00:00Hello, everybody. Andrew Salchunas from 97.5, the Fanatic host of Kincade and Salchunas
00:07mornings on the Fanatic from Monday through Friday, and of course, also the host of our
00:11Eagles pregame show. Busy time, but football season is just really the only busy time for me.
00:17Being a doctor is a busy time throughout the entire year, and I love that I get to do this
00:22every single month. Another episode of a Stay Well Health chat from somebody from the Virtua
00:28team, and I can't wait to talk to my man, Louis Balsama. Dio, bariatric surgeon, obesity
00:34medicine physician with Virtua Health. The bio's long, and I always think the longer the bio,
00:38I feel even more comfortable with the doctor who's going to be treating us. He obtained his
00:42medical degree from Rowan University, so he's a prof at the osteopathic medicine school there,
00:47completed an internship at Henry Ford Hospital, completed his residency at Lehigh Valley Hospital.
00:53Dr. Balsama has been doing this for 24 years in the medical field and has been performing
00:58bariatric surgery since 2005. He's got focuses on advancements in surgery, including robotics and
01:04new techniques. Doc, the longer and longer the bio is, the more and more comfortable I feel.
01:09How are you doing today? Thank you for joining me.
01:12Thanks for having me.
01:13I bet you didn't expect to drop the props on you at some point.
01:17They're rolling.
01:18Backer Stadium. All right, Doc, so this is when I get to talk to you and ask questions about you
01:23and your specialty. What is the difference between medical weight loss and bariatric surgery?
01:31Well, as these new medications come out, then they're a little bit more effective.
01:36We see a lot of people now on weight loss medications. Weight loss surgery has been around
01:41for 30-plus years in continual evolution, but the medications have only more recently become,
01:50I think, more effective and useful.
01:53So is medical weight loss safer than having bariatric surgery?
01:59Well, I would consider them both very safe. At this point, we've, like I said, evolved into
02:06a very safe environment for surgery. We have very low complication rates. The medications,
02:14although they have a few side effects, are also considered very safe. So I have full confidence
02:21that our patients are going to do well and be safe under treatment with us.
02:25And you mentioned that there's a lot of different weight loss drugs now out there. What's the difference
02:30between these weight loss medications that are offered? Of course, we all know the big one that
02:35is out there on the TVs every single day with Ozempic. So can you break down some of the different
02:40ones? Tell us a little bit about different medications that are offered.
02:43Sure. Yeah, the GLP-1 medications are the newest and greatest medications to help people lose weight.
02:52And they really are broken down into different categories. Those that are used primarily for
02:59diabetes and those that are used for weight loss. And the newer weight loss indicated medications like
03:05Wagovi and ZepBound have been, you know, showed to be very effective and are being adopted very widely
03:14in our population. So people are really, you know, they have satisfying results with those
03:22medications. You said both medical weight loss and bariatric surgery are both safe approaches,
03:28whichever direction you decide to choose. How do you know which one is best for you at the given
03:34point of your life? Well, I think some of it depends on how overweight an individual is.
03:40Just based on, you know, how much you're expected to lose with medications versus surgery.
03:47Surgery is still a little bit more effective for the majority of patients.
03:50But they can be used together where somebody who's already had surgery, maybe not done as well as
03:59they wanted, could have medications or somebody that's afraid of surgery, you know, may do the
04:04medications first, get some weight down and then decide that they want to do surgery. So we can use
04:12them interchangeably and it really works very complimentary for the patient.
04:17It's not necessarily about stepping on the scale, but what is the difference in the amount of weight
04:22that somebody could lose if you were to go with the route of medical weight loss versus
04:27bariatric surgery? Is there a big difference between the two?
04:31Well, if you give an example of somebody that's say 300 pounds, if you go with the medication route,
04:38you're expected to lose about 20 percent or 60 pounds of your weight. That's how the literature
04:44is written for medication. So if you do surgery, though, it's expected you lose around 60 to 70
04:52percent or about two thirds of your excess weight, which in that case would be more like 80 to 90
04:57pounds. So you can see 80 to 90 versus 60 pounds. Surgery wins, but but still medication is very
05:04effective also. Now, you mentioned somebody could do both. You can either do the medicine and then
05:11obviously get the surgery or vice versa. Is there a proper way to do it? Would you suggest
05:15getting the medication first and then the surgery or is there any sort of specific way to go about it?
05:22Lately, I've been suggesting to patients that if they're leaving it up to me to decide whether
05:29it's medication or surgery, I typically tell somebody that's very overweight that surgery should
05:35be entertained first. Somebody that is just, you know, sort of barely making the cut for
05:42weight loss surgery, they may be better candidates for weight management with medication first just to
05:50see how they do. And if they don't do well, the medication doesn't work for them or they have a
05:55side effect that they can't tolerate it. Of course, we can always go the surgical route. But I always
06:00reinforce it. The surgical data shows it's better than medication. So, you know, it's still the better
06:09of the treatments out there. So you mentioned if somebody is severely overweight, I'd like to know,
06:15is there a ground floor that you base your practices off of where you say, hey, if you're at this BMI,
06:22if you're at this weight, we consider you obese and we say that you should take action. Is there a ground
06:28floor? Well, it's in general, it's 100 pounds overweight for surgery. But the BMI wise, it gets
06:35a little bit more specific. They the insurance companies want you to usually have a patient
06:42that's a BMI of 35 or greater with some type of weight related medical problem, usually high blood
06:48pressure, diabetes, sleep apnea, high cholesterol, something like that. And then if their BMI is greater
06:54than 40, then those comorbidities, those different medical problems don't really matter. They can still
07:00get the surgery even if they don't have any medical problems. And with medicine, it's similar, but the
07:05bar is set lower. It's more like BMI of 27 with comorbidities or BMI of 30 without for treatment. So they're
07:14set up quite similarly, but the BMI level is much lower for medications.
07:19So there's a million reasons why I love the team at virtual. I've been able to speak to a lot of your
07:25fellow doctors and you guys are all so knowledgeable and tremendous and great people. And I love the
07:30bios that you have. You guys are also Jersey natives. I know you have you have two daughters. You love
07:36running. You you love being just the normal person that we all are. But something else that I love about
07:41virtual, there's always seems to be some sort of program for people. It's not just surgery. That's what
07:46you're getting. Can you tell us a little bit about the complete weight management program that virtual
07:50offers? Yeah, definitely. I basically left a different job in February to come here virtual because I was so
08:00impressed with their program. I felt like they were very forward thinking in how they're strategizing with
08:07these new weight loss medications, combined with surgery. And I don't think a lot of programs around this
08:13area are doing that. They typically separate them into two different departments, which I think is
08:18the wrong strategy. And I've been talking to virtual administration a lot about, you know, how
08:25impressed I've been since I've been here, that the program is really just it's it's very ahead of its
08:30time. And I'm glad to be part of it. See, I love hearing that, that you made the jump to the
08:36virtual team. I already felt comfortable with the virtual team. But when I see peers of yours,
08:41where I see you or I see doctors go, that's the company, that's the hospital that I want to work
08:45with. I love hearing that. But if you can, can you expand a little bit more about the program?
08:49Because I imagine it's not just about whether or not you're getting surgery. What other resources does
08:55the program provide? Yeah, we provide a lot of different resources for the weight loss patient,
09:03including nutritionists. We provide a navigator to help the patient set up consults for other
09:11practitioners, such as pulmonary cardiology. We also have in-house psychology, psychiatry,
09:19and they're all for our weight loss program specifically. So all of those practitioners
09:24are very accustomed to treating our weight loss patients, and they do a great job.
09:30And I love hearing that because weight loss, I get it. A lot of people say it's easy to just
09:34step on a treadmill and get moving. There's a lot more to it. And I appreciate everything
09:38that Virtua has to offer. If you got enough information, that's great. If you want more,
09:44check out Virtua.org slash weight management. If you go to Virtua.org, you can find everything
09:49that the team at Virtua does. But specifically from today's conversation, Virtua.org slash weight
09:55management. Dr. Balsama, I appreciate the time so much. Thank you. And thank you to the team
10:00at Virtua. Thank you for having me. Yeah. I mean, you guys are amazing. And I learn so much
10:06every single time I get to do one of these Stay Well Health Chats. And if you learn a lot and you're
10:10more interested and you want to learn more, you can always go to the Virtua website, Virtua.org,
10:15and you can find anything, whether you're looking for a weight loss program, or if you're looking at
10:20something for heart conditions, or just overall surgery, you got some nicks and bruises in some of
10:25your bones, check it all out at Virtua.org. Dr. Balsama, I really appreciate the time today.
10:30I always learn so much more from you. So thank you as always. And thank you everybody for watching.
10:35And we'll talk to you again soon.
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