2016 Top Doctor: James Swain, M.D.

Written by Editorial Staff Category: Profiles Issue: April 2016
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Med School/Year Graduated: University of Kansas, 1995

Years in Practice: 15

photography by Steve Craft; James Swain, M.D.Have you or anyone you’re close with struggled with weight? If so, how has that helped you empathize with and better serve your patients?
Absolutely. My mother and I have always had our weight ups and downs. My mother has significant weight-related problems that limit her life. It’s a daily struggle. I definitely can empathize.

When does a patient become a candidate for gastric bypass surgery?
In general, patients with a Body Mass Index (BMI) of greater than 35 with a weight-related condition or a BMI greater than 40 are considered enough overweight that the risks of the surgery are outweighed by the benefits of the expected weight loss.

Is the term “stomach stapling” a misnomer?
“Stomach staplings” were some of the original bariatric procedures in the ’70s and ’80s. Very poor operations based on physically “restricting” how much a person could eat. A very large stapler was placed across the stomach. These staples would eventually “come undone” and the patient would regain any weight they lost. The staples themselves were not the problem; it was how they were used. They really gave bariatric surgery a bad reputation. These procedures are no longer performed.

Do modern bariatric procedures use staples?
The major bariatric procedures performed today use small titanium staples. They are inert (the body ignores them). The procedures performed today have been refined using the staples in a way that provides long-term durability.

What new advancements in bariatrics are you most excited about?
The laparoscopic (minimally invasive) approach led to a revolution in safety and efficacy. Surgery could now be done through very small incisions, which resulted in a much safer procedure. As a researcher, the current trials we are running at HonorHealth have shown a big shift to incision-less procedures – devices placed endoscopically into the stomach, or even swallowed, that will help patients lose weight.

What are the biggest obstacles for people in losing weight and maintaining weight loss?
The “yo-yo” of weight loss and weight gain is the result of our body wanting to stay stable. Any significant weight loss causes a slowdown in our metabolism, which causes us to stop losing weight despite eating much less. People then become frustrated, blow their diet and regain their weight. True long-term weight loss occurs when three things occur consistently: 1) Limit daily calories – 90 percent  of weight loss is diet; 2) Exercise – keeps muscle mass and metabolism higher; 3) Behavioral health – assure that a person does not use food to compensate for behavioral issues (depression, stress, etc). All three must be done well for a person to lose weight. Surgery helps with the most difficult part, dietary compliance.

What’s the biggest myth about obesity?
That obesity is a willpower problem. There are metabolic and hormonal processes in our body that help us increase our appetite or make us feel satisfied after eating. Some people are more sensitive or resistant than others to these hormones. Many patients never feel “full.” This leads to weight gain over time. Bariatric surgery helps by manipulating these hormone levels to the patient’s advantage, causing them to have a minimal appetite or feel “full” much faster, leading to weight loss.

“If I wasn’t a physician, I’d be a...”
Bass player for Metallica.