The document discusses various treatment options for obesity including dietary approaches, exercise, behavioral therapy, very low calorie diets, and obesity drugs or surgery for more severe cases. It provides details on meal replacement plans, the exchange diet system which divides foods into categories, recommended aerobic and anaerobic exercise, and the benefits of group behavioral treatment programs.
The presentation has three parts: UNITE for Diabetes Philippines CPG recommendations on medical nutrition therapy (MNT), improving adherence to MNT and use of SMS.
The presentation has three parts: UNITE for Diabetes Philippines CPG recommendations on medical nutrition therapy (MNT), improving adherence to MNT and use of SMS.
Obesity is a chronic heath problem ,the no.of people having obese rising rapidly world wide and making obesity 1 of the fastest developing peoples health problem
How is COPD and Nutrition Overlapped and Affecting Each Other
How to Solve the Problem as a Part of Pulmonary Rehabilitation
The Presentation is Discussing these items in the form of Problem Solving
This ppt contains all the details about what is obesity, etiology, & mainly focuses on various methods of assessment of obesity from field tests to lab tests.
Obesity is a chronic heath problem ,the no.of people having obese rising rapidly world wide and making obesity 1 of the fastest developing peoples health problem
How is COPD and Nutrition Overlapped and Affecting Each Other
How to Solve the Problem as a Part of Pulmonary Rehabilitation
The Presentation is Discussing these items in the form of Problem Solving
This ppt contains all the details about what is obesity, etiology, & mainly focuses on various methods of assessment of obesity from field tests to lab tests.
Health IT Summit San Diego 2015 - Case Study "Analytics Strategy: Enablement, Innovation, Transformation" with Eric Hixson, PhD., Senior Program Administrator, Business Intelligence, Cleveland Clinic
Obesity decoded by California Medical Weight Management | calmwm.comgrayjohn
Obesity decoded by California Medical Weight Management. For weight loss tips and proper medical weight loss book an appointment at http://www.calmwm.com/
Modeling an Integrated System for Obesity & Weight ManagementSIMUL8 Corporation
Worldwide obesity has more than doubled since 1980 (WHO; 2015). This is contributing to the growing number of patients living with chronic diseases and placing mounting pressure on health systems.
In 2013, part of the Public Health system in England transferred out of the NHS into local government. Responsibility for the prevention and management of obesity in adults and children transferred with these teams, while parts of the NHS primary and secondary care system remained responsible for aspects of treatment, including bariatric surgery.
This workshop explores the challenges in commissioning a healthcare organization to provide an integrated service for obesity, weight management, and treatment in Nottinghamshire County, UK. These challenges include:
- Estimating the health needs of overweight and obese people across the County
- Taking into account the fact that needs will change over time
- The lack of available evidence
Learn how out how Scenario Generator, a population health modeling and simulation tool, was used to test assumptions and develop the evidence to procure an integrated service
Learn from Bethany Doerfler, MS, RD, LDN, a registered dietitian whose clinical practice and research focuses on providing wellness-based medical nutrition therapy for digestive disorders and allergic bowel diseases. She currently practices in the Division of Gastroenterology and Hepatology at Northwestern Medicine in Chicago, IL. She is the first dietitian to be fully integrated into a gastroenterology division for both research and patient care. This presentation is optimized for Scleroderma patients to learn about their diet options to improve scleroderma symptoms and their gut health.
Healthy diet | Nutrition and Diet : weight loss Indiaweightlossindia
We are committed to helping you reach important weight loss goals and we are here to support you. Surgery is just one step on your journey.Following surgery, many patients lose weight rapidly.But it's important to make the commitment to a lifestyle of healthy eating and regular exercise.
Management of Diabetes by Ayurveda & Yoga | Treatment and Medicine | BK ArogyamBK Arogyam
Controlling blood sugar through diet, oral medication or insulin is the main treatment. India is said to be the diabetes capital of the world. With nearly 50 million people in India suffering from diabetes, the country has a big challenge to face. First, let's know what is diabetes. Regular screening for complications is also required. Permanent Cure for Diabetes without Taking Insulin - New Research. Diabetes cure by islet transplantation (Edmonton Protocol )
In pancreatic islet transplantation, cells are taken from a donor pancreas and transferred into another person. Once implanted, the new islets begin to make and release insulin. Researchers hope that islet transplantation will help people with type 1 diabetes live without daily injections of insulin.
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For so many people, weight loss is an overwhelming process that includes starvation, feeling unhappy and tired, and ultimately, gaining back what was once lost.
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Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
2. Treatment options
When does obesity threaten the health
and life of a patient?
Which patients have co-morbidities
that make an aggressive treatment
necessary?
2012 2
3. Steps in determining treatment
Determine BMI.
Assess complications and risk factors
2012 3
4. Steps in determining treatment
Determine BMI-related health risk
Determine weight reduction
exclusions
Mental illness
Unstable medical condition
Some medications
Temporary
Pregnancy or lactation
2012 4
5. Steps in determining treatment
Possible exclusions
Osteoporosis
BMI in minimal or no-risk category
History of mental illness
Medications
Permanent exclusions
Anorexia nervosa
Terminal illness
Assess patient readiness
2012 5
6. Steps in determining treatment
Treatment Options
1. Mild energy-deficit regimen
Diet, diet and exercise, behavioral therapy
2. Aggressive energy-deficit regimen
VLCD
Extensive exercise program
3. Obesity drugs
4. Surgery More extreme
options
2012 6
7. Dietary treatment
When someone is a few pounds overweight
and is motivated to lose weight, dietary
approach is a safe and effective method for
weight loss. It is also the best method for
helping to acquire new skills for maintaining
a weight loss.
2012 7
8. Dieting with the Exchange List
The Exchange diet.
Monitor intake of carbohydrates, fat
and protein as well as portion sizes.
Includes foods from each group and
can be used indefinitely.
It also works well in weight
maintenance.
2012 8
9. Dieting with the Exchange List
Foods are divided into 6 categories:
Starch/Bread
Meat
Vegetables
Fruit
Milk
Fat
2012 9
10. The Exchange List
The number of exchanges is
determined by the total number of
calories required.
Different for each person and
depends on:
height, weight, and energy expenditure.
2012 10
12. Example of daily exchange diet: 1800
Kcals daily
BREAKFAST
1 c orange juice 2 Fruits
2 slices of toast 2 Breads
1 hard-cooked egg Yields 1 Meat
2 tsp margarine 2 Fat
1 c 2% milk 1 Milk
Coffee or tea Free Food
2012 12
13. Example of daily exchange diet: 1800
Kcals daily
LUNCH
½ c tuna 2 Meat
2 slices whole wheat bread 2 Bread
½ c tomato slices 1 Vegetable
Lettuce/cucumber salad Raw Vegetable
Yields
1 c sliced peaches 2 Fruit
1 tsp margarine 2 Fat
Tea with lemon Free Foods
2012 13
14. Example of daily exchange diet: 1800
Kcals daily
3 oz baked chicken DINNER 3 meat
½ c mashed potato 1 Bread
1 small whole grain roll 1 Bread
½ c broccoli, ½ c carrots 1 Vegetable
Yields
Tossed salad Raw Vegetable
1 Tbsp salad dressing 1 Fat
1 tsp margarine 1 Fat
Coffee Free Food
2012 14
15. Example of daily exchange diet: 1800
Kcals daily
EVENING
SNACK
2 graham crackers 1 Bread
1 c 2% milk 1 Milk
2012 15
16. The Exchange Diet
For more information please visit:
http://www.diabetes.org/home.jsp
2012 16
17. Dieting Using Calorie Controlled
Portions
MEAL REPLACEMENT PLAN
Liquid formula or a packaged item
Fixed number of calories to replace a meal.
Control portion sizes
Fat, carbohydrate, calories
Balanced meals
2012 17
18. Meal Replacement Plan
4 types of meal replacers:
Powder mixes
Shakes
Bars
Prepackaged Meals
2012 18
19. Meal Replacement Plan
An intake of five fruits and vegetables is
recommended.
Effective
Convenient
Nutritionally balanced
2012 19
20. Example:
A MEAL REPLACEMENT PLAN
Breakfast Meal Replacement
Lunch Sensible Meal or Meal
Replacement
Dinner Sensible Meal
Snacks Fruit, vegetable, fat-
free yogurt or cheese,
nuts, pretzels, or air-
popped popcorn
2012 20
21. Exercise
Adults: 30-45 minutes of exercise three to five days
each week
Include 5-10 minute warm up and cool down
Weight loss: at least 30 minutes of aerobic activity a
day for five days
2012 21
22. Exercise
Energy Balance = maintaining
weight.
Positive energy balance leads to
weight gain.
Negative energy balance leads to
weight loss.
2012 22
23. Exercise: Benefits
Exercise builds lean body mass.
Walking, running and doing physical activity
can burn two to three times more calories
than similar amount of time sitting.
With exercise there is an improvement in
overall physical fitness.
Exercise improves maintenance of weight after
weight loss.
2012 23
24. Exercise
For Weight Loss
150 to 200 minutes of moderate physical activity
each week
diet for weight loss
For Improved Health
An exercise program with less than 150 minutes a
week and lower intensity can result in improvement
in cardio-respiratory fitness.
2012 24
25. Aerobic Activity
Aerobic exercise is any extended activity that makes the
lungs and heart work harder while using the large muscle
groups in the arms and legs at a regular, even pace.
EXAMPLES
Brisk walking
Jogging
Bicycling Racket sports
Swimming Lawn mowing
Aerobic dancing Ice or roller skating
Using aerobic equipment
(treadmill, stationary bike)
2012 25
26. Anaerobic Activity
Anaerobic activity is short bursts of very
strenuous activity using large muscle groups
(Ex: weight lifting, curls, power lifting).
Helps build and tone muscles, but it does not
benefit the heart or the lungs.
2012 26
27. Very Low Calorie Diets (VLCD)
Formula diet of 800 calories or less.
Must be under proper medical
supervision.
Produce significant weight loss in
moderately to severely obese patients.
2012 27
28. VLCD: Facts
Not recommended for pregnant or breastfeeding
women
Not appropriate for children or adolescents
Not recommended for older individuals
2012 28
29. Behavioral Treatment
Widely used strategy
Based on adjusting energy balance
Individual treatment, or
Group Format
(Around 18-24 weeks)
One of the most successful
treatment programs
2012 29
30. Group Approaches
Social support
integration into social network and positive
interactions with others.
Individual feels support, acceptance, and
encouragement by others.
2012 30
31. Behavior Treatment
Need to change one’s approach
thinking
feelings
actions
to eating and physical activity.
2012 31
32. Behavioral targets
Total energy _ Total energy
Weight = intake expenditure
Eating Activity
Targets of behavioral therapy
2012 32
34. Behavior Therapy:
Important Components
3. Setting Goals
Calories, fat, physical activity.
Short-term goal of losing 1 to 2 pounds a week.
Choose specific, attainable, and realistic goals.
Have a long-term goal.
2012 34
35. Behavior Therapy:
Important Concepts
4. Keeping Track of Eating and Exercising
Tracking to raise awareness.
Self monitoring.
Record time, activating event, place and quantity of
eating, and activity behaviors.
2012 35
37. Behavior Therapy:
Important Concepts
Techniques to conquer eating triggers include:
eating regular meals
eating at the same time and place
use smaller plates
keeping accessible food out of sight
eating only when hungry
avoiding activities that encourage eating
2012 37
38. Behavior Therapy:
Important Concepts
6. Changing Eating and Activity Patterns
slowing pace of eating
reducing portion sizes
measuring food intake
leaving food on plate
improving food choices
eliminating second servings
2012 38
39. Behavior Therapy:
Important Concepts
Changing Eating and Activity Patterns
Programmed exercise vs lifestyle
Lifestyle activity preferable for weight
loss.
2012 39
40. Behavior Therapy:
Important Concepts
7. Contingency Management
Positive reinforcement (reward)
An effective reward - immediate, desirable, and given
based on meeting a specific goal.
Tangible rewards - a new CD
Intangible reward – taking time off
2012 40
41. Behavior Therapy:
Important Concepts
8. Cognitive Behavioral Strategies
Traditional behavioral treatment components
with emphasis on thinking patterns that may
affect eating behaviors.
2012 41
42. Behavior Therapy:
Important Concepts
9. Stress Management
Stress is a primary predictor of
overeating and relapse.
Stress management skills
2012 42
43. Drug Treatment of Obesity:
Indicated when
BMI is greater than 30
BMI is higher than 27 and there are
other cardiovascular complications
After several attempts diet alone is
not enough
Cardiovascular complications include:
Hypertension, Dyslipidemia, Coronary Heart
Disease, Type 2 Diabetes, and Sleep Apnea
2012 43
44. Drug Therapy
Commonly prescribed drugs for the
treatment of obesity include:
Phentermine
Sibutramine
Orlistat
2012 44
45. Drug Therapy: Phentermine
Brand names are Adipex-P, Obenix, Oby-Trim
Most commonly prescribed medication for weight
loss.
Phentermine increases norepinephrine, a
neurotransmitter in the brain that decreases
appetite.
Phentermine has stimulant properties, and it may
cause high blood pressure or irregular heat beats.
2012 45
46. Drug Therapy: Sibutramine
The brand name is Meridia
Sibutramine induces weight loss by reducing food intake.
It stimulates the
satiety centers in the brain.
Sibutramine use may increase heart rate and blood
pressure.
Sibutramine is not recommended for someone with
uncontrolled hypertension, tachycardia, or serious
heart, liver, or kidney disease.
2012 46
47. Drug Therapy: Orlistat
The Brand name is Xenical
Orlistat prevents the digestion of dietary fat.
Bowel habits will likely change.
Leads to improvement in blood lipids.
Multivitamin supplement is encouraged.
2012 47
48. Surgical Treatment of Obesity
Criteria used for surgical treatment:
BMI is 40 or higher
BMI of 35-39.9 and a serious obesity-related
health problem
such as: Type 2 diabetes, hypertension, heart
disease, or sleep apnea
2012 48
49. Types of GI surgeries available
Restrictive
Malabsorptive
Combined restrictive/malabsorptive
2012 49
50. GI Surgeries: Restrictive
Purely restrictive operations only limit food intake and
do not interfere with the normal digestive process.
Create a pouch.
Delay in food emptying.
2012 50
52. Restrictive Operations: Examples
2. Vertical banded gastroplasty.
Uses the band and staples to create
a small pouch. Not commonly used
today.
2012 52
53. Restrictive Operations: Advantages
1. Generally safer than malabsorptive
procedures.
2. Done via laparoscopy allowing for
smaller incisions.
3. Surgeries can be reversed if necessary.
4. Result in few nutritional deficiencies.
2012 53
54. Restrictive Operations:
Disadvantages
1. Smaller weight loss.
2. Can lead to weight gain over time.
3. No change in eating habits.
4. Success depends on the patient’s
willingness to adopt a healthy lifestyle.
2012 54
55. Restrictive Operations: Risks
1. Overeating can lead to vomiting.
2. Break in tubing.
3. Problems leading to a second operation.
These risks need to be taken into account
by any individual considering the
surgery!
2012 55
56. Malabsorptive Operations
The main malabsorptive operation is the
jejunoileal bypass which is not
performed today because of the high
incidence of health complications.
2012 56
57. Combined Restrictive and Malabsorptive
Operations
Restricts both food intake and the amount of
calories and nutrients the body absorbs.
Roux-en-Y gastric bypass (RGB)
Creates a pouch.
Connects the small intestine
to the pouch, bypassing large
sections of the intestines.
2012 57
58. Combined Restrictive and
Malabsorptive Operations
Biliopancreatic diversion (BPD)
Remove portion of stomach.
Connect this directly to the
final segment of the small intestine
completely bypassing sections of
intestines.
2012 58
59. Combined Operations: Advantages
1. Rapid weight loss.
2. Maintain good weight loss for 10 years or
more.
3. Can lose up to 75-80% of excess weight.
4. May lead to greater improvement in
health.
2012 59
60. Combined Operations: Disadvantages
1. Can be difficult.
2. May result in long-term nutritional
deficiencies.
3. Decreased absorption of iron and calcium.
4. Requires fat soluble vitamin
supplementation.
5. May have dumping syndrome.
2012 60
61. Combined Operations: Risks
1. May lead to complications.
2. Greater risk for abdominal hernias.
3. The risk of death may be higher.
2012 61
62. Bariatric Surgery: Facts
Procedures cost from $17,000 to $35,000.
Medical insurance coverage varies by state.
2012 62
63. NIDDK
(National Institute of Diabetes and Digestive and Kidney
Diseases)
The patient should consider the following
questions prior to weight loss surgery:
1. Are you unlikely to lose weight or keep weight
off long-term with non-surgical measures?
2. Are you well informed about the surgical
procedure and the effects of treatment?
3. Are you determined to lose weight and
improve your health?
2012 63
64. NIDDK
4. Are you aware of how your life may change
after the operation?
5. Are you aware of the potential for serious
complications, dietary restrictions, and
occasional failures?
6. Are you committed to lifelong medical follow-
up and vitamin/mineral supplementation?
2012 64
65. Conclusions
When there are no complications or co-
morbidities associated with obesity,
dietary, exercise and behavioral
approaches are the safest and best
approaches and can lead to long term
successful weight loss.
For successful weight loss to become
permanent, an individual has to adopt new
and permanent eating and exercise
behaviors.
2012 65
66. Conclusion
It is very important for individuals considering
weight loss drug therapy or surgeries to be well
aware of the risks associated with the
treatments.
Once all risks are understood, then ultimately it
is the individual’s decision whether to go along
with the treatment.
2012 66
67. References: Behavior Therapy and
VLCD Information
http://www.medhelp.org/NIHlib/GF-390.html
Foreyt, J.P., & Poston, W.S.C., Jr. (1998a). The role of the
behavioral counselor in obesity treatment. J Am Diet Assoc,
10(Supplement 2), S27-S30
Foreyt, J.P., & Poston, W.S.C., Jr. (1998b). What is the role of
cognitive-behavior therapy in patient management? Obes Res,
6(Supplement 1), 18S-22S
Foster, G.D., Wadden, T.A., Vogt, R.A., & Brewer, G. (1997).
What is a reasonable weight loss? Patients' expectations and
evaluations of obesity treatment outcomes. J Consult Clin
Psychol, 65, 79-85
2012 67
68. References : Behavior therapy
Poston, W.S.C., Jr., Hyder, M.L., O'Byrne, K.K., & Foreyt,
J.P. (2000). Where do diets, exercise, and behavior
modification fit in the treatment of obesity? Endocrine,
13(2), 187-192.
Wadden, T.A., Sarwer, D.B., & Berkowitz, R.I. (1999).
Behavioural treatment of the overweight patient. Baillieres
Best Pract Res Clin Endocrinol Metab, 13(1), 93-107.
Wing, R.R. (1993). Behavioral approaches to the
treatment of obesity. In G. Bray, C. Bouchard & P. James
(Eds.), Handbook of Obesity (pp. 855-873). New York:
Marcel Dekker, Inc.
Wing, R.R., & Tate, D.F. (2002). Behavior modification for
obesity. In J.F. Caro (Ed.), Obesity.
http://www.endotext.org/obesity/index.htm:
2012 68
69. Sites: Drug Therapy Info & Surgery
http://www.cdc.gov
National Heart, Lung, and Blood Institute, Clinical Guidelines
on the Identification, Evaluation, and Treatment of
Overweight and Obesity in Adults, 1998.
Astrup A, Hansen DL, Lundsgaard C, Toubro S. Sibutramine
and energy balance. Int J Obes Relat Metab Disord 1998
Aug; 22 Suppl 1: S30-S35.
Bray GA, Ryan DH, Gordon D, et al. A double-blind
randomized placebo-controlled trial of sibutramine. Obes Res
1996 May; 4(3): 263-70.
Heal DJ, Aspley S, Prow MR, et al. Sibutramine: a novel anti-
obesity drug. A review of the pharmacological evidence to
differentiate it from d-amphetamine and d-fenfluramine. Int J
Obes Relat Metab Disord 1998 Aug; 22 Suppl 1: S18-S29.
2012 69
70. References: Drug therapy & Surgery
www.meridia.net
Waitman, JA, Aronne LJ. Phrmacotherpay of obesity.
Obesity Management 1: 15-19, 2005.
Greenway, F. Surgery for obesity. Endocrinology and
Metabolism Clinics of North America 25(4):1005-1027.
Surgery for morbid obesity: What patients should know. 3rd
Ed. American Society for BariatricSurgery, Gainesville, FL
2001.
http://win.niddk.nih.gov/publications/gastric.htm
Escott-Stump, S. Nutrition and Diagnosis-Related Care. 5th
Edition. 2002.
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71. References: Exercise
http://www.cdc.gov
Ross R, Jansses I, Dawson J, Kungl A-M, Kuk JL, Wong SL,
Nguyen-Day T-B, Lee SL, Kilpatrick K, Hudson R. Exercise
induced reduction in obesity and insulin resistance in women: a
randomized controlled trial. Obesity Research 12:789-798, 2004.
Jakicic JM, Marcus BH, Gallagher KI, Napolitano M, Lang W.
Effects of exercise duration and intensity on weight loss in
overweight, sedentary women. JAMA 10: 1323-1330, 2003.
Ross R, Katzmarzyk PT. Cardio respiratory fitness is associated
with diminished total and abdominal obesity independent of body
mass index. International Journal of Obesity 27: 204-210, 2003.
McArdle WD, Katch FL, and Katch VL. Exercise Physiology:
Energy, Nutrition and Human Performance, 5th Edition. Lippincott
Williams & Wilkins 2004.
2012 71
72. References: Diet
http://www.cdc.gov
Noakes M, Foster PR, Keogh JB, Clifton PM. Meal replacements
are as effective as structured weight-loss diets for treating obesity in
adults with features of metabolic syndrome. J Nutr. 2004
Aug;134(8):1894-9.
Truby H, Millward D, Morgan L, Fox K, Livingstone MB, DeLooy A,
Macdonald I. A randomised controlled trial of 4 different commercial
weight loss programmes in the UK in obese adults: body
composition changes over 6 months.
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Halford JCG, Ball MF, Pontin EE, Maharjan LB, Dovey TM, Pinkney
JH, Wilding JPH, Mela DJ. The impact of using meal-replacements
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Association for the Study of Obesity Conference, November 14-18,
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2012 72
73. Pennington Biomedical Research
Center
Division of Education
Heli J. Roy, PhD, RD
Beth Kalicki
Division of Education
Phillip Brantley, PhD, Director
Pennington Biomedical Research Center
Steven Heymsfield, MD, Executive Director
2012 73
74. About Our Company…
The Pennington Biomedical Research Center is a world-renowned nutrition research center.
Mission:
To promote healthier lives through research and education in nutrition and preventive medicine.
The Pennington Center has several research areas, including:
Clinical Obesity Research
Experimental Obesity
Functional Foods
Health and Performance Enhancement
Nutrition and Chronic Diseases
Nutrition and the Brain
Dementia, Alzheimer’s and healthy aging
Diet, exercise, weight loss and weight loss maintenance
The research fostered in these areas can have a profound impact on healthy living and on the prevention of common
chronic diseases, such as heart disease, cancer, diabetes, hypertension and osteoporosis.
The Division of Education provides education and information to the scientific community and the public about
research findings, training programs and research areas, and coordinates educational events for the public on various
health issues.
We invite people of all ages and backgrounds to participate in the exciting research studies being conducted at the
Pennington Center in Baton Rouge, Louisiana. If you would like to take part, visit the clinical trials web page at
www.pbrc.edu or call (225) 763-3000.
2012 74
Editor's Notes
In this presentation we will discuss various treatments for obesity. Obesity has been established as a major risk factor for diabetes, hypertension, cardiovascular disease and some cancers in both men and women. Other comorbid conditions include sleep apnea, osteoarthritis, infertility, idiopathic intracranial hypertension, lower extremity venous stasis disease, gastro-esophageal reflux, and urinary stress incontinence. Deaths from Obesity: 300,000 premature deaths associated with obesity annually (CDC) Death rate extrapolations for USA for Obesity: 300,000 per year, 25,000 per month, 5,769 per week, 821 per day, 34 per hour, 0 per minute, 0 per second. Deaths information for Obesity: Approximately 280,000 adult deaths in the United States each year are attributable to obesity NIDDK _ Statistics Related to Overweight and Obesity: NIDDK)
It is important to consider the following questions before beginning a treatment program for obesity: When does obesity threaten the health and life of a patient? Is the degree of obesity such magnitude that the patient’s life is threatened? Which patients have co-morbidities that make an aggressive treatment necessary? Does the patient have heart disease, hypertension, diabetes, or any other chronic condition?
It is important to assess the patients’ Body Mass Index before beginning any kind of treatment program. There are several different measures used to evaluate a patient's weight status and potential health risk. However, a complete evaluation includes assessments of a person's age, height and weight, fat composition and distribution, and the presence or absence of other health problems and risk factors. Body mass index (BMI) is an easy assessment of obesity. BMI is the body weight in kilograms divided by the square of the height in meters ([weight in kg] ÷ [height in meters] 2). BMI does not actually measure body fat, but generally correlates well with the degree of obesity.
The categories of obesity developed by the World Health Organization are: BMI 25 to 29.9 - Grade 1 obesity (moderate overweight) BMI 30 to 39.9 - Grade 2 obesity (severe overweight) BMI > 40 - Grade 3 obesity (massive/morbid obesity). Example: Using a BMI table, a person 5'6" tall weighing 140 pounds would have a BMI of 23, well out of the range of risk. That same 5'6" person weighing 190 pounds would have a BMI of 31, in the range of Grade 2 obesity. A BMI between 25 and 27 is considered a warning sign and may warrant intervention, especially in the presence of additional risk factors. Treatments to use at this point are dietary counseling, exercise counseling, and behavioral treatment. A BMI of 27 or higher is associated with increased morbidity and mortality; this is generally considered the point at which some form of treatment for obesity is required. At this point, dietary counseling by a registered dietitian is suggested and behavioral counseling by a psychologist are the ideal methods of treatment. More aggressive treatments are not warranted unless there are other co-morbidities present. At BMI above 30, more aggressive treatment options can be considered, such as drug treatment, particularly in the presence of other risk factors. Determine if the patient has any exclusions that are contraindicated for weight loss: pregnancy, mediations, mental illness etc.
There are conditions under which weight loss is contraindicated: osteoporosis, low BMI, history of mental illness and certain medications. If there is any history of anorexia nervosa, weight loss is not recommended. Also if the patient has terminal illness. Determining your patients’ readiness for behavior change is essential for success. Initiating change when patients are not ready often leads to frustration and may hamper future efforts. In fact, the common cycle of failure and renewed effort that is so endemic to weight loss has been described as the “false hope syndrome,” in which patients mistakenly attribute their lack of success to either a failure of effort (low willpower) or a poorly-conceived diet. These faulty assumptions lead patients to fruitlessly search for “a better diet” or to vainly “work harder” the next time. The result is a vicious cycle of self-blame and weight cycling (AMA). Use targeted questions: • “ What is hard about managing your weight?” This open-ended empathic question readily acknowledges that weight control is difficult and conveys an interest for further understanding. • “ How does being overweight affect you?” This question probes the burden of obesity. Common answers refer to appearance, self-esteem and image, physical ailments, and quality-of-life issues. • “ What can’t you do now that you would like to do if you weighed less?” This question provides useful information regarding expectations and benchmarks for assessing progress. • “ What would you like to get out of this visit regarding your weight?” This question directly addresses patients’ expectations related to how you can assist them in weight management.
What kind of treatment is appropriate? Although dietary and physical activity management are the first line of treatment for many patients, pharmacotherapy, and surgery are appropriate at higher BMI’s.
What type of weight management goals should one have? A three-stage approach to weight management should be considered, depending on the patients’ risk status, abilities and desires, and the availability of resources. Stage 1: Prevention of further weight gain This should be considered for patients with low risk status who are currently prepared to make only minor behavior changes. Although prevention of weight gain still requires lifestyle modifications, it may appear less threatening and more achievable than setting weight loss goals. Stage 2: A reduction in body weight of 5% to 10% This should be considered for patients with low to moderate risk status who are committed to making specific behavior changes for weight loss. For most of these patients, a 5% to 10% weight loss is consistent with a loss of 1 to 2 lb/week over 6 months. Not only is this realistic and achievable, but a 10% weight loss can also significantly decrease the severity of obesity-associated risk factors. Stage 3: Maintenance of weight loss After attaining their goal weight, patients should continue lifestyle modifications for the long-term maintenance of their goal weight.
The Exchange diet was created by the American Dietetic Association and the American Diabetic Association as a treatment for diabetes and other chronic conditions. The diet is an easy way to monitor intake of carbohydrates, fat and protein as well as portion sizes. It is a balanced system with foods from each group and can be used indefinitely. It also works well in weight maintenance. For more information: http://www.nhlbi.nih.gov/health/public/heart/obesity/lose_wt/fd_exch.htm An example from the exchange list: Vegetables contain 25 calories and 5 grams of carbohydrate. One serving equals: 1/2 cup Cooked vegetables (carrots, broccoli, zucchini, cabbage, etc.), 1 cup Raw vegetables or salad greens, 1/2 cup Vegetable juice Fat-Free and Very Lowfat Milk contain 90 calories per serving. Very Lean Protein choices have 35 calories and 1 gram of fat per serving. Starches contain 15 grams of carbohydrate and 80 calories per serving.
Foods are within 6 categories. Within each group, these foods can be exchanged for each other. An example from the exchange list: Starches contain 15 grams of carbohydrate and 80 calories per serving. One serving equals: 1 slice Bread (white, pumpernickel, whole wheat, rye), 2 slice Reduced calorie or "lite" Bread, 1/4 (1 Ounce) Bagel (varies), ½ English muffin, ½ Hamburger bun Very Lean Protein choices have 35 calories and 1 gram of fat per serving. Lean Protein choices have 55 calories and 2-3 grams of fat per serving. Medium Fat Proteins have 75 calories and 5 grams of fat per serving. Vegetables contain 25 calories and 5 grams of carbohydrate. One serving equals: 1/2 cup Cooked vegetables (carrots, broccoli, zucchini, cabbage, etc.), 1 cup Raw vegetables or salad greens, 1/2 cup Vegetable juice Fruits contain 15 grams of carbohydrate and 60 calories. Fat-Free and Very Lowfat Milk contain 90 calories per serving. Fats contain 45 calories and 5 grams of fat per serving.
The number of exchanges used per day is determined by the total number of calories required by the individual. The number is different for each person and depends on that individual’s height, weight, and energy expenditure. The most accurate way to determine the number of exchanges needed is with the help of a registered dietitian, health professional, or a trained fitness professional .
The table shows the number of each food group at each calorie level. Skim milk is preferred at low calorie levels, while 2% milk is preferred at a higher calorie levels.
The rationale behind this plan is the use of a liquid formula or a packaged item with a fixed number of calories to replace a meal. By controlling portion sizes, fat and carbohydrate, a person can control calories. The replacement items are balanced and contain a mix of protein, carbohydrate and fat as well as other nutrients.
4 types of meal replacers: Powder mixes, Shakes, Bars, Prepackaged Meals The usual plan is to use a meal replacement for one or two meals a day while having sensible meals that combine lean meat, starch, vegetables, and fruit for the other meals during the day.
An intake of five fruits and vegetables is recommended. A meal replacement program is more effective for losing weight than a conventional, structured weight loss diet. Meal replacements offer a convenient, nutritionally balanced weight loss alternative to conventionally structured weight loss diets.
This is a recommended schedule for using meal replacers. Meal replacers are recommended for breakfast, if one meal, or breakfast and lunch if two meals, followed by a sensible dinner. It is recommended that people use fruits and vegetables for snacks.
The American College of Sports Medicine recommends that adults get 30-45 minutes of exercise three to five days each week, maintaining the intensity for the duration of the exercise Each session should contains a 5-10 minute warm up and cool down period If weight loss is a major goal, aerobic activity should last at least 30 minutes a day for five days each week.
Maintaining, gaining, and losing weight are tied to Energy Balance . Maintaining weight means that an energy balance has been reached. Positive energy balance leads to weight gain. Negative energy balance leads to weight loss. Physical activity and caloric intake balance each other out when an individual is at weight maintenance.
Exercise can build lean body mass , which burns more calories than fat. Walking, running and doing physical activity can burn two to three times more calories than a similar amount of time sitting. Weight loss similar to diet can be achieved by exercise alone. With exercise there is an improvement in overall physical fitness and a reduction in blood pressure. Exercise also improves maintenance of weight after weight loss.
For Weight Loss 150 to 200 minutes of moderate physical activity each week combined with a diet for weight loss can result in reduced body weight and fat. It is important not to compensate for the exercise calories with food . For Improved Health An exercise program with less than 150 minutes a week and lower intensity can result in improvement in cardio-respiratory fitness.
Aerobic exercise is any extended activity that makes the lungs and heart work harder while using the large muscle groups in the arms and legs at a regular, even pace. Aerobic activities help the heart grow stronger and more efficient. Aerobic activities use more calories than other activities. EXAMPLES Brisk walking Jogging Bicycling Swimming Aerobic dancing Racket sports Lawn mowing Ice or roller skating Using aerobic equipment (treadmill, stationary bike
Anaerobic activity is short bursts of very strenuous activity using large muscle groups (Ex: weight lifting, curls, power lifting). Helps build and tone muscles , but it does not benefit the heart or the lungs. During the anaerobic activity, glycogen (carbohydrate stored in muscle and liver) is used for energy and at the end of anaerobic activity, lactic acid is produced . This gives a burning sensation in the muscles.
VLCDs are commercially prepared formulas of 800 calories or less that replace all usual food intake. They are not the same as over-the-counter meal replacements, which are meant to be substituted for one or two meals a day. When used under proper medical supervision, they effectively produce significant short-term weight loss in moderately to severely obese patients. VLCD are prescribed and supervised by a medical doctor.
Generally safe when used under proper medical supervision in patients with a BMI greater than 30 Use of VLCD in patients with a BMI of 27 to 30 should be reserved for those who have medical complications resulting from their obesity. Not recommended for pregnant or breastfeeding women Not appropriate for children or adolescents, unless in specialized treatment programs Generally not recommended for usage in older individuals because of the potential of side effects caused by preexisting conditions
Widely used strategy for weight loss in overweight and obese individuals Based on adjusting energy balance to lower than before to meet ideal body weight calorie needs Individual treatment or Group Format (Ideally should be about 18-24 weeks for adequate support and formulating new habits) One of the most successful ways of treating obese individuals to lose weight with significant chance of them being able to maintain their weight loss
Groups offer Social support which is important in teaching new skills in social situations integration into social network and positive interactions with others. Individual feels support, acceptance, and encouragement by others. It is the social support that makes some of the better weight loss programs work.
Long-term lifestyle changes require more than simply watching what one eats and how much one exercises. It requires changing one’s approach (thinking, feelings, and actions) to eating and physical activity. A key component to any weight loss approach. Results in losing about 1 pound a week . Average weight loss is about 20 pounds after six months.
Weight is a result of total energy intake minus total energy expenditure. Total energy intake is all the food we consume and activity is every activity from waking until we go to sleep, and including sleep. We can modify what we eat (type of food, food preparation, portion sizes) and we can modify our activity level (whether or not we exercise).
Important Components of Behavior Therapy are 1. making lifestyle change a priority and 2. establishing a plan for success. . Making Lifestyle Change a Priority Making changes to last a lifetime is a difficult thing to do. Important to make health a top priority. It is impossible to be successful unless it is a priority. It cannot be a secondary thing in one’s life. Establishing a Plan for Success Determine diet and exercise plan prior to beginning, set a start date, and consider barriers that may make it difficult to reach goals. It is important to have a plan and dates for determining success towards goals, otherwise it will not happen. The plan must be written down.
Setting Goals Setting goals for calories, fat, physical activity and other modifiable behaviors. Targets a short-term goal of losing 1 to 2 pounds of weight a week, and establishes the caloric intake and exercise amounts needed to reach this goal. Effective goals are chosen that are: specific, attainable, and realistic (walk 30 minutes five times a week, eat 5 servings of fruits and vegetables). To reach a long-term goal, complete a series of smaller steps that get closer to the ultimate prize.
. Keeping Track of Eating and Exercising Tracking is used to raise awareness of behavior patterns and to identify faulty eating and activity patterns. Self monitoring involves observing and recording all eating and exercise behaviors, and monitoring weight. Self-monitoring records can help catch “slips” that may cause weight to creep back up. In the most basic form, individuals record time, activating event, place and quantity of eating, and activity behaviors.
Avoiding a Food Chain Reaction Stimulus control techniques are used to modify environment influences that affect eating or activity patterns. This involves learning what cues in life seem to encourage undesired eating and then taking charge to change those cues.
Techniques that help people conquer their eating triggers include: eating regular meals without skipping eating at the same time and place changing serving and food storage techniques (use smaller plates to make portions look bigger) keeping accessible food out of sight eating only when hungry avoiding activities that encourage eating (like watching television).
Changing Eating and Activity Patterns Techniques used to modify faulty eating behaviors that may interfere with feeling full or lead to overeating include: slowing pace of eating reducing portion sizes measuring food intake leaving food on plate improving food choices eliminating second servings
Changing Eating and Activity Patterns Exercise can be categorized as either programmed (regularly scheduled times of physical activity for a determined amount of time and intensity) or lifestyle (increasing energy expenditure throughout the day). Lifestyle activity has been associated with weight loss in several studies, and it provides a great alternative for the person who hates to exercise.
Contingency Management Positive reinforcement (reward) is used to stabilize and increase the maintenance of new eating and activity patterns. An effective reward is one that is immediate, desirable, and given based on meeting a specific goal. Rewards can be tangible (a new CD) or intangible (taking time off); however, efforts should be made to eliminate all rewards in the form of food.
Cognitive Behavioral Strategies Cognitive behavioral strategies combine the traditional behavioral treatment components with emphasis on thinking patterns that may affect eating behaviors. The goal of these strategies is to alter mood, unhelpful beliefs, unrealistic standards, and negative evaluations that affect eating patterns
Stress Management Stress is a primary predictor of overeating and relapse. Stress management skills include progressive muscle relaxation, diaphragmatic breathing and meditation. The goal of stress management is to reduce arousal and provide distraction from stressful events.
Drug treatment of obesity is indicated when: BMI is greater than 30 BMI is higher than 27 and there are other cardiovascular complications When someone has attempted weight loss by diet but After several attempts diet alone is not enough Cardiovascular complications include : Hypertension, Dyslipidemia, Coronary Heart Disease, Type 2 Diabetes, and Sleep Apnea
These are commonly used drugs to treat obesity currently: Phentermine Sibutramine Orlistat. All of these drugs have side effects.
Brand names of Phentermine are: Adipex-P, Obenix, Oby-Trim Most commonly prescribed medication for weight loss. Phentermine works by increasing the release of norepinephrine, a neurotransmitter in the brain that decreases appetite. Phentermine has stimulant properties, and it may cause high blood pressure or irregular heat beats.
Sibutramine brand name is Meridia. It is a widely used weight loss drug. Sibutramine induces weight loss primarily through its effects on food intake and to a lesser degree through its effect on metabolic rate. Sibutramine affects serotonin and norepinephrine metabolism in the brain by stimulating satiety at the appetite centers in the brain. Sibutramine use may increase heart rate and blood pressure. Regular blood pressure checkups are encouraged. Sibutramine is not recommended for someone with uncontrolled hypertension, tachycardia, or serious heart, liver, or kidney disease.
Orlistat is actually available over the counter as Alli. The Brand name is Xenical Orlistat prevents the digestion of dietary fat. It inactivates an enzyme that is involved with fat digestion called lipase, and about 30 percent less fat is absorbed. There may be oily or fatty stools, an increased frequency of bowel movements, and inability to control bowel movements. Because less fat is absorbed, there is improvement in blood lipids. Since less fat is absorbed, a person may become deficient in fat-soluble vitamins A, D, E, and K during the treatment and a multivitamin supplement is recommended.
Criteria used for surgical treatment : BMI is 40 or higher. (This is about 100 pounds overweight for men and 80 pounds for women). BMI of 35-39.9 and a serious obesity-related health problem such as : Type 2 diabetes, hypertension, heart disease, or sleep apnea (when breathing stops for short periods during sleep). Gastrointestinal surgery is an option for people who are severely obese and cannot lose weight by traditional means or who suffer from serious obesity-related health problems. The operation promotes weight loss by restricting food intake and, in some operations, by interrupting the digestive process.
Types of GI surgeries available: Restrictive Malabsorptive Combined restrictive/malabsorptive
Purely restrictive operations only limit food intake and do not interfere with the normal digestive process . At first, the pouch,which the doctors create at the top of the stomach, holds about 1 ounce of food and later may stretch to 2-3 ounces. The lower outlet of the pouch is usually about ½ inch in diameter or smaller. This small outlet delays the emptying of food from the pouch into the larger part of the stomach and causes a feeling of fullness
Types of restrictive operations available are: Adjustable gastric banding. A clamp is placed at the upper part of the stomach to create a small pouch. The band can be tightened or loosened over time to change the size of the passage by increasing or decreasing the amount of salt solution which inflates the band. This type of surgery is reversible because nothing is removed or cut and the band can be removed.
Another type of restrictive operation is Vertical banded gastroplasty. This also creates a small pouch with a band and staples. It was used in the early phases of bariatric surgeries, but is not used a lot today because of complications such as infection from the staples.
The benefits of restrictive operations are that they are: Generally safer than malabsorptive procedures. Adjustable gastric banding is generally done via laparoscopy allowing for smaller incisions, less tissue damage, shorter operation time and hospital stay. Surgeries can be reversed if necessary. Result in few nutritional deficiencies.
Disadvantages of restrictive operations are: Patients generally lose less weight than patients undergoing malabsorptive procedures. Some patients regain weight by eating high calorie soft foods that easily pass through the opening to the stomach. Others are unable to change their eating habits and do not lose much weight. Successful results depend on the patient’s willingness to adopt a long-term plan of healthy eating and regular physical activity.
Some of the risks of restrictive operations are: Vomiting, which occurs when the patient eats too much or when the narrow passage into the larger part of the stomach is blocked. Common risk of adjustable gastric banding is breaks in the tubing between the band and the access port, requiring another operation to repair. Between 15-20% of vertical banded gastroplasty patients may have to undergo a second operation for a problem related to the procedure. These risks need to be taken into account by any individual considering the surgery!
Restrict both food intake and the amount of calories and nutrients the body absorbs. Roux-en-Y gastric bypass (RGB) A small pouch is created to restrict food intake. A section of the small intestine is then attached to the pouch allowing for food to bypass both the large portion of the stomach, the duodenum, and the first part of the jejunum.
Biliopancreatic diversion (BPD) The lower portion of the stomach is removed and the small pouch that remains is connected directly to the final segment of the small intestine completely bypassing the duodenum and the jejunum Although this procedure leads to weight loss, it is used less often than other types of operations because of the high risk for nutritional deficiencies.
The advantages of the combined operation are rapid weight loss continues 18-24 months after procedure. With Roux-en-Y procedure, many patients maintain a weight loss of 60-70% of their excess weight for 10 years or more. With bilopancreatic diversion, there has been reported an average weight loss of 75-80% of excess weight. May be more effective at improving health problems associated with severe obesity because of the greater weight losses observed when compared to just restrictive surgeries.
Some of the disadvantages of the combined surgeries are: More difficult to perform than restrictive surgeries. More likely to result in long-term nutritional deficiencies. Decreased absorption of iron and calcium since the duodenum and jejunum are bypassed from the surgery. Patients undergoing BPD operation require fat soluble vitamin supplementation and life-long use of special foods and medications. Dumping syndrome is likely to occur with these procedures after ingestion of a meal high in simple carbohydrates. Nausea, bloating, abdominal pain, weakness, sweating, faintness, and sometimes diarrhea are observed with dumping syndrome.
Some of the risks of combined operations are: More likely to lead to complications than the restrictive surgeries. Greater risk than restrictive operations for abdominal hernias (up to 28%), which require a follow up to correct. The risk of death associated with these procedures is less than 1% for gastric bypass and around 2.5-5% in biliopancreatic diversion with duodenal switch operation.
In terms of cost, it varies from state to state and from hospital to hospital. Insurance coverage as well varies among carriers. The procedure is expensive and results in complete change in life. The person has to be very regimented with supplement intake for the rest of his or her life.
The patient should consider the following questions prior to weight loss surgery: Are you unlikely to lose weight or keep weight off long-term with non-surgical measures? Are you well informed about the surgical procedure and the effects of treatment? Are you determined to lose weight and improve your health?