In a fascinating study published in the Proceedings of the National Academy of Sciences, a research team led by Tamas Horvath at the Yale School of Medicine has published findings that indicate our brains are hardwired in different ways.  Some of us are born with and continue to develop brains that do a better job at signaling satiety or fullness after taking in an adequate number of calories.  In other brains, the hardwired neurons do not.  In addition, the hardwiring of brains associated with obesity may be less effective sending signals to the body to burn excess calories instead of storing them.

The Yale School of Medicine study examined rats and assessed particular brain mechanisms associated with eventually becoming obese.  Some of the rats were likely to become obese with a high calorie obese while other rats were not likely to become obese.  There appears to be both some hardwiring that occurs at birth as well as some changes over time in the brain cells, or neurons, that affect whether an individual  gains weight and becomes obese, or simply maintains a healthy weight, even on a high calorie diet.

One of the most interesting, but troubling findings of the study is that the brains of some individuals who are more susceptible to diet induced obesity exhibit a type of brain inflammation, whereas those individuals who are resistant to diet induced obesity do not.  The concern is that this type of change in the brain or inflammatory response of the brain with weight gain, may explain why it is so hard for obese individuals to lose weight and keep it off once changes in the brain have already occurred.

More studies will lead to a better elucidation of the exact mechanisms by which certain neurons signal for the sensation of satiety or fullness and the decisions to stop eating or drinking further calories.  Additionally, we hope to learn more about how the brain signals whether calories are stored as more fat or whether they are burned.  What is clear is that some individuals are more prone to obesity than other individuals.  Yet, the primary change that has taken place in the last forty years is not one of the genetics of our brain cells, but is one of the changing environment around us and the dramatic increase in the calorie content of foods, drinks and meals, such that most of us are consuming 30-40% more calories than our predecessors were forty years ago.

So while the rat studies indicate that some of us are likely to be more protected or resistant to obesity with this new high calorie diet, most of us are not.  If public health predictions hold true, very soon the percentage of all Americans who are overweight or obese will approach 100%.

After a year’s long process, I was very gratified to receive the designation as a Fellow of the American Society of Colon and Rectal Surgeons.  The society has quite rigorous criteria and requires extensive training including fellowship residency training beyond general surgery training plus a passage of a series of board exams and an application process including review of colon and rectal surgical cases.

It is an honor to become a fellow in the society that sets such high standards for colon and rectal surgery.  My areas of expertise are particularly focused of laparoscopic and minimally invasive intestinal abdominal surgical procedures.  I was fortunate to receive extensive training in minimally invasive surgery for intestinal disorders and colorectal disease as well as other gastrointestinal and abdominal disorders.  And in the years since that training have been fortunate to be in a position to further refine the techniques for successful outcomes with less invasive surgical intervention.

Minimally invasive intestinal and colorectal procedures allow for people to return to work sooner and recover more quickly after surgical intervention.  I perform a high number of laparoscopic and minimally invasive intestinal surgical procedures for many abdominal and colorectal disorders including colorectal cancer, inflammatory bowel disease, Crohn’s disease, ulcerative colitis and a host of other abdominal conditions including gallbladder disease and hiatal hernias as well as, of course, bariatric surgery.

So my thanks to the society for designating me a fellow and I look forward to participation in the society in the future.

We’ve seen the long haired, young Jesus, the bearded serious Jesus, the bare chested Jesus, the suffering on the cross Jesus, but I don’t think I have seen the morbidly obese Jesus.

Why do you suppose it is that artistic depictions of the Last Supper depict increasingly larger and larger portions? According to a recent finding described in the International Journal of Obesity and shared through scientificamerican.com, over the last thousand years the portion sizes depicted in the paintings of the last meal shared by the Apostles and Jesus has grown markedly. Brian Wansink, a clever obesity and eating behavior researcher, together with his brother Craig, a religion professor, examined fifty-two Last Supper paintings. They found the serving size of the bread depicted was 23% larger in modern paintings and the serving sizes of the other entrées had grown by 70%! They used the size of the Apostles craniums as a control measure so as to help avoid exaggerations that were simply due to a different scale of the painting.

I think Da Vinci would be astonished to learn just what supersizing has done to actual portion sizes in modern times.

Researchers in the United Kingdom have been studying a fibrous material in seaweed or sea kelp known as alginate. They have found this material is quite affective at preventing fat absorption. Researchers performed laboratory studies that modeled fat absorption within the human intestine and demonstrated that alginate will bind the fat and prevent its absorption into the body. The researchers believe when this material is added into commonly consumed foods such as breads and other staples that up to 75% of dietary fat would pass through the intestinal system without being absorbed into the human body.

Anyone who has taken Xenical will know that blocking absorption of fat into the body means one thing: it passes out the stool, usually in the form of diarrhea or a special greasy form of diarrhea known as steatorrhea. The appeal of fat blockers stems from the fact that fat is a very calorie dense nutrient containing 9 calories per gram of food.

However, research that has focused on reduction of fat has lead to very disappointing results for the outcomes that matter: weight loss and resolution of obesity related conditions like diabetes. Research involving fat blocking drugs such as Xenical have shown very mild weight loss and to such a low extent that most professional weight loss physicians only recommend the drug (also sold as Alli over-the-counter) when a weight loss patient is suffering from constipation.

So seaweed might have an interesting role in cutting down some calories we absorb. Reducing fat calories will help the overall cause, however it is quite unlikely that reducing fat calories is going to solve obesity for most people. The epidemiological evidence points strongly toward carbohydrate over-consumption as the main culprit so unless we discover a seaweed that is a “carb blocker “then it is unlikely to make a dent in the obesity epidemic

Mother’s Day, May 9th, 2010, kicked off National Women’s Health Week. A special week promoted by the U.S. Department of Health and Human Services and their office on Women’s Health. This year the theme of the week long campaign is called “It’s your time” and the idea is for women to take steps to improve their health and to make their health a top priority.
While there are many important things that women can do to improve their health, number one among them in this day and age is to maintain a normal body weight and avoid weight gain and obesity. If a woman has crept up to a body mass index greater than 25 than a serious effort at calorie reduction and increased exercise is in order. For a body mass index greater than 30, a more rigorous and structured program is warranted, and the evidence strongly favors taking a very proactive and serious approach including consideration of a Lap-Band operation in conjunction with such a program. For a body mass index of 35 and greater, a small percentage of women can lose the weight successfully without weight loss surgery, but for more this would be a very challenging undertaking. Even with weight loss surgery, successful return to normal body mass index will require diligence, hard work and a structured program. But these efforts are well rewarded with vastly improved health, longevity and quality of life.
Various events are planned around the country to celebrate National Women’s Health Week and these can be found at:
http://www.womenshealth.gov/whw/events/
The Surgeon General, Dr. Regina Benjamin emphasizes the importance of empowering women to make their own health a top priority.
Our recent Health Moms campaign dovetails importantly with National Women’s Health Week and the project this summer aimed at helping moms lose the pregnancy weight and promoting health families in obesity prevention among children will succeed in improving the health of not only women in our community, but the entire families that women lead.

A friend of mine who has been an inspiration to me recently suffered and Achilles tendon rupture that seemingly struck out of the blue. She is one of those people who seems to do it all, a super-mom who manages to run and continue an impressive career, maintain fitness, recover well from childbirth and just about everything else. But recently a recreational game of racquetball, lead to a snap and a diagnosis of a ruptured Achilles tendon that is going to require months of lifestyle change, rehab, crutches and more. It has been yet another reminder of how fragile we are and how tenuous our hold onto health and fitness truly is even when we are seemingly doing everything right. So what lessons do we take from it? Well, one thing is to certainly appreciate everyday that we have in this wonderful world and especially appreciate every day we have with good health. Never take such days for granted and cherish the precious minutes of nice weather and the ability to exercise and experience vitality and nature. It also reminds us to be careful and try to balance the risks of our activities against the enjoyment and the benefit of them. For example, many of us are a lot less reckless on the ski hills nowadays than we once were in our youth. I see far too many serious orthopedic injuries and brain injuries among skiers, both of which would be pretty problematic for my kids so I take a little more caution and go a bit slower (but still have just as much fun!).

Research indicates that running and vigorous long term exercise is not associated with increased orthopedic injuries. This runs contrary to popular opinion on the subject, but nonetheless it does appear true from a large Stanford study and other trials that comparing, for example, runners to non-runners over the course of many years, runners experience no greater incidents of knee injuries or other orthopedic ailments. On the other hand, skeptics argue that these runners are “self selected” because they have more durable knees and joints, but it is difficult to prove. It is certainly better for our cardiovascular health and our mental health to exercise regularly throughout our lives and hopefully into advanced age. Whether capricious injuries derail that hope is something none of us can predict. But one hopes my friend will recover uneventfully and will go on to have a long and health career exercising and the rest of us can avoid injury by being careful, staying active and eluding the risks we take. And above all, acknowledging and cherishing every day of good health we get.

Recently some of the U.S. High Command, some of our top generals, has reported that the number one medical reason for our military personnel being unfit to serve in the military is you guessed it, obesity. A shocking 27% of America’s fighting force in one recent survey were found to be overweight and over the regulatory limits considered the uppermost allowable weight that allowed one to be fit enough to serve in the U.S. Armed Forces.

Having served in the United States Air Force Reserved and spent several short tours in my annual active duty service at military hospitals- mainly Malcolm Grow Medical Center in Washington, D.C.- I of course also witnessed the gradual increase in the average weight of our nation’s troops. Our fighting men and women mirror the rest of society and struggle with the same temptations and the same obesogenic environment.

What is the solution? The solution is a radically different approach to health, fitness and weight maintenance in the military. All one has to do is spend a few days on any U.S. military base to see a pervasive culture and environment that promotes obesity. I believe there are many factors in action at U.S. military bases that lead them to be worse than most U.S. communities, cities, towns and schools in terms of their likelihood of promoting obesity. Why do I say this? Here are some key factors.

1. A culture that discourages work. Yes, let’s face it, as any long term military person will tell you, if they are being honest, there are an unbelievable number of people who are considered R.O.A.D. warriors. This means Retired on Active Duty. Ask some of your friends who are in the military and you will see there is a tremendously deleterious civil servant culture that incentivizes laziness and discourages productive work. More on this in other sections and chapters, but let be honest, any job that encourages people to sit, be less active and accomplish far less work in any given day than any civilian job would tolerate is not going to be conducive to maintaining a healthy weight.

2. Obesogenic food service. On the base where I would normally serve one could find several of America’s typical fast food restaurants with long lines in the drive through and a great many of the soldiers accessing the high calorie, high fat and especially the high carbohydrate fast food for their meals. Even the military food service often consisted of high carbohydrate meals, snacks, plentiful desserts, soda machines, snack machines and no real effort to discourage our fighting men and women from consuming all these calories.

3. A military that does not enforce its own fitness regulations. Nowadays, quite frequently, physicians like me will determine that a soldier is unfit for deployment only to find that they remain on active duty because of the command staff which does not want to bother with the paperwork or the termination procedure. Or, they really know that since no one really enforces these regulations anyway it doesn’t matter all that much if another soldier is vastly overweight and couldn’t run a 100-yard dash to save his life.

4. These are but a few of the dangers that America’s fighting forces face on their own home base and presumably many of these same factors continue in bases abroad.

5. An environment and culture that promotes screen time, power points, TV watching and less physical activity.

6. Very little awareness or education about the deadliness to the strength of the fighting force that is posed by high carbohydrate, high calorie diets. Very little information exists on bases. There is no real general awareness of the problem and thus no active effort underway to combat it.

Clearly the combat forces do much better with respect to weight maintenance. They are encouraged to maintain an active fitness regimen. They tend to be involved in a culture that is at the tip of the spear and does involve physical combat where personal fitness is at a premium, but it falls steeply downhill from there.

So if the number one threat to the fitness of our current fighting force is obesity, one would imagine that people concerned with national security would be interested in formulating a solution to this number one threat. I am guessing that with a thin fraction of the resources that are spent on the dozens of levels of bureaucracy in the U.S. military devoted toward preventing obesity that the results would be astonishing, a fitter, more effective, more serious fighting force protecting the United States of America.

The Washington Post recently reported it is becoming increasingly common for paramedics and ambulances to be called upon to transport patients weighing 350 pounds or more. In fact, this has become a daily occurrence. According to the article, every few months patients weighing as much as 600 pounds require emergency transportation.

The super-sized patients require super-sized equipment as well as additional training to avoid injuries among the emergency medical personnel and paramedics. Expensive equipment upgrades have lead paramedic communities to increase their fees for transporting patients who are obese.

I know from my own experiences talking with hospital and emergency medical personnel that back injuries are a serious concern for these workers when transporting obese patients.

It is an increasing problem not only in the paramedic/ambulance situation, but within the hospital itself. A great number of these workers who themselves are often becoming overweight, suffer increased strains and lumbar and cervical spine difficulties as a result of having to lift and transfer heavier and heavier patients. Purchasing expensive equipment upgrades provides only a partial solution, but it does not really solve the day-to-day needs of transferring a patient say from a gurney to a bed. This normally requires human hands and human bodies. With the shortage of personnel, healthcare dollar cutbacks and lower staffing models, there are fewer people available to help with these tasks. More often than not, a two person team will be forced to perform the transfer even if the patient is obese.

A vaccine is most effective when given in the intramuscular position, meaning the vaccine substance and molecules enter the muscle tissue where the immune fighting antibodies can be activated. If the vaccine is simply injected into the subcutaneous fat then it is probably less effective at generating immunity. We have long known that vaccines were less effective in obese individuals, probably as a result of this fact. Now recent studies indicate that vaccines are more effective when a longer needle is used, presumably because the vaccine can enter directly into the muscle tissue and not be wasted in the subcutaneous fat.
It is striking to me that virtually every facet of health and disease is adversely affected by obesity, even preventive efforts such as vaccinations. In this most recent study analyzing the effect of Hepatitis B vaccines, the Baylor College of Medicine researches compared the antibody levels with short needles compared to long needles. The antibody numbers when short needles were used were about half of that when a longer needle is used. The authors note that there already exists a CDC recommendation to use longer needles (usually 1.5-inch long) in obese individuals.

A recent study out of Singapore, which examined over 60,000 people over the course of fourteen years, found that those subjects who drank two or more sugared soft drinks per week had doubled the risk of developing pancreatic cancer than those who did not.

It is not known why increased soft drink consumption could lead to an increased risk of pancreatic cancer or whether this effect is going to be born out in other studies. Some facts we do know about cancer: many cancers are markedly increased in obesity. Colorectal, breast cancer, endometrial cancer and others double or more than double among obese individuals when compared to normal weight individuals. We know there is an association between soft drink and sugar consumption in obesity, so it stands to reason that some link may exist between the soft drinks and cancer development. Pancreas cancer in particular may be one that has some special sensitivity to the elevations and hormonal surges of insulin, leptin and other hormones associated with carbohydrate consumption and obesity.

Whether some subtle toxin could be present in soda cans or whether there is something specific about the soft drinks as opposed to other sugar drinks like fruit juices remains to be seen.

What is known is that drinking lots of sugared soft drinks is bad for your health. It leads to weight gain and obesity, which increases cancer risks markedly. This latest study is one more, small piece of data that should discourage drinking high carbohydrate soft drinks.