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Interview with Dr. Stan Rogers: Weight Loss Surgery and Type 2 Diabetes

Audio Interview

Hear a Patient Power interview with Dr. Stan Rogers, director of the Bariatric Surgery Center, and a patient, Brenda Abraham, who underwent a minimally invasive gastric bypass procedure and headed off type 2 diabetes.

Interview Transcript

Introduction

Andrew Schorr

Obesity is an epidemic in the United States, and type 2 diabetes is an epidemic as well that can go along with people who are overweight, sometimes 100 pounds or 200 pounds overweight. Bariatric surgery is proving to help people alleviate or reduce their diabetes. Learn the latest about that, next on Patient Power.

Hello and welcome to Patient Power sponsored by UCSF Medical Center. I'm Andrew Schorr. Well, the statistics are not good. Well over 30 percent of Americans are overweight. Some people are what we call morbidly obese. It is really affecting their overall health. Many people, as they become overweight, develop type 2 diabetes. And there are other problems that we'll hear about in just a minute.

Where does bariatric surgery come in? Sounds like an aggressive approach affecting the stomach and the digestion, maybe for the rest of your life. Some people are going forward with it, and it can be life changing and greatly improve their health. I want you to meet someone who has been in those shoes and that is Brenda Abrahams, and her doctor, surgeon Dr. Stan Rogers, director of the UCSF Bariatric Surgery Center.

Brenda is 53 years old now. She joins us from Windsor, Calif., just north of San Francisco.

Brenda, let's go back to age 52. You were something like 117 pounds overweight?

Brenda Abrahams

Yes, approximately.

Andrew Schorr

And having trouble walking.

Brenda Abrahams

Yes. It was definitely affecting my daily life. I had started using a cane and had been told by my doctor that within a short span of five years, I very well could end up in a wheelchair due to my severe joint problems with arthritis. The weight was certainly exacerbating that.

Andrew Schorr

And you were told you were pre-diabetic.

Brenda Abrahams

Yes, it was coming.

Andrew Schorr

It was coming, like a freight train. And you had been putting on weight, I understand, since you were 10 years old?

Brenda Abrahams

Yes, it started about the age of 10.

Andrew Schorr

Oh, my goodness. So what about weight-loss diets? I mean, they're all out there. Did you try them?

Brenda Abrahams

I tried every one, you name it, and I had success with every one. They do work. All of them work. It's sticking with those programs that just didn't work eventually. I've done Weight Watchers, Jenny Craig, Nutrisystem, banana a day diet that I made up once. You name it, I was on it. But they were not successful in the end.

Andrew Schorr

So you opted for bariatric surgery. That's a big decision.

Brenda Abrahams

Yes, I finally felt that the battle was not going to be won through the programs that were out there, not for me, anyway, and that I was ready to make the commitment that it would require from me for the rest of my life.

Andrew Schorr

Commitment is the big word, isn't it, with a capital C?

Brenda Abrahams

Yes.

Andrew Schorr

So this has affected your digestion, bathroom habits probably, need for vitamins, exercise, special diet. I mean, it's an everyday thing.

Brenda Abrahams

Every day, yes. I get up every day and realize that the tool or gift that I was given needs to be implemented by me, and every day I make the decisions to do what it takes, which starts with vitamins in the morning and supplements and sticking with an exercise program and making the right choices, food wise, and so forth.

Andrew Schorr

I understand you go to the gym five days a week, and two days a week you ride your bike around Windsor, and you have a basket for your little mini dachshund, Walter?

Brenda Abrahams

Yes, I do. He adds an extra 20 pounds, which makes me work out a little harder on what I call my fun exercise days, which is riding my bike.

Andrew Schorr

So, let's meet your doctor, Brenda. But before we do, what do you want to say to people listening, to underscore how life changing this has been for you? I mean, how big a difference is it?

Brenda Abrahams

Well, a big a difference is 117 pounds, so far, lighter. I think I have about another 10 pounds to go. I am feeling 30 years younger. I have energy. I can walk. I can almost run. I can go up and down stairs. I no longer use a cane. Sleep apnea is gone. I am no longer pre-diabetic. My high blood pressure is in the optimal range. My triglycerides, cholesterol are excellent and I've never been happier. I am the healthiest I've ever been since I was about 9 years old.

Andrew Schorr

Well, let's meet the man who has played a role in you achieving that happiness. A lot goes on and I'm sure there are other people who support you. But a key surgeon, an experienced surgeon is certainly part of that.

Joining us now is your doctor who has performed more than 1,000 bariatric procedures. That is Dr. Stanley Rogers. Dr. Rogers is chief of minimally invasive surgery at the UCSF Medical Center in San Francisco.

Dr. Rogers, first of all, when you hear Brenda's story and how she's doing and how she feels about things, that's what it's all about, isn't it?

Dr. Stan Rogers

Greetings. Yes, that's what it's all about. The surgery, as you mentioned, is a huge advantage for people with obesity, and medical problems associated with obesity. When successful with weight loss over time, and the resolution of these medical problems, people have a complete change in their life, their life perspective and their medical conditions.

Reversing Type 2 Diabetes

Andrew Schorr

Let's tick off some of the comorbidities, as you all call them, that go with people who become very obese.

Dr. Stan Rogers

Yes, obesity itself is associated with a number of medical problems. The most common are diabetes, hypertension, sleep apnea, in some cases depression, and we know that with weight loss these medical problems, that had occurred because of weight gain, disappear over time.

Andrew Schorr

Let's talk about type 2 diabetes. People acquire it as they get heavy, not always, but often. Tell us about the surgeries that you do at UCSF, the different approaches, and then how that can reverse diabetes.

Dr. Stan Rogers

The procedures that we do at UCSF, primarily, are done using minimally invasive surgery or laparoscopic surgery, which means small incisions, also known as keyhole surgery.

Long instruments and a scope are used to perform the procedure that we previously performed using a larger incision in what we would call open surgery.

Three main procedures that are done using this minimally invasive surgery are gastric bypass procedure, also known as the Roux en Y bypass procedure.

Andrew Schorr

And that's what Brenda had?

Dr. Stan Rogers

That's what Brenda had. This involves dividing the stomach and creating a small gastric pouch and then using a loop of small bowel to connect that gastric pouch with the rest of the intestinal tract. This anatomy bypasses the first portion of the intestinal tract including the stomach, the duodenum, and a small portion of what we call the jejunum, which is the very proximal small bowel.

That process allows a twofold approach to weight loss. One is restriction of intake, so the amount of food a person can eat in one setting is decreased. It also has a mild malabsorptive component, which allows decreased nutritional absorption by the bowel.

Andrew Schorr

Brenda said she takes vitamins, so you may need supplements because you're not absorbing certain things from food.

Dr. Stan Rogers

Exactly. The vitamins are given to every patient who has bariatric surgery, whether restrictive or malabsorptive, in order to ensure that the basic nutritional needs and vitamin and mineral needs are met.

Andrew Schorr

So that's one approach. Tell us about the others.

Dr. Stan Rogers

The other two surgical procedures that we perform, using minimally invasive surgery, are the gastric banding procedure, which is an adjustable silicone band placed around the first portion of the stomach in order to create again a small gastric pouch. This band is connected to an adjustable port that is placed in the subcutaneous tissue in the abdominal wall. This port can be accessed so the band can be adjusted, and made tighter or looser, depending on the patient's progress.

This procedure is being performed less commonly now because of a new kid on the block called the sleeve gastrectomy where, again, using minimally invasive surgery. The greater curvature of the stomach is excised from the stomach itself and removed leaving the patient with a sleeve or a small gastric tube, which produces the same effect of restriction, meaning it decreases the amount of food that a person can eat during one sitting or one meal.

Choosing the Right Surgery

Andrew Schorr

Doctor, how do you and the patient, together, decide if you're going forward with a bariatric surgery . . . which approach might be right for them?

Dr. Stan Rogers

Well, most patients choose what's called the gold standard or the most common, most successful procedure, that being the gastric bypass. Gastric bypass procedures are associated with a 75 to 80 percent excess weight loss over time.

The other two procedures — gastric banding and sleeve gastrectomy — are less invasive overall, although only minimally so, but they are associated with less overall weight loss over time. So most figures would quote a 45 percent excess weight loss with the band and a 55 to 60 percent excess body weight loss with the sleeve gastrectomy, compared withthe 75 to 80 percent excess body weight loss with the gastric bypass.

Andrew Schorr

Brenda, you heard those statistics too, so did that make the decision easy for you? You just want to go for it and have the best result.

Brenda Abrahams

Absolutely. I was really tired of monkeying around with this weight problem so I was willing to go for the more invasive one that required a bigger commitment. I decided, when I heard that it was between 70 to 80 percent of excess weight . . . I thought if I could go that far, why not go for 100 percent, and that's why I've added so much exercise and decided it's all coming off.

Andrew Schorr

I've seen your photographs. You look marvelous, you really do.

Brenda Abrahams

Well, thank you.

Andrew Schorr

You look great.

Dr. Stan Rogers

Brenda has done very well.

Comprehensive, Support Team

Andrew Schorr

I've seen the "before" pictures, too, Brenda. You've really come a long way. Commitment is what it's all about.

Doctor, so there's the commitment from the patient, there's you as an expert surgeon, but there's a team at your institution, UCSF, to support people too. There's work-up and counseling and helping people be prepared for what may be ahead of time, before the surgery and then there's support afterwards, right? It's a whole program.

Dr. Stan Rogers

Absolutely. We have a comprehensive, multidisciplinary group of people who participate in our bariatric surgery program. We know that programs that have high volume but also have this multidisciplinary team to help patients . . . not just with surgery but with the educational needs in advance of surgery and the follow up needs including evaluation of laboratory parameters over time and assessment of progress . . . this team approach really does have the highest ability to provide success to our patients.

Tips for Success

Andrew Schorr

Brenda, you wrote me a note and you gave certain points that you thought were really important. One of them is listen to your team. Dr. Rogers is part of a big team. They have a lot of expertise, but if you don't listen to it, it doesn't help, right?

Brenda Abrahams

Oh, that's right. I actually am aware of one patient who had her gastric bypass done at Christmas and she's not having very much success and it's no small wonder. She's not following the instructions that were given to her, and she's only lost, I think, 30 pounds since then and she's sick all the time. She vomits daily. She's drinking a lot of alcohol, and I don't see her being a successful patient in the end. And she never bothered to read the literature that was given to her. I talked to her and she's not following the program. So, I think, it's key to follow what your surgeon tells you to do, and if you do, you will be successful.

Andrew Schorr

Yeah, right. I mean, as we know with Dr. Rogers, he's done more than a thousand procedures. That's a lot of people. Beforehand, you did your research, Brenda. You knew what you were getting into. You knew what hadn't worked for you before, and then you knew what was required of you going forward and you went in with your eyes open. And now after the surgery and the months—well, we're about a year later now, you've been religiously following those instructions and with that commitment.

Brenda Abrahams

Yes, every day. I wake up and make a decision to follow the rules.

Andrew Schorr

And you keep a food journal, too.

Brenda Abrahams

Yes. I think it's really important, because we can start to lie to ourselves or slip, and so I do write down everything I have and keep calorie counts and stay within the parameters that I should be at this stage following surgery, and definitely keep track of my protein. That's very important. So definitely—I think it's a good idea for everybody in the world to keep a food journal but especially for a bariatric patient.

Andrew Schorr

So, Dr. Rogers, as we get to know Brenda, it sounds like she's a model for what a bariatric patient can be and the results they can have.

Dr. Stan Rogers

Yes. Brenda is doing just what is needed to be successful. She has approached this process in a highly intelligent way, meaning she's educated herself in advance, understood all of the issues associated with the preoperative preparation and the postoperative course, and has taken a serious attitude about being successful. She understands the limitations of the surgical procedure she had, and there are limitations. None of these procedures are foolproof, and, as Brenda mentioned, there are people who have the surgery who do not get to their goals and are not successful over time for a variety of reasons. But Brenda understands those limitations, has made sure that none of them affect her ability to be successful, and the proof is in the pudding. Brenda has done extremely well and continues to lose weight and has an ongoing goal to achieve, which I anticipate will be reality within a very short period of time.

Closing Thoughts

Andrew Schorr

Well, that is certainly a great assessment. And of course we should remind everybody we're talking about surgery. You go into surgery with your eyes open, you assess what the risks are, but of course, the risks we talked about, of being very obese and all the health problems that go with it, and diabetes that we talked about. And one last thing about diabetes, I wanted to ask you about, Dr. Rogers. I understand you've seen some remarkable turnarounds related to people who were pretty seriously ill with diabetes. Just tell us how quickly can that be?

Dr. Stan Rogers

Diabetes can be a major problem for people, some of whom are not obese, but a majority of whom are obese or overweight. We know that insulin resistance and glucose intolerance are significantly greater in a person who is overweight and obese, and that weight loss, either with or without bariatric surgery, can improve diabetes, in particular type 2 diabetes or noninsulin dependent diabetes, but also insulin dependent diabetes.

Andrew Schorr

Wow. Wow. Well, as with, we have had this discussion with Brenda, there you are, on with your doctor, is there anything publicly you want to say to him in that your life has been given back to you?

Brenda Abrahams

Oh my gosh, I could get verklempt. I don't have the words to say to Dr. Rogers. Thank you. Really, just thank you. He has returned to me a life I haven't known since I was a child, and I have the utmost confidence in his skills and abilities and trust, and if anybody were to come to me, thinking about having this is surgery, I would definitely direct them in the direction of UCSF and Dr. Stanley Rogers, himself, just an amazing man and I just can't thank him enough. I'm humbled and grateful. So thank you, Dr. Rogers.

Dr. Stan Rogers

My pleasure. And I would like to add, Brenda, you should look in the mirror and thank yourself for the success that you have attained and for the approach that you've taken to this process. I think you have shown how it is possible to be successful in this process, and I think a lot of the success, that you have attained, is due to your serious attitude about this process and commitment to the program that you've enrolled in.

Brenda Abrahams

Well, thank you very much.

Andrew Schorr

I'm glad to be with both of you, and I think for our listeners, if you're in this situation, where your health has been going downhill, as your weight has been going way up, maybe for decades, here's a good example of a team, a patient, a surgeon and a program standing with that, but it's a lot on you as the person trying to improve your health, and we certainly heard that with Brenda. Brenda, we wish you all the best.

Brenda Abrahams

Thank you.

Andrew Schorr:

Getting to all your goals, continuing to look terrific and just going on with a full life.

Brenda Abrahams

Thank you very much, Andrew.

Andrew Schorr

And Dr. Stanley Rogers, chief of minimally invasive surgery, a bariatric surgeon at UCSF, thanks for all you do, Doctor, and your devotion to people like Brenda.

Dr. Stan Rogers

My pleasure. And thank you for your bringing this to the forefront of our Patient Power interviews.

Andrew Schorr

Well, this is what we do, and it is so good to know how it can really turn peoples' lives around, and really reduce health problems, diabetes being one main example.

I'm Andrew Schorr. Thank you for listening. Remember, knowledge can be the best medicine of all.

Recorded in May 2013

 

Reviewed by health care specialists at UCSF Medical Center.

This information is for educational purposes only and is not intended to replace the advice of your doctor or health care provider. We encourage you to discuss with your doctor any questions or concerns you may have.

Related Information

UCSF Clinics & Centers

Bariatric Surgery Center
400 Parnassus Ave., Sixth Floor, Room A-655
San Francisco, CA 94143-0338
Phone: (415) 353-2804
Fax: (415) 353-2505

Diabetes Teaching Center
400 Parnassus Ave., Suite A-550
San Francisco, CA 94143
Phone: (415) 353–2266
Fax: (415) 353–2337

Diabetes Clinic at Parnassus
400 Parnassus Ave., Suite A-550
San Francisco, CA 94143
Phone: (415) 353–2350
Fax: (415) 353–2337

Diabetes Clinic at Mount Zion
2200 Post St., Suite C-418
San Francisco, CA 94115
Phone: (415) 885–3868
Fax: (415) 885–7724

Key Treatments

Condition Information