Gastric Bypass surgery: Pros and Cons

This is a well done article by KJRH 2 in Tulsa. Let us know what you think!

Gastric bypass surgery is growing more popular every year as America’s obesity epidemic tips the scales. Even the elderly, and people with health problems are turning to this surgical solution to obesity.

It is a surgery that saves lives. But some also warn there can be life-changing drawbacks.

“These were 26 – and I wear a size 8 now,” said Leslie Blunt as she proudly showed off the pants she will never wear again thanks to gastric bypass surgery. She has lost 140 pounds. “It works. It does. You live a healthier life,” she added.

Micah Anderson chose gastric bypass surgery when his weight ballooned to 500 pounds. “Lost little over 200 pounds – easy,” he told 2News anchor Karen Larsen. “I’m happy with myself. More confidence.”

While gastric bypass is known for bringing on drastic weight loss, what many do not realize are specific changes it may cause for an individual, along with health benefits.

“A lot of this junk food they were eating before – their taste has disappeared they don’t want it anymore,” according to Dr. Luis Gorospe, gastric bypass surgeon at Bailey Medical Center in Owasso. Both Anderson and Blunt went to Dr. Gorospe for surgery. His patients come from surrounding states, drawn by his surgery success rate, the promise of dramatic weight loss and the immediate health benefits of gastric bypass.

“If they have diabetes – 70 percent of these patients wake up with normal blood sugar and will not require medications – forever,” Dr. Gorospe said.

Studies show gastric bypass may improve or even eliminate such health problems as:

-type 2 diabetes
-high blood pressure
-high cholesterol
-sleep apnea

Leslie Blunt says she is living proof, “I don’t have high blood pressure. I don’t have diabetes. I am pill free.”

However, Micah Anderson tells a different story. “I’ll vomit maybe not every week – but if something doesn’t agree it does come right back up.”

When surgeons create a tiny new stomach for patients, vomiting is a common problem when patients eat too much, too fast – until they get used to their new, smaller stomach. Micah says he expected that – but then he started fainting – once behind the wheel of his car.

Anderson’s wife Katie said, “The passing out has happened four times. Spells where he could potentially pass out… weekly!”

Frightened by the potential danger such episodes represented, the Andersons began researching online and discovered other gastric bypass patients having such problems.

“Describing the same kind of drunk-like symptoms, incoherent, can’t talk, slurring the speech. and people were experiencing the same things,” Katie added.

The Andersons say they went to numerous doctors and nutritionists, trying to find a physician who was experienced with gastric surgery side effects. After trial and error, they say they have finally found the right doctor to care for Micah. As a result, Micah now follows a diet carefully crafted to meet his personal needs. He eats every two hours, consumes plenty of protein and takes vitamins.

“For me its lack of eating. I forget to eat and that’s what causes my issues. It’s partially my fault as much as it is the surgery,” Micah said. “If I don’t follow the rules like they tell you – you do have issues.”

Doctor Gorospe agreed. He said healthy eating – the same issue obese patients struggle with before gastric bypass – is more important than ever after surgery. “If you follow the rules, this surgery will be successful,” Dr. Gorospe said.

Because some patients do encounter issues following surgery, and with their new lifestyle, Doctor Gorospe offers monthly support groups. “I make it a point of being there,” he said. “I want to be available to my patients.” The meetings offer patients an opportunity to share their stories and talk with Dr. Gorospe.

Micah did attend the monthly meetings. However, some of his problems did not occur until several years following the procedure. As a result of his struggle, the Anderson’s suggest to those considering gastric bypass surgery: do plenty of research, know the rules they will have to live by, and read up on potential side effects.

“There is a list and, by golly, one of those things on the list will affect you,” Katie Anderson said. “They just need to tell you flat out – you are trading one set of issues for another set of issues.”

However, when asked if he would have the surgery again, Micah’s answer is, “Unfortunately, yes.” He went on to say he is pleased with his more than 200 pound weight loss. His joints ache less when he gets out of bed in the morning, and it is easier to be active.

Leslie Blunt agrees. Now, this svelte hair stylist says work is easy. No more suffering from carrying too much weight while being on her feet each day. Plus, she loves buying clothes with her new look and the fact that she is setting a good example for her young children by living a healthier lifestyle.

In fact, Leslie says gastric bypass surgery is the best thing she ever did for herself.  “Yes! I would do it over and over and over again! I never want to be that way again.”

Article originally published athttp://www.kjrh.com/content/news/franchises/segment2/story/Gastric-Bypass-surgery-Pros-and-Cons/rWWm6av9XkK-fsvZ2bpXeQ.cspx

Are you Listening?

By Colleen Cook

Woodrow Wilson said, “The ear of the leader must ring with the voices of the people.” Many of us work at such a neck breaking pace, that we rarely find time (or make time) to stop, be still, and LISTEN!

Often Bariatric Support Groups are held in the evening at the end of a leader’s crazy busy day. We hurriedly review our lesson materials, confirm the guest speaker, run in set up and begin. Great lesson content, yes, but how long has it been since you have taken a moment to evaluate if you are, in deed, meeting the needs of your bariatric patients? I invite you to consider your group, and ask yourself these questions:

Who is there?

Why they are there?

What are they getting from your support group meetings?

It seems sometimes that the room is filled with the ‘same people’ just different faces. How long has it been since you have solicited verbal feedback, or sent around an evaluation?

Asking and then listening, will provide us with greater insight to how we can better meet the needs of those who attend our support groups. So, are you listening?

Obesity Surgery Complications on the Decline

We thought this was an interesting article published on Yahoo that we thought our reader would like. It looks like with the use of laparoscopy by skilled surgeons, bariatric surgery is getting safer.

WEDNESDAY, April 29 (HealthDay News) — Obesity surgery-related complications in the United States declined 21 percent between 2001 and 2006, and payments to hospitals for obesity surgery decreased by as much as 13 percent, partly because there were fewer patient readmissions due to complications, a new study reports.

The findings from a study by the U.S. Agency for Healthcare Research and Quality are based on an analysis of more than 9,500 patients under age 65 who had obesity surgery, also known as bariatric surgery, at 652 hospitals between 2001 and 2002 and between 2005 and 2006.

The researchers found that the complication rate among obesity surgery patients dropped from 24 percent to about 15 percent. Contributing to that decrease were declines in post-surgical infection rates (58 percent lower), abdominal hernias, staple leakage, respiratory failure and pneumonia (29 percent to 50 percent lower).

There was little change in rates of other complications such as ulcers, dumping (involuntary vomiting or defecation), hemorrhage, wound re-opening, deep-vein thrombosis and pulmonary embolism, heart attack and stroke, the researchers noted.

Between 2001 and 2006, hospital payments for obesity surgery as a whole fell from $29,563 to $27,905. Payments for patients who experienced complications declined from $41,807 to $38,175, and from $80,001 to $69,960 for those who had to be readmitted to hospital because of complications, according to the study in the May issue of the journal Medical Care.

Among the other findings:

• Complications fell even though there were more older and sicker patients having obesity surgery. During the study period, the proportion of patients over age 50 having obesity surgery increased from 28 percent to 44 percent, and the average number of underlying illnesses — such as diabetes, high blood pressure and sleep apnea — in bariatric surgery patients more than doubled.
• The six-month post-surgical death rate remained at about 0.5 percent during the study period.
• Hospital readmissions due to complications fell from 10 percent to 7 percent, and complication-caused, same-day hospital outpatient visits fell from 15 percent to 13 percent.

The researchers said three main factors are behind the decline in complications and costs among obesity surgery patients: increased use of laparoscopy, which allows surgeons to operate through small incisions; increased use of banding procedures without gastric bypass, such as vertical-banded gastroplasty and lap band; and increased surgeon experience.

More information

The U.S. National Institute of Diabetes and Digestive and Kidney Diseases has more about bariatric surgery.

Original Source:http://news.yahoo.com/s/hsn/20090429/hl_hsn/obesitysurgerycomplicationsonthedecline

Bariatric Advantage Announces New Lemon Calcium Citrate Chews

Bariatric Advantage just announced that they will begin selling a new flavor of their ever so popular calcium chews. The new flavor is Lemon! They are sugar-free and only have 15 calories per chew – far below the levels previously found in early products (view nutritional information).  They are sure to be a great tasting way to get your Calcium!

As of right now you can pre-order the  new lemon calcium citrate chews that will begin shipping by the end of May.

The new Lemon Calcium Chews can be pre-ordered at a discount at Barisaver.com along with any other supplement made by Bariatric Advantage.

Weight-Loss Surgery Works Even For Moderately Obese

ScienceDaily (Apr. 20, 2009) — Surgeons once recommended weight-loss surgery only for severely obese patients who failed to drop pounds with conventional weight-loss methods, but a review now finds that bariatric surgery helps the moderately obese lose more weight, too.

“Until recently, only people with severe obesity — with a body mass index (BMI) greater than 40 — were considered for bariatric surgery,” said review author Jill Colquitt, Ph.D.

But studies, such as those included in this review, now examine the effects of surgery on people with a BMI of 30 to 40 who have diseases such as type 2 diabetes or hypertension that potentially could improve, said Colquitt, a senior research fellow at the University of Southampton, in England.

“We see a wide range of patients who consider surgery. The majority are people that attempted medical weight loss for years and decades without success, and they have an intimate understanding of what morbid obesity means to them in their life. They’re looking for a therapy that can give them some help,” said Peter Hallowell, M.D., an assistant professor of surgery at the University of Virginia. He has no affiliation with the review.

In the new review — the third update of a 2002 review — researchers led by Colquitt examined 26 previously published studies on bariatric surgery involving 5,766 patients. Five of the included trials took place in the United States.

Six studies compared bariatric surgery outcomes to those from conventional weight loss management. Twenty studies compared different bariatric surgery procedures.

The review appears in the latest issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews like this one draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

The conclusions of the new review were broadly similar to previous research, Colquitt said. Researchers found that weight reduction surgery in obese patients led to more weight loss than conventional methods, such as dieting and exercise.

However, “since we conducted the first review, we made changes to the inclusion criteria to include people with a lower threshold of obesity,” Colquitt said.

Specifically, two trials examined people of moderate obesity — with BMIs between 30 and 40 — who had weight-related conditions such as type 2 diabetes.

In these patients, weight reduction was greater two years after surgery and conditions like diabetes and metabolic syndrome improved, compared to those in the conventional management group.

For example, one study found that moderately obese people who received weight-loss surgery dropped 87.2 percent of excess weight. In comparison, those who used drugs, diet and exercise only lost 21.8 percent of excess weight.

The review evidence also suggested that the type of surgery a patient had affected their weight-loss results. In gastric bypass, surgeons make the stomach smaller and shorten the length of the small intestine, whereas gastric banding involves using silicone bands that the physician can adjust to reduce the stomach’s size.

Researchers found that gastric bypass led to greater weight loss than vertical banded gastroplasty or adjustable gastric banding. The results were similar for gastric bypass and two techniques called isolated sleeve gastrectomy and banded gastric bypass.

However, it is not possible to draw any conclusions because of the small number of studies comparing each procedure and the risk of bias in some of the trials, Colquitt said.

Some complications from surgery did occur, such as pulmonary embolism and post-operative death. Most studies had no deaths and those that did had one or two.

Although they aimed to update the review with information about bariatric surgery in patients younger than 18 years, researchers found no studies that compared surgery with conventional management in this group of patients, so they could not comment, Colquitt said. They also excluded older trials that examined surgical techniques no longer used “to keep the review as relevant and helpful as possible,” Colquitt said.

“The frontline question is, ‘Is surgery better for patients with lower levels of obesity?’ Those are areas of research that are just beginning to come to light,” Hallowell said.

“Their findings are very important. In the small number of randomized controlled trials to look at, there’s clear evidence that surgery is better than not having surgery,” Hallowell said.

“There are risks to surgery — we don’t want to minimize that to any degree — but the health benefits noted in these studies certainly outweigh the risks for patients who undergo it,” Hallowell said.

This project received funding from the UK’s National Institute for Health Research (NIHR) Health Technology Assessment Programme.

Originally published at http://www.sciencedaily.com/releases/2009/04/090415171128.htm#

How Blood Sugar Levels Affect Weight Loss

By Janean Hall, Director Patient Education

When we eat, our body converts digestible carbohydrates into blood sugar (glucose), our main source of energy. Our blood sugar level can affect how hungry and how energetic we feel, both important factors when we are watching how we eat and exercise. It also determines whether we burn fat or store it.

Our pancreas creates a hormone called insulin that transports blood sugar into our body’s cells where it is used for energy. When we eat refined grains that have had most of their fiber stripped away, sugar, or other carbohydrate-rich foods that are quickly processed into blood sugar, the pancreas goes into overtime to produce the insulin necessary for all this blood sugar to be used for energy. This insulin surge tells our body that plenty of energy is readily available and that it should stop burning fat and start storing it.

However, the greater concern with the insulin surge is not that it tells our body to start storing fat. Whatever we eat and don’t burn up eventually gets turned into fat anyway.

The greater concern is that the insulin surge causes too much blood sugar to be transported out of our blood and this results in our blood sugar and insulin levels dropping below normal. This leaves us feeling tired and hungry and wanting to eat more. The unfortunate result of this scenario is that it makes us want to eat something else with a high sugar content. When we do, we start the cycle all over again.

Watch For:

• Simple Carbohydrates: Because of their small molecular size, simple carbohydrates can be metabolized quickly and are therefore most likely to cause an insulin surge.
• Simple carbohydrates include the various forms of sugar, such as sucrose (table sugar), fructose (fruit sugar), lactose (dairy sugar), and glucose (blood sugar). Watch for the “-ose” ending.
• Hidden Sugar in Processed Foods: Watch for “hidden” sugar in processed foods like bread, ketchup, salad dressing, canned fruit, applesauce, peanut butter, and soups.
• Sugar in Beverages: Be aware of the amount of sugar in beverages, especially coffee and soda pop. It can add up quickly, and most such drinks aren’t filling.
• Fat-Free Products: Sugar is often used to replace the flavor that is lost when the fat is removed. And as if that’s not bad enough, without any fat to slow it down the sugar is absorbed into your blood faster.
• Cereal Box Claims of Less Sugar: Many newer cereals do contain less sugar, but the calories, carbohydrates, fat, fiber and other nutrients are almost identical to the full-sugar cereals. The manufacturers have simply replaced sugar with other refined, simple carbohydrates.
• No Sugar Added: Does not mean that the product doesn’t naturally contain a lot of sugar. 100% fruit products often contain concentrated fruit juice, still another form of fructose or sugar.

Table sugar (sucrose) is often said to provide “empty calories” because it has no nutritional value other than providing fuel for energy. Honey and other more natural sugars, on the other hand, are often considered to be healthier because of the trace vitamins and minerals they provide. Still, for weight loss purposes, all of these sweeteners can simply be treated as sugar.

What You Can Do:

Regulating your blood sugar level is the most effective way to maintain your fat-burning capacity. Never skip a meal, especially breakfast, and eat healthy snacks between meals. Eating frequently prevents hunger pangs and the binges that follow, provides consistent energy, and may be the single most effective way to maintain metabolism efficiency.

When you will be away from home or work, plan your snacks and take them along so that you will be able to eat regularly and won’t be tempted by junk food. This may be good advice for people who stay at home, too.

Snacks:

But remember that it was probably snacking between meals that caused you to become overweight in the first place.

It will be very important;

• That any snacks are healthy.
• That they are pre-portioned so you won’t be tempted to overeat.
• That meal sizes are reduced to compensate for the additional calories the snacks provide.

High fiber snacks and meals also help to regulate your blood sugar level.

The fiber slows down glucose absorption and your rate of digestion, keeping your blood sugar level more consistent and warding off feelings of hunger. This makes eating apples and oranges a better choice than drinking (pulp free) apple and orange juice.

Reference: Caloriesperhour.com, Tutorial

DON’T LET ALCOHOL CRAMP YOUR WORKOUTS

By Janean G. Hall

Alcohol is a diuretic, forcing the body to lose more fluid than the drinks even contain, potentially leading to dehydration.

“Muscle cells contain more water than any other cells in the body,” said Andy Fry, assistant director for fitness and wellness at Indiana University’s Division of Campus Recreational Sports. “When the body is dehydrated, it pulls water from the muscles to hydrate the rest of the body. You can actually lose muscle cells if you don’t hydrate properly after a loss of electrolytes.”

Dehydration can lead to muscle tears, sprains and cramps. Alcohol consumption also can reduce workout gains in several ways:

• Strength. Muscle growth will slow down because alcohol decreases protein synthesis, which is the body’s ability to use protein to build and create muscle tissue. Binge drinking can lower levels of the hormone testosterone, which is important for muscle growth, and increase levels of cortical, which can destroy muscle tissue.
• Balance. A hangover can signal that alcohol probably is still in the system, potentially compromising balance, coordination and other motor functions, all of which are important for good workouts. A weightlifter, for example, who has decreased motor control could injure herself by dropping weights.
• Weight loss. Alcohol contains almost twice the calories of protein or carbohydrates but the calories are empty, meaning the liver transforms them into fat and puts them into “storage.” Weight loss efforts can get a double whammy from excessive alcohol consumption because more calories will be stored as fat at the same time that the body burns fewer calories because of muscle loss.
• Detoxify runs? Sweating off a hangover could be counter-productive, because the exertion results in the loss of fluids when the body needs to be rehydrated, not dehydrated.

Fry suggests waiting to workout for at least an hour for each drink, and this only after considerate efforts to rehydrate the body. Water is the best for rehydration.

Reference: “Don’t Let Holiday Spirits Cramp your Workouts”, Andy Fry assistant director of fitness and wellness at Indiana University’s Division of Campus Recreational Sports

Weight-loss surgery worthwhile for diabetes

This is an interesting article about weight-loss surgery from Reuters Health. Enjoy!

NEW YORK (Reuters Health) – As a strategy for treating type 2 diabetes in obese individuals, gastric surgery to induce weight loss is effective and worth the cost, investigators in Melbourne, Australia, report.

A recent clinical trial showed that “surgically induced weight loss leads to the remission of type 2 diabetes in the majority of obese patients,” Catherine L. Keating at Monash University and others note in the medical journal Diabetes Care.

Using data from that trial, the team estimated the costs and benefits of weight-loss surgery as a way to treat type 2 diabetes.

The analysis covered 60 obese patients with diabetes diagnosed within the previous two years. Thirty were assigned to adjustable gastric banding, which reduces the capacity of the stomach, and 30 were assigned to best available medical management.

Remission of their diabetes was achieved by 22 patients (73 percent) treated surgically and 4 patients (13 percent) treated medically.

The researchers calculate that, over a two-year period, the cost of resolving one case of diabetes was $25,500 with conventional medical treatment, and $16,600 more than that with surgical therapy.

This cost is within the threshold of $50,000 – $60,000 that is usually considered acceptable from a societal standpoint.

Keating and her associates also extrapolated the costs and outcomes to the lifetime of the patients in the study.

Compared to conventional therapy, surgically induced weight loss was actually associated with health care savings, as well as with health benefits, they report.

Specifically, they calculate, “this analysis suggests that after 10 years the return on investment of surgical therapy is fully recovered through savings in health care costs.”

SOURCE: Diabetes Care, April 2009.

http://uk.reuters.com/article/healthNewsMolt/idUKTRE5374BC20090408?sp=true

“Program Fees are Unethical!”

By Colleen M. Cook

Well, now we have your attention, don’t we? That was just one of the comments BSCI received in our nationwide survey on bariatric program fees.

Who’s charging them, how much, and what are they being used for?

Great questions all; and the responses have been quite insightful.

We were not surprised to find that a whopping 34% of the programs are indeed collecting an out of pocket patient program fee with an additional 8% considering implementing one. And many expressed very strong opinions about the need for, absence of, or collection of bariatric program fees.

Of the 168 respondents to date, 54% were representing hospital-based programs and 24% were from surgeon’s offices. 25% were Bariatric Program Managers, 17% RNs, 6% RDs, and 21% Bariatric Support Group Leaders, and nearly 15% were bariatric patients. (Some wearing multiple hats, as you might imagine)

Over 40% reported that program fees are being collected by surgeon’s offices, compared to the 27% collected by hospitals. Program fees range from $100 to upwards of $1500 with the majority of the programs charging between $200 – $500.

Respondents reported that program fees provide revenue to fund a variety of programs and services not covered by insurance. According to our survey, 18% of the funds are being used for Support Groups, 13% for an RD visit or dietary consultation. Nearly 16% of the funds are being used for patient educational materials and 8% for websites (which, in my estimation have been designed primarily as marketing tools, not to educate, serve, and support post-op patients).

We were quite surprised that some even reported that their program fees are used to cover such things as the cost of their “info” or marketing sessions, the surgeon’s cell phone, protein supplements, and even follow up appointments.

It was however, a pleasant surprise to find that some are utilizing the funds to provide patient conferences and events, fitness center membership, personal trainers, and support group materials.

While we would love to share just BSCI’s views on the subject, (BSCI’s viewpoint and impact) the real value of this survey and subsequent article is to share many views for consideration. You may read the actual survey responses here or please read on for a candid review of the pros and cons expressed in our survey:

The Pros:

“Appropriate for patients who come from other practices.”

“Our program was giving away a lot of services so we now charge a program fee”

“It is essential to pay for non- clinical services”

“People are more committed if they have to pay for something.”

“We charge a pre-op nursing education fee.”

“I am an RD and we receive no reimbursement for my time.”

“Program fees allow us to provide long-term educational and support programs”

The Cons:

“Connecticut law does not allow it”

“Indigent population cannot afford to pay”

“Too difficult to collect”

“Medicare patient have limited resources”

“Our group is to help people, not make money!”

“Will we lose people from our program if we charge?”

“We charge cash so a program fee is redundant and unfair.”

Attend Support Group? Why should I?

By Colleen M. Cook
As we travel from coast to coast, meeting and working with many bariatric professionals, it is interesting to see how different areas respond to the need for and value of support group meetings. In some programs, groups are overflowing with energetic, positive people. The mood is up, encouraging and celebratory. In other areas we see that groups are struggling, both with poor attendance and with poor attitudes.

We have noticed that when support groups are established as part of the ‘culture’ of a particular program, new patients embrace them and attendance thrives. When the bariatric surgeons, nurses, dieticians, mental health professionals, management and support staff, post op patients and supporters are ALL sold on and involved with support groups – then it comes across to the new patient as an essential part of their care. It instills in new patients a sense that NOT attending is simply not an option, but that involvement in support groups is absolutely necessary to their success. It is just what is expected.

On the other hand, sometimes we see programs that seem to regard support groups as a nice “add on” – rather than an integral part of their standard of care. They may require support group attendance as an item to be checked off on the pre-op patient’s ‘to do’ list in order to ‘qualify’ for surgery. And of course, that first impression of a support group is essential. It is there that they will likely determine how important support group attendance will be in their own journey.

So, why do they come when they come? Why do they stay away, when they stay away? Important questions, all!  Rather than speculate, we decided to find out. BSCI has just launched a survey to the bariatric community to find answers to these and other questions about the need for and value of support groups.  If you are a patient – you may take the survey here .

Also, thanks in advance for forwarding this link to your bariatric patients. We are looking forward to sharing the results with you.