Weight Loss Surgery: Intermittent Fasting

On today’s Bariatric Friday, Kemal Erkan, Chairman of American Surgery Center, is accompanied by Dr. Isaias Irgau, President of Christiana Institute of Advanced Surgery (CHRIAS). CHRIAS has the number one weight loss surgery program in the State of Delaware and quite possibly on the entire east coast. The discussion will focus on the topic of intermittent fasting and how patients may or may not benefit from this type of diet.

Before they begin that dialogue, Dr. Irgau introduces and defines bariatric surgery and the qualifications needed to undergo the process. Bariatric surgery treats morbid obesity; it is currently the most effective treatment. “Morbid obesity is defined as obesity where the weight is at least one hundred pounds higher than the healthy or ideal body weight of the person.” Dr. Irgau explains, another way to quantify this is to talk about body mass index (BMI), which is a number we calculate by putting the height and weight of the person together, and a body mass index of forty defines morbid obesity”. A person with a BMI of thirty-five can also qualify for the surgery if the person has already developed illnesses such as high blood pressure, sleep apnea, or type 2 diabetes.

Erkan reintroduces Katrina and Samantha, fictional patients used to personify realistic cases that the pair encounter. Katrina is thirty-seven years old with a BMI of thirty-seven; she has sleep apnea and high cholesterol and is receiving a gastric sleeve. Samantha is a sixty-two year old who initially visited the office requesting a gastric sleeve but after evaluation has concluded that a gastric bypass is the right procedure for her. She has a BMI of forty-two with heartburn. The surgeons guide the patients throughout the process leading up to surgery to ensure the patient is undergoing the right surgery for them.

Erkan opens the discussion regarding intermittent fasting and how the bariatric program utilizes it. Dr. Irgau explains that intermittent fasting is a valuable tool to manage weight; however, it is still important to remain physically active during this time as well. “When we talk to our patients about bariatric surgery, we don’t say to them ‘you’ve tried to diet in the past, you’ve tried to exercise in the past and you did not succeed, stop those things and let’s do bariatric surgery,’” Dr. Irgau states. He says that they explain to the patients to stay healthy with diet and exercise while also utilizing the powerful tool of bariatric surgery. Dr. Irgau clarifies, “intermittent fasting is a great tool… most other diets focus on what people should be eating, whereas intermittent fasting focuses on when people should be eating.” People are awake for a longer period throughout the day due to social media, streaming devices, and technology overall; this allows considerably more time for increased snacking and/or meals. This is a major problem. It is important for people to define periods of time during the day in which they eat. Intermittent fasting is just that. There are designated periods of fasting and designated periods for food consumption. “When you are awake… don’t be open to eating all the time, define the hours of the day in which you are not going to eat at all… it may be the most natural way for us to be healthy.” The human can survive through extended periods of time without eating. Erkan explains how intermittent fasting began as a study to assess aging but also resulted in weight loss. He then explains his personal analysis that if the body is eating nonstop throughout the day, then the body’s organs are working nonstop, which correlates to aging.

Erkan then asks how Katrina could best utilize this method of weight loss. Dr. Irgau mentions that the best first approach would be to suggest the patient cut out basic caloric items, such as soda and sugary items, and have the patient follow the nutritionist’s plan. He then explains that if the patient does not regularly eat breakfast, they should continue to follow that. Once food has entered the body, all the “machinery” inside it has begun to work for the day. “Giving ourselves a break is important, and this type of education is important for our patients when we first encounter them”. He then elaborates that following bariatric surgery patients ask how they can continue their weight loss, and “the first thing I talk to them about is time restricted eating or intermittent fasting… it is useful not only in preparing patients for bariatric surgery but afterwards as well.”

The idea of having three meals a day is a social norm more than it is a necessity. It is not essential to have set times for eating; the idea of three meals is something imposed on cultural norms and habits. Dr. Irgau continues, “hunger does not increase over time, you are hungry and then it fades away… is it [intermittent fasting] safe for the vast majority of people, it is absolutely safe.” Individuals with diabetes or other illnesses, young people or pregnant women should not ignore their hunger. Eating is an energy supply to our body, but our body weight is stored energy. This does not imply people should never eat, but it does mean most everyone can afford to eat less often than socially suggested. Society offers endless access to food, so there is no surprise that people overindulge. “It is a blessing to have abundance, but when you don't pay attention then we are obviously paying the price here with obesity and all the illnesses associated with it,” Dr. Irgau states.

Samantha has diabetes, so Erkan inquires if the same approach would be beneficial for her as well. Dr. Irgau explains that intermittent fasting is safe for someone with diabetes, but a healthcare professional who knows Samantha needs to closely monitor her medications and daily habits. “There are studies that show that diabetes does improve with intermittent fasting,” he says.

Erkan shares a graph that represents data from patients at CHRIAS who have had immense weight gain over the previous two years. A patient whose weight is extremely high, for example 450 pounds, cannot undergo bariatric surgery. At this point, the best option is for the patient to try intermittent fasting to bring their body weight down to an acceptable range, so the surgeon can perform the procedure safely. Erkan explains how important it is for morbidly obese patients to get the proper treatment by their physician. In situations like the example, the physician needs to refer the patient to CHRIAS for treatment prior to the patient reaching such an extreme weight. It is imperative to catch this development before it is too late. “After a certain age things become slower and harder to change,” Erkan proclaims.

Intermittent fasting is not a requirement prior to the surgery; however, it is helpful in lowering the visceral fat in the body, fat located inside the abdomen. Patients who have used the practice of intermittent fasting find it very natural and easy to follow. Erkan concludes with, “this is all doable and this is all available… our goal is to help those who are looking for solutions the safe way”.