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

 

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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Weight-loss Surgery Myths – Setting the Record Straight

If you are considering bariatric surgery, you’ve probably heard many of the popular myths. These run the gamut from horror stories to fairy tales. In reality, these procedures are neither as awful nor as fantastic as they’re made out to be. Here are some facts to help set the record straight about weight-loss surgery (WLS).

Myth: All bariatric surgery involves stomach stapling.

  • There are many different types of gastrointestinal procedures for weight loss, some of which reduce the functioning size of the stomach and others that bypass parts of the digestive tract, reducing absorption of calories and nutrients. Different types of surgeries offer different results, and some are more suitable for particular people than others.

Myth: People who get weight-loss surgery don’t have willpower.

  • Many bariatric surgery patients have struggled for years, pushing themselves to extremes to lose weight and keep it off. They understand that surgery is a final option when everything else has failed. The surgery, recovery and lifestyle changes that accompany WLS require both courage and determination on the part of the patient.

Myth:  Bariatric surgery is only for the morbidly obese.

  • Obesity is only one of the criteria that qualify patients for surgery. Overweight patients may also be candidates if they have one or more health problems that might be reduced or alleviated by weight loss such as diabetes, sleep apnea, hypertension, arthritis, and high cholesterol.

Myth: Bariatric surgery is extremely dangerous.

  • Any type of surgery has associated risks, such as complications or even death. However, a number of recent advances have helped to minimize risks. Surgeries are usually done laparoscopically with mini-incisions that result in faster healing, less pain, and less scarring.

Myth: You will finally be skinny after bariatric surgery.

  • Losing just 50% of excess weight and keeping it off is considered a success story. That’s still going to be overweight in the eyes of most people. Plus, your skin isn’t necessarily going to tone up and be free of drooping after weight loss. However, the health benefits in reducing weight-related problems like sleep apnea often occur even in patients who don’t lose all the weight they would like.

Myth: Weight loss from bariatric surgery is permanent.

  • Unfortunately, even this one is not true. In fact, some regain is likely. Part of this is simply the body adjusting and learning to store fat even on a very restricted diet. At other times, a patient’s failure to adhere to the post-surgery lifestyle recommendations plays a role.

Myth: You should only have WLS if you are done having kids.

  • It isn’t safe to get pregnant in the first year or two after bariatric surgery. You simply won’t be getting enough nutrients to support a growing fetus. After you are done losing weight (if you are taking all your supplements and monitoring your health carefully), getting pregnant should be okay. This is something to discuss with your bariatric surgeon.

Myth: After bariatric surgery, you won’t be able to eat anything that tastes good.

  • Patients who undergo gastric bypass may need to avoid very sweet foods because it can cause side effects like dizziness and nausea. Patients who have a duodenal switch typically need to keep fatty foods to a minimum. However, many patients can and do eat their favorite foods after they recover from surgery. They just eat very small portions.

Myth: You can never be far from a bathroom after WLS.

  • In the aftermath of surgery, you may find yourself having some “emergency” bathroom visits. However, symptoms like diarrhea and vomiting should subside over time as you get a better handle on how your altered digestive system responds to food.

Myth: Bariatric surgery is reversible.

  • Gastric banding is usually reversible. That’s because the stomach and intestines are not cut or stapled with this surgery. Gastric bypass may be reversible, but this is a very involved surgery. It’s more difficult to put everything back where it was, and there is a risk that the revision won’t restore normal function. Sleeve gastrectomy and duodenal switch entail actual removal of part of the stomach without reattaching it lower on the intestine. This type of surgery is not reversible.

Surgery for weight reduction is not a miracle procedure. Weight loss surgery is designed to assist the morbidly obese in developing a healthier lifestyle. A surgical weight loss operation is a useful tool for weight loss, but it is a surgical procedure that requires a substantial lifelong commitment. The surgery alone will not help someone lose weight and keep it off. The patient must change eating and exercise habits. Without changes to the daily pattern of eating and activity, the patient is likely to regain the weight over time.

 

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.

 

Tips for Choosing the Right Surgeon for You

Whether you need a complicated, invasive surgery or a simple out-patient operation, choosing the right surgeon can seem overwhelming. Even what should be relatively straightforward procedures such as gallbladder removal or hernia repair can sometimes result in serious complications, so you always want to be in good surgical hands. Here are some tips on finding the surgeon and hospital that are best for your situation.

Once you have narrowed down your list of potential surgeons, schedule a consultation. If you have a fairly urgent need for surgery, you may have to cross surgeons off of your list purely because of the wait for a visit. Otherwise, plan to meet with at least two surgeons and discuss your potential surgery.

Things to ask:

  • Is surgery 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.
  • What are your success, failure, and complication rates? Not all will be able or willing to tell you, but the good ones should.
  • What’s the hospital’s infection rate?
  • Does the hospital follow best practices? The federal Centers for Medicare and Medicaid Services tracks how frequently hospitals give antibiotics on schedule, control blood sugar in heart-surgery patients, prepare skin properly before incisions and take other steps proven to help prevent surgical complications.Make the right choice.

You may be expected to schedule a surgery at the end of the consultation. If you are not confident that you have found your ideal surgeon, do not schedule the surgery. Either way, it’s fine to ask for a day to consider everything the doctor has said before making the surgery official.

If the surgeon you consulted with is not your ideal surgeon, schedule a consultation with a different surgeon. Even if you think the first surgeon is your best choice, a second opinion from another surgeon can be valuable. Most types of insurance will allow for two or three consultations. If you believe you have found your ideal surgeon you can schedule your surgery, confident in your decision.

If you’re looking for an experienced general surgeon in the Las Vegas area, Dr. Shawn Tsuda specializes in minimally invasive surgical techniques including the laparoscopic Roux-en-Y gastric bypass, laparoscopic adjustable gastric band, sleeve gastrectomy, foregut surgery, ventral and inguinal hernia repairs, endoscopy, and basic laparoscopy. Schedule a consultation to learn what he can do 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

 

 

 

Heart Health after Bariatric Surgery

Obesity has become a global pandemic affecting virtually all ages and socioeconomic groups and is majorly contributing to the international burden of chronic illness, including diseases of the cardiovascular system. Traditional treatments to achieve weight loss such as diet, lifestyle, and behavioral therapy have proven relatively ineffective in treating obesity and associated cardiovascular risk factors in the long term. These treatments have been specifically ineffective on the morbidly obese subgroup of patients.

Weight-loss (bariatric) surgery can be a useful tool to help break the vicious weight gain cycle and achieve long term weight loss and improved overall quality of health and life.

  • Bariatric surgery has been shown to help improve or resolve many obesity-related conditions, such as type 2 diabetes, high blood pressure, heart disease, and more.
  • Bariatric surgery, such as gastric bypass, gastric sleeve, and laparoscopic adjustable gastric banding, works by changing the anatomy of the gastrointestinal tract or by causing different physiologic changes in the body that change energy balance and fat metabolism. It is important to remember, however, that bariatric surgery is a “tool.” Weight loss success also depends on many other important factors, such as nutrition, exercise, behavior modification, and more.
  • Bariatric surgery may improve a number of conditions and hormonal changes to reverse the progression of obesity. Studies find that more than 90 percent of bariatric patients are able to maintain a long-term weight loss of 50 percent excess body weight or more.

Most, if not all, of the cardiovascular risk factors associated with obesity are improved or even resolved after bariatric surgery. The amount of improvement in cardiac risk factors is generally proportional to the amount of weight lost. The degree of weight loss varies with different bariatric procedures.

If you live in the Las Vegas area and want to learn more about your bariatric surgery options, schedule an appointment with Dr. Shawn Tsuda. He and his team of experts can help you find the right treatment for you.
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