Crystal Springs Surgical
Associates, A Medical Group,
the Opening of its New
Bariatric Weight Loss Surgery
Office in Walnut
Creek, CA. - Serving the East
Bay of San Francisco; Oakland,
Alameda, San Leandro, San
Ramon, Hayward, Fremont,
Vallejo, Concord and many more
surrounding east bay
Crystal Springs Surgical
Associates, A Medical Group,
the Opening of its New
Bariatric Weight Loss Surgery
Office in Lodi,
CA. - Serving Stockton,
Sacramento, Modesto, Lodi,
Fresno and the San
1/1/2007 Crystal Springs Surgical Associates, A Medical Group, Inc., Announces the Opening of its Two New Bariatric Surgery Offices in San Mateo and San Francisco, CA. Download Press Release
John J. Feng, M.D., FACS was established in November 2006 after its founder John Feng MD spent four years with Laparoscopic Associates of San Francisco. Now with offices in San Mateo and San Francisco, the Bay Area has direct access to the latest weight loss surgery techniques.
Gastric Bypass Surgery Explored as Cure for Type 2 Diabetes
Medscape Medical News 2007. © 2007 Medscape
April 13, 2007 (Seattle) — A bariatric surgery procedure used for treating severe obesity is now being explored as a cure for type 2 diabetes mellitus in normal-weight and moderately overweight patients with diabetes. Specific recommendations for using surgery in these patients are expected to appear this summer, according to a presentation here at the annual meeting and clinical congress of the American Association of Clinical Endocrinologists.
When used as a last resort for weight management, certain gastric bypass procedures have been known to completely reverse, or at least mitigate, type 2 diabetes. Until recently, researchers had assumed that weight loss alone was somehow responsible for this benefit. However, new research in rodents and very preliminary work in humans suggest that hormonal and metabolic changes caused by the surgery must be responsible, not simple weight loss, said Karen Foster-Schubert, MD, acting instructor at the University of Washington in Seattle.
"We really don't know what is being affected yet," Dr. Foster-Schubert told Medscape about the mechanism of diabetes reversal. Research in the laboratory of her colleague, David E. Cummings, MD, of the University of Washington, shows that ghrelin, a recently discovered peptide that stimulates appetite, is decreased after gastric bypass surgery. Other peptides, including the distal small intestine hormone peptide YY (PYY), and glucagon-like peptide 1 (GLP-1), secreted by intestinal L cells, increase after the operation, she said.
Finds 1 in 3 Americans Try
Unproven Diet Pills
As reported by MSNBC
Increases Risk of Parkinson's
Weight Loss Surgery Is Safe!!August 15th, 2009
In the most recent New England Journal of Medicine, one of the most significant and landmark studies ever conducted on the safety of bariatric surgery has been published. The findings re-affirm the safety of bariatric surgery and inspire greater confidence from the general public and policymakers.
This National Institutes of Health (NIH) sponsored sutdy found that the risks of weight loss surgery have dropped dramatically and now are no greater risk than having gallbladder or hip replacement surgery. This is great news and we’ve known this all along, especially with Dr. John Feng’s patients. In fact, as we expected, the risks are lower than the longer-term risk of dying from heart disease, diabetes and other consequences of carrying more weight than a person’s organs can tolerate. The 30-day risk of dying after surgery is only 0.3 percent (less than 1 percent!!!) for either Roux-en-Y gastric bypass or laparoscopic adjustable gastric banding. Only total of 4.3 percent (less than 5 percent) of patients had at least one major problem after surgery. Thus, the researchers in this study concluded that “Surgery is safe, effective and affordable” because it can lower the number of doctor visits, medication use and other medical expenses.
4,776 first-time bariatric surgery patients from 2005-2007 were followed (3,412 gastric bypass, 1,198 gastric band). Complications were higher in people with history of clot problems, sleep apnea, and certain other medical issues. In comparison, having heart bypass surgery has a 10 times higher risk of death.
One commentary sums this information up quite well: “The very low mortality of bariatric procedures found in this study are consistent with several recent publications which confirm that risk of complications and mortality of bariatric surgery has decreased significantly.”
Dr. Feng will perform telesurgery as part of the live surgery training portion of the Stanford Laparoscopic Sleeve Gastrectomy course.
Dr. Feng has been asked to participate as a mentor due to his extensive experience in performing this procedure 100% minimally-invasive without the need for large, open incisions from 2001. The surgery can be performed for qualified patients of almost any Body Mass Index with optimal results. The procedure is unique in its versatility and effectiveness.
Dr. John Feng will be participating in the upcoming Laparoscopic Sleeve Gastrectomy course on December 12th 2008. This expert course will be held at Stanford University at the Stanford Cancer Center. The course is attended by experienced laparoscopic bariatric surgeons. Dr. Feng will be performing live surgery education via telesurgery from Sequoia Hospital in Redwood City, California.
The Sleeve Gastrectormy live surgery will be performed by Dr. Feng as part of the overall course agenda. Drs. David Schumacher, Dennis Smith, John Morton are the other course faculty members. Topics include the Evolution of Weight Loss Surgery, Pre-Operative and Post-Operative Considerations with focus on Surgical Techniques. This procedure is considered a standard bariatric procedure by both the American College of Surgeons as well as the American Society for Metabolica and Bariatric Surgery.
Dr. Feng provides a comprehensive, laparoscopic surgical treatment program for severely obese patients. There are 4 minimally invasive procedures offered, including the laparoscopic Lap-Band System placement, Realize Band, Roux-en-Y gastric bypass (or RNY), vertical sleeve gastrectomy and duodenal switch with extensive experience in all these options to provide a tailored treatment plan for individual patients depending on their condition.
Dr. John Feng to Speak at Obesity Help National Event in San Ramon, California
Bariatric Surgeon specializing in laparoscopic weight loss surgery, Dr. John Feng, MD, FACS will speak at the Obesity Help National Event in San Ramon, Calif. to educate participants about the latest, minimally invasive weight loss surgery techniques.
Obesity Help, known for its great support for the bariatric community of weight loss surgery patients, asked Dr. Feng to speak because of his expertise in bariatric surgery.
Dr. Feng will speak about the variety of surgical treatments for obesity with a focus on laparoscopic techniques. He will also speak to the key elements of successful and healthy weight loss after surgery.
WHEN: This is
an all day event on December 6,
Finally, the decision is made! - Laparoscopic gastric bypass is better than openMonday, September 29th, 2008
In the United States, the obesity epidemic has become a major health concern over many years. About 31% of all Americans are obese and 5% of all Americans are morbidly obese with a body mass index (BMI) over 40 kg/m2 or at least 100 pounds overweight. Since there are over 300 million people in the United States, according to www.Wikipedia.com, that would mean that over 15 million people in the United States are morbidly obese and potential candidates for weight loss surgery according to National Institutes of Health guidelines. This number doesn’t even include those people with a BMI greater than 35 but under 40 with medical problems related to obesity which would also make them candidates for surgery in terms of their weight as a factor to consider.
Bariatric or weight loss surgery has been shown to be the gold standard in the treatment of morbid obesity with effective and long-term weight loss as the desired outcome. A recent article in the August 2008 Annals of Surgery, researchers analyzed the data across the United States of over 19,000 patients who underwent gastric bypass surgery in order to determine whether laparoscopic surgery (surgery using incisions less than 1/2 inch) was better than traditional open surgery where the incision was much longer of at lease 6 inches in the upper abdomen.
Previous reports in the surgical literature clearly found that laparoscopic Roux-en-Y gastric bypass when compared to its open, large incision counterpart was associated with shorter recovery time, smaller wounds, and less pain after surgery. Pain is a significant issue since the larger incision in the upper abdomen would force patients to take smaller breaths to minize pain. Taking smaller breaths often can result in fevers and pneumonias after surgey, and thus more complications.
In this current study and analysis, researchers found that over 75% of patients underwent laparoscopic surgery. More importantly, open surgery patients were more likely to require additional surgery, with more complications with the heart and lungs, as well as leaks at connections and septicemia. They also discovered that there were more procedural or technical issues in the open surgery patients. As you would expect, those patients who underwent laparoscopic gastric bypass had a shorter length of stay in the hospital. There were higher costs associated with laparoscopic surgery, most likely related the the very specialized equipment used in the operating room to perform the procedures correctly and efficiently. The hospital costs for care of the patient were less when compared to open surgery patients in past studies.
This is a landmark study in the analysis of outcomes of a large number of patients over the course of a year (2005) in the United States. It confirms past studies that there was significant clinical benefit to the patient who undergoes laparoscopic gastric bypass surgery compared to patients who undergo open, larger incision surgery.
Dr. John Feng, MD, FACS specializes in laparoscopic bariatric surgery. Since his specialty fellowship training, he has not had to perform open surgery using techniques he’s created to achieve this for his patients. There are 4 different procedures used for weight loss and all can be performed laparoscopically. These include the Roux-en-Y gastric bypass, the vertical sleeve gastrectomy or vertical gastroplasty with gastrectomy, the biliopancreatic diversion with duodenal switch (duodenal switch or DS) and placement of an adjustable silicone stomach (gastric) band such as the Lap-Band System or REALIZE Band.
Size does matter - Making a small stomach pouch in the Gastric BypassFriday, September 26th, 2008
The gastric bypass is the most common procedure performed in the United States. However, there are still a variety of techniques used to perform this operation for morbidly obese patients. In addition, the amount of weight loss varies on a patient to patient basis.
In a recent study published in September 2008 in the Archives of Surgery, researchers at the University of California San Francisco Department of Surgery published the results of a prospective study that attempted to determine what factors contributed to inadequate or poor weight loss after gastric bypass surgery over a 3 year period.
Although the study did not analyze factors such as exercise level, body composition and fat distribution, they did find that 2 factors did contribute to poor weight loss: the presence of diabetes before surgery and larger stomach pouch size created by the surgeon at the time of the gastric bypass.
Thus, the researchers concluded that changes to the use of diabetes medications may be necessary to help achieve better weight loss. And, of course, careful attention to creating a small stomach pouch at the time of the gastric bypass is critical to maximizing the success of the operation for the obese patient.
Dr. John Feng, MD, FACS utilizes 4 distinct types of weight loss procedures to tailor to the needs of each patient. These bariatric procedures are all performed laparoscopically (with 1/2 inch incisions) and include the Roux-en-Y gastric bypass, the duodenal switch (DS), the vertical sleeve gastrectomy (vertical gastroplasty), and both the Lap-Band or REALIZE Band systems. Specifically, in the Roux-en-Y gastric bypass, Dr. Feng purposefully creates a stomach pouch that’s no bigger than a “Chapstick.” The pouch essentially is 1/2 inch wide and only 2 - 2 1/2 inches long, or about the size of a finger. He handsews the stomach to the intestine, instead of stapling those 2 parts, specifically to create a small pouch. Even prior to this study, Dr. Feng believed that it’s a small, vertically oriented pouch with a small opening (without the use of foreign objects) that would achieve the greatest success, allowing it to stay smaller for a longer period of time. These principles are carried over to both the gastric band procedures and especially the vertical sleeve gastrectomy where stomach size is important. For longevity of keeping stomach pouch size smaller for a longer period of time, Dr. Feng feels strongly enough about these issues that he used special techniques to achieve these goals.
Gastric Bypass Cures Metabolic SyndromeThursday, September 4th, 2008
Physicians define “Metabolic Syndrome” as a group of abnormalities that together lead to higher risk of developing Type II diabetes and atherosclerotic blood vessel disease (such as heart disease or stroke). Thus, Metabolic Syndrome puts people at high risk for complications of these diseases and shortened life expectancy. It is also known as Syndrome X or Insulin Resistance Syndrome.
Metabolic Syndrome is comprised of the following features:
1) High fasting blood sugar levels, or hyperglycemia
2) High blood pressure, or hypertension
4) Low HDL cholesterol (the “good” cholesterol)
5) High triglyceride levels (one of the “bad” cholesterols)
It has been long known that weight loss surgery, or bariatric surgery, has helped a majority of morbidly obese patients eliminate diabetes, high cholesterol, sleep apnea and high blood pressure after losing much of their excess body weight. A recent study published by a group of scientists in the August 2008 Mayo Clinic Proceedings found that the Roux-en-Y gastric bypass can cure a patient of metabolic syndrome. The researchers studied patients from 1999 to 2003 and compared the patients who underwent surgery to those who didn’t. Everyone had extensive followup with education and instruction about good, healthy dietary and exercise habits. Patients were followed on average for almost 3 and 1/2 years.
They found that of the 180 patients who underwent the Roux-en-Y gastric bypass, the percentage of those who had metabolic syndrome significantly dropped from 79% to only 29%. However, in the control or non-surgery group of 157 patients, the value decreased from 85% to still 75%. Surgery patients lost about 97 pounds while those who didn’t have surgery only lost 1/5 of a pound over that time - a very dramatic difference.
The authors of the study recommend that “Roux-en-Y gastric bypass surgery should be considered as a treatment option in patients with metabolic syndrome that has not responded to conservative measures” in those eligible for bariatric surgery.
Dr. Feng specializes in the expert and comprehensive care in the treatment of morbid obesity with advanced laparoscopic surgery, including laparoscopic placement of an adjustable gastric band system, such as the Lap-Band System or Realize Band, laparoscopic Roux-en-Y gastric bypass, laparoscopic restrictive vertical gastroplasty (vertical or sleeve gastrectomy) and the laparoscopic duodenal switch (biliopancreatic diversion with duodenal switch, BPD-DS, or DS). Results are optimized using the latest techniques with significant emphasis on followup care and support.
Speed of Weight Loss and Curing DiabetesFriday, June 27th, 2008
At the most recent meeting of the American Society for Metabolic and Bariatric Surgery, Duke researchers presented results on the effect of weight loss after gastric bypass surgery on putting diabetes into remission. In the 71 patients they studied who were being treated with both oral medication and high-dose insulin for diabetes, it was those people who lost weight the quickest with the most weight loss in the first 3 months that went into remission from diabetes which lasted at least 2 years.
Factors that didn’t seem to make a difference included pre-operative BMI (body mass index), age, number of years taking insulin, number of medications, hemoglobin A1C levels (a marker of diabetes control).
These conclusions are important to the underlying idea that it is the weight loss, not necessarily the type of surgery performed, that plays an important role in helping patients who undergo weight loss (bariatric) surgery improve their overall health, both mentally and physically. Of course, close monitoring is important, probably best performed by the surgeon who operates on the patient. Clearly, both nutritional and exercise regimens that enhance the weight loss after bariatric surgery in a safe manner are important to overall success.
These findings help confirm the observation that after gastric bypass, vertical sleeve gastrectomy and duodenal switch surgery, and many gastric banding patients, that diabetes can improve even in the first couple of days after surgery. The researchers suggest that gut hormones are affected and thus fixing insulin resistance seen in morbidly obese patients. The amount and speed of weight loss appear important, further complementing data just published 2 months ago that diabetic, obese patients who merely underwent Lap-Band System surgery (76%) were successfully cured of diabetes over a 2 year period.
Results are optimized using the latest techniques with significant emphasis on followup care and support.
Risk of hospital-acquired infections are much lower in laparoscopic surgeryThursday, May 8th, 2008
For the last several decades, patients have known the obvious benefits of less pain, less scars, and quicker recovery with having laparoscopic surgery versus the open type with the much larger incisions. This has been true with gallbladder removal surgery, hernia surgery and appendicitis surgery. Of course, laparoscopic bariatric or weight loss surgery is no exception. For example, research has shown that patients who undergo laparoscopic gastric bypass surgery have less pain, have smaller scars, and return to normal activities sooner than patient who have a large, open incision from the breastbone down to the belly button.
Recent information presented just last month at the annual meeting of the Society of American Gastrointestinal and Endoscopic Surgeons revealed that laparoscopic surgery was linked to a 50% reduction in hospital-acquired infections and a 65% reduction in return admission to the hospital, as compared to open surgery. The study focused on gallbladder, appendix, and uterus surgery.
Results such as these further support the fact that laparoscopic surgery, especially for patients at high risk of infection such as obese patients, will be better for patients than open, or large incision, surgery.
Current laparoscopic, or minimally invasive, techniques that are offered to patients of board-certified surgeon Dr. John J. Feng, FACS, include adjustable gastric band surgery (Lap-Band(R) or REALIZE), restrictive vertical/sleeve gastrectomy/gastroplasty, Roux-en-Y gastric bypass, and duodenal switch. With each procedure, Dr. Feng uses specialized strategies and equipment to optimize healing and recovery.
Obesity Increases Risk of Cancer: A Reminder about the Seriousness of Being ObeseWednesday, April 16th, 2008
It’s scary. Obesity already shortens ones lifespan by causing several diseases such as high blood pressure, diabetes (high blood sugar which can lead to blindness, heart disease, poor circulation and other diabetes-related problems), sleep apnea, severe disability from degenerative joint disease, as well as acid reflux, urinary incontinence, infertility.
As discussed in a new article this month in Lancet by Dr. Andrew Renehan, men who gain about 33 pounds and women who gain about 29 pounds over a Body Mass Index (BMI) of 23 kg/m2 are at higher risk for cancers of the esophagus. In women, cancers of the inner lining of the uterus (endometrial), gallbladder and kidneys are at higher risk of occurring with obesity. The risks of thyroid, colon and kidney cancers are higher in obese men.
Other cancers that are also at higher risk of occurring in individuals who are obese but to a smaller degree, include rectal and malignant melanoma in men; postmenopausal breast cancer, pancreatic, thyroid, and colon cancers in women; and leukaemia, multiple myeloma, and non-Hodgkin lymphoma in both men and women.
The conclusions of this paper comes from analyzing over 140 articles, including 282,137 cases of cancer by the British researcher and his colleagues.
In the April 23, 2004 issue of the New England Journal of Medicine, the topic of cancer and obesity was well studied and discussed. Researchers at the American Cancer Society in Atlanta, Georgia studied 900,000 adults who were free of cancer starting in 1982. Sixteen (16)years later, over 57,000 of these people had died from cancer.
People who were morbidly obese (BMI greater than 40 kg/m2 or about 100 pounds overweight) had death rates 52% higher in men and 62% higher in women, compared with normal weight people.
Higher risks of esophagus, colon and rectum, liver, gallbladder, pancreas and kidney, non-Hodgin’s lymphoma and multiple myeloma. In addition, men had a higher trend risk of cancer of the stomach and prostate. In women, it was breast, uterus, cervix and ovaries. Obesity women are 4 times as likely to get kidney cancer and 6 times as likely to get uterine cancer than normal weight women. The researchers estimate that overweight and obesity situation in the United States is probably responsible for 14% of all deaths from cancer in men and 20% of deaths from cancer in women.
In the Lancet article, they discussed also how researchers are not sure why obesity and cancer are so strongly linked. Hormonal, stress and other factors are probably involved. For esophagus cancers, acid reflux in an obese patient may be responsible.
Of course, there have not been large studies about whether or not weight loss surgery or weight loss would reduce the risk of cancer. This would probably turn out to be true since losing weight and keeping it off clearly has been shown to have many health benefits. However, if a person is 100 pounds overweight, it becomes extremely difficult to lose that much weight and keep it off in the long run, unless weight loss surgery is performed. The adjustable gastric band systems (LAP-BAND and REALIZE Band), vertical/sleeve gastroplasty/gastrectomy, Roux-en-Y gastric bypass and Duodenal Switch are the mainstream acceptable methods currently available with only a handful of surgeons trained to offer all 4 procedures, tailored to patients medical needs. There are even a fewer number of surgeons worldwide who offer these procedures laparoscopically with incisions larger than 1 inch, usually 5 or less scars less than 3/4 of an inch with comprehensive understanding of how each of the procedure works. Dr. John Feng is one such expert. In his fellowship specialty training under Drs. Michel Gagner, Alfons Pomp, Daniel Herron and Barry Inabnet in New York, he became a specialist in Advanced Laparoscopic and Minimally Invasive Bariatric Surgery and was the first surgeon to bring the Laparoscopic Vertical/Sleeve Gastrectomy to California and the West Coast.
Pedometers Improve Activity Levels and Weight LossMonday, January 28th, 2008
Everyone knows that exercise is essential for weight loss, especially after bariatric or weight loss surgery. Many patients state that they walk a lot, and therefore conclude that they are getting enough exercise. What is a good amount of walking? Well, it’s hard to quantify unless you are measuring distances or better yet, counting steps with a pedometer.
In a recent study earlier this month in the Annals of Family Medicine, researchers examined several past studies that involved just pedometer-based walking programs without dietary intervention. They concluded that pedometer-based walking programs resulted in modest weight loss and that the longer the program, the more the weight loss. Imagine with the dietary control that weight loss patients achieve, such programs would probably show even better results.
Another study from Stanford University was published in the Journal of the American Medical Association late last year in November 2007 by Dr. Dena Bravata, a colleague of mine. Dr. Bravata and her colleagues found that just using a pedometer increases activity significantly, by over 2000 steps in her study. The daily recommended walking goal is 10,000 steps or at least increase steps each day to this goal. Using the pedometer, by increasing activity, help both weight loss and blood pressure.
Using a pedometer to measure walking is very smart since it gives a person the ability to objectively monitor their own progress. Monitoring and even recording this progress helps the individual to plan on improvement that can also be measured.
After weight loss surgery, use your pedometer. You’ll be suprised how much (or how little) you walk. So you can decide to walk that much more the next day. Eventually, it will be come natural, especially as your own cardiovascular health and your weight loss goals improve.
Obesity Surgery Cures DiabetesMonday, January 28th, 2008
In last week’s article on January 23rd, 2008, in the Journal of the American Medical Association (JAMA), entitled “Adjustable Gastric Banding and Conventional Therapy for Type 2 Diabetes: A Randomized Controlled Trial,” weight loss achieved after laparoscopic adjustable gastric band (LAGB) surgery cured type 2 diabetes mellitus better than non-surgical methods, or conventional, ways of treating obesity and diabetes.
Sixty obese patients with type 2 diabetes were entered into the study which lasted for 2 years. In the conventional group, standard treatment with dieting, exercise, medical and lifestyle changes methods were used. In the weight loss surgery, or bariatric surgery treatment group, patients underwent uncomplicated placement of an adjustable gastric band system. The research group involved in this study historically uses the Lap-BAND System from Allergan which has been FDA approved in the United States for surgical treatment of obesity since June 2001.
Patients were followed on a regular basis and compared at the end of the study. The average BMI in both groups were approximately 37 kg/m2 at the beginning of the study with an average age of 47 years. At the end of the study there were 26 conventionally treated patients and 29 surgery patients.
Overall, 76% of all the surgery patients who had undergone adjustable gastric band surgery were cured of diabetes. This result was much lower than the non-surgery patients where only 15% of the patients experienced diabetes remission. Surgery patients lost over 62% of their excess body weight compared to only about 4% weight loss in the conventionally-treated patients. Curing diabetes was directly related to the success in losing a significant amount of weight. With gastric band surgery, BMI decreased from 36.9 kg/m2 to 29.5 kg/m2. Without surgery and the best available nutritional, exercise and appropriate medical treatment, the average BMI only went from 37.1 kg/m2 to 36.6 kg/m2.
As stated in the conclusions, it is important to realize that this study is the first one to document how diabetes can be cured effectively with adjustable gastric band surgery with minimal complications in patients with a BMI of 30-35 kg/m2, as well as in BMI 35-40 kg/m2. Bariatric surgery currently is the best way to successfully achieve significant and long-lasting weight loss in severely obese patients. Currently, NIH criteria state that patients with a BMI of 40 kg/m2 without obesity-related illnesses are appropriate candidates for surgery, along with other criteria, such as failed prior attempts at supervised weight loss and psychological clearance. In addition, if a patient has a BMI from 35-40 kg/m2, that patients must have obesity-related conditions that would qualify him or her for bariatric, or weight loss, surgery. This study emphasizes that perhaps lowering the BMI criteria would also help patients that have diabetes, but only if the risks of surgery have been decreased. In the United States, the Allergan Lap-BAND System procesure and the more recently FDA-approved, REALIZE Band System from Ethicon are probably the types of procedures that should be used in these instances. Undergoing surgery of any type must involve weight the risk to benefit ratio. Future, larger studies will probably better answer these questions.
Today, there are 4 commonly accepted types of bariatric surgery procedures used to treat obesity. These include the Roux-en-Y gastric bypass, the Duodenal Switch, the Vertical/Sleeve Gastroplasty/Gastrectomy, and the adjustable gastric band procedures such as Lap-BAND or Realize Band. Surgeons, such as Dr. John Feng, MD, FACS is probably best at discussing the appropriate options for each patient in an individualized manner since Dr. Feng performs all 4 procedures in his practice laparoscopically. It is important in choosing not the right surgery but also the right surgeon who can provide optimal care for the patient.
A New You for the New Year! How to achieve long-term successful weight loss…Thursday, January 3rd, 2008
According to the definition in Wikipedia, a New Year’s resolution is defined as…
“… a commitment that an individual makes to a project or a habit, often a lifestyle change that is generally interpreted as advantageous. The name comes from the fact that these commitments normally go into effect on New Year’s Day and remain until fulfilled. More socio-centric examples include resolutions to donate to the poor more often, to become more assertive, or to become more economically or environmentally responsible. People may act similarly during the Christian fasting period of Lent, though the motive behind this holiday is more of sacrifice than of responsibility…”
Often, resolutions are related to a lifestyle change, and commonly include losing weight or getting healthier, whether by improving dietary or exercise habits. The New Year can signify or memorialize a new chapter in one’s life journey. It is a good time to mark change, especially after the holiday season and its festivities are over. Unfortunately, in the frenzy to start a new plan for health and wellness, a person can find themselves misguided by suggestions from friends, family and the media.
For long-term successful weight loss, especially for those who have to lose 100 pounds or more, only weight loss surgery, or obesity surgery, has been shown to achieve this goal in most people.
Of course, the question remains… What is the safest way to lose weight?
The answer is diet and exercise.
There is a caveat. Recent scientific studies have shown that certain diets are better at achieving weight loss and even improve obesity-related health conditions, such as high cholesterol, diabetes and high blood pressure. These studies have come to the conclusion that low carbohydrate and low calorie diets are better than low fat or just high protein diets. Unfortunately, these differences, although statistically significant, are small. The overall result is less than 10% weight loss after one year of supervised effort.
Thus, although the safest way to lose weight is diet and exercise, these efforts alone, in most obese individuals, do not create the weight loss accomplished by treatment with weight loss, or bariatric, surgery.
However, to understand how surgery achieves greater than 60-80% excess body weight loss in a majority of people, it is important to realize that surgery is mainly a tool to comfortably, satisfyingly undergo a low calorie, low carbohydrate diet without an overwhelming sensation of hunger. All the surgeries that are available today make the stomach smaller, allowing the person to feel full with the right diet. The minimally-invasive, or laparoscopic, methods of performing these surgeries allow the patient to recover faster, with less pain, and fewer scars when done properly.
The Roux-en-Y gastric bypass is the most common procedure and bypasses the majority of the stomach to restrict the amount of food eaten. The Lap-Band System Procedure allows the stomach to feel smaller with an adjustable belt around the upper stomach and can be done safely as an outpatient procedure. For patients with a large amount of excess weight, the Duodenal Switch procedure not only decreases stomach size but also bypasses much more of the intestine to decrease absorption of calories from fats. Last, but not least, the Vertical Gastrectomy, also Sleeve Gastrectomy or Restrictive Vertical Gastroplasty, achieves shrinking stomach size without any intestinal bypass with very favorable results as a more modern procedure. This last procedure allows a patient 100 or over 400 pounds overweight to undergo surgery laparoscopically, and thus reaping the benefits of minimally-invasive procedures, especially in those who need it most.
The key to success after weight loss surgery is to remember that no matter which surgery a person undergoes, each one is a tool. The tool can be used well but also can be misused. Thus, for each New Year, weight loss surgery patients should remember the key elements on how to use their “tool” well.
For the New Year, especially to become a “New You,” attend a support group meeting or informational seminar, and educate yourself about how to succeed with weight loss.
Obesity Increases Risk of CancerTuesday, November 20th, 2007
A recent study in the British Medical Journal discovered that increasing BMI (body mass index) is associated with increased risk for certain cancers. The study, called the Million Women Study, was conducted in England (United Kingdom, Great Britain).
In the Cancer Epidemiology Unit at Oxford University, Dr. Gillian Reeves, PhD, found a significant relationship between BMI and cancer in 1.2 million British women between the ages of 50 and 64 years during 1996-2001. In the United Kingdom, 23% of all women are obese and 34% are overweight.
During the 5.4 average study years, 45,037 cancers occurred with mortality followup of 7 years with 17,203 cancer-related deaths. Dr. Reeves analyzed the risks for the occurrence and risks of death for all cancers and 17 specific ones.
Higher BMI was associated with increased risk of cancer of the endometrium (lining of the uterus), esophagus (adenocarcinoma type), kidney, pancreas, ovaries, breast (in postmenopausal women) and colon (in premenopausal women), as well as leukemia, multiple myeloma, and non-Hodgkin’s lymphoma.
For colon and rectal cancer, malignant melamoma, breast and endometrial cancers, a woman’s menopausal status determined higher or lower risk. Half of all endometrial and esophageal cancers are attributable to being overweight or obese.
The final conclusions were that 6000 new cancers each year in postmenopausal women in the United Kingdom are due to overweight or obese, with 4800 new cancers each year just due to obesity. Overweight is defined as a BMI of 25-29.9 kg/m2. Obesity is defined as a BMI of 30 kg/m2 or more.
Clearly, not only does obesity cause diseases such as diabetes, high blood pressure, cholesterol abnormalities, heart disease and strokes, but can also lead to higher risks of certain cancers. Previous studies over the years also support these conclusions.
Weight loss or bariatric surgery is the treatment of choice for patients with severe obesity since it gives the patient the best chance at achieving significant weight loss that can be maintained long term. Since the Million Women Study showed higher risk of cancer in overweight or obese women, especially after menopause, it would be interesting to see if weight loss surgery before that time would decrease the chance of such cancers.
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