Bariatric surgery bolsters quality of life

Posted on June 2, 2011 by Dr. Brian Quebbemann

Dr. Brian Quebbemann

There are very few events in a person’s life that can impact them in such a positive way. Bariatric surgery can dramatically improve the quality of your life, give you new hope for the future and forever end your struggle with excess weight.

People who are overweight have significant quality of life obstacles to overcome and many people in society, including many physicians, have little sympathy or compassion for your struggles. The prejudice against overweight people is widespread and all too often the only help offered is another standard weight loss program, with the same long term results as all the ones you’ve tried before, or more commonly the simple comment “Why don’t you just start to exercise and diet.”

Imagine if the recommendations for treating cancer resulted in the lousy level of success that you’ve gotten following the “diet and exercise” advice that you’ve been offered by everyone. When chronic excess weight reduces the scope of your daily activities and diminishes your thoughts and feelings about yourself, its time you finally did something that works.

The good news is that bariatric surgery has benefits far beyond its most visible result of dramatic weight loss. After surgery, many chronic illnesses markedly improve and most of patients at The N.E.W. Program have discontinued multiple medications previously required due to obesity-induced illnesses. Through our research and numerous other published studies, the connection between obesity, chronic illness and quality of life has become quite clear. One thing is certain, when substantial excess weight is lost, both chronic illnesses and quality of life improve, and The N.E.W. Program can help you reach both of these goals.

Consider causes when tackling weight-loss plateaus

Posted on March 16, 2011 by Administrator

Early after surgery, you may loose inches and pounds quite rapidly. Sooner or later, however, your rate of weight loss will slow down, or seem to stop. This is almost never a cause of concern, just a normal physical process. Your body has had a major change in its function. There is no reason to expect it to adjust to this change immediately!

Anyone who has attended support groups will tell you that plateaus are inevitable and should be taken in stride. Plateaus are not a sign that all your weight loss has stopped or that you will now begin to gain weight.

If a plateau continues more than a few weeks, it might be wise to look at the following:

What are you eating? Check your nutritional program. Are you following your plan carefully? Have you maintained your caloric intake at a weight loss level? Are you careful to eat a nutritionally balanced diet?
How much are you moving? Check your exercise program and activity level. Are you being consistent with your increased activity and the exercise you are doing? If you have decreased your exercise, your body may be slowing its fat-burning function.
How much is new muscle? Have you added muscle-building exercises to your program? You may have built enough heavier muscle to offset some of your loss of the lighter fat.
Do you need to change your intake/output balance? You may temporarily need to decrease your caloric intake and/or increase your exercise output to start losing again. Check with your physician or dietitian for recommendations about using this method to halt your plateau.

Most people, even competitive athletes, think about factors affecting their weight on a regular basis. This is normal and OK.

If you’ve reached your goal weight, these considerations will then keep you on the plateau. If you are still on the weight loss phase of your program, and have hit a plateau, it may be wise to consult with your physician or support team members about how to implement some of these strategies. Most of the time you will be surprised at how easy it is to overcome your plateau.

Weight-loss efforts combat chronic pain

Posted on February 24, 2011 by Administrator

This cycle is one everyone recognizes – when we hurt for a period of time, we are less active and tend to put on weight. In turn, the extra weight makes us hurt more.

Excess body weight puts greater physical strain on the joints and muscles. The “daily grind” of just moving around can especially affect the lower extremities, including the hips, knees, ankles and feet. In fact, among the patients we evaluate before surgery at the N.E.W. Program, severe pain is most often reported in the knees, lower back, feet and hips, in that order. Many have already had knee and hip replacement surgery.

Chronic pain problems and obesity go hand-in-hand. Excess weight slows you down. You get less exercise, less activity in general.

In a study of patients at a local pain clinic,. more than 63 percent of chronic pain patients had moderate to severe obesity. Did the weight cause the pain, or vice versa? Cause and effect doesn’t matter much, although 41 percent of these patients said they were overweight before the onset of their pain. The rest claimed that their weight gain occurred after their pain started.

Medications used to treat pain may work at first, but they ultimately lose their effectiveness and require greater dosages. Some pain medications also lead to weight gain. Gradually increasing physical activity, not medication, is the primary way professionals treat chronic pain. This is often a very difficult goal when pain is severe, especially in a patient with excess body weight.

In many cases, patients find not only significant reductions in extremity pain following weight-loss surgery, but increased activity as well. Some, who were candidates for knee or hip surgery, no longer need it after weight loss.

In a recent study done at the N.E.W. Program, a group of our patients wore pedometers which measure the number of steps taken each day. Patients wore them and recorded their daily steps for one month before and five months after bariatric surgery.

The pedometer reading is an excellent indicator of activity level. Most of our patients increased their activity by more than 100 percent within 6 months after surgery, compared with pre-surgical readings These new results were presented at a San Diego meeting of the American Society for Bariatric Surgery.

When there is excessive body weight, the most effective way to prevent or reduce chronic pain is to lose weight. This is particularly true for those with morbid obesity. In this case, bariatric surgery is a powerful tool to combat chronic pain.

Program choice crucial in weight-loss journey

Posted on February 14, 2011 by Administrator

Surgery for obesity is recommended by the American College of Physicians (ACP) if you have a BMI greater then 40 or a BMI greater then 35 and an obesity related co-morbidity such as elevated cholesterol or high blood pressure.

Published medical literature does show a mortality benefit from cardiovascular disease after significant weight loss. Co-morbidities such as diabetes mellitus, elevated cholesterol, hypertension and sleep apnea generally improve after gastric bypass. Other complications from obesity such as stress urinary incontinence (urinary leakage with coughing or sneezing), non-cardiac shortness of breath, asthmatic symptoms and joint pain and stiffness also improve dramatically.

Dr. Tracy Siegfried

When choosing a bariatric surgical program where and by whom your surgery is performed can make a significant difference in your outcome. The association between superior experience and lower mortality is well documented. In one study, the mortality was 5 percent among patients of surgeons who had performed fewer then 20 procedures per year and near zero for those treated by clinicians who have done greater the 250 surgical procedures annually.

Another to factor to consider is whether a surgeon performs the operation laparoscopically for the majority of procedures. When you interview prospective surgeons ask their percentage of transition from laparoscopic to open incisions. The ACP guidelines observe that critical differences are not limited to the surgical skill but extend to more comprehensive aspects of the providing program.

Better outcomes depend also on the capacity of the systems of care, from the pre-operative evaluation to the post-operative follow-up. Many surgical groups do not have comprehensive pre-operative evaluations or extensive close follow up care, which is critical to long term success after your procedure and weight loss.

And lastly, your surgery should be performed at a COE, “Center of Excellence” as designated by the American Society for Bariatric Surgery. These centers are evaluated extensively by the society and must meet rigorous criteria in order to maintain a COE classification.

This article was written by Tracy Ann Siegfried , M .D., Bariatric Internist for The NEW Program in Newport Beach, Calif. The NEW Program at South Coast Medical Center offers state-of-the-art weight loss treatment for people who are at least 100 pounds above their ideal body weight. The N.E.W. Program is the most comprehensive weight loss surgery program in the region.

Whole foods, lean proteins give maximum benefits

Posted on January 17, 2011 by Dr. Brian Quebbemann

Most diet and nutrition plans are full of foods to avoid or eliminate. What’s good to eat, then?

High-protein foods are the cornerstone of any healthy eating strategy. Eggs, for example, contain one of the most complete and digestible proteins available. The biological value of egg whites is so high that egg protein is the reference protein against which all other forms of protein are measured. Eggs are also a source of B vitamins, including B12. Fish is also a great source of protein and offers many other benefits: wild salmon is rich in heart-healthy omega-3 fatty acids; tuna provides B12 and thiamine, and many other types of fish are rich in nutrition.

Broiled, baked, seared, poached, or steamed, fish should not be overcooked to retain most of the vitamins. Fried fish is usually high in grease that makes you feel stuffed; for healthy weight people the feeling of being stuffed is uncomfortable and this is a key point to be aware of if you wish to control your weight.

Another fact to remember for healthy eating is that whole protein foods have the advantage of being digested slowly, resulting in a feeling of fullness and satisfaction that lasts for hours. Whole protein, natural foods are also packed with flavor.

We encourage clients of The N.E.W. Program to make these foods a substantial part of their N.E.W. nutrition strategy, not as weight loss tools, but as great tasting sources of nutrition with maximum health benefits that make them satisfied and happy after a meal.

The Safer Answer for Weight Control (Dispelling Myths on Weight Loss Surgery)

Posted on December 20, 2010 by Dr. Brian Quebbemann

By now, everyone is aware that excess weight will threaten your health. It’s in the newspaper and on television, the internet and radio. Hardly a week goes by where a new report on the hazards of excess weight doesn’t hit the national media.

The media has focused on adverse health consequences associated with excess weight, but the truth is that the primary problem caused by severe obesity is the inability of many overweight people to live life to the fullest. The more overweight a person is, the more difficult it becomes to enjoy normal activities; to walk up stairs comfortably, to easily get in and out of a car and to sit in a booth at a restaurant are some of the constant restrictions felt by obese people every minute of their lives.

What can be done? How can this excess weight be controlled and how can a severely overweight person experience that healthy feeling, that “normal life” again? Of course, the answer is permanent weight loss. But, how is this achieved? Fortunately, the truth is finally being published in the major medical journals and reported in the national media. The truth is that for people suffering from severe obesity, the only highly successful method to achieve substantial permanent weight loss is through weight loss surgery. This has been demonstrated over and over again in scientific studies (as opposed to the misleading reports promoted by diet companies). So, knowing the truth about weight control for people 80 lbs or more overweight, what are the key questions? The questions are obvious; “Is weight loss surgery safe?” and “Where should I go for surgery?”

The Gold standard for weight loss surgery is Laparoscopic, or minimally invasive, weight loss surgery. At The N.E.W. Program Laparoscopic Gastric Bypass has been performed safely in patients weighing over 700 pounds. Almost every patient who has surgery for weight loss is able to have surgery successfully using these minimally invasive techniques. The need to perform these surgeries by the traditional, large-incision method generally indicates that the surgeon is poorly trained in laparoscopic surgery and probably should not be performing weight loss surgery at all.

With Laparoscopic Gastric Bypass, Laparoscopic Sleeve Gastrectomy and Laparoscopic Gastric Band surgery, the complication rate should be very low. The vast majority of patients should never need to be in the intensive care unit (ICU) after surgery and should be able to go home after only one night in the hospital. Recovery should take about one week. Finally, the mortality rate from this surgery should be well below 1 out of 200, or less than 0.5%. In over 2000 procedures, there has never been a single death due to a leak or other complication after weight loss surgery at The N.E.W. Program.

After thinking through these facts, it is clear that severely obese people who wish to gain permanent control of their weight should consider surgery. Of course, before deciding on which surgeon to see, be sure to ask about their statistics, and write them down. If the surgeon ends up performing open, large-incision surgery more than 2% of the time, be wary. And of course, don’t be afraid to ask about that surgeon’s mortality rate, complication rate and the chance of ending up in the ICU. Always remember, it’s your life. If done right, surgery for weight loss can be done safely and effectively, with a fast recovery. The long-term goal is to improve your health and help you to regain that healthy feeling, that “normal life” again.

Bariatric professionals on frontline of battle of bulge

Posted on December 6, 2010 by Administrator

Reports from the Center for Disease Control place obesity in the ranks of serious, life-threatening conditions in the United States. As the epidemic worsens, bariatric professionals have stepped into a war with both social and economic ramifications.

The N.E.W. Program is a leading bariatric surgery center that has helped over 2,200 patients lose weight, feel and look better, yet more importantly, they have helped change lifestyles so that their patients enjoy sustainable optimal health, look good in their clothes and are able to play with their children and grandchildren. The N.E.W. Program is answering some of the top questions that patients considering bariatric surgery should ask their doctors when making this important life decision.

For the complete article, Finding Solutions to Life-threatening Obesity, visit The Orange County Register.

Joint Pain, Weight Loss and Orthopedic Surgery

Posted on October 29, 2010 by Administrator

Orthopedic surgeons, rheumatologists and physicians specializing in rehabilitation medicine know that the knee joint has to support the force of three to six times one’s weight. The impact of extra weight is also multiplied on other joints, including those of the back, hips and ankles. The results of this increased wear and tear are impressive; for example, men who are just 40 pounds over their ideal body weight have a five-fold increase in osteoarthritis (1). This close link between obesity and osteoarthritis is well documented (2). Of course, the incidence of severe osteoarthritis in people that are one hundred or more pounds overweight is exponentially higher, and the age of onset is much earlier. As always in medicine, unless patients and their doctors attack the root cause of their disease, in this case arthritis, medications and other therapy will only temporarily alleviate the pain and allow for permanent injury to the bone and cartilage.

For patients who do not yet require surgery to replace damaged joints, substantial weight loss has been shown to alleviate the debilitating symptoms of osteoarthritis. Schauer, et al, documented that seventy percent of patients that were taking medications for joint pain had no pain and were off all arthritis medications after weight loss surgery (3). Another published study documented that 58 percent of patients undergoing weight loss surgery complained of chronic low back pain, but this number decreased to only 20 percent after surgery (4).

Unfortunately, not everyone will have resolution of his or her knee pain after weight loss since joint cartilage lost after years of obesity will never regenerate. This damage may result in the need for surgery to repair or replace the damaged joint. Of course, recovery from joint replacement is more difficult in obese patients and many orthopedic surgeons will not perform joint replacement surgery in severely obese patients because of the significantly higher risk of complications. A patient who is unable to undergo joint replacement due to excess weight is a prime example of a person who needs surgical weight loss.

To evaluate the impact of surgical weight loss on patients requiring joint replacement therapy, the Mayo Clinic followed 20 patients who had hip and knee replacements after weight loss from gastric bypass. This recent study found a significant improvement in physical rehabilitation after joint replacement in patients who had previous weight loss due to gastric bypass. In fact, not only did the recovery from joint replacement improve, the re-operation rate due to complications after surgery was dramatically lower (5).

Everyone is aware that osteoarthritis will often improve with good weight control. For those people who are severely obese and are suffering from chronic joint pain, surgery for permanent weight control may be the best option to help your physician or surgeon improve your treatment results.

1- Annals of Rheumatic Disease; Felson, 1996, 2- Amer. Jour. of Public Health; Sahyoun, 1999, 3- Schauer 20004, 4- Melissas, 2004, 5- Parvizi, 2000

Article courtesy of Ramsey Dallal, MD

Beyond Nutrition Labeling

Posted on October 26, 2010 by Administrator

After weight loss surgery, you should take an active interest in the nutrient content of everything you eat. Because you can’t eat much, everything you eat should be packed with nutrients. While most of you are aware that you need to take vitamin and mineral supplements for the rest of your life, you may not be accustomed to extracting the maximum amount of useful information from a food label. Label information can help you make good food choices and have a healthier body postoperatively. If you follow these five simple steps, nutrition labels can be easy to use and understand.

1. Serving Size:
Look at serving size, including how many servings there are in the food package, and compare it to how much you can actually eat. After restrictive operations, Roux-en-Y gastric bypass (RNY-GBP) or adjustable gastric banding (Lap-Band®), serving size tends to be much smaller than the typical size listed on the label. Naturally, the serving size actually consumed influences all the nutrient amounts listed on the top part of the label. Try to estimate what percentage of the serving you ate, i.e., a half, a quarter, etc.

2. Calories and Calories from Fat:
Calories do count – although you shouldn’t have to “count calories” after surgery. While you don’t need to consume a specific number of calories per day, you should be aware of the approximate relative calorie content of most foods. During the first few months after bariatric surgery, patients typically take in 700-1000 calories per day. As you would expect, calorie-dense items are contraindicated after surgery. Be aware of how many calories in a serving come from fat. Fat provides 9 calories per gram while protein and carbohydrates supply 4 calories per gram. If you are getting a high percentage of your calories from fat, you probably aren’t getting enough protein in your diet.

3. Limit These Nutrients:
The nutrients that are most important for your health are listed on the label in two main groups. The nutrients listed first, total fat, saturated fat, cholesterol and sodium should be limited. Eating too much fat or too much sodium may increase your risk of heart disease, some cancers, or high blood pressure. High fat intake is usually linked to weight gain and obesity. Too many carbohydrates in the form of sugar can add unnecessary calories to food and cause dumping in RNY-GBP patients. Common names of sugars in food include; dextrose, high fructose corn syrup, fruit juice concentrate, brown sugar, molasses, honey, and dextrin. Ingredient names ending in “-ose” are sugars and those ending in “-ol” are sugar alcohols – both can cause dumping.

4. Get Enough of These Nutrients:
After surgery, you should make a concerted effort to increase calcium, iron, and vitamin C in your diet. Calcium and iron absorption are decreased after RNY-GBP. Intake of good sources of iron such as chicken, pork, and beef is also decreased after both RNY-GBP and Lap-Band® surgery. Vitamin C can facilitate iron absorption. Many patients also don’t get enough dietary fiber. Dietary fiber can contribute to the feeling of fullness and satiety. If you eat only soft, mushy items after surgery, you may experience frequent hunger between meals as well as chronic constipation. Postoperatively, you are encouraged to gradually increase the fiber content of your diet.

5. Percent Daily Value (%DV):
This portion of the label tells you whether the nutrients (fat, sodium, fiber, etc) in a serving of food contribute a lot or a little to your daily diet. Your “diet” is all the different foods you eat in a day. Percent Daily Values are based on recommendations for a 2,000 calorie diet. Your Daily Values will be much lower as you should not be consuming 2,000 calories per day after weight loss surgery. If you are eating 1,000 calories per day, your daily values for total fat, saturated fat, and total carbohydrate would be half of that needed for a person eating 2,000 calories per day.

Remember, you can’t get everything you need nutritionally from your vitamin and mineral supplements — no matter how great they are. You must use food to supply adequate protein, fat, carbohydrate and fiber. In addition, vitamins and minerals are usually better absorbed when provided by food rather than a pill. Continue to take vitamin and mineral supplements but use food labels to help you achieve your weight goal and improve your health.

Gastric Sleeve Procedure

Posted on October 20, 2010 by Administrator

Dramatic Weight Loss with No Adjustments and No Bypass!

The Vertical Sleeve Gastrectomy (VSG) is an exciting new weight loss procedure that results in dramatic and lasting weight loss without risk of malabsorption. The VSG is a very simple procedure that is now being performed worldwide as an excellent alternative to the gastric band and bypass operations. The Gastric Sleeve Procedure causes weight loss through much the same mechanism as the gastric band, by restricting the amount of food that a person can eat before becoming “full.” Approximately 80% of a patient’s stomach is removed but because there is no bypass involved there is no defined risk of malnutrition. The VSG is performed using minimally invasive surgery and patients typically leave the hospital in less than 24 hours.

The gastric sleeve procedure generates weight loss due to reduced stomach volume and earlier satiety (feeling full with smaller amounts of food). The stomach is made smaller by removing approximately 80% of the volume, so the procedure is not reversible. The remaining stomach is filled with approximately 3-4 ounces of food, there is no dumping and the sleeve operation requires no adjustments.

An important fact to remember is that the sensation of certain food cravings seems to be far less after this procedure than after the gastric band procedure, and studies have shown that the average weight loss with the VSG is much more consistent and significantly greater than with the gastric band. Many patients have described a complete lack of hunger for several months after this operation which may be due to a dramatic reduction in the hunger-inducing hormone grehlin, which is produced by the stomach.

All patients who qualify for weight loss surgery are candidates for the Vertical Sleeve Gastrectomy. This surgery has also been shown to be safe and effective for individuals with lower BMI, between 30 and 35, meaning people who’s excess weight is having a negative impact on their health and quality of life but who are only moderately obese.

Individuals who qualify for this procedure include:

Any person that otherwise qualifies for weight loss surgery.
People with a BMI between 30 and 35 who have struggled with weight control and have weight related health concerns.
Those who are concerned about the potential nutritional effects of gastric bypass.
Those who do not want gastric band surgery because they dislike the idea of an artificial device attached to their stomach and do not want to have to undergo band adjustments.

Although weight loss is still the greatest after gastric bypass, the VSG provides weight loss that is superior to the gastric band operation making it an excellent option for patients interested in permanent weight control.

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