Have you ever felt judged or misunderstood because of your weight or health struggles? Shame and stigma often surround the conversation about obesity and treatments like bariatric surgery. In this episode of the BariNation podcast, we welcome Dr. Ann Rogers, Bariatric Surgeon and President of ASMBS (American Society of Metabolic & Bariatric Surgery), who sheds light on the stigma surrounding bariatric surgery and how it addresses more than just weight loss. Dr. Rogers explains how bariatric surgery can correct serious health problems like diabetes, sleep apnea, and fatty liver disease, ultimately improving a person's quality of life. We also dive into the resistance to bariatric surgery, the changes needed in healthcare, and how medications and mindfulness can play a role in weight management. Dr. Rogers also shares valuable advice to help break the cycle of shame and self-doubt.

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IN THIS EPISODE:

• [0:42] What drew Dr. Rogers to bariatric surgery and improving the quality of life
• [6:58] Why do people resist bariatric surgery? Is it shame and stigma
• [15:36] Changes general practitioners need to make in the insurance industry
• [25:01] Medications to lose weight and why obesity wants to come back
• [34:55] The value of mindfulness and the capacity to live life differently
• [40:23] Discussion that Medicare and Medicaid will have access to GLP1 and forecasting for 2025 and Dr. Rogers's parting advice
• [45:54] Believing the lies we tell ourselves and hear more in the BariNation Support Community

KEY TAKEAWAYS:

• Bariatric Surgery Addresses More Than Weight Loss. While bariatric surgery visibly impacts weight, its actual value lies in addressing underlying health conditions like diabetes, sleep apnea, and fatty liver disease, significantly improving quality of life. However, the stigma surrounding obesity and bariatric surgery often deters patients from seeking help. 
• Obesity is a complex, chronic disease that is influenced by genetics, biology, and environmental factors. It's not just a matter of personal choice or willpower; blaming individuals for their condition is unjust and counterproductive.
• Bariatric surgery and related treatments can offer substantial benefits, and despite challenges like weight regain or access to medications, patients should remember that they are worthy of care and support.

RESOURCES:

• BariNation Website 
• Join the BariNation Membership community meetups to support you on your journey with obesity treatment. https://barination.com/pages/join-our-community
• Want to see bonus content? Head over to Drive To Thrive to get more and support the podcast for as low as $5 per month! https://www.DriveToThrive.com/BariNationPodcast 

ADDITIONAL RESOURCES:

Patient Resource Link

GUEST BIO: 

Dr. Rogers is the Director of the Penn State Health Surgical Weight Loss Programs. 

Dr. Rogers is currently serving as the President of the American Society of Metabolic & Bariatric Surgeons (ASMBS) with her term concluding in June 2025 at the National ASMBS Conference in Washington, D.C.

ASMBS MISSION: To enhance the well-being of individuals affected by obesity and associated illnesses through the progression of metabolic and bariatric surgical techniques and other medical interventions.

ABOUT:

If the BariNation podcast helps power your bariatric journey, become a monthly podcast supporter and help us produce the show! Visit www.barinationpodcast.com and help us support people treating the disease of obesity with humor, humility, and honesty.

April Williams: You've just tuned into a podcast that welcomes you into a community, a resource center, and a safe place that powers your [00:00:15] journey towards personal wellness.

Natalie Tierney: Our goal is you leave us today feeling helpful, inspired, and ready to live your best bariatric life.

Dr. Ann Rogers: Sure. I'm Anne Rogers. I'm a [00:00:45] medical doctor. I'm a bariatric surgeon.

April Williams: to bariatric

Dr. Ann Rogers: care and medicine? In a past life, uh, believe it or not, I was a breast surgeon, and then, uh, I went back to school to do a fellowship in bariatric surgery.

Wonderful. Who knew? Yeah.

Dr. Ann Rogers: The ASMBS actually has a formal mission statement and they say that it's to enhance the well being of individuals affected by obesity and, uh, obesity associated illnesses [00:02:00] through progression of or support of metabolic and bariatric surgical techniques and other interventions.

That's the formal mission statement

starting to include the patient voice. Are there aspects or elements of the ASMBS that are patient facing or patient forward?

And it has patient testimonials and FAQs and [00:03:00] you name it. It's, it's got a lot of information and we have patients involved on our corporate council council. And we actually have a patient education committee that's manned by doctors and integrated health people, you know, to, to [00:03:15] provide education in a variety of settings for patients.

The page is a wonderful job of really breaking that down and also talks about some of the things to be aware of before surgery and [00:03:45] after surgery.

Jason

Dr. Ann Rogers: That's fantastic.

And in your size and your shape, what it's really doing is addressing all of those underlying things that are happening in a [00:04:45] person's life that aren't necessarily visible, right? Like Jason, you're high blood pressure. You've talked about this many times on the podcast. You wouldn't know outwardly that you were struggling with that, but bariatric surgery helped you reduce your your high blood pressure [00:05:00]

Jason Smith: a little bit.

Yeah, it runs in my family on both sides, so it will never go completely away. But I am down on the amount of medications and the types of medications that I'm taking have been adjusted. dramatically. That's

Uh, but yes, skinny people can have high blood pressure too. But other things are, uh, in the nineties, things like fatty liver and, uh, obstructive sleep apnea and whatnot.

I don't even want to know what it's like. A lot

Dr. Ann Rogers: of people feel that way. It's amazing. You may have to dial it down a little.

April Williams: I feel like you're describing myself, Dr. Rogers. I had fatty liver disease, obstructive sleep apnea. My A1c was in the pre diabetic level and I, when I had my surgery, my surgeon said, you have to come to your procedure with your [00:06:00] CPAP machine.

We won't perform this unless you have it. And I never wore it another day in my life.

It's hard for some people to get used to.

Dr. Ann Rogers: I think it's interesting that a lot of people just think it, it is about sleep quality.

April Williams: So I guess this, this kind of leads to a question that I didn't even think that we would ask. Why do you think then [00:07:00] that people resist having bariatric surgery?

Dr. Ann Rogers: I have a number of thoughts on this, but a lot of it gets. Gets back to the theme of my year, which is the stigma of obesity, and I think, you know, I was talking to a guy a few months ago, and he happens to be [00:07:30] a, uh, a dating coach.

It's the same sort of thing. It's just entirely different from conventional diet and exercise. And I think, I think partly, [00:08:00] uh, people are unaware of that. Partly I think doctors are not up to date on how safe it is. They think it's rash. They think it's the easy way out, you know, and I, I always say, well, if you're in a burning building, are you going to take some [00:08:15] Byzantine route or are you going to go the fastest way right out the door?

But, but I think a lot of people think that it is, it's a way around just getting your face out of the trough. [00:08:45] There's so much stigma about obesity that there's an equivalent amount of stigma about obesity surgery. I think is the bottom line.

April Williams: It's one of the reasons we started Berry Nation or way back in the day when we were called the East to West WLS.

Dr. Ann Rogers: That's very interesting. So you actually have, have listeners who have not yet undergone surgery. Oh, that's great. That's [00:09:45] great. It's great to educate as many people as possible. Yes,

April Williams: absolutely. You said earlier, the theme of this year's ASMBS conference is lifting shame and stigma. How did you arrive at that theme?

I couldn't attend anymore, but, but it's something near and dear to my heart. [00:10:30] And, uh, one of our past presidents, some years ago, Stacey Bretthauer, was giving his speech at his, uh, annual meeting, and he said that obesity is Probably the poorest, the most poorly understood medical problem. And I [00:10:45] think that is really true.

And then once we get. beyond that and [00:11:15] people start getting treated, it becomes accepted. So I'm, it is my greatest hope that that's going to be the same for obesity treatments.

Dr. Ann Rogers: They don't even want to go into a doctor's office. They're sure that they're going to be put down and We know that that happens. There's all sorts of literature that says that health professionals, even people who work [00:11:45] in obesity facing fields, tend to put patients down, whether it's openly, overtly, or, or just they don't even realize it's happening necessarily, but they can say some pretty hurtful and harmful things.

April Williams: We were actually talking about this, uh, this week in, in the Berry Nation membership community. Some of our [00:12:30] most poignant conversations happen when members join one of our support groups or classes or meetups, and they talk about an experience they just had, even at a bariatric follow up appointment. And it breaks our heart because they are, they're excited to talk [00:12:45] about, you know, the things that they're learning and what they've done and they would like a benchmark of progress.

Dr. Ann Rogers: hard to break free from. Oh my gosh. Yes. In fact, I was surprised to see that. I won't name any names, but the surgeon on my 600 pound life is a real guy.

So it kind of gives our field a bad name, but I don't think he's the only one, unfortunately. It's a struggle,

Dr. Ann Rogers: I think there's probably a way to give both at the same time. Tough love, understanding what [00:14:15] people are struggling with. You know, a lot of times patients will ask me, well, have you had the surgery? Because they sense that I, I get it, you know, oddly I haven't, but I, I definitely struggle with weight, right?

Jason Smith: Yes. And I feel like you're, you're, you kind of hit the nail on the head there.

So [00:15:15]

Dr. Ann Rogers: I have a project right now that one of our medical students is working on.

Send them to the surgeon! Right? A patient comes to your office for a checkup and they have symptomatic gallstones, what do you You go to the surgeon, right? Okay, so it's we have to start [00:16:15] with the fact that it's a medical condition and that we have treatments for it. It's not something that requires shame or blame or anything of the sort.

April Williams: important. If my primary care physicians or any of them and in the 43 years that I've been on this planet would have approached it that way to [00:16:45] say, you know, just like every other doctor. Disease that humans can can suffer through for somebody to say, you're battling a disease.

Dr. Ann Rogers: correct?

And whether you believe it or not, it just is. And most insurances cover it's, you know, at least the surgical treatment of obesity, severe obesity. Yes, [00:17:45]

April Williams: that is the other interesting thing, right? Bariatric surgery is one of the most accessible treatments for the disease of obesity. It is covered by so many insurance carriers and plans.

Dr. Ann Rogers: It all does get back to stigma, unfortunately. But for instance, there are all sorts of, [00:18:30] um, really strange, difficult requirements that most insurances make, make you jump through in order to qualify. And that for a lot of insurances is somewhere between three months and a year of [00:18:45] preoperative classes and, uh, A lot of insurances will require that you have meetings with dieticians.

And I believe it's in [00:19:15] hopes that That a lot of people will fall out and a lot of people do over 50 percent of people who enter a surgical weight loss program do drop out for one reason or another. And some of it has to do with with high costs. Some of it has to do with the fact that many [00:19:30] insurers, yeah, they'll pay for you to have a first time operation and then it's one and done, right?

You know, it's not one and done, it's a lifelong, it's a chronic disease that wants to [00:20:00] recur. And so we should be prepared for the treatments to go on if necessary. Like anything else.

Dr. Ann Rogers: Yeah. [00:20:15] You, you, how dare you, right?

You had

Jason Smith: one hip replaced. We replaced one hip already, then we're just going to have to ride it out. Then

And so you [00:20:45] never meet with your lawmaker, you meet with their staffers and their staffers are these young 23 to 25 year olds, healthy, generally speaking, beautiful, blah, blah, blah. And we were talking to this one girl and she says, well, can you think [00:21:00] of any other disease where patients bring it on themselves and insurance still pays for it?

Oh, sorry. We're going to leave you here to die. No, these people all get treated. Doesn't matter. And by the [00:21:30] way, obesity isn't a situation where you're just bringing it on yourself. Like nobody wants to have obesity. Nobody choose it. Oh, I think I'll just overeat and have obesity. No, It's something that happens because of the difficulties of genetics and [00:21:45] biology and a number of other things.

You got me started. Big mistake.

But what became so apparently clear when you were talking, talking to Dr. Rogers was [00:22:15] the cruelty of obesity treatment, I'm just going to say in America,

Dr. Ann Rogers: it is, it's terrible. It's cruel. It's not even just in the U S it's, it's pretty, pretty bad all over wherever they have it.

Yeah, yeah. Or drop out of the protocol because you, you already know the cruelty that lies ahead. You already, even if you don't consciously understand it, you unconsciously know. I have a year of jumping through hoops. I have [00:22:45] a year of dealing with the reality of this disease. I still internally deeply believe that I'm causing this fault.

Right. And if

April Williams: As

Dr. Ann Rogers: you know,

So

Jason Smith: you've gone through this twice. Yes, ma'am. December 12th was my one year from revision to Sadie from the sleep.

Jason Smith: Thank you. Yeah, I thank you. We talked about the shame and the stigma and I shamed and stigma myself for about nine months, nine, nine months telling myself I didn't deserve to have surgery

Dr. Ann Rogers: and you failed it.

Jason Smith: I failed myself. I failed the community. I failed April. I [00:24:00] failed Natalie. It's so

Dr. Ann Rogers: interesting because you might try several different blood pressure medications before you find one that works and you don't think of yourself as a failure.

Jason Smith: when I would tell a hundred other people the exact same thing, but I would not tell myself that no matter how hard I tried. And, and Dr. Cribbins, when it came time, he, we were talking about it and he was like, would you tell yourself, would you tell anybody else in the [00:24:30] community what you're telling yourself?

And I was like, absolutely

Dr. Ann Rogers: not.

Jason Smith: Why are we talking about it? And I was like,

Dr. Ann Rogers: That's so interesting. I

Jason Smith: had no response.

Dr. Ann Rogers: Well, I can tell you one thing, uh, Along those lines, which kind of segues into a whole nother topic, which is that a friend got me some semaglutide [00:25:15] The pill version which is called ribelsis. So it the higher dose is injectable. It's ozempic or Wigoby And I had these ribelsis tabs and this person who shall remain nameless had taken it and [00:25:30] lost a significant amount of weight and said, Hey, try it because this person is from Canada.

I could, I could go a whole day and [00:26:00] be able to think about other things. This is amazing. And I, I don't have severe obesity. I'm just Joe Blow. Right. But, but, but I'm dealing with that. Right. And so everybody potentially is. [00:26:15] So I think those medications when they work can be very, very effective at. A, helping people realize it's a medical problem that is responsive to medications, so I think that's a good thing.

April Williams: [00:26:45] That silencing of the food noise is something that we experienced initially after our bariatric procedures.

Dr. Ann Rogers: Correct.

April Williams: But then it

Yes. Yes. Because obesity does want to come back.

Dr. Ann Rogers: chronic recurring disease that's driven by genetics. I don't know if it's because, [00:27:30] you know, we're supposed to be dreading another ice age and, you know, we're supposed to have extra.

And even I at my advanced age have by far outlived my usefulness [00:28:00] genetically. Not that I'm ready to die yet. But yeah, it's, it's just complex biology. We don't understand it all, but I know that it's, it's very willing to try to come back.

I am the type of person that always wants to know the why. My brain is always saying, right, but why, but why, but why? I know. [00:28:30] Me

Dr. Ann Rogers: too, .

April Williams: Okay. Right. But we don't a last, but we don't. And, and I guess what just clicked is it doesn't matter why you are experiencing or, or, or you're noticing the recurrence of some of your obesity symptoms.

April Williams: reason is. It's a disease.

Dr. Ann Rogers: Yeah, correct. And

April Williams: we, and we can give ourselves permission to stop there.

April Williams: It

Dr. Ann Rogers: should.

Dr. Ann Rogers: this. I think that hopefully we all continue to learn, right? There's, there's a lot. I don't know. And I'm not a finished product. I guess I'll be a finished product when I finally, Cork off, but, you know, [00:29:30] you got to stay open to it and read the papers and read.

April Williams: Well, and really what you just described, Dr.

Dr. Ann Rogers: Good. [00:30:00] Absolutely.

But what also comes with curiosity is, is especially for me, which I'm going to have to embrace this year is it's good enough to stop at because you're fighting a disease. The why is. Exactly. Yeah. Absolutely. It doesn't have to be a [00:30:30] failing on your part. No, and it's not a failure on my part. It is the disease progressing.

Or trying to.

I don't know if you can see it. See that line going up? People [00:31:15] tend to gain weight over time. That's normal and an operation will send you to a good weight really fast and then everybody wants to stay at that good weight. In reality, what happens is people [00:31:30] struggle and gain and re equilibrate and do something like this, okay?

And, by the way, it's not too difficult to get Down again, usually it takes like journaling again and, you know, maybe meal replacements with protein shakes once a day, you know, a variety of things and most people will lose [00:32:15] five pounds within two weeks and realize, okay, all is not lost. I can get myself back on track.

Not that it's easy, but.

It's what we're telling ourselves. It's what we believe. [00:32:45] And we help people identify how those thoughts are maybe getting in their own way. And then we provide them the space to practice doing things differently.

And some of them are are hurt by the fact that you've lost weight or some of them like you because you're the heavy person. There's a variety of strange, uh, [00:33:15] interactional things that. Surround weight, you know, so you you have to not just get your own head screwed on straight You have to know who's good for you and who is not basically

Like any day is a good day to start and you're, and you're meeting yourself where you are. You're not starting over from scratch.

Jason Smith: Oh yeah. The countdown, the countdown to the gym flood is on because I have regular, I've been going about six, six months now, solid.

Dr. Ann Rogers: That's a good point. Yes.

Jason Smith: I'm going to get a shirt made that says, new year, same me.

And as we talk often about, it's not that we are [00:34:45] learning. Absolutely. Brand new things before and after surgery, learning how to do what we already know how to do just a little bit differently.

And it is very, very easy to go through life. Mindlessly in, in, in for so many reasons, you know, this is part of one of the tenets of Buddhism, right? It's [00:35:15] just to calm down and take a breath and think about the fact that you're okay right now. We're safe right now. There's no rhinoceros chasing us that I think, but [00:35:30] it's, it's hard to be mindful.

It's so easy to just turn your brain off and go through life and like, wake up and realize. Yeah. Hey, that bad thing happened. Maybe if I'd been a little more aware, things would have been okay.

We have to catch that thinking. We have to check it and we have to change it. [00:36:00] But the gift of surgery is it gives us The space between what we used to do and what we want to do. We all of a sudden have this capacity to to really live life differently. And that's what [00:36:15] this is all about. Getting the space and grace from the disease so that we can engage with life in different ways.

But. But most of these [00:36:45] operations work because of hormonal effects that just so happen to be related to these reconstructions, you know, so people should get away from thinking about, you know, restriction and malabsorption. No, it's mostly hormonal [00:37:00] effects. And that's why these medications kind of work in a similar way because they're hormonal agonists.

And suddenly they realize they better slow down. No, no. You gotta drive slowly within the lanes and not crash into a bulkhead and not have the [00:37:45] thing deploy. Right? Yeah. So this, this whole thing about, oh, it'll make me have dumping or it'll make me vomit. No, I, I wish that had never happened in the first place, because that's really not what these operations are.

Based on

Dr. Ann Rogers: Exactly. So even with [00:38:15] bypass patients, maybe 5 to 10 percent of patients have actual dumping.

Probably not that cake. And it never tastes as good as it looks. Donuts, they're never [00:38:45] as good. You regret it afterwards, right? What does your body actually really want and need? I think most Americans don't even know what. Hunger is because they fear it and dread it so much that they eat constantly so that they [00:39:00] don't feel the pain of hunger, right?

April Williams: And I know for me as a patient, I never experienced fullness before surgery, or there was maybe a few times where it was that, right? This uncomfortable

April Williams: Yeah. Well, my, my hunger never dissipated. My [00:39:45] hunger was constant and after surgery, right. I was prescribed a GOP one medication and it absolutely helps. That food noise, I mean, I've lost access to it several times now, but it's amazing and it's [00:40:00] frustrating at the same time because starting in 2025, I will not have access to it anymore.

So, my options are

April Williams: We've read in the news the Biden administration wants to add GLP 1 medications to Medicare and possibly Medicaid.[00:40:30]

I mean, and I think a lot of people are holding out hope that insurance companies or the government will make these medications available. Do you see that actually being the case in the near

So those medications have been specifically disallowed. Uh, by [00:41:00] Medicare, probably because of, um, the valvular heart disease that was seen with FinFIN. Uh, but we've had a number of things since then that are FDA approved that do not cause those problems and Medicare continues not to pay for them. [00:41:15] And they're just simply not going to pay for anything at, at this time, even these generic things, right?

April Williams: So really the best still form of treatment that people can access will [00:41:45] remain bariatric surgery.

April Williams: Okay. Well, we have just a few more minutes left. Jason, do you want to So we have three questions left. What can patients do to help What can patients do to access care?

Dr. Ann Rogers: Yeah. Um, I think, you know, most doctors, primary care providers are like a mouse on a wheel. They're just running to catch [00:42:30] up. They're paid to see patients every six minutes and, you know, they may see 30 to 50 people a day and then go home and do their charting later.

It's safer than hernia and gallbladder surgery. So it's not like the old days where it was considered rash and dangerous and you know, you're highly, you know, now that we do everything, well, most things through minimally invasive procedures. techniques, [00:43:15] laparoscopic or robotic, you know, these have gotten to be very safe procedures.

And this is you, this is your health. I tell women there's exactly two things that women do for themselves. They [00:43:45] get their hair trimmed every six weeks and bariatric surgery, right? It's like,

Natalie Tierney: you

I think most insurances will still cover it. I think it will still be difficult to get GLP 1 agonists for one reason or another, but I know they're working on more. So more and more [00:44:15] are going to come available. So, uh, it's getting a lot of play and it's making people realize that treatments are out there.

So I, I only see that as a good thing.

Dr. Ann Rogers: conversation?

This is, you are not a bad person. This is not a failing on your part, you [00:45:15] know? You're worthy. You're here for a reason. And you know, you're allowed to take care of yourself and hopefully practitioners will hear that as well and realize nobody wants to be sick. Nobody wants to have a problem. Nobody wants to be heavy, [00:45:30] blah, blah, blah.

So just take pity on people and be nice, be nice to them and offer them some treatment.

That wraps up another empowering episode of the Barrie Nation podcast. If you enjoyed today's episode, keep the conversation going by joining the BariNation membership community where you can [00:46:00] attend live support events, access On demand resources and find a caring community.

Jason Smith: And just remember at the end of the day, you've got this, we've got you, and we'll see you next time. Bye everybody.