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Weight Loss Surgery

>> Sunday, August 30, 2009

Weight loss surgery, or bariatric surgery as it's called, is one hot topic in the obesity world. And I have lots to say about it, as it is the main focus of my research during my year-long sabbatical here at the University of Copenhagen. Here's a little introduction....

Desperate times call for desperate measures. We exist in a global society that has seen an explosion of obesity in the last few decades. The majority of Canadian adults are overweight at a staggering 59%, with one in four being clinically obese.

The treatment of overweight and obesity must be approached on an individual basis. For most people, obesity has its roots in lifestyle problems, and as such, adopting a new paradigm of lifestyle is the best solution. However, for some people, this seems to be beyond reach. For some people, medications for treating obesity can result in successful weight loss, though they may not be effective for long term weight loss, particularly if not accompanied by lifestyle alterations. For those individuals who are severely overweight, and have not been successful with intensive attempts at lifestyle alteration and/or medical therapy, surgery may be the most appropriate option.

At present, bariatric sugery is a treatment that is reserved for people with very severe, or very complicated obesity.

Commonly accepted criteria for qualifications for surgery include:
  • A BMI (body mass index) of 40 or more; or

  • a BMI of 35 or more, PLUS either type 2 diabetes, high blood pressure, or obstructive sleep apnea (as complications of obesity)

(You can calculate your BMI using the BMI calculator on my website, in the right hand column

There are several types of bariatric surgery. The most commonly performed currently are Roux-en-Y gastric bypass surgery (RYGB), and laparoscopic adjustable gastric banding (LAGB).

  • LAGB involves putting an inflatable ring around the stomach near the top of the stomach, such that it restricts the size of the stomach.

  • RYGB is more complex surgery in which the stomach is made smaller, and part of the small intestine is also bypassed, thereby reducing both the amount of food a person can intake, as well as the capacity to absorb that food (diagram displayed above).

There are pros and cons to both procedures. LAGB is a less complicated procedure, and is reversible. RYGB results in greater weight loss and has a higher likelihood of curing diabetes and other cardiovascular risk factors, but has a higher risk of operative complications.

Stay tuned for much more in the coming months.....

Is this topic of interest to you? Email if you'd like to hear more.


Does Vitamin D prevent the common cold?

>> Saturday, August 22, 2009

We all dread it, and we do everything we can to avoid it - but the cough & cold season is just a month or two away. Are there any vitamins we can take to prevent it?

Vitamin C is usually the vitamin that jumps to mind in conjunction with this answer, but a recent study in the Archives of Internal Medicine considered whether vitamin D may actually be where it's at.

Dr. A. Ginde and colleagues conducted an analysis based on US population data, comparing the association between vitamin D levels and a recent history of upper respiratory tract infection. They found that the lower the vitamin D levels, the higher the likelihood of having had a recent cough or cold. This association was even stronger in people with asthma or lung disease from smoking (emphysema).

Why did they think to look at Vitamin D? Recent evidence suggests that vitamin D plays an important role in immunity, and previous smaller studies had also suggested a relationship between lower vitamin D levels and risk of cough & cold. Vitamin D is a hotbed of research these days, as studies have shown that higher vitamin D levels are not only beneficial in terms of bone health, but are also associated with a lower risk of multiple sclerosis, type 1 diabetes, and possibly cancer.

Dr. Ginde's results must be taken with a grain of salt, however, because association does not necessarily mean causality. In other words, just because lower vitamin D levels were seen in people with higher rates of coughs and colds, does not mean that the lower vitamin D was the reason for the susceptibility to infection. There may be other factors playing in here - for example, a person who takes better care of themselves may be in better general health (therefore less infections), and in keeping with good habits, are more likely to take vitamin D supplements regularly (though the study does take several of these potential 'confounders' into consideration). Randomized controlled clinical trials need to be done to explore this relationship further.

As for our old friend, vitamin C: Overall, the evidence does not actually support that it decreases the risk or the severity of colds, though it may decrease the duration of colds slightly.

While the jury is still out on whether vitamin D prevents the common cold, there are many other important health reasons to make sure you are getting enough vitamin D - and most Canadians do not. For most adults, total vitamin D intake of 800 to 1,000 IU per day will maintain optimal vitamin D levels, and this is very rarely attained through diet alone - an additional supplement is required. Talk to your doctor about your vitamin D status and how much supplementation is right for you.


Does aspirin prolong survival after diagnosis of colon cancer?

>> Friday, August 14, 2009

Colon cancer, unfortunately, is a common and potentially lethal disease. The risk of colon cancer is 50% higher in overweight individuals, relative to people who are not overweight. Obesity also increases the risk of dying from colon cancer.

The good news is that aspirin appears to increase lifespan in people who have had non-metastatic colon cancer, according to a study published in this week's JAMA (Journal of the American Medical Association).

Dr. Andrew Chan and colleagues conducted an observational study of 1279 men and women who were diagnosed with colon cancer, designed to examine the impact of aspirin use after the diagnosis on both colon cancer-specific, and overall, survival.

They found that after 12 years of follow up, aspirin users had a 29% lower colon cancer-specific mortality and a 21% lower overall mortality than nonusers. In people who did not use aspirin before diagnosis, but started using it after diagnosis, the effect was greatest, with a 47% decrease in the risk of colon cancer-specific death.

The link between aspirin and colon cancer is an enzyme called COX-2 (or cycloogenase 2), which promotes inflammation and multiplication of cells. COX-2 is overexpressed by 80-85% of colon cancers, and in these colon cancers, is likely promoting growth of the tumor.

Aspirin works by inhibiting the COX enzymes, of which there are actually 2 types:

  • COX-1 is a 'housekeeping' enzyme that is expressed in most tissues in the body, regulating normal cellular functions, including maintaining protection of the lining of the stomach, as well as blood clotting.

  • COX-2 is the enzyme that mediates the inflammatory response (as above). This mechanism is also what makes us feel better when we take aspirin for headaches or inflammatory pain.

In light of aspirin's ability to decrease COX-2 activity, it is therefore not surprising that Chan's study found benefit for aspirin use only in those patients whose colon cancers produce COX-2 (remembering that most colon cancers do express COX-2).

The benefits of aspirin, of course, have to be balanced against the potential risks. The side effects of aspirin stem from the unwanted effect that aspirin has on COX-1. The most significant of these effects is the risk of bleeding, especially from stomach ulcers.

It is important to point out that this study was an observational study. In other words, it was not the gold standard 'randomized controlled trial' that we like to hang our hat on - there is potential for error in the conclusions. While there is certainly a suggestion that aspirin is beneficial to patients who have had colon cancer (and this has been suggested in other studies as well), we are not at a point where it can be recommended routinely. Further studies are required, and in fact, one such randomized trial is already underway.

Dr. Sue © 2009


Who is the Lucky Winner?

>> Saturday, August 8, 2009

I had a really neat interview with a Danish newspaper recently, which started with 4 real-life weight loss success stories:

1. Ulla has lost 10 lbs. She eats whatever she wants, but exercises at high intensity for an hour, 6 times per week. She eats chocolate every day, and calls herself an exercise addict.

2. Claus lost 25 lbs with help from a dietician. He eats more protein and vegetables than he used to. He takes his dog on a 30 minute leisurely walk every day.

3. Katrina lost 20 lbs by counting calories. She eats 1400 calories per day, and goes to the gym 3 times a week.

4. Jakob lost 33 pounds. He has been working with a dietician, and has also hired a personal trainer.

Question to me: Are all of these good ways to lose weight?

Answer: The principle behind any successful weight loss is Calories In <>
It is a great idea to get a dietician involved, if this is accessible to you - they can help you figure out a detailed weight loss diet plan and help you find the healthiest food choices with which to do so. The important point from the stories above is that there are a variety of approaches out there, and it is a matter of finding which one works for you!

I am a bit concerned about Ulla's long term success, because she has not made any changes to her diet. If she develops an injury, or some other reason why she cannot exercise, she will probably start to put the pounds back on again. For a weight loss/maintenance program to be successful long term, the biggest focus should be on the dietary side of the equation (though I certainly do advocate for exercise!)

Question: Can you lose weight without exercising?

Answer: Yes! This bit of information is particularly important for people who are extremely overweight, or who have related problems such as osteoarthritis, which usually affects weight bearing joints. These issues can make it very difficult to exercise to much extent. A reasonable approach is to start just by decreasing food intake such that the pounds start to come off - with time and weight loss, people often find a weight lifted (literally!) off their shoulders, such that they have the energy and physical capacity to start exercising! From there, it is a positive reinforcement cycle of weight loss >> more energy >> more exercise >> more weight loss, etc.!

Alternatively, swimming is a great way to start exercising, as it does not cause pain or strain on weight bearing joints.

Question: Should exercise and diet be combined into one big plan?

Answer: Absolutely! The bigger the difference between Calories In and Calories Out, the better!

Remember to be alert to the increase in appetite that comes with working out. Also remember that exercise does not give you the carte blanche to eat your heart out, or drink your heart out for that matter - you can undo an hour long run in as long as it takes to down a venti Caramel Frappucino (R) from Starbucks (500 cal, in case you're wondering).

Question: Are there any methods which you would not recommend to lose weight?

Answer: I would not recommend using herbal or alternative products to lose weight. It is often unknown what these products contain, and further to that, their content, quality, and safety are not strictly regulated like prescription medications are. If you feel that you are not having any success with any lifestyle/diet/exercise intervention, you should speak with your doctor about futher options.

Dr. Sue © 2009



I am excited that you have arrived at my site, and I hope you are too - consider this the first step towards a Healthier New You!! As a medical doctor, Endocrinologist, and obesity specialist, I am absolutely passionate about helping people with weight management. Though there is certainly no magic cure for obesity, there IS a successful treatment plan out there for you - it is all about understanding the elements that contribute to your personal weight struggle, and then finding the treatment plan that suits your needs and your lifestyle. The way to finding your personal solution is to learn as much as you can about obesity: how our toxic environment has shaped us into an overweight society; the diversity of contributors to obesity; and what the treatment options out there are really all about. Knowledge Is Power!!

Are you ready to change your life? Let's begin our journey together, towards a healthier, happier you!!

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