There is a misconception that after you have a weight loss surgery procedure, you will never eat or be hungry again. This is simply not true. Patients need to focus on their nutritional needs and ensure they are hitting their macronutrient goals everyday to find and maintain metabolic wellness. But this can be scary for patients because they feel that "eating" is what made them obese in the first place. This is another false and misleading piece if information that can no only deter patients from having a bariatric procedure, but can lead to disordered eating after surgery.
In this episode of The BariNation Podcast, Dr. Eric Smith, the Director of The Kentucky Bariatric Institute and his partner, Dr. Sarah Hayak, share with us their prescription for post-op eating. They explain why it is critically important for patients to hit their nutritional goals and not be afraid to eat more when they have healed and their body is asking for more nutrition. They teach us how eating too few calories can actually slow our metabolism and decrease our changes of reaching our weight loss goals.
You can watch and listen to this powerful episode here. Be sure you subscribe to The BariNation Podcast on your favorite podcast player and YouTube to be notified when our new, weekly episodes drop!
If you are a patient of Dr. Smith and Dr. Hayek, you have access to three FREE months in the BariNation Support Community! Email or call your KBI Care Team to sign up today!
Episode 203 Transcript
April: Hello! We are so excited to have you both on to talk about something that is often discussed in Bari Nation support groups, classes, and meetups, and just in the greater bariatric community. [00:01:30] About three to six months after any type of bariatric procedure, patients notice that they can eat more. And it is a moment of panic.
They think that they have done something wrong, that their surgery has failed them. And it can be a triggering [00:01:45] moment where many of us think, oh my gosh, do I need to kind of return to this diet culture mentality? Do I need to follow a specific eating plan? Just panic, right? It is a, it is a moment of panic.
So today we're so thankful to have you both on this podcast so that you can kind [00:02:00] of definitively give us an answer to what we should do as patients when we experienced this. So before we jump into the conversation, we'd love to give both of you the floor to introduce yourselves to people who have never met you before.
So [00:02:15] Dr. Smith, let's start with you.
Eric: Yeah, well, I am Dr. Smith. Probably most people have seen me somewhere. Um, but I'm the medical director at the Kentucky Bariatric Institute in, um, Georgetown, Kentucky, or just outside [00:02:30] of Lexington, Kentucky. And, um, I have had the pleasure of doing a bunch of these with you all in the past.
Um, we also have had the pleasure to be the very first practice to ever collaborate with Bari Nation [00:02:45] and offer this as part of our support system after surgery as well, um, to really encourage patients to kind of find their people, find their groups, um, and continue to, you know, [00:03:00] um, go through whatever type of, of, um, information and education that they need, not only before surgery, but more importantly, after surgery too.
It's been, it's been really helpful for our patients to come back and the longer we've [00:03:15] done that and they make references to it. So it's a really cool thing. And in April, you and I were talking about this earlier today. It's really cool to see other programs start to do the same thing. Um, and see the value in that.
And more [00:03:30] importantly, I'm also excited to be on here because it's the kind of point the right direction. I think that's in the right direction. I feel like I'm on, uh, What was the, the, the Brady Bunch? The Brady Bunch, yeah. I'm dating myself. Sarah's probably like, I have no idea what the Brady [00:03:45] Bunch is. Oh no,
Sarah: the Brady Bunch.
Eric: Yeah. Um, my, my new partner, Dr. Sarah Hyatt, who joined me in November, and we're super, super excited to have her, so I'll turn it over to her. Awesome. Hi
Sarah: guys. So yeah, Sarah Hyatt, I [00:04:00] have been, um, on a journey to kind of join Kentucky bariatrics for a little bit here. Dr. Smith and I were working together. I was practicing out in West Virginia and we were working together on some projects across state lines.
And, um, [00:04:15] eventually it just kind of made sense for me to pick up and move out to the Lexington Kentucky area. Um, not really where I anticipated finding myself in life. When I was younger, I lived in the northeast. [00:04:30] I've slowly been kind of working my way down the east coast here a little bit. So here we are now in Kentucky, joining Kentucky Bariatrics and really, really loving, um, the collaboration that we've been able to create.
loving interacting [00:04:45] with our patients and getting them to interact with all of you on Bari Nation, which has been really an awesome project to You know, something that I came into once this was all established in here and I know you guys have built this with such a [00:05:00] labor of love and to see what you've created is just absolutely phenomenal.
The things that our patients can get out of this are just, there's nothing else like it. It's amazing. And so the patients really, really love this and I am so [00:05:15] excited to be joining and kind of participating and collaborating, helping people in any way that we can.
April: That, that is what this is all about, uh, and if you are new to Bari Nation or you're new to the Kentucky Bariatric Institute, uh, what [00:05:30] we have created is this amazing collaboration, really, and partnership.
So our role with Bari Nation is to connect patients. with the tools, the resources, and that additional support that we all need along our bariatric journey. So this isn't a [00:05:45] replacement for the amazing support and care that you get at the Kentucky Bariatric Institute. This is just simply additional support that you can tap into when and where you need it.
So if you are a patient of KBI, absolutely get in contact with Dr. Smith, with Dr. Hayek, [00:06:00] with your care team, and Take advantage of your three month membership. The Kentucky Bariatric Institute paid for every single patient, uh, who is with their program to have this opportunity to tap into this support for free.
So you get [00:06:15] three months of membership for free. Absolutely take advantage of it. We'd love to welcome you into the community. All right, my friends, I think we did it. Let's dive in. I'm going to start us off by actually, Jason, asking you a question. [00:06:30] When you were first post op, or now that you've gone through your round of revision, did you notice that your hunger returned and that your capacity changed?
Jason: For my initial sleeve surgery [00:06:45] that was four years ago. Yes, it did. I didn't really notice much of a change after revision one way or the other. I woke up kind of being able to do all the things I could do before without much, without much issue. But before from the sleeve, you know, when I, when I had the [00:07:00] sleeve and started realizing I could, um, and the hunger came back, I freaked out.
Absolutely. I freaked out. I was a panic button, all the red flags. I thought I popped stitches. I thought I did all the things I wasn't supposed to do because I was, I lost it. But [00:07:15] really, honestly, it was awesome for me to have access to not only you and Natalie, but to have, you know, the, the kind of the groundwork that we had been laying with experts in the community, even at that time.
So I could kind of reach out and be [00:07:30] like, Hey man, I did a lot of reaching out to make sure that I was good. And it really was. And I know that a lot of people don't have that option, so it's good that we're talking about this today, because it really does set off a lot of panic, because for a lot of us, this is the end of the road.
[00:07:45] This is the final, you know, the final countdown, the final option we've got, and if we mess this up, you know, where are we going to be? So, you know, the fear is very valid, but at the same time, it just takes a little bit of education to realize that, you know, it is A normal thing that you will be dealing with.[00:08:00]
April: Yep. It is, it is right. And as patients, we, we, we know that fear, many of us go into surgery worrying, thinking like, oh my gosh, I can't mess this up. Just like what you said, Jason, right? Like I can't fail at this. And then all of a sudden when hunger returns or when our ability [00:08:15] to eat more, right, we noticed that our capacity has changed those alarm bells goes, goes off.
So Dr. Smith, let, let's start with you. Why does our capacity. to eat larger amounts of food change as we recover from [00:08:30] bariatric surgery.
Eric: So, you know, there's a couple reasons why and you, and you kind of have to clump it all in together because obviously everybody doesn't have the same surgery. Um, you know, so whether they had a DS or they had a Sadie, whether they had a [00:08:45] bypass or they had a sleeve, um, First and foremost, you have surgical trauma and swelling.
And so for early on, number one, you have that residual nausea. Like you feel like you can't get anything in early on. It's, it's [00:09:00] actually work to get your bare minimum in. Um, and so you're intentionally minimizing what you take in and then you're to the point where like, I'm trying to overcome that, but there's a lot of swelling.
So when you create a sleeve. [00:09:15] I tell patients all the time, you know, think of a half kinked water hose. And, you know, that half kinked water hose, if you just think of a sleeve, um, if you turn the water on to a trickle, it doesn't really want to go through. But if you turn the pressure up [00:09:30] on the water hose, it will straighten the hose out.
And I use that as an analogy to get people to understand that nausea will get worse if you don't drink. But the tendency is to say, I'm nauseous, so I shouldn't drink, right? And so I use that to educate them to push the boundaries [00:09:45] a little bit and open things up. But as that swelling, as when that swelling's there, you just don't have a lot of room.
So you immediately in the first couple of weeks think this is it like, this is my restriction forever. And, and you're [00:10:00] almost freaking out to the point of like, I got to get more in than this. But you think, okay, the surgery's over, the work has been done, then over time, that swelling is going to go down.
And, you know, there's, there's a variety of factors of how long [00:10:15] that takes, right? If somebody's retching a lot or throwing up a lot, that's going to irritate your stomach and that swelling may stick around longer. For people who don't have that, that's, that swelling may go away quicker. But as that swelling starts to reserve or to [00:10:30] resolve, things start to kind of take the shape that they're going to take long term.
But you only have it compared to when you woke up from surgery and now three months later, six months later, oh my goodness, this is different. The other thing is, is you [00:10:45] start when you hit that three to six month window, you start to be able to experiment with foods, right? You know, usually for the first four to six weeks, depending on your surgeon's recommendations, you're on, you know, stages or phases of a diet.
And it's really based on [00:11:00] consistency. Obviously we're trying to get you to eat healthy foods, but it's more of like liquids to thicker liquids, to kind of a soft mushy foods, to maybe certain things you can chew up. And then you eventually don't have, uh, really any restrictions whatsoever as far as consistency.[00:11:15]
So as you that in itself for anybody listening, that's a great example of proving to yourself that there was swelling and now it's getting better because if you can eat chew up ground beef four weeks after surgery, six weeks [00:11:30] after surgery. You know, you would have never tolerated that at week two and things don't change that quickly except for the swelling.
So you're now navigating through more food choices, right? You're now starting to find certain things [00:11:45] that you tolerate and you start to gravitate towards things that you tolerate subconsciously. Oh, that soft stuff that I eat that I kind of have to chew, but I don't really have to chew completely. I can eat a little bit more of that and I've been so [00:12:00] focused on getting my nutrition, getting my calories.
My doctor's saying, Hey, you got to get your protein. That this is the thing that I can do to eat, to be able to get that accomplished. And then all of a sudden, Oh, I didn't used to be able to eat this much, [00:12:15] right? So, you know, you've heard slider foods and things like that. You start combining some liquids with some of the solids.
And so there's multiple factors that play a role as to why that tolerance or that capacity increases. [00:12:30] And it does increase compared to early post op. But it's not increasing above and beyond what, what normal should be. And I think, you know, we don't want, as surgeons, we don't want the patients To [00:12:45] feel like they're having to force nutrition in to meet requirements.
That's not how this should work. That's why the bands failed drastically. Cause so many patients were told, you know, we just need to make you so tight. I'll [00:13:00] never forget years ago. We had a band rep, I won't say the company, cause there were two different companies, but one of the reps would literally say, oh, I just get, I go out and I do these talks with patients and I bring in chicken nuggets and I bring And I say, if you can [00:13:15] eat this one chicken nugget, but it takes you multiple bites, then you're, you're tight enough.
And I'm like, well, we've missed the boat if we're teaching them to eat chicken nuggets. Right. But you're creating that sensation of, oh, two bites. I feel it in my throat. That's going to [00:13:30] help you lose weight. That is not how we want you to lose weight. We want you to be able to eat. within reason, a normal portion, um, for your new stomach, but you have to be able to get in enough nutrition or you can't support your muscle mass.
You can't [00:13:45] support weight loss and you can't support nutrition in general to set you up for success long term. So for patients just think swelling, swelling is getting better. That's why there's really a change and your tolerance of a [00:14:00] variety of foods and allowance to try foods has gone up too.
Jason: Yeah. And that's, that's really a lot of what we find, you know, when you hear people around that timeframe, like what you were talking about with the, being able to tolerate the softer, the softer foods where people will either go back [00:14:15] to the puree diet, or they'll go back to the soft food diet and stay extended periods of time because they're like, well, it just feels better.
It's just, it's easier for me to take. I don't feel as nauseous. I don't feel sick, but at the same time, a lot [00:14:30] of, you know, the, the thing that we're trying to get across is that you're also not getting the proper amount of nutrition that you're, you need to get, because it's probably not made the same way, you know, you're probably not adding extra protein to it or your, there's things that you're missing out on [00:14:45] if you stay on that or the, you know, the dreaded pouch reset, I'm just going to go back to all liquids for a little bit.
Cause it just feels better. And it's like, it doesn't, doesn't. Work that way, but cool, like, do you, but if you call your doctor, they're not going to tell you, they're not going to tell you that works that way, [00:15:00] but at the same time, it's just, it, it really shows, you know, how desperate people are to make sure that they don't make mistakes, but they want to feel good at the same time.
And like you said, it does kind of create a sort of disordered eating mindset [00:15:15] when you, you know, when people are just striving for the numbers and not worrying about anything else. Like if I, Oh, I got to try to, you know, you wind up, could wind up hurting yourself. There's lots of things that can happen if it's not done the correct way, which is why staying in touch with your surgical center or, you [00:15:30] know, your dietician, or it's so important, especially in these stages.
April: I'm so thankful, Jason, that you, that you brought that up, right? Because it can trigger us in a lot of different ways and it can push us in, in different directions, right? Either I'm [00:15:45] going to force myself to, to eat, even when I'm having a difficult time doing it, or I'm really going to monitor and restrict because I'm just so worried that I'm going to go over those macros.
Dr. Hayek, that's the question that we wanted to ask you. Why is [00:16:00] it so important after surgery, especially when we get to that six to month sick, or excuse me, three to six month mark that we are focusing on, on being okay with eating, eating more, right? Because that increased capacity means [00:16:15] now we can, take in more nutrients.
We can really hit those goals that have been set forth for us and we can help repair and start to rebuild maybe some of that muscle that we lost. So can you speak to that? Why is it important that we can eat more? Absolutely. So that's, [00:16:30]
Sarah: this is where we want to be, right? And I think that can be hard to understand that this was the goal.
This was always the goal. We wanted to be here. We just went through a process. To get here and that [00:16:45] process to get here was a huge swing in both directions, right? We started off somewhere very different in what we could eat, what we were eating, the choices we were making. Then we completely stepped back away from that.
But we don't want to [00:17:00] be over here the whole time. We want to come back to the middle. We want to be there where you're having a fulfilled life, where you're having a balanced diet, where you're focusing on feeding your body good foods and maintaining a healthy diet. [00:17:15] Right, because we started off with maybe not the most healthy habits, but if we stay in those post-op diets, we're not doing healthy habits either.
And we're not supporting a healthy body. Right. We're, we're doing what we need to [00:17:30] for what our body just went through. Absolutely. We're recovering from a major event. Bariatric surgery is a major surgery. I know we do it through small incisions. We just did something pretty impressive inside your [00:17:45] body.
You need to recover from that, and that's gonna mean some restrictions. It's gonna mean slowly getting places, but now we finally get to where we want to be. But it's so often that we don't focus on the three to six month [00:18:00] mark when we're preparing for surgery. right? There is so much information coming at you.
At some point, we need to draw a line and say, we can only focus on this much. And so we usually focus on that. Let's talk about the post op. Let's talk about [00:18:15] recovery. And then how do we get to where you want to be? And this is normal for you now, like you need to achieve normal. This is good, but now we need to support a healthy body.
We want to make sure that you lose weight in the right ways, because if we're just focused on losing [00:18:30] calories or losing weight. then we're also potentially losing protein and muscle. And if we do that, we get ourselves kind of boxed into a corner where now you can't eat because you don't [00:18:45] have enough muscle and protein to support a normal healthy diet.
We in our office have this really amazing ability to do a body composition on our patients and to watch what happens to your muscle and your protein. [00:19:00] And if you continue to stay in that postoperative restriction, you see that protein starting to fall off of our patients. They're losing their skeletal muscle and all of a sudden the number of calories they can eat in a day starts dropping pretty quickly.[00:19:15]
And you got to watch out for that. Because now, even if you're eating good things, you're going to go over your, what your body can tolerate in a day, and you're going to get weight reeking, and that's when we start to get into real difficult spaces for [00:19:30] people, both physically and mentally, being stuck in that position.
So we want to make sure that we are feeding the body appropriately and using the body appropriately. But you can't use your body appropriately if you aren't giving it the fuel that it needs. [00:19:45] So it needs fuel. You're also likely going to start increasing your activity at this point. You're probably starting to feel better.
You're starting to have a little more energy and maybe that knee pain is gone. Maybe we can start doing things. You're going [00:20:00] for walks, you're getting out to the gym, those sorts of things. We need to support that activity too. So it's so important that we are establishing a new normal, embracing this as the new healthy normal.
And that we use it to fuel our body to [00:20:15] do all of the things that we were hoping that we could do and to start exploring the boundaries of what can we do now.
Jason: Yeah, it's one of those, you know, we talked to a lot of people about the fact that this is a journey unlike anything you've done before. Like, we've done [00:20:30] diets, we've done things, we've done all types of different things, but we've never, Continuously lived a healthy, sustainable type of life.
And so it's the, what, what is my plate supposed to look like? What does that movement look like? [00:20:45] How does one fuel the other? Because I remember myself in those stages, like what you were talking about in the three to six month stage, Dr. Hayek is people are like. They, you know, you've been on liquids and soft for so long.
All you want is real food. So you, [00:21:00] you get so hyper focused on the timeline, but not what it looks like. You don't care what it is. You just want to eat. You're like, I just want to eat something. I can't wait till I can choose something. I just want to eat. I'm tired of mashed potatoes or beans or whatever it is that you've been eating.
And [00:21:15] so once you get to that point, like I remember myself, uh, because I've told everyone this plenty of times. Once I hit the point where my, they were just like, Now you're free to, with no restriction to eat whatever. That scared me to death because I was [00:21:30] like, wait a minute, cause I don't know what that looks like.
Don't tell me to eat whatever. Cause I'll, I do not need to hear that. I was like, I need to hear these are the things that I can, these are the areas I can start dabbling in, but just telling me to do, you know, do whatever. I'm like, nope, I [00:21:45] don't like that. Because I, I've lived, I know how to live an unhealthy life because I did it for so long.
And so. It is a really delicate balance. Like what you had talked about, like to be able to fuel the body enough to be able to [00:22:00] move, like we're going to need to move to maintain all those levels, because we want to go so far on that pendulum to the point of why if I'm only getting 1200 calories, then I'll be great because that's what they said, 1200 calories forever.
It'll be fantastic, but that's [00:22:15] just 1200 calories in the initial to make sure that you're good doing what you're doing. Once you start moving. They're going to tell you, like, we got to up that we've got to move some things around. You need to be able to have this much intake of, of a starch or a carb or this or that, you know, to be able to [00:22:30] maintain like what you're talking about.
So I'm really glad you brought that up because it's super important for people to understand.
April: And for patients like Jason and I and like you, if you're listening or watching right how you ate before surgery, you are [00:22:45] looking for a departure from that. But you could also experience some grief and loss over.
I can't eat like that anymore. So you have bariatric surgery and you're hopeful that I'm going to eat soon. So little, and I'm going to have so little desire, right, to eat. [00:23:00] And if we stay in that mindset, it will be equally unhealthy for us. Just like what you said, Dr. Hyde, we're going to lose muscle mass.
We need, we need protein. We need nutrients to allow our bodies to do the things that it wants to do. So as a patient, you're, you're [00:23:15] almost doing what you feel is rocket math, because I don't want to get back to the point where I'm eating larger quantities of food. I'm terrified about that. Okay. And if you don't have that, that education behind why we eat, why we need to eat and the importance of it, [00:23:30] especially in that three to six month mark, when it comes to our muscle mass, maintaining muscle mass, we, we can be in a very dark, scary place, which is why this conversation is so critically important.
It's why it's amazing that both of you are in your patient's corner, helping them understand [00:23:45] this. And if you are a member of the Bari Nation membership community, you can attend support groups, classes, and meetups that are going to help teach you. All of these things that we're talking about today, uh, in a more interactive manner, right?
So if you have more questions about [00:24:00] why eating, uh, in that three to six month mark is so important, the important foods to eat during that time period, uh, and just connecting with other patients who are probably thinking the same thing you are, join the Bari Nation membership community and access, access this [00:24:15] support.
Dr. Smith and Dr. Hayek, thank you so much for joining us today. Before we wrap up the conversation though, I would love to give you both, uh, a final moment to pass on some words of wisdom. So this is for [00:24:30] both of you. If a patient came to you and they said, I am really panicked because I can eat now half a cup or a cup of food.
What would you tell them? Dr. Smith, we'll start with you.
Eric: The first thing is to not fall into that [00:24:45] trap that you're having this surgery so we can ultra restrict your food long term to help you lose weight. And I think it's easy to fall into that trap because we, you know, your, your stomach's changing size and we know we're doing these things, restricted [00:25:00] things to your body.
But you fall in, you, you fall into that trap, as I've said three times of like, okay, the less I eat, the more weight I'll lose. Thanks. You've always wanted to not be hungry. You've always wanted to not feel [00:25:15] like eating that extra bite. And at the end of the day, we don't want that to be the method or modality that helps you lose weight.
What we want is the surgery and combined with your lifestyle changes to give you that kickstart to help you [00:25:30] hormonally overcome the disease you have, but to educate you on how to eat. a healthy diet. Um, and, and that is eating a healthy diet is going to support long term weight loss. That's unfortunately why [00:25:45] we have seen, you know, the sudden burst of the GLPs.
And now we're hearing a lot of these horror stories combined, combined with these sex, success stories, because many of those people were just given a drug and says, Oh my gosh, this is [00:26:00] amazing. I feel like I'm going to vomit, but I'm not hungry. And that's not really how we want. The mechanism to be to help you lose weight.
Um, we want to educate you on yes, maybe we don't want to exceed the calories that you have in the past, but [00:26:15] more importantly, we want those calories to be good calories. And so it's okay to eat a normal portion, you know, it's okay. Don't let somebody look at you and say, I can't believe you can eat that.
And you've had a bariatric surgery that we could do three more podcasts [00:26:30] on that. I know, but we, we want to continue to remind them like, like Dr. Hayek said early on that restriction is the nature of the surgery. And yes, your restriction will always be there compared to before, but we [00:26:45] want to get you to the point that you can eat.
a reasonable serving of food, we want you to fill that space up with a healthy source to change your body composition for the better, which is setting you up for long term [00:27:00] success. Simple things like getting adequate protein, taking adequate vitamins. These are not just checking boxes. Dr. Hack and I've been talking about that a lot lately.
They are actually setting you up for success. [00:27:15] Maximizing your nutrition is a major factor in you not only losing weight, but having the best chance to maintain weight loss. It's not just a rule. And so we want you to have room. This is a good thing. Just like she said, this is where [00:27:30] we want you to be. So, you know, just remember this early stuff is just surgery early stuff.
The journey is lifelong and continuing to find those healthy habits. So always go [00:27:45] back to that and check in with your team. You are going to be anxious. It's okay to check in and say, am I freaking out over nothing? But understand we want you to be there. We want those good choices to be combined with the tool that we gave you.
April: [00:28:00] Perfect. Dr Hayek. Well, what would you say?
Sarah: So I think it's a shift in mindset from a volume to a quality. It's okay. It's okay that we [00:28:15] have some increased volume, but are we increasing the quality as we're doing that? Because, you know, sure, you can sit down and eat a cup full of you know, whatever your favorite sugary cereal is, that's [00:28:30] fine.
But are you going to feel like that was quality calories? Is that really feeling what you need? We can make other choices. We can go to proteins. We can go to foods that fuel us, that [00:28:45] make us feel good after we've eaten them, that allow our bodies to do these wonderful, amazing things. And that comes from quality, not quantity.
Quantity kind of follows [00:29:00] quality. High density nutrition, nutrition foods tend to be high powerful foods that are in smaller quantities, but you feel fuller from them. A lot of foods that [00:29:15] we can go to and eat a ton of, we can eat a ton of because they don't have a lot of nutrition to them. So if you're finding like, Oh my gosh, I'm eating so much.
Okay. Let's talk about what quality are you eating? Are you eating? [00:29:30] high quality foods and a lot of them, or are you eating low quality foods and a lot of them? And what are those two doing in your body? So change it from volume. Volume is certainly something that we think about, but let's replace the number one thing we think about as [00:29:45] quality.
Am I choosing quality foods for myself? Am I fueling my body? Because if I'm not feeling my body, why am I putting this in my mouth? And what is it going to do for me? It's intention, right? Think about it [00:30:00] intentionally. Feel your body first, and if it's not a thing that's fueling your body, what is it doing, and why?
Sometimes those things are important for us to understand too, but think about why. So quality and [00:30:15] your why. When my kids come and they say that they're hungry and they've already had six snacks, I'm like, eat a banana. Here's a banana, right? The requirement for snacks immediately stops. It's funny how that
April: works.
It's funny [00:30:30] how that works. Oh my goodness. Dr. Smith, Dr. Hyatt, thank you so much for joining us today. We know How busy you are. We appreciate you and all of this expertise that you are passing on to everybody in the Bariatric community. Thank you. [00:30:45]