Thursday, March 31, 2011

Obesity: The New Smoking

A while ago I retweeted something a friend regarding an article written for The LA Times had written about obesity being the new smoking and I think that is a very interesting analogy.

The actual article was in regards to health and how obesity can cause cancer, but I am interest in exploring the social stigma of obesity and smoking. Research dating back decades has shown that excess weight and smoking are both bad for you. So why do people still smoke and why is there an obesity EPIDEMIC?

I admit it, even at 250 pounds I judge fat people. I also judge people I see sucking on their cancer sticks, especially ones I know sat through all of the same education I did growing up. This as I belly up to fattening foods. So my question is: Is an overweight person eating fattening foods the new smoking? Is one worse than the other?

An overweight person and someone with a nicotine addiction may pity one another for their dependencies, but are they so different? They both say that they can give up their vice, yet most diets fail and cigarette companies are still in business. They are also both marketed to youth. For fast food it may elicit memories of going to McDonalds with your family when you were little, for cigarettes it may embody teenage rebellion or the feeling people got from that rebellion years later. The common denominator is that research indicates both fattening foods and cigarettes are addicting and both threaten the health of the planet.

There's no doubt in my mind that a single cigarette does more harm than a single burger. There's something called second hand smoke and a burger isn't slowly killing a person leading a balanced lifestyle. However, this article has me thinking again before I shake my head at smokers.


Before & After Photos

Well I only have before photos. Lots of them. Actually at all different weights. Anyways, nothing frustrates me more than seeing a bad before photo. Yes, I know we don't all look our "best" before we lose weight but c'mon people! I know people don't feel their best when they're heavy but it's so frustrating when the before pic is a blurry shot of someone eating KFC.

Here are my tips to a good before shot:
  1. Smile! Even if you have to fake it just keep grinning!
  2. Look into the camera, it's not a mugshot
  3. Take it in front of a door frame or the refrigerator - anything that will help you gauge size and cropping so your pics aren't all zoomed into different proportions
  4. Angles are key - make sure you get them from all sides and make sure you do it every time. 
  5. Get someone to take them for you or get a tripod. A lot of mine were sideways from trying to use a dinky tripod so I got a taller one and really like the shots I have now
  6. Why not a before VIDEO? Talk about yourself, your life, why you want to lose weight, how you feel, etc.
  7. Try wearing a variety of clothes - ones you feel great in now, ones you don't fit into well, dresses, pants, workout clothes
  8. Take note of what you're wearing in the photos - i.e. what size and brand of jeans?

Wednesday, March 2, 2011

So What Is Weight Loss Surgery?

There are many misconceptions about bariatric surgery, also known as weight loss surgery or WLS, that I would like to address. I was guilty of believing many untruths or quasi-realities of weight loss surgery that is often documented.

There have been many incarnations of WLS over the years but there are only 3 major surgeries used today. Bariatric surgeries can be classified into 3 types:
  1. Malabsorptive. These procedures reroute or remove the digestive process which means that vitamins and calories are not fully absorbed by the body
  2. Restrictive. These procedures reduce the size of the stomach
  3. Combination. Some surgeries combine malabsorption and restriction
There Are Three Major Types of WLS performed today...
RNY Gastric Bypass Surgery
 RNY is the most well known type of bariatric surgery practiced today. RNY gained  attention when Carnie Wilson allowed her surgery to be streamed online. Even though she helped spark interest in WLS, Ms. Wilson is not necessarily the poster girl for WLS. Many celebrities such as Al Roker, Sharon Osborne, Roseanne Barr, and Randy Jackson have also undergone the procedure.

This form of WLS is both malabsorptive and restrictive. It divides the stomach into a smaller upper and larger lower pouch to give patients a feeling of satiety (restrictive) and also rearranges the small intestine (malabsorptive). The larger part of the stomach which is bypassed is also the center of the hunger hormone (grehlin) production.

Before educating myself I was not aware that the intestines absorb calories and nutrients. Since some of the intestines are being bypassed this has its pros and cons. While not all calories are absorbed, not all vitamins and minerals are either. Furthermore, the bypass itself can cause patients to get sick, or "dump", easily when they consume certain levels of fat and sugar and this effect can last forever.

I was also surprised to learn that the bypass is very effective in essentially curing Type 2 diabetes. Many patients have instantaneous drops in their blood sugar count before they even leave the hospital. Other WLS surgeries aid in eliminating diabetes but it is more from losing weight and lifestyle changes.

There are many years of research to show that RNY is a solid procedure and is still the most common weight loss surgery performed.

Gastric Banding
Although this procedure is often referred to as the lap band, lap band is actually a brand of gastric band. Results for this surgery are mixed depending on the amount of weight people want to lose and their dependency on food as a drug.

The band is an actual device that gets put around the stomach to create a small restrictive pouch to give the people the feeling of fullness.

This surgery definitely has its success stories, but studies are showing that it may have a lower success rate than other types of WLS. With RNY many patients who intake mass amounts of calories will get sick. However, people with food addictions can intake large amounts of calories by eating calorie dense liquids and soft foods such as milk shakes and mashed potatoes.  This is why I think studies are coming back showing that people who are only obese or overweight can benefit from being banded while morbidly or super morbidly obese patients have a lower success rate.

Please now reference the image above. There are many less than credible doctors performing the surgery on anyone willing to pay which affects the statistics. The way that gastric banding is marketed it feeds the negative connotations of WLS in a way by making it look like an easy solution for everyone.

Vertical Sleeve Gastrectomy (VSG)
I chose VSG after a lot of research and consideration and am extremely happy with my decision. Considered a newer surgery in the US but has growing popularity both domestically and internationally. Many surgeons believe it may be the future of WLS.

VSG started off as the first phase of a duodenal switch. It was used as a stepping stone to make surgery less risky for extremely overweight patients.The switch is still used by some doctors but the procedure is waning in popularity partly due to the results physicians saw in their patients who received the VSG.

Vertical Sleeve Gastrectomy is a restrictive surgery that involves removing the part of the stomach that produces grehlin. The result leaves a tube shaped sleeve composed of the more muscular part of the stomach that is resistant to stretching.

Why I Chose VSG
I call gastric banding the gateway surgery because it's what a lot of people seem to consider at first. On paper it is appealing because there's no cutting involved and it seems fairly non-invasive. The band has reaped incredible results, but it has drawbacks which include slower weight loss.

I almost immediately switched my focus to having an RNY and was very secure in my decision. I wanted immediate results and liked that cheating was very difficult and could be very painful.

I decided on VSG because there is a lower risk of malnutrition in the long run and I am confident that overall weight loss will be about even with RNY even if the pace of loss isn't as rapid. I am fortunate that my insurance company pays for VSG since many insurers still consider VSG to be experimental.

Patient Education
Most reputable bariatric programs require pre and/or post-op education and many insurance companies also require some sort of pre-op diet program to show commitment to losing weight and a lifestyle change. With Kaiser they essentially are my surgeon AND insurer because they have developed the program with the surgery group they contract out to. I needed to lose 10% of my original weight and complete a 6 month program about surgery and post-WLS life.

It sounds trite, but knowledge is truly power and patients need to empower themselves to change their lives. Part of the reason why many fail to lose the weight or regain has to do with whether or not they have truly adopted a healthy lifestyle. WLS is not for everyone and it's up to you to make the choice to have surgery.

Risk of Complications
Like with any type of surgery WLS does run risk of death or injury in the short and long term. There could be leaks along incision lines, intestines can tangle, you may be more prone to hernias, you could form a blood clot, etc.

The way that I look at this is that right now I'm not living the life I'm imagining in my head and people don't see me for who I feel like I am on the outside. Yes I have a career that I love, I have family, I have friends - but there's still something missing.

If you read other blogs or go on different forums you will see many people talk about quality of life. Not only does WLS help give you years back, it also raises your quality of life by helping you gain your health back. My unhealthy behavior has given me high cholesterol, PCOS, a fatty liver, and has increased my risk of stroke or a heart attack.

Bariatric surgery is not a cure all solution or "the easy way out". In order to get approved you have to jump through bureaucratic hoops, lose weight on your own, and go to classes. There are people who have surgery that shouldn't just as there are surgeons performing surgeries on anyone with money.

At the end of the day WLS is a tool just like a Bodybugg or Weight Watchers. How you decide to use the tool is up to you and will directly affect the results you yield.
For anyone looking for more information please visit I also highly recommend Bariatric TV to anyone interested in learning more about the ups and downs of WLS. Their podcasts are hilarious and they touch on many things WLS patients and their loved ones face pre and post surgery.