Archive for the ‘Medical Weight Loss’ Category

LOW CARB DIET SURPASSES LOW FAT DIET FOR CARDIOVASCULAR HEALTH IN TWO YEAR RANDOMIZED STUDY

Thursday, September 9th, 2010

In a recent study published in the Annals of Internal Medicine, a research group from Temple University randomized patients to either a low carbohydrate diet or low fat diet and followed them closely for two years.

The findings come a little surprise to most physicians working today in the field of medically supervised weight loss, but have appeared surprising to many in the general population.  The low carbohydrate diet proved better at creating a better cholesterol level profile than the low fat diet and appeared better at controlling high blood pressure, both considered cardiovascular risk factors for events such as heart attacks and stroke.

Both diets have produced around 7% weight loss at two years of follow-up with no significant difference between the two groups.  There was no change in bone mineral density for either group at any point in the study and no change in body composition-or the percentage of body fat versus protein- at any point during the study.

High density lipoprotein (HDL cholesterol or so-called “good cholesterol”) was increased among the low carbohydrate group significantly above that of the low fat group.

The researchers point out that the key to long term success lies with changing behaviors staying focused on reduced calorie intake and carbohydrate consumption, avoiding snacking and other excess calorie intake.

Previous studies comparing low fat to low carbohydrate diets have demonstrated that dieters found greater satisfaction and were more successful in sticking to the low carbohydrate diet when compared to the less enjoyable low fat diet.  This recent Temple University study adds to the evidence favoring a low carbohydrate approach by pointing out the more favorable outcomes for cardiovascular risk factors among the low carb dieters compared to low fat dieters.

DOCTOR’S ORDERS WINS BOOK OF THE YEAR BRONZE

Monday, August 2nd, 2010

Well it was very gratifying that Doctor’s Orders: 101 Medically Proven Tips for Losing Weight won the bronze medal for Book of the Year in the health category.  This book, a practical guide with research proven tips to help a person lose weight, was up against some very stiff competition.

Doctor’s Orders has been the most in demand of all of the books I have written and it’s nice to see a little bit of critical praise as well.  Thank you very much to the Book of the Year judges and officials of the contest and to the readers.   Hopefully that will help expand the readership a bit and bring some vital health information to so many people who need to lose those unwanted pounds.

WEIGHT LOSS SURGERY REVERSES DIABETES: A NEW STUDY PROPOSES THE EXPLANATION

Wednesday, July 7th, 2010

In a new study released by the University of California, Davis has found a proposed mechanism by which bariatric surgery resolves type 2 diabetes in humans. In the study, a specific line of rats known as the UC Davis type 2 diabetes mellitus rat was studied. A model was created which a surgical procedure that mimics malabsorptive human bariatric surgical procedures was employed in this special group of rats. After the procedure, a dramatic reduction in the onset of type 2 diabetes was noted 120 days later. 78% of the control group rats developed the diabetes as expected while only 38% of the rats that had undergone the surgical procedure developed diabetes.

The researchers described a hypothesis in which two specific hormones are implicated in the resolution of diabetes or the prevention of type 2 diabetes. These two hormones are known as GLP1 (Glucagon- like peptide-1) and PYY (peptide YY). These two hormones have been previously identified and are involved in regulation of insulin secretion and appetite. GLP1 is believed to increase insulin secretion and increase insulin sensitivity in the tissues, which would lead to improvement or resolution- or in this case prevention- of type 2 diabetes.

The study is important in part because some of the findings about blood sugar regulation after weight loss surgery appears to contradict the hypothesis that the phenomenon is purely weight related. While long term studies of gastric banding and gastric bypass demonstrate similar rates of diabetes resolution, short term studies indicate the gastric bypass, a malabsorptive procedure with greater hormonal changes, produces faster and earlier improvements in type 2 diabetes. The explanation for this phenomenon may lie with hormonal changes such as those that occur with GLP-1.

Undoubtedly future studies on these hormones in both animals and humans will shed greater light on the subject and help us understand how and why weight loss surgery exerts is powerful effects. In addition, such studies may lead us to new drugs, pharmaceutical solutions to the problem that will involve drugs that mimic the actions of GLP-1 or block other hormones that create harmful effects and perhaps allow a way to chemically produce the effects of weight loss surgery.

Some researchers in the field of obesity postulate that within ten years we will have a whole array of new drugs that produce some of these effects, but obesity is likely to remain a complex, multi-factorial disease with many psychological, behavioral, genetic and cultural factors that play a role.

Life Changing Weight Loss Books Arrive!

Monday, January 25th, 2010

After some delays, we have received the shipment of my newly released book: Life Changing Weight Loss. In these times, everyone could use a guide to real, successful weight loss.

In radio interviews on stations around the country, I have been so pleased at the reception the book has received so far. One of the common threads I hear is that media people are inundated at this time of year with weight loss books and information, most of which has very little basis in the practical science of what truly works. Much of it is based on wishful thinking, marketing plans or fanciful obsessions with obscure root extracts and proprietary blends of unregulated secret, magical herbs. The truth about successful weight loss is much simpler and yet, also much more complicated.

At the end of the day, to solve a weight problem and keep the pounds off, we must find a successful strategy to consume less calories every single day, burn more calories every single day, and find satisfaction and contentment despite this. Many of us can muster the motivation on a short term basis to consume less calories and burn more calories, but we feel like we are starving ourselves or doing the impossible. That won’t work for the long term. Long term success lies in mustering that motivation, but making an internal life change, a new look at how we view ourselves, our weight, our diet and our activity. Only then does the “light switch” flip on, only then do we successfully lose the weight and keep it off for the long term.

Anti-Psychotic Drugs Cause Weight Gain In Adolescence

Sunday, January 24th, 2010

Recent reports offered some disturbing news: a series of drugs commonly prescribed to treat mental health conditions in adolescence cause weight gain as a side effect. This is not terribly surprising news as it has long been noted that many of the antidepressants and anti-psychotic drugs have been associated with weight gain in numerous previous studies. What is disturbing is there has frequently been lack of full recognition of the deleterious effects of weight gain on the mental health conditions themselves. This is perhaps most aptly demonstrated in the relationship between obesity and depression. It is well known depression itself often leads to over-eating, inactivity and weight gain. Likewise, it has been demonstrated that weight gain and obesity lead to depressive feelings and a cycle of downward mood spiral.
These latest reports offer further disturbing news that sometimes our pharmacologic answers to serious health conditions can often have a dangerous side effect: obesity. It also speaks to the fact that when any prescribers are offering drugs to treat one condition, it would be terribly helpful to consider the negative effects of weight gain just as other side effects are factored into the decision of the prescribing the medication. In the past, weight gain has often been thought of as a relatively minor side effect, but in today’s obesogenic environment, I don’t think that should be the case any longer. Obesity is more widely recognized now as a quite serious health problem in its own right and drugs that lead to weight gain and obesity as a side effect must be scrutinized closely before they are prescribed. I would argue that patients, who are embarking upon any drugs that include weight gain as a typical side effect, should concomitantly enroll in a weight controlled program or weight reduction program to actively combat the effects of the drug.
Some of these drugs directly stimulate appetite. Others lead to inactivity, but many of them have in common the empirically noted finding that patients on the drug gain weight when compared to patients on placebo.

Depression And Weight Loss Surgery

Tuesday, November 24th, 2009

I saw a patient today who has battled with depression intermittently throughout her life and also struggled with obesity. She wonders if the two are related, but also about how she will manage the depression after her weight loss surgery. Is it still possible to take medications should she need them? Might her depression improve if she undergoes weight loss surgery?
Interestingly, the research on depression and obesity shows it is a two way street: depression leads to more obesity, but obesity itself exacerbates depression. It makes sense, if we think about it. Depressive feelings can lead to overeating and loss of motivation to exercise. Likewise, obesity can lead to feelings of lower self-esteem and lower one’s mood.
Research also indicates some people do experience improvement in their depression after weight loss surgery.
Similar data exists about non-surgical weight loss. Of course it is hard to separate out which comes first, better feelings of self-esteem and higher motivation that lead to successful weight loss or some improvements in weight, leading to better body image and some improvement in mood. Ultimately, this chicken and egg question may be difficult to answer, and the most important advice is to seize the day and to work very hard on both problems. By this, I mean that if you struggle with depressed mood then seek help immediately including psychological counseling and visiting with health professionals who may offer effective antidepressant medications and recommend mood elevating activities like exercise. Likewise, if you are overweight or obese, don’t let another day go by without working on this problem too. Seek professional help. Follow the strategies and tips outlined here and in my books and you will benefit with lower weight and an improved mood.
For my patient today, I also let her know that antidepressant medications can be taken and absorbed after Roux-en-Y gastric bypass surgery. We do believe it is best to change from any extending release formulations (for example Effexor XR) to the standard release formulations that usually must be taken two to three times a day rather than only once a day.
Like so many complex facets of human health, depression and obesity are closely linked. One affects the other, but more importantly one is improved by improving the other

Weight Loss Options If Your BMI Is Below 35

Friday, November 13th, 2009

If you’ve been searching for a weight loss solution and your Body Mass Index is between 28 and 35, you may have found that solutions are hard to find. (Calculate your BMI here).

An increasing number of large, high quality prospective research studies have demonstrated a high success rate in effectiveness with laparoscopic adjustable gastric banding surgery. Studies have also indicated that other types of weight loss surgery are effective in this “lower BMI” group. To date, the generally accepted guidelines that health insurers and most bariatric surgical centers follow begin at a BMI of 35 and go upward.

Options for Weight Loss If BMI is 28 to 35
In this category of severe overweight or moderate obesity, weight loss considerations boil down to a few important options:

Medically based weight loss
A medically based or medically supervised weight loss program. Increasingly, physicians who are devoted to weight loss surgery offer specialized programs for people in this Body Mass Index category. The best of these kinds of programs combine all of the elements of proven weight loss strategies. I outline a comprehensive strategy that is based on our medically supervised weight loss program at iMetabolic in a soon to be released book entitled, “Life Changing Weight Loss.” This book offers a very candid and revealing look at what a comprehensive medically based weight loss strategy entails. As you might predict, it centers around making permanent changes in ones diet and physical activity. It also centers specifically on a focus toward true and enduring “life change”, which is sometimes easier to talk about than actually do. But it requires a change in attitude and a change in habits, as well as a very structured program. The best medically supervised weight loss programs involve many or all of the following elements:

  • Structured dietary advice.
  • An induction or initial weight loss program to get the pounds off rapidly and early, over eight to 24 weeks.
  • The use of medically formulated protein-based meal replacement shakes.
  • Maintenance of a diet or food journal.
  • Individualized counseling from specialists, experts in eating behavior and psychology.
  • Ongoing support groups with other people on the same journey.
  • Regular exercise programs with commitments such as walking groups.
  • Goal oriented encouragements with participation and performance goals.
  • A transition phase with specific introduction of carefully designed and monitored foods.
  • Rigorous teaching for increased awareness of calories, carbohydrates, vitamins and nutritional needs.
  • Inclusion of appropriate vitamins and supplements for weight loss and maintenance of healthy muscle mass.
  • A long-term ongoing maintenance program after the weight has been lost to stay engaged and focused and avoid rebound weight gain.

In the next post I will discuss the surgical weight loss options for people who fall into the lower BMI range of 28 – 35.

Sleep Well and Lose Weight

Friday, September 11th, 2009

Did you know that lack of sleep leads to more weight gain? As if there weren’t enough things out there to cause us to gain weight, research as shown that a lack of a good night of sleep leads to more wight gain. The mechanism is thought to be related to an increase in hunger and a decrease in some of our impulse control and mindfulness with respect to eating and giving into temptation around food.

I have definitely seen this phenomenon in my own life. After a night on call when I have had very little sleep, I tend to do a very lousy job of eating well the next day. Somewhere in my subconscious I seek to reward myself, or find comfort and pleasure in things like doughnuts and pastry’s in the doctor’s lounge that I would otherwise, usually avoid. I also find that if I have not slept well, or slept enough hours, that it is much harder for me to find the energy or motivation to go for a run or do other exercise. So, none of these are health results from lack of sleep!

So what can you do about it? Well, there are a few, very important practices you can undertake that will maximize better sleeping and therefore help you in your journey to a healthier weight.

  • For starters, don’t consume caffeine or other stimulants in the afternoon or evening. Avoid alcohol beyond two or three ounces of wine and avoid eating a late night meal.
  • Find 30 minutes for a brisk walk or other exercise in your day or evening and you will sleep much better.
  • Establish a routine in which you sleep in a safe and comfortable environment that is controlled to your likings, in respect to the temperature and darkness.
  • Establish your bedtime and stick to it every night. Try to minimize emotionally charged events and activities that occur close to bedtime.

Importantly, many of us have un-recognized sleep disturbances that can only be diagnosed by a formal sleep study. The most common among these is obstructive sleep apnea, a very common condition that occurs as a result of weight gain. It results from airway obstruction of some soft tissues.

Competition Goals Can Be A Useful Weight Loss Tool

Wednesday, July 29th, 2009

You may be saying that you have relied upon good medically based and scientifically based information from me and my books and columns so that you can achieve better fitness, improve your health and live at a healthier weight.  But you really were not interested in competing with anybody, and I understand this.  But what I am raising with this idea of competition goals is a little bit like a psychological lever that you can use to motivate yourself to achieve your broader goals of improved fitness, health and longevity.

We all have a competitive instinct. Some of us display it and are driven more by it than others, but we all have it.  What you want to do is tap into it to help you achieve your goals.

Sometimes the competition is only with yourself and sometimes it is with others.  But the point here is to not shy away from some competition and to enjoy it and use it as a motivational tool for you to reach a better level of fitness, and lose weight in the process.

Let me give you an example:  A patient of mine had been active as a teenager, but gained a large amount of weight after each of her pregnancies and found herself seriously obese in her early forties.  As part of her weight loss program, I encouraged her to join our weekly walking group and eventually encouraged her to sign up for a 5K run/walk race.  Now the word “race” causes many people to shy away from the event. After all, she had never “raced” before, certainly was not in good enough shape to win any races.  On the other hand, I knew that once I got her hooked on the idea that she would begin to compete against herself and want to improve her times.

In fact, she went on to complete a 10K race and is signed up for more future races.  Each race is scheduled several months out in advance and it gives her a target for her “training”.  Now, all of a sudden, instead of being a seriously overweight 40-something, she is an active person who is training for races.  It changes the way she thinks. It changes what she talks about with her friends and colleagues.  It has changed, in fact, who she is as a person.  And, oh by the way, she has lost 60 pounds.

The Value of Multidisciplinary Follow Up After Weight Loss Surgery

Thursday, July 23rd, 2009

Well, that’s really a mouthful!  But what does it mean?  Multidisciplinary means that professionals with different areas of expertise can offer helpful guidance after your weight loss surgery.  This finding is supported by several research studies that have recently reported their data in addition to our own clinical experience at Western Bariatric Institute and iMetabolic.

After weight-loss surgery we have found that the people who succeed in losing weight best and maintaining their weight loss, do follow up with our multidisciplinary team.  So what are some of those “disciplines” and how do they help?

Well, one of them is with our medical staff. This includes the doctors, the bariatric surgeons, in addition to the physician assistants, nurse practitioners and registered nurses.  This group of people has a medical or clinical focus thinking about health problems related to obesity as well as potential health problems that might result as people return year after year.  They also understand things like vitamin deficiency and future risks for people who have had weight-loss surgery.

Another discipline is dietary.  So a registered dietitian can offer insights into improved eating behaviors, food choices, meal planning and so forth.

Another discipline is eating behaviorists or psychologists.  This is a group of professionals who focus on what really goes on above the shoulders and between the ears.  This is where some of the best work is often accomplished, with people learning to avoid temptations, identifying their “triggers”, finding better coping mechanisms other than food, and generally working on psychological strategies that allow reduction of carbohydrate and calorie intake.

In addition to all of these, follow up with support groups, with lay people, as well as motivational life coaches, and exercise therapists and personal fitness trainers are all exceedingly valuable in keeping the momentum going and promoting and maintaining the weight loss.

All of these concepts are covered in more detail and with more specificity in the recently released e-book entitled, “After Weight Loss Surgery”.  I highly recommend it as a way to add some very valuable guidance to your journey after weight loss surgery.  I wish you the greatest success in your weight loss journey.


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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