Recently, a series of papers in the New England Journal of Medicine have highlighted the importance of what is called brown fat. This is a  special type of fat that is involved in thermoregulation or heat generation for the body.  More commonly present in infants, “baby fat” and in some kinds of animals.

One of the more interesting ideas to emerge from brown fat research is that a method for losing weight may be found by simply turning down the thermostat in our homes.  The idea is that when the thermostat is down and the ambient temperature drops, our brown fat revs up and goes to work increasing our body temperature.  It’s our own sort of internal combustion engine.  It also burns quite a lot of calories.

So while more research will need to be done, the idea of lowering the thermostat in our homes may very well be a simple and yet effective way to increase significant calories burned by our bodies.  (As long as you don’t eat more when the room temperature is lower!).

For those of you who have received our emails and letters or seen the ads, the date is fast-approaching. The 7th annual Western Bariatric Fashion will take place this Saturday March 28th.

I will be signing books and selling advance copies of my new book, “Outpatient Weight-Loss Surgery: Safe and Effective Weight Loss with Modern Bariatric Surgery”, starting at 5:30 PM. There will be gifts and drawings and inspirational stories and entertainment. Local news anchor Joe Hart will be this year’s emcee.

I look forward to seeing you there!

I think just about everyone would agree  that one of our top priorities should be to ensure the health of our nation’s children.   And although some of us point to a failure of personal responsibility as a component of the problem of weight gain and obesity, few can make a compelling claim that our nation’s children bear the responsibly for their own obesity and unprecedented suffering with diabetes (and other obesity-related health problems).

And what of the causes of this devastating increase in childhood obesity and childhood diabetes?  Numerous recent studies have noted the striking rise in obesity related illness among kids.  A disturbing, growing percentage of our nation’s youth have a condition known as “prediabetes” or impaired glucose tolerance that leads to outright diabetes.

The best evidence points to multifactorial causes.  We are a more sedentary society.  Our children spend more time in front of screens than out kicking balls and running through the grass.  Physical education has disappeared from the school curricula.  A greater fraction of the child’s meals are fast foods and prepared foods.  And these same fast foods are more delicious than ever and higher in calorie content than ever.  And finally, our children have exhibited a stunning increase in the consumption of carbohydrate sweets, especially table sugar (sucrose) and high fructose corn syrup, that parallels the epidemic of weight gain and obesity. As a weight loss expert having worked with so many overweight people over the years, the consumption of sweeteners stands out as accounting for a disproportionate amount of the problem of weight gain.

Scientific studies further link the consumption of high fructose corn syrup-laden beverages and increasing rates of childhood obesity.

In 1970, the average per capita consumption of soft drinks, sodas, in the United States was 28 gallons per person per year.  In 2008, it was 56 gallons per person per year (of beverages usually sweetened with high fructose corn syrup).  Over the same period of time, the rate of obesity (Body Mass Index greater than 30) has increased from around 5% to over 15% among children and adolescents in this country.  Between 1970 and 1990, the US per capita consumption of high fructose corn syrup has increased tenfold or more than 1000%.  According to a comprehensive review undertaken by the American Journal of Clinical Nutrition in their article published in 2006 (American  Journal of Clinical Nutrition, Volume 84, page 274-288), the comprehensive review of all of the clinical trials and evidence-based, peer-reviewed studies demonstrates that “the weight of epidemiologic and experimental evidence indicates that a greater consumption of sugar sweetened beverages is associated with weight gain and obesity”.

So how do we as individuals, as communities, as governments, as schools, and as corporations lead, protect and nurture our young people?  How do we, as the adult stewards of our young people, prevent them from suffering the scourge of obesity, type II diabetes and its complications (blindness, amputations, stroke, kidney failure)?

My belief is that the solution lies in every community in the country, every government chamber in the country, every school in the country, every corporate boardroom, and every home.  It will take all of us working on many solutions to fix a problem that is so widespread and so damaging to kids.

When tobacco was shown to cause health problems (cancer, heart disease, birth defects), initially the tobacco industry dug in and created an advertising, public relations response that tried to deny the science.

Now we see the same head-in-the-sand response by the makers of high fructose corn syrup. Instead of acknowledging the obvious role of sweeteners in fostering childhood obesity, diabetes and disease, the industry is mounting a public relations campaign to dispel the science.

Instead of stepping up and taking responsibility, the industry is putting out spin with ads like these from the corn council.

Sure, there are differences among tobacco, alcohol and sweeteners. But if we are to reduce the alarming rates of childhood diabetes, it is undeniable that we must find a way to reduce consumption of these high calorie, high carbohydrate sweeteners.

As a physician and parent, I would appreciate industry taking a leadership role in educating kids and parents about the damaging aspects of high fructose corn syrup. Imagine a responsible corn industry running ads that say that consumption of this sweetener needs to be limited in kids and overweight adults. Consuming too much of this sweetener leads to weight gain which causes real health problems for kids, like diabetes. So enjoy our delicious sweeteners, but do so in moderation, and make sure your child is staying on a healthy growth curve and not gaining weight beyond a healthy level.

I suspect it is a matter of time before governments force the Corn Council to step up and act responsibly. Based on this sad spin campaign that ignore our childrens’ health and serves only to promote more profits for the purveyors of high fructose corn syrup, it does not appear that the corn industry is prepared to act responsibly on its own.

New York’s governor, David Patterson, favors a tax on sugared beverages such as popular soft drinks, Coca-Cola, Sprite, Pepsi and others. His argument is that weight gain and obesity cost the public tremendous amounts of money and healthcare dollars and they take an enormous toll on the health and well-being of all citizens. The governor further notes that heavy taxes on cigarettes have helped reduce the consumption of these tobacco products which also contribute greatly to disease and burdens on the healthcare system.

Opponents of such attacks say that taxing sugared beverages is just a cynical means of raising money for cash-strapped governments, and they doubt whether raising the price of Coca-Cola will have any impact at all on the obesity epidemic.

What do you think?

When I studied public health at the University of California Berkeley, I learned that government can influence personal behaviors through public policy changes including taxes. I was also taught to look “upstream” at the root causes of major health problems and try to come up with ways that public policy could impact those root causes.

But it is hard to know whether a tax on sugared beverages would discourage people from drinking them. Judging from the tobacco taxes, it has taken very high taxes to impact a person’s behavior significantly. Are societies prepared to levy taxes on soft drinks of 50% or 100% or 200%?

And then the problem of obesity becomes even more muddled. How much of it really stems from sugared beverages? And if sugared beverages become prohibitively expensive, will people just get there “sugar fix” by turning to other less expensive treats? Perhaps public policy should take into account that the consumption of calories in general and high carbohydrate foods in particular, contribute to the obesity epidemic. It is true that this places a great burden on the tax payers. But how to construct a fair and equitable tax to address these questions? For example, should we tax only foods that are high in calories and high in carbohydrates? And would we apply those taxes across the board or only to certain subgroups? For example, should we just tax sugared beverages but not sugared ice creams and cakes?

No matter what the ultimate answers to these questions, the sobering truth is that the consumption of more high carbohydrate foods and beverages is contributing to an alarming and devastating rise in type 2 diabetes, cardiovascular disease and obesity. With nearly a third of our nation’s children overweight or obese, an alarming increase in the number of pre-diabetic kids and adults, creative public policy solutions need to be found. But is this the right one? Tell us your thoughts.

Laurie McGinley, RN, was recently elected president of the National Association of Bariatric Nurses. I had the great pleasure of working with Laurie who served us as a clinical nurse specialist for Western Bariatric Institute. She provides outstanding care to the bariatric surgical patients in every phase of their weight loss journey. She is compassionate, highly dedicated, and devoted to each and every patient.

It is a real honor for her to be chosen the president of the National Society, and no one could be more deserving. She will be honored in Reno, Nevada at the Western Regional National Association of Bariatric Nurses conference to be held April 4, 2009 at Renown Regional Medical Center.

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?