Laparoscopic or minimally invasive surgery has revolutionized many surgical procedures and has spread to many fields including orthopedic surgery, spine surgery, gynecological surgery and general abdominal surgery.

Colorectal surgery can be performed with the laparoscopic or minimally-invasive technique with substantial reductions in complications, pain, narcotics use, hospital stay, and postoperative recovery time.

Minimally-invasive techniques allow the colorectal surgeon to remove benign polyps, malignant tumors, diverticular disease and inflammatory bowel disease in any or all parts of the colon or rectum.

Benign versus malignant cases
In the past, a concern existed that colorectal cancers should be removed with an open standard technique, sometimes known as a laparotomy. Gradually, however, the improvements in technique and the technical advancements led to more and more of these common colorectal surgical cancer cases being performed with the laparoscopy. In the largest studies to date, this technique appears equally safe and effective without any increased risks of complications or tumor cell spread, as long as it is done by an experienced surgeon with advanced training in laparoscopic colorectal surgery.

When I completed my colorectal surgical fellowship back in 2000, the tide was just turning on this topic. Today, in the hands of an experienced laparoscopic colorectal surgeon, laparoscopic colectomy for cancer is a widely accepted and appropriate choice for many people.

Advantages of laparoscopic colectomy
The advantages of a laparoscopic colorectal resection are similar to the advantages of any minimally-invasive procedure. Statistically there is less blood loss, less postoperative pain, less use of narcotics, less hernia formation from the wounds, and less strain on the heart on the lungs. Perhaps more important for most people, laparoscopic colorectal resections result in a much reduced recovery time after one leaves the hospital. In my clinic, one of the most striking changes over the years has been to see the vigor and fitness of my patients after they have undergone a laparoscopic colectomy. Within a few weeks, most of them are getting out, going back to work and resuming activities, whereas in the days of open colectomy procedures, most patients do not hit these recovery milestones until six or eight or ten weeks postoperatively.

Disadvantages of laparoscopic colectomy
The initial concern that surgical manipulation with the laparoscopy might somehow spread cancer cells to the incisions, wounds or other tissues, has been debunked by a number of large multicenter studies. Nonetheless, it is believed that such problems can occur with any kind of cancer surgery whether the technique is open or laparoscopic, and a novice laparoscopic colon surgeon may be more apt to manipulate the tumor aggressively and result in some shedding or spread of these malignant cells. So finding an experienced laparoscopic colorectal surgeon is of critical importance if the procedure is being done for a malignant tumor or colorectal cancer.

Experienced surgeons and high volume teams create success

In keeping with that recommendation, I would reinforce the notion of surgeon experience for this type of procedure as being very important because the procedure is highly technical and presents many surgical challenges. The more experienced the surgeon, the shorter the operative time and the lower the complication rate. At our center, for example, most laparoscopic colorectal surgical procedures are performed in a timeframe that is shorter than the usual timeframe for a comparable open procedure. Nearly all of the laparoscopic colectomy procedures are performed in a total of between 40 and 90 minutes. While speed is not the most important goal, it indicates a systematized operative approach in which an experienced surgeon and operating room crew have established instruments and systems for conducting the procedure smoothly, efficiently and safely.

In experienced hands, there is absolutely no difference in the oncologic success, the margin of resection, the number of lymph nodes harvested, or the security, safety and integrity of the surgery and the anastomosis (this is the connection between the two ends of the colon after the specimen has been removed).

The emerging standard of care
In time, as more and more surgeons undergo the rigorous training required to become expert laparoscopic colorectal surgeons, and as patients and referring doctors increasingly demand the advantages that come along with the minimally invasive technique, we will see laparoscopic colorectal surgery become the standard of care for most cases.

1. Stay positive.  Focus your friends’ efforts on their goals and successes, their triumphs and hopes.

2. Be persistent.  It is a long road, no matter whether your friend has surgery or pursues a medically supervised program.  Long-term weight loss does not happen overnight.

3. Meet for a walk.  Even the most motivated patient working on their weight loss goals, often finds it hard to find walking partners or people to socialize with as they pursue fitness goals and exercise.  Become a walking partner or fitness partner.  Make specific dates and regular times when you meet with your friend and go on that long walk or head to the gym together.

4. Meet for lunch.  If you have a standing date with somebody, you can make it at a place that will promote very healthy nutritional choices.  You can get in the routine of ordering a satisfying but healthy salad and enjoying some sugar free iced tea with your friend on a regular basis.  The conversation and social interaction will make the meal and experience enjoyable every time.

5. Bring others into the circle.  Losing weight is a long-term project that takes a lot of support and effort.  If you can bring others into the circle and help encourage everyone in the circle of friends to think healthier and educate themselves about long-term healthy nutrition and healthy weight, it will really help your close friend that you are trying to support.  It is a statistical fact that you are more likely to lose weight and stay at a healthy weight if the people around you are also at a healthy weight.

6. Be an example. Are you a little overweight yourself?  Could you stand to lose a few pounds?  Take the messages to heart.  Focus on your own health also and improve your own fitness in support of your friend’s efforts. He or she will admire you for what you are doing, and you will both then be pulling in the same direction.

7. Expand your own food repertoire.  If you are entertaining or hosting a baby shower or going out to dinner or having a group of friends over for book club, you need to expand your repertoire of what is acceptable to serve.  If you are truly going to be a top level support person to your friend who is pursuing long-term serious weight loss, you will help immensely if you can change the menu a bit at these social functions involving food.  Check out some of the recipes from Chef Dave Fouts 90 Ways to Ditch Your Diet (360 Publishing).  This part can require tact and grace, cleverness and great sensibility about how to not draw undue attention to your friend’s weight problem, and yet at the same time offer healthy snacks, meals and hors d’ oeuvres for company.  But you can do it.  Be creative.

8. Avoid singling out your friend.  This can be a challenge if you and perhaps other friends or acquaintances would like to treat you to ice cream or cotton candy or order your favorite fast food cheeseburger.  The name of the game here is to make your weight loss and experience a positive one for your friend.  Avoid singling them out, making them feel unworthy, lonely or separate.  Work hard to try to integrate them into situations where everyone is doing healthy things and doing activities, using muscles, burning fat, consuming healthy calories, or doing totally non-food things altogether.  Try hard to avoid making their weight loss journey a negative experience where they might feel they are missing out on the fun of sharing cotton candy with friends.

9. Run interference.  Here is another delicate one.  You probably realize who in your circle of acquaintances around your friend is likely to become a saboteur or undermine their efforts to become healthier.  Maybe it is another person with a weight problem who refuses to get help.  Maybe it is a person who is always “naturally skinny” and prefers your friend in their role as the overweight one.  Whoever they are, you can probably predict some of the things that are going to happen that will undermine your friend’s chances of success.  Take action.  It is delicate, I know, but there are some things you can do.  The first is to use the knowledge that you have gained by becoming an expert in the health statistics of overweight and obesity and the great health improvements associated with weight loss.  Share these with your would be saboteur friend and acquaintances.  Bring them on board gently through knowledge, insight, education and persuasion.  Don’t be heavy handed but little hints here and there, little facts could really help; and who knows, you might be helping more than one person lose weight and become healthier.

10. Be the lifeline.  Everyone trying to change their life hits weak moments or relapses when they need a life line.  Life’s craziness starts to intervene and throw us off our mission, and we find for reasons seemingly out of our control we are reverting back to old behaviors. In that situation your friend could really use the chance to call you and talk in a moment of crisis.  Your job is to be the life line, be there and listen.  Ask them if they still feel the goals they originally set are worthwhile.  Ask them to enumerate what their goals were and why they wanted to achieve them and reassure them that there is no reason to throw in the towel, no relapse is too great.  Tell them they just have to get right back on that horse.

Bonus Tips:

11. Celebrate milestones with non-food rewards.  If your friend has lost the first 10 pounds or 20 pounds and this feels like a serious accomplishment, then celebrate it for what it is, and offer a reward that does not involve food, like say a new pair of jeans or a massage or an offer to baby sit the kids while your friend goes to the movies.

12. Help with the pantry clean-out.  There will come a time if your friend is really serious about losing weight that he will need to rid the pantry, refrigerator and whole house of the favorite high calorie, high carbohydrate snack foods.  You can help.  Stand shoulder to shoulder with him as he tosses away the favorite orange flavored crunchy chips and the bags of candy treats. Your extra pair of eyes may spot some things that need to go.

Childhood obesity has grown to become one of the nation’s most pressing health problems. We have already seen a tremendous surge in adult obesity in the last 30 years. That rise in obesity among the adult population is shortening life expectancy and creating a terrible amount of early disease and suffering, with conditions like diabetes, heart disease, stroke, depression, sleep disturbance and degenerative bone and joint disease.

Today, at least 1/4 of American children are seriously overweight. That number is expected to rise in the future unless we can do something about it.

But how do we tackle such a difficult problem?

As with any complex multifactorial problem, the best solutions start with understanding the root causes of the problem. In the field of Public Health, we talk about the “upstream, downstream” theory. In the upstream, downstream theory we recognize that problems are usually identified at some point downstream where they have begun to cause symptoms or disturbances. Sometimes those problems (example: Heart attack) demand immediate solutions right there in the stream. However, a broader understanding and approach to a more comprehensive solution requires turning and looking upstream to the root causes of the problems (example: Smoking and obesity as causes of heart attacks). Only when we look upstream can we truly identify root causes of complex problems and begin to offer solutions.

So looking upstream at childhood obesity we see many causes.

• We see a tremendous rise in the dietary consumption of high calorie, high carbohydrate meals.
• We see portion sizes increasing in meals across the board.
• We see an influx of high calorie, high carbohydrate commercial foods being brought into the schools and displacing more traditional meals that are prepared on site with fresher ingredients.
• We see a rise in the consumption of high fructose corn syrup and sugared soft drinks.
• We see a tremendous sophisticated effort on the part of the commercial food industry to market and advertise directly to our children and promote consumption of high calorie, high carbohydrate unhealthy food.
• We even see government subsidies of corn crops, and effectively, high fructose corn syrup.
• We see falling, strained budgets for American schools and greater reliance on commercial purveyors of fast food and soft drinks to fund extracurricular activities in schools.
• We see increasing concern about outdoor safety and security for our children and less willingness to let them run loose in the streets or parks.
• We also see tremendous increase in the sophistication and appeal of video games, movies and computer entertainment, which involves very little physical exertion.
• We see a tremendous rise in the average weight of the parents of the at risk children.

Wow! That is a stunning and formidable list of root causes, and there are certainly more.

How might we tackle this problem or at least begin to make inroads?

Well, before I founded the Obesity Prevention Foundation, I grappled quite a bit with these very questions. And while certainly there are no simple solutions, the recognition of these root causes leads to some avenues for intervention that might help us turn the tide on this terrible epidemic of childhood obesity.

For one thing, we must engage as many people in our communities as possible to work collectively to fight this problem. The best solutions are going to come from many fronts and are going to include some policy changes at the levels of local and state governments, school boards and the U.S. Congress.

We are all stewards of our nation’s young people. It is in everyone’s interest that we raise a generation of healthy active kids. It helps no one to promote obesity among our young people, no matter what the short-term profits are for soft drinks or fast foods. Not even the most cynical business person would argue against the idea that our collective interests lie in raising a generation of healthier eaters and less overweight kids.

So solutions begin with raising awareness and promoting education among all of the stewards of the community. This includes business leaders who understand that an educated, productive work force comes from a healthier, normal-weight generation of kids. It comes from educating our teachers and school administrators because they play such a critical role in forming school policies and childhood education programs. It comes from engaging and educating parents who can serve as better role models and encourage healthier eating among kids. And it comes from educating legislators and political leaders who need guidance and direction about how to attack the problem most effectively.

I saw a patient in the office this week who brought in a list of diet plans and programs that she had read about or heard about. She wanted my opinion on each one. So we went through the list. And I must say that I was very discouraged to see that of the 12 or 13 diet plans that had piqued her interest, only one of them would qualify as having any sort of scientific validity or underpinning whatsoever.

Yet, weight loss fads and popular diets seem to have become more commercially successful and popular in the public consciousness than ever before. It is big business.

Yet why is there such growth in fad diets which offer very little chance of success?

I think the answers come from many corners. From one thing, scientifically based programs usually lack the sort of commercial push behind them that would allow them to be successful in the public market place. It is very difficult to compete with the commercial plans that can hire celebrity spokespeople and buy huge amounts of media time, create magazine and newspaper placements, and, in short, do all of the things that bring their products to our attention. There are many other factors, of course; for example, the media in general is usually very apt to cover “news items” that seem “timely or hot.” They are often interested in fresh angles and novel stories, and medically-supervised weight loss programs don’t always offer that kind of appeal.

But I would argue there is also a lot of blame to laid at the feet of the medical establishment. For many years, physicians and the medical community in general failed to address obesity as a serious disease. Only now that it is the number one cause of shortened life expectancy and the number one preventable cause of disease in the country, are physicians and medical systems really engaging in a serious way in the process. So in a sense, it can be argued that the medical establishment vacated the playing field and left it to commercial enterprises and fad diet profiteers instead of focusing on the challenges of clinical research and finding cures for this serious health problem.

It would be great if a product existed that allowed us all to “burn fat while we sleep.” And it would be great if a diet plan enabled us to effortlessly lose all the pounds we wanted to lose without any sacrifice on our part. And it would be great if some of our favorite fruits contained the secret mystery ingredient of health and fitness. The truth is that you can succeed in losing weight and keeping it off, but it is not easy. You need serious motivation and you need the right tools and the right information. It takes hard work, persistence, dedication and attention to many small and large things that add up over the course of the year to reduce pounds. It won’t happen overnight, but with a sound medically supervised, or scientifically-based weight loss program, you can do it.

Have you ever noticed that fad diets tend to change every season? If you go back a few years in the fashion magazines and popular press, you will find mention of a mind-boggling number of fad diets over the last years. But every issue and every season the specifics of the diet change. If they are highlighting a particular ingredient, the ingredient usually changes.

It certainly leads to the conclusion that these fad diets live a fairly short life and that the lack of any durable success shoves them off the front pages to be replaced by the next fad diet. And yet why are fad diets so popular?

One reason they are popular is that weight gain and obesity are increasingly serious and increasingly ubiquitous problems. Nearly everyone, it seems, would love to have a simple way to lose pounds after they have built up, and what better way to do it than with a painless diet plan?

The trouble is that fad diets nearly always result in rebound weight gain. Rebound Weight Gain is a phenomenon that occurs after the energy and enthusiasm of the diet wanes. For example, on a very typical fad diet, a person dramatically restricts one’s overall nutrient consumption and eats a narrow range of food choices. The fad diet rarely consists of emphasis on the medically proven, sound building blocks of weight loss, namely that of emphasizing protein and multivitamins along with exercise and increased calorie expenditure. So at the end of the fad diet, a person begins to experience a tremendous amount of hunger.

This hunger stems from the body’s muscles or “lean body mass” which has been depleted as a result of the fad diet. The muscle hunger is powerful and nearly impossible to resist and leads most people to begin voraciously consuming more calories. Usually the calories consumed are not in keeping with the medically sound guidelines that might help facilitate long-term weight loss. As a result of this whole cycle of the fad diet, a person usually yo-yos and ultimately gains more weight than had they not even started on the fad diet.

But it doesn’t stop us from looking for the magic bullet of a fad diet that might one day work. Does it?

1. Be an example to your kids. Be physically active. Promote healthy eating. Strive for and maintain a normal weight.

2. Write a letter to the editor. Let your voice be heard in your local paper or newsletter. Let people know this is one of the most serious and worsening health problems in the country affecting our young people.

3. Joint the Parent Teacher Organization of your local schools. Ask about healthy hot lunches, snacks and meals for all the school children.

4. Write your member of congress. While you are bringing out the pen and paper, send a personal letter to your congressional representative. Let them know what a devastating problem this is in your community and in the nation. Collectively we can do something about it, but it will take change from the highest levels of government. A sample of such a letter is available at www.obesitypreventionfoundation.org.

5. Get outside! Take the neighborhood children outside at least three times a week for some vigorous activity. Take a long walk but bring a Frisbee or a football with you so you can run and catch during the walk. Make it fun and interesting for the kids.

6. Bring it to the Club. The importance of childhood obesity must be brought to the consciousness of everyone. If you belong to Rotary or Elks or a country club, or just your own reading group, bring it up at the club and encourage everyone to get engaged.

7. Support local school extracurricular activities and sports. One of the reasons schools must turn to fast food and soft drink sponsors, is that no one else is stepping up to the plate. Attend the games, encourage your community to take an active interest in sports and extracurricular activities that are “active” for the kids in your area. Then find ways to support them financially.

8. Volunteer. Public school libraries, hospitals and clinics, boys and girls clubs, youth programs: all of these programs, organizations and centers need volunteers. Be a volunteer who also brings awareness about healthy eating and exercise. If you read to toddlers or school children, make it active; between books or chapters stand up, do jumping jacks, go outside, walk, emphasize the importance of physical activity and healthy eating whenever you get a chance.

9. Be a volunteer coach. Today more than ever, the sports and extracurricular activities for youth depend upon coaches and parents who are in short supply and lead busy lives. If you once played soccer or volleyball or anything else, you might make a perfect volunteer assistant coach at a local school. Who knows, you may get tapped to start a new team or a junior varsity or, in some other way, bring in more children into an athletic environment. You could change a life.

10. Join the Obesity Prevention Foundation community today. And tell two friends. This project, to prevent childhood obesity, will take all of us. And together we can make a very important difference in the lives of young people.

With so many people around the world gaining weight, the Metabolic Syndrome has taken on greater importance as a cause of individual heart attacks and strokes, and as a public health problem.

The clinical definition of the metabolic syndrome is as follows:

Metabolic syndrome is diagnosed when a person has three or more of these conditions:
1. Elevated blood pressure. Blood pressure of 130/85 or higher is a component of metabolic syndrome. If only one of your two blood pressure numbers is over the limit, it’s still a risk factor for metabolic syndrome.
2. Elevated triglyceride level in the blood of 150 mg/dL or higher (or you are taking medicine to treat high triglycerides).
3. A lower than normal level of HDL cholesterol, less than 50 mg/dL for women and less than 40 mg/dL for men (or you’re on medicine to treat low HDL).
4. A large waistline. A waist measurement of 35 inches or more for women and 40 inches or more for men.
5. Higher than normal fasting blood sugar (glucose) (or you’re on medicine to treat high blood sugar). Fasting blood sugar of 126 mg/dL or higher is considered diabetes. A fasting blood sugar of 100 mg/dL or higher (prediabetes or diabetes) is a component of metabolic syndrome.
The more of these risk factors, the greater the chances of developing heart disease, diabetes, or stroke. Someone with metabolic syndrome is twice as likely to develop heart disease and five times as likely to develop diabetes as someone without metabolic syndrome.

The treatment for the metabolic syndrome is really based on two concepts: Historically, doctors tried to treat all of these diseases or problems independently. For example, we would treat diabetes with blood sugar lowering pills or insulin shots. We would then treat the high blood pressure with blood pressure lowering medication and lastly, we would prescribe lipid-lowering drugs for the hyperlipidemia. While this still remains a necessary part of the treatment, some of these drugs can have adverse effects also including weight gain. And since weight gain is such a powerful factor in the development of metabolic syndrome, it really makes sense to focus efforts on losing weight.

So the more modern and forward-thinking approach to the metabolic syndrome is to emphasize weight loss as a primary treatment. It is very common to see that people with full-blown metabolic syndrome resolve one, two or three diseases entirely as a result of a successfully medically supervised weight loss program. And while losing weight successfully and keeping it off for the long-term is definitely harder than just taking a pill to treat the high cholesterol level, the results are worth it.

What has changed?

I find that a very high percentage of my own patients are working more than ever, have less free time, have less time to exercise, and rely to a greater and greater extent on fast food and restaurant food options. This is a real recipe for disaster with weight gain and a high risk of developing obesity. Today it might be said that we are living in an area of a “perfect storm” with respect to weight gain and obesity.

• Food manufacturers and restaurants have succeeded in making meals more delicious than ever, but also higher in calories and carbohydrates.

• Advertisers tempt us at every turn with the sights, sounds and smells of succulent offerings.

• Schools depend on fast food and soft drink purveyors to fund their programs.

• Most parents work and nobody has much time to prepare healthy meals.

• The streets are not always safe and we spend less time outdoors exercising.

• TV, computers and video games are more entertaining, and more sedentary, than ever

The number of people among the population who were overweight or obese held steady for many years until the 1980s. Then, a sharp rise in the level of obesity occurred in the United States. Over a roughly 30 year time period, we have seen a dramatic increase in the percentage of Americans in almost every state who are now considered overweight or obese.

To be considered overweight, you must have a body mass index of greater than 25. To be considered “obese” in the medical sense, you must have a body mass index over 30. Today, more than 2/3 of Americans are overweight.

So what has changed in that relatively short time frame of 30 years or so? Well if you are old enough, think back to what was different then. You probably realize that most people ate more meals at home, portions were smaller, and people tended to have more time on their hands to be active and outdoors.

You might not be aware of the extent to which meals have increased in size and in calorie content over that time frame. For example, the average meal has increased in calories by approximately 1/3. Greater numbers of people eat more of their meals in restaurants and fast food establishments. Those same establishments have dramatically increased the portion sizes and calorie content of their offerings. And, people have less time to shop, cook, prepare fresh fruits, vegetables and grains and exercise outdoors. Think for a moment if any of that information seems surprising to you or if it fits your own lifestyle.