Fat people not more jolly, says study that links obesity and depression – discuss on our Weight Loss Surgery forums.

by Lindsey Tanner
July 10, 2006

Fat people are not more jolly, according to a study that instead found obesity is strongly linked with depression and other mood disorders.

Whether obesity might cause these problems or is the result of them is not certain, and the research does not provide an answer, but there are theories to support both arguments.
Depression often causes people to abandon activities, and some medications used to treat mental illness can cause weight gain. On the other hand, obesity is often seen as a stigma and overweight people often are subject to teasing and other hurtful behavior.

The study of more than 9,000 adults found that mood and anxiety disorders including depression were about 25 percent more common in the obese people studied than in the non-obese. Substance abuse was an exception _ obese people were about 25 percent less likely to abuse drugs or alcohol than slimmer participants.

The results appear in the July issue of Archives of General Psychiatry, being released Monday. The lead author was Dr. Gregory Simon, a researcher with Group Health Cooperative in Seattle, a large nonprofit health plan in the Pacific Northwest.

The results “suggest that the cultural stereotype of the jolly fat person is more a figment of our imagination than a reality,” said Dr. Wayne Fenton of the National Institute of Mental Health, which funded the study.

“The take-home message for doctors is to be on the lookout for depression among their patients who are overweight,” Fenton said.

Both conditions are quite common. About one-third of U.S. adults are obese, and depression affects about 10 percent of the population, or nearly 21 million U.S. adults in a given year.

Previous studies produced conflicting results on whether obesity is linked with mental illness including depression, although a growing body of research suggests there is an association.

This latest study helps resolve the question, said Dr. Susan McElroy, a psychiatry professor at the University of Cincinnati and editor of a textbook on obesity and mental disorders.

“This is a state-of-the-art psychiatric epidemiology study that really confirms that there is, in fact, a relationship,” she said.

The study was based on an analysis of a national survey of 9,125 adults who were interviewed to assess mental state. Obesity status was determined using participants’ self-reported weight and height measurements.

About one-fourth of all participants were obese. Some 22 percent of obese participants had experienced a mood disorder including depression, compared with 18 percent of the nonobese.

McElroy said the study bolsters previous research suggesting that drug and alcohol abuse are less common in the obese. One reason might be that good-tasting food and substances of abuse both affect the same reward-seeking areas of the brain, McElroy said. Why some people choose food as a mood-regulator and others drugs or alcohol is uncertain, she said.The study found the relationship between obesity and mental illness was equally strong in men and women, contrasting with some previous research that found a more robust link in women.

You need to be careful about your levels of vitamin A, as Gastric Bypass may boost blindness risk. Gastric Bypass/Blindness. Discuss diet and suppliments on our Weight Loss Surgery forum.

15 June 2006, Forbes – A boom in gastric bypass surgery could lead to an unwelcome trend: an increase in vitamin A deficiency among patients that raises their risk for vision loss.

So conclude U.S. researchers who studied the medical histories of patients who were nearly blind or had very poor eyesight but no family history of blindness.

Gastric Bypass May Boost Blindness Risk

The study, published in the current issue of the British Journal of Ophthalmology, focused on three patients over age 65 who had been diagnosed with vitamin A deficiency. Each of the patients had also undergone major intestinal surgery in the last 20 to 35 years.

Vitamin A deficiency, caused by malnutrition, is needed to maintain healthy tissues and functions of the eye. Blindness or poor eyesight is one of the first symptoms of vitamin A deficiency, which is the primary cause of blindness in children in less affluent countries.

But researchers at Baylor College of Medicine in Houston note that vitamin A is absorbed through the small intestine. So, with gastric bypass surgeries on the rise, vitamin A deficiency may also increase in developed countries — even though it’s been predominantly an issue for underdeveloped countries until now.

Patients in the study had either intestinal bypass or gallbladder surgery, or surgery to remove tissue damaged by inflammatory bowel disease. Each patient had also taken vitamin A supplements, but still maintained poor eyesight. Two of the patients received intramuscular injections of vitamin A, and saw improvements in their vision within just a few days.

The Royal Opera House rehired a singer fired over weight. Yes, weight loss surgery definately helps with employability. Discuss on our forums how weight loss surgery has helped you with you employment, or had you fired over weight.

Associated Press, 9:43 PM EDT ON 9 July 2006

London — An American soprano fired by the Royal Opera House because of her weight has been rehired after undergoing stomach surgery and losing 135 pounds, her spokeswoman and the prestigious theatre said Sunday.
Royal Opera House rehires singer fired over weight.
Deborah Voigt, one of the world’s top opera singers, lost her part in Richard Strauss’ “Ariadne on Naxos” in 2004 because the Royal Opera House decided a slimmer singer would be better.

She now has a contract to return to the role in the 2007-2008 season, a Royal Opera spokeswoman said, speaking on condition of anonymity because the house does not officially announce its casts so far in advance.

“She’s very, very excited,” Ms. Voigt’s spokesman Albert Imperato said in New York. “She’s just definitely felt like, ‘I’ve not had a chance to really build my career in London, it’s a major opera capital.’ It was very sad for her that she didn’t get a chance to do Ariadne originally.”

Mr. Imperato said he did not know how much Ms. Voigt had weighed before the surgery.

Ms. Voigt had been scheduled to play the lead in the Royal Opera House’s summer 2004 production of “Ariadne on Naxos,” but the casting director had selected a black evening dress for the part and believed Ms. Voigt would not look right in it, the opera house said at the time.

German Anne Schwanewilms sang the role in that production.

Ms. Voigt had gastric bypass surgery in June 2004. When she disclosed it the following March, she said she had worn size 30 clothes at her heaviest and her goal was a size 12.

“She had decided on doing this procedure completely based on her health concerns, it was something she had thought about for many, many years, long before the little black dress,” he said.

It is better to sleep 7-8 or more hours per night, as Lack of Sleep can Pack on the Pounds. Lack of sleep increases the hunger urges and brings the body to a state resembling pre-diabetic. Discuss on our Weight Loss Surgery Forum.

Lack of Sleep Can Pack on the Pounds

By Alan Mozes
HealthDay Reporter

FRIDAY, July 7 2006 (HealthDay News) — If an improved diet and extra trips to the gym fail to help shed those excess pounds, a growing body of research is shining light on a new way to get to a new you: Do nothing.

Do nothing, that is, but sleep.

As millions of Americans move through life weary and sleep-deprived, scientists are uncovering more and more evidence that insufficient slumber may cause hormonal shifts that boost both hunger and appetite — particularly for fat-laden carb catastrophes like jelly-filled donuts and super-sized fries.

“We all need to be aware there is a relationship between sleep and obesity,” says J. Catesby Ware, chief of the division of sleep medicine at Eastern Virginia Medical School, and director of the Sleep Disorder Center at Sentara Norfolk General Hospital in Norfolk, Va.

Ware and his colleagues found signs of this link in a recently completed study of more than 1,000 men and women that indicated those who reported sleeping less also weighed more.

He is now in the midst of new research focusing on another group of 1,000 individuals that is quantifying specific daily sleep habits, with preliminary data reinforcing his previous observation — less sleep equals a bigger belly.

“There are a number of research studies that all support the thesis that too little sleep leads to weight gain,” Ware said. “How that happens is still somewhat unclear, but there are hormonal secretions that are affected with sleep loss that apparently affect appetite and eating.”

Other researchers are working to unravel the mechanism behind the mystery.

Eve Van Cauter, a professor of medicine at the University of Chicago, recently found that when 12 healthy men in their 20s were instructed to sleep just four hours a night for two nights straight, they reported an increase in feelings of hunger by 24 percent.

What’s more, Cauter and her colleagues noted that levels of the hormone leptin, which delivers feelings of satiation to the brain, decreased by 18 percent among the men.

Conversely, levels of the hormone ghrelin, which sparks hunger, shot up 28 percent — prompting cravings for candy, cookies and cake.

Dr. Phyllis Zee, a professor of neurology at the Northwestern University Feinberg School of Medicine, said that while researchers continue to be stymied by the exact nature of the sleep-weight connection, the relationship is undeniable.

“This kind of short-term sleep deprivation study supports the relationship we see in the larger population-based studies, which shows that if you restrict sleep, the hormonal and metabolic profiles begin to resemble those of people who are pre-diabetic, while bringing about autonomic changes that can be related to the development of cardiovascular disease,” added Zee, director of the Sleep Disorders Center at Northwestern Memorial Hospital in Chicago.

According to several polls by the National Sleep Foundation, many Americans of all ages barely meet or fail to meet the minimal daily sleep requirements most physicians and researchers recommend.

In its most recent 2005 survey, the NSF found that more than 70 percent of adults over the age of 18 get less than eight hours of sleep a night on weekdays — and 40 percent get less than seven hours.

A 2003 poll found that, on average, American adults between the ages of 18 and 54 sleep just 6.7 hours a night during the week, and seven hours a night on weekends.

Among older adults — those between 55 and 84 — 13 percent sleep less than six hours a night during the week, while 11 percent have a similar sleep pattern on weekends.

Against such a national backdrop of sleep deprivation, researchers concur that the battle of the bulge may ultimately best be waged beneath the sheets.

“Between seven and eight hours seems to be a fairly magical number for sleep duration,” said Zee. “People who report, on average, getting between seven and eight hours of sleep are the ones who appear to have the lowest risk” of weight gain.

Ware agreed: “By sleeping more, you gain on all fronts. If you are obese and are trying to lose weight, it’s almost a no-brainer.”

More information

Find out more about the value of sleep from the National Sleep Foundation (www.sleepfoundation.org ).

SOURCES: Phyllis Zee, M.D., Ph.D., professor of neurology, Northwestern University Feinberg School of Medicine, and director, Sleep Disorders Center, Northwestern Memorial Hospital, Chicago; J. Catesby Ware, Ph.D., chief, division of Sleep Medicine, Eastern Virginia Medical School, and director, Sleep Disorder Center, Sentara Norfolk General Hospital, Norfolk, Va.

Read about the success of Teenage Stomach Surgery on RenewedReflections. Then discuss with others how you can reduce obesity, on our Weight Loss Surgery Forum.

SAN FRANCISCO (Reuters) – Obese teenagers who had surgery to shrink the size of their stomachs on average lost nearly half their weight in the four years after the procedure, according to a study presented on Thursday at a medical conference.

Researchers from the Hospital Sao Camilo in Brazil also said that the laparoscopic gastric bypass surgery eliminated high blood pressure and type 2 diabetes for the teenage stomach surgery patients who had those conditions.

Source

“Morbid obesity is a progressive disease so the earlier the intervention whether by surgery or other means, the better the chances are to avoid future health problems and to prolong life,” said Dr. Ricardo Cohen, the study’s lead author.

The study involved 42 teenagers ages 13 to 18 whose average weight fell from 260 pounds (118 kg) before surgery to 135 pounds (61 kg) four years later. Sixteen of the youths with hypertension and three with type 2 diabetes were free of those diseases 50 days after surgery.

The study comes amid growing concern about rising levels of obesity among teenagers and an increasingly heavy adult population, predominantly in the United States.

“It is the fastest growing disease in the pediatric and adolescent age group,” said Dr. Neil Hutcher, president of the American Society for Bariatric Surgery. “It is estimated that at least 15 percent of children are obese and another 10 percent to 15 percent are overweight.”

Additionally, in the United States one in 50 adults are diagnosed with morbid obesity, a condition imposing an estimated $117 billion annually in costs on the country’s health care system.

Morbid obesity is a disease marked by high level of body fat and when a person is at least 100 pounds (45 kg) overweight.

The study on how teenagers fared after the stomach surgery was presented at an American Society for Bariatric Surgery conference in San Francisco.

Other studies at the conference reported gastric bypass surgery helps reduce the risk of heart disease by half for the morbidly obese, and that the risk of dying from morbid obesity is up to 85 percent greater than the risk of dying as a result of the stomach-reduction surgery.

Read about how a Half-ton Mexican man loses 200 pounds on RenewedReflections. Then discuss with others how you can reduce obesity, on our Weight Loss Surgery Forum.

MONTERREY, Mexico (AP) — Manuel Uribe weighed 1,235 pounds when he made a desperate plea for help on national television in January 2006.

Unable to leave his bed for five years, the 41-year-old mechanic in the northern industrial city of Monterrey longed to move again and get help for the lesions on his legs, which he kept bound together with duct tape to keep the infections from getting worse.

His plea was answered by doctors and nutritionists who prescribed a high-protein diet and suggested gastric bypass surgery, and Uribe has lost some 200 pounds since February.

See the full story on cnn

Read about how Obesity Increases Risk for Disease on RenewedReflections. Then discuss with others how you can reduce obesity, on our Weight Loss Surgery Forum.

The American Cancer Society recently presented evidence that links weight gain later in life to an increase risk of breast cancer. The study of more than 44,000 women found that the more weight a woman gained, the greater her risks for all types, stages and grades of breast cancer. Breast cancer is linked to increased levels of estrogen. Fat tissue produces estrogen, which adds to the risk.

San Diego, CA (PRWEB) June 22, 2006 — The American Cancer Society recently presented evidence that links weight gain later in life to an increase risk of breast cancer. The study of more than 44,000 women found that the more weight a woman gained, the greater her risks for all types, stages and grades of breast cancer. Breast cancer is linked to increased levels of estrogen. Fat tissue produces estrogen, which adds to the risk.

According to the Centers for Disease Control and Prevention (CDC), 64 percent of all U.S. adults are overweight or obese. Morbid obesity is closely correlated with a number of serious conditions that severely undermines the health of overweight patients, including heart disease, high blood pressure and diabetes. Divided gastric bypass surgery is widely accepted as the most effective surgical weight-loss treatment available and is considered the gold standard to alleviate severe obesity.

Surgeons at Pacific Bariatric Surgical Medical Group Inc. (http://www.pbsmg.com) have performed over 9,000 procedures on adult and adolescent patients at Scripps Mercy Hospital. As a result of outstanding aftercare programs and support groups, patients at Pacific Bariatric and Scripps Mercy Hospital see a slightly higher success rate than the national average.

Pacific Bariatric Surgical Medical Group Inc. and Scripps Mercy Hospital are nationally designated by the American Society for Bariatric Surgery as a Center of Excellence for bariatric surgery. Pacific Bariatric Surgical Medical Group, also known as Hillcrest Surgical Medical Group, Inc., has an 80-year tradition of surgical excellence and leadership in San Diego County. Scripps Mercy Hospital has been a health care leader in San Diego County for more than 115 years, offering patients an unparalleled continuum of care. For more information, visit http://www.pbsmg.com.

Established in 1890 by the Sisters of Mercy, Scripps Mercy Hospital serves the San Diego and Chula Vista communities. With 700 licensed beds, more than 3,000 employees and 1,300 physicians, Scripps Mercy Hospital is San Diego’s longest established and only Catholic medical center. With two campuses, Scripps Mercy Hospital is the largest hospital in San Diego County and one of the 10 largest in California. For more information, visit www.scripps.org.

Press release obtained via PR Web.

Tags: American Cancer Society, breast cancer, Obesity, gastric bypass, bariatric surgery, weight loss surgery, obesity surgery, gastric bypass surgery support, gastric bypass insurance

By Sanae Tanaka, M.D.

Many people who have had weight loss surgery wonder how many calories (kcal) they need each day to reach and maintain a healthy weight. If you are not far out post-WLS, your calorie intake will be minimal, and will be below your intake for weight maintenance. In those first few months after surgery, it is critical that you stick to the recommendations from your doctor and dietitian.

However, for reference, the basic recommendation for calories when trying to lose weight (without WLS) is that you take in 500-1000 calories less than your daily caloric requirement, as calculated from your present weight and activity level. The minimum recommended calories while on a diet are 1,000-1,200 kcal/day for women, and 1,200-1,600 kcal/day for men. Most of the popular diets aim for 1,500 kcal/day.

General Physical Requirements

Your basic caloric needs are determined by your weight and how active you are. Your ideal weight range depends on your height, and equates to a Body Mass Index (BMI) of 18.5-24.9 (median 22). But, in addition to your weight, you also have to consider how many calories you burn doing daily activities to determine how many calories you need to take in. Unless you are math savvy, you will need a calculator to figure it out. However, here’s a simple equation that will give you the general range by showing you how many calories you burn daily for each pound you weigh and your level of activity.

Sedentary, seated during most of the day: 11-13.6 kcal/lb/day
Moderate labor, on your feet most of the time: 13.6-16 kcal/lb/day
Heavy labor, competitive or professional athlete: 16+ kcal/lb/day

The upper limit for heavy labor is not set because it is is variable, depending on the amount of activity. For example, an average heavy laborer uses anywhere from 3000 to 4500 kcal/day, depending on stature, while for very competitive professional athletes, it may go up to over 6000 kcal/day.

Another important note: Although they are on their feet much of the day, homemakers generally fall into the “sedentary” category. This is because the muscular distribution of women differs from men, so the expenditure level is lower for women. An inactive homemaker should use the lower end of the scale, and a very active housewife, the higher end. So, unless you are doing some pretty heavy housework daily for hours, go by the sedentary and not the moderate labor figures to calculate your daily caloric needs.

Example Calculation

The examples below are for someone who works at a desk job and is mostly inactive. For each scenario, the total represents the daily caloric requirement to maintain the individual’s current body weight. (Note: This does not mean that you should maintain this body weight, only the amount of calories it takes to stay at that level.)

5′5”, 300lb (BMI 49.9): 300 x 11-13.6 = 3300-4080 kcal.
5′5”, 150lb (BMI 24.96): 150 x 11-13.6 = 1650-2040 kcal.
5′5”, 130lb (BMI 21.5): 130 x 11-13.6 = 1430-1770 kcal.

Distributing the Calories

Of the foods that you eat, carbohydrates, proteins and fat are the major nutrients, called macronutrients, and the source of the calories you burn. The recommended dietary calorie distribution is:

Carbohydrates: 45-60% (No less than 130g because of the brain/central nervous system requirements)
Protein: 10-35% (At least 0.36g/lb/day)
Fat: 20-30%

Calculating the Actual Amount of Each Macronutrient

To calculate how much you can eat in terms of volume of food, you have to convert the calories into grams. (After all, you can’t “weigh” the calories, they are a unit of energy.)

Carbohydrates: 1g = 4 kcal
Protein: 1g = 4 kcal
Fat: 1g = 9 kcal

So, as an example, let’s look at a 1600 calorie diet, with the following distribution:

Carbohydrates 50% = 800 kcal = 200g
Protein 30% = 480 kcal = 120g
Fat 20% = 320 kcal = 35.5g

An important point to note when going food shopping or planning your meal is that there are no “pure” foods that contain nothing but a single nutrient, unless it has been processed and refined, as in refined sugar. Just about every natural food contains multiple nutrients, so you have to choose the food by its major content. For example, rice—which is a major carbohydrate food—contains 77% carbohydrates, but also 6% protein, and 1% fat. With beef, depending on which portion, the counts are around 20% protein, anywhere from 5%-30% fat, and negligible carbohydrates.

Maintenance Mode

First things first, you need to ask your doctor/dietitian what your maintenance intake should be, and what the macronutrient balance should be. If you need to figure out by yourself how many calories you need, the most important point is that daily intake must equal your daily expenditure. If you eat more than you need, your body will stock up the extra. If you eat less than you need, you will keep on losing. Keeping that in mind, you will have a general idea of how much you can eat, and how to balance your food intake when you reach goal. If you make the right choices with your food, you may find that you can eat a fair amount (though not as much as when your weight was at its maximum) while keeping the calories low.

Calculating your daily caloric intake immediately after gastric bypass surgery and for long-term maintenance can seem confusing. But with practice, running the numbers will become second nature, and you will also be more familiar with the calorie count and nutritional values of your favorite foods. Remember to take one day at a time as you learn healthy eating habits post-WLS. May your journey be full of rewards for all your hard work.

Tags: gastric bypass, bariatric surgery, weight loss surgery, obesity surgery, lapband, gastric bypass surgery support, how many calories

Health experts recommend fish as the best animal protein alternative to red meat. It is an important source of omega-3 fatty acids, which are so important to our health.

Numerous studies suggest that a predominantly plant-based diet is linked to long-term health. The phytochemicals, minerals and vitamins in plant foods seem to bolster the body’s defenses against cancer, heart disease and stroke.

And to go with your steamed fish, why not steam a variety of colorful and healthful vegetables? We recommend gradually making the transition to a plate that contains 2/3 (or more) vegetables, fruits, whole grains and beans to one-third (or less) animal protein. A spring dinner of steamed fish with yogurt dill sauce is a good place to start.

Ingredients

• 2 Tbsp. extra virgin olive oil
• 1 Tbsp. finely chopped fresh chives
• 1 tsp. finely chopped fresh basil
• 1 Tbsp. fresh dill, divided
• 1-1/2 lb. firm-fleshed fish fillet, (e.g. halibut, cod, or salmon) cut in 4 pieces
• Salt and freshly ground pepper
• 1/3 cup low-fat, plain yogurt
• 2 red bell peppers, thinly sliced
• 2 orange or yellow bell peppers, thinly sliced
• 1 scallion, finely chopped (green part included)
• 1 large lemon, thinly sliced
• 1/2 cup fat-free, reduced-sodium chicken broth
• 4 sprigs fresh dill for garnish (optional)

Directions

1. In a small bowl, mix together oil, chives, basil and half the dill. Rub mixture into both sides of fish, then sprinkle with salt and pepper. Set aside.
2. Mix remaining dill with yogurt and set sauce aside.
3. In a deep-rimmed serving dish large enough to hold the fish and broth, arrange bell peppers and scallions evenly along bottom. Place fish on top. Arrange lemon slices on top of fish. Add broth. Place in microwave and cook at medium power, checking every few minutes, until fish flakes with a fork.
4. Remove from microwave and garnish with remaining dill. Serve with yogurt-dill sauce.

Makes 8 pouch or 4 (earthling) servings.

Tags: gastric bypass, gastric bypass recipes, bariatric surgery, weight loss surgery, obesity surgery, lapband,

Anyone who lives in hurricane or tornado country knows that the time to get their emergency kit of food, water, flashlights and first-aid supplies together is long before the storm season starts. That way, they are prepared should an emergency strike, and they don’t have to waste valuable time looking for the essentials in the midst of a crisis.

That’s also the way it needs to be when it comes to assembling your “life emergency kit.” We WLS patients are a special group that has made a choice to radically alter our bodies, which in turn can change the way we relate to people and situations. Our physical and emotional needs are very different post-op than they were pre-op. As I have said often, we are “wired differently”, and that difference means we have to prepare ourselves to survive the special storms that may be headed our way.

Storm Clouds
Our life storms take the form of temptations to eat the wrong things, or too much of the right things. The storms also encompass emotional peaks and valleys triggered by both the physiological changes our bodies are adjusting to, as well as the psychological ones. We really are different from everyone else, and if we’re not managing the fact that we are different, we could be caught off-guard. Like people who live in storm country, we need to recognize the potential dangers of our environment and have a plan in place prior to when the clouds roll in.

Do you know where your emotional first-aid kit is right now? Do you have a network of fellow post-op partners you can depend on to gather around and protect you from a storm? Can you reach out and contact someone any time, day or night, when you feel threatened, alone or depressed? If the answer is “No”, you need to start building that network right now. There won’t be time when the dark clouds are gathering.

Helping Hands
Maybe you think you don’t know anyone else in your situation. Maybe you think you’re the only person who experiences food temptations, yo-yo emotions and a sense of loneliness that comes from being a stranger in a thin world. If you’re thinking that, I’ve got good news: You’re not going to die from terminal uniqueness.

You have an entire network of people just like you, and they come together online and in person to offer one another encouragement, guidance and support. You can find a group of them every day at 10am and 8pm Central time in the Gastric Bypass Chat Room. You can hear their thoughts and join in the conversation anytime in the forums at Weight Loss Surgery Forums. All the friends you could ever need are reading this same newsletter. Your support group exists; reach out now, while the sun is still shining, and get to know your emergency rescue team.

While you are building your network, remember that others are trying to build theirs. Help is a two-way street. Be a friend, and you’ll attract friends. Offer to help a stranger, and a stranger will reach out to help you. As the children of the 60s used to say, “What goes around comes around”. And as the good book tells us, “Do unto others as you would have them do to you”.

There’s more to putting together your life emergency kit than building a network. There are discipline issues related to everything from finances to meal planning and exercise routines, for which there are what I like to call “recovery tools”. We’ll take a closer look at these tools in the next issue. Until then, you’ve got a network to build. See you in the chat room!

Tags: gastric bypass, bariatric surgery, weight loss surgery, obesity surgery, lapband, gastric bypass surgery support, gastric bypass insurance

David Phelps
Star Tribune – March 25, 2006

As insurers balk at paying for stomach-shrinking surgery, doctors fear they are losing power to make medical decisions.

It’s a new twist in the battle of the bulge.

So many overweight Minnesotans are seeking obesity surgery that insurers struggling to control the cost of the procedure are getting in disputes with health-care providers, who say the companies are taking medical decisions away from doctors and their patients.

The most common obesity surgery is called gastric bypass, in which a surgeon creates a small stomach pouch to restrict food intake. The pouch is attached at one end of the esophagus and the small intestine.

But some insurers are balking at paying for the procedure, which averages about $18,000, unless patients first submit to supervised diets, exercise programs and psychological evaluations. Doctors say they worry some patients will die before getting approval for the surgery.

But insurers are defending the prerequisites, noting that the procedure carries some risk. Millions of dollars are at stake.

Blue Cross and Blue Shield of Minnesota, which saw bariatric procedures grow by 108 percent between 2001 and 2005, spent nearly $11 million on obesity surgery in the first 10 months of last year.

Medica, the state’s second largest insurer behind Blue Cross, covered claims for more than 1,000 of the procedures in each of the last two years. At HealthPartners, the number of patients getting the obesity procedure grew from just 78 in 2000 to 675 in both 2004 and 2005.

“We think utilization has reached a peak, but there is still a significant demand,” said Dr. Paul Karazija, Medica’s medical director of care management.

Obesity surgery is Blue Cross’ fourth-costliest inpatient procedure, trailing only joint replacement, major bowel complications and angioplasty that includes a drug-eluting stent.

Hospitals are following the money. More offer bariatric programs today than five years ago, and patients appear to be spreading the business around.

The bariatric surgery program at St. Joseph’s Hospital in St. Paul is less than two years old. The hospital did 100 obesity procedures last year and expects to double that this year. Fairview Southdale Hospital in Edina began its bariatric program in 2003 and has done 500 surgeries.

As a result of the demand, insurers have cobbled together special programs and some restrictions to determine whether individuals are good candidates. Certain hospitals have been designated as preferred providers based on their volume, experience and outcomes.

Medica added a pre-authorization requirement to its bariatric coverage last fall, meaning doctors have to contact the insurer for approval before scheduling surgery. Blue Cross released its list of preferred hospitals for the surgery in January.

Different requirements

“Every insurance company has its own criteria and guidelines for who qualifies for surgery. They’re all different,” said Marie Brown, surgery director for Fairview Southdale.

The latest gastric bypass insurance requirement, Brown said, is patient participation in a physician-monitored diet and exercise program.

“This can’t be Jenny Craig or Weight Watchers,” Brown said, naming two popular consumer diet plans.

Some insurers, such as HealthPartners, require bariatric candidates to participate in a six-month supervised weight loss program before they can become eligible for surgery. Brown said some insurers require patients to participate in the program for up to a year.

Janet Rudlong, manager of the bariatric program at Unity Hospital in Fridley, objects to that. “There’s no six-month weight-loss program for hernia repair or knee replacement, she said. “Show me the research that says six months of structured weight loss benefits the patient.”

Reducing risks

But medical directors for insurance companies say the requirements are critical to reducing risks associated with the surgery.

Medica’s Karazija said his organization approves the procedure once a patient meets the requirements. “We want to have a confidence level that the patient made a good-faith effort through exercise and diet,” he said.

Insurers also evaluate hospitals to determine where to send patients for bariatric surgery.

Earlier this year, Blue Cross identified eight hospitals in Minnesota and North Dakota it considered to be preferred providers of bariatric procedures. The eight were picked for the relevant experience of the medical staff, low readmission and complication rates, and follow-up care.

Blue Cross patients do not have to use these facilities. “But the incentive is that this is a big decision,” said Gold. “It’s not a cakewalk surgery. We want them to go to the best place possible.”

According to a Blue Cross study, complications occur in 30 percent of bariatric surgeries, one in 12 patients is rehospitalized within 90 days, and 20 percent require follow-up surgery within five years.

The typical patient

Dr. Michael Schwartz, director of the HealthEast Bariatric Center at St. Joseph’s Hospital, said his center’s typical bariatric patient is a 42-year-old woman who is 5-foot-5 and weighs 287 pounds. That would give her a body-mass index of 48. An index of 40 is usually the threshold for the surgery.

Potential bariatric patients have to go through an extensive pre-surgery program that lasts several months and is designed to coach the patient on the risks, benefits and uncertainties of the procedure. Patients also receive post-surgery counseling.

Unity’s Rudlong said two-thirds of Americas are overweight, but only about 1 percent are being treated for chronic morbid obesity. “It’s a shame,” she said.

Schwartz, from HealthEast, agrees. “You get the money back that you spend on surgery in three years,” he said. “There are tremendous gains to be had in (reduced) health care costs.”

Tags: gastric bypass, bariatric surgery, weight loss surgery, obesity surgery, lapband, gastric bypass surgery support, gastric bypass insurance

CNN.com
Wednesday, March 22, 2006

CHICAGO, Illinois (Reuters) — Weight loss surgery has the added benefit of dropping high blood pressure levels as it slims morbidly obese patients, according to a new study.

Patients who had not been taking drugs to treat their hypertension prior to surgery saw a significant easing of their blood pressure afterward, and some of those on antihypertension drugs were able to stop taking them, according to research published Monday in the Archives of Surgery.

Roughly two-thirds of morbidly obese people have high blood pressure, which is considered a prime risk factor for heart attacks and strokes, the report said. Obese people who take weight off can also lower the associated risks of ailments such as diabetes, some cancers and joint stress.

The study tracked 347 severely obese patients who had gastric bypass surgery at the University of Pittsburgh Medical Center from 1992 to 2001. Half had high blood pressure, with some 100 taking drugs to treat it.

Eighteen months after the surgery, which often involves shrinking the stomach and bypassing the nutrient-absorbing large intestine, the patients’ weight had stabilized at around a body mass index of 35 — a level at which someone is considered moderately obese.

A person’s body mass index is a ratio of height and weight, with a figure 30 or above considered obese and 40 or more morbidly obese.

Long-term benefitsAfter surgery, patients who had not been undergoing drug treatment for hypertension experienced a modest decrease in their systolic blood pressure — the higher reading taken when the heart contracts — and a significant decrease in diastolic pressure — the lower figure when the heart is at rest.

Among those who had been taking blood pressure drugs, one-third were able to stop taking them and others lowered their dosages.

“In counseling patients who are considering gastric bypass surgery, this study will help us to identify those patients who can reasonably expect the long-lasting health benefits from significantly reduced blood pressure,” said study co-author Madelyn Fernstrom, an associate professor of psychiatry, epidemiology and surgery at the University of Pittsburgh.

“It also is important to note that blood pressure reductions occurred in patients even though they remained obese with (a body mass index) in the 35 range, which is still not ideal, further suggesting that weight loss itself — in this study, achieved through gastric bypass surgery — can improve health outcomes,” Fernstrom said.

Weight-loss surgery is booming in the United States, doubling to 140,000 operations in 2004 compared to two years earlier, with an estimated 2 percent of the U.S. population morbidly obese. The death rate from complications after surgery ranges from 0.5 percent to 1 percent of patients.

Tags: lap band, gastric bypass, bariatric surgery, weight loss surgery, obesity surgery, lapband, sleep apnea, high blood pressure, hypertension

By Steven Reinberg
HealthDay Reporter

WEDNESDAY, March 22 (HealthDay News) — Weight loss surgery, called bariatric surgery, has become an increasingly popular solution to obesity, but as with any invasive procedure, there are some risks, according to a new report.

Increasing age and a type of surgery known as a “duodenal switch” are associated with an increased risk of complications after surgery, the study found.

“With every year of increasing age after the age of 60, there was a slightly increasing risk for complications,” said lead author Dr. Robert W. O’Rourke, an assistant professor of surgery at Oregon Health & Science University in Portland. In addition, patients who chose a duodenal switch rather than a gastric bypass had a two-fold increased risk of complications, he added.

For the study, O’Rourke’s team collected data on 452 patients — 372 women and 80 men, with an average age of 44 — who had had bariatric surgery. The patients received either gastric bypass surgery, which sections off a small portion of the stomach into a pouch that connects directly to the small intestine, or a duodenal switch. In this less-common procedure, part of the stomach is removed and a slightly larger pouch is left. In addition, an intestinal bypass-like-procedure is done that attaches the first part of the small intestine to the lower part of the small intestine.

During more than one year of follow-up, the patients lost an average of 54 percent of their excess weight. However, four patients died, 10 percent had major complications and 13 percent had minor complications. Patients who were 60 or older were more likely to develop complications than younger patients. And, the duodenal switch procedure was associated with more complications than gastric bypass surgery, the researchers found.

The findings appear in the March issue of the Archives of Surgery.

O’Rourke said that most of his patients receive gastric bypass surgery because of the data cited in the study. “The gastric bypass is the gold standard,” he said. “The gastric bypass is the operation most often done in this country.”

Dr. Shawn Garber, chief of bariatric surgery at Mercy Medical Center in Rockville Centre, N.Y., concurs that gastric bypass is the preferred procedure.

“I personally do not offer the duodenal switch procedure, because I feel the morbidity is much higher, even though some studies have shown that the weight loss is better than gastric bypass,” he said.

“In this study, there was no better weight loss with the duodenal switch,” Garber added.

Another study in the same issue of the journal looked at the potential for beneficial changes in blood pressure after bariatric surgery.

“Blood pressure doesn’t always change after gastric bypass surgery,” said co-author Madelyn H. Fernstrom, director of the University of Pittsburgh School of Medicine’s Weight Management Center. “Most people do see some improvement. But it all depends on your blood pressure before surgery.”

In this study, Fernstrom and her colleagues reviewed the medical charts of 347 patients who had undergone bariatric surgery between 1992 and 2001.

About half the patients had high blood pressure before surgery. After surgery, these patients saw a slight drop in systolic blood pressure and a significant drop in diastolic blood pressure, the researchers found.

Patients who didn’t have high blood pressure and those taking blood pressure medications had smaller drops in blood pressure than those with high blood pressure who had not been taking medications prior to the operation.

Of the 103 patients who were taking blood-pressure medication before surgery, 35 were able to stop taking the drugs after surgery, Fernstrom’s group found.

“Improvement in blood pressure depends on where you started,” Fernstrom said.

Garber said: “This article confirms that surgery for morbid obesity results in significant improvement in patients’ weight, which results in improvement of their hypertension.

“In the long run, weight loss improves patients’ medical problems like diabetes, hypertension, and sleep apnea, and decreases the number of medications that patients need to take,” he added. “This will lead to increases in the lifespan of patients that lose weight and resolve their medical co-morbidities. Surgery for obesity is the only effective means for long-term weight loss in patients that suffer from morbid obesity.”

SOURCES: Robert W. O’Rourke, M.D., assistant professor, surgery, Oregon Health & Science University, Portland; Madelyn H. Fernstrom, Ph.D., director, Weight Management Center, University of Pittsburgh School of Medicine; Shawn Garber, M.D., chief, bariatric surgery, Mercy Medical Center, Rockville Centre, N.Y.; March 2006 Archives of Surgery

Tags: lap band, gastric bypass, bariatric surgery, weight loss surgery, obesity surgery, lapband, sleep apnea

TIFFANY ST. MARTIN
Herald Staff Writer – March 23, 2006
Eileen Gentile’s family planned to take a cruise to Europe this summer, but they thought the money they’d set aside could be better spent – on Gentile’s well-being.

They opted to postpone their trip and spend the saved money on a weight-loss surgery new to Manatee Memorial Hospital. Gentile underwent the minimally invasive procedure March 3 – just the second day doctors performed Lap Band surgery at the Bradenton hospital.

Manatee Memorial is the first hospital in the area to offer Lap-Band surgery, says Bonnie Murphy, the hospital’s Surgical Weight Loss Center coordinator.

Michelle Adams, another of the hospital’s first Lap-Band patients, had the surgery March 2. Both Adams and Gentile chose to ha ve the operation for health, not vanity reasons.

Adams, whose pre-surgery weight was 245 pounds, has had diabetes for three years. She’s 41. A week after her surgery, she already was off one of her medications and taking a lower dosage of the other.

Her diabetes was the deciding factor in her decision to have the surgery. She’d heard about Lap-Band surgery from Murphy, a co-worker at Manatee Memorial. Adams is the hospital’s admitting supervisor.

Murphy had gastric bypass surgery before Lap-Band surgery was available, and it worked well for her, she says, but Lap-Banding is “quite an awesome procedure.”

It helps severely obese patients lose and control their weight, Murphy says.

“When I heard about this (Lap-Band system), it was just ‘Yeah, I’m gonna do it,’ ” Adams says.

Neither she nor Gentile ever considered having gastric bypass surgery because of its risks.

Gentile, a financial analyst, says she was happy and overall a healthy obese person at her pre-surgery weight of 330 pounds but, at 36, she could barely move because of her worsening arthritis.

After doing extensive Internet research on Lap-Banding – “I wanted to know everything about it,” she says – Gentile considered having the procedure done in Mexico, where it’s cheaper. But the more she contemplated it, the more she wanted to be close to home, to be within reach of medical support.

Still, she admits that she was a little nervous to be one of Manatee Memorial’s first Lap-Band patients. Adams says she wasn’t nervous but had very high expectations, which the hospital’s doctors and nurses exceeded.

A cut above

Outside Manatee Memorial’s second-floor Joseph B. Ganey, M.D. Surgery Center on March 3, proctor surgeon Dr. Mark Fusco gathered with Bradenton Surgical Group surgeon Dr. Jose Erbella and Inamed Health sales representative Tom Alioto.

Erbella’s surgical partner, Dr. Gary Bunch, stuck his head out of a double door that swings into the surgery room just long enough to say “We’re ready.” Then he was gone.

It was the second consecutive day of back-to-back Lap-Band surgeries, the first at the hospital. The surgery for severely obese patients has been performed around the world for a dozen years, and the U.S. Food and Drug Administration approved it in 2001. Since then, it’s grown in popularity in the United States. More than 120,000 have been performed.

The Lap-Band acts as a belt for the stomach. During surgery, which requires only a keyhole-sized incision, an adjustable silicon band is placed around the top part of the stomach. An attached tube extends to just under the skin, and on the inner part of the band is a balloon, which can expand and contract. With a simple in-office procedure, a physician can tighten or loosen the band by inserting a needle through the skin and into the tube, and adding saline or taking some out.

“It’s a hunger-control device,” Fusco says.

Advantages of the Lap-Band system include adjustability and reversibility. Also, it’s safer and less invasive than other weight loss surgery. Lap-Banding is an outpatient procedure that usually requires only an overnight stay, and most patients return to work within a week.

Of course, even a surgery as minimally invasive as Lap-Banding isn’t without risks. An Inamed Health handout for the Lap-Band system says there’s up to a 1.9 percent chance of band erosion and up to a 10 percent chance of band slippage. But the mortality rate of Lap-Band patients is 1 in 2,000, compared with 1 in 100 in gastric bypass patients.

Lap-Band weight loss of one to two pounds a week occurs over about three years, resulting in the improvement of all other weight-related health issues, Fusco says. Such as Adams’ diabetes and Gentile’s arthritis.

Fusco oversaw their surgeries as part of Inamed Health’s proctoring process. It’s in place to ensure that surgeons perform the Lap-Band procedure safely and meet standards set in place by Inamed, he says.

BioEnterics Corp., a subsidiary of Inamed Health, holds the U.S. patent on the Lap-Band system. Inamed Health’s mission includes providing “world-class training and education for surgical and medical professionals,” according to its Web site.

Drs. Bunch and Erbella went through a sort of application process to become certified to perform Lap-Band surgeries. They submitted evidence to Inamed Health that showed they are capable of performing laparoscopic surgeries, then received training specific to the Lap-Band system, Fusco says. Laparoscopic surgeries are minimally invasive procedures that eliminate the need for a large incision, according to MedicineNet.com.

A week before the first Lap-Band surgeries at Manatee Memorial, the hospital held a seminar on the procedure with seating for 50 people. More than twice that number showed up.

Murphy, the hospital’s Surgical Weight Loss Center coordinator, lists the dates of upcoming seminars on her voicemail. When asked why, she says, “You wouldn’t believe the phone calls I’m getting. I can’t keep up with them. It’s great!”

Erbella says so many people are interested in Lap-Banding because “obesity’s a big issue. It’s an epidemic.”

In the United States, about 9 million adults are severely obese. Sixty million are obese, and 127 million are overweight, according to the American Obesity Association.

Murphy says more health insurance companies than expected cover Lap-Band surgery. (Adams’ did, but Gentile’s did not.) Murphy hopes to see even more insurance companies working with Manatee Memorial’s Surgical Weight Loss Center in the future so more patients can take advantage of the procedure.

Many obese people are searching for a solution, something to help them lose their excess weight, Fusco says. That’s where Lap-Banding comes into play. As Alioto puts it, “It’s a healthier way to lose weight.”

At a loss

A week after their surgeries, Adams and Gentile had lost 47 pounds between them (17 for Adams, 30 for Gentile), but the Bradenton women were still on liquid diets then. Now they’re in their second week of eating baby and mashed foods. When they’re able to eat solid foods in another week, their stomachs will hold only a few ounces at a time.

They’ll have to chew their food completely and eat it with something wet, like a sauce – water will make food pass right through them.

As of March 9, neither had felt hunger pangs, and they were eating only because they knew they had to. Adams was amazed by how easy it had been to eat nothing but Jell-O and soup for a week.

Gentile imagined that if she were uncomfortably full, she’d feel it. “Either you’re full or you don’t feel anything,” she says.

She described the Lap-Band system as a tool that has to be used correctly. Both women know their weight loss will taper to a couple of pounds a week, and they plan to make exercise a part of their lives as soon as they’ve healed.

Adams’ main goal is to rid herself of diabetes, but she’d like to reach 145 pounds.

Gentile’s goal weight is 150 pounds. If and when she reaches it, she says, she doesn’t know that she’ll feel like a thin, healthy woman. She just can’t imagine it.

She won’t have to. Her whole life will change, as will Adams’, but one thing will remain the same: Gentile and her family plan to take that trans-Atlantic cruise to Europe sometime next year.

Tags: lap band, gastric bypass, bariatric surgery, weight loss surgery, obesity surgery, lapband, sleep apnea