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.

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

 

"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.

Every fall the clinic sees some lap-band patients who haven’t been in for a while, but are suddenly struggling with night cough, heartburn or feeling overly restricted.  These patients come in questioning whether they are suddenly “overfilled” and requesting to have some of their fill removed.  Based on their reported symptoms and persistence, the medical staff has little choice but to comply.  And each January, we see some of these patients back again, often having regained a significant amount of weight, feeling frustrated, discouraged and angry.  Some report that after several fills, they are unable to get to that “sweet spot” of perfect restriction they had before.  Ongoing struggle, frustration and despair can result.

Many patients who choose the lap-band do so because it is “less invasive”.  Since the typical lap-band involves the same risks of surgery and amount of incisions as the RNY, and one might argue that having a foreign object incorporated into one’s body is equally as radical as having ones “intestines re-routed”, I have to wonder if what feels less invasive about the lap-band is really the level of commitment.  Does the lap-band feel safer because it is easier to reverse?  Because it is adjustable?  Because it allows for a “bandcation”?

In many ways, success with the lap-band requires more commitment and vigilance than the RNY.  I frequently tell patients that both the beauty and the curse of the lap-band is that one does not really start seeing results until one has made an investment in enduring lifestyle changes.  These changes include figuring out how to sustain healthy diet and exercise habits despite what else might be going on in life.  This includes learning how to make good choices during the holidays and while on vacation.  Getting fluid removed from the band for a special occasion or because a patient “deserves a break” from the band does not empower the patient to really develop an understanding of nor increase control over the eating behavior which contributed to obesity in the first place.  In some cases, these breaks can cause heartbreaking setbacks.  For example, the typical patient will gain back 10 lbs over a 2 week band “holiday”.  This means that over a 1-2 month period (think scheduling difficulties, weather related cancellations, ambivalence over getting the fill put back in), a patient could easily undo a year’s worth of weight loss progress, or even return to their per-surgery weight.

Patients and medical professionals alike pretty much agree that the lap-band is a tool.  However, just as having a hammer in my basement does not make me a master carpenter (and I assure you it does not), simply installing a lap-band does not allow for magical weight loss success.  The lap-band is a precision tool, which must be maintained and used correctly at all times.  This means getting fills as scheduled and eating correctly (see Jody’s recent blog about eating appropriately with lap-band) as well as learning to have the band as a welcomed guest for holidays, vacations and other special events.

Dr. Tom Brown, bariatric surgeon at the Colorado Bariatric Surgery Institute (CBSI) and expert for Doctors of Weight Loss, is now extending his Lap-Band fill clinic and aftercare program for individuals with the Lap-band who might be traveling, have relocated, or their surgeon may have moved or retired.  Dr. Brown is highly experienced, with more than 25 years in surgical practice, the past 10 years specializing in bariatric surgery. He has performed more than 3000 weight loss procedures, almost all of which have been performed laparoscopically, minimizing pain and scarring for his patients.  He and the other Doctors of Weight Loss experts are committed to providing supportive, innovative, professional care for bariatric surgery patients. Dr. Brown's comprehensive weight loss program at CBSI has an emphasis on long-term attention to dietary and lifestyle issues that contributes to highly favorable outcomes and has earned its reputation as one of the leading programs in the Rocky Mountain Region.

 

Getting pregnant after having a weight loss surgery like the lap-band or the gastric bypass surgery may be somewhat frightening.  There are many questions that may arise and it is very important to do some research and talk to your physician before considering having a baby. What you should know is that you can get pregnant, and it can be a healthy, wonderful experience. Just so you are prepared, here are some things to know about pregnancy after weight loss surgery.

1. You may get a boost in fertility
Bariatric surgery can produce a sudden positive change in your fertility. A report in a November 2005 issue of the Journal of Obstetric, Gynecologic, and Neonatal Nursing found that women with fertility problems linked to obesity who have the surgery can start ovulating regularly for the first time in years.
Important caveat: This newfound fertility can raise your chances of getting pregnant by accident if you haven't been using birth control — a problem if you're in the initial 18-month post-surgery period (see below).

2. You should wait 18 months before getting pregnant
It's safe to get pregnant after bariatric surgery — after your weight stabilizes. After surgery, your body goes through potentially stressful changes and significant nutritional upheaval, which can pose problems for a growing baby.
To protect women and their babies from potential malnutrition, doctors recommend that women not get pregnant until 18 months after surgery. A report in a November 2005 issue of the Journal of Obstetric, Gynecologic, and Neonatal Nursing explained that getting pregnant at least 18 months after surgery reduces the "potential for maternal and fetal malnutrition and small-for-gestational-age infants." By then, Schauer says, a woman should have reached a stable weight and be able to provide her baby

3. You'll need to monitor your nutrient intake closely
Even past the initial post-surgery period, many women have nutritional deficiencies that can be problematic during pregnancy. A study in the April 2006 issue of the American Journal of Medical Science found that the most common nutritional complications associated with bariatric surgery are deficiencies in B12, iron, calcium, and vitamin D. In some cases, post-surgery patients can experience protein-calorie malnutrition and fat malabsorption. After surgery, many women eat as few as 500 calories a day and often have to take extra vitamins to compensate for the ways in which their bodies no longer metabolize nutrients.
It may be extra difficult to get the nutrients you need during pregnancy because of nausea — a common post-surgery complication that morning sickness can exacerbate. If nausea has killed your appetite or you can't keep food down, talk to your healthcare provider about antinausea drugs that you can safely take during pregnancy.
To make sure you and your baby are getting enough nutrients, see your dietitian, who's knowledgeable about weight-loss surgery. You should also have your provider check your vitamin levels regularly. They may suggest that you take additional vitamin supplements.

4. You may need to educate your ob-gyn
Since the weight-loss surgery boom is relatively recent, many ob-gyns don't know how to treat women who've had it.
If you've had weight-loss surgery and you recently got pregnant or want to get pregnant, start the ball rolling by talking to all your healthcare providers early. This will give them a chance to do some research and have the most up-to-date facts at hand when caring for your health.

5. Your risk of complications drops, but doesn't go away
A 2005 study in the journal Obstetrics and Gynecology found that women who had weight-loss surgery developed pregnancy-induced hypertension and gestational diabetes at rates similar to those of healthy-weight women who'd never been obese or had weight-loss surgery.
But since many women who get weight-loss surgery are still plus-size to some degree when they become pregnant, moms-to-be can expect their doctors to keep a closer watch on their pregnancies, says Sharon Phelan, an obstetrician in Albuquerque, New Mexico, who has treated many plus-size women during pregnancy, including women who have had weight-loss surgery.
"You're still at risk for gestational diabetes [if you're plus-size but have had weight-loss surgery], but the risk is far less than before surgery," says Phelan.

6. You may face a body-image battle
One of the biggest emotional effects of pregnancy for post-surgery women, says Phelan, arises from body image. Not only does a woman have to get used to the idea that her belly will grow again, but she may also have some scars from the surgery that don't stretch very well as she grows.
"Psychologically, a lot of women who've had surgery to lose weight have a very hard time accepting that they have to gain weight," says Phelan. "They have to get comfortable with the fact that 'Yes, now is the time to gain weight.' Another emotional part of pregnancy is that it's stressful and people tend to eat when they're stressed."
So women run the risk of going to extremes — either dieting while pregnant, which can have serious nutritional consequences for the baby, or gaining back some of the weight they lost because they're eating more food. There's also the problem of food pushers, Phelan notes. These are the people who, seeing you're pregnant, say, "Go ahead, have another slice of cake!" 

7. You're more likely to have a cesarean
Pregnant women who've had bariatric surgery are more likely to end up with a c-section, according to a 2004 study published in the American Journal of Obstetrics and Gynecology. It's not clear exactly why this is the case and what factors are involved, but it helps to talk to your healthcare provider.
Does your provider consider you at high risk for a c-section, and if so, why? Ask about your provider's c-section rate and  philosophy about c-sections in general. If you have no serious health problems, is the provider fine with trying vaginal delivery? During a vaginal delivery, what might cause your provider to order a c-section intervention?
Also, you may be able reduce your odds of having a c-section by following your doctor's weight-gain recommendations, exercising during pregnancy, and taking childbirth preparation classes.

 

Erica Van Hamme, RD

 

Everybody knows that bariatric surgery is only a tool to help patients employ the lifestyle changes which will help them lose weight.  Diet transformations and activity makeovers are an expected, albeit challenging, part of the process.  Patients who get to the point of deciding to proceed with surgery are usually aware of these requirements and have a decent understanding of the limits of surgery without lifestyle change.  However, there is another lifestyle adjustment that is critical to weight loss success.

Some people refer to it as “taking responsibility”, “being proactive” or “taking charge of your life”.  Really what all these things are referring to is making a shift from passive recipient to active participant.  Rather than waiting to be told what to do or asked how things are going, those who are proactive work to educate themselves and make use of the resources they have at their disposal.  They think outside the box about how they might need to make changes in multiple areas of their lives in order to incorporate aspects of a healthier lifestyle.  This requires a global shift in mindset as well as lots of practice.  Here are some examples of making the transition:

A patient has tried two types of recommended multi-vitamin, both of which make her nauseous.  Instead of stopping her supplementation, she contacts the dietitian who helps her find alternatives.

A patient is having trouble finding the energy to exercise after work.  Rather than deciding he will start exercising after he loses more weight (and therefore has more energy), he gets up 30 minutes earlier to exercise when he is fresh.

A patient is dissatisfied with her weight-loss.  Instead of waiting for someone from the clinic to contact her to see how she is doing, she calls the office to set up an appointment.

All of these examples demonstrate patients taking the initiative to get the most out of their surgeries rather than passively accepting limitations that might, at first, seem insurmountable.  These patients use their commitment to succeed to drive them towards new information that they can use to solve problems.  They use their resources and look for realistic new paths rather than continuing to force a routine that isn’t working.  Finally, they refuse to give up and they recognize that nobody else is going to do it for them.  Below is an article on what it takes to be successful.  Although the article focuses on business success, the tenets hold true for all goals, including weight loss and improved health.

http://ezinearticles.com/?The-Top-3-Personal-Characteristics-For-Success&id=2142663