All posts by Dee Anne Agonis

March 7, 2017 – Changing Relationships after Surgery

Bariatric Support Group

Date:  March 7, 2017

Facilitator:  Dr. Ravi Sabapathy

Dr. Sabapathy came to talk to the group how bariatric surgery impacts relationships, both before and after surgery.  He discussed that there were 3 domains that are impacted:

  • Biological
  • Psychological
  • Social

Patients talked about the ways their lives had been impacted positively in each of those domains.

Biologically: 

  • Physically more comfortable
  • More energy
  • Greater mobility
  • Off medications – healthier

Psychologically:

  • Increase in self-confidence leading to being less concerned with what others think
  • Increase in self-esteem and able to focus on themselves
  • Feel that they have more choices and more options, since they are not limited by their weight
  • They are no longer noticed for “being fat” – but no longer “invisible”
  • Feel that they have their freedom back, and are more willing to try new activities
  • With absence of continuous urge to eat, have more time rather than planning on eating all the time

Socially:

  • Have enough energy to do things in the evenings rather than being too tired all the time
  • Go out and do things by self, meet new people, join social gatherings
  • Increased professional/career confidence
  • Find their family/friends are more conscious of what they eat and have begun making better food choices and losing weight also.
  • Don’t have to worry about going places like theatres that may not have large enough seats, restaurants that don’t have adequate seating, etc. Can go anywhere now

Dr. Sabapathy says these are the reasons he calls weight loss surgery “health improvement and function surgery!” He talked about the different relationships in our lives.  The first one we think of is the relationship with our spouse.  There is currently a 50% divorce rate just in the general population.  There are a few statistics showing that 2 years after bariatric surgery can be a time of challenge; but he finds that those who have a strong relationship find it gets stronger, and those with a weaker relationship find it gets weaker.   While it is easy to blame the surgery, there are usually other issues involved.  For example, if the patient who has had the surgery has more energy and wants to get out and do more, this can be challenging for the partner who doesn’t want to see that change.  Change is hard, and “change breeds more change.”

  • The first big change most people make is a job change. Once they have lost the weight, they feel they are freer to explore more career options.  Previously they frequently work long hours and have a lot of emotional exhaustion.  Once they lose weight and are focused on self-care, they often want to look at something that isn’t so draining, and they have the confidence to consider more options.
  • Another change can be with family and friends. Some patients mentioned that the control in a relationship can change, and some find themselves facing some rejection from the other person who doesn’t want to give up control.  Families may resist changes that involve the patient spending more time away from home as the patient becomes more social; and some have sensed jealousy from family and friends who may be jealous of the new, thinner person.  It may force them to look at themselves, and can bring out their own insecurities.
  • Some relationships in our lives are toxic, and those can sabotage patient outcomes.  You may need to leave those toxic relationships behind in order to be successful.  Communication is key, addressing how different you feel and addressing how that changes the way they feel. 
  • Your relationship with food is a big one that needs to change. You develop your habits beginning as a toddler, and you just eat what you’re given.  You now eat for nutrition, and not for other reasons.  Sugar is as addictive as heroin, so you need to avoid it, especially if you know you are prone to addiction.  Be very mindful about food.  Find something to replace the pleasure you got from eating – find another source of pleasure instead. 

The most important relationship you want to address is the relationship you have with yourself.  Patients at support group agreed that self talk is important – especially when you go somewhere socially and you cannot have something that is available to eat.  You want to keep reminding yourself of what you are trying to accomplish and keep on track. 

The Harm of Fat Shaming and its Effects on Weight Loss & Health

Fat-Shaming-Scale_127604420

What is fat shaming and what does it mean for weight loss? Fat shaming is the process of insulting, bullying or stigmatizing a person for their weight. This is nothing new in American culture where rhetoric, the entertainment industry and media have all insisted fat people are inferior.

Even well intentioned instances of fat shaming are considered socially acceptable because they are framed in a way that seems to express concern for someone’s health. Examples include discouraging someone from eating dessert or telling them they need to be more active. But fat shaming has been proven to be counterproductive. The language we use to talk about weight and the assumptions we make based on a person’s size can actually contribute to more weight gain and less self-care, like seeking medical attention.

Think you’re helping that overweight family member or friend with fat shaming commentary?  Here’s what actually happens:

Fat shaming can spike stress hormones that can increase weight gain

  • Numerous studies show weight stigma and discrimination can lead to elevated levels of cortisol, a stress hormone that’s been linked to overeating, binge eating and weight gain;
  • Dieting alone is also considered inherently stressful and can lead to weight gain, not weight loss, because weight anxiety is linked to binge eating.

Fat Shaming stems from the insinuation that overweight people lack control, but losing weight isn’t as simple as having willpower  

  • Too many in our society hold the belief that weight loss is as simple as summoning willpower; that people who fail to lose weight just aren’t trying hard enough, that they are lazy;
  • Weight loss-focused shows like The Biggest Loser, suggest getting thin is about working hard and really wanting it, but they don’t tell the full story. Several former contestants of The Biggest Loser struggled to maintain their weight loss, according to the New York Times. Contestants that lost the most weight had to actually eat less and exercise more to maintain their weight loss than their peers who had lost less weight; clear evidence that losing weight and maintaining it involves much more than just self-discipline;
  • These forms of entertainment actually perpetuate the fat shaming myth: research has shown that people who are not trying to lose weight that watch weight loss reality TV are more likely to believe that weight can be controlled solely by self-discipline;
  • Weight gain and obesity stem from a whole host of factors including genetics and environment, a report from Harvard Medical School noted. Roughly 400 genes, childhood habits and many features of modern life (e.g. inflated portion sizes, sedentary jobs, lack of sleep) can increase the likelihood someone is overweight or obese.

Even doctors are prejudiced, which can be harmful to their overweight patients

  • Fat-Shaming-Doctor-Prejudice_49297156Many medical professionals hold weight biases which can prevent provision of the best possible care; they too can buy into the fat shaming stereotype about lack of willpower and self control;
  • Yoni Freedhoff, assistant professor at the University of Ottawa and founder of Ottawa’s Bariatric Medical Institute, has addressed professional biases toward the overweight population and how they can affect the type of treatment a provider recommends. Freedhoff also suggests patients who sense this bias from a health professional can be less likely to seek care if they have had a negative experience with a medical provider in the past;
  • Dr. Michelle May, a medical physician and member of the advocacy group, Health at Every Size, shared, “This is about people receiving inadequate health care, and preventative advice, and counseling and support and treatment – because the focus is on weight instead of managing risk factors.”;
  • While already facing health consequences, obese patients risk facing even more dangers if their doctors don’t support them or if they feel so discouraged that they stop seeking professional care;
  • Health care providers shouldn’t think of obesity any differently than other medical conditions that carry degrees of risk.

Fat-Shaming-Results_127604387In the end, it would be wise for all to understand that body size is not directly correlated with a person’s work ethic or worth. If there’s any laziness associated with fat shaming, it’s the laziness of failing to correct our own flawed beliefs about weight and health. Love, compassion and encouragement will do far more to help than the counter-productive effects of fat shaming.

Original Article – https://mic.com/articles/162629/fat-shaming-not-lack-of-willpower-is-why-so-many-americans-struggle-with-their-weight#.d4FXOOW2t

 

Empower Your Gut Microbiome Footprint to Heal and Protect Your Health

Gut Bacteria

Microorganisms are everywhere. From those that live in the ocean to those found in the soil that helps feed the world. Other microorganisms live in a host environment, and our body is no exception to this rule.  According to Merriam Webster’s Dictionary, a microbiome is “a community of microorganisms (such as bacteria, fungi and viruses) that inhabit a particular environment and especially the collection of microorganisms living in or on the human body”. There are about the same number of cells that make up the entire human body as the number of microbiomes in us. Microbiomes that reside inside the gastrointestinal tract are referred to as gut microbiomes and are found all throughout the GI tract. They participate in a wide variety of systems and they influence human health in important ways. 

Here are some areas of potential influence when gut microbiomes heal and protect your health:

  • Act as a mediator. They are the first to be in contact to environmental changes, protecting you from illness;
  • Maintain human homeostasis. They can modulate your body’s metabolic status, vitamin production, nutrient absorption, and how you utilize carbohydrates and fat, whether you feel hungry or full;
  • Influence inflammatory process. They help maintain the integrity of the gut lining, regulate immunity, and control inflammation preventing a leaky gut;
  • Influence your brain health. They directly affect the function of the cells along the vagus nerve. Some of the gut’s nerve cells and microbes release neurotransmitters that speak to the brain in their own language. Many scientists are now calling them the “second brain”. They affect your mood, ability to concentrate, and libido. A dysfunctional microbiome could be the root of headaches, anxiety, and inability to concentrate;
  • Act as a physical and chemical mechanism to prevent gastrointestinal infection. They can detoxify chemicals such as environmental toxins in a way that when they are consumed, they can act on the primary source of exposure and protect you. This means they serve as natural antibiotics, antivirals, and antifungals. They can interact with oral medications and potentially reduce side effects.
Probiotics help you lose more weight
Probiotics help you lose more weight

You can change the state of your microbiome footprint and the fate of your health, opening the door for better health. A study published in the Journal of Gastrointestinal Surgery showed that patients who take probiotics after the gastric-bypass procedure tend to lose more weight than those who don’t take the supplements. Other researchers have found evidence linking bariatric surgery to long-term positive changes among the gut microbiomes.

Significant changes in the array of gut bacteria can take place in as little as six days after instituting a new dietary protocol. This plan can help you get started:

EAT FOODS RICH IN PROBIOTICS

Probiotics are live bacteria and yeast that support good digestive health. Long before probiotic supplements became available, the health benefits of fermented foods such as sauerkraut and yogurt were well recognized. The type of fermentation that makes most foods rich in beneficial bacteria is called lactic-acid fermentation. In this process, good bacteria convert sugar molecules in food into lactic acid, and, in doing so, the good bacteria multiply. This lactic acid, in turn, protects the fermented food from being invaded by pathogenic-bacteria because it creates an environment with a low pH. This kills off harmful bacteria, which has a higher pH. There’s no better way to consume bifidobacteria and lactobacilli than to get them from food sources as well as food based micronutrients. However, due to stomach restriction after bariatric surgery, it is recommended to include probiotics into your daily nutrient supplementation regimen.

These are some of the best food sources for probiotics:

  • Live-Culture Yogurt: Check the label to make sure your yogurt contains live cultures, and avoid products that are heavily sweetened. Coconut yogurt is an excellent alternative for people who are sensitive to dairy;
  • Kefir: A fermented-milk product that has a more liquid texture than yogurt;
  • Kombucha Tea: A tart, fermented black tea;
  • Kimchi
    Kimchi
    Kimchi: Spicy, fermented vegetables that are Korean in origin. Kimchi is one of the best probiotic foods you can add to your diet;
  • Sauerkraut: Real, fermented sauerkraut fuels healthy gut bacteria and contains choline, a chemical needed for proper transmission of nerve impulses from the brain through the nervous system. You can make your own real sauerkraut at home or find it in the refrigerated section of grocery stores;
  • Pickles: The most basic and beloved probiotic. As with sauerkraut, choose real, brined pickles that have been refrigerated.

 

LOWER YOUR CARBS AND CHOOSE HIGH QUALITY FATS

Healthy Fats From Nuts & Seeds
Healthy Fats From Nuts & Seeds

A diet that keeps your blood sugar balanced keeps your gut bacteria balanced. A diet high in rich sources of fiber from whole vegetables and fruits feeds good gut bacteria and produces the right balance of short-chain fatty acids to keep the intestinal lining in check. A diet that’s intrinsically anti-inflammatory is good for the brain also.

Diets high in sugar and low in fiber fuel unwanted bacteria and increase the chances of intestinal permeability, a compromised immune system, and widespread inflammation. It’s a vicious cycle; all of these further disrupt our protective microbial balance. Choose fats from those naturally found in the protein foods, from butter and olive oil used to prepare the dish, and from nuts, seeds, avocado, and coconut.

CONSUME FOODS RICH IN PREBIOTICS

Prebiotics are food-borne fuel for the beneficial bacteria that live in the gut, and they occur naturally in raw garlic, cooked and raw onions, leeks, chicory, artichokes, and jicama. Estimates suggest that for every 100 grams of prebiotic carbohydrates we consume, a full 30 grams of good gut bacteria are produced.

Prebiotics have many additional benefits, including the ability to reduce inflammation in inflammatory-bowel disorders, enhance mineral absorption, and promote a sense of satiety. Animals given prebiotics produce less ghrelin, the hormone that signals the brain that it’s time to eat.

DRINK FILTERED WATER

No Chlorine
No Chlorine

Consuming plenty of water is important to intestinal health, but it’s critical that the water doesn’t contain gut-busting chemicals like chlorine. Environmental toxins can disrupt your microbiome footprint.

Use a household water filter. There are a variety of home water-treatment technologies available, from simple filtration pitchers to under-sink units with a separate spigot. Make sure the filter you buy removes chlorine as well as other contaminants, and be sure to maintain and change it regularly. Finally, ditch plastic water bottles and choose reusable bottles made from stainless steel or glass instead.

References:

Experience Life Magazine September 2015. David Perlmutter, MD

ASMBS Obesity

Week Conference 2016 New Orleans, LA

https://www.sciencedaily.com/releases/2009/07/090713114512.htm

http://www.the-scientist.com/?articles.view/articleNo/43681/title/Gut-Microbiome-After-Weight-Loss-Surgery/

 

February 16, 2017 – Cooking with Healthy Fats

Bariatric Support Group

Date:  February 16, 1017

Facilitator:  Diane Doolin, RN, CYT

Diane Doolin is a nurse in the GI Lab at Shawnee Mission and also works as a yoga instructor.  In addition, she spends a lot of time studying healthy nutrition and does health retreats around the area.  She came to talk about healthy vs unhealthy fats and show us a few recipes that incorporate them in order to improve our health.

The handouts are self-explanatory, but there were questions that helped clarify some of the information:

  • How long is olive oil good for?  About a year – should be in a dark glass bottle and the less refined it is, the better, which is why some is called extra-extra virgin olive oil vs extra virgin olive oil.  The best are found at the Tasteful Olive in downtown Overland Park; or California Olive Ranch in         the store
  • Animal fat is fine if it is grass fed – avoid grain fed meats and fats. Kerrygold butter is made from grass fed cows
  • Olive oil cannot be heated to over 350 degrees without smoking, so for high heat, use coconut oil or avocado oil – these can be heated to 500 degrees
  • Seed and nut oils, such as peanut oil, sesame oil – must be refrigerated
  • The word “Natural” means nothing. Look for organic or at least partially organic when shopping for foods.
  • The best source of omega 3’s – the good oils- are smaller fish, such as sockeye salmon, sardines, anchovies, skipjack tuna. They are less likely to contain contaminants.
  • The least refined sweeteners are raw honey and stevia leaves. Powdered stevia is acceptable, but is more refined than just using the leaves.

Additional Information Provided by Diane Doolin . . .

Fats; Good, Bad and Ugly

 Fats have gotten a bad reputation over the past few decades, but it turns out that getting some of the right kinds of fat is absolutely necessary for good health.  Fat helps protect the brain, nervous system and organs of the body (yes, even the heart), enhances cell function, metabolism and hormone function, and just plain makes food taste good!  The key is to consume the right kind and in small quantities.  The healthiest fats are found in their most natural forms (a fish, nut or seed), and then in the least processed (cold-pressed, expeller pressed, extra virgin, unrefined etc) oils.


We need a balance of different types of natural fat, which we can achieve if we prepare our own meals using high quality ingredients.  The “Standard American Diet” (convenience foods, restaurant foods) is high in fat overall, but is extremely high in Omega 6s and processed, refined fats, while being extremely deficient in health-promoting Omega 3 fats. 

Can you make one dietary change today to positively influence the rest of your life?

Diane’s  Favorite Recipes

Overnight Omega Porridge

1 Tbsp chia seeds

1 Tbsp flax seeds

¼ c old fashioned rolled oats

1 Tbsp walnuts, chopped

½ c blueberries (or other berries)

Few drops vanilla

Pinch of cinnamon

Sweetener of choice if needed

½ c hot water

½ c Hemp milk (or other milk) or more to thin porridge to desired consistency

Combine seeds, oats, cinnamon and vanilla in a jar with a tight-fitting lid.  Pour in hot water and shake to combine. Let sit a moment, then add other ingredients and place in refrigerator overnight (or for a few hours).  This can also be cooked like oatmeal and enjoyed as a hot breakfast.

 

Hemp Milk (or any nut/seed milk)

½ c hemp seeds (also try almonds or cashews)

2 c water

Optional- few drops vanilla, pinch of cinnamon, drop or two of stevia/sweetener

Combine everything in a blender and blend until seeds are pulverized (30-60 seconds).  Store in a jar with a lid in the refrigerator up to 5 days.  Seed residue will settle to bottom of container.  If preferred, may strain milk through a cheesecloth (thin towel) to remove sediment completely.

 

Lemony Garlic Dressing

1/3 c extra virgin olive oil

¼ c lemon juice

2 cloves garlic, minced

½ tsp salt (to taste)

Pinch of pepper

Place all ingredients in a jar with a tight fitting lid.  Shake before serving.  This is a great salad dressing, but is also good over steamed veggies, chicken or fish.

 

Creamy Non-dairy “Ranch” Dressing

½ c extra virgin olive oil

¼ c lemon juice

1/2 c raw cashews, sunflower seeds or combination of both

1 avocado

½ c fresh herbs (parsley, dill, green onion tops are my favorites)

3 cloves garlic

½ tsp salt

Pepper to taste

Combine all ingredients in a high-speed blender and puree.  Store in refrigerator for 3 days.  Freezes well too!

 

Orange Dressing

2 Tbsp extra virgin olive oil

Juice of one large orange

1 tsp mustard

1-2 tsp chia seeds (optional)

Place all ingredients in a jar with a tight fitting lid.  Shake to combine.  Let set for 10 minutes or more before serving (so the chia can swell).

 

Salmon with Veggies

1 fillet of wild Sockeye Salmon

½ medium squash (zucchini or yellow), diced

½ bunch asparagus, ends trimmed

¼ c leeks or red onion slices

¼ tsp dill (or any herbs you like)

½ tsp butter

Extra virgin olive oil

Preheat oven to 350 degrees.  In a small casserole dish, place salmon (skin side down) and veggies.  Add butter, drizzle with a bit of olive oil.  Cover with foil (or wrap in parchment) and bake in oven for 25-30 minutes (until salmon temp reaches 145).  Add salt and pepper to taste and serve.  Double the recipe and you will have a great lunch the next day!

 

Simple Sardine Salad Wraps

2 can sardines (or 1 can sardines and 1 can skipjack tuna)

1 ripe avocado, mashed

1-2 tsp lemon juice (or to taste)

1 tsp Dijon mustard (optional)

½ tsp garlic powder

½ tsp dill

1 Tbsp red onion, finely chopped (or sub green onion)

¼ c celery, chopped

Salt and pepper to taste

Romaine or leaf lettuce leaves

In a medium size bowl, mash the sardines (and combine with tuna if using).  Add all other ingredients except lettuce; stir until well combined.  Chill.  Serve on lettuce leaves.

 

Crispy Walnuts (try other nuts too!)

4 c raw walnuts

2-3 tsp sea salt

Place walnuts in a large jar or bowl and cover with water.  Add salt and stir.  Cover the jar/bowl and let it set on the counter overnight (or at least 5 hours- this improves the digestibility of the nuts).  In the morning, preheat oven to lowest setting (usually 175 degrees).  Drain the nuts (do not rinse if you like them salty).  Place on parchment-lined cookie sheet(s).  Roast for 4-6 hours or until nuts are dry and crispy (ovens vary greatly). Taste-test hourly after 4 hours. Store in an airtight container in the refrigerator and use as a topping for salads, on Omega Porridge, or as a filling snack.

 

 

 

 

 

 

 

 

February 7, 2017 – How the Body Regulates Appetite

Bariatric Support Group

Date: February 7, 2017

Facilitator:  Dr. Hassan Saradih, Prairie View Medicine

Dr. Saradih talked about how our body regulates appetite.  Your body views food as energy.  There is a monster hormone, ghrelin, that makes you feel hungry.  It is secreted by the stomach and tells you when you need to eat.  Then there are hormones secreted by your intestinal tract that make you feel satisfied.   These hormones send signals to your brain which tells you when to eat, and when to stop eating.

This system is extremely complex, and can be easily disrupted when you try to diet and lose weight.  Your body wants to try to prevent you from starving, so when you try to eat less, the body slows down your metabolism to try to preserve the energy it has.  When you diet and lose weight, the body tries to make you hungry and never feel satisfied so you will eat more and regain the weight.  This is why diet and exercise only work in the short term.  This desire to eat becomes too strong.  When we do surgery, we remove or bypass the Ghrelin monster hormone so you are now able to lose weight and keep it off.

When you diet and lose weight, your hunger increases, your sense of being satisfied decreases, your metabolism slows, and you begin to crave high calorie foods. 

Once you lose the weight after surgery, and your energy regulation system is working correctly, you will lose the cravings for unhealthy foods and crave the foods that are good for you.  This is why it is so important to make the lifestyle changes necessary as soon as you have surgery.  Begin eating healthy, begin moving and incorporate healthy habits into your life so you can get the weight off and keep it off.  It is easier to lose weight in the first 6 – 9 months than it will be later on.  While ghrelin does not return at the same level it was prior to surgery, it will return somewhat.  If you have already developed a healthy lifestyle and maintain that, you won’t have to worry.

If you are not losing weight as quickly as anticipated, that’s when you need to see a physician who can evaluate the medications you are on and get you off anything that has the side effect of weight gain.  Many of the antidepressants cause weight gain, and many of the medications for diabetes cause weight gain, as do beta blockers, anti-seizure medications, steroids and antihistamines used for sleep.  Then there are medications we can use to increase your metabolism and decrease hunger to assist with further weight loss.  The key is to do these things early while it is easier for your body to lose weight.

Obesity Rates Higher Among Women Than Men

Last June, a national survey published online by The Journal of the American Medical Association, showed 40.4% of women in America are obese and 9.9% are extremely obese, while men’s numbers are 35% and 5.5% respectively. Women’s obesity rate (BMI > 30 kg/m2 ) increased from 35.3% and extreme obesity rates (BMI > 40 kg/m2 ) from 7.4% in the past decade, while men’s rates did not increase significantly. 

Obesity in Women
Obesity in Women

Coauthor Cynthia Ogden, PhD, told Medscape Medical News, “Something is going on with women and not men, but we couldn’t determine from this analysis what that was.” She said the increases were consistent for women regardless of race or other demographic factors. Also after adjustment for the other factors, women who had education beyond high school were significantly less likely to be obese than those with only a high school education. Non­ Hispanic black women had the highest numbers in the study, and the numbers were consistent across age groups: 56.7% were obese for ages 20 to 39 and 57.5% for all ages 40 and above. 

Teaching Kids Eating Habits
Teaching Kids Eating Habits

Dr. Ogden also co-authored a companion obesity study by CDC researchers that focused on children and teens.  That study found that obesity among adolescents ages 12 to 19 had doubled over the past 25 years, to 20.6%, and extreme obesity in that age group more than tripled, from 2.6% to 9.1%. The editorialists said both studies call for an urgent look at new approaches. “Perhaps new incentives are needed to encourage the food industry to work with families and the medical community to prevent obesity,” they assert. “Could some form of tax credits be used to ensure that if food company profits decline with the phase ­out of unhealthy products and failure or slow adoption of new products, the industries will be protected from shareholders’ concerns? Are partnerships between medical organizations and the food industry feasible, such as a local healthy eatery providing nutrition or cooking classes at a medical clinic? The stakes for the health of people in the United States are high, and creative solutions are needed,” they conclude. 

Watching TV With Family
Watching TV With Family

The American College of Obstetricians and Gynecologists says that “Obesity prevention must start with women of childbearing age,” as studies have shown obesity starts early and continues through life. And because parents determine what kids eat, prevention effort must encompass entire families, Drs.  Zylke and Bauchner write, acknowledging, however, that even with motivation, lack of convenient and healthy food sources may be a roadblock to healthy eating, especially in poorer neighborhoods.

Running Women

In conclusion, while obesity rates in men have remained relatively stable, clearly obesity rates for women, adolescents and teens have been on the rise over the last decade. As researchers continue to look for answers as to why, it’s important to note for the public in order to raise awareness among these populations in an effort to change behaviors and lifestyles in support of weight reduction and improved health. As moms make lifestyle and diet changes for themselves, hopefully these changes will “trickle down” and have a positive impact on the rest of the family as well.

Source: Marcia Frellick / Medscape.com: “Obesity Among Women in U.S. hits 40%; For Men It’s 35%”

Original Article – http://www.medscape.com/viewarticle/864520

 

January 21, 2017 – Bone Health Before and After Bariatric Surgery

Bariatric Support Group

Date:  January 21, 2017

Facilitator:  Chris Bovos, RN, CBN, Bariatric Coordinator

Chris presented a PowerPoint on keeping your bones strong.  We reviewed that your bones have a couple of functions – providing a shape for your body and being a storehouse for calcium so they can be called on when the body needs to increase the amount of calcium in the bloodstream. Since calcium is critical for functioning of muscles, and the heart is a muscle, the kidneys monitor the level of calcium and withdraw calcium from the bones as needed by activating the parathyroid gland to produce a hormone that then leeches calcium from the bones.  If this happens too often, your bones become weaker and more prone to fracture.  

We discussed the 3 essential nutrients that are important for bone health – Calcium citrate, Vitamin D3 and Protein – what they each do and what foods you can obtain them from.  But in addition, after bariatric surgery, you need more calcium over and above what you are able to eat, which is why taking calcium daily is so important.  Unfortunately, the research shows that a large percentage of bariatric patients feel good after a year and then stop taking their supplements. Over time, their bones become thinner and more brittle, and osteoporosis can set in.   

So it is crucial for everyone to continue to take calcium daily.  If you take iron, you need to take your calcium at least 2 hours before or after your iron.  Exercise is also important to preserve bone density, as is follow up lab testing and bone density scans at least every few years. 

Please email Chris with any questions:   chris.bovos@shawneemission.org

 

Type 2 Diabetes And Bariatric Surgery

Type 2 Diabetes and Bariatric Surgery

Bariatric Surgery Promising for Obese Patients with Type 2 Diabetes

A breakthrough in support of bariatric surgery for obese patients with diabetes was achieved recently when 48 multidisciplinary organizations came together to update existing diabetes treatment protocols to now include metabolic/bariatric surgery to control blood sugar and reduce cardiovascular risk! *

 

Additionally, the American Society for Metabolic and Bariatric Surgery (ASMBS) has developed important and helpful information on this topic that we would like to share with you.

Did you Know?

  • Someone in the world dies from complications associated with diabetes every 10 seconds.
  • Diabetes is one of the top ten leading causes of U.S. deaths.
  • One out of ten health care dollars is attributed to diabetes.
  • Diabetics have health expenditures that are 2.3 times higher than non-diabetics.
  • Approximately 90 percent of type 2 diabetes mellitus (T2DM), the most common form of diabetes, is attributable to excessive body fat.
  • If current trends continue, T2DM or pre-diabetic conditions will strike as many as half of adult Americans by the end of the decade. (according to the United Health Group Inc., the largest U.S. health insurer by sales).
  • The prevalence of diabetes is 8.9 percent for the U.S. population but more than 25 percent among individuals with morbid obesity.
  • Metabolic and bariatric surgery is the most effective treatment for T2DM among individuals who are affected by obesity and may result in remission or improvement in nearly all cases.

Type 2 Diabetes Mellitus (T2DM)

Diabetes Complications

Type 2 diabetes(T2DM) is the most common form of diabetes, accounting for approximately 95 percent of all cases. Obesity is the primary cause for T2DM and the alarming rise in diabetes prevalence throughout the world has been in direct association increase rates of obesity worldwide. T2DM leads to many health problems including cardiovascular disease, stroke, blindness, kidney failure, neuropathy, amputations, impotency, depression, cognitive decline and mortality risk from certain forms of cancer. Premature death from T2DM is increased by as much as 80 percent and life expectancy is reduced by 12 to 14 years.

Current therapy for type 2 diabetes includes lifestyle intervention (weight-loss, appropriate diet, exercise) and anti-diabetes medication(s). Medical supervision and strict adherence to the prescribed diabetes treatment regimen may help to keep blood sugar levels from being excessively high although medications and lifestyle changes cause remission of the disease. In fact, T2DM often worsens with time, requiring even greater numbers of medication or a higher dosage to keep blood sugar under control. For this reason, T2DM has been considered a chronic and progressive disease.

Metabolic and Bariatric Surgery and Type 2 Diabetes

Nearly all individuals who have bariatric surgery show improvement in their diabetic state. Bariatric surgeries performed in more than 135,000 patients were found to affect type 2 diabetes in the following ways:

Surgery improves type 2 diabetes in nearly 90 percent of patients by:

  • lowering blood sugar
  • reducing the dosage and type of medication required
  • improving diabetes-related health problems

Surgery causes type 2 diabetes to go into remission in 78 percent of individuals by:

  • reducing blood sugar levels to normal levels
  • eliminating the need for diabetes medications

Health Improvements

  • Cause the improvement or remission of T2DM to last for years

Stop DiabetesWe are excited to see progress being made in acceptance of obesity as a disease process and the effectiveness of bariatric surgery in improving the health and quality of life for patients affected by obesity. 

If you suffer from Type 2 Diabetes, have a BMI of 30 or higher and have had difficulty controlling your blood sugar and side effects caused by diabetes, we encourage you to share this information with your physician and have a discussion about the potential benefits of bariatric surgery as an acceptable treatment option for you.  Contact The Bariatric Center of Kansas City at 913-677-6319 to learn more about bariatric surgery as an effective treatment option for patients with Type 2 Diabetes.

 

*Updated Recommendations from AACE and ADA

Source: http://asmbs.org/patients/surgery-for-diabetes

January 5, 2017 – Boosting Metabolism with Resistance & High Intensity Interval Training

Bariatric Support Group

Date: January 5, 2017

Facilitator:  Greg Justice, M.ED, Owner AYC Fitness

Greg talked to the group about metabolism, how to boost it, and the importance of mixing strength and resistance training into your routine. 

Greg started by explaining that metabolism is the total sum of all the chemical reactions that take place in your body. The four components of metabolism are:

  • Resting Metabolic Rate (RMR) – what your body burns due to normal breathing, heart pumping, resting activity – accounts for 70% of your daily metabolism
  • Physical Activity Level (PAL) – what you burn when you exercise – accounts for 20%
  • Thermic Effect of Feeding (TEF) – what you burn digesting food – accounts for 5%
  • Non-Exercise Activity Thermogensis (NEAT) – based on genetics – accounts for 5%

The only one you cannot control is NEAT – your genetics.  All the rest you can influence.

Metabolic Training is a way to maximize calories burned and increased your metabolic rate not only while you exercise, but also after your workout.  After you work out, there is something called the Excess Post-Exercise Oxygen Consumption (EPOC) or “Afterburn.”  EPOC is the increase in your metabolism and calories burned following exercise.  Resistance training (using the weight of your own body as resistance) and High Intensity Interval Training (HIIT) or circuit training, give you a higher EPOC than cardio training, where you do one type of exercise for 30 -60 minutes. Metabolic training takes much shorter period of time, and give you a much higher EPOC.  All exercise is good for you, but when trying to lose weight, the metabolic training is the best.  Greg demonstrated the typical resistance training workout circuit for everyone, and told everyone to go online to You-tube and there are tons of workout videos.  He also shared a worksheet that he will email to everyone who gave him their email so they can structure their own workout at home. 

You can also work out with Greg at one of the classes for bariatric surgery patients and learn how to do it.  All classes are $10 each, and information on the classes is available from Chris at chris.bovos@shawneemission.org   You need to be at least 8 weeks post op before you begin training. 

 

 

Getting a Jump on Weight Loss Resolutions for 2017

Now that the New Year is right around the corner, it may be a good time for those among us battling extreme weight issues and obesity to consider “getting off the fence” and making a resolution to do something constructive about it. Consider the possibility that 2017 can be the year for many to start a new life geared toward better health and nutrition!

Rivka Galchen recently wrote an excellent expose’ about bariatric surgery titled, “Bariatric Surgery: The Solution to Obesity?” with a sub-title that states: “Diet and exercise alone rarely help people lose weight and keep it off. Are operations the answer?”

As we approach the start of a new year, let’s consider that question and some interesting facts and information about weight loss and bariatric surgery as an acceptable, low risk and valid remedy for obesity:

  • Weight Loss ThoughtsSince the early nineties, bariatric surgeries performed increased from fewer than 20,000 to around 200,000;
  • Only in the past few years has what was once considered a high-risk and extreme measure been transformed into a relatively standard, safe and straightforward one;
  • There is a strong consensus that bariatric surgery is effective, and Medicaid now covers it in 48 states (a strong indicator of government acceptance for the effectiveness of bariatric surgery and the subsequent reduction of long term healthcare expenditures for these patients);
  • Research into conventional weight-loss methods has repeatedly pointed to an overwhelmingly dispiriting conclusion – that diet and exercise alone, no matter how disciplined the individual, fail overwhelmingly often;
  • Only about 1% of those who medically qualify for bariatric surgery get it.

There was an interesting study done in 1956 when ten Swedish women, each at least 125 pounds overweight, agreed to a trial for intestinal bypass. All of the participants had attempted more straightforward ways of losing weight. Following the surgeries, all ten patients experienced dramatic weight loss, with no immediate serious consequences. But then the bypasses were reversed, and after the reversal surgeries, the women regained every pound, sometimes more.

Throughout the 1960s and 1970s stomach stapling became popular. As the field of bariatric surgery began to grow and evolve with new procedures attempted, initially the risks were much higher than today and complications more plentiful.  During this same period of time, however, health risks associated with obesity were also becoming quite apparent.  These co-morbidities as they are called include:

  • Higher rates of stroke and heart disease
  • Type 2 diabetes
  • Infertility
  • Sleep apnea
  • Osteoarthritis
  • Increased risk of certain cancers

weight-thoughts-42718673Over time bariatric procedures continued to improve dramatically. The transition to laparoscopy, which became the norm in the past decade, has resulted in fewer complications, less time in the operating room and much shorter recovery times. And physicians now have a better sense of how to prevent and treat the complications of surgery. As recently as 15 years ago there was a 1% chance of dying from a bariatric procedure. Now that is 0.15%, which is less than that for a knee replacement, a procedure commonly recommended to people who have developed joint problems from carrying around excessive weight.

woman-talk-with-doctor-129971063

 

 

However, it is worth noting that the physician population as a whole remains collectively uninformed about the advances and reduced risks in this field, and it’s not uncommon for many primary care physicians to still be of the old mindset that buys into the obesity stigma that inaccurately views the cause of obesity to be tied more to a person’s dieting self-discipline and exercise regimen than the actual disease process we now understand it to be.

Clinical psychologist, Tom Wadden, from The Center for Weight & Eating Disorders at the University of Pennsylvania states, “. . . there’s no question that bariatric surgery is going to provide a larger and more durable weight loss than life-style modification, medication or even a combination of the two.”

Around 75% of bariatric patients have sustained weight loss five years after their surgery and that percentage is higher if you don’t include lap-band patients in the analysis. Comparatively, weight loss through diet and exercise rarely leads to more than short-term changes. Only a small percentage of these patients see sustained weight loss.

body-mass-index-113401251Currently, one out of three American adults can be said to have obesity as defined medically based on a person’s body mass index (BMI). A 2012 study from the Journal of Health Economics estimated the medical-care costs of obesity in the US in 2005 to have been as high as 190 billion dollars, a figure that is steadily increasing. Today, obesity is second only to tobacco as a killer in this country.

According to William Dietz, from the Center for Disease Control & Prevention, “. . .  Everything has changed: everything on the dietary side, everything on the physical-activity side – everything.” George Bray, in his 2011 book, “A Guide to Obesity and the Metabolic Syndrome,” cited these reasons for societies weight gain:

  • Decades of subsidies for corn, sugar & rice;
  • The “Snackwell effect” that developed after studies in the late 1980s suggested people should lower fat intake, leading consumers to consume sugary treats advertised as low-fat or non-fat – advertised in essence as good for you.
  • Long commutes
  • Sedentary jobs
  • Yo-yo dieting

And then there are our electronic devices. Wadden noted, “I’m sure that Steve Jobs wasn’t thinking that he was going to make devices that contributed to people expending 500 – 800 fewer calories a day, but that’s what has happened.”

Diversity People Connection Digital Devices Browsing Concept

Marc Bessler, one of the first surgeons in the nation to perform a bariatric procedure laparoscopically in 1997, shared that he had operated on two people from ‘The Biggest Loser’, one of which had actually won. Bessler expressed concern about the unrealistic setting that involves exercising 6 –  8 hours per day. A follow-up study of 14 contestants revealed all but one of the finalists had regained much or most of their original weights. And their metabolic rates had slowed dramatically, making maintaining a healthy weight even more difficult. People who undergo gastric bypass do not tend to experience the same sustained metabolic slowing.

Woman On CouchWhen asked what kind of person is more inclined to choose bariatric surgery, Bessler said, “Well, women, of course. A man who is a hundred pounds overweight, he will still be treated with respect. But a woman who is one hundred pounds overweight – it’s much more difficult for a woman.”

Sander Gilman, author of “Obesity: The Biography (2010) suggests that surgery works best when paired with psychotherapy or behavioral therapy, since there are so often underlying problems to address; you don’t want the symptoms to just transfer to another domain. As one woman who posted in an online post-bariatric surgery blog states, “Once the fat is gone, your real problems are no longer masked – they’re out in the open and you have to deal with them. You’ve always thought skinniness was the cure-all, it can be quite a slap in the face when you get there and find out your problems followed you.”

road-to-weight-recovery-95698637Most studies suggest that expenses related to obtaining bariatric surgery are usually recouped within 2 – 3 years because surgeries avert future obesity-related medical expenses.  The overwhelming majority of bariatric surgery patients who post online about their experiences are happy they had the procedure. Many describe it as the best decision they have ever made, and that their only regret is not doing it sooner. One patient relayed that after surgery she had the energy to move into her own apartment, to finally get a driver’s license, and go back to school while working a full-time job.

Bariatric surgeon, Yulia Zak, shared that she’d never had any particular interest in the field until she did a required rotation. “I would be seeing a preoperative patient, often someone who was depressed, maybe unable to find a job, in part because of their mobility and appearance, and who was on insulin meds and blood-pressure meds, and with sleep apnea and high cholesterol,” she said. “Then, right next door, I would see someone for their two-year postoperative appointment, and they would be off those medications, and they might have a baby with them, or a new job. Obesity-related infertility or mobility issues were no longer a problem for them. There was no other field of medicine where I saw people’s lives improved so dramatically.

success-79367708So as you enter into a new year, if you are someone who has been considering bariatric surgery but have been leery and afraid, or have been convinced by well-meaning family members or friends that it is too risky to pursue, it may just be time to face the reality that bariatric surgery has evolved greatly and is now a relatively low risk, highly effective way to combat obesity and allow for successful long term weight management and improved health. As you kick off the new year, it might be worth making a New Year’s resolution to consider the benefits of bariatric surgery as the perfect weight loss solution for you!  

Credits to: Rivka Calchen, “Bariatric Surgery: The Solution to Obesity?” Written for the Annals of Medicine, New York Magazine, September 26, 2016 Issue. http://www.newyorker.com/magazine/2016/09/26/bariatric-surgery-the-solution-to-obesity