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Sexual Function Before and After Bariatric Surgery

>> Friday, April 27, 2012

In preparation of patients for bariatric ('weight loss') surgery, there are many issues to discuss with regards to postoperative changes that we need to prepare for, ranging from changes in meal size, to changes in medications, to vitamin supplements, and so on.  One important element that may often go under discussed is changes in sexual function after bariatric surgery.

People who struggle with weight may be at increased risk of sexual dysfunction, for many reasons, including:

1.  There is a higher risk of erectile dysfunction (ED) amongst men with obesity.

2.  Obesity can lead to lower testosterone levels in men.

3.  Women with obesity are at increased risk of polycystic ovary sydrome, which affects reproductive hormones and is an important cause of infertility.

4.  Some medications that are used to treat complications of obesity (eg some blood pressure medications) can interfere with sexual function.

5.  Excess body weight can lead to body image issues that can negatively affect sex drive.

And the list goes on....

After bariatric surgery, the effect on sexual function can be variable.   Medications needed to treat obesity related complications may decrease with weight loss, and hormone levels may improve towards normal.  The effect on body image can be highly variable - some may feel empowered and 'sexier' with a lower body weight, whereas others struggle with the excess skin that may become apparent.  The sexual partner's response to a body weight change can be variable as well - some may find it a positive change, whereas others may feel threatened by it.

Fortunately, there is research going on in this important area!  There is a study at the University of Pennsylvania ongoing currently, which will examine changes in sexual function, sex hormones, body image, and marital satisfaction after weight loss surgery, compared to people with obesity who do not have surgery.

I would love to hear from any of my readers who would like to share their thoughts on this important topic.

Dr Sue Pedersen © 2012 

Follow me on Twitter for daily tips! @drsuepedersen 


Chatelaine Interview on Exercise in Menopause

>> Sunday, April 22, 2012

I was recently interviewed by James Fell, columnist and strength & conditioning specialist about the benefits of exercise in menopause.  In addition to my comments, James gives some interesting perspectives as well.  Have a read!

Dr Sue Pedersen © 2012

Follow me on Twitter for daily tips! @drsuepedersen


The Skinny on Tim Hortons

>> Friday, April 13, 2012

There is no doubt that Timmy's is an icon in Canada - it's the largest fast food chain nationwide (yes, even surpassing McDonald's!).  Tim's has made some changes lately that could either help or hinder weight struggles - with a sharp eye and a little pre-planning, you can get in and out the door with a reasonably healthy meal in your belly.

One recent addition to the Tim's menu is the Egg White Omelette Breakfast Sandwich (pictured above).  If you choose ham and a whole wheat english muffin, it comes out at a very reasonable 240 calories, with 17 grams of protein and 7 grams of fat.    This is a great improvement over the standard Tim's Breakfast Sandwich on a homestyle biscuit with the same ham and cheese, which comes in at 400 calories and 21 grams of fat.

As far as coffee goes, Tim's has recently increased its portion sizes.  Now, when you order a large coffee, you get 20 ounces instead of 14 oz (the old 14oz large size is now a 'medium').  From a calorie perspective, the coffee itself doesn't have a calorie impact, but what you put it it does.  A Large Double Double now contains 280 calories, up from 230 calories with the older portion sizes.  The extra calories in this larger portion size translates to 5 pounds of weight gain in a year, if you drink one per day.

If you substitute milk and splenda for cream and sugar in your Large Double Double, you knock the calorie count down from 280 to only 60 calories.

Tim Hortons has done a great job of making their nutritional info readily available online, to the point where you can enter your food choices into a nutrition calculator to figure out the calorie impact of what you are choosing to eat.  It's very user friendly - with a click or two of your mouse, it's easy to compare different meal and beverage choices to see where the calorie balance pans out.

To put these numbers in perspective, you can calculate the approximate total calories that you require in a day using the 'BMR Calculator' in the right column of this screen.

So, while it's best to keep fast food to a minimum, it is possible to make healthier choices, empowered by a little background research.  Before your next trip to Tim's, take a moment to consider what you usually order, and consider making a few small modifications to make your meal healthier!

Dr Sue Pedersen © 2012

Follow me on Twitter for daily tips! @drsuepedersen 


Medications vs Bariatric Surgery for Treatment of Type 2 Diabetes

>> Thursday, April 5, 2012

It has become clear that bariatric (obesity) surgery can result in substantial improvement, or even remission, of type 2 diabetes for some people.   Two new articles from the New England Journal of Medicine now add to our knowledge on this topic.

(For the non-scientists in the audience, feel free to skip down to 'So what does this mean?' below.)

One of these studies, by Mingrone and colleagues, looked at 60 patients randomized to receive either gastric bypass surgery, biliopancreatic diversion surgery (BPD), versus their usual diabetes care with medications, and examined how many people would be in remission from their diabetes 2 years later.  They found that 75% of the patients who had gastric bypass and 95% of the patients who had BPD were in remission, whereas none of the control group was in remission.  Interestingly, none of age, gender, baseline body mass index, nor duration of diabetes were predictive of remission.

The other study, by Schauer and colleagues, randomized 150 patients to receiving either gastric bypass surgery, sleeve gastrectomy, versus usual medical care of type 2 diabetes, with the goal being to see how many patients from each group could achieve very tight control of their diabetes (defined by A1C of 6% or less) at one year.  They found that more patients who had surgery achieved this goal (42% of gastric bypass patients and 37% in sleeve gastrectomy patients), compared with 12% of patients receiving medications alone.  At one year, the mean A1C in the medication group was 7.5%, compared to 6.4% in the gastric bypass group and 6.6% in the sleeve gastrectomy group.

While each of these studies could be discussed with chapters of detail, for purposes of brevity I'll highlight just a couple of important caveats.  While a strength of these studies is that they are randomized clinical trials (very hard to do in the area of bariatrics), both studies are small.  In the Mingrone study, BPD was used as a surgical technique, which is a fairly drastic surgery (it bypasses more of the bowel than gastric bypass), and is currently only experimental.  The longer term follow up of these patients is important, as other studies now suggest that at 5 years after bariatric surgery, about half of the diabetes cases that initially went into remission come back (though the diabetes-free years are undoubtedly still of substantial health benefit).   In the Schauer study, one could argue that the diabetes control goal (A1C 6% or less) was too tight and not appropriate for routine clinical care, given that we no longer strive for this tight control in most cases of type 2 diabetes because of the potential risk of harm (see the ACCORD trial).  What is interesting to me, however, is that the overall control was better in the surgical groups compared to the control group.

So what does this mean?  These studies show us that bariatric (obesity) surgery can put type 2 diabetes into remission, and can improve control of diabetes in those who don't go into remission.  However, it must be noted that remission does NOT mean cure - each patient must be followed on a lifelong basis and monitored for possible recurrence of diabetes down the road.  These surgeries have significant risk associated with them, and the balance of benefit versus risk has to be considered on a patient-by-patient basis.  The improvement in diabetes does not appear to depend on how much the person weighs before surgery, implying that the current body mass index (BMI) critieria for selecting patients for surgery may not be the right way to determine who would benefit the most. (More research needs to be done to figure out what does predict best success with bariatric surgery.)

Overall, (and as noted in the accompanying editorial), studies such as these suggest that bariatric surgery should perhaps not be a 'last resort' in the treatment of patients with obesity and type 2 diabetes.

Dr Sue Pedersen © 2012

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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