Archive for the ‘Weight Related Medical Problems’ Category

POSSIBLE NEW CHOLESTEROL “MIRACLE DRUG”?

Tuesday, December 7th, 2010

Some of us live with tremendous hope that technology and drugs will lead us out of the darkness and suffering associated with obesity related disease.  Adding to that hope was a recent study examining and experimental drug called Anacetrapib, which appears to markedly lower bad cholesterol while raising good cholesterol.

The study, which was published in the New England Journal of Medicine, was led by Dr. Christopher Cannon out of Brigham and Women’s Hospital in Boston and carries a great deal of credibility.  The drug showed unexpectedly striking reductions of the LDL cholesterol while HDL rose.  After six months, the study reported that the LDL fell from an average of 81 down to 45 for the test subjects who were taking the new drug, whereas those given the placebo saw an insignificant drop from 82 to 77.  At the same time, the HDL-the good cholesterol- rose from 41 to 101 for those on the study drug, but changed from 40-46 on the placebo.

It is probably a couple of years before Anacetrapib might be widely available on the market.  And as we’ve learned from countless other drugs, sometimes serious side effects do not become evident until years later.  Nonetheless, this drug looks promising and more studies will continue to accrue.

The real exciting data will come if and when the studies can show a reduction in cardiovascular health events and deaths.  That may take time, but appears likely given these marked changes in the LDL and HDL.

Perhaps combinations of drugs will continue to emerge that not only reduce the late stage consequences of obesity, but perhaps help with obesity itself.   In other blog discussions I have talked about emerging and experimental pharmaceuticals and we’ll revisit this topic again periodically.

WEIGHT LOSS AND CANCER

Wednesday, August 4th, 2010

Many people do not know that weight gain and obesity are associated with many types of cancer.  Among the most common types of cancer that are markedly increased in their incidence in overweight and obese people are breast cancer, colorectal cancer uterine cancer and ovarian cancer.  Usually the risks for each of these types of malignancy more than doubles when a person’s body mass index exceeds 40.  Numerous studies have confirmed these worrisome findings.

Less well proven is that weight loss can reduce the risk of cancer, but there are many studies that give us some encouraging evidence that this phenomenon does indeed occur.  Among the studies are those by Flynn and many others that have demonstrated a reduction in cancer risks after successful weight loss surgery.  In a large population based study, these researchers have demonstrated a reduced risk of these same cancers in the years following weight loss surgery.

We know that weight gain and obesity markedly increase the cancer risk for human beings.  We know that in weight loss surgery studies this cancer risk subsequently declines.  We hope that research will also demonstrate that successful weight loss with medically based programs, such as the iMetabolic program, also result in a drop in cancer risk, but those long term studies are not yet available.  What is know is that cancer is yet another very compelling consideration and a powerful, motivating tool we should all take advantage of to help encourage long term weight reduction and maintenance of a healthy weight.

CHINA HAS RECENTLY OVERTAKEN INDIA AS THE WORLD LEADER IN DIABETES

Friday, July 23rd, 2010

According to a recent study in the New England Journal of Medicine,  China has surpassed India as the world’s leader in diabetes.

Over 92 million adults in China are afflicted with type 2 diabetes, a disease primarily related to obesity, high calorie diets and sedentary lifestyle. Yang Wenyng, chairman of endocrinology at the China Japan Friendship Hospital in Beijing, lead a team of researchers studying more than a dozen Chinese hospitals across 2007 and 2008 to determine the prevalence of type 2 diabetes. In addition to their findings that over 92 million Chinese individuals currently suffer with type 2 diabetes, they further report that an estimated 148 million Chinese have pre-diabetes (this is a condition that leads to full blown diabetes and time and is measured by higher than normal circulating blood glucose levels and abnormal glucose tolerance tests).

This study and other reports related to diabetes in China, indicate a massive economic and social toll from the disease. A high toll of early cardiovascular death is expected from the rapid rise in type 2 diabetes across China and poses a major public health problem.

In the United States there are estimated to be around 26 million diabetes sufferers or around 12% of the population. There are many more than this number who are pre-diabetic and will develop diabetes as the years progress. As the epidemic of obesity widens, these numbers will markedly increase over time. Obesity and diabetes are sometimes together refered to as “diabesity” post a major, worldwide, public health challenge.

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.

Too Fat To Fight?

Friday, May 7th, 2010

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.

Vaccines Not As Effective In Obese People – Using A Longer Needle Helps

Wednesday, March 24th, 2010

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.

Incisional Hernias And Obesity

Thursday, March 4th, 2010

One of the many overlooked health problems related to weight gain and obesity is the problem of incisional hernias. Incisional hernias are a common form of the broader category of ventral hernias, meaning an abnormal bulge protruding through the muscular tendinous layer of the abdominal wall. Ventral hernias may be congenital, protruding through naturally occurring weak spots of the abdominal wall such as the umbilicus and the midline areas where muscles fuse during development. Or, ventral hernias may occur in weakened areas of the abdominal wall that occur as a result of surgery.

Surgical incision sites are closed well after surgery, but they never regain the full strength of the natural musculotendinous strength-layer of the abdominal wall. Over time the strength of the closure site reaches around 95% of its original. During the healing phase and for years to come, if significant stress is placed upon the abdominal wall then the muscles and tendons in the closure area can separate creating a weak spot or hernia through which the abdominal tissues can protrude. This is known as an incisional hernia. Such protrusions are much more likely to occur with weight gain and obesity.

Dangers Of Ventral Hernias
The problem with ventral hernias of all kinds and incisional hernias in particular, is that they can produce abdominal pain, enlarge over time, produce obstruction of the intestines and, in rare occasions create strangulation of the intestines, which can be life threatening. Strangulation occurs when the intestine becomes caught within the fibrous neck of the hernia and while entrapped becomes swollen and damaged leading to ischemia – loss of blood supply of the intestines – and dangerous infection, perforation or sepsis. This does not occur often, but it is important rationale arguing for the repair of these hernias to be done when feasible.

Repairing Incisional Hernias
In the last decade advances have been made in the repair techniques of incisional hernias. Traditionally these have been repaired with an open incision through the previous scar or over the bulge. The contents of bulging tissues are pushed back into the abdomen. The edges of the muscle or tendinous neck are sewn together if possible and then a type of synthetic mesh material is placed to further strengthen the muscle layer. In more recent years, I, and other pioneering surgeons around the country have utilized laparoscopy to repair even large and complex incisional hernias with a much less invasive technique. The laparoscopy involves placement of a camera and additional ports through small keyhole type incisions to work from the inside of the abdomen, reduce the bulging contents of the hernia back internally where they belong and create the mesh repair from the inside.

Differences in Types of Repairs of Incisional Hernias
Traditional open repairs involve the disadvantage of a larger scar that comes from open surgery. This translates into more hospital time and more recovery time in the weeks following surgery. The larger wound also creates a greater opportunity for wound infection, an especially common complication in obese individuals. Some surgeons have historically preferred the open technique because they are accustomed to this type of exposure and they try to close the muscles and tendons back together even if this occurs under tension. Open surgical repairs of ventral and incisional hernias have historically had a significant rate of recurrence of the ventral hernia over time as well as other complications stemming from the more major abdominal surgery required.
The laparoscopic or minimally invasive approach has several advantages and differences.

The National World Diabetes Day and Month Being Celebrated in Nevada

Thursday, January 21st, 2010

The Nevada capital is adorned in blue to draw attention to diabetes, the timing couldn’t be better. More Americans than ever suffer with diabetes. Increasingly, this disease is afflicting old and young and the vast majority of cases stem from obesity. A small percentage, less than around 5% today, of all diabetes is type 1 diabetes, a condition that typically comes on in young people and is related to a loss of function of pancreatic data, islet cells and diminished insulin production. The remainder of cases stem from the complex metabolic disorder known as type 2 diabetes. Most such cases arise with weight gain and age, but today with more and more teenagers and children becoming obese, we see a dramatic rise in type 2 diabetes among young people.
Hopefully, greater awareness will lead to more resources, thoughts and effort being applied where it will yield the greatest results: in prevention. Visit obesitypreventionfoundation.org for ways you can help.

Vegan Diets And Weight Loss

Thursday, January 14th, 2010

I had a great conversation with Louie Free, the Ohio talk radio host, who himself is a vegan. He said something I thought was very important to point out and that was he knew, as a vegan, he had to eat a “healthy” vegan diet and pay attention to all of his food selections to avoid weight gain. As he mentioned, it is possible to eat snack chips and soda pop and be “vegan” and yet such a diet would be unhealthy and would lead to weight gain and obesity.
I, myself, see a great many people who are vegans with obesity.
It is not veganism that is healthy per say. A vegetarian or vegan diet is not going to prevent obesity or solve obesity or even lead to weight loss. The food choices that will lead to weight loss are a shift away from high calorie, high carbohydrate foods and toward foods with a lower glycemic index and lower overall calories. Then combine that change with increased exercise and you have a winning formula.
It’s certainly possible to eat a nutritionally sound diet that is a vegan diet. And it is certainly possible to maintain a healthy weight and be fit and well nourished as a vegan. It is also quite possible to do the same while eating meat as part of a healthy diet. The key for vegans is to not be lulled into a sense of “healthy dieting” in believing that a vegan diet that is high in simple carbohydrates and high in calories in somehow better for the body than a diet that is lower in these things or one that might even contain meat. As I have discussed elsewhere, there are many reasons individuals choose to pursue a vegetarian diet including ecological choices, environmental awareness and an appreciation of the role that animals play on this earth and how humans should interact with them. But as a physician specializing in weight loss and the treatment of type 2 diabetes , I must point out that the real enemies for human health are not animal proteins, but are high calorie, high carbohydrate foods, especially including the sweets, treats and snacks that are packed with simple sugars. Those are the worst culprits that lead to rampant obesity, diabetes, high blood pressure, sleep apnea, hypertension, blindness, renal failure, amputations and early heart attacks, even among vegans.

Obesity Linked To Cancer

Friday, January 8th, 2010

Many of you may have seen in USA Today and other major media articles discussing the association of obesity and cancer. The American Cancer Society and some recent scientific studies have confirmed that a high number of cancers in the United States are caused by obesity. The American Institute for Cancer Research released an analysis of cancer data and offers some striking and discouraging news about the dangers of gaining weight and becoming obese. For example, 33,000 cases per year of breast cancer are due to obesity. Another 20,000 endometrial (uterine) cancers are due to obesity. And many other types of cancer including colorectal cancer, kidney cancer, pancreatic cancer and esophageal cancer are caused by obesity in many cases.
There are likely several reasons why the cancer risk rises so strikingly with obesity. To begin with, our cellular metabolism changes and is influenced strongly by the different hormones and biochemistry associated with obesity. For example, insulin levels rise dramatically as do leptin levels with certain phases of eating, digestion and weight gain. These hormones exert powerful influences on the growth regulation of individual cells that is intimately linked with the development of cancer. Scientists have not yet unlocked precise ways to intervene and block this cancer growth and development, but research continues. In addition, increasing studies demonstrate a reduction in cancer risk with weight loss, primarily coming from weight loss surgery.


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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