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MAYOR BLOOMBERG AND NEW YORK LOSE TO FEDS AND BEVERAGE INDUSTRY

last edited: September 20th, 2011

In a policy decision handed down from the USDA, the federal government has refused to grant Mayor Bloomberg and New York City permission to stop allowing New York’s needy residents to buy high calorie, sucrose and high fructose corn syrup laden soft drinks with food stamps.

Mayor Bloomberg and the City of New York, among many other government entities around the world, have been trialing numerous efforts to combat the obesity epidemic among adults and children.  New York requires posting of a calorie content of many foods for sale.  And in the latest effort the Bloomberg administration sought to disallow high calorie soft drinks among the list of subsidized items that needy residents could purchase using the food stamp program.  The federal government however disagreed and this refusal to grant the waver was met with relief by the soft drink industry.

What is striking about this turn of events and intergovernmental decision making is that it points to just how difficult the battle against childhood obesity is going to be.  If stopping the purchase of high calorie, sugared drinks using food stamps cannot be universally politically agreed upon then imagine how difficult it is going to be to tackle even more challenging aspects of the obesity epidemic where even more entrenched business interests fear a loss of market share or profits.  The increased consumption of high calorie, high carbohydrate soft drinks is one of the many factors linked to the childhood obesity epidemic.  It makes absolutely no sense for the government in any way shape or form to consume more high sugar, high calorie drinks during the midst of the epidemic.  Nor should the government encourage other similarly risky behaviors through subsidies if they are harmful to the individuals and harmful to the public.  Certainly, many people might choose to purchase high sugared drinks using other monies and that  in no way of course would be prohibited under the proposed New York change in the food stamps program.  But to argue that the tax payers ought to incentivize or encourage children to consume one of the most obesogenic foods during the midst of the rampant obesity epidemic, strains credulity.

CHOOSING AMONGST WEIGHT LOSS SURGERY OPTIONS, WHY IS IT SO COMPLICATED?

last edited: September 17th, 2011

You would think these surgeons and weight loss experts would simplify matters and devise one procedure and one standard diet program that worked the best.  Plain and simple, here is the one that works the best, sign up and you can these are the results you can expect.

Unfortunately, it has not worked out to be nearly so simple.  Instead, the surgical approaches have moved toward recognition of a few principals and have also shifted from the types of operations performed.  However, there are still several operations that appear very viable as contenders for the “best” procedure and advocates of each one continue to point to data showing its success.

Over time, we have seen that the science tells us a few important principals:

  1. The surgery works best when combined with a comprehensive program.
  2. Protein or meal replacement shakes are appetite suppressing and probably represent the second best tool we have in the battle against excess weight.
  3. Going totally without surgery yields a very, very small percentage success rate when the BMI has crept over 30-35.  (It doesn’t mean well shouldn’t try!)

The operations performed however have become perhaps somewhat more confusing for the consumer or the patient who is seeking medical help.  Over time, the surgery has shifted largely away from more invasive, open surgery toward less invasive, laparoscopic or minimally invasive surgery through keyhole incisions.  It has shifted from long hospital stays and intensive post-operative treatments and management of complications to outpatient surgery or very short hospital stays after a minimally invasive procedure.  And finally, the operations themselves have changed.  The surgery that was most successful forty years ago was an operation that involved bypassing a large percentage of the small intestine, the portion of the intestine that absorbs nutrients.  Other “mal-absorptive” operations were also very successful, but lead to long term complications such as vitamin deficiencies and deficiencies of iron and other nutrients.  So the most successful surgery has now shifted towards ones that focus most of the attention on the stomach and reduce our appetite, decrease our hunger, decrease portion sizes and may offer a small amount of mal-absorption.

Today, four operations deserve mention as being truly minimally invasive, involving minimal hospital stay and being highly successful with very few complications (especially relative to older procedures).  The four procedures I consider viable today as highly successful weight loss surgical procedures are:

  1. Laparoscopic adjustable gastric band or LAP-BAND.
  2. Laparoscopic Roux-en-Y gastric bypass or gastric bypass.
  3. Laparoscopic sleeve gastrectomy.
  4. Laparoscopic “mini” gastric bypass or “loop” gastric bypass

Each of the procedures has its pros and cons, but the bottom line is that the properly motivated person who is engaged in a long term plan with a diet plan that emphasizes proper vitamins, minerals and proteins, the use of protein shakes and regular exercise (let’s hear it for the walking club!) is highly likely to result in terrific success with long term weight loss, better health and a greater sense of energy and wellbeing.

GREAT JOB TO LACE EM’ UP TEAM AT BROWN ELEMENTARY SCHOOL AND WENDY DAMONTE

last edited: September 15th, 2011

What an amazing morning!  I had the profound honor of getting to see the fantastic moms and dads of Lace Em’ Up, the organization put together by Wendy Damonte here in Reno, Nevada to engage kids and everyone in the school toward encouraging regular exercise.  In the program, all the children in the school are encouraged to get outside and run and in fact, they are awarded for all of the accomplishments.  Prizes are given when the children have run a cumulative total of 5 miles, 10m miles and special prizes are given to those who complete a half marathon and a marathon distance over the course of their many intervals around the track.

This year, Lace Em’ Up has a fancy, electronic bar code system where by the children run their distances and scan in bar coded tags on lanyards they wear.  The reward system is fantastic and the kids who achieve special distances like running the full marathon over the course of the year are acknowledged with their photographs on the wall of fame in the school assembly hall.

Wendy and her team of moms that founded Lace Em’ Up, do an amazing job and provide a tremendous amount of inspiration.  I have never seen 700 children so fired up to get outside and run as I have after the great assembly she and her team put together.

Now, how to capture all of the enthusiasm in a bottle…

Obesity treatment is going to pale in its impact when we compare it to prevention.  And programs like Lace Em’ Up offer us a glimpse into the future of how obesity prevention efforts that start in the school and emphasize healthy eating and fun exercise will pave the way toward a healthier America.

OBESITY AND CARDIOVASCULAR DISEASE

last edited: April 25th, 2011

While weight gain and obesity adversely affect the heart and the entire cardiovascular system in many ways, I think it is important to point out a few of the ways doctors and researchers can actually measure that negative impact. One simple method is to measure the blood pressure in people of different weights, and in the same person over time as his or her weight changes. Such studies find that weight gain is associated with elevated blood pressure increasing the body weight by 22 pounds or more (10 kg) is associated with a 3 mm of Mercury higher systolic blood pressure and a 2.3 mm higher diastolic blood pressure.  This is rather significant and increases the incidence of coronary heart disease and stroke.

By contrast, weight loss translates into reduced blood pressure and reduced risk.  In more than half of individuals, decreasing even one 1 kg, or a mere 2.2 pounds of body weight reduced the systolic blood pressure 1-4 mm of Mercury and the diastolic 1-2 mm of Mercury according to several studies.  While these are not huge numbers, they represent a tangible improvement in health and measurable reduction in risk of heart attack.

The ability of the heart muscle to squeeze and pump blood is also adversely affected by weight gain. A 2006 study in the Journal of the American College of Cardiology demonstrates that right ventricular function suffers as body mass index rises.  This association remained present when the right ventricular function changes were adjusted for age, for diabetes and insulin usage and blood pressure.  This cardiac function is measured using several techniques – images with ultrasound, images with nuclear isotope labeling, and with inserted catheters that use measuring instruments. In all of these measurement methods, heart performance suffers when body weight rises. This means less energy, less blood available to the tissues that need it most during exertion, and more chance of fatigue or loss of vital blood supply to organs thirsty for it, like the kidneys.

Napa Marathon Part II

last edited: April 24th, 2011

Fortunately by mile 10 the rain lightened substantially.  It actually became quite pleasant for a stretch, and just the faintest of breezes blew, moving some of the low lying clouds off the vineyards.  We passed Rutherford Hill, ZD wines, and Quintessa vineyards, most of them stunning and picturesque, but a bit of a rainy blur.  We crossed through the St. Helena region and I at least felt like we were making good progress as I imagined the map of the Silverado Trail in my mind’s eye.

As I ran, I was once again astounded by the range of body types and running styles as we approached mile 11.  A man who had to be in his late fifties chugged by me with a loud wheeze and a locomotive style that looked about as efficient as a rickshaw being pulled through mud.  Yet here he was on mile 11 and doing just fine, thank you very much.  I passed a few runners, but – let’s be honest -more runners passed me.  These included the old and the young, even some who were heavy set and some who flailed their arms in a much more lateral motion than seemed natural, but they all got the job done.  In fact most of them were putting me to shame.

About this time a gregarious threesome approached and one of them, a fellow named Mike with a white shirt that said “Visalia Runners” on it started chatting me up in a friendly manner that was his routine.  “What sort of time are you shooting for, Kent?’  He asked after a time.  I told him that my supposedly waterproof Garmin was clearly not waterproof and that my not-waterproof iPhone was also not waterproof, so I really had no idea what sort of pace I was on at this point in time, other than the fact that it was a tad fast.  So I told him I was shooting for around a 3:45 or 3:50 marathon pace to which he replied “Whoa, you are way ahead of that.  Just keep your legs under you and don’t get too far ahead of yourself.”  At mile 13.1 – mile “halfway point” – Mike checked the time for me and it was 1:45, so we were on for a pretty solid 3:30 race pace, and sadly I just knew I wouldn’t be able to keep that up. I stayed with him for a mile or so and then let him and his partners drift on ahead.

The rain eased to a light drizzle by around mile 15 and I cruised on for a while before beginning to really feel the pain.  By mile 16 I had given up any hope of running 3:45 and I was beginning to wonder if I could come in anywhere near 4 hours.  My legs felt heavy and my calves, knees and hamstrings all ached.  I had slowed to what I imagined was probably around a 10 minute mile pace and was in fairly desperate need of more significant walk breaks.  I soldiered on for a couple more miles at this sort of pace and then encountered a long, slow, winding hill someone had earlier referred to as Napa’s “heartbreak hill”, but mercifully it proved to be much less difficult than I had feared.  I walked a bit of it and ran my slow, shuffling gait up the rest of it – cresting and actually feeling a very temporary surge of energy moving forward.  And low and behold the rain actually stopped for a period of time about mile 20.  We passed Stags’ Leap, Chimney Rock and Clos Du Val wineries, some of the most beautiful wine properties in the world.  The long straightaway past Chimney Rock led me to look back over my shoulder, and I saw the tight winding group of runners flowing like a river down between the beautiful vineyards.

The problem after mile 20 was that I didn’t have the legs to run at much of a pace. I also dimly realized I simply was not willing to suffer quite as greatly as some of the folks around me.  A few others scurried by me, some of them looking lean and strong, but quite a few others chugged past noisily with obvious and profound grimaces of pain.  I had slowed to a pace that allowed me to carry on without enduring the sort of the pain that some of these folks clearly displayed.  Was I not strong enough or man enough, perhaps I should pick up the pace again to an 8 minute mile and really suffer?  I tried that for about ten paces and then lapsed back into my slow shuffling gait.  Fortunately as these last few miles ticked by I relied upon the sense of shame and embarrassment I had to avoid if I came in with too slow of a time.  I drew upon this feeble sense of honor that I must uphold to avoid pulling over to the side and walking, which by this point was becoming a pretty strong desire.  The scenery changed and that helped.  We turned through some beautiful tree lined roads and one could sense the finish now as we entered the outskirts of Napa proper.

Certainly visiting the beautiful wine country and running on a beautiful marathon course is a treat no matter how ill-prepared one is to run 26.2.  I always seem to finish these things with a similar thought in my mind, and it goes something like this, “if only I had spent X number of weeks, days and hours training properly I could have done so much better!”  But this is the way things are right now and the proper plan is to enjoy each and every opportunity to run in each and every race.

Encouragingly, the intersections were increasingly full of spirited supporters, the cowbells were ringing and the distance between intersections with supporters and clever signs grew smaller and smaller.  At mile 21 I told myself I only had an easy 5 mile run to go and broke it down into a 2.5 mile “out and back” –  that meant I really only had 2.5 miles.  And frankly, let’s think about this further, the last mile of a marathon is a gimme so we can just subtract that one and let’s really imagine that we only have 4 miles left until we reach the last mile.  I can certainly run the last mile, I knew that.  So what I really had left was a 2 mile out and back.  I could run two miles, turn around and come back any day of the week no questions asked.  So all I had to do was run two miles and by the time I had worked this out in my addled runner’s 20 mile brain I had probably already covered one of the miles, so I started the calculations all over again.  As I neared the more urban blocks in the city of Napa I actually thought I could hear the cheers from the finish line, which took place at Vintage High School, and for about a good mile and a half I think I did.  This of course spurred me on and prevented me from taking longer walk breaks than I actually wanted.  As I turned the final few corners and enjoyed the support of the great fans, my spirits lifted and I felt like I was glad had signed up for the race and gotten out of bed in the rain.  The pain I was feeling all over now meant that I continued to tell myself I would never do another one of these races again, but I knew that I would at least finish this one.  The home stretch was pretty short and only in the last few steps did I catch the clock, which turned over to 3:56 as I approached the finish line.  I raised my arms for that final photo and made sure my shoe hit the electronic reader so there would be no doubt.  Small victories finishing a marathon in under 4 hours.  Now I need to remember it was “just a training run” and build upon it for the next one.

And yes within a few hours I knew there would be a next one.

NAPA VALLEY MARATHON

last edited: April 22nd, 2011

The Napa scenery in early March of 2011 was certainly stunning.  Foggy, cool, beautiful, low plumes of clouds over the rolling vineyards and verdant hillsides, nothing to complain about except, er, a bit of rain.  The day before had been warm and mostly sunny so I was a bit discouraged to hear rain steadily falling when I awoke, nervous, at 3:00 A.M.  Unfortunately the rain kept up all the way through start time and indeed during most of the race itself.

Lately I seem to be entering races with the notion that they are “just another training run”, mostly because I struggle to do any actual proper training.  The race then serves as an excuse to get out and actually run a long run. But, as I always say when it comes to health and fitness, we have to use any possible excuse in order to accomplish our goals, even if we have to scale those goals back a bit.

By some great stroke of luck and planning, the hotel proved to be about two blocks from the starting line.  So I couldn’t have been happier avoiding the dreaded 4:00 A.M. wake up, the long bus ride and the standing out in the dark in the cold.  Instead, I very happily rolled out of bed, kissed my wife on the forehead, changed and walked my way over to the starting line.  This meant I only had to stand in the rain for about fifteen minutes prior to the National Anthem being sung and the race beginning.

I am a bit of a fair-weather runner, I’ll be the first to admit.  So standing in the rain in 40 degree temperatures was not exactly what I had hoped to be doing on Sunday morning.  I did give some serious consideration to climbing back in my warm bed, but before I could lose my sense of duty, the racers were getting ready, and I felt the surge of adrenaline that I hoped would carry me through the race.  The Star Spangled Banner was sung in a lovely if somewhat off-key tenor and surreptitiously I slipped my earphones in place (like most of these races nowadays the Napa marathon has banned iPods and earphones as a safety concern, but I remain a music rebel and am infinitely happier running with music than without) and I dialed up some Dave Matthews Band, live of course, and started out in the rain.  The race started out on a gentle, downhill slope, which was pretty wonderful, but had the effect of exacerbating the usual high-energy race start pace of the pack of runners.  I knew we were way ahead of the eight minute mile pace I had hoped to run for the first ten miles, but it felt so relaxing and so good to finally be moving in the rain that I didn’t bother to check my watch until the second mile marker. When I did, I had to downshift immediately because I crossed the first two miles in 14:05, a ridiculously fast pace for me and one that would clearly lead to early heartbreak if I kept going with that speed for much longer.

I dialed it down to a reasonably comfortable 8 minute mile pace and just began to enjoy the scenery and the music, and I even detected a degree or two warmer ambient temperature.  The road, The Silverado Trial, offered many curves and some gently rolling hills, the downhill of which threatened to bother my knees.  The slope of these was gentle enough though that it was pretty comfortable and I felt content staying at this pace for a while longer. Passing the gorgeous wine properties of Rombauer and Casa Nuestra, I thought happily for a moment about the wonderful route this race enjoys. In the back of my mind I knew I had not trained to maintain this pace throughout the whole race, but as I crossed mile seven the crazy notion began to creep into the back of my mind that just maybe I was in better shape than I should be if one only looked at the training regimen.  Let’s see, that added up to a grand total of about two runs in the last three weeks.  One of them, 9.5 excruciating miles banged out on the treadmill ten days ago while it snowed heavily outside.  And the other, a legitimate, if very slow, 21 mile run when the weather was nicer three Sundays earlier.  I just had not found any time between work and kids and everything in between to get any intermediate runs, do any speed work or put in very many miles at all over the last several months.  So why I let these foolish thoughts enter my head at all I have no idea, but somehow it occurred to me that perhaps I had some special genetic gift that had eluded me up to now, and that today it was going to show itself by allowing me to run a 3 hour and 30 minute marathon despite inadequate training.

Perhaps to dampen such foolish thoughts, at mile 8 the rain turned into a deluge.  I was now splashing through major puddles, and wide rivers of water were rolling from the shrubs and trees and embankments and off the steeply canted roads, which had clearly seen such precipitation before.  I was beginning to rethink the whole concept of finishing the race at all, but dimly realized that the logistical challenges involved in abandoning a race at this point were not very attractive either.

Doctors Sometimes Add to Misperceptions about Being Overweight

last edited: March 31st, 2011

A great many of us perceive our weight to be in the normal range when in fact we are overweight or even seriously obese. And in many cases, our doctors are not helping correct the misperception. Studies show that 55% of overweight people (BMI 26-29.9) and 33% of obese people (BMI 30+) have never been told by a doctor that they are overweight.

Twenty percent of obese patients who have never had this conversation with their doctor described themselves as “not overweight” compared to just 3% of those whose doctors had spoken to them about their weight.  A similar study of overweight patients found that 23% of females and 48% of males considered their weight to be “just right” despite their heightened risks of diabetes and many other diseases stemming from all the extra pounds of body weight.

Physicians and other health care providers do serve an important role in communicating when an individual is overweight or obese because it is such an important health matter and one that every person needs to understand so that they may begin doing something about it.

FEWER TEENAGERS DIE IN CAR CRASHES: A SMALL PUBLIC HEALTH VICTORY

last edited: March 30th, 2011

The Centers for Disease Control and Prevention has analyzed the number of fatal car crashes with teens behind the wheel.  Over the last five years the number of deaths involving such accidents dropped about a third, from around 2,200 in 2004 to 1,400 in 2008.

The leading explanations for why this improved death rate has occurred point to changes in policies affecting youth drivers, such as the graduated driving license.  In forty-nine of the fifty states teenagers gradually gain full privileges behind the wheel. Younger drivers experience restrictions about having additional passengers, having young people in the car and driving at night.  The combination of these restrictions is thought to be a primary factor explaining why less traffic deaths are occurring with teen drivers.

Teen drivers still markedly increase the risks of accidents, averaging about four times as many crashes as adult drivers per number of miles driven.

The reason I found this information so noteworthy is that it serves as an example of a rare victory by the forces of public health in actually reducing deaths in an important area of health for young people.  I can’t help but think if there are some lessons we could draw to find policy solutions to make a dent in the much greater health problem for youth: childhood obesity.

Public health solutions arise somewhat more naturally when an acknowledged regulatory function such as driver’s licensure comes into play.  Driving a car is an area everyone would agree deserves some government scrutiny and is a public privilege.  Obesity and the personal choices of diet and exercise are just that: personal.  They are the governance of families and not governments.

Even things like breaks on school tuition, use of state scholarship funds and lots of other financial incentives for young people could be implemented, but these might also be considered discriminatory against overweight or obese people if viewed as penalties against weight gain.

Just how far the public would permit the government to reach in to individual lives and families to correct the obesity epidemic remains very unclear.

Certainly the severity and deadliness of the epidemic warrants some unconventional thinking about how to tackle the problem.  But in this most personal of health problems, finding the right answer to help us save children from early death and disease while balancing the respect for personal freedoms and family responsibilities will remain a great challenge.

CHILDHOOD OBESITY PREVENTION TAKES A GROUP EFFORT

last edited: March 27th, 2011

So far our Obesity Prevention Foundation has worked to bring messages of healthy eating and nutritional awareness to schools including students, teachers and parents.  We had the great pleasure of working together side by side with Wendy Damonte and the Lace ‘Em Up team to also bring the message of fun exercise and activity.  So far the programs in the schools have met with great support and enthusiasm and have been a lot of fun.

ANOTHER SHORT TERM STUDY ON BARIATRIC SURGERY

last edited: March 24th, 2011

Numerous short term studies report to show the benefit of one procedure over others, and usually the more invasive procedure demonstrates higher “success”.  This reflects the fact that the less invasive LAP-BAND procedure is shown to have a much slower weight loss curve, typically approaching or equaling the overall weight loss of gastric bypass surgery after thirty-six to forty-eight months.  Another recent study falls along these lines.

From my alma mater, UCSF, comes a new study examining the results of gastric bypass when compared to LAP-BAND surgery in 200 morbidly obese patients.  Complications rates were similar, but the weight loss results were better for gastric bypass and re-operation rates were lower for gastric bypass.  However the follow-up was only for one year.  It was already previously known that the LAP-BAND procedure will take three to five years to reach the approximate level of weight loss usually seen within twelve to eighteen months after gastric bypass surgery.

So do these short term studies contribute anything further to the current knowledge base?  Probably not.  What we already know is that minimally invasive weight loss surgery, when performed in the hands of highly experienced surgeons, has very low risk and complication rates.  Laparoscopic Roux-en-Y gastric bypass surgery is highly effective and has low complication rates in the hands of such high volume surgeons.  That the weight loss results are greater at the end of one year when compared to LAP-BAND is not new information.

Yet short term weight loss success is not to be discounted as an import achievement either. For many of my patients, achieving a one-year weight loss target is critical to avoiding an irreversible slide to poorer health or even death. For some people the difference between 18 and 36 months to reach a goal weight is highly significant, and in others it is not as important.


Dr. Kent Sasse, Medical Director | 75 Pringle Way Suite 804 Reno, NV 89502 | Phone: 775-829-7999

Dr. Kent Sasse serves the entire city of Reno and all the surrounding areas. Dr. Sasse is one of the nation's foremost medical weight loss and bariatric surgical experts.
Dr. Sasse has educated patients about food nutrition and weight loss for many years.

Copyright © 2007-2010 Kent Sasse, M.D. All Rights Reserved.

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