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.

So where do we get the motivation? Where does it come from? Because, if there were a place, a shelf perhaps somewhere some identifiable reservoir in our consciousness or bodies, how do we find it? How do we tap into it? How do we keep finding it and accessing it long after the initial enthusiasm for a new goal has long since waned?
These are some of the most challenging aspects of long term weight loss. In one moment we may think, we may know, in fact, that we will feel better. That our lives will be better if we can lose weight and keep it off. Our health will improve, our relationships may improve, we may feel more energetic, we may get more things done, we may accomplish more, make more money, look better, etc, etc. And in that flash, some motivation is tapped and we may even act upon it. But the process of losing weight is not like the process of accomplishing a project around the house or acting upon the one lingering item that has been sitting upon our desk. It is a long term process, a long term process, a journey, really. So how do we tap into that reservoir of motivation so that we may succeed in such a long term journey?
Our patients have taught us a few things and I will share a few of them with you here. One of them is a simple notion that the ideas that we keep in our consciousness are fairly few at any given moment. And each of us is certainly bombarded with many other messages through the course of our day and through the course of our week. Think of all the countless messages about food, snacks, eating at restaurants and buffets and desserts that we experience on a daily basis. Now think how often do you go out of your way to reinsert thoughts of your long term weight loss goals? When you add it up this way, it becomes quickly apparent that our own noble thoughts about change are often drowned out by these other messages we are bombarded with. So what’s the solution?
Well, here’s a simple one. Write down your main goal. Keep it very simple. “Lose 20 pounds by October 1st.” Write it on a note card in big black magic marker and post it where you will see it very single morning. In fact, make three and post one in a place on your dashboard in your car, one on your computer above the screen and one at home in the bathroom mirror. That way you are forced to think about your goals at least several times a day.
Then there is more. It involves digging very deep into what truly motivates us. This is more than simply that you would like to look trimmer. It is the important stuff such as the specific ways in which you would like to be a better parent, or a better partner. It is achieving personal goals like riding your bicycle with your kids or completing a 5K race or some of the other hundred things you would like to do before you die. It means recapturing and not giving up on your dreams. So spend a little time and dig deep and find out what you would really like in life and how being overweight is keeping that from happening. Then put pen to paper and write down some of those deeper, more important goals, the good stuff; the things that make life really wonderful and worth living. Now you have something powerful that you can refer to and tap into when your motivation is ebbing.

A disturbing study of British children found that among 12,000 3-year-olds, the risk of childhood obesity was 34% higher if grandparents cared for the children full-time.
Parents as caregivers and other substitutes like daycare centers and babysitters did not produce an increased risk of obesity, but grandparents as caregivers did.
While the study did not investigate the precise reasons why grandparents appeared to lead to greater obesity among these children, it is speculated that a more indulgent attitude toward sweets and treats and food choices may be the answer. What we might fondly recall as the sweet doting grandmother or grandfather who indulged us in home baked cookies and treats might have a darker implication in today’s environment of escalated childhood obesity. Grandparents may also be less physically active and may promote less physical activity among small children.

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.

The White House has officially endorsed the “Let’s Move” campaign that is taking an ambitious approach to partner with food companies, media, athletes, school lunch providers and federal agencies in an effort to prevent childhood obesity. This is exactly the sort of effort this has been missing for the last thirty years, and most egregiously in the last ten years.

While I am not going to like every single aspect of the Institutes of Medicine’s recommendations, it is undeniable that this is a profoundly positive and massive effort to address a massive nationwide health problem. Nothing short of this type of initiative will succeed. In fact, this is probably only one of many critical steps that will be necessary to actually make a dent in the epidemic and decrease the rate at which our nation’s children become obese, develop diabetes and die at earlier ages, living less full lives.

A real energy drink should give good, solid energy for a period of many hours.

A real energy drink should not make you jittery and “hyper” and impair your concentration; it should focus it.

A real energy drink should definitely not lead to a short spike in energy followed by a big fall in your energy level – instead it should give good, long, sustained energy that is even.

The ideal energy drink would have a few other characteristics too. It would come from natural ingredients. It would not only provide some energy, some calories, but also some other important nutrients like vitamins and minerals. And for the vast majority of us who want energy, but not in the form of empty carbohydrate calories that lead to weight gain and obesity, it should help us maintain a healthy weight and healthy, long term energy. A true energy drink should not leave you craving more food, more calories, more energy drinks shortly after you have consumed one. It ought to provide some real, solid satisfaction. Also, an energy drink can have a little caffeine, that’s fine, but not hundreds and hundreds of milligrams of caffeine. Those kinds of doses are shown to cause tremors and make one feel jittery. They also often interfere with sleeping and actually make people more tired through the course of the week.
Oh yeah, and it should taste great.
So for my money the best energy drink is going to be a nice mixture of vitamins, minerals and natural whey protein to give a clean energy boost instead of all that sugary, make you fat and tired kind of energy that the big drink companies have promoted in the past.

It’s not that we want to be fat. In fact most of us find ourselves gaining weight and are struggling to find ways to stop it. But these energy drinks, sport drinks and just plain ole’ drinks taste so good and are so cleverly marketed to us that we can’t stop drinking them. At least we can’t stop drinking them unless we think about it and use our own free will a little bit.
What a lot of people don’t realize is that big jolts of simple carbohydrates make us fat. Not immediately of course, not that day or that week even, but over time. Big doses of simple carbohydrates, say those in the sucrose and high fructose corn syrup of an energy drink or other soft drinks, the simple carbohydrates are digested quickly and enter the blood stream quickly and result in a very rapid surge of circulating blood sugar or serum glucose level. This also leads to a rapid spike in the important hormone insulin and leptin followed by a rapid fall of the blood sugar level. The next step is a sense of hunger which is often even stronger than before the jolt of sugar. It is no wonder this cycle leads to obesity as it repeats itself over and over.
The make-you-fat drinks have awesome, inspired and expensive Madison Avenue advertising and marketing. They look cool, we think they’re cool and, of course, they taste great. Some of us even like that rapid spike and jittery feeling; the surge of energy, even if it is very short lived, but with a little thought we could all do a lot better.

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.

I had the great pleasure of talking on the air with Bill Dean on his program The Morning Brew that airs in Minnesota. Bill is a fantastic host and we got to discuss the importance of weight loss and maintaining a healthy weight as well as my recently released book, Life Changing Weight Loss. Bill also noted he himself was diagnosed with vitamin D deficiency, a surprisingly common finding for a great many of us. Usually the symptoms of vitamin D deficiency are fatigue and loss of energy so they can be very subtle. Most people don’t even realize they have it.
We also touched on a number of topics including childhood obesity.
Bill is a great host and I hope I have an opportunity to appear as a guest on his show again.

After the Kevin Smith and Southwest Airlines slap, lots of people have been scratching their heads and wondering just what is truly fair. After all, if every person pays the same amount to fly on Southwest Airlines then doesn’t that mean, because of the high cost of jet fuel, that the skinny people traveling with less luggage are in fact subsidizing the heavier people with more luggage? Of course it does to some degree, although one could argue that much of, if not most of the cost of travel stems from simply getting the aircraft from A to B including the cost of infrastructure, maintenance, purchasing of the airplane, supporting of the salaries and staff, and that only a small portion of the overall “costs” for travel really stem from the per pound calculation of jet fuel. So perhaps there is a certain baseline charge to travel that every person must bear and then any number of pounds over and above this must be paid on a per pound basis? For example, let’s say Southwest Airlines calculated the overall amount that it must pay to support aircraft, personnel, salaries, jet maintenance, runway fees, etc and established that the first 150 pounds of traveler plus luggage cost a base fare and anything above that is charged on a per pound basis to account for the additional jet fuel and additional wear on the aircraft. Something like that might take into account all of the economics of the matter and it might simply be left to decide what is the “baseline fee” per person to travel on Southwest Airlines and what is the baseline weight that fee would include. Is it 100 pounds, 200 pounds, perhaps it is 250 pounds. Interestingly, for shipping air cargo has in effect a similar mechanism where packages, regardless of weight, now cost a flat rate to ship, but larger objects, heavier objects and other types of objects that don’t fall into the standard business envelope or air cargo envelope are in fact charged on a per pound or per ounce basis.
But what of the actual size limitations posed by the seats and the inconvenience factor that many non-obese passengers experience. After Kevin Smith’s many Tweets and YouTube posts, a lot of people have commented they do not appreciated having to sit next to an obese person who in fact takes up more physical space and crowds them in their own seat, in effect making their journey less comfortable. What is the solution for this problem? Is there is a “size” limit beyond which a person must buy two seats? Should some seats be made larger and be a requirement for people over a certain size?