For those of you in the Northern Nevada or Lake Tahoe region, I have completed a TV interview on the subject of the emerging technological frontiers in weight loss surgery, to air within a week or two with Wendy Damonte, the anchor of Channel 2 – KTVN. 

  I discuss some of the recent breakthroughs occurring in the field of weight loss surgery and in revision weight loss surgery.  A number of exciting developments have evolved over just the last year or two.  Among these is the emergence of laparoscopic sleeve gastrectomy as a viable, effective alternative to gastric bypass or gastric banding.  While not perfect, sleeve gastrectomy offers an intermediate choice and is also a laparoscopic or minimally invasive operation.  It appears to have good weight loss results, though we do not have good long-term data beyond a few years.  There are, of course, risks and side effects including risks of nausea, indigestion and reflux or heartburn symptoms.   

In addition, I talk about revision of gastric bypass surgery and stretched pouches that I am now doing with an endoscopic technique, with no incisions whatsoever. The medical device is called StomaphyX, made by Endogastric Solutions, a company aimed at reducing the invasiveness of gastrointestinal surgical procedures. This emerging technology appears to hold promise for reduction or shrinkage of stretched pouches that may reinvigorate weight loss.  Thus far the patients for whom I have performed the Stomaphyx procedure in this region are losing weight and feeling satiety again!

  I also mention the REALIZE gastric band and how it will compete with the LapBand in the years to come.  Both are outpatient procedures done laparoscopically with good long term weight loss results.

There are many other exciting developments in the field of weight loss surgery including trials that are ongoing with intragastric balloon and the electronic gastric pacemakers.  These two technologies hold some promise, but in their current form do not appear likely to have a great impact due to side effects and limited effectiveness.  But often one technology spawns newer and better technology and that may be the case with these.

  I will update you on the time of the broadcast and thank you for tuning in. 

Get Started!

 Losing weight is among the most important things you can do for your health and quality of life.  Even modest weight loss will improve your chances of avoiding sickness, diabetes, infection and high blood pressure. None of these are cosmetic issues. 

The solutions to help you lose the pounds and keep them off are better than they have ever been before.  Weight loss with medical supervision is a growing, and increasingly successful method of losing weight.  You can succeed, and no goal is more worth it.

 Aristotle once said, “We are what we repeatedly do. Excellence, then, is not an act, but a habit.”  Successful weight loss means establishing excellent habits. 

Here are the Top 10 tools for weight loss success you can start today.

1.                  Set a short term goal today. 

How many pounds do you want to lose in the next 1 month?  Write it down.

Write an even shorter term goal of your plan to weigh yourself daily, exercise five hours this week, and avoid desserts this week.  No one can accomplish a long-term objective all at once.  It takes time and baby steps.  Plan that first baby step in detail.

2.                  Park two extra rows away from the entrance to your work. 

Two extra rows away might not seem like much, but think of adding 50 extra calories a day to your regimen from parking and walking; that’s 18,250 calories in the course of a year.  That translates into over five pounds lost every year, just from this one change!

 3.                  Serve yourself on a smaller plate. 

We get used to big portions on big plates, but research suggests we feel just as satisfied with a small plate of food.  Have you ever really enjoyed the ninth bite of apple pie quite as much as the first bite?  If we use smaller plates, we feel just as satisfied, and, you guessed it, we end up consuming far less calories.

 4.                  Walk up one flight. If you are only going up one level, make yourself walk. Think of the advantages.  For one thing, you don’t have to wait, and then stand in a crowded elevator with a bunch of strangers who don’t share your tastes in cologne.  One flight can burn over 16 calories, and it probably will even speed up your arrival. Make it your habit.    5.      Eat breakfast every morning.  It turns on our metabolism, and we burn more energy through the day.

Skipping breakfast means eating later meals throughout the day and night, a pattern that leads to increased fat storage.  The key is to avoid the harmful high calorie, high carbohydrate offerings such as donuts and fast food.  It’s really the ideal meal of the day for a healthy protein bar.  The best ones contain around 150 to 230 calories and 12 to 15 grams of protein with less than 10 grams of carbohydrates.

 6.                  Brush your teeth an hour earlier.

Then keep them clean and have only ice water the rest of the night.

Who doesn’t like to have fresh, minty clean teeth?  Sometimes around 7:00 p.m. there comes a vague decision to have more food, dip into the ice cream, or pop some popcorn.  We could really do without the calories, and we’re not that hungry then anyway.   Most of us will just skip the late night snack if we already brushed.

 7.                  Read every label. 

We tend to change our own shopping behaviors without real outside pressure, once we become knowledgeable or mindful of the consequences of our behaviors. So can you become more mindful just by reading the label?  You bet you can.  Your goal is to reduce calories, but more importantly, reduce carbohydrate calories.  And pay attention to the serving size on the label, too.

8.                  Make a rule opposite to what your mother told you:  Always leave food on your plate.

Never finish all of anything, no matter how good it is.  Unfortunately, in this one case, mother was wrong. Telling us to finish everything on our plate was a bad idea, in this modern, overweight world.

9.                  Find rewards for yourself other than food:

massages, good books, movies, visits with friends, clothes.  Reward yourself with these treats.  Just make them anything but food. Celebrate your successes.

10.              If you watch TV, new rule: no sitting.

Studies have shown standing and pacing burns over twice the calories of sitting. Just imagine if you used that time to exercise, even if only mildly.  The result would be a substantial caloric burn. A simple change from sitting to standing or pacing while watching TV can lead to significant weight loss.

This is your life.  Your choices define you, your health and your quality of life.  Don’t give up.

Today, weight loss solutions exist that can help you lose the pounds, improve your health, and live longer.  Nothing is more important for your health.

Kent C. Sasse, M.D., MPH, FACS

Medical Director,

International Metabolic Institute

www.iMetabolic.com

Revision weight loss surgery is sometimes necessary and sometimes very beneficial to re-start the weight loss process.  Over time, some patients with gastric pouches after gastric byass (RYGB) or sleeve gastrectomy (SG) will feel that they can eat substantially more, and feel they have lost a sense of restriction.

Sometimes the pouch is larger on an upper GI Xray, done with Xrays after taking oral contrast.  Sometimes the pouch looks the same but it no longer produces the restricted outflow it once did.  Other times, rarely, new complications may have arisen, such as a fistula, or connection to the larger portion of the stomach.

With hundreds of thousands of Americans and millions of people worldwide having undergone weight loss surgery in the past years, more patients are seeking revisions years later.  In the past the only options were to perform a type of open revision procedure, or to simply press on with nonsurgical efforts.

Times have changed.  A number of revision options are available and successful.  Most commonly, a stretched pouch can be surgically revised with a laparoscopic surgical technique.  The goal is to create another, small, pouch, and re-establish the sense of restriction and satiety.  Other times a laparoscopic adjustable gastric band (LAGB) can be placed over the prior surgery to create better restriction.  These both work in many cases, though certainly not in every case.

Additionally, sometimes a procedure can be converted to a diffferent type of surgery, such as converting a LAGB to a RYGB or biliopancreatic diversion (BDP).

Most recently, the use of Stomaphyx, an endoscopic technique performed with a scope passed down the throat, can be used to revise and tighten a stretched pouch.  It advantage is that it is the least invasive procedure.  Its disadvantage is that long term data are not available.

In sum, many options exist for a patient who has had weight loss surgery and is now re-gaining weight.  A medically-supervised weight loss program, sometimes with the aid of prescription weight loss drugs, is often helpful.  Re-dedication to the weight loss goals, renewed commitment to long term successful behaviors of shopping, eating, and exercise, are essential.  And if surgery is being considered, a visit with an experienced bariatric surgeon who has performed many types of revision procedures is often very helpful.  There are many good options available, and the goal of improved health and healthy weight loss are too important not to explore every option.

One of the most exciting developments in the field of weight loss surgery is the emergence of new technologies that allow revising and shrinking stomach pouches without surgical incisions.

 An FDA approved device, called Stomaphyx, is available through my surgical practice at Western Bariatric Institute and selected other centers nationally.  It allows the experienced bariatric surgeon to approximate tissue, and reduce the size of a stretched stomach pouch.  This is particularly appealing for people who have previously undergone Roux-en-Y gastric bypass and have experienced stretching of the stomach pouch.

I perform the procedure under anesthesia, by passing a flexible tube down the mouth and esophagus, and into the stomach pouch.  There, the pouch tissues are brought together using advanced technology creates plications, like sutures, in the wall of the stomach pouch.  The result is a much smaller stomach pouch and a renewed sensation of gastric restriction.

WHY DIETS LEAD TO REBOUND WEIGHT GAIN AND HOW MEDICALLY SUPERVISED CALORIE RESTRICTION CAN BE BETTER

Rebound Weight Gain causes almost all diets to fail. As seen on Forbes. com, (Click here for article), I have worked to help people avoid this frustrating problem after all the hard work of losing the weight with a diet. And there is a better way!

Successful weight loss does not happen by magic. There are no solutions that take all the burden off your shoulders and eliminate the need for hard work, dedication and perseverance. And yet, clearly some weight loss solutions succeed much more often than others. Diets, by and large, do not work. But what do we mean by “diets”?

Generally, what we mean by diets are temporary changes in one’s nutritional intake that result in a significant calorie intake reduction. There are numerous published diets, fad diets, and many personalized diets that individuals have used before to lose five or ten pounds prior to summer season, for example. By and large, these involve eliminating certain food groups or certain subsets within the diet and, in addition, restricting calories a great deal through certain mechanisms such as simple avoidance or substitution with very narrow list of foods, like raw carrots.

Why don’t diets work? Diets don’t work because they don’t involve a plan to transition to future phases of the diet or to a maintenance program. Diets don’t work because they are not sustainable as eating behaviors beyond a very short term. Diets don’t work because they feel like deprivation and they require a high level of motivation to deprive oneself. This does not last.

And lastly, diets don’t work because they don’t involve creating the right kind of calorie intake that can result in appetite suppression, as well as maintenance of lean body mass. Nearly all diets that people try result in burning of lean body mass or protein mass to an equal or greater degree than burning of the fat mass. When the diet comes to an end, a phenomenon known as rebound weight gain occurs as a result of the hunger and nutrient deprivation experienced by the muscles. So it’s a very powerful biochemical response that leads to an even higher level of hunger and a rapid rebound weight gain.

So if diets don’t work, how can “calorie restriction” work?

Well, calorie restriction can work if it is used properly, if it involves the proper selection of foods, and if it employs the optimal techniques to avoid rebound weight gain. Let’s examine what those are:

First, calorie restriction needs to reduce carbohydrate calories. The most potent stimulus of circulating blood glucose is carbohydrate intake. The carbohydrates stimulate secretion of insulin and leptin into the bloodstream and these surges of hormones cause surges of satiety followed by equally powerful surges of hunger. Protein and fat stimulate these responses to a much less degree. It’s true that protein, and its building blocks, amino acids, do stimulate a rising blood sugar, but it is much less potent in effect than carbohydrate intake. Fats, interestingly, do not stimulate a rise in the blood sugar or insulin. So one of the keys to successful calorie restriction is to limit the carbohydrate intake and try to dampen these surges in circulating blood glucose and the hormones, insulin and leptin. You will then experience less hunger during your calorie restriction. It’s well known, for example, that people on an Atkins type diet that emphasizes protein will feel less hunger and greater satiety over the course of the yearlong dieting attempt than people who attempt to consume a low fat diet that does not restrict carbohydrates. As a result, the diet that restricts carbohydrates and allows more protein, results in somewhat greater weight loss over the course of the year. These findings have been reported in 2007 after a major national trial, and made headline news in the New York Times.

Next principle – protect lean body mass. How do you do this?Two ways:Exercise and protein and vitamin intake. So the key is to try to burn as much fat mass as possible while preserving all the muscle mass that we can. This is best accomplished by adequate intake of protein with a wide variety of amino acids, and an adequate vitamin intake.

Next, you must think of the calorie restriction as a step toward long-term weight loss and this requires developing a transition plan. Ideally, this means setting a number of weeks for the initial calorie restriction component and then having a planned transition to the next phase that is also clearly defined. We are much more likely to comply with the program if the program is clearly defined. That way we know exactly how many days we have to follow one regimen and we know exactly when the transition is to the next regimen.

Next, the calorie restriction program needs to be very well spelled out. This is one reason why meal replacement programs work so well. The “diet” is not open to discussion or debate. It is very clearly laid out for you:Meal replacement shakes and bars through the day at prescribed hours with no substitutions and no variations. Period. Simple.

As a weight reduction program prior to bariatric surgery.

Here is a role that has proven very successful for calorie restriction programs. For successful weight loss surgery to take place, it is best to optimize your condition prior to undergoing surgery. There are numerous studies indicating that if a patient loses weight prior to surgery, their outcome is improved. In addition, there is specific information about calorie restriction resulting in a very advantageous shrinkage of the liver prior to bariatric surgery. The liver shrinkage makes for less cracking and bleeding and less chance of conversion to an open operation. So a four to eight-week program of calorie restriction, ideally using meal replacements, is very helpful for the successful outcomes of weight loss surgery. And the added advantage is that the time frame is very finite. There is a clear transition to the “postsurgical diet” and a clear transition point on the date of surgery after which eating will never be the same again. The vast majority of people who lose weight with a preoperative calorie restriction weight loss program will never see those pounds again in their lifetime.

As a weight reduction “induction” program in a medical weight loss center.

Here, an individual begins his or her weight loss journey with a powerful initial induction program that consists of significant calorie restriction using meal replacements. The choices are eliminated, and a strict regimen of shakes and bars, fluids and vitamins is established. In some centers, prescription appetite suppressants are added. During this phase, the individual loses weight rapidly, usually 2-4 pounds per week. At the end of a 12 week program, a substantial weight loss has occurred. But the only way it will succeed is if the 12 weeks are used learning behaviors that will succeed for the long term. Transition to a plan of slowly introducing real foods occurs next. These real foods contain lower calories and carbohydrates than the individual was consuming under their old bad habits. The best centers teach motivational and will power techniques that enable the person to fight the hunger and stick with the healthier, lower calorie, lower carb meals and snacks. In time, the whole package of induction, behavior techniques, motivational tools, group support, prescription medications, and meal replacements come together for a person to succeed long term. It’s not magic, but it works.

So in summary, calorie restriction does work if used properly. The critical elements are to reduce carbohydrates, maintain protein, amino acid and vitamin intake, exercise is critically important to maintain lean body mass and avoid rebound weight gain. View the calorie restriction as a key step towards a long-term goal of weight loss. Define the calorie restriction time frame very clearly, whether it is four weeks, eight weeks or 24 weeks. Have a clear date on the calendar when the calorie restriction period ends and know what you are transitioning to. This is often a good time for some professional help as it is difficult to craft a healthful and effective long-term maintenance program. Calorie restriction works very well in preoperative weight loss and as a weight loss program to move off of a plateau or to reverse a relapse or period of weight gain. Meal replacements work best as they take away all the choices in the day and the opportunity for cheating or rationalizing extra calorie consumption.

What experiences have you had with calorie restriction?What has worked for you and what has failed for you?

For more information on this topic and the keys to how YOU can successfully lose the weight, look at the Special Reports section on this website. I wish you great success in your own weight loss journey.

Happy Holidays! Potential Nutritional and Vitamin deficiencies following bariatric surgery.

While we are all thinking of finding some healthy holiday meals, and enjoying some excellent holiday recipes, let’s not forget our important vitamins!

Modern weight loss surgery is a highly successful intervention by almost any measure. In numerous studies modern weight loss surgery is demonstrated to prolong life, improve quality of life, and reduce the incidence and impact of many health conditions including diabetes, hypertension, hyperlipidemia, obstructive sleep apnea, degenerative joint disease and many others. But weight loss surgery can lead to vitamin and nutritional deficiencies in some cases. These deficiencies can be serious, so it’s important for patients to prevent them by remembering to take the vitamin supplements your bariatric surgeon recommends!

Some overweight individuals have preoperative vitamin and nutritional deficiencies before they ever even attend a weight loss seminar. After bariatric surgery, the most common deficiencies occur in the operations which have a “malabsorptive” component, in which some of the intestine is bypassed, and some of the nutrients are not absorbed. In some intestinal bypasses performed prior to the 1970s, numerous nutritional deficiencies occurred that in some cases led to liver failure and hurt the reputation of weight loss surgery (despite the deficiencies, however, patients who had jejunoileal bypass markedly outlived their obese counterparts who did not undergo weight loss surgery).

Today, the frequency and severity of vitamin deficiciencies is least after LapBand surgery (which usually requires only the Omni Bariatric Vitamin supplement), then increases with Gastric Bypass (which requires the vitamin supplements listed in the table below), followed by further increases with Biliopancreatic diversion or long limb gastric bypass (even more nutritional/vitamin supplements needed – email us for a list). In the vast majority of cases, vitamin deficiencies can be prevented by taking the vitamin supplements your bariatric surgeon recommends. Western Bariatric Institute makes all of these supplements, made in FDA-inspected labs, available on our website at www.westernbariatricinstitute.com.

VITAMIN SUPPLEMENTS NEEDED AFTER GASTRIC BYPASS

IronIron deficiency anemia is among the most common nutritional abnormalities. Many female preoperative have iron deficiency, as high as 44% of patients in recent studies, including one in the Journal of Gastrointestinal Surgery. After Roux-en-Y gastric bypass surgery, as many as 75% of patients exhibit iron deficiency anemia if iron is not supplemented and the condition not treated.

Gastric bypass leads to iron deficiency anemia in large part because the bypassing of the acid-producing portion of the stomach prevents the reduction of iron to the absorbable ferrous iron. If you are experiencing symptoms such as fatigue or discomfort or enlargement of the tongue, these could be signs of significant iron deficiency anemia. Sometimes people with iron deficiency also feel cold even when the room temperature is normal. The problem is detected with a routine blood test, hemoglobin and serum iron studies (iron level, TIBC, ferritin, transferrin)

Iron deficiency is common enough that iron supplementation is recommended for every patient undergoing weight loss surgery. We generally use ferrous sulfate, 325 mg p.o. daily or this can be increased to twice a day. For more severe cases, intravenous iron infusion may be required.

Vitamin B12

B12 (cyanocobalamin) deficiency is common following bariatric surgery, especially Roux-en-Y gastric bypass surgery. The decreased exposure to stomach acid and the less overall secretion of stomach acid leads to less release and absorbtion of vitamin B12 from foods. Oftentimes, patients consume less B12 because foods such as beef and chicken are consumed less frequently.

Sometimes people who are deficient in B12 may also experience tingling or numbness in their hands and feet, or unsteady walking. Sometimes people experience an enlarged tongue, weakness or depression. Because B12 deficiency would occur commonly after gastric bypass surgery, it is a standard recommended supplement postoperatively. This is given either as an intramuscular injection monthly with 1000 to 3000 mcg per injection. Intramuscular injections are available locally at iMetabolic, at 971 W. Moana at Lakeside. More recently, good absorption of B12 occurs with sublingual preparation and nasal sprays. Our standard practice is for every patient to take sublingual B12 daily for a lifetime. Sublingual B12, and all of the vitamins we recommend, are available at our website and soon at the WBI Arlington office itself, after the renovations are done!

Thiamine

Thiamine is otherwise known as vitamin B1. Thiamine is found in foods such as beef and pork and to a lesser extent in some legumes, dried beans, peas and in certain grains. Mild thiamine deficiency is fairly common among seriously overweight individuals prior to surgery and can worsen after surgery or any prolonged illness with vomiting. The symptoms of thiamine deficiency can be vague and include fatigue, poor memory, appetite suppression, abdominal discomfort, difficulties with balance or unsteady walking, even confusion or neurologic changes. It is supplemented in the bariatric multivitamins an can be further supplemented if necessary in rare cases.

Vitamin B6 (pyridoxine)

Vitamin B6 is present in meats, beans, whole grains and certain nuts. Many people are deficient in B6 if it is tested rigorously. The incidence is probably increased after gastric bypass and bariatric surgery. It appears to be well absorbed and effective if given in a standard multivitamin dose. There are symptoms such as those of thiamine and B12.

Folic acid

Folic acid is important for red blood cell production. It is present in green leafy vegetables, as well as beans. Folate is another B complex vitamin that is absorbed less after gastric bypass surgery or any procedures that decreases the stomach acids’ contact with the meal. Confusion, weakness, anemia, enlarged tongue and neuropathy are all symptoms of thiamine(?) deficiency. It is treated with thiamine replacement and is generally bioavailable in the multivitamin. It can also be given as an intravenous supplementation.

Calcium and vitamin D

Mineral calcium and vitamin D are interrelated as they work together in maintaining the serum calcium levels. Vitamin D is found in milk, eggs, fish and liver. Calcium is present in dairy products. Calcium deficiency may result after gastric bypass and Vitamin D deficiency may result from any type of intestinal bypass procedure that leads to decreased absorption of fat-soluble vitamins. Fat-soluble vitamins (A, D, E and K) tend to be reduced most in biliopancreatic diversion, duodenal switch, and jejunoileal bypass. The fat-soluble vitamins can also become deficient in patients taking Alli or Xenical, the fat-blocking weight loss drug. The active form of vitamin D requires sun exposure to the skin.

Deficiencies of calcium and vitamin D lead to increased breakdown of bone deposits to liberate calcium for the bloodstream. Symptoms of vitamin D and calcium deficiency are muscle aches, fatigue, joint pain. Progression to osteoporosis increases risk of bone fracture.

Calcium and vitamin D should both be supplemented with1200 mg of calcium and 8 mcg of vitamin D or more. Some bone loss appears to occur with significant weight reduction independent of calcium and vitamin D deficiency.

Vitamin A

Vitamin A is a fat-soluble vitamin present in an array of foods including dairy products, pumpkins, cantaloupe and liver. Deficiencies of vitamin A can lead to night blindness and ocular symptoms. Deficiencies of vitamin A generally occur as a result of the deficiencies that involve the fat-soluble vitamins. This generally results from an intestinal bypass procedure such as jejunoileal bypass (no longer performed) or biliopancreatic diversion/duodenal switch procedures. In these procedures, fat absorption is markedly impaired. There is the potential for vitamin A deficiency with use of Xenical or Alli weight loss medications.

Treatment can be given with oral or intramuscular vitamin A. Specific oral vitamin A routine supplementation is not generally felt to be necessary after Lap Band or gastric bypass, but is necessary after duodenal switch or biliopancreatic diversion.

Vitamin K

Vitamin K is a fat-soluble vitamin present in green leafy vegetables. Deficiencies can lead to impairment of the blood clotting system and therefore lead to bruising and bleeding of the gums. Vitamin K deficiency is possible after procedures that result in significant fat malabsorption such as biliopancreatic diversion or duodenal switch and jejunoileal bypass. It appears to be less common and reported and is not routinely supplemented or tested.

Vitamin E

Vitamin E is found in green leafy vegetables, nuts, seeds and vegetable oils. Vitamin E deficiency appears rare and is associated with neurologic symptoms. It is not routinely tested or supplemented.

Protein deficiency and muscle wasting

Protein is increasingly recognized as import for maintaining muscles and for helping with weight loss. Bariatric centers generally recommend a person consume between 60 and 100 grams of protein daily.

Protein deficiency is often detected by serum protein measures including total protein, albumin and prealbumin. Protein deficiency can occur in patients who have complications following bariatric surgery or if they experience excessive food intolerance and diminished protein intake. Usually this problem is resolved once the person has begun eating more foods.

For patients with routine postoperative courses, emphasis on protein supplementation with meal replacements, shakes, bars and carefully selected foods are important to emphasize. A wide variety of protein-based shakes and snacks and other delicacies are now produced by high quality labs and manufacturers. We have made many of these available online at our website and at iMetabolic. Let us know online which ones you like or what others you would like to see carried!

It is also important to emphasize muscular activity to stimulate synthesis of muscle mass and preservation of lean body mass during rapid and profound weight loss.

Zinc

Zinc is a mineral found in meat, fish, eggs, grains and nuts. Zinc deficiency may be present in 5 to 10% of patients prior to surgery and zinc deficiencies result from procedures involving malabsorption, including gastric bypass surgery. Zinc deficiency is associated with hair loss, skin rashes and impaired wound healing. It is recommended to routinely supplement postoperatively with zinc in the form of a multivitamin that contains zinc. For specific identified deficiencies, increased dose of zinc sulfate may be warranted and may arrest hair loss following gastric bypass surgery.

Selenium

Selenium is a mineral that is an antioxidant like vitamin E. Selenium deficiency has been reported in a small percentage, perhaps 5%, of obese patients prior to bariatric surgery. After bariatric surgery, selenium deficiency increases although it is not clear what symptoms may arise as a result of impaired antioxidant function. Selenium supplementation is recommended as part of a multivitamin.

Conclusion

So enjoy the holidays, work hard to avoid the carbohydrates in all the holiday treats. Remember your weight loss and health goals. At Holiday events, try to enjoy the people more, and the food less! It sometimes takes hard work to achieve your potential, but you can do it.

And don’t forget your vitamins!

Diabetes is among the fastest growing health problems on the planet today.  Within the next two decades, over 300 million people worldwide will have Type 2 diabetes.  Numerous avenues of investigation have opened for researchers seeking to find a cure.  In recent decades, weight loss surgery, or bariatric surgery, has proven highly successful in eradicating Type 2 diabetes among patients whose diabetes stems from being severely overweight.

It is now well demonstrated that approximately 90% of Type 2 diabetics experience resolution of their diabetes after Roux-en-Y gastric bypass surgery, the most commonly performed weight loss procedure in the U.S.  A somewhat lower, but still remarkable 65% of patients undergoing LapBand surgery resolve their diabetes.

Both of these procedures are now widely performed in the United States with a minimally invasive, or laparoscopic procedure requiring a minimal hospital stay.  Over 200,000 of these procedures are expected to be performed in the U.S. in 2007.  Medicare and commercial health insurers increasingly recognize bariatric surgery as an effective treatment of diabetes that saves the plans money in the long run.  Four major studies have demonstrated marked increased life expectancy after weiaght loss surgery.  In most cases, there is no more need to fund the ongoing treatments of diabetes and its complications after weight loss surgery.  So, it is clear that for obese individuals with Type 2 diabetes, there is a strong likelihood that their diabetes can be cured with surgery.  But what about surgery for diabetic patients who are not severely overweight?

Recent studies have demonstrated that the surgical techniques applied in weight loss surgery may, in fact, result in resolution of diabetes in non-obese individuals also.  A number of centers have begun reporting that even non-obese diabetic patients experience rapid resolution of diabetes after gastric bypass surgery.  In many cases, patients are discharged from the hospital in a euglycemic state (normal blood sugar level) and never resume their diabetic medications!  This very early and rapid resolution of glucose control is not explained simply by calorie intake or pounds lost.  The phenomenon has lead many investigators to think that the surgical technique may fundamentally change the body’s regulation of blood sugar.

Most of the early and dramatic success resolving diabetes has occurred with gastric bypass surgery.  A recent study, published in Surgery of Obesity Related Disease, vol 3, 2007, by Cohen et.al., described these researchers’ experience with a surgical procedure called duodenal-jejunal bypass, a fairly simple procedure that causes food intake to bypass the first part of the intestine.  Their early findings are that these diabetic patients also resolved their Type 2 diabetes, independent of weight loss.

So, are we entering a new era in which Type 2 diabetes can be cured in a large percentage of cases with a minimally-invasive surgical procedure?  Time will tell, but the early studies are leading many to believe that what has been called “bariatric” surgery, or “weight loss” surgery, may prove the most effective treatment yet in the battle against Type 2 diabetes.  It may further the call to change thte name of the surgery to “Metabolic surgery”, as it serves to correct metabolic abnormalities and not just obesity.

Western Bariatric Institute (www.westernbariatricinstitute.com) is among the centers nationally with IRB-approved research protocols offering this type of metabolic surgery for selected patients with Type 2 diabetes.

Comments?

Do you have type 2 diabetes or have a loved one who does?

With all of the commercial weight loss programs, centers, diet plans, products and supplements available, is it really the case that a medical weight loss approach might offer some advantages?  And what is really meant by “medical weight loss program” anyway?

Well these are great questions as we enter a new era in which physicians and medical centers are beginning to apply their know-how to the problem of weight gain and obesity.  In my view it is has been far too long in coming.  Physicians and mainstream western medicine have neglected weight problems as though they were social problems or behavioral self control problems and had nothing to do with the mission of medical care to improve life and longevity.  

As we all know by now, gaining weight is a health problem and one of the most common and most serious health problems any of us will face.  Medical science may have been slow to recognize the seriousness of what has now become an epidemic, but rest assured that many of the best and brightest in an array of disciplines of science and medicine have turned their full attention to this problem, and they are achieving results.

When I describe a medical weight loss program, I am really describing a concept or a program that embraces all of the tools available to successfully battle against those extra pounds.  Furthermore, the concept of a medical weight loss center implies an adherence to an evidence-based approach.  So in its best sense, it means dedicated people taking the time to develop creative solutions and then test them experimentally to see if they do indeed work for real people.  Over time, with enough experiments and enough smart and dedicated people creating new and better solutions, the evidence accumulates that some treatments are in fact superior to others. 

It is this devotion to evidence and to proven strategies that brings out the most successful treatments for all kinds of health conditions and diseases.  It is true that this approach is imperfect, and open in some cases to manipulation or commercial bias, but it has been the most effective paradigm for developing new and successful treatments across the span of human conditions.

So while some particular commercial programs or individual treatment supplements, formulas, products and theories tend to reflect the commercial goals of the particular products being recommended, medical weight loss centers tend to evolve with the evolving evidence and change strategies as newer and better strategies prove more worthy.

Medical weight loss centers have no restrictions on the types of interventions and treatment options they may recommend or administer, other than those that guide medical practices in general.  This certainly makes a very important difference when it comes to prescription medications, a form of treatment that is advancing rapidly in two ways.  The first way that the field of weight loss medications is advancing is in the discovery of new medications.  With the belated, but now dedicated attention of the pharmaceutical industry, weight loss drug development is now in full swing.  Several promising avenues for treatment continue along the pharmaceutical research pipeline.  Inevitably within a few years, we will have more options for successful treatment of cravings, hunger and weight gain.

The second way that the field of weight loss medication is improving rapidly is in the area of newer and better clinical trials of existing medications.  For example, recent studies have demonstrated the effectiveness of phentermine, a commonly prescribed weight loss medication, in treating adolescents, in treating patients long-term, and for use in induction weight loss programs in combination with very low calorie medically supervised diets.   So better clinical research is teaching us better ways to use medications, just one more arm of a comprehensive weight loss approach.

A good medical weight loss center remains curious about the literature and about the newest evidence.  A good medical weight loss center maintains an open mindedness to the best treatments that may come from anywhere in the world or from any company or from any discipline.   It strives to integrate the best approaches, including behavior modification techniques, communication and education techniques, exercise and fitness training techniques, dietary meal replacement options, prescription medications, supplements and vitamins, hormonal manipulation or other methods.  

A quality medical weight loss program remains open to the best ideas that provide its patients with the greatest success.  It remains free of commercial bias and is willing to change brands, formulas, medicines or techniques as the science leads in new directions.  It is not quick to jump on hot trends or fad programs, but instead expects a certain threshold of evidence and proof and clinical studies before jumping on board.  The physicians who operate a medical weight loss clinic should remain actively curious and highly engaged in the medical literature that discusses pharmaceutical, behavioral, social, motivational, psychological and physical methods to achieve health and weight loss.

So does a medical weight loss program offer something unique?  I believe it does.  I believe that it offers the chance to bring together the very best strategies of all of the competing types of commercial weight loss programs.  It can bring together programs centered around meal replacements which have proven successful.  It can bring together the motivational social support systems that have been shown to be successful.  It can bring together the proven techniques of the branch of psychology that deals with behavior modification that have proven successful in weight loss, smoking cessation and many other behaviors.  Elements of life coaching that provide greater depths of motivation and help a person ground their weight loss efforts within the greater context of their life goals. 

And added to all of this is the fact that the weight loss program is directed by a physician who can not only apply medical solutions such as prescription medications of weight loss surgical techniques, but can assess the individual for the many related conditions associated with weight gain.  Only a physician can determine if for example an individual is currently suffering from a condition such as hypothyroidism which in fact causes weight gain, or can review a person’s medications and see that one or more of them has the unwelcome side effect of causing weight gain, and lastly the physician can be an excellent physician to diagnose the underlying causes and find the treatments for conditions associated with the weight gain like sleep disturbance and snoring disorders, headaches, depressed mood, lowered quality of life as well as the overt medical manifestations like diabetes, high blood pressure and elevated cholesterol.

In short, a well designed, well-executed medical weight loss program combines the best elements of all weight loss disciplines, adding a caring physician to oversee the journey, and providing much needed medical supervision.  At iMetabolic (www.imetabolic.com) the entire staff including five physicians, the behaviorists, nutritional and exercise counselors, fitness and life coaches and assistants endeavor to live up to that standard.

Have you participated in a medically-supervised weight loss program?

Do you see ways in which iMetabolic could improve?

In the future, iMetabolic plans to start an online weight loss program, that an individual could access and participate in from home.  Do you think people would take advantage of this?

Medical weight loss is receiving increasing attention in the media and in public life. From Oprah’s successful medical weight loss program and shift to healthy chef-prepared meals to successful weight loss surgery by Al Rocher. You see public figures battling the same sorts of weight problems that we battle in our own lives. With all the advertising, hype, and information available and bombarding us regarding weight loss and nutrition, it is hard to discern what kinds of information and programs have some evidence-based validity and what are really more advertising efforts for specific products and services that may or may not offer much hope of success. In this blog, I will try to point out as many useful and practical programs and solutions that have demonstrated scientific and evidence-based validity.

For example, here are a few concepts that have shown scientific merit and been successful in improving the weight loss outcomes:

• Support groups: Support groups and moral support from friends, colleagues and other people going through the same weight loss journey has been helpful at improving and maintaining weight loss.
• Meal replacements: These carefully formulated meal replacements are generally shakes that have low carbohydrate content and have been shown to improve weight loss success.
• Prescription medications: A number of prescription medications also have demonstrable effectiveness especially when prescribed as part of a comprehensive weight loss program. This small group of medications has been shown to be effective both for short-term weight loss and for long-term weight maintenance with minimal side effects.
• Exercise: Exercise is a key component, especially in the long-term weight maintenance phase. Studies demonstrate that individuals who exercise, particularly by walking 30-60 minutes daily, are successful at keeping to a healthy weight for the long-term
• Healthy food choices: Perhaps one of the most critical pieces for successful short and long-term weight loss is proper selection of foods that go into the shopping basket and find their way to our pantry shelves. Critical reading of every food label and constant vigilance to avoid unnecessary calories and carbohydrates play a critical role in achieving long-term successful weight loss.
• Vitamins and supplements: A surprising number of people who are overweight and appear to eat an ample diet have unrecognized vitamin deficiencies.Attention to these details and long-term vitamin supplementation play an important role in long-term health and avoidance of nutritional deficiencies.
• Weight loss surgery: Also known as bariatric surgery, plays an important and effective role for people who are unsuccessful losing the weight with medications, diet, exercise and a comprehensive medical weight loss program. While surgery is not for everyone, it is a valuable tool for individuals who qualify. It is important that people who do chose this option learn how to maximize its effectiveness for long-term success.