Obesity now accounts for over 20% of health care spending in the U.S., according to a new study from Cornell University.  Previous research had calculated this figure to be just 9% more than half of what Cornell researchers calculated using a new method to determine the causal effects of obesity on health care costs.  They calculated the cost by treating the heritable component of weight as a natural experiment.  Previously, the cost had been determined using a simple calculation of the difference between the medical expenses of heavier and lighter people.  The researchers explain that this figure is misleading because obese and non-obese people are very different.  For instance, if someone suffers a back injury at work it may lead to weight gain.  The back injury could result in more medical costs that are not caused by the weight gain, but rather, by the initial injury.  Using the new method of calculation, the researchers found that an obese person's medical costs are $2,741 higher annually than that of a non-obese person.  This costs translates into almost 200 billion each year, which is approximately 21% of the total medical expenditures in the U.S.  Obesity is a risk factor for several health concerns, including stroke, heart attack, diabetes, and even certain types of cancer.  Additionally, obesity increases the costs of treating almost any medical condition and the costs pile up quickly.  A growing body of research is showing that for many obese people, bariatric surgery, such as the lap-band or gastric bypass may be the best treatment.  You can learn more about the comprehensive program and surgery options offered at the Colorado Bariatric Surgery Institute.

Each of us views and experiences our sexual identities, personalities and relations in different ways.  Attached below are multiple articles provided in hopes you will find at least one which resonates with your current situation or needs.  Some article topics may encourage you to explore your sexual self-understanding or your desires, while other articles may prompt change or stimulate your thoughts, feelings or senses.

I would like to personally thank all patients in attendance at the February CBSI Support Group, specifically for their willingness to participate in this discussion topic and, in some cases, to expose their individual situation for support or to provide insight to others.

I have attached an article about this topic in hopes of giving myself and you as the reader some insight into this week’s blog subject.  Additionally, I have attached some definitions regarding the various words and links to articles and websites.

Happy Reading,

Elisa Fadum-Montoya, LCSW

Bariatric Social Worker

Hospital Says Weight Loss Surgery May Lead To Better Sex By Armen Harevan

Does weight loss surgery lead to better sex? It certainly could, especially for men suffering from obesity-related erectile dysfunction. A clinical study recently published in The Journal of Sexual Medicine showed that obese men with erectile dysfunction had low levels of testosterone. As the severity of obesity increased, the levels of testosterone further decreased.

Excess abdominal fat, cardiovascular disease, high blood lipids and type 2 diabetes have been associated with erectile dysfunction. According to leading sex researcher Irwin Goldstein, M.D., this information may help motivate men to make healthier lifestyle choices.

“This is a landmark study that shows sexual health is clearly linked to overall health,” said Dr. Goldstein, who directs the sexual medicine program at San Diego’s Alvarado Hospital. “Improving one’s general health is an opportunity to improve erectile function.”

However, similar benefits are not as clear for women. Obese women do report more sexual impairment than obese men. However, published studies indicate this may be more related to low self-esteem, unsatisfactory relationships, social stigma, and other psychological issues.

“A woman’s libido can be affected by many factors, such as the stress of caring for a sick relative,” Dr. Goldstein said. “There is no evidence yet to indicate that weight-loss surgery automatically makes sex better.”

He added that when it comes to sexual activity, body size doesn’t always matter. Thin, healthy people may be perceived as having the best body image and sexual function, but that is not always the case.

“There are plenty of sexually active heavy people and sexually inactive thin people,” Dr. Goldstein said. “I see them every day in my practice.”

Weight Loss Leads To A New Body Image
Just as weight-loss surgery requires life-long behavioral changes in nutrition and exercise, body image must also be addressed. As the pounds come off, patients often find other people start responding differently to them. It is not uncommon for a partner to expect more sex. Additionally, some patients may become uncomfortable about increased attention from strangers.

Then there’s the new reflection in the mirror. A weight loss of 100 pounds or more may leave folds of excess skin. Plastic surgery is effective, but it is costly and not always covered by health insurance.

Psychologist Lisa Steres, Ph.D., who provides counseling for bariatric surgery patients at Alvarado Hospital, says it can take years for a patient’s brain to catch up with the new body. As part of her pre-surgical evaluation, she asks delicate yet direct questions: How has the weight impacted sexual relationships? How do they expect the weight loss to impact their sex life?

“Body image greatly impacts libido, particularly in women,” Dr. Steres said. “Young women typically have better body image, and some women are sexually confident at any size.”

Dramatic changes during the transition to a normal weight can impact self-esteem and confidence. During the pre-surgical evaluation, Dr. Steres prepares patients to expect this, so they may come back and discuss it if necessary.

Dr. Steres said that both patients and partners typically go through stages of being relieved about the reduced medical concerns, but are then surprised at their own responses to the excessive skin that often results from massive weight loss. Some patients choose to consult with a plastic surgeon, while others are just as content as they were before the weight loss.

“Occasionally, a woman doesn’t like how she looks after surgery without her clothes on,” Dr. Steres said. “But when patients are basically happy people in loving, caring relationships, we find they work these things out.”

The following information was posted by:

Katherine Rabinowitz, LP, M.A., NCPsyA http://therapycanwork.com/index.php?option=com_content&view=category&layout=blog&id=46&Itemid=95#intimacy and

Life Planning Education, Advocates for Youth, Washington, DC  http://www.advocatesforyouth.org/storage/advfy/documents/circles.pdf

Sensuality - is awareness and feeling about your own body and other person’s bodies, especially the body of a sexual partner.  Sensuality enables us to feel good about how our bodies look and feel and what they can do.  It also allows us to enjoy the pleasure our bodies can give us and others.

Intimacy - does imply closeness, honesty, trust and a willingness to be exposed and vulnerable.  To have emotional intimacy means being able to share the good, the bad and the ugly.  Sharing intimacy is what makes personal relationships rich.  While sensuality is about physical closeness, intimacy focuses on emotional closeness.

Sexual Intimacy - is the ability to let go of inhibitions and be naked, in both the literal and metaphorical sense of the word, with another person. For some people, that loving and tender kind of energy is easy. They feel united and alive. Others feel vulnerable and ashamed. 

Sexuality - is often confused with intimacy. For some people they can be one and the same, but not always. It is not unusual for an individual’s or couples' involvement in sexual activity to wax and wane. There are periods where one or the other person loses interest. Change in hormones (both male and female) can play a role. Weight gain, weight loss, the normal changes in appearance brought on with age, or plain old fatigue because of work/child/relationship stress might be the reason for the change. The need to be alone can also change over time and affect how sexual you feel. 

Love vs. Intimacy

"The value of the personal relationship to all things is that it creates intimacy... and intimacy creates understanding...and understanding creates love." ~Anaïs Nin

Love and intimacy are not exactly the same. You can love without being intimate, and you can be intimate without loving. Intimacy is that ineffable quality that authenticates a sense of closeness. What does it mean to be intimate? Some might say, "We have sex, so we must be intimate." While sexual relations can be one of the most intimate of human experiences, it is possible to engage in sexual activity without a drop of intimacy. Intimacy implies the willingness to expose yourself in all your naked vulnerability, to admit when you are wrong, to rejoice in the other's triumphs. Intimacy means sharing your feelings and accepting without judgment those shown to you. Difficulty with intimacy doesn't necessarily mean a relationship falls apart, but surely its presence solidifies one, and its absence is an indication of a lack of true relatedness.

OTHER INFORMATION and ARTICLES

DEFINITIONS

http://therapycanwork.com/index.php?option=com_content&view=category&layout=blog&id=46&Itemid=95#intimacy

http://www.advocatesforyouth.org/storage/advfy/documents/circles.pdf

RELATIONSHIPS

http://www.medicinenet.com/healthy_relationships/article.htm

http://www.psychologytoday.com/blog/love-and-gratitude/201112/5-thoughts-new-year-love-and-happiness

SENSUALITY

http://psychologytoday.tests.psychtests.com/take_test.php?idRegTest=1327

http://www.artofloving.com/artofsensuality/index.htm

WEIGHT AND SEX

http://www.yourbariatricsurgeryguide.com/sex-after/

http://www.psychologytoday.com/PRINT/32092

http://www.psychologytoday.com/blog/all-about-sex/201005/sex-and-weight

http://www.webmd.com/sex-relationships/guide/sex-and-weight

HEALTHY SEX

http://www.medicinenet.com/sex_and_love_quiz/quiz.htm

http://www.psychologytoday.com/blog/not-born-yesterday/201201/psychology-in-the-bedroom

http://www.aphroditewomenshealth.com/news/keeping_sex_fresh.shtml

http://www.webmd.com/vitamins-and-supplements/lifestyle-guide-11/natural-sex-boosters-can-you-rev-up-your-libido?page=1

http://www.medicinenet.com/sexual_health_pictures_slideshow/article.htm

SEXUALITY

http://www.npr.org/templates/story/story.php?storyId=18975616

http://www.better-lifestyle-tips.com/papavibe

http://www.aphroditewomenshealth.com/news/reconnect_sexuality.shtml

http://www.psychologytoday.com/blog/enlightened-living/200902/sexuality-intimacy-and-the-masculinefeminine-archetype

DIFFICULTIES

http://www.psychologytoday.com/blog/love-and-gratitude/201201/love-make-sex-and-the-silent-treatment-0

http://www.webmd.com/sexual-conditions/ss/slideshow-sex-drive-killers

BODY IMAGE

http://www.medicinenet.com/beauty_and_body_image/article.htm

http://www.aphroditewomenshealth.com/news/female_sexuality_body_image.shtml

http://www.aphroditewomenshealth.com/news/20110509012819_health_news.shtml

WEBSITES

http://www.signaturesensuality.com

http://www.worldsexology.org

http://www.aphroditewomenshealth.com/news/female_sexuality.shtml

http://www.aphroditewomenshealth.com/forums/ubbthreads.php?ubb=cfrm

This may be helpful to some to help you get back on track and get back in touch with your band.  Please refer to the “How to eat appropriately for weight loss after Lap-Band surgery” for long term guidelines on properly using your band.

How many of you lap-band patients have asked any of these questions:

Does my pouch still work?

Have I broken my pouch?

Am I doomed to be a failure at this too?

Can I lose the weight I’ve regained?

Is the honeymoon with pouch over?

If you have asked yourself any of these questions, just know that you are not alone. There is a way to get back on track with your band and to feel the tightness again. It is called the 5 Day Pouch Test. This is the 5-day plan that has been developed and used to determine if your pouch is working and return to that tight newbie feeling. And a bonus to this plan, it helps one get back to the basics of the weight loss surgery diet and it triggers weight loss. Also, it is not difficult to follow and if you are in a stage of carbohydrate-cycling it will break this pattern.

The 5 Day Pouch Test should never leave you feeling hungry. You can eat as much of the prescribed menu as you want during the day to satiate hungry and prevent snacking on slider foods and/or white carbohydrates. You must drink a minimum of 64 ounces of water each day. A reduction of caffeinated beverages is suggested, but do not stop caffeine cold turkey.

Weight loss is not the intent of the 5 Day Pouch Test; however, many who have tried this plan report a significant drop in weight. More importantly they celebrate a renewed sense of control over their pouch and eating habits and easily transition back to a healthy post-surgical weight loss way of eating.

Prescribed menu:

Day 1 and 2: Liquid Protein

The first two days are all liquids. You can have as many low-carb protein shakes as you like to satisfy hunger or cravings. In addition drink at least six 8-ounce glasses of water each day. The purpose of all liquids is to break any snacking, grazing or processed carbohydrate habits. In addition the liquids will work to cleanse your system and prepare you for the following three days.

Low-carb protein shakes, broth, clear or cream soups, sugar-free gelatin and pudding.

Day 3: Soft Protein

The next three days you get to eat as much as you want as often as you want! Ahhh, but there's a catch: it has to be solid protein(not liquid like what was mentioned before) and you only get 15 minutes each time you sit down to eat. No drinking 30 minutes after meals and no drinking with your food. A dry pouch will hold your soft protein longer helping you to feel full and fed longer.

Protein Recommendations: canned fish (tuna or salmon) mixed with lemon and seasoned with salt and pepper, canned turkey or chicken, eggs cooked as desired seasoned with salt pepper and/or salsa, fresh soft fish (tilapia, sole, orange roughy), baked or grilled, and lightly seasoned.

This starts your program with "soft" protein. Measure your portion (1 cup volume or 4-6 ounces weight) and eat only until you feel full, not overfull. Remember, no water for 30 minutes after you meal, and no fluids with your meal. We are going back to the beginning and fluids will prevent you from feeling the pouch. If you need to add a moist condiment (Miracle Whip or mayonnaise) to the canned fish I understand, but keep it to a minimum so the meat is not too moist. One reason we lose the sense of tightness in our pouch is that we eat "slider foods" - foods that are too moist and do not stay in the pouch very long, they slide right through the stoma

Day 4: Firm Protein

By now you should be experiencing that familiar tightness that will reassure you that your pouch is working. Remember to drink plenty of water between meals. Take some time to meditate and rediscover the wonder of your pouch. Often we don't like that uncomfortable tightness of the pouch, which is why we gradually move toward slider foods that don't make us uncomfortable. It is always my preference to eat moist protein so I don't get uncomfortable, but doing so allows me to consume more than I should. Lots of times I hear, "But I don't like that uncomfortable tight feeling of solid protein in my pouch." But the very purpose of the pouch is to signal fullness, which often comes by way of slight discomfort when we are eating in compliance with our bariatric owner's manual. The slider foods will never ever signal fullness. They are dangerous and in most cases non-nutritional. Rediscovering the pouch with this 5-day plan reminds me of how the tool really works. I hope by now you are rediscovering your tool and enjoying the hope and excitement because your pouch still works

Protein Recommendations: ground lean meat (beef, turkey, lamb) cooked dry and lightly seasoned, shellfish, scallops, lobster steamed and seasoned only with lemon, salmon or halibut steaks, grilled and lightly seasoned.

Day 5: Solid Protein

Remember to chew, chew, chew. Measure your portion (4-6 ounces) and eat only until you feel your pouch tighten. Remember, only 15 minutes per meal, so you'll have to work fast to chew your food completely. By now you should be out of any carbohydrate cycle you were in and perhaps you have lost a pound or two. You will have new confidence in your pouch and your ability to work the tool for your health and emotional well being.

Protein Recommendations: white meat poultry cooked dry and lightly seasoned, beef steak (if tolerated) grilled or broiled.

Day 6 and on: Low fat, low-sugar, heart healthy diet

Now is the time to get back to your healthy lifestyle. You are more conscious of when you feel full and you have retrained your pouch and brain. Remember to choose low fat foods, low-sugar items and whole grains.

The 5 Day Band Pouch Test was created by a band patient, Kaye Bailey. Ms. Bailey is the voice behind the popular website, LivingAfterWLS.com which has become the premier online destination for weight loss surgery information and support. The website boasts an extensive article and video library, recipe collection, eZine newsletters and active support forum called The Neighborhood. Ms. Bailey's interaction with the community and dedication to quality on-going education and support for those who chose surgical weight loss for the treatment of obesity is unsurpassed.

For more information on the 5 Day Pouch Test, visit the website at:

http://www.5daypouchtest.com/

Erica Van Hamme, RD

Reference:

Bailey, K. The 5 Day Pouch Test. LivingAfterWLS, Liability, Co. 2007-2012

Having a strong support system is essential to being able to make lasting lifestyle changes after bariatric surgery.  In fact, it’s essential to just recovering physically and emotionally after the surgical process itself.  Finding people who will truly support you takes some work (and some training).   What you are looking for are those people who care enough about you to have unconditional willingness to support you in ways that are helpful to you.  This basically means that they are willing to learn what you find to be supportive, and to practice honing this communication with you.  Notice, this puts the bulk of the responsibility on you (the supportee) for carefully choosing and then training your support system.  This will involve ongoing conversations about what works and what doesn’t.  It also means that expecting support from people who are incapable of providing it (either due to lack of willingness or skill) is a set-up.  Like everything else about life after surgery, taking a proactive stance will serve you well.

The following article is  about ways we can invalidate each others’ experiences. It may help you begin thinking about which people in your life are capable of offering true support and ways they can be supportive (or at least not be unsupportive).

http://mindfulconstruct.com/2011/02/18/75-things-people-say-to-shut-up-your-feelings/

"Addiction transfer" is what psychologists call the phenomenon when people give up one addiction--overeating, for example--and transfer that addiction to something else such as alcohol abuse, gambling, or excessive shopping.  There have been anecdotal reports of addiction transfer following weight-loss surgery, with one of the more serious addiction transfers being to alcohol.  Some procedures, such as the gastric bypass, allow food and drink to bypass most of the stomach and part of the small intestine, which can results in alcohol being passed more rapidly into the bloodstream.  A study published last year on gastric bypass patients found that a single galss of wine was enough for patients to reach the legal driving limit of .08 percent and it took longer for their blood alcohol content (BAC) to return to zero after drinking; 108 minutes compared to 72 minutes in a control group.

But are weight-loss surgery patients more likely to abuse alcohol? A study led by Dr. John Morton, Director of Bariatric Surgery at Stanford, examined the issue of addiction transfer after bariatric surgery and found no evidence of post-operative addiction transfer to alcohol abuse.  The study was made up of weight-loss surgery patients surveyed both before and after bariatric surgery.  The researchers found that the patients drinking habits changed significantly after surgery; they consumed fewer drinks at one time, and also reported drinking fewer times per week.  Additionally, Dr. Morton found that 40% fewer patients drank at all post-operation.

Another study looked at 121 post-op patients and found that there was no statistically significant difference in alcohol abuse.  There was actually less post-op alcohol abuse reported, at 17% down from 21% pre-op.  Also of note, a study conducted by the same researchers on gastric band and gastric sleeve patients did not find significant changes in alcohol metabolism, in terms of higher peak and long to BAC of zero.  Weight-loss surgery patients should, however, exercise caution when drinking, as associated behaviors like being more relaxed and being around friends who are likely snacking can sabotage weight loss efforts.