Understanding The Risks Of Obesity Surgery

Older people who have undergone a certain type of procedure known as the duodenal switch have an increased number of complications following bariatric surgery, according to a study in the March issue of Archives of Surgery, one of the JAMA/Archives journals.

But there is an ever increasing number of bariatric surgeries being performed to induce weight loss which keeps rising dramatically. These procedures are technically demanding and performed on patients whose obesity and related conditions may put them at risk for complications after surgery. Therefore, it is important to understand risk factors that may influence risk, including body mass index (BMI), age, other illnesses and choice of procedure, the authors write.

Robert W. O'Rourke, M.D., and colleagues at the Oregon Health and Science University, Portland, reviewed data from 452 patients (372 women and 80 men, average age 44 years) undergoing inpatient bariatric procedures at the university between 2000 and 2003. The patients received either gastric bypass surgery, which involves sectioning off a small portion of the stomach into a pouch that connects directly to the small intestine, or biliopancreatic diversion with duodenal switch, a less commonly used procedure in which surgeons remove part of stomach but leave a slightly larger pouch and then also perform an intestinal bypass-like procedure by attaching the duodenum (the first part of the small intestine) to the lower part of the small intestine. Researchers examined several variables, including patients' age, BMI (calculated by dividing their weights by the square of their heights), gender, surgeon experience, other illnesses, type of procedure and whether they underwent open or laparoscopic (minimally invasive) surgery.

Participants lost an average of 54 percent of their excess weight in the year following surgery.

During the study, which followed patients for an average of 419 days

1.) four (.9 percent) died
2.) 10 percent had major complications
3.) 13 percent had minor complications
4.) Patients who were age 60 years or older were more likely to develop complications than younger patients, a risk that appeared to increase with each additional year.

The duodenal switch procedure was also associated with more complications than gastric bypass surgery. BMI, sex, diabetes, surgical approach (open vs. laparoscopic) and surgeon experience did not appear to be associated with increased risk for complications.

Given the amount of risks for the patient the surgeons should warn older adults and those considering duodenal switch procedures of the risks involved. "While some investigators have suggested a specific age limit as an absolute contraindication to bariatric surgery, we do not employ such limits for our patients," they write. "We nevertheless approach older patients with caution, especially in light of recent data that suggest that the benefits of bariatric surgery with respect to longevity may wane in older patients."

Obesity in Children

Obesity has long been a problem among many Americans. This disease can damage many aspects of a person's life. It can cause many more physical problems including heart disease and diabetes. It can also cause sufferers emotional strain and a negative self image. In recent years, Americans have been watching their children struggle with the same problems. And they aren't the only ones. Problems with childhood obesity are being dealt with in many areas of the world.

According to the Centers for Disease control and prevention, sixteen percent of American children between the ages of six and nineteen are overweight or obese. That adds up to over nine million children who struggle with the many challenges of dealing with obesity.

While the number of American children struggling with obesity is overwhelming, the really staggering aspect of it is how this number is increasing. The number of children who are overweight or obese has refused to decrease or even stay constant. It rises at a downright scary level every year.

Children who are overweight as children are very likely to stay overweight as adults. This means dealing with the same problems for their whole lives. This is all the more reason for adults to take a stand and do something about our children's health. But first, we must understand why are children are having so many problems with obesity.

There are many reasons that a child may struggle with their weight. The first reason is diet. So many times, adults let children eat what they want. Their young, they should enjoy their lives, they say. But children are more likely to enjoy their lives when they are healthy with restrictions than when they are unhealthy and may do what they want.

It is sometimes hard to decide what foods are good for children. There are many prevailing theories, but a good guideline to follow is to simply think sensible. Low sugar, low fat, whole grains, fruits, vegetables, and lean meats are usually good ideas. However, we all know that most children aren't going to like that spinach you deem healthy, so you may have to be a little creative when it comes to supper recipes. If you would like a little help coming up with nutritious and healthy meals, there are many sites online that you can visit.

If you need more help, you may think about contacting a professional nutritionist. He or she will be able to help you in constructing a practical diet plan tailored to your child's specific needs.

Of course, poor diet is not the only reason that so many children are struggling with their weight. Lack of exercise is another reason. Television and video games are often self-consuming, even to many adults. So the time spent with these activities should be monitored and limited to make way for physical activities.

Genetics and environment also play a role in the causation for childhood obesity. People all want their children to be healthy, but sometimes they are simply born with the lower hand. Many factors can't be helped. However, one way to curb weight problems in children is to set a good example for them. Don't eat what they can't, and don't watch TV more than they can. Be good to your body, and they are more likely to be good to theirs

Is BMI-Body Mass Index Calculation An Accurate Measure Of Obesity?

Everyone knows obesity is a potential time bomb by increasing the risks of getting heart diseases, strokes and certain types of cancers. These are potential killer diseases. By keeping obesity down, these diseases may be avoided and even prevented.

One of the most popular methods of measuring whether one is overweight or obese is by using the Body Mass Index or BMI calculation. The formula for calculating BMI is:-

•Body weight in kilograms (pounds) divided by height in metres (ft) squared.

The World Health Organization (WHO) recommends that a BMI measurement above 25 indicates that a person is overweight and a BMI measurement over 30 indicates that he is obese.

However, is this calculation accurate? The BMI recommendation by WHO was based on studies done largely on Caucasians. Thus the BMI recommendation by WHO may be an accurate indication of obesity on an average Caucasian. There are now findings to suggest that people of Asian and African origins have a significantly higher percentage of body fat compared to Caucasians although they may look slimmer than their Caucasian counterparts. Therein lays the danger. If you are an Asian or an African, you may look slim but may carry extra body fat of which you are oblivious to.

As a fitness personal trainer, it is not uncommon that when I measure body fat of my Asian clients who do not look fat physically, their body fat ratio are high.

According to Dr Mabel Yap, Deputy Director of the Department of Nutrition, Ministry of Health, Singapore, ethnic differences in BMI values have important public health implications as they imply that cut-off points for obesity should be lower or higher in different ethnic groups. "Lowering the cut-off point from 30 to 27 in Singapore, for example, would double the prevalence of obesity," she said.

In a study, the School of Physical Education of the National Institute of Education, Singapore and Wageningen University of Netherlands found that body built of a person does affect the BMI calculation of various ethnic groups. This result was further confirmed by other studies in Thailand and Indonesia.

As commonly known, BMI calculation is not accurate for muscular people (muscles are heavier than fat) and now, it may also not be accurate across the board for all ethnic groups. For a start, Asians and Africans may want to define their BMI results as being overweight if it is above 23 and obese if above 27.

The First Steps to Curing Obesity

Obesity has become an epidemic, especially in The United States. An average of 300,000 Americans die each year and nearly $177 billion is spent on illnesses related to obesity.

Obesity can affect your legs and back. It can raise your blood pressure and even cause diabetes.

We are becoming fat and lazy, but before we can conquer the problem, we have to start accepting responsibility for our own actions. What you are about to read may offend some people, but it needs to be said.

Many people suffer from being overweight. It may result from a stocky build, slow metabolism, or some other physical reason, but it is a fact of life for many people. They will probably struggle with it their entire lives.

But obesity is different. A very miniscule percentage of obese people have medical reasons for their condition. The rest of them just cannot stop shoveling the food in long enough to see the consequences of their actions.

How many times have you been in a restaurant or at a party and watched an obviously obese person shoveling in the food and drinking a diet soda? Do they think the diet soda will make all that fat and calories go away? It doesn't work that way.

Please understand that the following suggestions are only the beginning of a very long and bumpy road to recovery. But even the longest journey begins with a single step.

1. PUT DOWN THAT TWINKIE! Someone, right this minute, is probably reading this article and eating something fattening. If not, it has probably been less that an hour since they have last eaten.

Before they can recover from their problem, they have to admit that they have one. And that Twinkie is the first sign.
If this is you and you feel that you absolutely must eat something, get some fresh fruit or vegetables. They not only contain the essential nutrients that your body needs for good health, but some will actually burn more calories that they replace.

2. See your doctor. If you are more than 50 pounds overweight, only a fool would recommend any diet plan until you are medically cleared by your physician.

Your doctor can also advise you on the best programs to help you get started.

This cannot be emphasized enough. Once you have eliminated the fattening foods, see your doctor before going one step farther.

3. Consider seeing a counselor. Is there a deep seated, subconscious reason for your eating disorder or are you just a pig? The answers may surprise you.

Once you discover the reasons for your self destructive behavior, you will be better equipped to handle them.

If you cannot afford counseling, talk to a trusted friend or, if you are a religious person, perhaps someone at your church.

They may not be able to diagnose your problem, but they can be there for you when you encounter those bumps in the road to recovery.

The bottom line is this. Being fit not only will increase the likelihood of a longer life, it will make that life much more pleasant.

Maybe it's time you stopped looking for sympathy and give yourself a swift kick in the pants.

Medicare Is Missing The Obesity Target

On July 16, 2004 the headline posted all over America was "WASHINGTON (AP) -- Medicare now recognizes obesity as an illness, a change in policy that may allow millions of overweight Americans to make medical claims for treatments such as stomach surgery and diet programs." (cnn.com)

It was almost impossible to miss this story, since it was plastered on virtually every front page in the nation and received heavy rotation on all the major news networks.

The government representative in front of the cameras said all the right things about the dangers of excess body fat: Health and Human Services Secretary Tommy Thompson said, "Obesity is a critical public health problem in our country that causes millions of Americans to suffer unnecessary health problems and to die prematurely."

Treating obesity-related illnesses results in billions of dollars in health care costs, Thompson said.

"With this new policy, Medicare will be able to review scientific evidence in order to determine which interventions improve health outcomes for seniors and disabled Americans who are obese," Thompson told a Senate panel on Thursday. (end quote from cnn.com)

That is all 100% true and accurate; obesity DOES cause a multitude of health problems in the United States and around the world. Fitness professionals around the nation have joined together in congratulating the Department of Health & Human Services in finally taking a much more pro-active role in obesity prevention.

However, we must take issue with what appears to be the main focus of this new initiative: fat loss results through surgery. On July 21, 2004 the Idaho Press Tribune (idahopress.com) ran a much more in-depth story on this issue (written by Mark Sherman of The Associated Press). In part, this story stated that "Now willing to pay for a treatment that works, Medicare is shunning fad diets to focus on one of the more radical solutions, stomach bypass surgery. Despite the claims of various diets and surgical procedures, most researchers agree that no approach to weight reduction has been proven to be effective over the long haul.....officials said they would consider paying for something, but only something that can be shown to work."

We are shocked and dismayed that anyone at the Department of Health & Human Services would not automatically endorse and promote exercise as the number one proven remedy for obesity!

Please understand that we are not discounting the effectiveness of stomach bypass surgery. On the contrary, it is perhaps the best solution for some people. However, for the vast majority of Americans, regular cardiovascular and resistance exercise is will provide much better and long-lasting results.

Further along in the article from The Associated Press we find this quote: "Some health plans subsidize gym memberships, but it is unlikely that Medicare would, despite the undeniable benefits of exercise." The folks at Medicare just don't seem to get it. They're missing the obvious solution to obesity.

The plain and simple fact of the matter is that liposuction, stomach bypass surgery, and other surgical forms of obesity control do not convey the same benefits as exercise. That is an undisputed fact. Yes, fat-loss surgical procedures work for some people and have even saved lives. If you think you may be a candidate, then by all means please talk it over with your physician. Odds are good that your doctor will discuss it with you and then recommend (prescribe?) a healthier diet and regular exercise.

There are two basic reasons why exercise is superior to fat-loss surgery. First, the simple act of removing fat from your body does not make your heart healther (as exercise does). Surgically taking fat off your body (via liposuction) will also not prevent diabetes or hypertension (as exercise does). In short, although surgical procedures will make you healther they will not convey the same benefits as regular exercise.

The second reason that exercise is superior to surgical solutions is that we must change our behavior if we are to make life-long changes in our body composition. Think about it. What if we could magically take 20 lbs. of fat off our body today? Poof! It's gone. Now doesn't that feel (and look) good? What will happen if we don't change our diet or activity level....will that 20 lbs. come back? Of course! Similar to the yo-yo diets many of us have experienced, without permanent changes to our lifestyle and/or dietary habits, permanent change is next to impossible.

So, while we applaud the folks at Medicare for their added emphasis on obesity, we are alarmed that exercise will not (for the time being, at least) play a role in their new initiative. In the meantime, let's continue to work out regularly and try to keep our diets 'clean'. Let's talk to our doctors about our goals.....the odds are good that they'll continue to recommend regular exercise and a healthy diet.