Most Common Surgical Treatments for Clinically Severe Obesity

The obesity epidemic continues to grow in our country, and with obesity comes a whole host of additional health risks, like type 2 diabetes, heart disease, high blood pressure, osteoarthritis and stroke. Those looking to reduce these obesity-related health risks are turning to bariatric or medical weight-loss surgeries like gastric bypass.

With weight-loss surgery, your surgeon makes changes to your stomach or small intestine, or both. The procedure resolves diabetes 80 percent of the time, and patients lose an average of 70 percent of extra weight. However, gastric bypass isn’t the only choice. Learn about your options:

Laparoscopic Adjustable Gastric Band – The surgeon puts a small band around the top of your stomach. The band has a small balloon inside it that controls how tight or loose the band is. The band limits how much food can go into your stomach. This surgery is done using a laparoscope. Advantages include:

  • Minimally invasive with small incisions
  • Short hospital stay
  • Adjustable without additional surgery
  • Can support pregnancy
  • Removable at any time

Laparoscopic Gastric Sleeve – This surgery removes most of the stomach and leaves only a narrow section of the upper part of the stomach, called a gastric sleeve. The surgery may also curb the hunger hormone ghrelin, so you eat less. Advantages include:

  • No cutting, bypassing, or stapling of the intestine
  • Little concern about vitamin and calcium absorption
  • No adjustments or artificial devices put into place
  • Most foods are possible

Laparoscopic Roux-en-Y Gastric Bypass Surgery – The surgeon leaves only a very small part of the stomach (called the pouch). That pouch can’t hold a lot of food, so you eat less. The food you eat bypasses the rest of the stomach, going straight from the pouch to your small intestine. This surgery can often be done through several small incisions using a camera to see inside (laparoscope). Doctors can also perform a mini-gastric bypass, which is a similar procedure also done through a laparoscope. Advantages include:

  • Tiny incisions, resulting is less scarring and easier healing
  • Excellent cosmetic result
  • Little pain
  • Few wound complications
  • Fast recovery
  • Short hospital stay
  • Resuming physical activity soon
  • Little risk of hernia formation

Duodenal Switch- This is complicated surgery that removes most of the stomach and uses a gastric sleeve to bypass most of your small intestine. It limits how much you can eat. It also means your body doesn’t get as much of a chance to absorb nutrients from your food, which could mean you don’t get enough of the vitamins and minerals you need. Advantages include:

  • Results in greater weight loss than other methods, i.e. 60 – 70% percent excess weight loss or greater, at 5 year follow up
  • Allows patients to eventually eat near normal meals
  • Reduces the absorption of fat by 70 percent or more
  • Causes favorable changes in gut hormones to reduce appetite and improve satiety
  • Is the most effective against diabetes compared to other methods

If you’re considering bariatric surgery, schedule an appointment with Dr. Shawn Tsuda. He can help you decide which, if any, of these treatments is right for your unique situation.Fat man running

 

Gastric Bypass for a Longer Life

According to research by the Geisinger Health System, one of the largest health service organizations in the U.S., patients with severe obesity who have gastric bypass surgery reduce their risk of dying from obesity and other diseases by 48% up to 10 years after surgery, compared to similar patients who do not undergo the procedure. This is significant considering that the American Society for Metabolic and Bariatric Surgery estimates about 24 million Americans have severe obesity, which would mean a BMI of 35 or more with an obesity-related condition like diabetes or a BMI of 40.

Researchers from the Geisinger Health System followed nearly 2,700 patients who had gastric bypass at the system’s nationally accredited bariatric surgery center between 2004 and 2014. Mortality benefits began to emerge within two years after surgery and were significant within four years. The biggest reduction in risk occurred in patients 60 years or older at the time of surgery and in patients who had diabetes before surgery.

“The long-term survival benefits these older patients and those with diabetes experience likely relate to improvements in long-term metabolic and cardiovascular health, among other risk factors,” said Michelle R. Lent, Ph.D., a Geisinger Obesity Institute researcher. “While this study did not evaluate specific-cause mortality, as expected, we did find significant improvements or remission in diabetes and high blood pressure.”

In the study, more than 60 percent of patients with diabetes before surgery experienced diabetes remission about five years after surgery. Previous studies have shown death from heart disease and even certain cancers are lower in gastric bypass patients than patients with severe obesity who do not have the operation.

People with obesity and severe obesity have higher rates of heart disease, diabetes, some cancers, arthritis, sleep apnea, high blood pressure and dozens of other diseases and conditions. Studies have shown individuals with a BMI greater than 30 have a 50 to 100 percent greater risk of premature death compared to healthy weight individuals.Live Longer

If you live in the Las Vegas area and are interested in learning what bariatric surgery can do for you, schedule an appointment with Dr. Shawn Tsuda. He and his team of experts can help you choose the best treatment for your unique situation.

 

Obesity: The Disease that Keeps on Growing

A number of studies have shown that individuals who are obese are often stereotyped as “lazy” or “lacking in willpower.” However, obesity is no longer considered a cosmetic issue that is caused by overeating and a lack of self-control. The World Health Organization (W.H.O.), along with National and International medical and scientific societies, now recognize obesity as a chronic progressive disease resulting from multiple environmental and genetic factors.

In the United States, epidemiological data from a study that measured the actual body size of thousands of Americans, showed that 34 percent of adults more than 20 years old are affected by obesity and 68 percent are overweight (2007-2008 data). Obesity affected 10 percent of children between two and five years of age, 2 percent of those between 6 to 11 years old, and 18 percent of adolescents.

Throughout the last 3 decades, the prevalence of obesity has been increasing at an alarming rate. Since 1985, the Center for Disease Control (CDC) has supported an ongoing study, conducted on a yearly basis by state health departments, to examine changes in obesity prevalence state-to-state, and has found the following:

  • In 1990, the obesity prevalence for most of the states was 10 percent or less.
  • By 1995, more than half the states had a prevalence of 15 percent.
  • By 2000, nearly half the states had a prevalence of 20 percent or higher.
  • Five years later (2005), all but three states had a prevalence greater than 20 percent and nearly a third had a prevalence of 25 percent or more.
  • By 2010, the data show that most of U.S. states had a prevalence of 25 percent and many had a prevalence of 30 percent or higher.

Obesity is considered a multifactorial disease with a strong genetic component. Acting upon a genetic background are a number of hormonal, metabolic, psychological, cultural and behavioral factors that promote fat accumulation and weight gain.

Many other conditions associated with obesity contribute to the progression of the AdobeStock_69574863 (2).jpgdisease. Obesity reduces mobility and the number of calories that would be burned in the performance of activity. Weight gain may also cause psychological or emotional distress which, in turn, produces hormonal changes that may cause further weight gain by stimulating appetite and by increasing fat uptake into fat storage depots.

Sleep duration is reduced by weight gain due to a number of conditions that impair sleep quality such as pain, sleep apnea and other breathing problems, a need to urinate more frequently, use of certain medications, and altered regulation of body temperature. Shortened sleep duration, in turn, produces certain hormones that both stimulate appetite and increase the uptake of fat into fat storage depots.

Weight gain also contributes to the development of other diseases such as hypertension, diabetes, heart disease, osteoarthritis and depression, and these conditions are often treated with medications that contribute to even further weight gain. In all of these ways and more, obesity ’begets’ obesity, trapping the individual in a vicious weight gain cycle.

Multiple factors acting upon a genetic background cause weight gain and obesity. Conditions associated with weight gain and biological changes in the body that occur as a result of weight gain contribute to progression of the disease, often trapping the individual in a vicious weight gain cycle. Obesity is a complex disease influenced by several issues, including genetic, physiological, environmental, and behavioral.

If you live in the Las Vegas area and are concerned about your weight, schedule an appointment with Dr. Shawn Tsuda to learn more about how to improve your weight and health.

 

Get the Facts about Bariatric Surgery

Bariatric surgery is an option that many obesity medicine specialists say is too often ignored or dismissed. Yet it is the only option that almost always works to help very heavy people lose a lot of weight. Weight-loss surgery can also make some chronic conditions vanish entirely.

Here are some facts about bariatric surgery and what it does:

  • Twenty-four million, Americans are eligible for bariatric surgery according to the American Society for Metabolic and Bariatric Surgery. The criteria are a body mass index (BMI) above 40, or a BMI of at least 35 along with other medical conditions like diabetes, hypertension, sleep apnea, or acid reflux.
  • Fewer than 200,000 have the surgery each year.
  • There are four surgical types in use today. The two most popular procedures are the Roux-en-Y gastric bypass and the gastric sleeve. Both make the stomach smaller. The bypass also reroutes the small intestine. A simpler procedure, the gastric band, is less effective and has fallen out of favor. And a much more drastic operation, the biliopancreatic diversion with duodenal switch, which bypasses a large part of the small intestine, is rarely used because it has higher mortality and complication rates.
  • The average cost of a sleeve gastrectomy is $16,000 to $19,000, and the average cost of a gastric bypass is $20,000 to $25,000. Most insurance plans cover the cost for patients who qualify, though some plans require that patients try dieting for a certain amount of time first.
  • Bariatric surgery is not a magic bullet that will solve all of your weight-related problems. Leading a healthy lifestyle full of healthy foods and exercise post surgery is crucial.

If you live in the Las Vegas area, have a BMI above 40 or any of the other conditions mentioned above, schedule a consultation with Dr. Shawn Tsuda. He and his expert team can help you find the treatment that’s right for you.

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Weighty Misperceptions

People generally assume that obesity is strictly a matter of personal choices, the product of bad choices about physical activity and diet. That kind of thinking gets in the way of actually dealing with obesity as a health condition.

Obesity is a very complicated condition. About 50 to 70% of one’s risk of obesity is genetically determined. You can make choices that make it better or worse, but that’s just like any other chronic disease. When the blame and shame that is so common gets in the way, it makes it hard to actually improve the health of people living with obesity.

A lot of health plans have had broad, blanket exclusions for obesity, thinking that it is a cosmetic condition. However, the rise in the prevalence of obesity that’s happened over the last 3 decades has made it clear that it’s creating a burden of chronic disease ranging from cardiovascular disease to diabetes to many cancers.

Because weight-based stereotypes and prejudice so often emerge from attributions that obesity is caused and maintained by personal characteristics such as laziness or lack of willpower, there is a clear need for increased public awareness and education about the complex biology of obesity and the significant obstacles present in efforts to achieve sustainable weight loss. The prevailing societal and media messages that reinforce blame on obese persons need to be replaced with messages that obesity is a chronic disease with a complex etiology, and is a lifelong condition for most obese persons.

A number of studies have consistently demonstrated that experiencing weight stigma a fat man with a big belly holding scalesincreases the likelihood of engaging in unhealthy eating behaviors and lower levels of physical activity, both of which exacerbate obesity and weight gain. Among youths, several studies have demonstrated that overweight children who experience weight-based teasing are more likely to engage in binge-eating and unhealthy weight control behaviors compared with overweight peers who are not teased, even after control for variables such as BMI and socioeconomic status. Other research has consistently documented a positive association between weight-based victimization and eating disorder symptoms and bulimia. Weight-based victimization among overweight youths has been linked to lower levels of physical activity, negative attitudes about sports, and lower participation in physical activity among overweight students.

If you’re looking for treatment for this very real, physical disease, contact Dr. Shawn Tsuda for an appointment. Our expert team understands the complexity of obesity and all of the issues that come with it. We can help find the right treatment for you.

 

Denial is Not a River in Egypt – Do you Acknowledge your Obesity?

According to the Centers for Disease Control and Prevention (CDC), more Americans than ever are overweight. However, according to some new Gallup data, far fewer of us actually think we’re overweight

In recent years, the gap between how overweight we think we are and how overweight we are is wider than it’s ever been. In 1990, about 56% of Americans qualified as obese or overweight, according to the CDC. Back then, we were pretty honest with ourselves about the state of our waistlines, although we fudged it just a bit — 48% considered themselves “very” or “somewhat” overweight, according to Gallup.

Over the years, however, that eight-point gap between perception and reality has ballooned along with our waistlines. Today, 7 in 10 Americans are obese or overweight, but only 36% think they have a weight problem.

In 1990, for instance, the typical American man weighed 180 pounds and said his ideal weight was about 171. Today that man has gained 14 pounds, and his ideal weight has moved up with it. The typical man now says he’d like to weight about as much as the average man in 1990 actually did weigh. You see a similar effect happening among women, although in this case the gap between actual and ideal weight is even wider — close to 20 pounds in 2016.

State and federal policymakers have tried to tackle the obesity epidemic with limited success, to say the least. Perhaps the most well-known recent program is Michelle Obama’s Let’s Move! initiative aimed at ending childhood obesity.

Some critics of these programs have argued that they don’t work because overweight people already know they’re overweight, and they know that being overweight is bad for your health. Federal efforts to raise awareness of, say, the negative health consequences of being overweight don’t do much good if everyone knows that being fat is bad for you. Taken together, the Gallup and CDC data suggest a different mechanism at work: Anti-obesity efforts might not be working because roughly half of overweight people don’t actually realize they’re overweight.

 
If you are not one of those in denial and are seeking treatment for obesity and the conditions that go along with it, schedule an appointment with Dr. Shawn Tsuda. He and his team of experts can help find the right treatment for you.AdobeStock_94497217.jpeg

 

 

 

Exercise and its Role in Treating Obesity

Obesity — everyone knows it’s bad and that it’s everywhere. Nearly 78 million adults and 13 million children in the United States deal with the health and emotional effects of obesity every day. The solution to the problem sounds deceptively simple; take in fewer calories a day, while energizing the calorie-burning process with regular exercise. Unfortunately, it’s not that easy.

Exercise is an essential part of any weight-loss program and should become a permanent part of your lifestyle. The benefits of exercise can include:

  • burning off calories and losing weight
  • maintaining muscle tone
  • increasing metabolic rate (the amount of calories the body burns 24 hours a day)
  • improving circulation
  • improving heart and lung function
  • increasing sense of self-control
  • reducing level of stress
  • increasing ability to concentrate
  • improving appearance
  • reducing depression
  • suppressing appetite
  • helping one sleep better
  • preventing diabetes, high blood pressure, and high cholesterol
  • decreasing risk of some cancers, such as breast, ovary, and colon cancer.

To gradually increase your physical activity, your doctor may suggest that you:

  • Walk every day.
  • Take the stairs instead of the elevator.
  • Do errands on foot, if possible. If you need to drive, park farther away, and walk to your destination.
  • Go to a spa, gym, or exercise class. Water aerobic classes are especially good if you have back, knee, or joint problems.
  • Do some form of strength training using gym equipment or your own body weight. In addition to making your muscles stronger and able to work longer without getting tired, strength training helps you burn more energy when you are at rest. Muscle mass burns more calories than fat, so as muscle increases so does the ability to burn calories.

To maintain an exercise program, follow these guidelines:

  • Avoid setting your expectations too high. Start out slowly and build your stamina gradually.
  • Find a friend to exercise with.
  • Avoid being competitive. Try to improve on your last effort instead of compAdobeStock_89524788 (2).jpgaring yourself with someone else.
  • Recover completely from illness before resuming exercise. Then start with less exercise and increase the amount you do gradually to avoid injury.
  • Remember that exercise needs to be continued throughout your life.

If you live in the Las Vegas area and are looking for long-term answers for potentially life-threatening obesity, schedule an appointment with Dr. Shawn Tsuda. He and his team of experts can find the right treatment for you.