Aging and Obesity: Is Bariatric Surgery an Option for the Elderly Patient?

The good news is that improved life expectancy is allowing baby boomers to enter their golden years in unprecedented numbers. The bad news is that rates of obesity among this aging demographic are climbing in never-before-seen numbers as well, putting this population at risk of developing cancer, heart disease, diabetes, lower extremity arthritis, sleep apnea, and stroke, all of which can lead to disability. Treatment guidelines to lose weight in the elderly have been difficult to define, yet it is very clear that obesity in the elderly contributes to worsening of multiple parameters which along with the metabolic problems mentioned already, include cognition, functionality and quality of life. While ample evidence supports the safety and effectiveness of weight-loss aka bariatric surgery in the general adult population, more information is needed in patients age 60 years and older.

Surgical treatment of obesity in the elderly, particularly over 65, remains controversial; this is explained by the increased surgical risk or the lack of data demonstrating its long-term benefit. Few studies have evaluated the clinical effects of bariatric surgery in this population.

The risk of any surgical intervention increases as one gets older. However, weight-loss surgery is very safe, and the potential benefits routinely outweigh any of the associated risks if there are no other health issues that would dramatically increase the risk of surgery.

Ideally, a comprehensive assessment would focus on psychosocial and functional status in addition to physical data. An excellent support system of family, friends, or caregiver resources is imperative. The selected patient should be capable of engaging in physical interventions focusing on mitigating muscle loss and osteoporosis and of maintaining changes in eating behavior as needed as well. A recommended “pre-habilitation” program may include a physical therapist to assist with strength and endurance training and a nutritionist to aide in enhancing protein intake, vitamin D, and other nutrient sufficiency.

Identifying goals of care, quality of life, and improved function should be considered as primary objectives of undergoing surgery. Goals of the surgery include not only weight loss but also improvements in physiological function, comorbidity, and quality of life, and reduction in institutionalization.

If you live in the Las Vegas area and are considering bariatric surgery, VIPSurg is here to help. Dr. Tsuda and his team of experts can find the best treatment for your unique situation.

Old obese woman walking with stick

 

 

 

Obesity in America: The Unhealthy Truth

Most Americans are overweight. Most – let that sink in for a minute. The majority of American adults are at least carrying around a few more pounds than is considered healthy. Severe obesity is also on the rise across the country. Unfortunately, these stats tell a story that won’t have a happy ending unless something changes:

  • Nearly 40% of adults and close to 20% of adolescents are obese in America. 
  • A body that is 20% overweight is prone to major health problems. 
  • Life expectancy is greatly reduced in someone who is obese.
  • The obesity problem is growing everywhere, but rural areas tend to have both higher obesity rates and much greater rates of what medical researchers term “severe obesity,” which is a BMI of 40 or more.

The main concern with this alarming trend is that being overweight affects all areas of your health. Carrying around extra weight not only make you feel heavy, but it also contributes to other health problems like sleep apnea, diabetes, high cholesterol, painful joints, and heart disease.

 The good news is that these risk factors can be eliminated by losing weight and maintaining a healthy lifestyle. The bad news is that changing behavior long-term is extremely difficult for all but the most committed. For the very obese, even commitment and willpower often aren’t enough.

Eating the wrong foods, eating too much food, lack of exercise, genetics, stress, emotional eating, and a slow metabolism are the major contributing factors in obesity. Nevertheless, even though we are more aware than ever that nutrition and health value should be playing a bigger role in our selections when it comes to choosing what we eat, most Americans surveyed still listed convenience as their number 1 priority when deciding.

Whatever its causes, believing severe obesity can be managed or eliminated by having a low-fat diet and engaging in exercise is a bit naïve. When a person is 50, 70, or 100+ pounds overweight, it can be difficult to impossible to diet and exercise enough to lose the troublesome weight. 

Unfortunately, diet, exercise, and weight-loss pills are generally ineffective for severely obese people. Studies have demonstrated that when the BMI reaches 40, the chances of success with medical therapy for weight loss are approximately 1%. 

Since 1991, the National Institute of Health has supported bariatric surgery as a treatment for morbid obesity when combined with a healthy diet and exercise.

Surgery can help a person lose weight so that they are able to exercise better to maintain a healthy weight loss. Some obese people need weight-loss surgery because, despite drug therapy, exercise, and behavioral modifications, they still have increased risk of comorbid conditions including heart disease and diabetes. These are the people who are often candidates for bariatric (weight-loss) surgery.  

Obesity is a common and complex medical condition, losing weight isn’t easy to do, and there’s really no magic cure. If it were simple, everyone would be healthy and trim. However, if you are at an unhealthy weight, you must start somewhere. Going it alone into a crash diet isn’t a good idea. You will put the weight back on, and chances are you’ll gain even more than you lost. Checking with your doctor, who can advise you on a plan that is safe and right for you, is a good way to begin your journey to a healthier, happier you.  

If you’ve tried diet and exercise but still aren’t losing the weight you need to lose to be healthy, schedule an appointment with VIPSurg. Dr. Tsuda and his team of experts can help find the right treatment for you.

Lady eats hamburger

The Sugar/Obesity Connection

In ancient times, sugar was regarded not as something to be avoided but rather as a cure-all for anything that ailed you. In every culture, sweetness has a symbolism related to goodness. It was valued so highly partly because it was so rare, obtainable mostly in tiny quantities as honey. Now, we demonize it, and yet we can’t seem to stop gorging on it. Few plants have caused more human misery than sugar cane — through obesity, tooth decay, and Type 2 diabetes. Yet despite everything we now know about the harm caused by sugar and other modern sweeteners, such as high-fructose corn syrup, it never stops being something we seem to delight in.

There’s no doubt that sugar adds to the prevalence of obesity in America. Therefore, every food product that includes sugar may be contributing to the scope and costs of the obesity epidemic, accelerating the volume of premature deaths among millions of people in the United States.

Obesity and overweight rates have steadily grown. Type 2 diabetes, once unheard of among kids or even young adults, now is an increasingly common diagnosis among children. Obesity and obesity-related diseases have become the world’s leading killer.

Fortunately, sugar affects all of us differently, and for many people it is neither addictive or deadly. Just like many other substances that carry inherent risk, sugar can be safely used in moderation by most people without wreaking havoc on their lives or contributing to their premature deaths.

While calories from any food have the potential to increase the risk of obesity and other cardiometabolic diseases, nutrition researchers agree that sugar-sweetened beverages play a unique role in chronic health problems. The disease risk increases even when the beverages are consumed within diets that do not result in weight gain.

Doctors have long suspected sugar is not simply a source of excess calories but a fundamental cause of obesity and type 2 diabetes. But until recently, fat consumption and total energy balance have dominated the debate about obesity and the nature of a healthy diet.

Official estimates are that one in 11 people in the United States has diabetes, and latest diabetes-1724617__340estimates suggest that obesity and diabetes may now cost the US healthcare system as much as 1 billion dollars per day. In 2016, World Health Organization (WHO) director general Margaret Chan described the twin epidemics of obesity and diabetes worldwide as a “slow-motion disaster” — and suggested that the likelihood of preventing the current “bad situation” from getting “much worse” was “virtually zero.”

The past decade has seen a renewed interest in the possibility that calorific sweeteners — particularly sugar and high fructose syrups — have major roles in causing obesity and diabetes, and major public health organizations are now recommending strict limits to the consumption of these sugars. Much of the current discussion about sugar focuses on the effects of excess energy intake and weight gain, and the subsequent risk of diabetes, heart disease, cancer and some forms of dementia. But while being overweight or obese increases your risk of these diseases, excess weight is not a prerequisite.

While the development of diseases is no doubt also based on genes and lifestyle factors other than diet, the evidence of the potential harms of high-sugar diets is accumulating. It’s certainly compelling enough for many to consider limiting how much sugar we eat and drink. Whether or not the sugar itself is the culprit, sugary foods are linked to health problems, and that should be reason enough to cut down.

If you’re looking for ways to treat severe obesity, schedule an appointment with VIPSurg. Drs. Tsuda and Ryan and their team of experts can help find the right treatment for you.

High Blood Pressure AKA Hypertension: What You Need to Know

High blood pressure (aka hypertension) is dangerous because it makes the heart work too hard and contributes to atherosclerosis (hardening of the arteries). It increases the risk of heart disease and stroke, which are the first- and third-leading causes of death among Americans. High blood pressure also can result in other conditions such as congestive heart failure, kidney disease, and blindness. About two-thirds of people over age 65 have high blood pressure. 

If you have high blood pressure, you and your health care provider need to work together as a team to reduce it. The two of you need to agree on goals and make a plan and timetable for reaching your goals. 

Blood pressure is usually measured in millimeters of mercury (mmHg) and is recorded blood pressureas two numbers—systolic pressure (as the heart beats) “over” diastolic pressure (as the heart relaxes between beats)—for example, 130/80 mmHg. Monitoring your blood pressure at home between visits to your doctor can be helpful. 

Being overweight or obese increases your risk of developing high blood pressure. In fact, your blood pressure rises as your body weight increases. Losing even 10 pounds can lower your blood pressure—and losing weight has the biggest effect on those who are overweight and already have hypertension.

Being physically active is one of the most important things you can do to prevent or control high blood pressure. All you need is 30 minutes of moderate-level physical activity on most days of the week. Examples of such activities are brisk walking, bicycling, raking leaves, and gardening. You can even divide the 30 minutes into shorter periods of at least 10 minutes each. 

What you eat affects your chances of getting high blood pressure. A healthy eating plan can both reduce the risk of developing high blood pressure and lower a blood pressure that is already too high. For an overall eating plan, consider the DASH diet, which stands for “Dietary Approaches to Stop Hypertension.” You can reduce your blood pressure by eating foods that are low in saturated fat, total fat, and cholesterol, and high in fruits, vegetables, and low-fat dairy foods. The DASH eating plan includes whole grains, poultry, fish, and nuts, and has low amounts of fats, red meats, sweets, and sugared beverages. It is also high in potassium, calcium, and magnesium, as well as protein and fiber. Eating foods lower in salt and sodium also can reduce blood pressure.

If you have high blood pressure, unfortunately the lifestyle habits noted above may not be enough to lower your blood pressure to a healthy level. In addition to eating healthy and staying active, you may need to take medication. There are many drugs available to lower blood pressure. They work in various ways. Often patients need to use two or more drugs to bring their blood pressure down enough to be healthy.

If you are suffering from obesity, and diet and exercise alone aren’t working to lower your weight, schedule an appointment at VIPSurg. Our experts can help you find a treatment to fits your unique situation. Call (702) 487-6000 to schedule an appointment.

Metabolic Syndrome: Risks and Prevention

Once known in the medical community as “syndrome X” or “insulin resistance syndrome”, metabolic syndrome is a cluster of conditions — increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels — that occur together, increasing one’s risk of heart disease, stroke and diabetes. Although it sounds mysterious, Syndrome X is very common.

As is true with many medical conditions, genetics and the environment both play important roles in the development of metabolic syndrome. Genetic factors influence each individual component of the syndrome and the syndrome itself. A family history that includes type 2 diabetes, hypertension, and early heart disease greatly increases the chance that an individual will develop metabolic syndrome. On the other hand, environmental issues such as low activity level, sedentary lifestyle, and progressive weight gain also contribute significantly to the risk of developing metabolic syndrome.

The following factors increase your chances of having metabolic syndrome:

  • Age — Your risk of metabolic syndrome increases with age.
  • Race — In the United States, Mexican-Americans appear to be at the greatest risk of developing metabolic syndrome.
  • Obesity — Carrying too much weight, especially in your abdomen, increases your risk of metabolic syndrome.
  • Diabetes — You’re more likely to have metabolic syndrome if you had diabetes during pregnancy (gestational diabetes) or if you have a family history of type 2 diabetes.
  • Other diseases — Your risk of metabolic syndrome is higher if you’ve ever had cardiovascular disease, nonalcoholic fatty liver disease, or polycystic ovary syndrome.

The good news is that with changes to diet and exercise, you can prevent, control, or even reverse metabolic syndrome. If you don’t, you could develop significant health risks related to diabetes, heart disease, and stroke as part of the condition. Because your risk for metabolic syndrome increases with age, it’s important to start adjusting your health habits early on.

If you are diagnosed with metabolic syndrome, aggressive lifestyle changes will likely be the prescription. While medication is often necessary for those with this diagnosis, changes in diet and exercise can delay or even prevent the development of serious health problems related to metabolic syndrome. 

If you are looking for treatment for severe obesity and the life-threatening conditions that often accompany it, schedule an appointment at VIPSurg. Our expert team can help find the right treatment for you. 

metabolic syndrome

Stats Don’t Lie: Learn How Bariatric Surgery is Helping Hundreds of Thousands of People Regain Their Health

In the early nineties, fewer than twenty thousand bariatric surgeries were performed in the U.S. each year. Now the number is around two hundred thousand. Only in the past few years has what was once considered a high-risk and extreme measure been transformed into a relatively standard, safe, and straightforward one. There is strong consensus that bariatric surgery is effective, and Medicaid now covers it in forty-eight states. 

Research into conventional weight-loss methods has repeatedly pointed to an overwhelmingly dispiriting conclusion—that diet and exercise alone, no matter how disciplined the individual, fail all too often. Still, only about one per cent of those who medically qualify for bariatric surgery get it. 

Over the centuries, suggested strategies for losing weight have included bitter tonics, bleeding, sea air, amphetamines, Turkish baths, tapeworms, purgatives, low-fat diets, high-fat diets, cinnamon, more sleep, less sleep, and the “vigorous massage of the body with pea-flour.” Surgery is an old idea, too. One of the earliest surgical approaches to weight loss, dating back at least a millennium, was simple: the jaw was wired mostly shut. Another story from pre-anesthesia days tells of a rabbi “being given a sleeping potion and taken into a marble chamber, where his abdomen was opened, and many baskets of fat were removed.”

But the health risks associated with obesity have become apparent—higher rates of stroke and heart disease, Type 2 diabetes, infertility, sleep apnea, osteoarthritis, and an increased risk of certain cancers. In addition, bariatric procedures have improved dramatically. 

Robotic surgery and laparoscopy, which became the norm in the past decade, result in fewer complications like hernias. Physicians now have a better sense of how to prevent and treat the complications of surgery. 

As recently as seventeen years ago, there was a one-per-cent chance of dying from a bariatric procedure—a relatively high risk. Now it is 0.15 percent, which is less than that for a knee replacement, a procedure commonly recommended to people who have developed joint problems from carrying around excessive weight.

Around seventy-five per cent of bariatric patients have sustained weight loss five years after their surgery, and that percentage is higher if you don’t include lap-band patients in the analysis. Weight loss through diet and exercise rarely leads to more than short-term changes—a quite small percentage of patients see sustained weight loss. 

Today, obesity is second only to tobacco as a killer in this country. If you live in the Las Vegas area and are seeking long-term weight loss and health benefits, schedule an appointment at VIPSurg. We will help you find the best treatment for your unique situation.

Doctor examining  patient obesity on light background

What is Metabolic Syndrome

Nearly 35% of all U.S. adults and an astounding 50% of those 60 years of age or older are estimated to have a syndrome that makes them twice as likely to develop heart disease and 5 times as likely to develop diabetes as someone who doesn’t have this syndrome. The disorder is called metabolic syndrome, and it involves a group of 5 risk factors that increase the risks of developing several potentially deadly conditions.

What is metabolic syndrome?

It’s a group of risk factors that increases the likelihood of developing heart disease, diabetes, and stroke. The 5 risk factors are:

  • increased blood pressure
  • high blood sugar levels
  • excess fat around the waist
  • high triglyceride levels
  • low levels of good cholesterol, or HDL

Having one of these risk factors alone doesn’t mean one has metabolic syndrome. However, having just one does increase the chances of developing cardiovascular disease. Having three or more of these factors is considered as having metabolic syndrome.

What are the risk factors for metabolic syndrome?

The risk factors are related mostly to obesity. The two most important risk factors are defined by the National Heart, Lung, and Blood Institute as:

  • excess fat around the middle and upper parts of the body
  • insulin resistance, which makes it difficult for the body to use sugar

Other factors that can increase risk for metabolic syndrome include:

  • age
  • family history of metabolic syndrome
  • not getting enough exercise
  • women with polycystic ovary syndrome

What are the complications of metabolic syndrome?

Complications that can result from metabolic syndrome are often grave and chronic. Obesity concept in x-rayThey include:

  • hardening of the arteries
  • diabetes
  • heart attack
  • kidney disease
  • stroke
  • nonalcoholic fatty liver disease
  • peripheral artery disease
  • cardiovascular disease

If diabetes develops, additional health complications may result including:

  • eye damage
  • nerve damage
  • kidney disease
  • amputation of limbs

How is metabolic syndrome treated?

If you are diagnosed with metabolic syndrome, your doctor will probably recommend lifestyle changes that may include losing between 7-10% of your current weight and getting at least 30 minutes of moderate to intense exercise five to seven days a week. They may also suggest that you quit smoking.

Your doctor may prescribe medications to help reduce your risk of stroke and heart attack.

What is the outlook for patients with metabolic syndrome?

People who take their doctor’s advice and lose weight will reduce their chances of developing serious health problems such as heart attack or stroke. However, for many who are obese and haven’t been successful with diet changes and exercising, more intensive treatment like bariatric surgery might be needed.

If you live in the Las Vegas area and are considering bariatric surgery, schedule a consultation at VIPSurg. Our doctors and team of experts can help find the right treatment for you.