Patients who underwent gastric bypass surgery had improved overall health even seven years post-op, a recent study showed, indicating the long-term benefits of bariatric surgery.
The study consisted of 182 patients initially, mostly women in their mid-40s, who underwent gastric bypass surgery. This procedure bypasses a large portion of the stomach and the small intestine to create a small stomach pouch that restricts calorie intake.
Researchers followed subjects for seven years, at which time they had solid data for 78 participants.
“For most of them, they came back to normal,” Dr. John Morton, director of bariatric surgery and surgical quality at Stanford University School of Medicine, told HealthDay. “There were roughly about a dozen measurements altogether, and there were substantial improvements across the board.”
The results proved the long term benefits of weight loss surgery. The average weight loss was 81 pounds, cholesterol levels dropped from 184 to 174, and triglycerides dipped from 151 to 87. In addition, the patients also showed a significant drop in high-sensitivity C-reactive protein. This protein is closely associated with a higher risk of heart attacks or strokes.
A previous study published in January of this year showed that gastric bypass surgery lowers the risk of a first time heart attack or stroke, as well as dying due to a heart attack.
The new study was presented last month at the annual meeting for the American Society for Metabolic and Bariatric Surgery (ASMBS) in San Diego. Until published in a peer-reviewed journal, the results for this study ought to be viewed as preliminary, researchers noted.
Even so, the latest findings are important, because the study tracks the effects of weight loss surgery over several years, Dr. Robin Blackstone, ASMBS president, told HealthDay. Changes in the body’s metabolism and related workings of the heart after losing excess weight can significantly reduce health risks, she said.
You may consider exercise a nuisance, a chore, or simply a bore. But if you’ve been diagnosed with type 2 diabetes, you need to look at physical activity in a whole new light. Now it’s a tool. Just like taking a drug or altering your diet, exercise can lower blood sugar on its own, even if you don’t lose weight.
“Exercising is the most underused treatment and it’s so, so powerful,” said Sharon Movsas, RD, a diabetes nutrition specialist at the Clinical Diabetes Center at Montefiore Medical Center in New York City.
For most people with diabetes, exercise is a safe and highly recommended way to reduce the risk of complications. However, check with your doctor to make sure you don’t have heart problems, nerve damage, or other issues that need special consideration when you are working out.
How exercise affects blood sugar
In general, blood sugar drops after exercise and is lower for the next 24 to 48 hours, says Movsas. “If I take a blood sugar reading after aqua-aerobics, I usually notice it’s down,” says David Mair, 79, of Marquette, Mich.
When you exercise, your muscles become more sensitive to insulin and absorb more glucose from the blood. However, like many aspects of type 2 diabetes, the response can be highly personal. Exercise can sometimes boost blood sugar. At first, you’ll need to test your blood sugar before, after, and sometimes during exercise, to see how your body responds).
Exercise also helps lower blood pressure—an important benefit since high blood pressure can contribute to heart attacks, strokes, eye problems, kidney failure, and other type 2 diabetes complications.
tart slow and work up
Even if you know exercise is good for you, it doesn’t make it easy. Luckily, studies have shed light on the most successful exercise strategies for type 2 diabetes. Using a pedometer and aiming for 10,000 steps per day is one tried-and-true approach, although you need to determine what works best for you.
Overall, the goal is 30 minutes of aerobic activity at least five days a week. But it may take some time to get there, particularly if you’ve never been a big fan of exercise. In those cases, medication and diet are the preferred first step to get blood sugar down. Then you can start out with short (five-to 10-minute) walks before increasing your physical activity.
At first, physical activity may not feel good, particularly if you are obese, says Virginia Valentine, a certified diabetes educator who also has type 2 diabetes. If you are obese or have another condition that impairs your mobility (such as arthritis), you may even need a specialized exercise program.
Check with local hospitals to see if they have programs for the mobility-impaired, which may include chair exercises, yoga for seniors, Aquacise, or the use of recumbent stationary bikes.
However you exercise, you may be able to reduce your need for blood-sugar-lowering drugs if you stick with it.
“There are some cases where people have been able to be taken off medication,” said Samantha Heller, RD, nutrition coordinator for the Fairfield, Conn., YMCA.
Over the past few years, several significant studies have demonstrated how effective bariatric surgery is at improving diabetes in obese patients. The research has been so encouraging that bariatric surgery for diabetes was named the top medical innovation of 2013. Now, researchers from the Cleveland Clinic have further pinpointed how the weight loss procedure, Roux-en-Y gastric bypass, improves uncontrolled type 2 diabetes. In a sub-study of the STAMPEDE trial (Surgical Therapy And Medications Potentially Eradicate Diabetes Efficiently), they discovered that gastric bypassreverses diabetes in moderately obese patients by uniquely restoring pancreatic function.
The cells of the pancreas that produce insulin are called beta cells. Malfunctioning pancreatic beta cells can cause the pancreas to not release enough insulin, or insulin that the body does not recognize. When the body can’t use insulin properly, it can’t regulate the amount of glucose in its bloodstream, leading to diabetes. The researchers explain that gastric bypass appears to uniquely restore pancreatic beta-cell function, seemingly by targeting belly fat—where hormones that are toxic to the body develop–and changing the hormones in the gastrointestinal tract. Patients in the STAMPEDE sub-study who had gastric bypass lost more belly fat than those who underwent gastricsleeve surgery. These findings point to a correlation between a decrease in belly fat and the ability of the pancreas to start working again.
The sub-study included 60 patients: 20 received intensive medical therapy for their diabetes, 20 had gastric bypass surgery and intensive diabetes therapy, and 20 had gastric sleeve surgery plus the therapy. The researchers found that at 2 years, 41% of the gastric bypass patients saw their blood sugar levels return to normal. Only 10% of sleeve patients and 6% of the intensive medical therapy group achieved the same results. Striking metabolic changes were observed in surgery patients compared with the intensive medical therapy patients, especially in the gastric bypass group. These findings provide substantial support for the use of gastric bypass surgery to treat diabetes in moderately obese patients.
“The Cleveland Clinic continues to lead the bariatric world by supplying us with first rate studies proving that weight loss surgery is about more than losing weight; it’s about making people healthy,” said Daniel Cottam, MD, expert bariatric surgeon in Salt Lake City. “This means treating each patient according to their metabolic problems. Many people have mistakenly decided that one procedure is best for all types of patients, however this study proves that for some patients, an intestinal bypass like the gastric bypass or the duodenal switch is vital to restoring patients health and eliminating diabetes.” Dr. Cottam advises that when patients are looking for surgeons to perform their weight loss surgery, they should look to surgeons who perform a range of procedures that can be tailored to their medical problems.
Tips for Eating Healthy When Eating out
- As a beverage choice, ask for water or order fat-free or low-fat milk, unsweetened tea, or other drinks without added sugars.
- Ask for whole-wheat bread for sandwiches.
- In a restaurant, start your meal with a salad packed with veggies, to help control hunger and feel satisfied sooner.
- Ask for salad dressing to be served on the side. Then use only as much as you want.
- Choose main dishes that include vegetables, such as stir fries, kebobs, or pasta with a tomato sauce.
- Order steamed, grilled, or broiled dishes instead of those that are fried or sautéed.
- Choose a small” or “medium” portion. This includes main dishes, side dishes, and beverages.
- Order an item from the menu instead heading for the “all-you-can-eat” buffet.
- If main portions at a restaurant are larger than you want, try one of these strategies to keep from overeating:
- Order an appetizer-sized portion or a side dish instead of an entrée.
- Share a main dish with a friend.
- If you can chill the extra food right away, take leftovers home in a “doggy bag.”
- When your food is delivered, set aside or pack half of it to go immediately.
- Resign from the “clean your plate club” – when you’ve eaten enough, leave the rest.
- To keep your meal moderate in calories, fat, and sugars:
- Ask for salad dressing to be served “on the side” so you can add only as much as you want.
- Order foods that do not have creamy sauces or gravies
- Add little or no butter to your food.
- Choose fruits for dessert most often.
- On long commutes or shopping trips, pack some fresh fruit, cut-up vegetables, low-fat string cheese sticks, or a handful of unsalted nuts to help you avoid stopping for sweet or fatty snacks.
Exercise for bariatric surgery patients is often the first part of a patient’s long-term plan to get skipped following surgery. In reality, it is almost as important as your diet. This page explores why along with the best weight loss surgery exercise options.
Why Exercise for Bariatric Surgery Patients is Important
The successful bariatric surgery patient regularly takes part in three main activities in their life after surgery:
- Follows an appropriate bariatric diet plan
- Actively participates in weight loss surgery support groups
- Follows a consistent and progressive exercise routine
Two of these are easier to adhere to…
If you don’t follow your diet plan, you will most likely get sick… ranging from trouble with digestion to vitamin deficiency. This risk – or actually getting sick as any patient who has had dumping syndrome can tell you – keeps most patients in line regardless of their motivation.
Participating in weight loss surgery support groups is the next easiest thing to keep consistent. They’re interactive and fun, and if time is an issue there are great at-home options available in the form of online weight loss support.
Not surprisingly, exercise for bariatric surgery patients is often the component that slips. It can seem daunting, especially after a long day at work or an especially difficult week.
But you must make it a priority for two big reasons:
- You will lose more weight
- The benefits to your physical and mental health are astounding
1. Exercise for Bariatric Surgery Patients Causes More Weight Loss
We’ll let the research do the talking…
- A recent meta-analysis found that consistent exercise for bariatric surgery patients leads to a 4.2% lower body mass index.1
- Another study compared the weight loss of gastric bypass surgery patients who completed moderately intense physical activity for a minimum of 2 ½ hours per week against those who did not. The 2 ½ hours+ per week patients showed significantly greater weight loss:2
- 6 months after surgery – 5.5% greater excess weight loss (56.0% vs. 50.5%)
- 12 months after surgery – 5.7% greater excess weight loss (67.4% vs. 61.7%)
- Still not convinced? A third study evaluating 200 bariatric surgery patients found that physical activity adherence was the sole significant behavioral predictor of weight loss outside of dietary habits. In other words, other than sticking to your diet plan it’s the main thing you can do to achieve and sustain your weight loss goals.3
So how does exercise contribute to weight loss?
Recent research suggests that your metabolic rate may not be as important as previously thought, especially when compared to an improved diet.
Regardless, good weight loss results and better overall health speak for themselves… a healthy diet combined with an appropriate exercise program equals long-term success.
As you probably know, it burns calories. But this is not the main reason it works. After all, if you weigh 275 pounds, you will burn 200 calories per mile walked at a pace of 5 mph. One cup of dried apples has over 200 calories, let alone your entire daily intake. Exercise will only directly burn a small portion of your daily calories.
The more important reason exercise for bariatric surgery patients works is by boosting your metabolism, which is especially important considering your body’s natural tendency to slow down your metabolism as you lose weight (see Set Point Theory). A higher basal metabolic rate means that your body will automatically burn calories at a faster rate even while you are resting, thus leading to additional weight loss.
To determine exercise’s impact on weight loss surgery patients, one study divided 60 morbidly obese gastric bypass patients into two groups:
- Low-exercise (worked out 1 time for 1 hour per week)
- Multiple-exercise (worked out 2 times for 1 hour each per week)
In addition to quicker weight loss, the multiple-exercise group had significantly earlier resolution or improvement of obesity health problems.4
In fact, exercise for bariatric surgery patients and obese individuals alike has been shown to improve a vast array of physical and mental issues, including:
Physical Improvements Caused By Exercise for Bariatric Surgery Patients
- Increased life expectancy5
- Reduced abdominal fat
- Stronger heart, muscles, bones and lungs
- Reduced risk of heart disease
- Lower blood pressure
- Reduced triglycerides
- Increased good cholesterol and reduce bad cholesterol
- Improved blood sugar control
- Improved insulin control
- Reduced risk of cancer
- More energy
- Improved balance
Mental Improvements Caused By Exercise for Bariatric Surgery Patients
- Improved appearance
- Improved motivation and mental “sharpness”
- Improved libido
It may be possible to strengthen and improve your self-control – and lose more weight – according to a new study by researchers at The Miriam Hospital’s Weight Control and Diabetes Research Center. The research was the first to examine whether practicing acts of self-control during weight loss is linked to an increase in self-control and better weight loss outcomes. They conducted two studies; the first involved 40 participants enrolled in a six-month behavioral weight loss intervention. The intervention included weekly sessions led by dietitians, behavioral psychologists, and/or exercise physiologists and featured private weigh-ins. All participants were given a reduced calorie, low-fat diet, physical activity instructions and guidance in behavior change strategies. At the conclusion, the participants’ global self-control was tested with a handgrip task, a commonly used test measuring how long participants can hold onto and squeeze a handgrip. The idea is to see how long participants will hold on to the handgrip, despite cramping, pain and discomfort. They have to override the desire to end the uncomfortable task in order to reach their goal.
The second study analyzed whether changes in self-control were connected with treatment adherence and weight loss outcomes. A similar six-month program was run, involving 23 participants. This time the participants completed the same objective measure of self-control (the handgrip test) both before the treatment program and at the conclusion.
The findings showed that participants in both studies who achieved a 10% weight loss had greater self-control compared to those who did not achieve such a weight loss. While this is not surprising in itself, the researchers further found that participants who showed increases in self-control from the start to conclusion of the trial achieved a significantly higher weight loss, ate a healthier diet, engaged in more minutes of physical activity, and attended more group meetings. The researchers concluded that self-control may be malleable and the practice of inhibiting impulses may help people lose weight, eat healthier and increase their physical activity. Future weight loss treatments may consider targeting self-control/willpower as a way to enhance outcomes. The study was published online by the journal Obesity Research and Clinical Practice.
Another recent experiment, presented at The Obesity Society’s annual meeting, also suggested that self-control/will power may be modifiable. In the experiment, some kids were given lego blocks to make a flower design, while others were given gummy bear candies to make the same flower design. After the activity, all the kids were offered a different type of candy to eat. According to the researchers, the kids that had been resisting eating candy because they were making flower out of it, ate notably less candy when it was presented after, as compared to those that were not practicing impulse control because they were making a flower out of legos. Combined with the findings from Miriam Hospital’s studies, this research may add to our understanding of how impulse control may be modified to help people lose weight.
When it comes to food and nutrition, even the most knowledgeable parents can use help making sure their children are eating healthy meals. Each March, the American Dietetic Association celebrates National Nutrition Month®, and this year’s theme, “Eat Right with Color,” encourages parents to take time to make sure their children are getting all of the nutrients they need to grow and thrive. The good news is that shopping, cooking and eating healthfully have just gotten easier with assistance from www.kidseatright.org, a new website from ADA and its Foundation.
The 2010 Dietary Guidelines Advisory Committee recently reported that children, teens and adults have diets deficient in dietary fiber, vitamin D, calcium and potassium, and the Kids Eat Right campaign calls for increased attention to the alarming nutrient deficiencies in children’s diets.
“Weight is not the only measure of good nutrition and health. Any child — whether they are of normal weight, overweight or obese — can be undernourished,” says registered dietitian Dr. Katie Brown, national education director for the American Dietetic Association Foundation.
“Quality nutrition requires a total diet approach that goes beyond calorie counting alone, to focus on including those nutrients critical for a child’s healthy growth and development,” Brown says. “This year’s National Nutrition Month theme is a great reminder for parents to focus on that total diet approach by including a variety of foods and colors in every meal, every day.”
Brown offers the following guidance for helping your kids “Eat Right with Color”:
- Give kids whole-grain cereals for breakfast, kid-friendly “white” whole-wheat bread for sandwiches, crunchy whole-grain crackers for snacks and whole-grain pastas for dinner.
- Eat more fruits and vegetables at every meal. At breakfast, enjoy fresh or frozen berries on cereal, slices of melon or a glass of 100 percent orange juice; at lunch, serve baby carrots or sliced apples; for dinner, put brightly colored vegetables at the center of every plate.
- Most young people in America are not getting enough calcium or potassium. Fortunately, it’s easy to consume the three daily dairy servings children and teens need. Try an 8-ounce glass of low-fat milk with breakfast, lunch and dinner; yogurt parfaits for breakfast or an after-school snack; or string cheese for an on-the-go energy snack.
- Getting enough protein at every meal and snack helps kids feel satisfied after eating. Start their day with egg or bean burritos. For snacks, provide peanut butter or sliced deli meat.
Designed around a SHOP, COOK and EAT theme, the Kids Eat Right website provides parents with practical tips, articles, videos and recipes from registered dietitians to help families shop smart, cook healthy and eat right.
Interactive kids games for National Nutrition Month will be available, including:
* Sudoku: Tackle these popular puzzles using food rather than numbers.
* Word Search: Find the words that represent the bold and vibrant colors associated with eating right!
* Rate Your Plate Quiz: Find out how you rate when it comes to making daily meal choices.
Whether speaking with a registered dietitian about essential nutrients and healthier cooking, or visiting www.kidseatright.org for tips and recipes, Kids Eat Right provides families with knowledge as well as ideas and tools to transform their eating behaviors.
The problem of childhood obesity in the United States has grown considerably in recent years. Between 16 and 33 percent of children and adolescents are obese. Obesity is among the easiest medical conditions to recognize but most difficult to treat. Unhealthy weight gain due to poor diet and lack of exercise is responsible for over 300,000 deaths each year. The annual cost to society for obesity is estimated at nearly $100 billion. Overweight children are much more likely to become overweight adults unless they adopt and maintain healthier patterns of eating and exercise.
A few extra pounds does not suggest obesity. However they may indicate a tendency to gain weight easily and a need for changes in diet and/or exercise. Generally, a child is not considered obese until the weight is at least 10 percent higher than what is recommended for their height and body type. Obesity most commonly begins between the ages of 5 and 6, or during adolescence. Studies have shown that a child who is obese between the ages of 10 and 13 has an 80 percent chance of becoming an obese adult.
What causes obesity?
The causes of obesity are complex and include genetic, biological, behavioral and cultural factors. Obesity occurs when a person eats more calories than the body burns up. If one parent is obese, there is a 50 percent chance that their children will also be obese. However, when both parents are obese, their children have an 80 percent chance of being obese. Although certain medical disorders can cause obesity, less than 1 percent of all obesity is caused by physical problems. Obesity in childhood and adolescence can be related to:
- poor eating habits
- overeating or binging
- lack of exercise (i.e., couch potato kids)
- family history of obesity
- medical illnesses (endocrine, neurological problems)
- medications (steroids, some psychiatric medications)
- stressful life events or changes (separations, divorce, moves, deaths, abuse)
- family and peer problems
- low self-esteem
- depression or other emotional problems
What are risks and complications of obesity?
There are many risks and complications with obesity. Physical consequences include:
- increased risk of heart disease
- high blood pressure
- breathing problems
- trouble sleeping
Child and adolescent obesity is also associated with increased risk of emotional problems. Teens with weight problems tend to have much lower self-esteem and be less popular with their peers. Depression, anxiety, and obsessive compulsive disordercan also occur.
How can obesity be managed and treated?
Obese children need a thorough medical evaluation by a pediatrician or family physician to consider the possibility of a physical cause. In the absence of a physical disorder, the only way to lose weight is to reduce the number of calories being eaten and to increase the level of physical activity. Lasting weight loss can only occur when there is self-motivation. Since obesity often affects more than one family member, making healthy eating and regular exercise a family activity can improve the chances of successful weight control for the child or adolescent.
Ways to manage obesity in children and adolescents include:
- start a weight-management program
- change eating habits (eat slowly, develop a routine)
- plan meals and make better food selections (eat less fatty foods, avoid junk and fast foods)
- control portions and consume less calories
- increase physical activity (especially walking) and have a more active lifestyle
- know what your child eats at school
- eat meals as a family instead of while watching television or at the computer
- do not use food as a reward
- limit snacking
- attend a support group (e.g., Overeaters Anonymous)
Obesity frequently becomes a lifelong issue. The reason most obese adolescents gain back their lost pounds is that they tend to go back to their old habits of eating and exercising. An obese adolescent must therefore learn to eat and enjoy healthy foods in moderate amounts and to exercise regularly to maintain a desired weight. Parents of an obese child can improve their child’s self esteem by emphasizing their strengths and positive qualities rather than just focusing on their weight problem.
When a child or adolescent with obesity also has emotional problems, a child and adolescent psychiatrist can work with the child’s family physician to develop a comprehensive treatment plan. Such a plan would include reasonable weight loss goals, dietary and physical activity management, behavior modification, and family involvement.
Atlanta Bariatrics understands that obesity is a disease, and that having this disease is not your fault. Obesity is a complex disease that is often times misunderstood. There are many genetic and environmental factors that contribute to your obesity. We understand the discrimination that you face and we believe this is unacceptable. Our mission is to help you to achieve a healthy weight and lifestyle.
We are here to help you break the cycle of obesity. You diet and lose weight only to gain the weight back, and more. This cycle of yo-yo dieting slows down your body’s metabolism, making it harder to burn fat. This cycle increases your risk of serious health conditions and it doesn’t work.
We have helped thousands of patients achieve their goal of a healthier life. Our knowledgeable staff will help guide you through the entire process, assisting you at every step with a decision that will change your life. Together, we will find the right procedure for you, taking into consideration your medical history, current health conditions and desired speed of weight loss. We don’t think one solution works for everyone, and instead tailor our procedures to fit your goals.
We are here to help!