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From NYT - Why WLS Works When Diets Don't

Don't shoot the messenger, I'm sharing this for my blog's historical reference because it's AMAZING INFORMATION -- and even if you "don't agree," because it's not your experience, it's science!

Via New York Times - https://nyti.ms/2kBVirc

Bariatric surgery is probably the most effective intervention we have in health care,” says Laurie K. Twells, a clinical epidemiologist at Memorial University of Newfoundland. She bases this bold claim on her experience with seriously obese patients and a detailed analysis of the best studies yet done showing weight-loss surgery’s ability to reverse the often devastating effects of being extremely overweight on health and quality of life.

“I haven’t come across a patient yet who wouldn’t recommend it,” Dr. Twells said in an interview. “Most say they wish they’d done it 10 years sooner.” She explained that the overwhelming majority of patients who undergo bariatric surgery have spent many years trying — and failing — to lose weight and keep it off. And the reason is not a lack of willpower.

“These patients have lost hundreds of pounds over and over again,” Dr. Twells said. “The weight that it takes them one year to lose is typically back in two months,” often because a body with longstanding obesity defends itself against weight loss by drastically reducing its metabolic rate, an effect not seen after bariatric surgery, which permanently changes the contours of the digestive tract.

In reviewing studies that followed patients for five to 25 years after weight-loss surgery, Dr. Twells and colleagues found major long-lasting benefits to the patients’ health and quality of life. Matched with comparable patients who did not have surgery, those who did fared much better physically, emotionally and socially. They rated themselves as healthier and were less likely to report problems with mobility, pain, daily activities, social interactions and feelings of depression and anxiety, among other factors that can compromise well-being.

Equally important are the undeniable medical benefits of surgically induced weight loss. They include normalizing blood sugar, blood pressure and blood lipid levels and curing sleep apnea. Although bariatric surgery cannot cure Type 2 diabetes, it nearly always puts the disease into remission and slows or prevents the life-threatening damage it can cause to the heart and blood vessels.

 

Even in the small percentage of patients who ultimately lose little weight after surgery, significant metabolic benefits persist, according to findings at the Cleveland Clinic. In a study of 31 obese diabetic patients who had not lost a lot of excess weight five to nine years after surgery, a “modest” weight loss of just 5 to 10 percent resulted in a reduction of cardiovascular risk factors and blood sugar abnormalities, Dr. Stacy Brethauer and colleagues reported.

For the two most popular surgical techniques — the gastric bypass and the gastric sleeve — “the metabolic benefits are independent of weight loss,” Dr. Brethauer said in an interview. Both methods permanently reduce the size of the stomach. However, the gastric band procedure, which is reversible, lacks these benefits unless patients achieve and maintain significant weight loss, he said.

Furthermore, as a study last year of 2,500 surgical patients at the Veterans Affairs Medical Center in Durham, N.C., found, those who underwent bariatric surgery had lower overall death rates up to 14 years later than comparable patients who did not have weight-loss surgery.

Experts in the field regard the reluctance of some medical insurers, including Medicaid programs in many states, to cover the cost of bariatric surgery as a penny-wise, pound-foolish position. Failing to reverse extreme obesity can end up costing far more per patient than the typical $30,000 price tag of bariatric surgery — sometimes even millions of dollars more.

 

Counter to popular impressions that most people treated surgically regain most or all the weight they lose initially, the latest long-term research has shown otherwise. In a decade-long follow-up of 1,787 veterans who underwent gastric bypass, a mere 3.4 percent returned to within 5 percent of their initial weight 10 years later. This finding is especially meaningful because the researchers at the V.A. center in Durham were able to keep track of 82 percent of gastric bypass patients, a task too challenging for most clinics.

The study, by Matthew L. Maciejewski and colleagues published in August in JAMA Surgery, found that 10 years later, more than 70 percent of surgical patients lost more than 20 percent of their starting weight, and about 40 percent had lost more than 30 percent. Gastric bypass, an operation called Roux-en-Y, resulted in a somewhat greater weight loss at 10 years than the newer gastric sleeve surgery and significantly more than the adjustable gastric band (Lap-Band) surgery, which “has fallen out of favor in the last two or three years,” Dr. Maciejewski said.

 

Bariatric surgery, regardless of the method used, is also much safer nowadays than it was even a decade ago, said Dr. Jon C. Gould, a surgeon at the Medical College of Wisconsin in Milwaukee who wrote a commentary on the V.A. study. However, he noted, the surgery is “vastly underutilized,” to the detriment of patients’ health and the nation’s health care costs.

“Less than 1 percent who would qualify for bariatric surgery are actually getting it,” Dr. Gould said. “Although the vast majority have health coverage, insurance companies and many Medicaid programs put it out of reach for most people by demanding that they already have several obesity-related health conditions and are taking a slew of medications to control them.”

 

For example, he said, to be covered for bariatric surgery, Wisconsin Medicaid requires that a person with dangerously high blood pressure has to be taking three or more medications for it and still not have a normal pressure.

He cited a further deterrent to bariatric surgery: “a perception that it’s dangerous and doesn’t work,” beliefs countered by the research findings cited above. Most of the surgeries are now done laparoscopically through tiny incisions.

 

Given the well-documented safety and effectiveness of bariatric surgery, it is now increasingly being performed in people whose obesity is less severe — those with a body mass index (B.M.I.) of 35 or perhaps even less — but who have a metabolic disorder like Type 2 diabetes related to their weight.

In recent years, the profession has promoted what Dr. Gould calls “centers of excellence,” where 100 or more bariatric operations are usually done in a year. Practitioners at these centers “learn from experience, share their knowledge and push for quality improvements,” he said.

Dr. Gould suggested that people interested in bariatric surgery seek out programs that have been jointly accredited by the American College of Surgeons and the American Society for Metabolic and Bariatric Surgery, which have combined forces to promote quality control.

While experts agree that money would be better spent on prevention than treatment, Dr. Twells pointed out that “we have yet to find a way to prevent obesity, and people whose health is compromised by their weight deserve to be treated by the most effective method we have.”

 

Worth a read. New York Times article about a year in the life of bariatric surgery

Worth a read, and worth a watch.  This mimics a bit of my experience, my family's experiences, and brings up some (deeper) questions.  As someone who's had gastric bypass in 2004, I'm always intrigued at any new science that's discovered about the gut - brain connections.

"Nearly 200,000 Americans have bariatric surgery each year. Yet far more — an estimated 24 million — are heavy enough to qualify for the operation, and many of them are struggling with whether to have such a radical treatment, the only one that leads to profound and lasting weight loss for virtually everyone who has it. Most people believe that the operation simply forces people to eat less by making their stomachs smaller, but scientists have discovered that it actually causes profound changes in patients’ physiology, altering the activity of thousands of genes in the human body as well as the complex hormonal signaling from the gut to the brain."

Article - New York Times


Alcohol Sensitizes Brain Response to Food Aromas and Increases Food Intake in Women, Research Shows

Something I feel like we already knew?  Sigh.  Please read.

PR from The Obesity Society -

Alcohol Sensitizes Brain Response to Food Aromas and Increases Food Intake in Women, Research Shows

First study of its kind ties hypothalamus, in addition to the gut, to the aperitif phenomenon

SILVER SPRING, MD – The first study of its kind measuring the brain's role in mediating caloric intake following alcohol consumption among women shows that alcohol exposure sensitizes the brain's response to food aromas and increases caloric intake. The research, led by William J. A. Eiler II, PhD, of the Indiana University School of Medicine's Departments of Medicine and Neurology, adds to the current body of knowledge that alcohol increases food intake, also known as the "aperitif effect," but shows this increased intake does not rely entirely on the oral ingestion of alcohol and its absorption through the gut. The study is published in the July issue of the journal Obesity published by The Obesity Society (TOS).

"The brain, absent contributions from the gut, can play a vital role in regulating food intake. Our study found that alcohol exposure can both increase the brain's sensitivity to external food cues, like aromas, and result in greater food consumption," said Dr. Eiler. "Many alcoholic beverages already include empty calories, and when you combine those calories with the aperitif effect, it can lead to energy imbalance and possibly weight gain."

Researchers conducted the study in 35 non-vegetarian, non-smoking women at a healthy weight. To test the direct effects of alcohol on the brain, researchers circumvented the digestive system by exposing each participant to intravenously administered alcohol at one study visit and then to a placebo (saline) on another study visit, prior to eating. Participants were observed, and brain responses to food and non-food aromas were measured using blood oxygenation level dependent (BOLD) response via fMRI scans. After imaging, participants were offered a lunch choice between pasta with Italian meat sauce and beef and noodles. 

When participants received intravenous alcohol, they ate more food at lunch, on average, compared to when they were given the placebo. However, there were individual differences, with one-third of participants eating less after alcohol exposure when compared to the placebo exposure. In addition to changes in consumption, the area of the brain responsible for certain metabolic processes, thehypothalamus, also responded more to food odors, compared to non-food odors, after alcohol infusion vs. saline. The researchers concluded that the hypothalamus may therefore play a role in mediating the impact of alcohol exposure on our sensitivity to food cues, contributing to the aperitif phenomenon.

 "This research helps us to further understand the neural pathways involved in the relationship between food consumption and alcohol," said Martin Binks, PhD, FTOS, TOS Secretary Treasurer and Associate Professor of Nutrition Sciences at Texas Tech University. "Often, the relationship between alcohol on eating is oversimplified; this study unveils a potentially more complex process in need of further study."

Study authors agree and call for further research into the mechanism by which the hypothalamus affects food reward.

"Today, nearly two-thirds of adults in the U.S. consume alcohol, with wine consumption rising, which reinforces the need to better understand how alcohol can contribute to overeating," continued Dr. Binks.

Read the full article in Obesity here.


Patients With Psychiatric Illness Require Close Watch After Bariatric Surgery

A study conducted in Brazil and presented at a poster session at the 2014 annual meeting of the International Federation for the Surgery of Obesity and Metabolic Disorders looked at six cases in which patients committed suicide or attempted suicide after bariatric surgery. The study did not specify the form of weight loss surgery that each patient underwent.

Continue reading "Patients With Psychiatric Illness Require Close Watch After Bariatric Surgery" »


If you're happy and you know it. #eatasnack

The most authentic commercial yet from Weight Watchers.  WW you win with this one, although it doesn't exactly motivate me to go sign up for your plan (...was that the goal -- because I didn't catch that vibe, I just laughed and wanted a snack for a second?) I still LOVE THIS because it's truth all right here for us emotional eaters.  

Sorry not sorry I agree.  

 


Bariatric Surgery Linked To Increased TASTE Sensitivity - Does Taste Perception CHANGE After Bariatric Surgery?

taste tongue
I think mine is broken. I go for SALTY every time.

I hereby define this study in the flesh.  Everything tastes too, everything to me.

-MM

Via Science Daily from ASMBS -

People with obesity may have an unexpected ally after weight-loss surgery: their tongues. New research from the Stanford University School of Medicine finds patients who reported a decrease in taste intensity after bariatric surgery had significantly higher excess weight loss after three months than those whose taste intensity became higher.

Findings from the new study, "Does Taste Perception Change After Bariatric Surgery?", were presented here at the 31st Annual Meeting of the American Society for Metabolic and Bariatric Surgery (ASMBS) during ObesityWeek 2014, the largest international event focused on the basic science, clinical application and prevention and treatment of obesity. ObesityWeek 2014 is hosted by the ASMBS and The Obesity Society (TOS).

In the study, the majority (87%) of patients reported a change in taste after bariatric surgery, with 42 percent reporting they ate less because food didn't taste as good. However, those who said their taste intensity decreased, lost 20 percent more weight over three months, than those whose taste intensified.

"In our clinical experience, many patients report alterations in their perception of taste after bariatric surgery. However, little evidence exists as to how and why these changes affect weight loss after surgery," said study author John M. Morton MD, Chief, Bariatric and Minimally Invasive Surgery, Stanford University School of Medicine. "It appears it's not just the flavor that influences weight loss, it's the intensity of the flavor. Patients with diminished taste intensity lost the most weight. A potential application to these findings may include teaching taste appreciation in hopes of increasing weight loss."

Before surgery, patients with severe obesity had lower total taste scores than a control group of individuals with no obesity. The 88 patients in the study were on average, 49-years-old, had an average age of 49.2 years, more than half were female with an average preoperative body mass index (BMI) of 45.3. Prior to surgery, the patients and controls completed a baseline validated taste test that quantified their ability to identify the primary taste, using paper strips with varying concentrations of each taste solution, presented in random order. The tests were then performed again at 3-, 6- and 12-months after surgery.

"The study provides excellent new insight on taste change after bariatric surgery," said Jaime Ponce, MD, medical director for Hamilton Medical Center Bariatric Surgery program and ASMBS immediate past-president. "More research is needed to see how we can adjust for taste perception to increase weight loss."

Study - American Society for Metabolic & Bariatric Surgery (ASMBS). (2014, November 4). For some, losing weight after bariaric surgery may be a matter of taste.ScienceDaily. Retrieved November 5, 2014 from www.sciencedaily.com/releases/2014/11/141104083132.htm


Video - YOUR CHAIR IS KILLING YOU. Get up! Non-exercise Activity Thermogenesis - the N.E.A.T. Energy of Life

HERE is one of my favorite speakers at the #YWM2014 event. HANDS, BUTT down.

  • Get up! Non-exercise Activity Thermogenesis - the N.E.A.T. Energy of Life
  • Streamed live on Sep 27, 2014

    Everything that we do throughout the day uses up our metabolic energy. Dr. Levine explains all the components of your daily energy expense, or N.E.A.T., and the science of how you can make this energy loss part of your strategy to improve health.

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The Biggest Loser Meltdown Moment

Did you watch this last night?

"I don't want you to go through what your dad has gone through." -Dr.

So -- you KNOW I am thinking it -- I probably yelled AT THE TV.

angry lego head

I would like to know what happened to Rob's dad after all this crying and freaking out with the shaming of the wheel-chair.  I hate when information about weight loss surgery is thrown out there to the general public like "this" without any context.

Biggest Loser, please explain.  I understand that the producers like to create 'breakthrough' moments with the contestants to get them motivated and moving forward and to tear off all excuses, but why create a stigma around weight loss surgery? 


Stomach Balloon For Weight Loss

Terrifyingly simple.

This is the Obalon system. It is a pill that has a balloon inside. Obalon is a weight-loss device, marketed as an alternative to bariatric surgery, that claims to help people eat less and "push back from the table sooner."

Obalon begins to work when you swallow Obalon and it lands in your stomach. Obalon remains temporarily attached to a thin tube, through which doctors can inflate it. They then remove the thin tube, and the balloon stays in your stomach for up to three months, bobbing around like buoy in gastric waters. You can take up to three at a time, the manufacturers say. The idea is that balloons partly fill your stomach to make you feel full, so you eat less. They are too big and buoyant to pass beyond the stomach. After twelve weeks, a doctor deflates the balloons and pulls them back out through your mouth.

  

 
 
 
 
 
 

“This balloon will act to educate [people] about portion size and retrain their brain and their mindset a little,” Dr. Sally Norton, a U.K. bariatric surgeon, told CBS News.

The Obalon balloon pill is approved for investigational use only in the U.S. However, it is approved in the E.U. and is available in Austria, Belgium, Germany, Italy, Luxembourg, the Netherlands, and Spain. What better way to see Europe than with expensive stomach balloons?

Would you do it -- would you swallow a belly balloon for twelve weeks for weight loss and have it removed?

Balloon-pop

I suppose I'd have to see the size of the "pill" first.  I kid you not.   (Hey -- I had my stomach and intestines realigned, I cannot judge one who chooses something LESS invasive.)

The Atlantic - http://www.theatlantic.com/health/archive/2014/01/this-weight-loss-pill-turns-into-a-balloon-to-fill-your-stomach/283399/


FTC Announces Initiative Against Deceptive Claims Made by National Marketers of Fad Weight Loss Products

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Finally, maybe?!  I can't wait to see some rules slapped down on these irresponsible companies.


Does That Really Work - Weight Loss Trends - Diets - Webinar from the OAC

  • Does that Really Work? Deciphering Popular Weight-loss Trends
  • A worthwhile listen!
  • 50% of Americans are on a diet at any time, and why?
  • Why do they use them?
  • BUT... "It's TRUE! I read it on the internet!"

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Gastric Bypass Causes Hypoglycemia

Wait - this is news?

"Consistent with that is the fact that there are new conditions—nesidioblastosis, noninsulinoma pancreatogenous hypoglycemia syndrome, hyperinsulinemia and hypoglycemia—[that are] becoming more common after gastric bypass,”

If you are new to my blog -- I self-diagnosed (well, myself!) with reactive hypoglycemia as a result of gastric bypass surgery in my first post operative year.  

I found myself with a severe case of "hand-in-box" syndrome and subsequent blood sugar readings in the 20-40 range after eating.  I found that doctors were not quite versed in what was happening to me -- so I had to deal with my issue on my own.

Now, in my tenth post-operative year, I know how to Eat Around My Gastric Bypass Surgery To Avoid Damaging Blood Sugar Lows -- because as you may also note:  I became an epileptic post-RNY and severe low sugars can trigger seizure activity in the brain.  While it has been established that my epilepsy is not connected to my low blood sugar - it can be triggered by it - so I am careful to avoid stepping into obvious triggers.

We patients - have been screaming about these symptoms for years and often been laughed AT - or ignored.

Just hook us up to an IV bag of glucose - we'll lose our cyclic regains and stop the insanity.  

19402BA
And yes, I know this article reads like an ad for the duodenal switch.  Because.

Enjoy -

Despite its reputation as the gold standard for weight loss, gastric bypass surgery may result in a post-meal glucose spike followed by a blood sugar crash that causes between-meal hunger, according to recent findings. The research examined the effects of different bariatric procedures on post-meal glucose reactions.

Mitchell S. Roslin, MD, Lenox Hill Hospital, New York City, and his colleagues first became interested in glucose tolerance testing after noticing that many of their patients who regained weight after gastric bypass surgery complained of inter-meal hunger, especially following meals rich in simple carbohydrates.

“Consistent with that is the fact that there are new conditions—nesidioblastosis, noninsulinoma pancreatogenous hypoglycemia syndrome, hyperinsulinemia and hypoglycemia—[that are] becoming more common after gastric bypass,” Dr. Roslin said. “These are entities surgeons rarely encountered previous to this [era in bariatric surgery].”

The research was presented at the 2013 meeting of the Society of American Gastrointestinal and Endoscopic Surgeons. The study was sponsored by Covidien.

Dr. Roslin and his team decided to compare glucose metabolism among patients who had undergone gastric bypass, sleeve gastrectomy or duodenal switch (DS), in which a common channel of at least 125 cm was preserved.

“This type of model gives us the ability to compare two operations that preserve the pyloric valve, as well as two operations that have an intestinal bypass component,” he said.

In the prospective, nonrandomized study, 13 patients received gastric bypass, 12 received sleeve gastrectomy and 13 underwent DS. All completed an oral glucose tolerance test (GTT) at baseline and at six, nine and 12 months. The nine-month GTT comprised a solid mixed-meal muffin. The only significant, preoperative difference among the patients was greater body mass index in the DS group. There were no significant differences in their glucose homeostasis parameters, fasting glucose or insulin.

At 12 months, the DS patients lost significantly more weight than the other two groups, although those patients also experienced good weight loss. All of the operations reduced fasting blood glucose levels as well. But after GTT, the gastric bypass group had much higher levels of one-hour glucose than the DS group, and the sleeve gastrectomy group had intermediate levels. The gastric bypass group also had higher one-hour insulin levels, higher even than their preoperative level, whereas insulin was suppressed in the DS group.

“When you have high insulin, glucose falls, and we know that hypoglycemia causes hunger,” Dr. Roslin said. “Looking at the one- to two-hour glucose ratio, the gastric bypass patients have the highest one-hour sugar [levels] and the lowest two-hour sugar [levels], and I think this begins to explain why we have inter-meal hunger with gastric bypass.”

All of the operations resulted in significant weight loss and other positive outcomes, but compared with gastric bypass patients, DS patients had a much smaller rise in one-hour glucose and insulin levels.

“The sleeve behaves intermediately to the bypass and DS, meaning that preserving the pylorus may be part of the explanation, but not the whole story,” Dr. Roslin said.

“Obviously, controlled trials between gastric bypass and DS are needed to determine the real long-term significance, but I think we should all be cautious before we label gastric bypass the gold standard operation,” he said.

Kevin M. Reavis, MD, of the Division of Gastrointestinal and Minimally Invasive Surgery, The Oregon Clinic, Portland, said that improved assays are allowing for a more rapid and better understanding of the true complexity of the physiologic changes that contribute to the results seen with each of the bariatric procedures.

“This study highlights aspects of glucose metabolism that have previously been underappreciated,” Dr. Reavis said. “Although it is a relatively small study, it illustrates that with gastric bypass, sleeve gastrectomy and duodenal switch, there are substantial metabolic changes we are just beginning to understand and must investigate on a larger scale in order to optimize clinical outcomes.”


Tara Costa Biggest Loser Star Sued for Regain

As if the show weren't bad enough, Tara Costa who lost 155 pounds on The Biggest Loser several years ago -- is now being sued for twenty two pounds of bounce-back regain.  

Seriously!?  

She BEAT THE ODDS!  Most dieters regain much, much more!  She did wonderful!  

You can't win.  PS.  To anyone signing up for these weight-loss shows and subsequent sponsorship deals, READ THE FINE PRINT - make sure it includes a "REAL LIFE CLAUSE."

Tara Costa Biggest Loser Regain


A dilemma-monade #fitbloggin #procrastination

It's 94 degrees in my bedroom right now where I should be packing my suitcase in anticipation for my flight out to fitbloggin' 2013 tomorrow morning.  However instead of packing I am playing the "until the very last minute" game because -

  • It is 94 degrees in my bedroom
  • And I am avoiding all things boob sweat.  (I am currently sweating, sitting still.)

IMG_0334

There is also this one thing --  I weighed in at 183 pounds last summer to fall.

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fitbloggin' 2012

I now weigh 144 pounds and that is a visible size difference.  
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2013

The thing is -- I've been wearing the same clothing regardless of its fit -- which means I probably look a mess quite often in a size 12-14 on a size 8 body.  I likely rock the plumbers crack.  #thumbsup

 

Gif-2-thumbs-up
I could use some clothes that fit, but I would rather not until I know I am settled into a size that I am staying in unless I find super-inexpensive deals.  I bought clothing prior to the last set of events I attended - and they're too big now.  

As someone who is pretty much stuck-at-home since I do not drive due to my seizures, I don't shop much at all, and rarely shop online either.  Also:  with five other people in the house, you don't just SHOP for clothes, you have to consider everyone, and we have a list seven miles long of "needs, wants and like-to-haves..." and my stuff sometimes gets bumped.  That's just the long way of saying I can't just run out and shop.  I do not have that luxury.  If I were an employed adult with a dependable weekly paycheck, who could drive myself to the mall?  I suppose I might consider it more often, but I know I'd likely end up spending on the kids first because that's what parents do.  School's out this week.  #brainimplodes  #sendababypool #sendairconditioning #help 

Do you like how I am avoiding?  

It is working.  

I am still sitting here.  

The suitcase is empty.  

I will also mention that it is empty because I did not get a sponsor for this event.  In the spirit of being honest:  I did not try very hard to gain a sponsor.  I did not ask much.  I was quite disheartened after the last event I attended and sort of gave up.   I promised myself that I would not attend another blog conference (...or otherwise) after paying out of pocket in full for the last one that went completely belly-up on me and my entire support group.  I swore I would never do it again, until this time.

I suppose I should attempt to put some poorly fitted clothes in a suitcase now that the sun has moved a bit.   (Still. trying. to. waste. time. here.)

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However, I've had two good experiences with fitbloggin'.    (A post from last year.)

I am off to Portland, Oregon in the wee hours tomorrow for fitbloggin' 2013 - which is my third trip to fitbloggin' - because they sort of rock.  I went in 2010, 2012 and now this year.  I will be live-blogging a session sponsored by #soyjoy about snacking!  *shrug*  

I like snacking.  

Many blog-friends will also be there!  Check out the list!  WLS bloggers in attendance:

 Watch the blogs - and