Many times I am asked what are a few straightforward and simple things I can do as a parent to help prevent obesity in my own child.  And while there are some more thorough discussions I have written in other articles on this website and on obesityprevention.org, I will describe here a few of the most important steps you can take today to prevent childhood obesity at home.

1. Set a great example.  Parents are powerful influences on children, but we lead more by example than by words so you must walk the walk quite literally speaking.  Be active and keep your own weight at a healthy level.  Avoid eating high calorie, high carb food, snacks and treats so you set the example for your child.
2. Read every label and encourage your children to read every label.  While the labels can be confusing and full of lots of useless information, they do contain some important bits of information so that you should encourage your child to always be aware of.   And here they are:  One, know the number of calories in every serving that you eat.  And two, know the number of grams of carbohydrates or sugars in everything you eat.  That’s enough, that’s all you really need to focus on and the rest will take care of itself if you stay mindful of these two figures.
3. Protein first.  This means every time you prepare a meal or snack you should be thinking             about protein first and foremost.  Protein provides greater satisfaction and does not result in immediate sense of rebound hunger like sugar does.  As a parent you are well aware of the sugar rush followed by the sugar crash, but you may not be as aware of the surges in hormones produced by sugar intake and how those result in rapid resurgence of hunger within about an hour.   Protein satisfies.  It is a good, healthy source of calories and don’t worry, your child will get plenty of carbs even without trying.  Let the protein (cheese sticks, protein bars, beans, nuts, meats and fish) satisfy them and they won’t be hungry for junk food so fast.
4. Clear out the pantry.  That’s right, you got it, this is tough love, but you need to get rid of all the high carbohydrate, high calorie snacks and treats, M&Ms, Ding Dongs, candies, chips and all those goodies that kids (and everyone else) love to eat.  It’s not doing anyone any good.  Stock your house instead with fresh fruits and vegetables and your kids will be just fine.  In fact they will be far healthier and less overweight as a result.  Sometimes parents tell me “my kid won’t eat anything but junk food.”  Trust me, if the house is full of delicious fruits and veggies and there is no junk food in the house then he or she will eat what is available and learn to love it.
5. Stay active and have fun at it.  Every kid should have 30-60 minutes of regular exercise every single day.  So make it a priority and find ways to make sure your kid is getting that activity.  Yes schools have cut physical education and we as parents no longer let our kids run loose in the neighborhoods like our parents did, but with a little effort you can certainly come up with an hour of physical activity for your kid.  Better yet do it with them.  Ride bicycles, take a hike, take the dogs out, sign up for sports, lessons, competitions, meets and tournaments.  Make sports and physical activity fun.  Find something your kid enjoys and support them.   Time will be a great investment in your child’s health.

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.

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.

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

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

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

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

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.

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

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

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

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.

Joining the ranks of celebrities that have disclosed they have undergone Lap-Band surgery is New York Jets coach, Rex Ryan and golf star, John Daly. In addition, a change is beginning to take place in the urban centers of New York, Los Angeles and Las Vegas wherein celebrities including entertainers, athletic personalities and politicians are undergoing a Lap-Band procedure because it can be done discreetly and without much disclosure.

I personally feel we should applaud and encourage people like Rex Ryan who publically acknowledge their weight struggles and make no effort to conceal their efforts to lose weight. It is a somewhat delicate and complex new era that we are entering, but one that needs to be faced with courage and honesty.

Most Americans are now overweight or obese and in the future nearly all of us will be overweight or obese if current trends hold. So pursuing solutions for weight gain and obesity simply means taking care of one’s self and pursuing better health. So why should a celebrity be ashamed of this? Would they hide the fact that they took blood pressure medicines or underwent coronary artery bypass grafting surgery? Of course not, there is no stigma associated with these interventions even though they are aimed at exactly the same outcome: better health and longer life. Perhaps it is because we associated obesity with indulgence, lack of self control and lack of self discipline that we find people ashamed to volunteer information about their obesity treatments.

I would just note that it is certainly no secret when a celebrity becomes obese. It is generally not possible to hide this particular disease and photographs will convey far more about the obesity condition than they will about the status of somebody’s coronary artery plaques. So I would like to see a day when people openly and courageously pursue the best available weight loss solutions- and today this is undoubtedly a combined program and weight loss surgery and medically supervised long term weight loss follow-up – because it is the best thing for their health. It is also the best thing to promote and acknowledge as healthy for other people who suffer with the same conditions. For if celebrities serve any useful purpose whatsoever it is to influence the rest of us toward better and healthier behaviors.

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

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

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

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

There is really no end to the silly things that people will spend money on if the lure of weight loss can be made attractive enough. In a recent such example the Mexican “Diet Ring” is slipped around one’s finger and produces up to 38 pounds of weight loss in one week. The ring is of course developed by “oriental scientists” and retails for 399 pesos.
Believe me, I wish with all my heart that such a thing were actually true and that I could help thousands of people in my own community and in my own practice lose weight and become healthier. The truth is more complex and a bit harder. But ultimately, there is a solution to successful, long term weight loss and you can lose weight and keep it off without wasting your money on gimmicks, fad diets and “miracle” cures and solutions that are nothing more than marketing schemes, gimmicks and somebody’s get rich quick idea.
Stick with what works, what is authentic, what has been studied and what is recommended by people who sincerely want you to get healthier.