Shownotes
Episode 287: What if everything you believed about obesity was wrong? Bariatric surgeon Dr. Eric Smith joins the BariNation Foundation Podcast to launch a six-part series on Mastering Metabolic Health and Weight Management. Today's episode is about the first lever: Beyond the Scale...Obesity as a Chronic Disease. He explains why only 0.5 to 2% of people can lose enough weight through diet alone to no longer be classified as obese and what the hormones ghrelin and leptin have to do with it. Mental health therapist, bariatric patient and BariNation Foundation Board, Community member, and licensed expert, Melanie Lindell adds the emotional truth: accepting obesity as a chronic disease is not giving up; it is finally getting honest. This conversation will shift how you think about your body, your habits, and your future. Join us for this six-part series, Mastering Your Metabolic Health and Weight Management.
What You Will Learn in this Episode:
Why obesity as a chronic disease cannot be resolved through willpower alone, and what the actual success rates of diet and exercise reveal about the biology working against you
How the hormones ghrelin and leptin resistance change the way your body responds to calorie deficits, making sustainable weight loss far more complex than simply eating less
Why bariatric surgery and GLP-1 medications create the conditions for change but cannot replace the controllable habits that determine long-term metabolic health outcomes
How building consistent habits around sleep, whole food nutrition, and movement forms the true foundation of lasting obesity treatment success
This episode of the BariNation Podcast is produced by the BariNation Foundation, a 501c3 dedicated to advancing metabolic wellness for people living with obesity by providing evidence-based education, stigma-free support, and meaningful connections in the moments that shape daily life. Funding is provided by the generous donations to the BariNation Foundation from listeners and viewers like you, Johnson & Johnson, the Texas Center for Bariatrics & Advanced Surgery, led by Dr. Joe Cribbins.
TIMESTAMPS:
00:00 The psychology of results and why visible change drives obesity treatment commitment
04:00 Dr. Eric Smith and Melanie Lindell introduce themselves and the bariatric surgery series
08:04 The six levers of metabolic health and weight management are introduced
09:18 Why diet and exercise alone fail: success rates as low as 0.5% for obesity as a chronic disease
11:56 How triggering life events lead to obesity and why reversing behavior is not enough
23:44 The hormonal science of ghrelin and leptin resistance and their role in weight loss, and why the body fights back against calorie deficits
33:00 The golf analogy: why patients become complacent and stop applying controllable health habits
38:30 The danger of removing friction and how easy access to GLP-1 medications can backfire, and leaning into the idea that obesity is a lifelong disease
44:13 Sleep consistency as a lever: the real science behind sleep and weight loss, and the mental health part of finding joy in yourself
53:08 April's personal gut check and the honest conversation about stalled weight management
1:00:12 How KBI redesigned its entire approach to treating obesity as a chronic disease
KEY TAKEAWAYS:
Obesity as a chronic disease has a biological basis. With success rates of 0.5 to 2% for diet and exercise alone, this is not a failure of character but a failure of biology working against patients without proper obesity treatment.
Surgery and GLP-1 medications provide the spark, but they are not the solution on their own. Without the controllable levers such as whole-food nutrition, sleep, and movement, results will stall or reverse.
Leptin resistance and rising ghrelin levels mean that the longer someone has lived with obesity, the harder the body fights against weight loss, making medical intervention and habit-building both essential.
Goals bring short-term motivation, but habits create lifelong results. Celebrating the consistency of controllable health habits rather than only the scale is what sustains metabolic health over time.
ABOUT THE GUEST:
Eric F. Smith, DO, FASMBS, CAQ-MBS
Dr. Smith is a board-certified general, bariatric and robotic surgeon who has been in practice since 2006.
Kentucky Bariatric Institute - Website
RESOURCES MENTIONED:
BariNation Community- $19 a month
BariNation’s How to Find an Obesity Specialist Guide
Transcripts
How am I gonna know if I'm living 10 years longer?" But if I [00:00:25] told you, "Go to that wall. Beat your head into the wall 10 minutes a day, and you will lose five [00:00:30] pounds a week," most of you in this room will do it at least for a week. And if you walk around [00:00:35] looking like a unicorn with a big pump knot on your head and that scale goes down by five pounds or 10 pounds or [00:00:40] whatever, you will continue to do it.
Why? Because whatever felt [:April Williams: Welcome to the BariNation podcast, a production of the BariNation Foundation.
Jason Smith: [:Natalie Tierney: Four pillars, one mission. We're so glad you're here [00:01:05]
the BariNation podcast. I'm [:That is not a small thing. Being first takes vision, and we are genuinely grateful for their [00:01:35] belief in our mission to bring knowledge, community, and hope together to support people fighting [00:01:40] obesity. Their gift is helping us build the kinds of conversations this community deserves: [00:01:45] honest patient stories, expert-guided education, science-backed resources, and [00:01:50] stigma-free support.
o the BariNation Foundation. [:Donor support funds the mission. It does not touch the message. That's a line we will never [00:02:20] cross, and honestly, it's one of our biggest, most important whys behind becoming a foundation. [00:02:25] If you want to support this mission and the show, become a donor by clicking the support link [00:02:30] in the show notes of this episode Okay, friends.
About today's conversation, [:He put a series on his Instagram a while back about these levers, and our community [00:02:55] absolutely lost their minds about it, so we invited him to the show to take a deep dive into the levers [00:03:00] and why they're so important on our obesity health journey. And in each conversation, we've invited [00:03:05] members of our community to join so they can offer their insights and ahas about each lever.[00:03:10]
besity is a lifelong chronic [:This series is one of many [00:03:35] conversations that we're gonna be having about the levers of health. Dr. [00:03:40] Smith did this amazing Instagram series, right, on these levers. We reached out to him immediately [00:03:45] and we're like, "Can we have you on the podcast? 'Cause we have a lot of questions in our community. They have, [00:03:50] uh, they really thought deeply about what you've presented, and they're very excited for us to go deeper [00:03:55] into what these levers are."
n the microphone over to Dr. [:Dr. Eric Smith: Well, um, I am Dr. Eric Smith, for those [00:04:05] that don't know me. Um, I'm the medical director of the Kentucky Bariatric Institute here in central [00:04:10] Kentucky. I have a couple other roles, medical director for both robotics and bariatrics [00:04:15] for all of LifePoint Health, which is the health system- that I'm a part of.[00:04:20]
now, which that doesn't seem [:And I thought how great would that be for BariNation to just be [00:05:05] part of what our patients have access to, and the rest is history.
April Williams: The rest is [:I mean, you would... You, you'd have to look hard to find a program that does more than you do. [00:05:25] But you have 15 minutes at a time or 30 minutes at a time. We have 24 hours, [00:05:30] seven days a week, right? We have experts on staff that deliver that in-the-moment support. It's just been [00:05:35] a phenomenal relationship, because it helps people get the care that they need, and it keeps them [00:05:40] involved with that care, right?
need to circle back with Dr. [:Dr. Eric Smith: Yeah. And I would say as a physician, it is very comforting [00:05:55] to know that our patients are going to a place where the information is vetted-
April Williams: [:Dr. Eric Smith: where it's moderated.
April Williams: Mm-hmm.
just for patients, but it's [:April Williams: Yes.
we know, you know, it's the [:April Williams: Yeah.
for the longest time, we, we [:Jason Smith: Yeah.
nd so to be able to say, "Go [:April Williams: [00:06:40] I- it's extremely important, and we are just so thankful that we've had the opportunity [00:06:45] to partner with KBI and you for so many years.
inda how this, this idea and [:Dr. Eric Smith: Yeah. Glad to do it.
esome. Well, Melanie Lindell [:Melanie Lindell: Well, you said most of [00:07:15] those things. I also have the privilege of being on the board for the foundation. Uh, and one of my [00:07:20] roles within BariNation, even before we were a foundation, is I get the privilege of vetting our [00:07:25] experts and, you know, making sure their licenses, you know, and all the information that they align [00:07:30] both with kind of our cultural, you know, um, norms that we have in BariNation, but also [00:07:35] that they truly are a licensed expert in the field that we're inviting them to share on.[00:07:40]
I became a therapist, and so [:April Williams: It's been amazing. Really, we have the dream team here on screen, and I'm [00:08:05] so excited to have this conversation with the two of you, uh, because, because of the levers, [00:08:10] and let me explain a little bit. So the title of this series is The Levers of Control: [00:08:15] Mastering Your Metabolic Health and Weight Management with Dr.
Smith. There are [:[00:08:35] The second lever is whole food nutrition. The third, recovery, so stress and sleep. [00:08:40] The fourth, movement is medicine. The fifth, controlling what we can [00:08:45] control. And the sixth is ongoing care and treatment, because as you're gonna learn [00:08:50] today, obesity is a lifelong chronic and progressive disease, and if we are not pulling that lever of [00:08:55] ongoing care and treatment, we're missing one of the biggest things that remains within our, our [00:09:00] control.
that first one, obesity is a [:Dr. Eric Smith: Oh. [00:09:20] Well, that's a, that's a loaded question, right?
Williams: Of course. Mm-hmm. [:Dr. Eric Smith: Um, you know, it, it's interesting that we still have that argument, [00:09:30] but I think with very educated people, we still have that argument. And there's a bunch of different [00:09:35] directions that you can go with that. But, you know, I think we have to first [00:09:40] separate the difference between someone who wants to lose weight and someone who [00:09:45] doesn't wanna be obese anymore.
and we're not talking about [:If you can do it for 15 and you just keep doing it, it's gonna [00:10:10] eventually turn to 30, and it's gonna turn to 60" and it doesn't quite work that way. Is it [00:10:15] physically possible? Yes. Anything is possible, right? I mean, we can [00:10:20] all do really rare things, but y- we also cannot... [00:10:25] We have to make sure patients don't understand that they are the, [00:10:30] they're not the exception, they're the rule.
Melanie Lindell: Mm.
f the first things that I t- [:Some, some data will say as high [00:11:00] as 2% to 5%. Mm-hmm. Pretty crappy no matter what.
Melanie Lindell: Mm-hmm.
Dr. Eric Smith: Right?
Melanie Lindell: Mm-hmm. Mm-hmm.
Smith: And so I want them to [:Um, you [00:11:20] know, when, when someone over time, it's not uncommon that people [00:11:25] have a triggering event that maybe kicks it off. Mm-hmm. A child, you have a child, you go through menopause. [00:11:30] COVID. Man, COVID got blamed for a lot of stuff, right?
April Williams: Oh, yeah. Oh, yeah.
Dr. Eric Smith: COVID, [:You know, I, I was just meeting with a guy [00:11:40] today, um, in Michigan, um, you know, virtually for our first meeting, [00:11:45] and, you know, he referenced COVID. He referenced a horrible relationship, you know, and he [00:11:50] had a, a former person he was in a relationship with who he lost, you know? [00:11:55] Mm-hmm. Lot, a lot of different things.
s, is we identify this issue [:April Williams: Mm-hmm. [00:12:15]
the event, but once someone [:Their body's not the [00:12:25] same as it was before.
Natalie Tierney: Mm.
es that go on. Mm-hmm. There [:Natalie Tierney: Mm-hmm.
Eric Smith: And so no matter [:Jason Smith: Mm-hmm.
t we have to do is be really [:It's no different than hypertension, hyperlipidemia. We could go on and on. And, [00:13:20] and the best example I use, I said, heck, if we were gonna hold it against [00:13:25] patients that they had a disease that was seen as self-inflicted, then why would we ever treat someone who has lung cancer? [00:13:30] Because 90% of those people participated in a [00:13:35] behavior that allowed that cancer to happen.
But we also know [:And, and she's still [00:14:00] kicking at this point. You're like, "Why, why am I gonna tell you to stop?" Right? Right. So there's a [00:14:05] disease there, right? There definitely was factors that w- that she could [00:14:10] control, which is what we're talking about, but sometimes it's out of your control. [00:14:15]
April Williams: Oh, yes.
lly inspired to do the whole [:April Williams: Mm-hmm. [00:14:30]
It's unfair that insurances [:But if it doesn't, I'm still on a journey. [00:15:00] And I wanted to be really careful when I did this because I thought, "Someone's gonna use this against [00:15:05] me." And a few people tried to, of like, wait a second. You're basically saying all [00:15:10] these things that don't require medication and surgery influence our weight, so why [00:15:15] don't we all just do these things?
This is the secret. [:April Williams: Yeah.
Dr. Eric Smith: So [:April Williams: Oh, a thousand percent. And before... I, I know, Melanie, you have a lot to add [00:15:50] on this, because you have become an expert in pulling those levers that are within your, your [00:15:55] control. Dr. Smith, I'd like you to, to answer that, right?
mebody listening to this or, [:Dr. Eric Smith: Right. So let's, let's, let's break it down into [00:16:15] practicality. When we say the chances of someone losing enough weight with, quote, [00:16:20] "diet and exercise alone", that's a very vague thing, right?
ause we all know it's just a [:Natalie Tierney: Yep.
at we mean by that. The, the [:That's not [00:16:40] saying that everybody tracked their calories. That's saying a mishmash of people that made a [00:16:45] conscious effort to change the way that they ate and exercised, but you have [00:16:50] to acknowledge there's human behavior involved.
Natalie Tierney: Mm-hmm.
d say, "Okay, well, let's go [:Good luck with that. [00:17:00] That's not gonna happen. So it's real world, you know? Mm-hmm. I think that's why there's been so [00:17:05] much conversation about the real world data of bariatric surgery and the real world data of medication, because [00:17:10] that's part of human behavior.
April Williams: Mm-hmm.
have to take that in. So did [:No, they didn't, but they [00:17:25] did it like a human does it, and so that's real world data [00:17:30] of how that ends up. The fact of the matter is, it's not ending up very good, and so [00:17:35] we have clearly identified that's not enough. So I think really what [00:17:40] I'm saying is, is if I could create a, a near-perfect [00:17:45] scenario of the controllables, here's what I would tell you.
While at the current moment [:April Williams: Mm-hmm ...
: let's dig deeper into this [:April Williams: Mm-hmm. Yes. [00:18:20] And Melanie and I can speak personally to this. W- we both were very active [00:18:25] before bariatric surgery. We both, uh, n- naturally had a whole [00:18:30] food diet, and when we went into surgery, our bodies were prepared for what was coming. [00:18:35] But if we stop doing those things after surgery, we're gonna be right back to where, where we were before.[00:18:40]
is. You've seen the power of [:Melanie Lindell: Mm-hmm. I [00:18:50] think I'll back up, though. I think one of the wrestling matches, I can say at least me personally, you know, I didn't [00:18:55] grow up hearing that obesity was a disease, you know.
u know, it was all presented [:And then when I went back and looked through all my [00:19:20] pictures, like, I have a picture saved on my phone that I see every morning, [00:19:25] and it's six months before I had surgery and didn't even know I was going to have [00:19:30] surgery, and it was me doing an 8K before they tore the viaduct down here in [00:19:35] Seattle. And, and just that realization of like, you know, I was doing [00:19:40] an 8K.
was in pain when I was done. [:Dr. Eric Smith: doing it ...
uldn't complete it ... of l- [:And, you know, and, and I think, uh, one of the things that, [00:20:10] um, because of my work in the behavioral health side, right, you know, is that so many people, [00:20:15] food was a comfort long before it ever became a problem because [00:20:20] food met a need that was meant to be met in relationship, and when those needs don't [00:20:25] get met, and I use a lot of work by a psychiatrist named Dan Siegel about all of [00:20:30] us need to be seen, soothed, safe and secure, and those needs are meant to be met in [00:20:35] relationship, but when they're not there, you find surrogates, right?
then when a new stress comes [:Dr. Eric Smith: [00:21:05] Yeah. And I think, you know, you, you asked this at the beginning and I, I kind of came [00:21:10] more from a conceptual thing. But, you know, from a pure science standpoint, getting [00:21:15] back to why can we not-- why, why are we so unsuccessful with losing weight with, [00:21:20] quote, "diet and exercise alone," there's science behind that.
Your body [:Melanie Lindell: Mm-hmm.
at we all have to agree upon [:Everybody in this room is capable of gaining weight." [00:21:55] You have a number, and if you exceed it, it is physically impossible for you to not [00:22:00] gain weight. And if you stay below your number, the net at the end of the day, [00:22:05] it is physically impossible that you won't lose weight. The question is: where does it come from?
Mm-hmm. [:Or at the, [00:22:35] at the, the, the gym that, you know, I, I probably can't say brand names, but you know the ones that love to show [00:22:40] you how many calories you burn and things like that. Mm-hmm. And I'm not, I'm not being sarcastic, you know. That's- Mm-hmm ... that's helpful. It's [00:22:45] very inaccurate many times. But they look at that and they say, "Okay, I'm creating a deficit, and if [00:22:50] I continue to create a deficit..."
ally hard at it and actually [:both body fat and muscle mass. Your body doesn't [00:23:20] see danger from obesity. Your labs do. Mm. Your [00:23:25] heart does, your lungs do, but your body as a whole in metabolism [00:23:30] doesn't typically see, "This is bad, I wanna reverse it." But many times your body will [00:23:35] see weight loss, if you're not careful, because the way we achieve it [00:23:40] many times is not structured.
a pure calorie deficit. And [:And just think of, [00:24:00] of ghrelin as a hormone that basically, um, it's our hunger hormone. [00:24:05] You know, some of the surgeries that we do, actually all the surgeries that we do, it [00:24:10] impacts the pr- the production of ghrelin. It decreases ghrelin. Ghrelin tells us we're hungry. I saw [00:24:15] where somebody one time says, "Ghrelin is your, is your body texting your brain saying that it, [00:24:20] that it, it wants food or needs food," right?
I mean, whatever. Perfect. I don't think
April Williams: we need to get- Makes all
Dr. Eric Smith: the sense. Yep. Right.
April Williams: Got [:Dr. Eric Smith: But here's what's interesting, like when we do... And, and I don't wanna get caught off on how surgery works [00:24:30] 'cause that's not what this part's for. But, you know, when we do a certain procedure, like a sleeve, for example, large amount of [00:24:35] ghrelin's made in the greater curve of the stomach.
r places, too. We don't take [:I'll... Some people [00:24:55] say, "I had to remind myself to eat." Mm-hmm. That's part of the problem, too. People don't eat enough. But [00:25:00] when you start losing weight with a calorie deficit, what happens is many times your [00:25:05] body actually increases ghrelin levels. Because it says, "Whoa, this [00:25:10] is not normal. I need to stop this process.
I'm gonna raise [:We got plenty of fat here. Chill out. Don't eat so [00:25:35] much." You know? Mm-hmm. "You're not hungry." Shutting hunger down. But when people have been obese [00:25:40] for over a long period of time, there is something called leptin resistance- Yeah ... to [00:25:45] where it's not as sensitive anymore And so you have these people that are going through [00:25:50] these hormonal changes.
resistant. Yeah. He's trying [:April Williams: Mm.
c Smith: Right? Mm-hmm. They [:It [00:26:35] may actually go up. And here's the funny part, it's not because you gained all this muscle mass, 'cause I promise you it's [00:26:40] really hard to do. Mm-hmm. As a guy who makes testosterone, it's hard to build muscle. For women, it's even [00:26:45] harder. But you, you, you, let's... You lift heavy. You lift heavy, you feel that [00:26:50] burning in your muscle.
Everybody likes to say, "Oh, that's lactic acid." That's, that lactic acid's there for a couple hours.
April Williams: [:Dr. Eric Smith: But you create these micro tears in your muscle, right? That's how you grow muscle. So [00:27:00] you create these micro tears, and your body comes in to heal those tears and fill in those gaps, but what also [00:27:05] happens?
luid shifts into the muscle. [:They're probably not.
April Williams: Yeah, no.
now you have people who are [:Because the way many of us go about it isn't.
April Williams: Yeah. [:Yeah. Like e- n- nutrition, [00:28:15] movement, focusing on your mindset. All of those things that you're already doing are actually going [00:28:20] to result in the things that you're hoping that they will result in because you've dealt with the thing that [00:28:25] has kept them in check for so long. Right. Which is the disease of obesity.[00:28:30]
w Melanie will agree with me [:How am I gonna know if I'm living 10 years longer?" But [00:29:00] if I told you, "Go to that wall, beat your head into the wall 10 minutes a day, and you will lose [00:29:05] five pounds a week," most of you in this room will do it at least for a week. And if you [00:29:10] walk around looking like a unicorn with a big pump knot on your head and that scale goes down by five pounds or 10 [00:29:15] pounds or whatever, you will continue to do it.
Why? Because whatever felt [:April Williams: Mm-hmm.
Right? We are motivated when [:And I think we'll probably talk about this later, the [00:29:40] gym is not where you actually lose weight. Yeah, no. I hate to say that, but it is not. Mm-hmm, [00:29:45] yeah.
April Williams: We know it's a different
y important. Yeah. But it is [:Why would you start [00:30:05] doing that? Mm-hmm. And so I think we cannot underestimate the [00:30:10] psychological benefit of when you see an intervention take place and [00:30:15] feel better. If you took an antibiotic and all it did was make you nauseous but your symptoms didn't go [00:30:20] away, you'll probably stop it, too.
April Williams: Mm-hmm.
Natalie Tierney: Yeah.
I think that's why we see so [:No matter what you're doing. E- And [00:30:35] you said it on one of the podcasts and, uh, and it's 1,000% right, right? A stall in our weight [00:30:40] is the goal. The goal is we find, find that weight and we stall out. But once you get there, you're [00:30:45] like, "Uh-uh. No, no, no. I, I am... No." A- And-
use you've been motivated by [:even though if you're at, near that end game, you get scared, [00:30:55] and you're like- Yeah ... this is what's drug me along. This is what caused me to make this choice. This is what caused me to [00:31:00] show up at the gym, if you wanna use that. This is what caused me to make that choice of whole [00:31:05] foods versus the snacks that I used to do, show up to my appointments, whatever that may [00:31:10] be.
t goes away and you're like, [:April Williams: Yep.
ink part of that is in those [:Dr. Eric Smith: Absolutely ...
Melanie Lindell: and, and [:Uh, [00:31:35] he was a cop, and he made me learn how to drive a stick shift. And I feel like those first [00:31:40] 12 to 18 months you're in an automatic, and now all of a sudden- Yeah ... you gotta drive a stick shift, right? And it's clunky and you, [00:31:45] you know, you kill the car and you do all these things because now I have to be more [00:31:50] intentional, more mindful, and, and I would say more [00:31:55] engaged, you know, once you pass- Yeah
. And I think sometimes many [:Dr. Eric Smith: Well, and, and as a patient, [00:32:20] you have... You start to change, right? And all these people come up to you and say, "You're doing so great. Your [00:32:25] doctor says you're doing so great. The numbers are going down." And you start to look around, and at first you may [00:32:30] think, "Ah, I don't know that I'm really doing a whole lot."
"Oh, I am doing great." And [:April Williams: Oh, yeah.
Those things are happening. [:April Williams: Mm-hmm.
I tell patients this all the [:[00:33:15] I love to compete with my friends. It's one of those things, as you get older, you can still do it, you [00:33:20] know? Mm-hmm. And, and be active and work on practice. Just, it's... I love it. But let's say, you [00:33:25] know, I said, if I, if I went... And I made a post about this, talking about the easy way out. Like I said, we [00:33:30] know if you have weight loss surgery, you must be a cheater.
And, you know, uh, [:Natalie Tierney: [00:33:45] Yeah.
things that I [:a professional golfer." Mm-hmm. And if I did one [00:33:55] through five, and the next thing I knew, I got my tour card- What do you th- what's the odds of [00:34:00] me doing six through 10?
April Williams: Yeah. None.
cause I've, oh, this must be [:April Williams: Yeah.
not non-compliant. I'm not a [:I just s- saw I'm pretty efficient, right? Yep. And I'm like, "Okay, this worked. I'm here. [00:34:15] Good. I'm moving on." And that's what happens with weight loss surgery, is, are people many [00:34:20] times not hitting some of those parameters from a nutritional standpoint, their vitamins, [00:34:25] following up with their appointments, but the results are coming.
And you, it's very easy to [:Natalie Tierney: [00:34:40] Yep ...
f doesn't work. And the next [:Yeah. And you now have a [00:34:55] calorie number reset that is, you have a body that says, [00:35:00] "Uh-oh, I don't like this. I'm in survival mode. Ghrelin [00:35:05] levels are high. I'm a leptin, leptin s, um, I, I'm leptin [00:35:10] resistant because I've lived obese for years. And oh, by the way, my calorie number used to [00:35:15] be 1,800 and now it's 1,400 because- Yep
I've lost so much muscle mass."
April Williams: Yep. "
Dr. Eric Smith: And I'm [:[00:35:35] is no different than what happens to that person who's trying to lose weight, and [00:35:40] actually makes them more prone to not only regaining but regaining [00:35:45]
ng organizations whose early [:It [00:36:00] means they believe in our mission enough to help us live it. We do not take that lightly. We [00:36:05] also wanna recognize Dr. Joe Crebbin and the Texas Center for Bariatrics and Advanced Surgery, who [00:36:10] became our first practice supporter of the BariNation Foundation, and have shown up for this community from day [00:36:15] one.
in what happens to patients [:There's never been a better time on the planet to [00:36:40] treat the disease of obesity because of all of the different treatment options that are out there. [00:36:45] But we can get ourselves into trouble if we are not working with a [00:36:50] holistic care team, because just based on the first 40 minutes of this conversation, hopefully you're understanding [00:36:55] the disease of obesity impacts every facet of your life.
And as the disease [:Right. And so [00:37:25] much goes into this disease. It is an extremely paradoxical disease. Just like y- what [00:37:30] you were talking about, people sign up for obesity treatment, surgery or meds, because you [00:37:35] are looking for a little ease in, in this, in this process. You are dying on the vine. You [00:37:40] are desperate. You are out of your mind frustrated, right?
use of that, what we've been [:because everybody's told you it's the easy [00:38:05] way out, and you're like, "Ooh, crap, yeah, no, I'm, I'm just gonna say I'm working hard even though I feel like I'm not." And then [00:38:10] all of a sudden you reach that wall, right? The disease progresses, which it [00:38:15] does, and there is no cure, and then all of a sudden you, you are left kind of right back where you were before [00:38:20] going, "Oh, crap, I, I actually have to pull the levers now."
Dr. Eric Smith: Yeah. [:April Williams: Yes.
it was, I think it was a, I [:started rambling [00:38:45] along. Um, it was talking about the word friction, right? And friction sounds [00:38:50] like this bad thing, like you have friction between people. He was talking about friction and brakes, and [00:38:55] he was talking about as a patient, he's like, "Doc, I need you to, to increase the [00:39:00] friction on my brakes when it comes to food, you know?
t..." And I started thinking [:Mm-hmm. You gotta be really careful with that [00:39:25] Because it depends on what kind of care that is and how that care is, is monitored and maintained. [00:39:30] When you remove friction, you remove work. When you remove friction, you [00:39:35] me- re- you remove resistance. You know, when you remove friction, you [00:39:40] remove the things that, that callus us in a good way.
m-hmm ... our scars are what [:Natalie Tierney: Mm-hmm, mm-hmm
t qualify for it and get 'em [:April Williams: Yeah.
Dr. Eric Smith: No medication, no pharmaceutical company requires it.
Um, [:April Williams: Mm-hmm.
Dr. Eric Smith: But [:Mm-hmm. Why are we having to spend [00:40:50] time talking about the importance of sleep, the importance of nutrition?
April Williams: Mm-hmm.
Smith: How much time do they [:April Williams: Yeah.
e deficit. Some of them love [:And here we are, [00:41:05] we've removed the friction, we've improved the access But we are [00:41:10] not reinforcing these tools to make people understand that there [00:41:15] is a right and a wrong way to do this.
Yeah. And I think with that [:You've got to have something- Yeah ... come at you to then propel you to, to make a change or [00:41:30] stay the course or whatever it is, but that force has to come in front of you to sort of [00:41:35] like you have to reckon with it to go, "Okay, what is the-" Right ... "next right thing in this moment?" And I think, and I [00:41:40] know, you know, at KBI is one of those places, like who you're tied to really matters.
[:He goes, "Every pound you lose now will only make your [00:42:05] surgery safer, and every habit you s- you, you establish now will only serve you post-op." [00:42:10] And those things have stayed with me all these years and has helped [00:42:15] me, you know, be as successful, and I don't even love that word. I would say as healthy [00:42:20] as I've been able to- Sure
years, and I also have, you [:Like you've got to start to accept that [00:42:40] your body is going to do this, and I think as someone who's lived with obesity, we get really scared [00:42:45] when we see one number go, "Oh, well, that means I'm going all the way back," right?
April Williams: Mm-hmm.
eah. And then, you know, the [:And I think we, we don't [00:43:05] trust our bodies, right? Because, well, if I could trust my body, I would have never been obese. Mm-hmm. But you [00:43:10] gotta start trusting that you have a disease. You gotta start leaning into these things in a [00:43:15] way that allows you to like reconcile some [00:43:20] of the distortions and replace those distortions with truth.
And- Yeah ... and so [:Dr. Eric Smith: Yeah. What your surgeon told you at the end is, is, is the most powerful [00:43:40] thing and so true. I steal this from Atomic Habits all the time, that goals bring l- [00:43:45] goals bring short-lived happiness, habits bring lifelong results.
Melanie Lindell: Mm-hmm.
Dr. Eric Smith: Um, and [:Melanie Lindell: [00:43:55] Mm-hmm.
Dr. Eric Smith: And goals, and goals are gone now.
Melanie Lindell: Mm-hmm.
ou hit your goal weight, now [:Melanie Lindell: Yep.
s that I talked about in the [:But people got tired of me calling them habits, so I had to find a, [00:44:10] another fancier way- ... to get them to engage a little bit, right? Yeah. Yeah. Yep. The habit of how you [00:44:15] eat, the habit of how you sleep- Yep ... the habit of how you track your nutrition, the habit of how you [00:44:20] control, you know, your, your stress. Sleep is such an easy thing.
I just can't sleep. I sleep [:Melanie Lindell: [00:44:30] Mm.
well, how many, how often do [:No, no, [00:44:40] th- that's not a habit though. How do we establish habits, you know? And, and it's [00:44:45] exactly right. Those habits are the controllables. Yeah. Those controllables are [00:44:50] celebrated when they become a habit, and you can't call something a habit unless it's regular. [00:44:55] Accepting that those are the only way you'll get the results that you [00:45:00] want takes your mind away from, "I'm only gonna continue to go do this if I get this [00:45:05] visual reward"- Absolutely
inue to do this because I s- [:Melanie Lindell: [00:45:15] Absolutely. I mean, I, I got checked by, um, a sleep specialist, you know, years [00:45:20] ago, and I've always, I've always had trouble sleeping, right? And I, and I do have onset [00:45:25] and maintenance insomnia and sleep apnea, all the things, right?
And so he gave [:Dr. Eric Smith: know.
ad, right? You know? Mm-hmm. [:I hate the title. Why do we have to call it sleep [00:45:50] hygiene? It just, you know- Yeah. I know ... but basically my sleep hygiene stunk, you know? And, [00:45:55] and- You're a crappy
Dr. Eric Smith: sleeper.
eed to go to bed at the same [:And I fought him, [00:46:05] fought him, fought him, and then I think it was three years ago I went in, 'cause I go in every year, and he looks [00:46:10] over my little report or whatever, and I remember him doing this. And then he [00:46:15] looks at me and he goes So, so what happened here? You [00:46:20] know? And I said, "Well, I mean, I, I, I guess I listened to you and it kind of worked," you know?
And, [:You know, we're looking for the flashy, we're looking for this, and, [00:46:50] you know, whole food is quiet. Mm. It's not, it's not sexy. Mm-hmm. You know, going, [00:46:55] having a bedtime, you know, as an adult, like, is not sexy- Yeah ... because we want to like, "Oh, when I'm an [00:47:00] adult, like I, I'm gonna stay up as late as I want." And, a- and
Smith: it just- My friends, [:I could have so many friends that would tell you right now that my saying that I used to say was, "You [00:47:10] can sleep when you're dead."
Melanie Lindell: Yeah. Yeah.
Smith: That's what I used to [:Like, I went nonstop, and I get it. [00:47:25] Mm-hmm. And, you know, I don't think that I've gotten old and boring. I [00:47:30] think I've become very intentional 'cause I love this life, and I love the way- Yeah ... it makes me feel. [00:47:35] This thing right here, for me to track that sleep, and it was so... Like, I thought, "I, I get up [00:47:40] so early during the week.
Why I need to do that on the weekend?"
Melanie Lindell: Right.
h: And it was crazy how that [:April Williams: Yeah.
Dr. Eric Smith: Um, [:Melanie Lindell: No. No. And I think [00:48:15] that's the thing is, like, like, healthy is also really slow, right? You [00:48:20] know? Yes. It's, it's- Yes ... and nobody wants.
culture, you know. Like, we [:Like, a few years ago- Mm-hmm ... when he [00:48:50] said, you know, "You have the best fit as of all my patients, and we need to talk about your age." And I'm [00:48:55] like, "Hey," right? You know, and basically he said, "You love to move." [00:49:00] And, and he goes, you know, we both know that I need new knees, and I have known that. I've had [00:49:05] five surgeries, three ACL replacements, all the things.
a, it's on its last thread. [:And he goes, "Well, that can be taught." And he go, and he goes, "My daughter's [00:49:30] doing it." I'm like, "What? She's, like, 10," you know? And- Yeah ... and so I was just... But he got in [00:49:35] my head just enough- Yeah ... that I reached out to the local aquatic center here on the [00:49:40] island- And said, "You have anybody that can teach me how to breathe in my face underwater," right?
And now [:Dr. Eric Smith: Yeah ...
think that's the other part [:And I [00:50:05] think I also am a big fan of Atomic Habits, and just got done doing the bariatric version I [00:50:10] created for us in BariNation. You know, and, and I think one of the things about, you know, [00:50:15] that space is you got to build your plan in real energy, not in ideal energy.
Dr. Eric Smith: Yeah.
Melanie Lindell: [:Not when everything is perfect and there's nothing coming at [00:50:30] you. You've got to build a way to stay healthy with the acknowledgement that life is gonna [00:50:35] life.
ou know, there's, there's so [:how we, what we do to [00:50:45] our bodies now is how we prepare ourselves when we are 70. Yeah. And I hate to say this, but [00:50:50] newsflash, when you hit 70, if you decide to do it then, it's too late. Yeah. [00:50:55] Like, I'm not saying you shouldn't do it. Mm-hmm. Right. But deciding to adopt healthy habits when you're 70 [00:51:00] because you're really struggling to get around, that's not gonna cut it.
Like how we live when we're [:Sometimes things need to be slow. [00:51:30]
Natalie Tierney: Yeah.
lly being proud of yourself, [:April Williams: Mm-hmm
rection that you want it to. [:April Williams: Mm-hmm.
scale change. And for people [:And, a- and, and you know, the Instagram, the [00:52:10] Instagram li- uh, get all kinds of likes when you look different in the past six to 12 [00:52:15] months. But when you post a picture of you 10 years out versus five years out and you look exactly the [00:52:20] same-
April Williams: Mm-mm ...
Dr. Eric Smith: it doesn't get a whole lot of attention.
April Williams: No.
one of those people like me [:And if [00:52:30] that's your motivation, if that's what gets you excited by what [00:52:35] everybody else is telling you, you're, you're setting yourself up for failure. Mm-hmm. [00:52:40] Finding that joy in the habits- Yeah ... all that stuff can be icing on the cake.
April Williams: [:Dr. Eric Smith: But finding that joy in those habits is finding the joy within yourself, and [00:52:50] that's, uh, that's a mental health concept for people.
Melanie Lindell: Mm-hmm. Oh, yeah.
Smith: Because just like we [:April Williams: Y- yes. Well, [00:53:10] and I, I wrote about this recently. Living as somebody with a disease of [00:53:15] obesity, I very much bought into and enjoyed that day one energy, right? I was [00:53:20] always trying something else. I was always trying something new, right? There was something else on the horizon that was coming. And [00:53:25] that day one energy is addicting, right?
fun things. You, you get to [:We talked about this in Atomic Habits. [00:53:50] It is the boring stuff. It, it, it, it's these levers. But when [00:53:55] you really wrap your mind around weight loss surgery is not really weight loss surgery, it's metabolic [00:54:00] surgery, right? Yeah. Weight loss is kind of a, a happy side effect. What you really are dealing with are, are the metabolic [00:54:05] issues that are going on.
is a total mindset shift on [:And- No ... and I'm the living proof of that. I just got my ass checked by my PCP. I'm [00:54:30] frustrated with my weight. All these things, right, are going off the rail. And the very first thing he said to me was, "Well, how's your [00:54:35] exercise?" And I was like, "Oh, yeah, it's great. I walk my dog two, three miles a day.
Everything's [:Right? But I needed that gut check [00:55:00] because for me, it's like I don't wanna pull these levers if I don't... if I'm not sure they're gonna work, [00:55:05] right? Why would I go through the energy of pulling the lever if I'm not guaranteed a result? And he just very calmly [00:55:10] said, "Well, we have evidence of what is gonna happen when you don't."
Dr. Eric Smith: Right. [:April Williams: And I was like, "Mm."
, I think, you know, I, the, [:And I'm not [00:55:40] quoting a particular person, but I'm, I- I'm paraphrasing, so, you know, forgive me if somebody puts two [00:55:45] and two together and figures out who said it and I'm screwing it up slightly, but I'm pretty close. Where they love [00:55:50] to say, "Yes, lifestyle changes are necessary, um, but [00:55:55] the medications help make those lifestyle [00:56:00] choices easier."
April Williams: Mm.
Dr. Eric Smith: And I have a problem with that.
April Williams: Mm-hmm.
Dr. Eric Smith: That is [:April Williams: Mm-hmm.
be stopped. Mm-hmm. Because [:People know what we mean by that. Medication doesn't give you, quote, "discipline." [00:56:30] Medication can blunt that dopamine response for a period of time, [00:56:35] but if that is the only source of that dopamine response, it can blunt your dopamine [00:56:40] response for everything in life.
April Williams: Mm-hmm.
Dr. Eric Smith: Your sex life could suck. Your nutrition could suck.
Yep. Your [:April Williams: Mm-hmm.
Dr. Eric Smith: [:Will it have an impact early on? Absolutely. Mm-hmm. It may do that, but what you've [00:57:15] done is you've bypassed the controllables.
April Williams: Yeah.
Dr. Eric Smith: And [:April Williams: Mm-hmm.
slippery slope if they lose [:Yeah. Mm-hmm. But it's even for the patients who have access to that, 'cause [00:57:35] listen, our bodies are smart. People get exposed to medications all the time. [00:57:40] Dosages go up. There is basic pharmacology, and I by no means pretend to [00:57:45] be a scientist or a pharmacologist, but we know basic pharmacology says when you [00:57:50] continually stimulate receptors, your body will adapt.
Mm-hmm. If st- if [:Right. To allow that tool to work for [00:58:20] you. Same thing with surgery. I'm not picking on the meds either. But there's never gonna [00:58:25] be a day that you're gonna hear me say the surgery will make your decisions [00:58:30] for you.
Melanie Lindell: Yeah. Right.
Dr. Eric Smith: Um-
can, you know, like I think [:the action, right? And so it's like we can give the [00:58:55] spot for where, what it does do, but then, then you've got to [00:59:00] lean into that with habits, actions, and all that. It, it's not, it isn't the [00:59:05] action, it is what sparks hope to take action, you know, with your, with your life.
pril Williams: Mm-hmm. Yeah. [:Mm-hmm. Treatment gives us hope, but that friction is what actually allows [00:59:20] the other levers, the other forms of treatment to work as effectively as they can. [00:59:25] And you have to have a marriage of, of the two, of treatment and the levers, and those [00:59:30] things have to continue to grow with you as the disease does as well.
But if you [:I'm gonna try, you know, this thing." [00:59:50] The, the research is clear. 2 to 5% of people can work out or eat their way past [00:59:55] obesity. And if you don't know if you have obesity, m- make an [01:00:00] appointment, right? Go into your PCP, make that appointment w- with anybody and just [01:00:05] say, "I would like to know, do I have the disease obesity or not?"
Yeah. Start there because [:Dr. Eric Smith: And you know, that, that is something that [01:00:15] we at KBI, we changed completely. Um, you know, I think you have to [01:00:20] evolve. Yeah. Treatments have evolved.
April Williams: Yep.
fe. You know, if you're not, [:April Williams: Mm-hmm.
. Eric Smith: And, you know, [:And it took us a while 'cause we had to redo our entire education. We had to redo [01:00:50] our- Mm ... entire process, videos, all this stuff, before we could launch it and do [01:00:55] it the right way. So if you come to KBI and you look, you won't find... You might on, archived on YouTube, but we no longer have a seminar that talks about sleeve gastrectomy, Roux-en-Y gastric bypass, SADI,[01:01:00] [01:01:05]
DS [:April Williams: Yeah.
Dr. Eric Smith: The [:Mm-hmm. We spent as much time talking about whole [01:01:30] food nutrition. We spent as much time talking about sleep, all these sorts of things, [01:01:35] body composition. Because what you said, April, as [01:01:40] we know, we just all came back from ASMBS, is [01:01:45] we We have treated 1% of the [01:01:50] population for 20 freaking years.
April Williams: Mm-hmm.
Dr. Eric Smith: This [:April Williams: Mm-hmm.
hole nother podcast on why I [:Many didn't even qualify for it, but so y- how many of those were obese and [01:02:25] non-obese? Nobody really knows, right? Because Big Pharma doesn't, doesn't really care or track that. They're just gonna say, "My [01:02:30] prescription was, you know, a drug was prescribed."
April Williams: Mm-hmm. Mm-hmm.
t I looked at our team and I [:of obesity."
Melanie Lindell: Mm-hmm. Yeah.
ric Smith: That's how we see [:Melanie Lindell: Yes.
and says, "I want Dr. Smith, [:But what you're gonna find out is we're [01:03:05] gonna make sure every doctor in this area knows if your patient's just simply willing [01:03:10] to talk about obesity and the fact of, "Maybe I [01:03:15] am willing to at least consider treatment," send them.
April Williams: Yeah.
Jason Smith: Mm-hmm.
Smith: What we have to do as [:We've had gatherings and events. When we [01:03:25] launched our, our second, um, satellite clinic in Maysville, Kentucky, I looked in a room, 40-some [01:03:30] people of orthopedic surgeons, GYNs, ER physicians, everybody. I said, "Look, I'll [01:03:35] own this." For years, we had the luxury that people showed up ready to talk about surgery, [01:03:40] and you saw me as a surgeon.
ts where they're at anymore. [:Melanie Lindell: Mm-mm.
just willing to bring you in [:And, um, my [01:04:05] hope is, is that we're gonna see more practices take that approach. I've had a lot of physicians come to [01:04:10] me because volumes have been impacted by GLP-1s, and I'm like, "It's not because surgery's not [01:04:15] impactful. It's just patients want to be navigated differently."
Natalie Tierney: Yeah.
Dr. Eric Smith: Um, you [:Melanie Lindell: Yeah.
really a new concept We just [:Melanie Lindell: Yeah.
Dr. Eric Smith: [:April Williams: Mm-hmm.
percentage of people who are [:Yeah. We just talk about here's all your options. Yeah.
Natalie Tierney: Yeah.
Eric Smith: And so, uh, you [:Melanie Lindell: Mm-hmm ...
ric Smith: then find another [:Melanie Lindell: Yes.
where that they have all the [:Melanie Lindell: Yeah.
biased opinion by a provider [:April Williams: Yes. Yeah.
listen to this podcast as we [:I don't think anybody with any education would argue that it matters to some extent.
April Williams: Mm-hmm. [:Dr. Eric Smith: If you just acknowledge that it matters a little bit, please keep going through this with [01:06:25] us. Yeah. And I think you'll learn how much it actually [01:06:30] matters.
Melanie Lindell: Yeah.
said it better ourselves. We [:Because surgery, medication, that, that is the treatment for obesity. [01:06:45] But these levers are what keeps whatever tool you choose sharp. Yep. And [01:06:50] that's really what this lever series is all about. Let's learn about them, let's control the controllables, [01:06:55] and let's come up with a game plan for how we can actually pull those levers each [01:07:00] and every day.
ends, if you have a question [:And Dr. Smith, of course, we're gonna see you back here, and maybe we'll go [01:07:25] live on a social platform so we can interact and, and answer your questions in, in real time. But we are [01:07:30] just so honored and so thankful that you're gonna be joining us for this lever series. Yes. It's really powerful. [01:07:35]
Melanie Lindell: Yeah.
ously got some traction, and [:April Williams: Oh,
th: man. It, it did its job. [:April Williams: It, it did its job, absolutely. Absolutely. All right, friends, share [01:07:50] this episode so other people know that the lever series is kicking off today. We appreciate [01:07:55] you spreading the word and just ensuring that everybody knows that this education is available.[01:08:00]
s the best place to do that? [:Dr. Eric Smith: Uh, practice website, you can go to kentuckybariatric- [01:08:10] bariatricinstitute.com. Um, you can follow me on social media, both on Instagram, I [01:08:15] think it's Dr- Dr. Eric Smith underscore. I don't know. I think it's Dr. [01:08:20] Eric Smith underscore.
Just goo- search me and s- look for the bald guy.
April Williams: Hey, hey-
Dr. Eric Smith: And then [:April Williams: Oh.
go to both of those places. [:April Williams: Yep. And we'll link it down below.
And [:But know there are thousands and thousands of providers out there that are [01:09:00] excited to help you start to treat your disease of obesity differently. So now is the time. [01:09:05] Let's stop waiting. Let's, let's start moving in action.
Dr. Eric Smith: Yeah.
April Williams: All right, [:Bye, Dr. Smith. Bye. [01:09:15]
Dr. Eric Smith: See ya.
rous donors who believe this [:Someone is going to find this [01:09:35] podcast on a bad day or right when they need it most, and you can be the reason it's [01:09:40] there. Your donation to the BariNation Foundation helps us advance metabolic wellness for people living with [01:09:45] obesity through evidence-based education, stigma-free support, and real connection in the [01:09:50] moments that shape our daily life.
making this possible, visit [:Natalie Tierney: Thanks for joining us. This podcast is a proud [01:10:00] production of the BariNation Foundation, a 501[c]3 nonprofit.
Jason Smith: Our [:April Williams: A quick reminder that the information discussed in this episode is not medical [01:10:20] advice. Be sure to speak with your personal medical provider about your specific health needs. [01:10:25] Thank you for listening or watching, and we'll catch you on the next [01:10:30] episode.