Weight Loss Surgeon: You're NOT Lazy! Why Diets Fail & Ozempic Is Changing Everything

Millions of people are told they're lazy, lack willpower, or simply need to "eat less and move more." But according to bariatric surgeon Dr. Bernie Hanna, the science tells a very different story.

In this episode of Ava Devine's Bad Advice, I sit down with my longtime friend and one of Las Vegas' leading bariatric surgeons, Dr. Bernie Hanna, to unpack one of the biggest health crises in America: obesity.

We discuss the science behind obesity, genetics, food addiction, processed foods, bariatric surgery, Ozempic, GLP-1 medications, Tirzepatide, Retatrutide, mental health, body positivity, and why traditional weight loss advice often fails.

Dr. Hanna explains why obesity is far more complex than personal responsibility, how hormones, genetics, environment, and ultra-processed foods influence weight, and why treating obesity with compassion, not shame, is critical to improving long-term health.

Whether you're considering Ozempic, bariatric surgery, struggling with food noise, or simply trying to understand why losing weight feels impossible, this conversation offers practical advice backed by over 20 years of medical experience.

In this episode, we discuss:

• Why obesity is not simply about willpower
• The truth about Ozempic, GLP-1 medications and Tirzepatide
• How bariatric surgery actually works
• Why processed foods keep you hungry
• Food addiction and "food noise"
• Genetics vs environment in obesity
• Weight stigma and mental health
• Muscle loss while taking GLP-1 medications
• Functional training vs endless cardio
• Insurance coverage for weight loss surgery
• Whether Ozempic is worth taking for cosmetic weight loss
• How to choose between medication and bariatric surgery
• Long-term weight loss strategies that actually work

⏱ CHAPTERS

00:00 Why Obesity Is One Of America's Biggest Health Crises

00:01:57 Meet Bariatric Surgeon Dr. Bernie Hanna

00:02:54 Genetics vs Environment: What Really Causes Obesity?

00:06:32 Is Sugar Actually Addictive?

00:10:32 The Biggest Challenge People With Obesity Face

00:12:21 Why "Just Eat Less" Doesn't Work

00:17:31 Ozempic, GLP-1 Medications & The Future Of Weight Loss

00:22:20 When Should Someone Consider Bariatric Surgery?

00:24:05 Gastric Sleeve vs Gastric Bypass Explained

00:25:51 Why Muscle Training Matters During Weight Loss

00:26:43 Cardio vs Weight Training: Which Is Better?

00:29:08 What Is Functional Fitness?

00:31:40 How Doctors Decide Which Weight Loss Surgery You Need

00:33:25 Does Insurance Cover Bariatric Surgery?

00:36:23 Why Mental Health Is Essential For Weight Loss Success

00:39:48 Why Some People Travel Overseas For Bariatric Surgery

00:41:32 Can Bariatric Surgery Stop Food Noise?

00:43:33 Ozempic vs Bariatric Surgery: Which Should You Choose?

00:46:59 Childhood Trauma, Obesity & Emotional Eating

00:51:39 Is Ozempic Worth It For Cosmetic Weight Loss?

00:54:47 Dr. Bernie Hanna's Final Advice For Long-Term Health

If this episode helped you better understand obesity, weight loss, Ozempic, or bariatric surgery, don't forget to like, subscribe, and leave a comment below. Conversations like these help reduce stigma and empower people to make informed decisions about their health.

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Transcript

SPEAKER_01 0:00

This week on Ava Devine's bad advice, I sit down with a near and dear friend of mine, but a bariatric surgeon, Dr. Bernie Hanna, to discuss one of the most important and controversial health topics in America today. That is obesity. With obesity rates continuing to climb, millions of Americans are struggling with chronic disease, mobility issues, mental health challenges, and a healthcare system that often leaves them feeling blamed rather than supported. Oh, I got goosebumps.

SPEAKER_00 0:36

Me too.

SPEAKER_01 0:37

Bernie explains, Dr. Bernie Hanna explains the difference between body positivity and health positivity, the realities of bariatric surgery, the rise of the GLP-1 medications like Azempic and Retitrutide, and why traditional weight loss advice often fails. This episode is about empowerment, education, and helping people understand that improving their health is not about becoming perfect. It's about getting more years, more energy, more freedom, and a better quality of life. Whether you're struggling with your own weight, supporting a loved one, or simply trying to separate facts from internet myths, this episode delivers practical advice and hope. So get cozy if you're watching from home and turn up the volume. If you're listening, this is Ava Devine's bad advice. Yay. Okay, yay. Okay. Well, welcome, Dr. Bernie Hanna. Welcome to the show.

SPEAKER_00 1:42

Thank you so much, Ava. This is just a passionate topic that I'm very passionate about. Yes. I've been treating obesity for over 20 years here in Las Vegas as a bariatric surgeon. So I'm well aware of the stigmas and everything around it. Yes. So it's a very important topic that there's so many misconceptions about it. And especially now with all of the medications on that's coming out. Yep, the peptides. And versus traditional medicine and diet and exercise and bariatric surgery. That's what I do. Yes. You know, I've been doing that for 20 years. So yeah.

SPEAKER_01 2:23

And I can't wait to elaborate more on that. Absolutely. Yeah. So not only are you a dear friend of mine, um, and part of the part of my family, you're my big brother, but we but also like your expertise and professionalism is very important to me. Um, I love you with all my heart and soul, but this topic goes deeper, you know? It goes deeper, deeper. And we looked up some statistics, right? You and I did. And roughly 42% of American adults are obese, and that number doubled since the 1980s. Yes. This isn't about appearance. It's a public health crisis that's touching heart disease, diabetes, cancer, joint uh failure, and mental health. This is a judgment-free zone, but kindness isn't silent. Absolutely. Right?

SPEAKER_00 3:14

Yeah.

SPEAKER_01 3:15

Okay. So understanding obesity. There is a difference between body positivity and health positivity. You deserve to feel good in your body. You deserve energy, mobility, and years. It's not about a pant size, it's about blood pressure, your inflammation markers, your ability to play with your kids. You can love yourself and want to better yourself. The most compassionate thing isn't to tell somebody about their weight or their weight doesn't matter. It's to help them access the tools to change it without shame. Okay. Now we need to know, Bernie, we have some questions. Okay. Your professional opinion. How much of obesity is genetic versus environmental? Please elaborate on that.

SPEAKER_00 4:08

I sure will. And that's a loaded question because obesity has so many moving parts, okay? And genetics absolutely plays a role. We do know that genes, studies that were done in uh by Kaiser and the CDC years ago shows that there's there's uh genetic with twins and adoptions shows that the genetic pool, 40 to 70 percent of individuals have genetic association with obesity. So say for instance, if there is an adopted child with uh non-biologic parents, that adopted child will carry the genes that their biologic parents have. So that body habitus is typical of the parents that they were born from. Sure. And similar with twins, we do see that. But environment certainly impacts all of that. And environment is a loaded, loaded gun, okay? Yeah. Because access to good healthy foods, especially now with the the production of all of the ultra-processed foods that are out there, say the corn, the soy, and the wheat products, these are the products that are the building blocks for unhealthy foods. You look at the urban and rural areas where people of poverty or low income status, they live in these areas with poor access to good uh supermarkets versus being in a higher, uh, wealthier neighborhood where supermarkets are all around. Yes. You know? And access to that, access to the healthy foods, the affordability, it really does impact all of that. So at the end of the day, you look at the lifestyle, genetics definitely plays a big role, and environment actually adds to that.

SPEAKER_01 6:12

Aaron Powell Sure, most definitely. Would that be considered like nature versus nurture?

SPEAKER_00 6:17

Both. Yeah. Yeah, yeah, absolutely. Yeah, right? Yeah.

SPEAKER_01 6:20

Because like also when we're talking about the processed food, you know, I was taught, and and I will agree that like for some reason, um, I heard sugar is like such a component like cocaine or gambling. Like it it fires off the same things in like in the uh and the endorphins or the SRIs. Yeah. That that it like stimulates, you know. And for me, I've noticed when I ingest sugar or flour, oh, I'm off to the races. It's like I want more. I want more. And and the crazy thing is, like, if I'm ingesting those products, those ingredients, I'm not in the mood for grilled chicken and broccoli. Like I want more ice cream. I want more fried stuff. Like, I don't know. Do you think do you think there is a uh addictive component ingredient?

SPEAKER_00 7:09

Absolutely. You know, the the food industry studies this. It's a science behind it. Yes. And there's also psychology behind it. Okay. You know, it does impact the pleasure centers. Sure. Okay. The the yes. Oh, yeah. With endorphins in your brain, and it stimulates you. So, you know, as as human beings, we were actually designed to seek out fat, sugar, and salt. Okay. But that was in the Paleolithic time when we were hunters and gatherers, cavemen, yeah. And cavemen, cavewomen, and we're getting food when it was not in abundance. But now we have it in abundance. Sure. And like I mentioned earlier, all of the processed foods, it's all around us. So we still have that biologic desire to want this stuff, you know, the sugar, the salt, the fats, and it's all around. So it's just our nature. Sure. You know, now all of the uh food, the food industry, they've capitalized on that. Of course. So we see it everywhere. It's all around, you know, and the sweets and the high calorie sweet drinks. So what I teach my patients, you have to look at the labels, you have to read the labels, you have to look at the numbers. And I mean, I'm guilty to I love chips, right?

SPEAKER_01 8:31

We we eat together. We've been together dinner together. Yeah.

SPEAKER_00 8:34

I love chips, right? And I'm not gonna say what brand chip I like, but I do like chips. Sure. And this certain chip, when you put it in your mouth and you crunch down on it, right away is like, oh my goodness, it's like the endorphins go off, it's it's tasty, that crunch stimulates your brain, and it just makes you want to go back and have more. And you go back and have more until later he's like, oh my gosh, that bag is almost finished. Sure. But if you turn around and look at that label and look at the calories and look at the serving size, you know, one serving size is 150 calories. Exactly. One ounce. You know? Yeah. So you have to understand the numbers and how it works. But yeah, environment definitely impacts us.

SPEAKER_01 9:20

For sure. And you know, like when you say you you ask your uh patients to read the ingredients, I was taught too that like if it if sugar is in the fifth ingredient, it's not as bad or it's not as like um intensified with sugar, it's not that high. Is that true? Aaron Ross Powell, Jr.

SPEAKER_00 9:38

You want you want to still look at it. It it should be there. You know, the FDA and there it's you have to put this on the label and you have to put the quantity and the amount and the type of sugar that it is, you know, with carbs or actual just sugar. Or if it's added sugar. Yes. So I just tell my patients just to make sure that it the number isn't as high as this, you know, like five to ten grams is plenty. Okay. Five to ten. Okay. Yeah.

SPEAKER_01 10:05

Yeah. Per serving.

SPEAKER_00 10:06

Per serving.

SPEAKER_01 10:07

Because it's not the whole container, yeah. Exactly. I wish. Okay. So here's another question. Uh what do you think is the number one challenge that people afflicted with obesity face?

SPEAKER_00 10:20

Loaded question. You know, we just talked about genetics and environment. Those, I would want to say those. But when you think about all of this, the stigma, the stigma behind obesity, because even though you may be challenged with the genetics and the environment around you, the stigma surrounding obesity is so powerful. The social impact if you let that affect you, no matter what environment you're in, you can be in the best environment with the healthiest foods, you still will be affected by you know, and impacted by the obesity, you know. Yeah. So you have to first try to, you know, figure out the stigma behind it. You know, we talk about love yourself, figure that out first. See what it is that's affecting you, you know, understand the genetics and the environment around you.

SPEAKER_02 11:17

Yeah.

SPEAKER_00 11:18

You know, if you need to seek out help or professional help, do that because that's that's powerful too, and educate yourself. I think education is key. Uh you want to understand all of this because it's so multifaceted, as I said before. You need to understand it, be educated about it. Not too many people are.

SPEAKER_01 11:36

Yeah, no, most definitely. And you know, I mean, the stigma I hear a lot about obesity is, oh, they're lazy, or uh that's their choice. Or I had a I had a therapist tell me, put down the fork. I'm like, it's not that easy. Like really that's a great idea. Thank you for mentioning that. But like the, you know, and it was like, wow, you're gonna like I I can't I was like uh telling them about, you know, how how I'm obsessively eating and and compulsively eating, and they said, just put down the fork. I'm like, that's not that easy. So it's so it's like, you know, it's not a I understand it's not a choice. It's not because I'm lazy or it's just there, I feel like that addictive uh ingredient fires off things in my system, you know?

SPEAKER_00 12:23

It sure does. And that's that's not a compassionate response. Yeah, you know, and you hear a lot of physicians actually saying that. Yes, eat less and move more.

SPEAKER_01 12:32

Yeah, great idea.

SPEAKER_00 12:33

Yeah, yeah. Like I'm eating less. I have patients like, I do eat less. Yeah. I barely eat. They're like starving themselves. Yes. And and they're exercising, but it's not working. No. Guess what? There's biology. Exactly. There's hormones, there's your genetics. It's all of that. And truly, if they're not truly educated with the type of foods that they're eating, they need to be more educated on that.

SPEAKER_01 12:57

And and peep like I said, your body is craving that now. It is. Or I'll speak for myself. My body was craving the ice cream, the sugary stuff. Like I didn't understand, like, you know, how how does one I I don't want to eat grilled chicken and broccoli, but I didn't understand I had that uh addiction, that that active ingredient in my system that I didn't detox from, the sugar and the flour. So of course I want to consume more, you know? And it is with the processed foods. Trevor Burrus, Jr. Oh yeah.

SPEAKER_00 13:24

Processed foods are are chemically designed to make you want more. Yes. You know, they really do. And now you have, like I mentioned, the corn, the fructose corn syrup, the soy products, and the wheat products. Now we have so many people out there with this gluten sensitivity and stuff, you know? But all the wheat products. So eating whole foods is is really key, you know? Fresh fruits, vegetables, access to that, and good, healthy, lean proteins. So you really have to understand what your body needs and what really makes you feel good.

SPEAKER_01 13:59

Sure.

SPEAKER_00 14:00

You know, these these uh ultra-processed foods make you feel good right away. Exactly. That's what I'm talking about. Five or ten minutes later, you don't feel good.

SPEAKER_01 14:08

And and you're famished. My body's starving. But but because of that, those active ingredients, I'm stuffing it with more. Yeah. I don't know, my body's craving something. Yeah. You know, and I don't understand it's craving spinach or grilled chicken, right? Because I have this uh obsession with the ice cream and and the processed stuff, right? And I'm trying to stuff more of that because the grilled broccoli and the grilled chicken's not happening. It's not working, you know? But right? So so yeah, like so it is, it's more than just like poor habits or you know, most definitely.

SPEAKER_00 14:42

And you did mention, uh, Ava that the stigma stigma around, you know, laziness and not trying hard. Yes. And you don't exercise, you don't move enough. Yes, yes. And these people are working really hard and trying hard to do this. They just don't have the right tools.

SPEAKER_01 15:02

Exactly. Exactly. And and even there was one time I think uh uh Lizzo had um a dance show where she she was hiring dancers.

SPEAKER_02 15:10

Yeah.

SPEAKER_01 15:10

And um it was uh they were bigger women just like her. Yeah, I believe they're all females, all women. And um, you know, they danced and had more energy than me and any other muscle-bound fit person could. I mean, I was just amazed, you know. Very true. But it it's not because of the the weight. I mean, they had more energy and more strength than I did, you know? And and I'm leaner than they were, you know? But but it's like it's not about being lazy. It's not because like you're not moving fast enough or you gotta do cardio for an hour at at 100 miles, you know. I mean, look, maybe it could be, but the reality is I that that's the stigma that they're not moving enough is nonsense to me.

SPEAKER_00 15:56

And then we have to touch on, which we will, yeah, the health aspect of it, you know, how obesity affects your health. Yes. And really that's the huge, the bigger topic here. Exactly. The health impact. Uh, because people, you know, society looks at weight. They look at BMI, that body mass index, that number, that magical number where you should be. But uh overlooking uh actual health and the health risks associated with obesity. We have individuals that have high BMIs at body mass index that are you know big individuals, but yet again they have no health problems. Yes. So the the question comes up later what about uh uh uh obesity as a disease, right? The AMA American Medical Association termed obesity as a disease in 2013. So that impacted us in making physicians more aware of obesity as a disease. But how does that affect us? It can be a conflict because now do we treat it? Do we treat it with medicine or medication? But we have some individuals that are obese and have no health issues.

SPEAKER_02 17:18

Yeah. Right?

SPEAKER_00 17:18

Exactly. So so we have to be careful how we look at all of this and put individuals in the right space and treat them individually, you know?

SPEAKER_01 17:29

Yes. Well, well, why don't we elaborate on can you elaborate on that about the differences of what you do and and the different types of surgeries and medications and all that? So just take it away, Dr. Hannah. That's a large topic. Yes, yeah.

SPEAKER_00 17:44

All the medications and all the surgeries that I do. So we'll touch on, you know, we have all these new medications that are out there now, the GLP ones, right? Um the GLP ones that's been around now for years, initially developed to treat individuals with diabetes, type 2 diabetes. But now, over the past three, four, five years, we see that these medications actually work quite well and people lose weight. Even individuals that don't have a health problem, like diabetes, hypertension, joint problems or whatever. So we're taking this now just to lose weight, even though you don't have a health problem. But in losing that weight, you still will stave off a potential health problem later, like type 2 diabetes or hypertension, because over time, if you're overweight, your body is taking this traumatic hit carrying on all this excess weight. Over time, if your genetics speaks to you and you have a family history of hypertension and diabetes, ultimately one day you just might get that. So it behooves you to work on your weight to get down to a healthy weight so that you can hopefully stave off those diseases later. Yes. You know? Now, as far as the medication, all these medications are developing as we speak, Eva. As we speak. The science is just exploding. It's it's it's a great time to be in this universe right now to experience all of this because it's so exciting.

SPEAKER_02 19:25

Sure.

SPEAKER_00 19:25

You know, you they came out with the single therapy medication, you know, like those EPIC, and then they came out with a double therapy, trzepitide, and you did mention the retare tetratide, which is now triple therapy medication. It's not FDA approved yet, actually, but people somehow are getting this from somewhere. I'm like, where are you getting this from if it's not FDA approved? It's in the third trial, clinical trials now, those three, going through the process, and they see that it's working very well. You know, GLP1, it's designed to work on your hunger and satiety uh factors so that you're less hungry, right? GLP is the uh glucagon-like uh polypeptide, and then um like the retta, it works on GLP1, it works on GIP, which is uh gastric inhibitory peptide.

SPEAKER_01 20:22

Okay.

SPEAKER_00 20:22

And it also works on glucagon, also. And glucagon is uh uh product that increases sugar. So this is this is the target that we don't want around in our body because our sugar spiking. Sure. So the GL insulin, yeah. So it's like GLP1 works like insulin to decrease your sugar, to decrease it, decrease hunger, improve satiety. And we see that this stuff is working so well, right? But not everybody responds the same way to these medications. And we s we see that now. All the studies show you may have some individuals taking a certain medication and it may not even work.

SPEAKER_02 21:10

Sure.

SPEAKER_00 21:11

That's why there are now so many medications that are out there coming out, and and some may work, some may not work. So uh it goes back to treating that individual as an individual because they have different genetics, different hormonal levels, different uh endocrine problems or or whatever, you know, cortisol levels are all different. So all of this stuff is very interesting. We talk about surgery.

SPEAKER_01 21:38

Yes.

SPEAKER_00 21:39

If somebody has failed at GLP one, I call myself the last resort. Okay.

SPEAKER_02 21:46

Oh wow, okay.

SPEAKER_00 21:47

Yeah, so the last resort if you can't do it on your own, right? And the stigma, as we mentioned, okay, you're lazy. Yes, you're just not trying hard enough. Yes. You're not exercising. Why you put the fork down? Why are you even taking that medication? You know? Like just get to it. And but you have to use the tools, whatever is at your disposal to try to improve your health. And now we're in an environment where the biohackers are out there doing research, looking around and trying to figure out what I can do to improve my health so that I increase my longevity and I live longer. And I stay healthy. And a quality of life. And a quality of life. And it's a lifestyle. So whatever tools you can utilize, there's nothing wrong with that. So there's nothing wrong with taking these medications if it's gonna work for you. But we see that utilizing these tools, you may have to continue using it for a long term.

SPEAKER_01 22:52

For sure.

SPEAKER_00 22:53

So individuals who are using these medications, if they stop, most of the time that hunger comes back and they gain the weight back. So there has to be some maintenance. Then there's access coverage, affordability. Is the insurance covering it? If you don't have diabetes, you can't get it.

SPEAKER_01 23:16

Yeah.

SPEAKER_00 23:16

So now you have to pay cash. Sure. Right? And that's that's a huge issue also now. But getting to surgery, we'll jump over that now. This is a really important thing. It's quite important. So with surgery, we do know that surgery is the most successful way to lose weight and keep it off durably. Okay. Okay. And what we do in surgery, bariatric surgery, is a tool.

SPEAKER_02 23:45

Yes.

SPEAKER_00 23:45

What we make the stomach smaller, okay? I mean it's surgery, right? It's minimally invasive surgery. We go in and we make the stomach smaller. There's a gastric sleeve, there's a gastric bypass. There was the gastric bands. Yes. But the bands are no more now. It's been at least five plus years that the bands have been off the market. So we don't even do bands anymore.

SPEAKER_01 24:07

Okay.

SPEAKER_00 24:08

And now there's the duodenal switch or the SADES, which is the modified duodenal switch, where the stomach is made smaller, and then you go down the intestine and you reroute the intestine. So there's malabsorption, eat less, malabsorption, lose weight. So having that tool at least gives you a little more of a management to handle this better, okay?

SPEAKER_02 24:36

Sure.

SPEAKER_00 24:36

If you eat a small meal, you're satisfied right away. Your little stomach is gonna tell you that with the surgery. So that's how the surgery works. Also, it's a metabolic procedure. It actually affects your metabolism, insulin resistance, and all of that change, just like how the GLP ones work now. It's similar metabolic effects. Yes. So surgery also gives you that, you know.

SPEAKER_01 25:02

So And there's more of a permanent result versus you know doing that.

SPEAKER_00 25:08

But you have to still follow the rules. You have to still be active, you have to have a good lifestyle, you have to eat healthy, you have to move your body, okay? And do some uh weight training and muscle preservation. Muscle is very important.

SPEAKER_01 25:24

Yeah, I was gonna ask you about that. Very important. Um I know um I've I had a girlfriend that was doing, was on the GLPs and she lost uh about 40 pounds. Right. But she also admitted she lost 40 pounds of muscle. So that's why she looks smaller because she lost all the muscle. Yes. How does one maintain or even get muscle, you know, while they're doing the uh weight loss surgeries or even the peptides?

SPEAKER_00 25:50

So that that's it gets very tricky there. That's why functional training and uh fitness training is very important while you're doing this. Yeah. Because you need to maintain your lean muscle mass. Sure. And with weights. With weights, absolutely with weights. Uh we, you know, as the years go by, you hear about all the fitness gurus talking about diet, exercise, and everything, right? And what's best. What's best? Cardio, cardio, cardio. We heard about cardio, cardio, cardio. Yeah. But cardio is overrated. Yes. Now we talk about zone two, where you're, you know, there's zone one, zone two, zone three, zone four, where you're on a treadmill or whatever. Walking, just talking is zone one, right? My heart rate isn't going up too much. Zone two, you're walking now at a little faster pace. Sure. But you could still hold a good conversation. That's actually cardio effective.

SPEAKER_02 26:47

Yes.

SPEAKER_00 26:48

Zone two. You go in that now, you go into a light jog, you're in zone three, zone four, you're running, right? Where it's like, okay, I have to really exercise hard to burn calories. Like, we know now that you don't have to do that. You don't have to do that. Zone two is good enough.

SPEAKER_01 27:04

Fantastic. I like zone two. I like zone two too. Zone one better to walk. Yeah. Yeah.

SPEAKER_00 27:09

Yeah. You know, and once you we we talk about getting your steps in, right? 10,000, now 20,000 steps a day. You just have to move. Your body is built to move.

SPEAKER_01 27:20

Exactly. You just want to move. Realistically. Yeah. You don't have to go to the uh treadmill and r run for the hour. I was taught to do that. Yeah. I was taught, oh, you're gonna do stair climber for an hour. Yeah. You know, you don't have to do that. Exactly. And then the minute I'm done, I'll go binge. You know, so it's like, but what's realistic? Exactly. But realistically, realistically walking, walking, having a competition. Yeah.

SPEAKER_00 27:46

That's acceptable. And now we talk about the uh exercise stacks where you're at work. You can take a 10-minute break and just walk around on your break, and that's enough to add some fitness to your routine throughout the day. Take a little 10-minute break and just do something. Just move a little bit. Okay. I like that.

SPEAKER_01 28:08

A little movement. A little movement, nothing intense.

SPEAKER_00 28:11

Nothing intense. All we need to do is a little bit of something. Realistic. Realistic movement. Now you have to add the physical fitness with muscle training. We do know that muscle training is very important. Functional training and functional medicine and muscle preservation increases longevity, it decreases our risk of falls, it decreases our risk of hip fractures and all of this stuff and adds years to your life. Trevor Burrus, Jr.

SPEAKER_01 28:39

And describe functional training, like basically using your body weight, getting up and down. What is functional medicine?

SPEAKER_00 28:44

Yes, functional medicine is all about balance, about movement. You know, these typical movements that we do every day, the majority of us, we don't actually do that. We're, for the most part, a sedentary society. Especially people who are uh desk jobs and just go to the office and sit down all day and go home and then eat and sit on a couch. They don't move every part of their body. So functional training actually uh teaches us to move everything, you know? Think about Tai Chi, okay? Yes. When you just you can just stand and just move. That's what Tai Chi is. Try to stand on one foot and balance yourself, Ava.

SPEAKER_01 29:31

Uh-huh.

SPEAKER_00 29:31

And just do that. That's functional training.

SPEAKER_01 29:33

That's functional training, okay.

SPEAKER_00 29:35

Stand on one foot for 10 seconds if you can. And I read some of these um informational studies that shows some people in Asia just practice standing on one foot while they're in the morning brushing their teeth. Okay? Just alternate. Stand on one foot, stand on one foot. That's functional training right there. Right.

SPEAKER_01 29:58

So it's like a lot of people.

SPEAKER_00 29:59

In the morning when you're brushing your teeth, okay? So these are little things that you can do to increase your longevity and your mobility. Sure. So if you're walking down a street and you slip off a curb, you're off balance, but you can just step off and catch yourself. Yes. That's what functional training does to you because now you've worked all these muscles, you develop these muscles for balance, and it it prevents you from injuring yourself.

SPEAKER_01 30:25

Yeah, for sure. Like even for me, functional training, like I want to be able to pick up a box and not and not round my back out or, you know, like stuff like that. Like I want to pick up a box.

SPEAKER_00 30:36

That's the daily mobility. Exactly. And it's realistic. Exactly. That's functional training.

SPEAKER_01 30:45

So I don't use my back to lift stuff. Like, yeah. So that's important. Now, now tell me about what you perform. You you would do the surgeries? Yes. Surgery-wise. And and how do you know which person gets what?

SPEAKER_00 30:59

Okay. Well, the three procedures that I perform is gastric sleeve, where we just make the stomach smaller, gastric bypass, where we cut the stomach and the intestine, and duodenal switch, SADI. So in talking to individuals, some individuals just don't want to alter their anatomy by too much. Sure. So it's really on an individual basis. All surgeries can actually work, Ava. They can all work. Sure. Sometimes you don't have to go extreme to get results. Sure. You just have to understand how that procedure is going to work for you. So I would say 80 to 90 percent of the surgeries that I perform is gastric sleeve.

SPEAKER_02 31:39

Okay, gastric sleeve.

SPEAKER_00 31:41

If I cut the stomach and I remove a part of the stomach, what's left is a little banana-looking stomach. Okay. It's one-third the size. And that surgery can affect your appetite also because it's less receptors for ghrelin, which is the hunger hormone in the stomach. So right away our sleeve patients have less appetite.

SPEAKER_02 32:00

Okay.

SPEAKER_00 32:00

Less hunger, less food noise. Okay. Yes. Different from gastric bypass where the stomach is smaller and then we reroute the intestine and there's malabsorption also. But so that sets you up for more possible nutritional problems if you're not taking your vitamins.

SPEAKER_01 32:18

Okay. And that was the bypass. I think that's a good question.

SPEAKER_00 32:21

That could uh have more complications.

SPEAKER_01 32:23

Nutritional issues. Nutritional issues. Okay.

SPEAKER_00 32:25

So we don't do as many of those. So we tr we really try to keep it simple. Yeah. You know, so that people can actually have a tool that can work and help them through this. Sure. And they can hopefully get to a point where they're at a happy, healthy weight and maintain it.

SPEAKER_01 32:42

Yeah.

SPEAKER_00 32:43

You know, so what comes with that is the actual education around all of this with the food and the nutrition and the education on reading labels and the physical activity and just move your body every day. Yeah. So all of this comes really hand in hand. Okay. Yes.

SPEAKER_01 33:00

Okay, Dr. Hannah. Yes. Here's another important question. How does health insurance cover the impact of surgeries and medication?

SPEAKER_00 33:08

Very important. Yes. All of these insurances have their own criteria and rules. Some insurances cover medication, some doesn't. Some cover it only when there's a health problem, like we mentioned the diabetes or whatever. So the medication issues are all very new, you know, relatively new. So insurances are now just getting on the bandwagon and now starting to cover these. But for the most part, a lot of these medications were not covered, okay? Which is why a lot of people have to pay out of pocket and and pay uh and end up not being able to afford them six months later. Or years later. Nine months later. And they may lose that 30, 40 pounds and then they can't afford the medication anymore, and then the weight comes back.

SPEAKER_01 34:00

Sure.

SPEAKER_00 34:00

But now what do they do? Okay surgery is the same. Some insurances cover it, some do not cover it. But this all actually brought the insurances on board when the American Medical Association in 2013 deemed OPCD as a disease. Okay. So it just alerted everyone to make it more aware. So most insurances do cover bariatric surgery. So there's criteria. We use criteria, the and it's based on the body mass index. So BMIs, if it's a lower BMI 35 to 40 body mass index, they have to have a health problem like diabetes, hypertension, joint pain, sleep apnea.

SPEAKER_02 34:46

Sure.

SPEAKER_00 34:47

If the BMI is 40 or higher, so someone who's bigger, no health issue is needed. So they do cover the procedure. However, there are still insurances out there that do not cover it. So there are still insurances that we battle with. And I've been doing this for over 20 years, 20 years, and still we struggle with insurances to cover these procedures. Yes. When it's a health crisis. Exactly. It's a health crisis. Okay. 42% of our nation is obese. That's obesity. You talk in class one, class two, obesity. And if you add the number of people who are actually overweight, overweight, that increases the statistics. 67% of the American population is either overweight or obese. That's two-thirds of the population.

SPEAKER_01 35:40

Now, what about like a psychological uh issue? Would that be considered like a part of a health issue? Would would insurance like if if someone went to their therapist or psychologist or psychiatrist and said, you know, I'm mentally It's not.

SPEAKER_00 35:57

It's not a one of the diagnoses associated with comorbid condition. Comorbid conditions include metabolic disease, such as the hormonal problems like the diabetes, the high blood pressure, things that actually impact the health. Trevor Burrus, Jr. Sure. Although psychology does impact it huge. Sure. And psychology is actually a part of the criteria based on the ASMBS, which is the American Society for Metabolic and Bariatric Surgeons. That is a part of the criteria to actually approve someone for bariatric surgery. Everyone has to get a psych eval to make sure. Absolutely. You have to make sure that they're emotionally ready to go through this because it's a big deal.

SPEAKER_02 36:42

It is.

SPEAKER_00 36:42

And in screening individuals, you know, uh bariatric surgery is very different from, say, the average general surgery. So if you came to me and you have a gallbladder problem, okay, Ava, I have to take your gallbladder out. We'll schedule you two weeks from now. Let's take the gallbladder out. You're done. Bariatric surgery is very different. Sure. There's a lot of things around that. So like we talked about the genetics, we talked about environment, there's psychosocial issues. So everyone has to get a psyche valve. Everyone has to get nutrition education.

SPEAKER_02 37:14

Wow. So we have to read rates.

SPEAKER_00 37:16

Yeah. With an actual nutritionist or dietitian. So you have to get education on food and with healthy living, a little fitness, all of that. So, you know, these things are very important for the ultimate success of the procedure.

SPEAKER_01 37:30

Most definitely, because I've heard some people have eaten their way out of the surgery. Right? You know, like they've had the sleeve or or the gastric bypass. And without uh educating themselves or understanding the food, they've ate themselves where they, I guess they, what is it, they open their stomach back or they push the boundaries.

SPEAKER_00 37:53

It's it it it's multi-factor again. Yes. You know, but for the most part, they just not doing it right anymore. Sure. They may be eating the wrong food to show. Sure.

SPEAKER_01 38:02

Again.

SPEAKER_00 38:03

They're now back to just high calorie foods. You know, they're back to drinking sodas and high calorie drinks.

SPEAKER_02 38:10

Sure.

SPEAKER_00 38:10

You know, these do matter. These calories matter. The ice cream and the cake. I tell my patients, look, we do the surgery, it's a tool. You could still enjoy the things that you really love to enjoy, which is the beauty of these things, you know? You can actually enjoy all of it. But I said, have your cake on your birthday. You can have ice cream on date night, you can have pizza, you know, on Fridays. And so you have to know how to do all of this, but your daily activity and your daily routine should be mindful eating every day. You have to have your lean, healthy protein, you have to have your vegetables and all of that stuff, fruits and vegetables, okay?

SPEAKER_02 38:45

Yeah.

SPEAKER_00 38:46

So that that's the rule and that's the routine. But if you fall off, fall off of that wiggle, you can go back to how it was before. So you have weight regain. Absolutely. Absolutely.

SPEAKER_01 39:00

Okay. Why do you think people go out of the country for weight loss surgery?

SPEAKER_00 39:04

It's cheap.

SPEAKER_01 39:05

It's cheap. Oh, easy answer. But also is there uh is there criteria if they go out of town uh out of state, out of country, I mean?

SPEAKER_00 39:14

Okay. You know, um and we we've been seeing this for the past 20 years. People cross the border and they go elsewhere. Okay. Sure. And the costs, if you have to pay out of pocket, most of the times it's the insurance doesn't cover it. Yes. If your insurance covers bariatric surgery, there's no reason for you to leave the country. Yes. You will have surgery here by a bona fide center of excellence program, right? For sure. If you can't afford it, now you're gonna be on the price hunt.

SPEAKER_01 39:42

Yes.

SPEAKER_00 39:43

And wherever you get the best price and the best deal, that's what people do. So they travel out of the country. And we they're, I mean, not to knock out of the country surgeons because they have great surgeons out of the country that do great work and great surgery. You know? Some of them are actually trained in the U.S. and they go back home and they do these surgeries. So you would say that.

SPEAKER_01 40:07

For a for a person to go out of the country, that means they don't want to uh or their health insurance doesn't cover, or they don't make the criteria.

SPEAKER_00 40:14

Correct.

SPEAKER_01 40:15

Okay. So they just like, oh, I want to get this, so I'm gonna go outside of the country.

SPEAKER_00 40:19

And then, you know, to to add to that also, you will hear you now have some employer groups, employer groups covering large employers, uh, certain insurances, it's a matter of cost also. So you do have employer groups that will actually fly their clients or members out of the country to have certain procedures like OBGYN procedure, bariatric procedure, or orthopedic procedure to a bona fide center out of the country that they've vetted out. That's also a center of excellence for cost reasons. Really? Yeah. The cost, say, to do an orthopedic procedure here in in the U.S., and then you would have taken them to an out of the country and and you can make that cut that cost in half. Oh, yeah. Insurances are actually doing that. Oh, insurances are involved in the case.

SPEAKER_01 41:15

Insurance is I know like a lot of us girls or people go to different countries for uh cosmetic pressure.

SPEAKER_00 41:26

Yeah, along the same lines, yeah.

SPEAKER_01 41:28

Okay. Um and um now let's talk about the mental uh health aspect of it. So, you know, how does one get the surgery, but how do they shut the food noise off? Or even take the medications? How do they shut the food noise off?

SPEAKER_00 41:46

The surgery itself has some metabolic effects that do help that.

SPEAKER_01 41:52

Okay, so it simmers it down.

SPEAKER_00 41:53

It tames it. Okay, amazing. It really does. So it does help to a certain degree. Also, these medications do that too. The medications also tame that food noise, tame that hunger. So it it just makes it easier, you know. Sure. Yeah.

SPEAKER_01 42:11

So it is beneficial. It is very beneficial. So it's not so much about um the matter of the mind. It's just these surgeries, these medications kind of arrest the the chatter. Sure.

SPEAKER_00 42:23

And that yeah, that food noise is less. And also if your stomach is smaller, you have these signals and the stretch receptors in the stomach that you're satisfied. Sure. So think about eating three shrimp versus eating ten shrimp, right? I mean, you're getting less calories, and now you actually feel good and you're actually satisfied. So it changes you.

SPEAKER_01 42:47

Sure. It really does. Sure. Okay. What is your advice or your bad advice? Would you give a patient before they start taking a weight loss drug or surgery?

SPEAKER_00 42:59

It's a choice. Okay. You know, we give patients choices. We educate patients. So I don't I try not to stir an individual in a certain direction. I first have to have a conversation.

SPEAKER_02 43:15

Yes.

SPEAKER_00 43:16

I sit down, I talk to you, and I try to understand your needs. Yes. And when we look at BMI, body mass index, we do know that look, if you weigh if you're 400 pounds, the medication just might not work. Sure. Okay. Yeah. If your ideal body weight should be two under 200 pounds and you're double your body weight, a lot of these medications, the success is not that great. Okay. I mean, you're talking twenty-five to thirty-five or forty percent of the excess body weight these individuals might lose. And you mentioned that number earlier, you said forty pounds. Yeah. Think about having needing to lose 200 pounds. Yeah. Okay. So a lot of these patients would lose 40 pounds, 50, 75 pounds, but you have another 100 pounds to lose.

SPEAKER_02 44:10

Sure.

SPEAKER_00 44:11

So we see a lot of these patients hitting a plateau and and now needing me to finish the job. So we use it all in concert now.

SPEAKER_02 44:20

Yeah.

SPEAKER_00 44:21

We embrace GLP1s in our practice. So it really helps us with individuals who need to lose weight. If I see that you're a low BMI or body mass index and you really may not need surgery, then it's okay to try this medication. So we do offer that. Great. Try the medication. And I'm in a practice now where I'm the surgeon, and we have a group also that they do all medical weight loss. So uh premier physicians and they manage all of the medical weight loss individuals. So I see consultations all the time. And some people come to me because they know I'm a weight loss surgeon or weight loss doctor. Yeah. And they walk in and say, Doc, I want to, I want to try the medications. I'm like, Sure. Okay. Let's do that. Exactly. And we'll stare you here, right? Or some knowing that they want surgery, especially they've seen family members who have had this surgery and they have great success, they go straight to it. We have patients that are coming to us and we mentioned the weight regain. Okay. Weight regained three years later, five years later. We see them. We may start you on a GLP one.

SPEAKER_02 45:37

Okay.

SPEAKER_00 45:37

And just jumpstart you and re-educate you and get you back to where you need to be. And that's all you might need, right?

SPEAKER_02 45:43

Exactly.

SPEAKER_00 45:44

So it's good to have all of these tools. The technology and the science is just a beautiful thing right now.

SPEAKER_02 45:50

Yeah.

SPEAKER_00 45:51

And the it's just moving so fast. We we don't know what the long-term outcome is going to be with all of this. You know, five, ten years from now, we just don't know where we're going to be. But currently, utilizing all the tools that we have in front of us is the way to go.

SPEAKER_01 46:09

Sure. Great. So you like to take the most conservative approach. Okay, I like it.

SPEAKER_00 46:15

I always say last resort. That's right. Exactly. That's right. That's right. Yeah.

SPEAKER_01 46:18

Okay, so we have some fan questions. So we want to hear Dr. Bernie Hannah's bad advice. Okay. Hi, Dr. Hannah. My name is Ashley, and I've struggled with my weight since I was 13. My mom used to have me diet with her when she was feeling bad about herself. I was a child and definitely didn't need to be on a diet. Now that I'm 28, 5'5, I weigh 250 pounds and I hate myself. Nothing I do works. I feel like I will be stuck at this size forever. My brain feels like it's on fire. Anytime I want to get healthy, please give me some advice on what I can do. Thank you for your help.

SPEAKER_00 46:59

Sometimes I get emotional with this. Me too. I like I've done this for so long. Yeah. And I still get emotional. Me too. Because I'm passionate about this. Me too. And I actually care about people. So when you see someone that struggles so much, there's a lot going on right here with this individual, Ashley. There's a lot going on with Ashley. Certainly, Ashley has suffered trauma. Childhood trauma is a big deal. We know that trauma affects individuals as a child. And all the studies show that that increases the chance of obesity in adulthood.

SPEAKER_02 47:32

Okay.

SPEAKER_00 47:33

If you've been emotionally abused, if you've been physically abused, if you've seen violence or whatever, sexual abuse, all of that stuff, it affects you. So now she's 25 or so, 28 and overweight, right? She needs help. Yeah. So first, I would say you need some social or psychological help. Sure. And hopefully she would be amenable to that. And that we we we would refer for that for counseling.

SPEAKER_01 48:02

Okay, fantastic.

SPEAKER_00 48:03

So you want to address that first. And then you want to also say it's not your fault, okay? It's not your fault. Genetics is involved, and then you're in an environment that is just working against us. Okay. Genetics, environment, you know, genetics is the fuel, and then the environment is the trigger, you know, you know, it just finishes you off.

SPEAKER_01 48:26

Yeah.

SPEAKER_00 48:26

So you have to understand it, it's not your fault. And there are solutions. We have all the solutions. I have we have it all, okay?

SPEAKER_01 48:35

Yeah.

SPEAKER_00 48:35

We can fix this. So we're gonna educate you with the nutrition to make sure that you're doing it right first. Sure. Make sure you understand calories. Make sure you understand the the ultra-processed foods and how to choose your foods wisely. You know, we wanna understand what your pantry and your kitchen looks like. What do you have in there? If it's not good for you, throw it out. But they say, wow, I spent a lot of money on that. Yeah. That case of soda, I'm like, but it's doing you no good. It's is your body a trash can?

SPEAKER_02 49:05

Yeah.

SPEAKER_00 49:06

You don't put it in there. Okay. Your body's a temple. You want to treat it, treat it right. So you want to focus on the right foods, you want to focus on the protein, you want to focus on the healthy nuts and the fruits and vegetables, that sort of stuff. And then you offer the tools that we have, you know, the medication and also educate about the surgery.

SPEAKER_02 49:26

Yes.

SPEAKER_00 49:26

And you take it from there. You know, a lot of our patients are in our program anywhere from four to six months. So they don't just see me and we do surgery next month. Okay. The criteria is a long criteria. So they have to have to jump through the hoops. They have to do what they're told, they have to do what we need them to do to understand that this is a lifestyle. It truly is a lifestyle. So you have to live the lifestyle to see the results. Okay. So that's we we take you down that path. That's great. And and we call our patients our patients for life. We don't just operate on you and then you you go on your merry way. Yeah. Which you do see people who go out of the country and they come back because now they're not following up with their surgeon or whatever. But we take patients like that, you know. If you traveled out, we see you. Yeah. Because we want health maintenance is a journey. It never ends. It's a lifestyle that continues forever.

SPEAKER_02 50:23

Yeah.

SPEAKER_00 50:24

And if if you're in the health health business, uh Ava, you know, you eat healthy, you exercise all the time, you understand all of this. So you know that this is a daily conscious decision that you have to make in order to for it not to fail. Yeah.

SPEAKER_01 50:40

It's about maintenance. But yes, but I've been on both sides of the spectrum. Right. Binging, eating, overweight, too, you know, healthy, then, then, or sometimes I get so uh restrictive. Right. Right. That that I want to starve myself. Right. So so it's like it's all over the map. But but yeah.

SPEAKER_00 50:59

That's why you have to constantly reel yourself in. Which is why, you know, for someone like Ashley, she has to really see a counselor or someone who can really weed out. Now, are you depressed? Do you need to be on an antidepressant to affect those the serotonin and all the stuff in your brain that's just making you just, you know, not love yourself.

SPEAKER_02 51:21

Yeah.

SPEAKER_00 51:21

So all of that stuff is a chemical imbalance. So you have to make sure all of that is right first.

SPEAKER_01 51:26

Yeah. And there's 12-step programs for overeating and stuff, too. That's that's a community. All these programs. Exactly. Exactly. Okay, here's a last question from another fan. Hey, Dr. Hannah. Everyone at the gym is either on peptides or some other weight loss drug. I've been trying to stop the weight naturally, but I won't lie. I feel discouraged. Do you think it's okay to take Ozempic or other drugs for cosmetic reasons? If if I do, how long will it take to see the effects?

SPEAKER_00 52:00

That's loaded. Yeah. That's so loaded. That's just loaded. And she mentioned for cosmetic reasons. And people are doing that now for cosmetic reasons. So one thing, first you want to try to focus on you. Okay. And I tell a lot of my patients, it's not about anyone else, it's about you. Yes. Okay. Don't listen to anybody. Don't do that, you know, just focus on you. What is it gonna what's gonna make you happy? So first you have to make sure you're right with yourself. Yeah. And what do you want out of this? What are you looking to achieve? Sure. Are you looking for a magic number that weight? Or are you looking to be healthy? Yeah. First and foremost is health. The magic number isn't really the target. Yeah. Okay. You want to feel good. And I ask patients, you know, if you're in the gym and you're working out and you actually feel good, what more do you want? Are you healthy? So stop looking at everybody else. But if it's that number that you're looking at, the GLP one is there. You can use it, you know. We don't know the long-term effects, but you know, there's certain side effects. Sure. You know, GI upset, nausea, you can get pancreatitis, that sort of stuff. So there are certain side effects that can happen, but it's very low. Okay. Yeah, the risks are very low. So you can certainly try it. And the results, it's a tapered process. So an injection starts at a low dose every week for the first month, then you double the dose the next month every week to see what the results will will be. You can lose a pound or two every month. Oh wow. Okay, that's nice. Yeah. Yeah. It's a slow process. Sure. But it's a process. You're not gonna lose a lot of weight. Not like bariatric surgery. Bariatric surgery, you lose a pound or two a day the first month. You can lose 20 pounds the first month. Wow. So the results are very different. Sure. So it's it's a slow walk, okay? It's a walk. And it can take six months, depending on the goal, the target. I don't know what your starting point is, but it can take six to nine months to hopefully get you where you want to be. Sure. Okay.

SPEAKER_01 54:17

And slow is steady is sometimes the race. Wins the race, right?

SPEAKER_00 54:20

That's it. Absolutely.

SPEAKER_01 54:21

All right. Well, thank you so much for joining us. And and can we can you leave a plug or a website or please do, where people can find you.

SPEAKER_00 54:30

Bernie Hanna, Las VegasBeriatrics.com. Yeah. And I'd love to say that weight loss, health maintenance is a journey. It's a lifestyle. First and foremost, it's all about health and wellness.

SPEAKER_01 54:48

Yes. Thank you so much. You're so welcome. Okay, this wraps up another episode of Ava Devine's Bad Advice. So here's my advice, my bad advice for all of you watching and listening. Um, I feel that this topic of obesity and uh solutions, it's like a four-legged stool. I feel that you have to nourish not only the physical, but the mental, emotional, and spiritual side of yourself. And um, there is a solution, and there's no wrong or right way to do it, whatever's realistic for you. And take the conservative approach and uh listen to my friend, Dr. Bernie Hanna. Thank you so much for having me being on here and and hanging out with me. Thank you so much.

SPEAKER_00 55:33

This is lovely. Thank you.

SPEAKER_01 55:35

Okay, over and up.