Defining Obesity

To define what obesity means today, we can’t count on a dictionary. However, since obesity has become a growing national health problem in the U.S., it has perhaps never been more important that we have a working definition that we can all agree on.

In order to understand how someone is categorized as overweight or obese, the world’s health organizations have adopted the use of body mass index (BMI) to classify and communicate about body weight. BMI is a widely recognized weight-for-height index.

Unfortunately, this index does not quantify total body fat or convey information concerning regional distribution of fat — both of which are key to how obesity affects health. Nonetheless, BMI is an easily obtained measure that has been recommended for use in all age groups. Most clinical studies assessing the health effects of overweight and obesity rely on BMI.

Currently, the National Institutes of Health and the World Health Organization use the same measures of BMI for defining overweight. obese-3011213__340 (2)

  • If BMI is 25.0 to <30, it falls within the overweight range.
  • If BMI is 30.0 or higher, it falls within the obese range.

Since BMI describes body weight relative to height, it correlates strongly (in adults) with total body fat content. However, some very muscular people may have a high BMI without undue health risks.

Obesity is often from a combination of factors, based on both genetics and behavior. Accordingly, treating obesity usually requires more than just dietary changes.

Being overweight is a significant contributor to health problems. It increases the risk of developing a number of diseases including:

  • Type 2 diabetes
  • High blood pressure
  • Stroke
  • Heart attack
  • Congestive heart failure
  • Cancer (certain forms such as cancer of the prostate and cancer of the colon and rectum)
  • Gallstones and gall bladder disease
  • Gout and arthritis
  • Osteoarthritis (degenerative arthritis) of the knees, hips, and the lower back
  • Sleep apnea

Ideally, health-oriented definitions of overweight and obesity should be used that are based on the amount of excess body fat that puts an individual at a higher risk for health problems. Unfortunately, no such definition currently exists. Health risks associated with increasing weight are part of a continuum. People can have weight-associated health problems at BMIs lower than 25, and others can have no identifiable health problems at BMIs significantly greater than 25.

Easily determine your BMI with this free calculator:

If you’re interested in bariatric surgery, schedule an appointment with us. Our team of experts can find the right treatment for you.


The Role of Genes in Obesity

Genes influence every aspect of human development, physiology, and adaptation, and research shows that genetics also play a role in obesity. However, we still know relatively little when it comes to which specific genes contribute to obesity. Nor do we know the importance of the complex interplay between our genetic makeup and our life experiences.

Obesity Word DNA Strand Medical Research Fat HereditaryWhat we do know is that genes do not always predict one’s future health. Genes and behavior probably are both needed for a person to be overweight. In some cases, various genes may increase one’s susceptibility for obesity and require outside factors such as plentiful food supply or not enough physical activity.

It’s well established that overweight and the different forms of obesity are conditions tending to center within a family. A person with a family history has a two to eight times higher risk than a person with no family history of obesity, and even higher risk is observed in cases of severe obesity.

The most common forms of obesity are probably the result of variations within a large number of genes. Sequence variations within a pool of 56 different genes have been reported as being related to obesity; however, only ten of those genes showed positive results in at least five different studies.

Any attempt to explain the obesity epidemic has to consider both genetics and how (the environment) one lives as well. One explanation that is often cited is that the same genes that helped our ancestors survive occasional famines are now being challenged by environments in which food is plentiful year-round.

As of now, genetic tests are not useful for directing personal diet or physical activity regimens. Studies on genetic variation affecting response to changes in diet and physical activity are still at an early stage. It stands to reason that doing a better job of explaining obesity in terms of genes and environmental factors could help encourage people who are trying to achieve and maintain a healthy weight.

Obesity is a serious public health problem because it is associated with some of the leading causes of death in the U.S. and worldwide, including diabetes, heart disease, stroke, and some types of cancer, but unfortunately, families can’t change their genes. They can, however, change the family environment to encourage healthier eating habits and more physical activity. Those changes can improve the health of family members and the family health history of the next generation.

If you live in the Las Vegas area and are interested in weight-loss surgery, schedule a consultation at VIP Surg.

Tips for Finding the Right Surgeon for You

Almost any surgery can cause serious complications, so you always want to be in good surgical hands. With so many doctors, how do you know which is the right surgeon for you?

One indicator to note is how often surgeons perform a procedure. That can be vital for operations that are relatively new, such as gastric bypass surgery for treating obesity. While many surgeons have started performing the operation, not all are qualified. A September 2009 study found that the risk of serious complications from the most common form of gastric bypass surgery fell by 10 percent for every additional 10 cases per year the surgeon had performed.

However, quantity isn’t the only or even most important measure of quality. A May 2009 study of 81,289 adults who had heart bypass surgery, for example, found that success depended more on how well surgeons and hospitals adhered to various markers of surgical excellence—such as using the appropriate technique during the operation and prescribing the right medications before and afterward—than the number of procedures performed.

Don’t be afraid to question your doctor. Ask your prospective surgeon these questions before going under the knife:

  • Is surgery really necessary? The best way to avoid surgical errors is to avoid surgery entirely, so ask about the effectiveness and safety of alternatives. Compare those with the risks of surgery and the chance that it will help you.
  • Is your board certification up to date? Look for a surgeon who has undergone the necessary training, even after being in clinical practice, to maintain board certification in his or her specialty.
  • What’s your experience? Ask how many operations the surgeon has performed in the past year and how that compares with his or her peers. You don’t have to find the busiest, most experienced surgeon in North America, but it’s important to avoid the doctor who does very few of the procedures, especially in a place that does very few.
  • What are your success, failure, and complication rates? Not all will be able or willing to tell you, but the good ones should be.
  • What’s the hospital’s infection rate? Seventeen states now make that information public, and many hospitals report their rates voluntarily.

doctor-650534_960_720Just remember to worry less about bedside manner and more about the final outcome. If you have to choose between a nice surgeon and a highly skilled surgeon, the skilled surgeon is the better bet.

If you live in the Las Vegas area and are looking for a surgeon who is both compassionate and highly skilled, Dr. Tsuda at VIP Surg is everything you’re searching for. Whether you have general surgery needs or are interested in bariatric surgery, he and his team of experts have the experience and skill for you to have an excellent outcome.

Robotic Surgery Explained

Screen Shot 2017-10-10 at 12.35.38 PMRobotic surgery is a type of minimally invasive surgery. “Minimally invasive” means that instead of operating on patients through large incisions, we use miniaturized surgical instruments that fit through a series of quarter-inch incisions. When performing surgery with the da Vinci Si—the world’s most advanced surgical robot—these miniaturized instruments are mounted on three separate robotic arms, allowing the surgeon maximum range of motion and precision. The da Vinci’s fourth arm contains a magnified high-definition 3-D camera that guides the surgeon during the procedure.

The surgeon controls these instruments and the camera from a console located in the operating room. Placing his fingers into the master controls, he is able to operate all four arms of the da Vinci simultaneously while looking through a stereoscopic high-definition monitor that literally places him inside the patient, giving him a better, more detailed 3-D view of the operating site than the human eye can provide. Every movement he makes with the master controls is replicated precisely by the robot. When necessary, the surgeon can even change the scale of the robot’s movements: If he selects a three-to-one scale, the tip of the robot’s arm will move just one inch for every three inches the surgeon’s hand moves. And because of the console’s design, the surgeon’s eyes and hands are always perfectly aligned with his view of the surgical site, minimizing surgeon fatigue.

The ultimate effect is to give the surgeon unprecedented control in a minimally invasive environment. Utilizing this advanced technology, surgeons are able to perform a growing number of complex surgical procedures. Since these procedures can now be performed through very small incisions, patients experience a number of benefits compared to open surgery, including:

  • Less trauma on the body
  • Minimal scarring
  • Faster recovery times

If you’re facing general or bariatric surgery in the Las Vegas area, contact VIP SURG to learn about how we can help. Drs. Tsuda and Ryan specialize in minimally invasive procedures and are experts in robotic surgery. Call for a consultation at 702-487-6000.

Exercise: How Much is Enough?

Our bodies were meant to move — they actually crave exercise. As a matter of fact, regular exercise is necessary for physical fitness and good health. It reduces the risk of heart disease, cancer, high blood pressure, diabetes and other diseases, and it can improve your appearance and delay the aging process. So why aren’t we all doing it?

Many say lack of time is their single biggest obstacle to fitness, but experts say you may be overestimating how much exercise you really need to get at one time. Many think exercise means you have to hit the point where you’re completely out of breath and panting after you’ve finished, and you can do that, but for the majority of health benefits, it’s not necessary.

People often assume that more is better. On the contrary; doing too much too soon or performing intense exercises on a daily basis can have harmful effects, such as muscle/tendon strains, loss of lean tissue, and fitness-level plateaus. However, if you don’t exercise at all, your muscles will become flabby and weak, your heart and lungs won’t function efficiently, and your joints will be stiff and easily injured.

If you are overweight or obese, your fitness goals probably go beyond lowering your risk for disease, but even if losing weight is your primary goal, it’s nice to know what research actually shows when it comes to how much exercise you should be doing each week for better health.

Here are a few statistics to consider:

  • 30 minutes of interval training per week (broken into 3 workouts) reduces the risk of type 2 diabetes.
  • 150 minutes of moderate exercise per week reduces the risk of cancer.
  • 120 minutes of moderate aerobic exercise per week offers improvements in memory.

People seem to have heard the message that you need 30 minutes of exercise, five days a Exercise tracking device Dollarphotoclub_101019544 (2)week according to federal guidelines. If you get that, you’ll get 85% of the health benefits we talk about. However, the misconception is that it’s all or nothing. It’s also important to note that federal guidelines call for moderate-intensity exercise, which means you don’t have to be killing yourself with long runs, boot camp, or spin class five days a week in order to relish the rewards. Being consistent with exercise is probably the most important factor in achieving desired results.

If you’re obese and looking for ways to get fit and lower your risk of disease, schedule an appointment at VIP SURG. We can help you find the right treatment.

Gallstones and Gallbladder Disease

Some people think of their gallbladder as being “expendable”. Not that anybody wants any of their organs to be removed, but since many people live a seemingly normal life after getting their gallbladder removed, many people don’t think their gallbladder plays an important role in their overall health. After all, how important can your gallbladder be if you can do just fine after it’s surgically removed? The gallbladder actually plays a very important role in your body. It is an essential part of the digestive system.

In the United States, about a million new cases of gallstone disease are diagnosed each year, and some 800,000 operations are performed to treat gallstones, making it the most common gastrointestinal disorder requiring hospitalization. Gallstones or gallbladder disease can quickly turn a great meal into a period of misery.

Gallstone disease is the most common disorder affecting the body’s biliary system, the network of organs and ducts that create, transport, store, and release bile. Bile is a thick fluid, made in the liver and stored in the gallbladder, which acts in the small intestine to digest fat. Bile contains cholesterol, water, proteins, bilirubin (a breakdown product from blood cells), bile salts (the chemicals necessary to digest fat), and small amounts of copper or other materials. If the chemical balance of bile contains too much of any of these components, particularly of cholesterol, crystals form and can harden into stones.

Bile is stored in the Gallbladder and is concentrated up to five times by the removal of water. Gallstones form when liquid stored in the gallbladder hardens into pieces of stone-like material. Bile contains water, cholesterol, bilirubin and other substances. Ideally these minerals remain in liquid form until they are passed out of the body. However, excessive amounts of these minerals in bile can cause them to crystallize.

These small crystals that form out of the saturated bile may begin to clump together. Any existing crystals makes it easier for other crystals to form. If they stay in the gallbladder too long, the crystals gradually grow larger until they become a gallstone so large that it cannot pass through the biliary ducts.

In terms of size, gallstones can be as small as a grain of sand or as large as a golf ball. A person can form one large stone in his or her gallbladder, or hundreds! About 10 percent of the population has gallstones, but the vast majority experiences no symptoms and need no treatment. However, in 1 percent to 2 percent of these people, gallstones can cause problems by lodging in bile ducts, stopping the flow of bile or digestive enzymes, and leading to severe abdominal pain, vomiting, inflammation, and even life-threatening infection.

Gallstone attack has some classic symptoms:

The most agonizing pain is experienced in the upper right part of the abdomen under the ribs. Usually it appears suddenly, sometimes an hour or two after eating a fatty meal. The pain may get worse quickly, and then last for several hours. Many times the pain may radiate to the back between the shoulder blades or under the right shoulder. Inhaling deeply, or moving, often makes the pain worse. The primary therapy for gallstones that are causing pain, inflammation, or infection is removal of the gallbladder.

A number of factors put people at higher risk of gallstones:

  • Gender: Women between the ages of 20 and 60 are 3 times more likely to develop gallstones than are men in the same age group. By age 60, 20 percent of American women have gallstones.
  • Age: The incidence of gallstone disease increases with age.
  • Genetics: Family history and ethnicity are critical risk factors in development of gallstones, though no gene responsible for gallstone formation has yet been discovered. African-Americans seem to have lower rates of gallstone disease than American Indians, whites, or Hispanics.
  • Obesity: Obesity is a significant risk factor, particularly for women. Obesity also slows down the emptying of the gallbladder.
  • Location of body fat: Belly fat, that spare tire around the middle, dramatically increases the chance of developing stones.
  • Diabetes: People with diabetes often have high levels of triglycerides in their blood, and these fatty acids tend to increase the risk of gallstones.

Even if you’re not at risk for gallstones, it is wise to maintain a healthy body weight, by among other things, sticking to a diet that is low in fat and cholesterol and high in fiber.

If you are in the Las Vegas area and suffering with gallstones or gallbladder disease, schedule a consultation with Dr. Shawn Tsuda.

Gallbladder Disease - Doctor with chalkboard on white background

What you Need to Know about Protein

You probably know you need to eat protein, but what is it and where exactly do you find it? The answer is – everywhere – if you’re talking about the body. Proteins make up about 42% of the dry weight of our bodies. The protein collagen—which holds our skin, tendons, muscles, and bones together—makes up about a quarter of the body’s total protein. Protein builds, maintains, and replaces the tissues in your body. Your muscles, your organs, and your immune system are made up mostly of protein. All of our cells and even blood are packed with protein molecules.

Proteins, along with fats and carbohydrates, are the macronutrients that form the basis of our diets. Once consumed, some people associate protein only with helping to build muscle, but keep in mind that’s not all it does for us. In our bodies, protein performs a range of duties, from building new cells to regulating metabolism to helping cells communicate. Proteins help shuttle oxygen throughout the body in the form of hemoglobin, as well as build muscle.

When you eat foods that contain protein, the digestive juices in your stomach and intestine go to work. They break down the protein in food into basic units, called amino acids. The amino acids then can be reused to make the proteins your body needs to maintain muscles, bones, blood, and body organs.

Amino acids are the building blocks of proteins. Our DNA directs the body to join various combinations of amino acids into a variety of sequences and three-dimensional shapes for an arsenal of over 2 million different proteins, each serving a unique function. Our bodies can make some of these amino acids, but there are nine that are considered “essential amino acids” because we must consume these through our diet.

Many foods contain protein, but the best sources are:

  • Beef
  • Poultry
  • Fish
  • Eggs
  • dairy products
  • Nuts
  • Seeds
  • legumes like black beans and lentils

While our bodies can store fats and carbohydrates to draw on when needed, we do not have a storage pool of amino acids. We need a fresh source each day in order to build the body proteins we need. If the body is missing a particular amino acid to form the protein it needs, it will pull that amino acid by breaking down existing muscle protein. If we consistently lack certain amino acids we will lose muscle weight, energy and, eventually, fundamental functions.

The amount of protein you need depends on your weight and health. The Recommended Daily Allowance (RDA) for protein for the healthy individual is 0.8 grams of protein per kilogram of body weight or 3 to 4 grams per 10 pounds, and two to three servings of protein-rich food will meet the daily needs of most adults. Athlete’s protein intake recommendations may be higher.

The good news is that you don’t have to eat all the essential amino acids in every meal. As long as you have a variety of protein sources throughout the day, your body will grab what it needs from each meal.

You can look at a food label to find out how many protein grams are in a serving, but if you’re eating a balanced diet, you don’t need to keep track of it. It’s pretty easy to get enough protein.

*Dr. Shawn Tsuda is a General Surgeon specializing in robotic bariatric surgery. Schedule a consultation to learn more.
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