Controversial surgical center for teens

On January 15, 2010, in Uncategorized, by Andrea

I’m of two minds of this.

At 17, I would not have been ready for a life-altering event like this.  At times, I don’t think I was really ready at 25.  At 17, I would not have been ready for the responsibility of the vitamin regimen for RNY.  Maybe a non-malabsorptive surgical option like VSG or AGB — but not DS or RNY.  But I know there has to be an option for those that ARE.

From the Denver Post:

Surgical hope for obese teens

Rose opens the first bariatric program for youths in Colorado — amid controversy

Kat Borst tried low-carb and no-carb and South Beach and Weight Watchers and so many other diets she “can’t even list them all.” None worked.

So at 17 years old and 280 pounds, Borst underwent surgery to squeeze her stomach smaller. She’s lost 54 pounds since June and now hits the gym with her dad, even though she couldn’t climb a flight of stairs without wheezing before.

Borst’s weight loss, and the success of other teens who’ve had Lap-Band or gastric-bypass surgery at Rose Medical Center in Denver, have led the hospital to open a new bariatric program for teens — the first of its kind in Colorado.

The new center comes as childhood obesity has reached epic levels — about 17 percent of American children and teens are considered obese — but also as controversy looms about the safety of bariatric surgery for adolescents.

The program at Rose is tailored to teens, with several weeks of pre- and post-surgery sessions on nutrition, psychology and behavioral changes.

“Being 17 is really hard,” said Dr. Michael A. Snyder, a bariatric surgeon who will direct the center. “Being a teen with bariatric surgery is very difficult. Being a morbidly obese teen is a total nightmare.”

Snyder, who has done more than 2,800 bariatric surgeries and developed a special high-nutrition food for his patients, said he makes sure teens “are ready for a life-long commitment” before he performs surgery, which costs about $9,500 and is only sometimes covered by insurance. For most adolescents, Snyder places a Lap-Band, which is gradually tightened to reduce stomach capacity to about 10 to 20 percent of its original space.

It should take about 4 ounces of protein — a chicken breast about as big as a computer mouse, for example — to make a patient with a Lap-Band feel “Thanksgiving full” for two or three hours, Snyder said. The bariatric center counsels teens not to waste calories on frappachinos or sodas or really anything without protein — otherwise they don’t lose the weight and could suffer from malnutrition.

Doctors disagree on rules

Snyder, one of few bariatric surgeons in the state who will operate on people younger than 18, said the ideal patient is at least 100 pounds overweight and has tried dieting and exercise without success. The doctor cites studies showing a less than 3 percent chance that a morbidly obese person will lose the excess weight and keep it off on their own.

“It’s the safest bet in Vegas,” he said. “If you are morbidly obese, the rules are different for you.”

But other physicians argue Lap-Band and gastric-bypass surgery on adolescents is irresponsible and unsafe.

“I am so disgusted with this,” said Dr. Wendy Scinta, a pediatric bariatrician on the board of the American Society of Bariatric Physicians. “In children, it’s still considered experimental.”

Scinta, who runs a medical weight-loss clinic for children and teens in Syracuse, N.Y., said adolescents who have bariatric surgery could end up with severe vitamin deficiencies and require surgery later to remove “elephant skin,” the kind that hangs off the body when weight loss happens too quickly without maintaining muscle mass.

“It’s kind of young to be going through something so drastic,” she said. “We’re at the point where the obesity epidemic is happening faster than we can get our arms around it, but especially with children, we do

have some time. We need to give them a shot at doing something less aggressive at first.”At Scinta’s clinic, kids take medication to control their insulin levels, they learn — with their parents — to change the family diet to five small meals per day, and they are hooked up with pedometers and an exercise program. Childhood obesity often is caused by family or medical problems, Scinta said.

“Kids are easy,” she said. “You really give them their life back or give them a life if they have never had one.”

Scinta said she would recommend bariatric surgery — and she never has for a child or teen — only for a kid who weighed 600 or 700 pounds, couldn’t get out of bed and was “truly on death’s door.”

Doctors said it’s often difficult to discern the parents’ desires from the child’s when considering bariatric surgery for an adolescent.

“The hardest thing in the pediatric population is determining who is deciding they should have surgery,” said Dr. Scott Fisher, director of bariatrics at Penrose-St. Francis Health Services in Colorado Springs. “Is it society? Is it the parents who are embarrassed of their child’s weight? For 40-year-olds, it is because they are choosing themselves to make themselves healthier.”

The Penrose bariatric surgery center has operated on only 10 to 15 teens in the last eight years, Fisher said.

Diet still a challenge

Borst, who is 18 now and working toward her goal weight of 145 pounds, wishes she would have had her Lap-Band surgery sooner in life. She struggled with her weight since age 4, was ridiculed throughout elementary school and left high school for an online program because of all the teasing.

Now she’s planning on college next fall.

“I’m getting more confident,” she said. “It’s not fully built up yet because I’m still pretty big.”

Still, Borst’s life is different now. Before her surgery she “was feeling like absolute death.” Now she enjoys hopping on a treadmill or stationary bike and playing badminton. Her clothes, she said, are “falling off.”

Changing her diet has been the biggest challenge.

“I’m not going to lie; I have a lot of spells where I lose my determination,” she said. “I get disappointed in myself. Every teenager that goes into this has to know it’s not easy.”

Jennifer Brown: 303-954-1593 or jenbrown@denverpost.com

Vitamins from A-Zinc — Vitamin A

On January 2, 2010, in Fat Solubles, Vitamins, by Andrea

Vitamin A

Vitamin A — What is it?

Vitamin A is a generic term that refers to compounds with the biological activity of retinol.  These compounds include the precursor, or provitamin A carotenoids – principally beta-carotene, alpha-carotene, and beta-cryptoxanthin, which are provided in the diet by green, yellow, or orange vegetables and by some fruits, and preformed vitamin A, namely retinyl esthers (such as retinyl palmitate and retinyl acetate) and retinol itself which are present in foods of animal origin – mainly in organ meats such as liver, other meats, eggs, and dairy products.

Rarely in research, you may come across connotations of vitamins A1 and A2.  Vitamin A1 is retinol as mentioned above, while vitamin A2 is dehydroretinol, an oily yellow alcohol found in some fish that is 40% less active in mammals.  These differentiations are rare in common usage – retinol is typically called as such rather than vitamin A1 and the other vitamin A analogues such as beta-carotene do not have such distinctions as they are not technically vitamin A – just precursors to the vitamin.

What is it good for?

Vision

Regulation of gene expression

Immunity – commonly known as the anti-infective vitamin, it is required for normal function of the immune system; plays a central role in development and differentiation of white blood cells

Growth and Development – essential for embryonic development; during fetal development, retinonic acid (RA) functions in limb development and formation of heart, eyes and ears; RA has been found to regulate expression of the gene for growth hormone

Red Blood Cell Production – stem cells are dependant on retinoids for differentiation into red blood cells; vitamin A appears to facilitate mobilization of iron from storage to developing red blood cells for incorporation into hemoglobin

Where do I get it?

As a fat-soluble compound, beta-carotene’s absorption in the GI tract depends on the fat content of the meal with which it is eaten.  It is less easily absorbed than retinol and must be converted to retinol and retinal by the body.  For this reason, a conversion factor has been created to represent this.  The most recent international standard of measure for vitamin A is Retinol Activity Equivalents (RAE) which represent vitamin A activity as retinol.

2 micrograms (mcg) of supplemental beta-carotene can be converted by the body into 1mcg of retinol, giving it an RAE ratio of 2:1.

1 mcg of dietary vitamin A     =     1mcg retinol     =     1:1 RAE ratio
1 mcg supplemental vitamin A     =     1mcg retinol     =     1:1 RAE ratio
2mcg supplemental beta-carotene     =     1mcg retinol     =     2:1 RAE ratio
12mcg dietary beta-carotene     =     1mcg retinol     =     12:1 RAE ratio
24 mcg dietary alpha-carotene     =     1mcg retinol     =     24:1 RAE ratio
24mcg dietary beta-crytoxanthin     =     1mcg retinol     =     24:1 RAE ratio

1 IU = 0.3mcg of retinol


Food Sources

Food Vitamin A (IU)* %DV**
Liver, beef, cooked, 3 ounces 27,185 545
Liver, chicken, cooked, 3 ounces 12,325 245
Milk, fortified skim, 1 cup 500 10
Cheese, cheddar, 1 ounce 284 6
Milk, whole (3.25% fat), 1 cup 249 5
Egg substitute, ¼ cup 226 5
Food Vitamin A (IU)* %DV**
Carrot juice, canned, ½ cup 22,567 450
Carrots, boiled, ½ cup slices 13,418 270
Spinach, frozen, boiled, ½ cup 11,458 230
Kale, frozen, boiled, ½ cup 9,558 190
Carrots, 1 raw (7½ inches) 8,666 175
Vegetable soup, canned, chunky, ready-to-serve, 1 cup 5,820 115
Cantaloupe, 1 cup cubes 5,411 110
Spinach, raw, 1 cup 2,813 55
Apricots with skin, juice pack, ½ cup 2,063 40
Apricot nectar, canned, ½ cup 1,651 35
Papaya, 1 cup cubes 1,532 30
Mango, 1 cup sliced 1,262 25
Oatmeal, instant, fortified, plain, prepared with water, 1 cup 1,252 25
Peas, frozen, boiled, ½ cup 1,050 20
Tomato juice, canned, 6 ounces 819 15
Peaches, canned, juice pack, ½ cup halves or slices 473 10
Peach, 1 medium 319 6
Pepper, sweet, red, raw, 1 ring (3 inches diameter by ¼ inch thick) 313 6


Vitamin Sources

Most multivitamins contain vitamin A as a combination of a retinyl esther and beta-carotene.  There have been some studies showing a higher risk of osteoporsis in older adults taking more than 5,000 IU of retinol per day, which has led many companies to reduce the retinol content in their multivitamin supplements to 750mcg (2,500 IU).  Additionally, there have been some studies showing supplemental beta-carotene as a pro-oxident, meaning it helps grow free radicals in the body rather than reduce them.  However, there has not been a push to reduce or limit beta-carotene from multivitamin supplements as of yet.  In fact, there are some experts that still believe a separate RDA should be set specifically for beta-carotene should be set — one that is set approximately 6x the current RDA for the entire vitamin A RDA is today.

The current RDA for vitamin A is:

Age
(years)
Children
(mcg RAE)
Males
(mcg RAE)
Females
(mcg RAE)
Pregnancy
(mcg RAE)
Lactation
(mcg RAE)
1-3 300
(1,000 IU)
4-8 400
(1,320 IU)
9-13 600
(2,000 IU)
14-18 900
(3,000 IU)
700
(2,310 IU)
750
(2,500 IU)
1,200
(4,000 IU)
19+ 900
(3,000 IU)
700
(2,310 IU)
770
(2,565 IU)
1,300
(4,300 IU)

Keep in mind that the RDA is the amount needed to avoid deficiency symptoms – not to achieve an optimum level.  Unfortunately, there have been no studies conducted to determine what the optimum vitamin A level is as of now.

Deficiency

Severe zinc deficiency often accompanies vitamin A deficiency.  Zinc is required to make retinol binding protein (RBP), which transports vitamin A, so a zinc deficiency limits the body’s ability to move vitamin A stores from the liver to body tissues where they are needed.  Zinc also helps to protect against potential toxicity of retinol.  Additionally, a zinc deficiency results in decreased activity of the enzyme that releases retinol from it’s storage form, retinyl palmitate, in the liver.  Zinc is also required for the enzyme that converts retinol into retinal.  Despite these well-documented associations between zinc and vitamin A, the health consequences of zinc deficiency on vitamin A nutrition status in humans is still unclear as of now.

Vitamin A deficiency may exacerbate iron deficiency anemia.  Vitamin A supplementation has beneficial effects on iron deficiency anemia and has been show to improve iron nutritional stores status among children and pregnant women.  A combination of supplemental vitamin A and iron seems to reduce anemia more effectively than supplemental iron or supplemental vitamin A alone.  Additionally, there have been some studies in which iron deficient anemia has been helped by supplemental vitamin A, even in the absence of a vitamin A deficiency.

Night blindness is one of the first symptoms of vitamin A deficiency.  Vitamin A deficiency contributes to blindness by making the cornea very dry, which damages it and the retina.

Deficiency in A also diminishes the body’s ability to fight infections.  In vitamin A deficient individuals, the cells lining the lungs lose the ability to remove disease-causing microorganisms.  This may contribute to a larger amount of pneumonia cases seen in vitamin A deficient individuals.

Keep in mind that a subclinical deficiency does not exhibit the signs and symptoms of a deficiency, but still may have the adverse effects of the deficiency.  A mild form of deficiency may increase the risk of developing respitory or diarrheal infections, decrease growth rate and slow bone development in children, and decrease the liklihood to survive a serious illness.

A vitamin A deficiency early in life could have adverse effects on neurologic and behavioral development and function later in life.  Some researchers even believe that schizophrenia may result from vitamin A deficiency.

Toxicity

Hypervitaminosis A refers to a high storage level of vitamin A in the body that can lead to toxic symptoms.  Severe cases may result in liver damage, hemmorrhage, and coma, and may generally only occur in individuals with long-term consumption in excess of 8,000-10,000 mcg/day or 25,000-33,000 IU/day.

Acute toxicity is relatively rare.  Symptoms include nausea, vomiting, headache, fatigue, loss of appetite, dizziness, dry skin, desquamation, cerebral edema, bone and joint pain, blurred vision, lack of muscular function, and abnormal liver function.

It is important to note a few things about vitamin A toxicity.  First, the Upper Limit (UL) does not apply to malnourished individuals receiving vitamin A either periodically or through fortification programs as a measure of preventing a vitamin A deficiency.  Additionally, beta-carotene and other carotenoids in foods, even when consumed in high levels have not produced toxicity; therefore, the UL does not include the carotenoids.

Age
(years)
Children
(mcg)
Males
(mcg)
Females
(mcg)
Pregnancy
(mcg)
Lactation
(mcg)
0-1 600
(2,000 IU)
1-3 600
(2,000 IU)
4-8 900
(3,000 IU)
9-13 1,700 (5610 IU)
14-18 2,800 (9,240 IU) 2,800 (9,240 IU) 2,800 (9,240 IU) 2,800 (9,240 IU)
19+ 3,000 (10,000 IU) 3,000 (10,000 IU) 3,000 (10,000 IU) 3,000 (10,000 IU)

There are some troubling concerns with the two major forms of vitamin A found in supplements today.

Intakes of retinol not far above the RDA, but well under the UL may reduce bone mineral density and increase the risk of osteoporatic disease and breaks.  It is speculated that perhaps retinol increases the bone resorption response or perhaps interferes with vitamin D in the maintenance of calcium within the bones.  This problem has only been found with the retinol form of vitamin A and not with beta-carotene, which has caused some multivitamin manufacturers to limit the amount of retinol in their product to 750mcg (2,500 IU).  In fact, my bottle of Centrum has a warning about taking too much vitamin A in the form of retinol on the label.

My bottle of Centrum...

The picture for beta-carotene isn’t a bed of roses, either.  Believing beta-carotene to be a powerful anti-oxidant, researchers gave patients supplements of both retinol and beta-carotene supplements to ascertain exactly how good it really was.  The findings of the Beta-Carotene and Retinol Efficacy Trial (CARET) shocked everyone.  Results suggest that high-dose supplementation of vitamin A and beta-carotene should be avoided in people at high risk of lung cancer.  One hypothesis had to do with the high amount of oxidation in the lung tissue – but there were no definative conclusions reached except the spike of lung cancers in high risk individuals who received the extra supplementation.  Despite this higher risk, there has been no push to remove or reduce beta-carotene from multivitamins.  However, a quick Google search will find a few tailor-made vitamins without beta-carotene for smokers, at a premium price of course.

Miscellaneous

Under conditions of vitamin A adequacy, most mammals, including humans, store more than 90% of their total vitamin A in their liver.

The safety of vitamin A is frequently questioned during pregnancy.  With vitamin A, there is such a thing as “too little” as well as “too much.”  Vitamin A is important in fetal development during cellular and tissue differentiation.  Excess retinol during pregnancy is known to cause birth defects.  There have been no birth defects observed at doses of preformed A from supplements below 3,000mcg (10,000 IU/day), but since foods are commonly supplemented, it is advised to stay under 5,000 IU/day.  It should be noted that vitamin A from beta-carotene is not known to increase the risk of birth defects.

WLS Concerns

Beta-carotene is a poor supplement of vitamin A for those who have had RNY, DS, and VSG.

To begin with, beta-carotene requires an acidic environment to absorb properly.  A study was conducted to measure the absorption of retinol, retinyl palmitate, and beta-carotene in an achlorhydriac, or low gastric acidic environment.  To test the supplements, subjects were given a proton pump inhibitor (PPI) to neutralize gastric acidity over a period of time, then tested with a gastric probe to ensure the pH level.  Once a low gastric level was reached, individuals were given supplements, then serum levels were checked.  Serum concentrations of beta-carotene were significantly greater at a low gastric pH (ie normal) than those at a high gastric pH (ie achlorhydria, or low gastric acid environment).  Serum concentrations of retinol and retinyl palmitate were not significantly different between the low gastric pH and high gastric pH.  Those with a lower acid content will not absorb beta-carotene fully, if at all.  It is also important to note that as we age, even those of normal stomachs will begin to neutralize their gastric acidity.  This was confirmed by a study published in the New England Journal of Medicine in reference to the breakdown of calcium citrate versus carbonate — but the problem of acidity remains the same.

Additionally, beta-carotene is absorbed in the duodenum, which is bypassed in the RNY and DS procedures.  Since this absorption site is bypassed completely, beta-carotene does little-to-no good to patients with either surgery – especially coupled with the lower gastric-acid component present in both surgeries as well.

Those with Adjustable Gastric Bands (AGB’s) should take note as well – beta-carotene absorbs better when eaten with some fat.  Those who have been extreme in removing fat from their diets should note this key interaction.

For post-WLS patients who become deficient in vitamin A, one can find dry-form, or water-miscible forms of the vitamin.  It should be noted that labs should be watched carefully, as always, when supplementing.  There is some evidence that water-miscible forms of retinol vitamins can be more toxic than their oil-based counterparts – but the study conducted was on non-bypassed individuals who had no level of malabsorption.  There are many rules in the nutrition world that simply do not apply to us – but I’m not going to be the one to say which ones are which.  Labs are really your only guide to know where you stand nutritionally and you should follow them accordingly.

Information compiled from:

Handbook of Vitamins, 4th Edition
Linus Pauling Institute
Advanced Health and Life

Office of Dietary Supplements
Gastric acidity influences the blood response to a beta-carotene dose in humans
Water-miscible, emulsified, and solid forms of retinol supplements are more toxic than oil-based preparations
NEJM — Calcium absorption and achlorhydria

http://www.amazon.com/Handbook-Vitamins-CLINICAL-NUTRITION-DISEASE/dp/0849340225/ref=sr_1_1?ie=UTF8&s=books&qid=1262205681&sr=8-1

Bariatric surgery is safe? Who knew?!?

On December 31, 2009, in Uncategorized, by Andrea

Well.  I guess I did since I’m still breathing.

And my readers who had it do, since, well, they’re reading this.  Unless there’s broadband and Farkle and such in the hereafter — and in that case put me down for a comfy chair, free refills of my coffee, with my current 20MBPS FiOS connection when I pass over to the other side, kthanx.

From Medscape:

How Safe is Bariatric Surgery?

Jacob A. Greenberg; Malcolm K. Robinson

Abstract

The use of bariatric surgery for the treatment of morbid obesity has increased dramatically over the past decade, which has raised concerns about safety, efficacy and cost-effectiveness. A new study by the Longitudinal Assessment of Bariatric Surgery consortium has assessed the safety of these increasingly frequent procedures.

Content

Clinicians are still struggling to find a solution to the world’s growing weight problem. New diets, prescriptions pills and exercise videos become available every week. Unfortunately, however, these weight-loss strategies fail to produce substantial, durable weight reduction for the vast majority of patients with morbid obesity. As a consequence, patients and physicians have turned to a more drastic approach to weight loss: bariatric surgery. Despite the 10-fold rise in bariatric procedures in the US—from 16,200 surgeries in 1994 to 171,000 procedures in 2005—the safety and advisability of such an extremely invasive therapy is often questioned. The Longitudinal Assessment of Bariatric Surgery (LABS) consortium have published the results of their first study, LABS-1, in the New England Journal of Medicine, which indicate that the overall risk of adverse outcomes of bariatric surgical procedures is low and contingent on patient characteristics.[1]

LABS-1 was a prospective, multicenter, observational study, which measured the 30-day morbidity and mortality of 4,776 patients who underwent one of the three most frequent bariatric surgical procedures performed in the US. The investigators found an overall mortality rate of 0.3% and a major complication rate of 4.1%, both of which are comparable to other major abdominal surgical procedures. Furthermore, they noted that patients with obstructive sleep apnea, poor functional status (for example, the inability to walk more than 100 feet), or a history of prior thrombotic events had increased complication rates.

The procedures evaluated in this study included open and laparoscopic Roux-en-Y gastric bypass, and laparoscopic adjustable gastric banding. Roux-en-Y gastric bypass involves the creation of a small upper stomach pouch and its attachment to the jejunum, which results in bypass of the rest of the stomach and the duodenum. This bypass leads to weight loss by restriction of food intake, as well as through a variety of poorly understood neurohormonal changes that enhance satiety. During the procedure of laparoscopic gastric banding, a small stomach pouch is generated by placement of an adjustable band around the upper stomach. Weight loss predominantly occurs as a result of restricted food intake, although neurohormonal changes that enhance satiety can also occur with this procedure. The LABS-1 investigators found that the 30-day composite end point of death, major thrombotic complication, reintervention and prolonged hospitalization was 1.0% for laparoscopic adjustable gastric banding, 4.8% for laparoscopic Roux-en-Y gastric bypass surgery, and 7.8% for open Roux-en-Y gastric bypass surgery.

The literature is rife with data on both the short-term and the long-term outcomes of bariatric surgery; however, the LABS-1 study differs from previous studies in a variety of ways. Previous data on clinical outcomes of bariatric surgery cannot be generalized, as they are derived from retrospective studies published by individual surgeons or institutions.[2,3] Inclusion of data from centers that do not practice state-of-the-art care within a comprehensive bariatric program might have added to the perception of increased adverse outcomes after bariatric surgery compared with other abdominal surgical procedures.

By contrast, the LABS-1 researchers analyzed data from patients treated by 33 different surgeons at 10 different clinical sites. Pertinent data points such as the primary endpoint and the presence or absence of specific prior comorbidities, were clearly defined and the data were managed by trained data collectors. Some critics might argue that the LABS-1 data underestimates the true morbidity and mortality of bariatric surgery, as the procedures analyzed were performed by highly skilled surgeons at high-volume centers of excellence which perform more than 100 laparoscopic Roux-en-y gastric bypasses annually. Previous research, however, has revealed that outcomes of both high-volume and low-volume programs are similar between centers of excellence and centers without said designation.[4] The data analyzed in LABS-1, therefore, represents the current state of the art in bariatric surgery and the study provides both surgeons and patients with realistic expectations of postoperative safety of three different bariatric procedures.

What LABS-1 does not address is the efficacy of bariatric surgery. Clinicians must be careful not to recommend a type of bariatric surgery on the basis of safety data alone. For example, although laparoscopic adjustable gastric banding is currently considered the safest bariatric procedure, gastric bypass might be the best option for patients who require substantial and durable weight loss.[5] In addition, bariatric procedures vary not only in the time until weight loss is achieved or the mechanisms that effect weight reduction, but also in their effects on glycemic control. After placement of an adjustable gastric band, improvements in glycemic control are dependent on weight loss, and patients might not see appreciable improvements in blood glucose control for some time.[6] After Roux-en-Y gastric bypass, most patients see an improvement in their glycemic control before any weight loss occurs. Although the mechanisms behind these changes are complex and not entirely clear, an alteration in the release of gut peptides seems to improve glycemic control independent of weight loss.[7] These effects, coupled with safety and other factors, must all be taken into account when a bariatric procedure is recommended for an individual patient. The results of the long-term LABS-2 study, currently in progress, will hopefully shed light on these efficacy issues and treatment recommendations.

In light of the imminent health-care reform proposed by the Obama administration, questions of cost-effectiveness must be addressed for all treatments, and bariatric surgery is no exception. The long-term health benefits after bariatric surgery include improved cardiovascular-related and diabetes-related outcomes. These improvements in comorbidities are associated with a decrease in mortality that ranges from 24-40% compared to patients treated non-surgically, as indicated by two other important studies published in the New England Journal of Medicine.[2,5] Ameliorations in overall health can lead to compensatory decreases in cost, if patients require fewer medications and less frequent hospitalizations than previously. At this point, however, it remains to be determined whether these decreases in cost are equivalent to the upfront cost of surgery and perioperative care. Further research through long-term cost-benefit analyses is needed before these questions can be answered adequately.

The prevalence of obesity and obesity-related disorders is on the rise in young adults, adolescents, and even in the pediatric population. Hence, this problem is unlikely to be resolved in the near future. In a perfect world, primary prevention through diet and exercise would alleviate the need for any surgical intervention. Unfortunately, until we begin to see success with primary prevention or develop equally effective medical management, bariatric surgery will remain an important—and reasonably safe—tool in our armamentarium for the treatment of obesity.

Good comparison of surgeries

On December 28, 2009, in Uncategorized, by Andrea

I’ll even agree that after the “honeymoon period” that RNY is primarily a restrictive surgery — except when it comes to vitamins.  Those we will malabsorb for life.

I only wish they had represented that DS was for all BMI’s — it can be modified for lower BMI’s if desired with a longer common channel, but alas, nothing in life is perfect.

Morbid fascination. Or Something.

On December 23, 2009, in Uncategorized, by Andrea

Don’t wanna go through the hassle and cost of slicing and dicing your guts to get a REAL weight loss surgery?  Not sure if you are really ready to commit to a lifetime of vitamin supplementation, or the reality of fills and such, but you’re sorta ready for a weight loss surgery without the pesky surgery part?

WELL!  If you live in California, and have $2k, your wait is over!

You can get a SLIMR Gastric Band!

Wait!  Andrea!  Tell me more about this SLIMR Gastric Band you say?!  Well, it’s a HYPNOTIC suggestion to your stomach muscles, telling them that you are full on 1/3 of the food you used to eat without the pesky risks associated with, you know, actual surgery!

WOOT!

Here’s the details. I’m not sure if I want to share them as I kinda want to keep factual information here.  I’m not really big on hypnotherapy.. maybe because I’ve never seen it actually, well, work.  Maybe it does, but maybe it doesn’t.  I think I’m too.. err.. analytical to think it works long-term.  Or skeptical.  Or .. something.  To me, this just seems like another fad diet.  And I don’t like that.  But just cause I find this interesting — if nothing more for the morbid fascination — here it is.

SLIMR gastric band makes its debut in the US at Tooley Weight Wellness Clinic

18. December 2009 03:26

An innovative weight loss program, the “SLIMR™ gastric band,” is making its debut in the United States at the Tooley Weight Wellness Clinic in Torrance, California.

“The sensation of a smaller stomach suggested through hypnosis offers results similar to a physical gastric band inserted by laparoscopic surgery, commonly called a lap band. The mind is very powerful, and what you think becomes real for you,” says Duncan Tooley, CHt, Certified Medical Hypnotist and developer of the program.

Tooley has developed a multi-faceted 27-week weight loss protocol that combines the power of the sub-conscious mind with the appetite-limiting features of a gastric band. Tooley’s unique program provides a lower risk, lower-cost option for those considering lap band surgery, or for whom diets do not work.

Joh Smith’s story of her 55-pound weight loss within a few months of receiving her hypnosis lap band was covered in the London Press earlier this year, as were similar results experienced by Marion Corns, another woman seeking weight loss. As part of the process, both women underwent a simulated lap-band surgery during a hypnosis session and afterward experienced effects normally resulting from the presence of a physical lap band.

Elaborating on the actual process of the SLIMR™ band, Tooley says, “As my client rests comfortably in hypnosis, I suggest that a narrow band of stomach-wall muscles contract to squeeze off a pouch identical to that produced by a physical lap band. Thereafter, the sensation ‘I’m full’ is triggered after about 1/3 cup of food fills the small pouch. The food trickles through the adjustable opening into the larger main stomach and is then digested normally. SLIMR describes both the process of installing the gastric band, Stomach-Limiting Induced Muscle Response, and the client’s end result!

While the appetite and metabolic effects of the SLIMR™ band are comparable to a surgically-implanted lap band, other aspects of the program differ substantially. “My program offers great results because it includes group support, nutritional education, and 27 weeks of hypnosis to adjust sub-conscious food habits. These features are unique to my program and lacking in the standard lap band surgery,” says Tooley.

The 6-month program costs $6,977, a fraction of the $15,000-$30,000 cost of a surgical lap band procedure. A few openings are still available in clinical validations now underway at Tooley’s Weight Wellness Clinic in the Medical Centre, located at 4201 Torrance Blvd, Torrance, 90503. The fee for participation in the clinical validation is only $1,977 and includes all features of the full cost program.

Tooley experienced the extraordinary power of the mind when he marshaled self-hypnosis to cure his own disability and later used it as anesthesia during hernia repair surgery. Thousands of medical studies confirm that the mind is extremely powerful in adjusting body processes when asked specifically to do so.

And if you want to, you know, participate?  Here’s the place to go:  Tooley Weight Wellness Clinic

Keep in mind, though — and I know that you, my loyal followers will be FLOCKING to go there — that this place is in Torrance, CA.  So you’d better be willing to drive or be local.  Anyone willing to go and do a review — lemme know ;-)

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