach, we also remove some of the hunger hormones that communicate with the brain to stimulate hunger," says Dr. Roslin.
Throughout his years as a surgeon, Dr. Roslin has reframed what bariatric surgery is: a means of improving someone's life. While this surgery is an efficient tool to treat obesity, Dr. Roslin drives home the importance of diet and exercise post-operation. "I don't do weight-loss surgery. I do eat differently, and eat-less surgery and hope weight loss and longevity are the beneficial effects of that. It's crucial to understand that I'm not making pretzels healthier in the operating room. I'm making it so you get full faster and are less hungry.
To close the discussion on bariatric surgery, Dr. Roslin talks about some of the health benefits people experience with weight reduction.
Weight loss can result in less pressure on the joints and lower rates of sleep apnea. Healthier joints help prevent arthritis and other age-related conditions. Improved sleep is important for many outcomes, like hypertension and focus, to name a few.
The major metabolic advantage of weight loss in overweight individuals is improved biomarkers related to longevity. Weight loss is associated with a decrease in fasting blood glucose, and over time, HbA1c levels also become more stable. Triglyceride levels and cholesterol also tend to benefit from weight loss, especially when paired with a healthy diet.
As with all guests, our hosts ask Dr. Roslin for his top tip for health promotion. His advice is to follow a healthy diet and socialize with others. He says to focus on eating adequate, quality protein in conjunction with a lot of fiber and plant-based foods. Dr. Roslin says it's great to get outside and interact with friends—mood impacts health like diet and exercise.