Saturday, June 28, 2008

Obesity epidemic leading to rise in gastric bypass surgery

Longview, TX
As advancements continue to change the field of medicine, patients continue to benefit. Average life expectancy is still rising, and new medicines are increasing the quality of life for patients with chronic conditions.

In spite of these medical advancements and a cultural shift emphasizing the importance of exercise, one particular area that remains unsettling is the growing number of overweight or obese Americans. Using measured heights and weights, the 2003-2004
National Health and Nutrition Examination Survey (NHANES) reported that 66 percent of American adults are either overweight or obese.

For many obese or overweight Americans, shedding weight has led them to lifestyle changes, such as a healthier diet and a new exercise regimen. Many others go the surgical route, as 177,000 Americans opted for weight loss surgery in 2006 alone. The vast majority of those surgeries were Roux-en-Y gastric bypass surgery. While gastric bypass can seem like a quick fix that enables patients to shed weight almost overnight, the surgery and its ramifications are in fact quite complicated, and should never be looked at as an easy way to drop weight.

What Is Gastric Bypass?

Roughly 80 percent of the weight loss surgeries performed in America this year will be gastric bypass procedures. This is a two-part procedure.

· Stomach pouch: The creation of a stomach pouch is the portion of the procedure many people refer to as “stomach stapling.” During this part of the surgery, the stomach is divided unequally, with one large pouch and one much smaller pouch. After this division, the smaller pouch is sewn or stapled. That pouch can only hold a very small amount of food (roughly one cup). Such a small holding capacity is designed to make people feel full faster, which in turn will make them eat less.

· Bypass: In the second stage the surgeon will employ the Roux-en-Y technique, in which the smaller pouch is disconnected from the first part of the small intestine (the duodenum). The surgeon will then reconnect the stomach to a lower portion of the intestine (the jejunum). Once that has occurred, any food consumed will pass directly from the stomach into this lower portion, where fewer calories and nutrients are absorbed.

What Happens After the Surgery?

While patients can expect to lose weight after gastric bypass surgery, there are negative consequences as well. Though not all patients will experience such consequences, and death is extremely rare (especially when surgery is performed by an experienced gastric bypass surgery), some of the following might occur after surgery.

· Wound infections

· Problems with digestion

· Bleeding

· Ulcers

Those are some of the more common complications after surgery. Some of the less common, though extremely serious and potentially life-threatening, complications include the following.

· Pulmonary embolism (blood clot)

· Serious infection and persistent bleeding

· Heart attack

· Leakage in the surgical connections in the intestines

Because of the nature of the surgery, in which food is re-routed into the jejunum where less nutrients are absorbed, certain health problems can arise as a result. For example, the human body needs a certain amount of iron and calcium to remain healthy. However, the jejunum does absorb these nutrients well, and therefore conditions such as anemia and osteoporosis can arise as a result. Iron and calcium supplements, as well as routine blood tests, can lower the risk of developing such conditions.

Although there can be complications, many gastric bypass patients experience positive results. Weight loss is often dramatic, especially for patients who were considerably overweight.

Another benefit of gastric bypass is that patients who have obesity-related health problems often see improvements in those conditions after surgery. Such conditions include diabetes, sleep apnea and high blood pressure.

While the benefits of gastric bypass surgery are numerous and have helped many a public figure, it’s important to recognize the surgery is not a one-size-fits-all solution, and each case needs to be examined on an individual basis.

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Saturday, June 21, 2008

ASMBS: Bariatric Surgery Found Superior to Drugs in Controlling Diabetes

Washington, D.C.
For morbidly obese patients with type 2 diabetes, bariatric surgery led to more improvement in glycosylated hemoglobin than standard treatment, a retrospective analysis showed.

Those who underwent Roux-en-Y gastric bypass had an average drop in hemoglobin A1c of 21% within a year (P<0.001), compared with an increase of 11% with conventional treatment (P<0.05), which included oral hypoglycemics and insulin, according to Daniel Mumme, M.D., of Gundersen Lutheran Medical Center in La Crosse, Wis.

Body mass indices fell from an average of 47.3 to 30.9 kg/m2 (P<0.05) in the surgery group and did not change significantly from 44.9 kg/m2 in the conventional-treatment group, he reported at the American Society for Metabolic & Bariatric Surgery meeting here. More >>


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Saturday, June 14, 2008

Post-gastric byass body lift surgery, only way to lose excess skin

New York, NY

Tipping the scale at 330 pounds, 47-year-old Cindy Schreiner decided to get gastric bypass surgery in 2002.
“I was downtown on 9-11,” Schreiner recounted. “And I couldn’t run … I had a colleague pulling me down the street saying come on, you can run, you can run and I just thought, I can’t move anymore and I was so huge.”

It was turning point for Schreiner, who has lost 185 pounds to date.

But working out daily and changing her eating habits has not helped Schreiner obtain the body she has always wanted.

“I would grab the skin and go I want this gone,” she told “Because I had worked so hard to lose the weight and I didn’t see all the benefits because the skin was hanging.”

Click here to watch Schreiner tell her story.

Dr. Lyle Leipziger, chief of plastic surgery at Long Island Jewish Medical Center and North Shore University Hospital, said weight loss surgery is only half the battle for patients like Schreiner.

The majority of patients have excess skin, which could weigh five to 10 additional pounds. As a result, psychological and physical issues often plague patients after weight loss surgery.

“We've had patients that have excess abdominal skin almost hanging down to their knees,” said Leipziger, adding that the skin sometimes makes it difficult for patients to walk or move. “Patients can come in and sometimes they can get infections in the area underneath that abdominal extra skin.”

Body lift surgery was the answer to Schreiner’s problems. Sort of like a tummy tuck for your whole body, Leipziger said, a body life is the only way for these patients to get rid of the extra, baggy skin.

“You feel self-conscious about it,” she said. “You feel like you have, you’re flattening it, pushing it down … to hide it.”

But even with surgery, results do not happen overnight.

“The patient should have most importantly realistic expectations, understand that we can do a lot, we can’t turn people into supermodels, but we can certainly improve their appearance and quality of life.”

Schreiner has undergone five body lift procedures to contour her tummy, breasts, outer thighs, buttock and back. With one more surgery left to go, Schreiner is excited to finally have her "dream body". “I feel like I’ve been given a new life,” admitted Schreiner. “I’ve always dreamt of looking like this. I really did. And it’s like, I’m here.”

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Soprano Deborah Voigt lost 120 pounds after gastric bypass surgery

New York, NY
Deborah Voigt chuckles when I ask her about the brouhaha over the skimpy frock she couldn't fit into that delighted the often dull world of grand opera.

In 2003 Voigt was obese, as she herself admits, and was dropped from a revival of Richard Strauss's ``Ariadne auf Naxos'' at the Royal Opera House in London. ``Inappropriate casting in this particular production,'' said the house, and paid off her contract.

In Christof Loy's staging, the character of Ariadne wears a silky and close-fitting outfit, and is required to roll on the floor. In fairness to the Royal Opera, Voigt had been booked to sing before the staging had been designed.

``In terms of the production, it was the right decision to drop me from the role,'' says the American soprano with a shrug. ``I still think it could have been worked through however. We could have come to a mutually satisfying result.''

When Voigt went public, the media had a field day about the rights and wrongs of realism in opera. The uproar became known as ``the affair of the little black dress.''

Voigt, 47, is now 120 pounds lighter after gastric bypass surgery, and has been invited back to London to sing Ariadne in the same staging. The soprano says she hopes that certain ghosts now will be laid to rest. More >>

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Tuesday, June 10, 2008

Gastric bypass surgery: Lifestyle change & lifetime commitment

McAllen, TX
I have been working at my hospital since 1986, and I was obese most of my life.

In 2004, my hospital began offering weight-loss surgery. I had health problems such as hypertension and metabolic syndrome. I was never able to lose enough weight to make a difference in my hypertension.

I made the decision to have a Roux-en-y Gastric Bypass.

Within 3 months postop, I was able to stop taking of my glucophage, as well as medication for my hypertension, which I had taken for 17 years.

I am now the Bariatric Program Manager as well as a Certified Bariatric Nurse and we have achieved ASMBS Center of Excellence for Bariatric Surgery.

I enjoy being a resource person for our patients undergoing weight loss surgery and for those considering weight loss surgery. I want everyone to be as successful and as happy as I am with this life changing procedure.

Weight-loss surgery is not without risks, but neither is being obese. I tell everyone this is a personal decision that only they can make. It is a lifestyle change and a lifetime commitment. Make sure you do your research and put yourself in the most experienced hands possible.

Medicare and some insurance companies are only reimbursing procedures done at facilities that have achieved ASMBS Center of Excellence by the Surgical Review Corporation or American College of Surgeons Level I Certification.

Weight-loss surgery is a treatment for obesity and is done for health reasons. It is not a cosmetic procedure.

To qualify for weight-loss surgery you should have a BMI of 40 or greater, or 35-39 with comorbid conditions such as diabetes, depression, hypertension, urinary stress incontinence or sleep apnea, just to name a few.

Remember, surgery is a tool that should not be taken for granted.

By Paula Kilgore, RN, CBN
McAllen, TX

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VBLOC: Gastric bypass surgery alternative

Los Angeles, CA

Disrupting the vagus nerve, which runs between the gut and the brain, may supplant obesity surgery.
Weight loss surgery works, but is so invasive and has such unpleasant long-term side effects that it's recommended for only a fraction of the obese population, and even many in that group are reluctant to undergo the surgery. In hunting for a simpler and safer alternative, researchers have zeroed in on a nerve that carries much of the communication between brain and gut.

Disrupting this communication, they believe, could lead to safe, effective and sustained weight loss -- mainly by cutting off signals from the gut that tell the brain it's time to eat. The concept still has to be validated, says Dr. Philip Schauer, immediate past president of the American Society for Metabolic and Bariatric Surgery, a Gainesville, Fla.-based association of U.S. weight loss surgeons, "But if it gives even a modest amount of weight loss, it could be a winner."

Two different methods of disrupting the vagus nerve are now in clinical trials. One method, vagotomy, simply cuts the nerve and permanently disables it. The other, vagal nerve blocking, uses an electric current to periodically confuse the nerve and prevent it from transmitting signals. Preliminary results suggest that both methods help to safely reduce excess body weight by about 20% on average within six months of therapy.

Amid the complex set of muscles, nerves and organs that team up to regulate body weight, one anatomical feature stands out: the vagus nerve. Running from the brain through the esophagus and branching out to reach nearly every part of the digestive system, this nerve plays a key role in weight gain.

When the stomach is empty, the vagus nerve informs the brain and triggers the feeling of hunger. When the stomach contains food, the vagus tells the brain and relays back the brain's commands to secrete stomach acid to help digest the food. The brain's control of the passage of food through the digestive system also relies on the vagus nerve. In short, without the vagus, we would get less hungry, and food would stay longer in the stomach.

The vagus nerve does even more than that. While food is being digested, the brain tells the pancreas to make insulin, a hormone that helps store energy from food in fat tissues. That command passes through the vagus nerve. So too does another that instructs fat tissues to grow by absorbing more nutrients. "Everything this nerve does is designed to make you take up energy and put it into your fat," says Dr. Robert Lustig, a pediatric endocrinologist at UC San Francisco and one of the lead investigators in a 30-patient clinical trial of vagotomy for weight loss. "It's your energy storage nerve." Read more VBLOC: Gastric bypass surgery alternative


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Wednesday, June 4, 2008

Bariatric surgery by itself isn't enough

Los Angeles, CA
Throw out any thoughts that weight reduction surgery is a shortcut to svelte. The surgery, performed on about 200,000 Americans a year, is a last resort to rescue people in danger of dying early from the health consequences of their extreme obesity.

After years of question marks, studies now show the surgery saves lives, sustains long-term weight loss and combats -- maybe even reverses -- diabetes. But although it's much safer today, it still results in the death of 1 in 200 patients and can result in complications such as blood clots, hernias or bowel obstructions. Patients can end up back in the hospital to repair intestinal leaks that can lead to serious infection.

Because of these complications, a National Institutes of Health panel of experts has recommended the surgery only for people considered morbidly obese, roughly 100 pounds or more over their ideal body weight. People whose weight is that far out of control face a risk of death from diabetes or heart disease five to seven times greater than those of normal weight.

"These people don't have a lot of options," says Dr. John Morton, director of bariatric surgery at Stanford's Center for Weight Loss Surgery. "When someone is drowning, I throw them a life preserver. I don't have time to build a bridge."

About 14,000 Californians undergo weight-loss surgery each year. But according to American Society for Bariatric Surgery guidelines, more than 1 million Californians qualify medically: those with a body mass index of 40 or more, or 35 or more if they have conditions such as heart disease or diabetes.
Read more, Bariatric surgery by itself isn't enough.

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Gastric bypass surgery expands life for entire family

Yuma, AZ
Betty Lee used to weigh 245 pounds; her sister-in-law, Jean Ferguson, weighed 226 pounds. Both can recall painful memories that caused them to feel ashamed as children and adults.

"I've been heavy all my life ... I can remember in high school ---- when you choose teams for basketball or baseball ---- I was among the last because I was always heavy," Ferguson said.

For Lee, the most painful memories are of people ignoring her. "They ignore you because they are embarrassed for you. That is what I found more than anything. They think to themselves, 'Oh that person could lose weight if they really wanted to,' and they don't understand how difficult it is."

But after having gastric bypass surgeries, Lee weighs 120 pounds and Ferguson weighs 180.

Lee and Ferguson are among 10 members of an extended family who underwent the procedure. Ferguson says all 10 agree that it is one of the best things they could have done for themselves.

Ferguson's three daughters, one granddaughter, two nieces and one nephew all had the surgery.

Lee had her surgery in April 2006 at the Alvarado Hospital Medical Center in California. So did Ferguson, who went through her surgery in January.

Lee's bypass surgeon was Julie Ellner, a bariatric surgeon at Alvarado Hospital. Through an e-mail, Ellner described how the surgery is done.

"The stomach is divided into two sections, creating a 'top' piece that is the size of a golf ball that receives the food. The rest of the stomach remains in place but is no longer attached to the 'new' small stomach ---- it is traced down to the next part of the digestive tract, called the small intestine. The small intestine is then attached to the 'new' small stomach to catch food.

"A very small amount of food will completely fill the 'new' stomach, and the person feels full immediately. When the food passes into the small intestine, the hormonal craving for food decreases and the brain's desire for food shuts down."

Lee and Ferguson both say they went through the surgeries for health reasons.

Lee had the surgery "because I had become borderline diabetic and my blood pressure was going up. I was getting into a very unhealthy category."

"The reason I did it," said Ferguson, "is because I'm on high blood pressure medicine and was borderline diabetic ... I could feel myself slowing down as I aged, and I thought to increase my health and longevity for life, I needed the surgery."

Now two years after her surgery, Lee says she feels like a new person.

"I lost more than half of my body weight, so I can walk and exercise. I went back to work after being retired for 12 years. You have energy (and) you feel good."

Although the surgeries were a success for Lee and Ferguson, Lee wants people to know that bypass surgery is a tool and not a cure for obesity.

"Of course you have to eat properly," Lee said. "There are certain rules to the menu that you have to maintain, and vitamins that you have to take.

"You have to take vitamins and you have to drink water, and you have to exercise, and no snacking. If you follow those guidelines you will be successful," Lee said.

"The surgery is not a quick fix and the patients need to be motivated" before the surgery, Ellner said. "If not, then I don't operate on them."

Ellner performs around 200 surgeries a year, and the candidates have to be 90 pounds over their ideal weight. She also has "long conversations" with her patients to inform them about certain side effects that come with the surgery.

"Complications can be caused by not following instructions," Ellner said. A leak between the stomach and the intestine can develop, or a pulmonary embolism can be caused by a clot that forms and goes to the lungs. Because of these risks, Ellner gives two-hour seminars on obesity, how the surgery is performed, the risks and benefits of the surgery and who would be a good candidate for the surgery.

The best patients are willing to make the commitment by researching for themselves what the surgery involves, Ellner said.

Ferguson's husband, Phil, who was 67 when he went through the bypass surgery, used to weigh 265 pounds and now weighs 180.

"I'd do it again if I had to. My wife is the 10th person in the family to have it done," Phil said. "It's good for your health, and if you got certain problems, it will relieve them."


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Is gastric bypass surgery a cure for Type 2 diabetes?

Greensboro, NC
When Dr. Enrico Jones became so overweight he could no longer work in his yard, he underwent bariatric surgery.

He expected to lose weight, and he has — 70 pounds. But he also has gotten other benefits.

In particular, combined with a diet he began before surgery, the procedure has left his Type 2 diabetes in remission. He no longer needs to take medicine to control it.

That's important because Type 2 diabetes, the most common type, can lead to blindness, kidney disease, heart disease, nerve damage and other problems. In North Carolina, the incidence of diabetes more than doubled in the past decade; more than 9 percent of the state's population now has the disease.

Researchers are now looking at whether a particular type of bariatric surgery, the gastric bypass, can be used as a direct cure for Type 2 diabetes in people who are not overweight. That's because some patients who have undergone gastric bypass surgery have seen their Type 2 diabetes disappear almost overnight.

Cris Clark of Greensboro had the procedure in December 2006. At the time, she weighed 298 pounds and suffered from Type 2 diabetes and high cholesterol, itself a risk factor for heart disease. She was taking medications for both conditions.

Her weight gradually receded to its present 180 pounds. But she was able to stop taking her diabetes and cholesterol medicines immediately.

"The day right after the surgery, I wasn't on (them) anymore," she said.

Other bariatric patients who have undergone a different procedure, in which a silicone band is wrapped around the stomach to reduce hunger — "lap band" surgery — have found that their diabetes comes under control more gradually as they lose weight. That's what happened with Jones.

How does gastric bypass affect diabetes? Researchers suspect that the answer has to do with hormones. Research with rats in which their upper small intestines were bypassed — also bypassing the pancreas, which produces insulin — found that the procedure eliminated Type 2 diabetes almost immediately. When the procedure was reversed, the rats developed diabetes again.

It is not clear whether the procedure could be used as a direct cure for Type 2 diabetes in people. The United States currently does not allow bariatric surgery on people who are not overweight. But clinical trials in Brazil are beginning to see whether such surgery can eliminate Type 2 diabetes in people who are not overweight.

"This requires much more research, which all the (medical) societies are doing," said Dr. Kristen Earle, a Greensboro bariatric surgeon. "It's an interesting finding, but it's very early. … Whenever you put a first study out there, you have to say, 'OK, what's your five-year data? What's your 10-year data?'"

Lisa White is a believer. The Gibsonville woman had lap-band surgery in 2007.

Although she did not have diabetes, both her parents did, and before the surgery, her own blood-sugar levels were approaching diabetes level. Now, they're normal.

But weight loss and diabetes control weren't the only benefits, she found.

Before surgery, her blood pressure had been 140 over 90 even with medication. Now, she says, it is 120 over 75, within the normal range.

"I'd do it again tomorrow," she said about her surgery.

Jones still has to take medication, but now his blood pressure is under control. Before the surgery, it wasn't.

He also no longer experiences the joint problems that led to his needing a hip replacement when he was still in medical school.

The painful bone spurs he used to develop in his feet are a thing of the past.

The benefits of bariatric surgery go well beyond simple weight loss, medical researchers have found. And that's good because obesity has become so common and the risks associated with obesity are so great.

About 15 percent of adult Americans were obese in the late 1970s, the U.S. Centers for Disease Control and Prevention found, but that figure had more than doubled by 2004.

In addition to high blood pressure, Type 2 diabetes and high cholesterol, obesity can increase the risk of heart disease, stroke, gall-bladder disease, sleep apnea and some cancers.

Researchers also believe that if obese people lose a significant amount of weight, they are at reduced risk of cancers of the kidney, breast, colon, liver, pancreas, ovaries, esophagus and gall bladder.

Weight loss from bariatric surgery also can eliminate sleep apnea, a condition in which a person stops breathing in his sleep multiple times during the night.

Sleep apnea doesn't just cause poor sleep. It also puts people at increased risk for heart attacks, strokes, high blood pressure, obesity and diabetes.

Weight loss from bariatric surgery can even reduce the incidence of erectile dysfunction and other sexual problems in obese men, new research suggests.

The benefits of bariatric surgery are not widely spread so far because only about 1 percent of Americans who are eligible for bariatric surgery have had it, CBS' "60 Minutes" has reported. It can cost $25,000 or more, and insurance doesn't always cover it.

But Jones found his procedure worthwhile, in part because he's back working in his yard. He has always loved doing that, but in the summer of 2006 he realized he had grown so heavy he no longer had the energy.

Now, since losing those 70 pounds, "my feet don't hurt anymore, and I'm back to cutting my grass."

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