Weighty Issues: The Real Skinny On Weight Loss Surgery

Featuring Bariatric Surgeon Scott Cunneen, MD, FACS

Sometimes Dr. Scott Cunneen thinks his job would be easier if he had a really cool pair of roller blades. At least on the days he operates on four or five patients, or when he goes from gastric band adjustments to pre-op and post-op appointments, one after the other, nonstop, do not pass “go.” And lunch? Fuggedaboutit! Add that to the administrative responsibilities of a major hospital’s weight-loss surgery department, and this director of bariatric surgery at Cedars-Sinai Medical Center in Los Angeles has his hands full. And that’s precisely why he decided to co-author a new book with Nancy Sayles Kaneshiro called Weighty Issues: Getting the Skinny on Weight Loss Surgery.

“Patients have questions that they need answered and are entitled to have answered,” Dr. Cunneen said. “I wish I had the time to sit down and talk at length with each of them about all the details involved in this life-changing decision, but the truth is I just don’t.” So that’s why he sat down and compiled a list of the most often asked questions and then answered each one; careful to use easy-to-understand language and a conversational tone that make readers feel as if they’re sitting across the desk from him, chatting about each of their concerns, whether they are post-op or in the decision-making process.

“One of the greatest challenges we surgeons need to overcome is the abundance of misinformation out there about weight-loss surgery,” Dr. Cunneen said. “The biggest myth I have to bust all the time is that these procedures (he does the gastric band, sleeve gastrectomy, and gastric bypass surgeries) are somehow the magic bullet, the easy way out.”

While recent studies have shown that weight loss surgery is the most effective and most durable treatment for diabetes, Dr. Cunneen explained, thinking that it’s a walk in the park is a big mistake. “Our patients experience huge, permanent lifestyle changes and a completely new relationship with food,” he said. “The patients who have the most success are the ones who go into this process totally informed, excited, and committed. They’re willing and able to comply.” Dr. Cunneen pointed out that “The ones we worry about are those who say, ‘OK, I’ve lost some weight, now let’s celebrate with a six- pack and a pizza,’ or those who tire of the restrictions and fall off the wagon for long periods of time.”

In Weighty Issues, Dr. Cunneen covers the basics of each surgery and then, one by one, he answers the questions he hears every day in his practice, in new patient seminars, or in “Ask the Doctor” support-group sessions. The book is written in Q & A format and has a full listing of questions in the back of the book. Readers get an overview of weight loss surgery options in a section called “Generally Speaking” and “Nuts & Bolts,” while patients’ new lifestyle requirements are covered in “Life Changes.” After that, questions about each procedure are answered in their own sections. There’s even a section in the book called “Girl Talk” with answers from the viewpoint of a female bariatric surgeon, Dr. Mona Misra. So all in all, this small book is the total package.

“It’s not an ‘everything you always wanted to know about bariatric surgery’ book,” Dr. Cunneen explains. “It’s more an ‘I wish my surgeon had more time to answer my questions’ kind of thing. And what I’d just like patients to do is use the book as a jumping off point for conversations with their own physicians,” he said.

The book came into being when a patient walked into his office with a list of questions she had collected since her last visit. “I asked if I could see it,” Dr. Cunneen recalled. “She said no.”

By the end of the conversation, the doctor said, patient Nancy Sayles Kaneshiro, who has a long history in the publishing industry, said, “You know, there’s a book here, and if you don’t write it, somebody else will.” Within a month, they became co-authors and scarcely a year later, the book was published.

“I so enjoy walking patients through this journey,” Dr. Cunneen revealed, “giving them the tool that will not only greatly improve their lives, but actually prolong them. But the real kick for me is that euphoric post-op time when their weight is just falling off and I can look at their labs, see the major improvements in their health, and know just how much better their lives are going to be.” He added, “And I have to laugh when I realize their biggest problem now is that their pants are too big!”

Dr. Cunneen concludes, “If this book can help patients understand what weight loss surgery is — and, maybe more importantly, what it isn’t — then it will have been worth the effort.”

Weighty Issues: Getting the Skinny on Weight Loss Surgery is available through your local bookseller or Amazon.com and BarnesandNoble.com. For further information, visit www.weightyissuesbook.com.

An Excerpt From Weighty Issues

What is the difference between not being hungry and being full?

The magic word we use is satiety. And that means satisfaction with your state. If you aren’t satisfied, then you’re hungry. That’s a different feeling from I need to feel stuffed. Ideally, when you really want to stop is when hunger is gone, you don’t want to continue eating until you feel like you’ve just had Thanksgiving dinner.

For a lot of people, hunger – or that insatiable desire to seek out food when your body is telling you it has to be fed – dissipates in about fifteen minutes. We try to get people to differentiate between that need to feel stuffed — what most people believe feeling full is — and when one is satisfied, that is, no longer hungry. It’s one of the reasons we ask you to take a pause, take a time-out, take a break, try not to eat continuously for two hours, but stop after half an hour and let your body catch up. Many times you’ll realize that you’re not eating because you’re hungry, you’re eating because you’re bored or because everybody else is eating, because it tastes good, because it’s there. Sometimes people get so full, they’re stuffed and ready to throw up, but they’ll still try to stick one more bite into their mouths. It’s not for hunger they’re eating at that point, and that’s what we try to get people to understand as they adjust to their new eating patterns.

ABOUT THE AUTHOR Dr. Scott Cunneen, Director of Bariatric Surgery Cedars-Sinai Medical Center, Los Angeles. Author of WEIGHTY ISSUES: Getting the Skinny on Weight Loss Surgery. He holds a bachelor’s degree from the University of Notre Dame, a master’s degree in physiology from Georgetown University and a master’s degree in human nutrition from Columbia University College of Physicians and Surgeons.. Read more articles by Dr. Cunneen!