Core Bariatrics
Episode 25: Dr. Shauna Levy on the Frontlines of Bariatric Surgery
Discover the profound insights of Dr. Shauna Levy, the trailblazing Chief of Minimally Invasive and Bariatric Surgery at Tulane University, as she joins us to discuss the complexities and triumphs in the fight against obesity. In an intimate conversation, Dr. Levy unveils her journey from an aspiring pediatrician to a pioneer in bariatric surgery, her advocacy for insurance coverage for obesity treatments, and her unyielding commitment to educate the medical community about obesity as a multifaceted disease. Our discussion delves into the significance of a multidisciplinary treatment approach, combining the expertise of providers, dietitians, and mental health professionals to craft personalized care plans for those grappling with obesity.
Join us for a powerful episode where we tackle the pervasive misconceptions and discrimination surrounding bariatric surgery and obesity. Dr. Levy passionately dissects the stereotype of bariatric surgery as the "easy way out," instead highlighting its role as an essential lifeline for many individuals. We also celebrate the transformative "losers bench" tradition, where patients commemorate their weight loss milestones. Through Dr. Levy's narrative, we explore the joy and fulfillment that accompany the life-changing impacts of bariatric surgery, and how support groups play a critical role in dismantling obesity stigma. This episode promises not just a deeper understanding of obesity care but also a look at the heartwarming victories that come with it.
Discover the profound insights of Dr. Shauna Levy, the trailblazing Chief of Minimally Invasive and Bariatric Surgery at Tulane University, as she joins us to discuss the complexities and triumphs in the fight against obesity. In an intimate conversation, Dr. Levy unveils her journey from an aspiring pediatrician to a pioneer in bariatric surgery, her advocacy for insurance coverage for obesity treatments, and her unyielding commitment to educate the medical community about obesity as a multifaceted disease. Our discussion delves into the significance of a multidisciplinary treatment approach, combining the expertise of providers, dietitians, and mental health professionals to craft personalized care plans for those grappling with obesity.
Join us for a powerful episode where we tackle the pervasive misconceptions and discrimination surrounding bariatric surgery and obesity. Dr. Levy passionately dissects the stereotype of bariatric surgery as the "easy way out," instead highlighting its role as an essential lifeline for many individuals. We also celebrate the transformative "losers bench" tradition, where patients commemorate their weight loss milestones. Through Dr. Levy's narrative, we explore the joy and fulfillment that accompany the life-changing impacts of bariatric surgery, and how support groups play a critical role in dismantling obesity stigma. This episode promises not just a deeper understanding of obesity care but also a look at the heartwarming victories that come with it.
Welcome to Core Bariatrics Podcast hosted by Bariatric Surgeon Dr Maria Iliakova and TMA LaCose, bariatric Coordinator and a patient herself. Our goal is building and elevating our community. The Core Bariatric Podcast does not offer medical advice, diagnosis or treatment. On this podcast, we aim to share stories, support and insight into the world beyond the clinic. Let's get into it.
Speaker 2:Hello everybody. Today we have with us the Chief of the Division of Minimally Invasive and Bariatric Surgery at Tulane University. She completed her fellowship in Minimally Invasive Surgery, Forgot and Bariatric Surgery at Vanderbilt. She did residency in medical school at UT, Houston and undergrad at Emory. She was actually one of the first surgeons ever to certify as a diplomat of the American Board of Obesity Medicine in 2020. Let's please welcome Dr Shauna Levy.
Speaker 3:Hey, good morning.
Speaker 1:Thanks so much for having me. Hello, thank you for being here, you're here.
Speaker 2:I know you're super busy. You've got two girls, I understand, who may be running around today. One of the things we really want to talk about with you is your incredible advocacy in the state of Louisiana and also nationally. You've been a really great advocate for bariatric care and a really great media presence even. Why is that so important to you and how did you get started doing that?
Speaker 3:Gosh, it's hard to even remember. At this point, I feel like this is just the way I was raised Me and my brother and sister are all very similar in that way and that we feel compelled to speak up whenever we see injustice, big or small. Actually, I know how it started is that when I first started working at Tulane University, they did not offer obesity coverage for their employees. I just started writing emails after emails and basically was very persistent and was able to get that overturned. Now I'm proud to say that Tulane University offers its employees excellent, very comprehensive care, comprehensive insurance for obesity. I realized that I am very good at being annoying and persistent.
Speaker 1:I feel like worried about that too.
Speaker 3:That's a big part of advocacy is just like never stopping and consistently presenting your message to anyone and everyone that's willing to not ignore you. Basically they don't even have to be willing to listen, just to not ignore you. From there, I think it branched out into being more involved in my state society, the local Louisiana ASFBS, and getting some mentors there and realizing that Louisiana is such a low access state but at the same time has such a high rates of obesity. If not me, then who? It's really a question I ask myself all the time and just continue to figure out ways to use my voice and band with other like-minded people to spread the message.
Speaker 3:Obesity is such a prevalent disease but it's not talked about enough we just need to continue to spread that message and find people that will scream with us and make the message known to those around us.
Speaker 1:basically, I think one big reason why I wanted to do this podcast too is especially getting providers and stuff talking about this is a disease, it's not necessarily what you're doing, because so many patients continually say I failed, I'm doing something wrong, why can't I lose this weight? Why just hearing it from multiple providers that we're interviewing saying this is a disease, that I think is just going to help a lot of people understand that it's not necessarily what you're doing, wrong or right or wrong. It's what your body may not be doing.
Speaker 3:Yes, we know that in 2013, the AMA declared obesity as a disease, and that was really overdue.
Speaker 3:That was really late, but even now that was over a decade ago People are still extremely, I think, reluctant as part of it, but just still there's a lack of knowledge. I think part of this goes to the fact that we are not taught this in medical school and doctors are supposed to be the experts at medical diseases, when primary care doctors, who are really the gatekeepers to health, don't know that much about weight and obesity because they were never taught then. I think that messaging is very difficult to spread to general public. I think that we really need to do a better job with training doctors.
Speaker 2:You've been on the cutting edge of really considering obesity as something that can be treated with a spectrum of different things, including medications and side and exercise and surgery and mental health and all the different components of that. In fact, you were one of the first people that really got that American Board of Obesity Medicine designation. Why was that so important for you to do, especially as a surgeon? Can you talk a little bit more about what kind of insight or experience that has given you responsibility with?
Speaker 3:current情況 in your life. Yeah, originally I saw a hole that needed to be fixed. My institution. I went and I approached the family practice doctors and internal medicine doctors and said our patients need anti-obesity medications in order to provide the best care and also it's also a gateway to surgery right to start with medication. And none of them wanted to do it.
Speaker 3:And again, same question then if not me, then he'll. If nobody's going to do it, then I better step up and do it. And that's when I decided to sit for the American Board of Obesity Medicine exam and since then, my knowledge about comprehensive obesity care has just grown exponentially and my interest in everything really about my understanding about how to treat patients with the disease of obesity has gotten better. And now I understand obesity so differently and, like you said that it is best treated by multiple different providers from multiple different angles. I know that something that we've talked about offline is that cancer I really think should be our guide, because they really do Cancer care does really an excellent job of drawing from multiple different providers to best treat their patients in a very difficult scenario.
Speaker 3:Of course, there are some that follow the textbook right and they respond to chemo and they respond to radiation and their cancer can be treated. But there are some more complicated cases that require multiple different physicians and multiple different specialists to come together and have difficult conversations about what is the best pathway to treat these patients, and they do something called a tumor board where they can get together and have these conversations. I don't see why obesity should be any different. This is an exceedingly difficult disease to treat. That we know. Even with medication, even with bariatric surgery, some people still have weight recurrence and they become more and more difficult to treat, and I think that we need a think tank, if you will, to best treat patients, and so I think that using cancer as a model of how to treat a difficult disease should guide us on our pathway of comprehensive care and it sounds like with a tumor board.
Speaker 2:some of our listeners may not know exactly what a tumor board is. Can you describe what that looks like in terms of who participates, why it's done that way and how that would look in the setting of obesity care?
Speaker 3:A tumor board is where multiple different physicians come together, like radiologists and oncologists and radiation oncologists and surgical oncologists Basically every aspect of somebody's care come together into a room to review pathology specimens, to review radiology, to review patients' cancer history, certain genetic markers and anything that may influence their care, and then determine, based on best evidence and best knowledge, what is the best pathway for a patient.
Speaker 3:The truth is, we cannot all know the same things. We cannot all be experts at the same things, and that's why it's good to get together with other experts and put our brains together to come up with the best decisions. And I think that it's hard as physicians because we're really all over the place and medical professionals in general, we're all over the place. But it's so much easier just to come together in a room and have this conversation rather than sending 50,000 emails back and forth I guess it's old school because most people communicate via text these days but to actually not only pick a room and a room together maybe or I guess we have Zoom now too it's just the best way to all be on the same page and really guide difficult care.
Speaker 1:We definitely got a pushback from being in person because, yes, we and I think you said you tried to do this model too of when we have those quote unquote red flag patients, just that we want to.
Speaker 1:We see risk factors that we want to address before going to surgery. So we would have the provider, me as a coordinator, the dietitian, the mental health provider all be in the same room and discuss some patients that we had concerns about, and me, as a bariatric patient, I'm able to put light in a different way to some patients. We had a patient that the mental health provider was like I don't know, I see some things that and then the dietitian said the same thing and I actually saw this patient as a star candidate because she reminded me a lot of myself and so I just needed that kick in the butt, aka surgery, to really help me. So that patient they listened to me that patient went to surgery and, I think, is doing very well. So, yes, everybody's sitting in a room talking to each other and figuring out the best plan of action.
Speaker 3:But I think you bring up an excellent point too is that support group and peer support is also incredibly important when it comes to obesity, and I think it's so important because of all the shame and discrimination that exists not only about obesity but about the treatments of obesity. How many times have we heard that bariatric surgery was quote the easy way out? And when I think about that, I'm like first of all, what's wrong with making the easy way out, like literally, if you?
Speaker 3:were in a traffic jam and there was a road that just opened up and said you would reach your destination 30 minutes earlier. There's not a single person that wouldn't go down that road. Give me a brick and brick.
Speaker 3:But, second of all, we know it's not the easy way out, so it's not even a relevant point, but for goodness sakes, it's a way out and I think that, just like you said, it's that tool, it's that boost that people need on a hormonal level and on a psychological level to help treat their disease. And so I think that having support group and peer support and people who have walked in that shoes to be like no, I promise you this is not only going to be fine but going to be great. That's an important aspect of obesity care as well.
Speaker 1:But, I like where you said sorry, maria, I like where you said that if you were able to get out of traffic jam and get to your destination 30 minutes earlier, you would. But sometimes, even if you take that route we take fast ways to work we end up in out of stoplight. We end up oh my gosh, there's a dog in the road. I don't know. Same thing with bariatric surgery. We might be taking that route, but there is still roadblocks and so, no matter what route we take, there's roadblocks 100%.
Speaker 3:I always say to patients that, like weight is never lost, it knows exactly where to find you. This is a chronic disease that there's always going to be those hurdles, there's always going to be those bumps in the road, and so it's like a constantly you're running from the weight your whole life. It's never. That fight is never going to go away, but you just need a little help to be a little faster than the weight.
Speaker 2:Definitely, honestly, your analogy. I do love that analogy of the road because you're absolutely right. It's one of the only, if not the only, specialty in which we make a judgment about the treatment and it's absurd that we don't. We wouldn't want people to have an easy way to get treatment. If that existed, we would all use it, we would all want it to be available to ourselves and we'd want it to be available to our family members and to our community members.
Speaker 3:Yeah, and that's what keeps me so fired up, honestly, is that obesity discrimination extends to every level of treatment, even if you look at it, if you look at cash pay price of Osembic, which we know. So Osembic is what. I'll take a step back. Osembic is a GLP one agonist which is originally intended to treat diabetes. They found as a side effect that people lost weight. And then, of course, drug companies are smart and then they created the anti obesity medications that we have today, and so Osembic is the generic form, is called somagotide and of course, that's the same thing as will go be, and so Osembic is branded for diabetes, will go be, is branded for obesity. Osembic cash is around $1,000. Will go be cash is around $1,400.
Speaker 3:That's not obesity discrimination, I don't know. And so when I hear things like that, I'm like, oh God, like I need to scream louder. This is like what is going on here. How are they getting us from every single angle possible.
Speaker 2:Yes, and you're so right because it's almost seen as OK once you get care. Let's say you get surgery.
Speaker 2:Let's say you get access to a medication, even if it costs you a thousand dollars a month, you still face a world that will stigmatize you and will judge you, no matter what route you take any route you take and it's really overwhelming for people. So I'm curious, if you could redraw the landscape, what this kind of care would look like, especially once people start any kind of treatment or don't go down any kind of path. What do you think that would look like?
Speaker 3:I think that number one, at least some component of care should be approved by all insurance. Right, this should be able to be a conversation with a doctor and a patient, and then the patient should have access to at least some form of treatment. You know, the fact that insurances are allowed to have complete exclusion on obesity treatment is preposterous to me. Like I understand that insurance is not going to allow every medication under the sun and maybe every surgical under the sun because of costs and whatever. You know what exists in other fields, but at least when it comes to high blood pressure or cancer, there's some access to treatments With obesity. The number one insurer in the state of Louisiana, which covers nearly 80% of the insured lives in the state of Louisiana, has a complete exclusion on obesity care no medicine, no surgery, no, nothing.
Speaker 3:Okay, and so the first thing we need to have is access and then, in order to treat a disease, then it needs to be a conversation with the doctor and the patient where they discuss or medical professional I understand there's nurse practitioners and PAs, so I don't want to be like, exclude them but the medical professional and the patient and then they have joint decision making where they patient describes what they want and the doctor describes what they think is the best course action, and then together they make a decision of what's you know best for the patient. I mean, that's obviously separate than the tumor board aspect, but that should be the first step and then the patient should be able to choose that treatment because they have access to that treatment. I think that on the most basic level, that's what needs to happen.
Speaker 1:Absolutely.
Speaker 2:That's such an important message for people to hear because there are multiple states in which the top insurance company in that state including with Florida, for instance, Louisiana many of the southern states actually applied to as well where the majority of people in that state who have private health insurance do not have access to any bariatric care. That is bonkers to me, because it is again like he said, like the American Medical Association Designated this as a disease over 10 years ago at this point, yeah.
Speaker 2:The data on these kinds of treatments are is not at all in question. There's really great data that these things work, and not just for treating obesity, but even for treating things like I have blood pressure and diabetes and the structural feedback we do to medical like disease and it's just. It's actually some of the most effective care. But we still have these hurdles. So I'm curious you have been very effective in Louisiana and nationally about raising awareness and changing policy. What makes what was the needle? What?
Speaker 3:makes the difference. I think there's two things. I think that we've seen this. Dr Renee Hilton has been extremely successful in the state of Georgia. She's really a hero for a lot of us who follow advocacy, and I think that one of the messaging that she Preaches is that Finding the holdout in politics there can be. Sometimes there's multiple holdouts, but sometimes there's just one holdout, and when it comes to obesity, we don't know people's stories right Like politicians, have obesity too right.
Speaker 3:And so if we can find somebody who's a decision-maker and understand do they have bias against this disease and meet one-on-one with them and explain the data and explain the story, and if we can reach those people, then we can maybe make change. We in the state of Louisiana Senator Barrows is a huge advocate for treating obesity and I know it's because she has a personal history with the disease and so we, if we can find those allies in Politics, the people, either help them understand the disease, help them understand the stigma or Touch on their personal experiences. I think we can make change. But the other thing is Helping understand, helping the budget office, which unfortunately guides a lot, understand that we can have cost savings a lot of people see Bariatric surgery and especially obesity medicine is just dollar bills.
Speaker 3:They don't see it as patients, they see it as dollar bills and if we can help explain that actually obesity is expensive and it's very costly to our systems and that if we can just help people get care, it's wallets and maybe an upfront expense.
Speaker 3:It's a long-term savings and that's the conversation of course we're having in weight loss surgery is that Long-term it's actually much more cost-effective than anti obesity medications, especially in younger people, knowing that they have to take it for the rest of their life. I think that those are areas that we need to Adjust, but the other big thing is policy right, like Obesity is not considered one of the essential health benefits, and that's another area that we need to change. That's why people can exclude obesity, because it's not considered one of the essential health benefits. So they're all big targets.
Speaker 2:I love it. It sounds like the holdouts we're coming for you and advocates. We're gonna sing your praises because it's so important to have both allies and also just target folks who May have some bias against this or may not fully understand. You're actually right, though. I think the stories are so powerful when you actually hear the kinds of transformations people go through, it really hit home. I think for a lot of people that this isn't it is about numbers, it is about dollar bills. It is about that too, but it also has it's having a huge impact on people's quality of life and ability to be there for their family, for their work themselves, when it really liberates, I think, people to really Be who they want to be, which is magnificent.
Speaker 3:It drives me, nanas, when you see those heat maps, those color maps that just show our obesity rates Getting worse and worse, and I, and I guarantee you, most people are thinking oh god, people are just getting lazy and lazier In eating more and more. Okay, sure, that may be a component of it, but also, our access to treatments are not necessarily improving. Yes, we know that this is happening, but what are we doing about it? And so I think when people see those maps, they forget that Are especially in a state like Louisiana. They're not, they're not improving access to care. And so what? Yes, we know that our environment is poor. We know that people are having kids, we know that jobs don't allow us to go work out or live helpful life, so supermarkets are unhealthy, like the food that they're offering us. So we live in the land of uber eats, which is what I call right now, and Then you're not providing us treatment.
Speaker 3:I was asked a question are these not man-made solutions to man-made problems? Okay, okay, what if they are? Does that mean we shouldn't offer them? You know what I mean? The disease exists. We're not. We're not gonna fix big food right now, the job industry right now, so should we not offer Treatment?
Speaker 2:absolutely.
Speaker 3:I just it threw me, it made me think a lot, but then I just I don't understand. Even if it is a man-made solution to a man-made problem, is it not worthy of still giving the people if it works?
Speaker 2:That's such a great sentiment and such a great question to ask, because it to me registers is that's the equivalent of us not treating trauma patients.
Speaker 1:Somebody get into a trauma.
Speaker 2:Okay, it's a man-made problem and we're using man-made solutions to solve it, and that's what is the problem there? You're right.
Speaker 3:Yeah, there's. I want to ask.
Speaker 1:Why bariatric surgery for you? Maria said that bariatric surgery was not her go-to right out of high school or whatever. She wanted to do transplant stuff. And even dr Renee Hilton row at the same thing. She, our dad, said I thought you would want to cut out cancer, so why bariatric?
Speaker 3:surgery for you. Interestingly, my story is very similar. I thought I was gonna be a pediatrician and then a medical school. I realized, nope, not it.
Speaker 3:I don't know the surgery. And then when I did my surgery rotation, I wasn't quite sure because I never thought I was going to do surgery and I realized I loved everything during surgery residency, except for maybe cardiac. But when I reflected on it as I got to my more senior years, I realized I loved minimally invasive surgery techniques. I loved, like laparoscopic colon resections and thoracic chest surgery that was done minimally, basically. And then I started and I loved my bariatric rotation and so I started putting it all together and then I applied for MIS and it evolved. Now, reflecting on it, it was where I was always meant to be, because I suffered or I struggled with weight pretty much my whole life, but especially as a kid, and I think that my experience as a child and discrimination that I experienced have influenced me. I don't know if my mom's going to listen to this, but she put me on Weight Watchers when I was in the sixth grade and you know that I kind of messes with you when you're a little kid.
Speaker 2:Yeah, wow.
Speaker 3:So I just think that this is 100% where I meant to be. Like, when you reflect on it, it's like how, what was I else I was going to do? But it didn't come as easily as I would have thought. And then now, as I started learning more and more about obesity and the physiology of obesity, I'm like I'm even more energized to learn more.
Speaker 2:So who knows?
Speaker 3:And then it was meant to be a surgeon, so that story really resonates A lot of people.
Speaker 2:This is a very personal field for them and even though people find it sometimes because of the technicality of it, and that everyone in their first time seeing a gastric bypass, I think are just like wow, that's the coolest thing I've ever seen for a lot of us, or like a revision or something. But your words about how this affected you as a child and that the passion that has given you to speak on behalf of other people and really advocate for this kind of care, I think is just an incredible testament to who you are and the incredible things that you're doing with your talent and with your skill that are unique to you, and I'm really grateful you do it because it's very inspiring.
Speaker 3:Thank you, you're so kind. I love it, and that's one of the other reasons to go into bariatric surgery. Right, it's such a happy field, like our. Patients are over the moon. We have losers bench in our clinic. Patients lose 100 pounds or they our body mass index drops below 30, they get to sign the bench and they are just thrilled, taking pictures, can't wait to come back to the clinic, even if they haven't followed up with us like as they should. They follow up when they get to that point so they can sign the bench because they've been thinking about it for so long. We're about. We're in a position where I think we need to get a second bench. It's so filled up, wow. So it's just so happy and exciting.
Speaker 3:Even when we have complications, people do so well. They may have a little bit of bumps in the road.
Speaker 1:And.
Speaker 3:I need that happiness in my life, like I enjoy, like I couldn't do surgical oncology. I feel like, even though there is joy, there's so much sadness and with obesity, is just happy.
Speaker 1:It is. We have a non scale victory board, so anything not related to weight. We had a board and people put on like no longer in plus sizes, no longer wearing my CPAP, I can bend over without being out of breath, yeah, so I love those little things that people can your loser bench or non scale victory board. Those are the things that keep people motivated.
Speaker 3:Yes, that gives me a good idea. We should paint the wall and just have people write their non scale victories on the wall, chalkboard wall too, oh my gosh.
Speaker 1:Yes, maria, write that down, you're doing it.
Speaker 2:I love it, I love it, I love it. But you're actually right, there's so much joy in the field and that wasn't necessarily something that was that I expected, but it's such a meaningful like that. I'm not a person who I thought liked clinic and then I guess I do now, because the kinds of conversations you're having with people, even in the beginning you can be a transformative experience for them. In healthcare. A lot of times people come in and they're a little bit beaten down by the process and by getting there. Tammy was kind enough to open up about her experience coming into the office for the first time and what, how not great that was in the beginning and then guiding people through in a way that is uplifting, that is evidence based, that is supportive and getting them to be able to reach goals. But I don't know, it's just incredible how joyful this field is. You bring up a really good point there.
Speaker 3:Yeah, patients usually, on average, have tried to lose weight seven times before they ask for help, before they even see talk to their primary care doctor or a doctor about losing weight, and then a lot of times when they talk to a doctor, the doctor is oh, have you tried eating less and moving more?
Speaker 3:And so I think, by the time, they reach us, people who actually get it they are just so elated and relieved. I'm sure your experience is very similar, but I would say 82% of all new patients I see at some point in their visit are crying Because it's such an emotional experience and because they okay, finally somebody gets it. Finally I don't have to feel guilty anymore and I just love it when patients cry, only because I just feel like they have a release.
Speaker 1:Safe place. That's what I think about when it comes to our clinic. Is their safe place to talk about the weight, the hardship of it, the yeah, yeah?
Speaker 2:I agree that's such a I just I'm so glad you said that, because it really is something that it's innovative, it's interesting. There's always stuff coming out, there's always technique improvement. We're learning more every day about the field. But it is also just one that is filled with joy and I think that's such a beautiful message. It's really not one I've heard expressed that way before, but, dr Levy, I think that really moves me. Thank you.
Speaker 3:Yeah, that's good. It's nice to be happy, it's nice to be happy.
Speaker 2:It's nice to be happy On that note we're really grateful that you chose to spend some of your Saturday morning with us. Hopefully you have a great rest of your weekend. And we're talking today about advocacy, about access to care, about tumor board applications, even to bariatric care and about the joy of this field, which is such a great and delightful thing to talk about. Thank you for joining us, expanding our world and sharing the pieces yourself with us today, Dr Levy, Thank you.
Speaker 3:Thank you for having me. Can't wait to do it again.
Speaker 1:Oh yeah, Thank you so much and for those that are listening, thank you again for tuning in. Head over to Instagram and like our core bariatrics page and send us a message if you want us to talk about something or want to be on yourself. Thank you all for listening. See you next time. Bye.