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Lap Banding May Have Poor Long Term Outcomes

>> Saturday, March 26, 2011

As weight loss surgery gains popularity globally, there is much debate as to which of the several surgeries available is the best option.  As we get more years of experience under our belts (so to speak), it seems that laparascopic adjustable gastric banding may be a poor choice of surgery over the long term. 

A study was published last week in the Archives of Surgery by Dr J Himpens and colleagues, examining the long term outcomes of lap banding.  This study comes out of Saint Pierre University Hospital in Belgium, which is the first site to ever perform the procedure in 1992. 

With a long term follow up of 12 years or more, the study found the average excess body weight loss with laparscopic adjustable gastric banding was 43%, though this varied greatly from person to person (excess body weight is defined as the amount of weight OVER a Body Mass Index of 25 that a person carries, so in other words, they found that patients lost an average of 43% of the total amount of body weight that they would need to lose in order to get to a 'normal' body weight). 

In terms of complications, they found that 22% of patients experienced minor complications (such as infection of the access port or incisional hernia) from their lap band, while 39% experienced major complications (such as erosion of the band through the wall of the stomach, or slippage of the band).  Sixty percent required at least one additional operation (often to fix a complication), and 17% percent of patients had their procedure switched to gastric bypass surgery (a more complicated weight loss procedure where the stomach is made permanently smaller, and the intestines are rerouted such that food bypasses the first 1.5m of small intestine).  Only 51% of patients still had their band in place at the 12+ year mark.  Having said the above, the majority of patients still rated their satisfaction with the band as good, though there was no overall change in quality of life scores.

In terms of obesity related complications, one in particular that I found interesting is their observations in regards to diabetes.  Over the shorter term (eg 2 years), data suggest that weight loss surgery is dramatically effective to put many cases of diabetes into remission.  In this study, they found that while only 5 of their patients had type 2 diabetes before surgery, 11 of them had type 2 diabetes at the 12 year follow up.  While it is very possible (and probably likely) that more of these patients would have developed diabetes had they not had the surgery, I think the point is that weight loss surgery should not be considered a lifetime 'cure' or prevention of diabetes, though it can certainly provide some disease-free years or lessen the severity of the disease.  I would also point out that more complex bariatric surgery procedures such as gastric bypass are superior to banding in their effect on diabetes, though cases of diabetes are often shown to recur over the long term post bypass as well.

This study is subject to several limitations, including the fact that they were only able to follow up with just over half of the patients that were contacted for full evaluation.    Newer techniques for lap banding are now currently being utilized that may have lower complication rates than the methods used 12+ years ago.  Successes, failures, and complication rates may differ from centre to centre as well.  However, this is the first study exploring outcomes of lap banding after more than 10 years post surgery, so they are important and must be taken into consideration.  This study, and other experiences accumulating around the world, is likely to lean surgeons away from performing lap band surgeries.

Dr Sue Pedersen © 2011

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Retail Giant Walmart Joins Fight Against Obesity

>> Saturday, March 19, 2011

As governmental and health care organizations strive relentlessly to find new and innovative ways to battle obesity, it often seems like a bit of a David vs Goliath battle, in that one of the main combatants is the overwhelmingly wealthy and powerful commercial food industry.  The retail and food giant Walmart now promises to take steps to improve the quality of the food on their shelves, as a contribution to a healthier America.

Walmart is one of the biggest grocery retailers in the US, accounting for about 15% of the American grocery industry.  As a move to align itself with Michelle Obama's anti-obesity campaign, they have pledged to reduce sodium, sugar, and fat in their store brand products by year 2015, and plan to push their suppliers to do the same.   They are also working on a front-of-package label that will identify more healthful products.   It is noted that other industry players have made similar pledges, but Walmart's promised changes are particularly noteworthy in light of their substantial market share of the US grocery industry. 

There is no doubt that we need the commercial food giants to be on board to help us shape a healthier society, and it is encouraging to see changes like this taking place!  Perhaps in a world where there are conscientious members of the food industry on our side, and where Subway has now surpassed McDonalds as the world's largest restaurant chain, we will start to see lasting impact in our fight against obesity and related diseases.

Thanks to Brian at for the heads' up!

Dr Sue Pedersen © 2011

Follow me on Twitter for daily tips! @drsuepedersen


Preventing Radiation Induced Thyroid Cancer with Iodine in Japan

>> Sunday, March 13, 2011

The consequences of the tsunami that struck Japan on March 11, 2011 are truly devastating, with hundreds confirmed dead and many more still missing.  Unfortunately, the potential dangers that stem from this tsunami may stretch long into the future, as the Fukushima Nuclear Power Plant sustained damage from the tsunami as well.  Health authorities are now preparing to distribute iodine to individuals potentially exposed to radiation for the prevention of thyroid cancer, and I thought I'd take a moment to explain why.

Thyroid tissue is among the most radiation-sensitive tissues in the body.  The link between radiation exposure and thyroid cancer was better understood in the aftermath of the Chernobyl nuclear accident in 1986, where an increased risk of a common type of thyroid cancer called papillary thryoid cancer was found in people exposed to the disaster.  It appears that the Chernobyl radiation may have caused rearrangement of a cancer gene called the RET gene in the thyroid cells of these patients, leading to ongoing expression of this gene (this gene is normally not active in thyroid cells).

In the event of a nuclear accident, potassium iodide can be taken to decrease the thyroid's uptake of radioactive iodine, thereby protecting the thyroid from developing these radiation-induced genetic alterations.  The ability of the iodine to protect the thyroid decreases within hours after the exposure, such that the iodine's ability to protect decreases to 80, 40, and 7 percent at 2, 8, and 24 hours following exposure, respectively.   As potassium iodide prophylaxis may have a small risk of causing hypothyroidism (underactive thyroid) or hyperthyroidism (overactive thyroid), particularly in people with enlarged thyroid glands, and because the risk of radiation-induced thyroid cancer is higher in younger people, the benefit is greatest in younger individuals. 

In terms of medical radiation exposure, there is an increased risk of thyroid cancer in some patients who have received external beam radiation treatment (for example, for treatment of a cancer in the head or neck area), particularly if that exposure was at a younger age.  There is no evidence that radioactive iodine used for diagnosis or treatment of hyperthyroidism is associated with increased cancer risk. 

Dr Sue Pedersen © 2011

Follow me on Twitter for daily tips! @drsuepedersen


Social Marketing and the Impact of Now

>> Saturday, March 12, 2011

I'm sure many of you have heard it from your doctor before, and for health care providers out there, I'm sure you've said it many times: even though you feel perfectly well and have no symptoms, take this medication now, because it will decrease the risk of disease decades down the road.  These words are often met with reluctance on the part of the patient - why take a medication when you are feeling well today?

At the inaugural International School for Obesity Research and Management this past week, I had the opportunity to both discuss my own research, as well as interact with colleagues who share my passion for obesity research, treatment, and prevention.  One session that really stands out was about social marketing, presented by Dr Sameer Deshpande from the University of Lethbridge.  Dr Deshpande dealt with this very issue of the human tendency to focus on NOW, in the context of the food industry's marketing of unhealthy food products.  Have you ever noticed how junk food is most often marketed with messages of instant gratification, such as McDonald's 'I'm Lovin' It', 'Snickers Really Satisfies', 'Pop Your Hunger with Pizza Pops'?  Or how about the messages that promise an instant catapult into the world of glory, coolness, or success: 'Pepsi: The Taste of a New Generation' and 'Red Bull Gives You Wings' are shining examples of this.

These selling strategies are taken because marketing research has shown time and time again that messages that promise an instant benefit are the most appealing to consumers.  In the battle against obesity and related diseases, these considerations must also be taken into account in the promotion of  healthier food choices.  For example, reduced salt products are preferable to the full salt variety, to decrease the risk of conditions such as high blood pressure, which is a risk factor for heart disease and stroke.  To appeal to the 'NOW',  such a product should be marketed with a slogan such as 'just as satisfying as the high salt original', rather than 'decrease your risk of high blood pressure by eating the low salt brand'.

The appeal of NOW is much harder to target when it comes to preventative medications.  For example, we often advise patients to take cholesterol lowering medication in order to prevent heart disease and stroke.  In most cases, high cholesterol is without symptoms for years until problems related to narrowing of the arteries (atherosclerosis) start to manifest.  I'm very keen to hear what my readers may think about this issue, and how they might suggest that health care providers could better approach the use of preventative medication.

Dr Sue Pedersen © 2011

Follow me on Twitter for daily tips! @drsuepedersen


Sedentary Activity Promotes Obesity More Ways Than You Might Think!

>> Sunday, March 6, 2011

Sad to say, but true: the modern way of life is centered around sedentary activity.  We take motorized transport most places we go, and we go less places.  We sit at our computers for hours on end; we often relax in front of the TV to unwind in the evenings; and the current generation of children is crazier about video games than ever before.  Clearly, this lack of activity contributes to the obesity epidemic by way of decreasing energy output overall.  However, the story goes much deeper than that: it turns out that certain types of sedentary activities have other important effects on the Energy In (food intake) side of the equation!

As reviewed by my University of Copenhagen colleagues and led by Dr Chaput, there is evidence to suggest complex effects of the following sedentary activities on food intake and obesity:

1.  TV Viewing.  Excess TV time is a problem that plagues our society, with nearly 60% of American adults watching TV for more than 2 hours per day.  Not only is this a sedentary activity, but studies suggest that as much as 25% of the day's calorie total is consumed in front of the screen, and TV watching also results in a preference for high calorie, tasty foods.  People who are more distractable may be particularly susceptible to the weight-increasing effects of TV time (it's the classic: open the bag of chips, start snacking as you sit down to a movie, and before you know it, you're reaching into an empty bag and are surprised that they are gone!). Not surprisingly, distractibility has been associated with overweight and obesity.

2.  Video Games.  Although many adults enjoy video games, perhaps the most important impact is amongst our children, who are estimated to spend 2 hours gaming on average per day.  Not only are most video games sedentary, but they have also been shown to result in an increase in food intake later in the day.  This may be due to hormones released during the mental stress or excitement of the game, advertisements for high calorie food seen during online gaming, or other factors.  As for the higher energy games like the Wii, it is not yet known where the energy balance pans out.  Even decreasing a child's sedentary video game time by an hour a day could have an important impact, as each hour per day spent at gaming doubles the risk of obesity.

3.  Cognitive Activity.  As technology progresses, we as a society are spending more and more time engaged in sedentary brain-heavy activity, and less time doing physical work.  Computer work is the primary offender in this area.  Mental work is fueled by glucose, which is in fairly short supply in the body (versus muscle activity which can also be fueled by fat).  The increased use of glucose by the brain may alter feeding patterns towards consumption of more carbohydrate and/or more calories.  Mental work can also be stressful, causing the release of stress hormones such as cortisol, which is also associated with increased food intake. 

4.  Music.  Believe it or not, the tunes you have pumping from your iPod or stereo may be impacting your weight as well.  Listening to music while eating results in longer meals and a higher calorie consumption; faster and louder music increases food consumption as well.  Unfortunately, soft, comforting music isn't the answer either, as this has been shown to result in an increase in liquid calorie consumption (particularly alcohol!).

So, how do we combat all of these factors in our struggles against obesity?  Well, the answer is clearly not to stop working at the computer, stop listening to music, or to refrain from enjoying the occasional movie or TV program to unwind after a hard day.  The first step is to think about the above points, and think about how they could perhaps be modified within your own life in a positive way.  For example, consider:

  • standing while talking on the phone at work - even better, try standing on a balance board (provided this is safe for you to do - it may not be if you suffer medical problems such as diabetic neuropathy or other issues that could impact your balance)
  • cutting TV time in half
  • investing in a desk that mechanically raises and lowers, such that you can stand at your desk
  • encourage your child to engage in a physical activity rather than play video games

As for music....?  Not sure what to say about this one.  Should we turn off the music while we're eating?  Or perhaps it's enough to just keep it in mind.  I'd be interested to know what my readers have experienced or may suggest?

Dr Sue Pedersen © 2011

Follow me on Twitter for daily tips! @drsuepedersen



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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