Sugar Roundup, Continued

Day of the Dead Cookies

This is a continuation of the collection of various Childhood Obesity News posts about sugar, a substance considered by some to be a white drug as dangerous as cocaine or heroin.

When Practice Does Not Make Perfect” looked at the historical significance of sugar in the context of Christianity—specifically the ecclesiastical season of Lent. Traditionally, for the forty days leading up to Easter, people would give up something they were very fond of. Throughout most of history, people lived with such limited resources that there wouldn’t be a lot of leeway for choice. Sugar was about the only thing available for giving up, so people had the opportunity to become very familiar with the feeling of deprivation.

Looking back from a contemporary perspective, it is easy to wonder why, having already gone through weeks of withdrawal, people would not take advantage of that head start to make their sugar abstinence permanent. But, given the shortage of luxuries for most people in most places, it is not so difficult to understand why a person would go right back to sugar after the religious obligation had been fulfilled. Also, until relatively recent times, most people didn’t realize what a seriously destructive substance sugar can be.

Sugar Is Everywhere

We went on to discuss the insidious availability of sugar in the modern world, hidden in food products where the presence of extra sweetener might not even be suspected. Even when the sugar content of a food was known, people could be misled about it. For the post “Everything You Know About Sugar is Wrong,” we found an old advertisement that urged the consumer to have an ice cream cone just before lunch! Why? Because, “Sugar can be the willpower you need to undereat.”

Probably the inspiration came from ad copywriters’ memories of their mothers saying “Don’t spoil your appetite.” The pitch here was to go ahead and spoil your appetite. According to the text, the energy boost provided by a sugar rush would provide a person with the willpower to eat a smaller lunch, and still lose weight while enjoying ice cream cones. What’s not to like about that proposition?

This post also looked at the ongoing controversy about high fructose corn syrup, which has its dedicated fans. One of the marketers’ tactics is to hide behind the acknowledged complexity of obesity causation to let their own products off the hook. They will also bring up the inappropriateness of using lab rodents to learn about human responses—something they don’t seem to mind when the experiments go in their favor. They will even try to suggest that people are somehow in danger of not getting enough sugar in their diets. Fat chance! On the roster of nutritional problems that people ought to worry about, insufficient sugar is way down at the bottom of the list.

Starting Sugar Addiction Early

The post “Cake Babies” was also headed by a fascinating graphic—a composite of the photos Google will reveal in answer to the inquiry “cake + baby.” Here, anyone who is delighted by pictures of babies diving face-first into frosted cakes will find plenty to enjoy. Grownups seem to especially adore pictures of babies having their first encounter with sugar. Surely this level of adult enthusiasm could only be matched by a crack dealer finding a brand new customer. Dr. Pretlow once estimated that “probably 2/3 of our country is addicted to sugar in one form or another.” Imagine being a heroin pusher who can bank on the certainty that two out of three people he meets are potential junkies!

Your responses and feedback are welcome!

Image by nicole danielson

Globesity – How Bad Can It Get?

GlobesIt is a challenge to find a source that has a good word to say about the future of globesity. Mostly, the prognosis is grim and the predictions are dire. The World Obesity Federation predicts that by the year 2025, one billion of Earth’s grownups will be obese. According to projections made by the McKinsey Global Institute (MGI):

If the prevalence of obesity continues on its current trajectory, almost half of the world’s adult population will be overweight or obese by 2030.

The Institute’s discussion paper, “Overcoming obesity: An initial economic analysis,” is described as presenting “an independent view on the components of a potential strategy” based on information gathered about 74 different interventions that are being either talked about or tried, somewhere in the world. The highlights of the report are not encouraging. If we look at the evidence, “no single intervention is likely to have a significant overall impact.”

The report also points out that while education and personal responsibility mean a lot, they don’t mean everything. They are necessary but not sufficient conditions. The new understanding is that lifestyle modification is not the whole picture. The Obesity Society, for instance, says:

We must ensure that appropriate attention is paid to the many factors that influence weight and health.

Or as the MGI phrased it:

Obesity is a complex, systemic issue with no single or simple solution.

Earlier this year, a series in the journal Lancet examined public health programs that exist in different parts of the world. In avoiding obesity, it is important to have fresh natural fruits and vegetables, and to expend an appropriate number of calories. But the international anti-obesity establishment has moved beyond the energy in/energy out paradigm.

In The Atlantic, Olga Khazan told readers about a study from York University in Toronto, which was published by Obesity Research & Clinical Practice:

It’s harder for adults today to maintain the same weight as those 20 to 30 years ago did, even at the same levels of food intake and exercise…In other words, people today are about 10 percent heavier than people were in the 1980s, even if they follow the exact same diet and exercise plans.

How can this seemingly inexplicable condition exist? Think of the implications. A lot of the “personal responsibility” rhetoric goes out the window. Being obese is not necessarily a person’s fault, or even a person’s mother’s fault.

What are the factors other than diet and exercise? Professor of kinesiology and health science
Jennifer Kuk offered three hypotheses. One of them is that chemicals in the environment change our hormones in ways that induce weight gain. People take in a lot of antibiotics and hormones indirectly. It’s like second-hand smoke, and very difficult to avoid in this modern world. Artificial sweeteners are probably an obesity villain—although it is one that could be avoided if people really wanted to pay attention and limit their menu choices a lot.

Also, millions of people are taking prescription antidepressant meds, whose propensity to cause weight gain is now beyond doubt. The third suspect Prof. Kuk mentions is the controversial microbiome. The world of gut bacteria has just begun to reveal its secrets, and once the optimal balance of populations can be understood, it can be manipulated for benign purposes. So it may be too pessimistic to assert that Americans’ BMIs are “influenced by factors beyond their control.” That particular inner universe appears to be amenable to an extensive amount of control.

The World Obesity Federation’s main candidate for obesity villain, by the way, is Big Food, the conglomeration of international food corporations that sell untrustworthy products and advertise shamelessly to children. Indeed, there is plenty of blame to go around.

It has become impossible to deny that the puzzle has many levels. It isn’t tic-tac-toe, it’s three-dimensional chess. Like quantum physics, the obesity puzzle contains some mind-boggling discoveries that continually demand further research, because some things just don’t seem to make sense. On the other hand, as MGI says, “while investment in research should continue, society should also engage in trial and error, particularly where risks are low.”

Your responses and feedback are welcome!

Source: “Global obesity rise puts UN goals on diet-related diseases ‘beyond reach’ ,”, 10/09/15
Source: “How the world could better fight obesity,”, November 2014
Source: “A Broader, Global Approach to Obesity Treatment and Prevention,”, 02/20/15
Source: “Why It Was Easier to Be Skinny in the 1980s,”, 09/30/15
Image by Paul L Dineen

Let’s Talk about Gastric Sleeve Surgery

gastric sleeveGastric sleeve surgery, also called sleeve gastrectomy, is in the category known as restrictive bariatric surgery. Because it doesn’t interfere with absorption, it is appropriate for people with anemia or Crohn’s disease or other conditions where gastric bypass is not a good choice. As with the other procedures, the patient goes through extensive physical and psychological screening.

Sleeve gastrectomy may be especially appropriate for two kinds of patients: those of advanced age and those in remote areas. Those of advanced age are relatively safer, because they will not necessarily be alive to suffer from any presently unknown long-term effects. Also, people who live in remote areas with poor transportation benefit from this type of surgery, because it does not require as much follow-up care as other varieties.

Because it is irreversible, this option is a genuine commitment. But even as definitive as it is, the sleeve gastrectomy is not always a stand-alone solution. In some cases, it is only a stage on the way to more extreme alterations. Cheryl Ann Borne of says:

Gastric sleeve also can be used as the first step procedure in cases where gastric bypass or duodenal switch are too risky before a significant amount of weight loss, such as in patients with an initial BMI of 50+. In this case, the second bariatric surgery — gastric bypass or duodenal switch — is done somewhere between 6 to 18 months after the gastric sleeve.

Although the intestine is left untouched, all but about 15% of the stomach is actually removed, so the remaining part is like a tube or sleeve. Amazingly, this can be accomplished with a laparoscopic or so-called “keyhole” approach. However, that does not necessarily mean it is an outpatient procedure. A night or two of hospitalization might follow.

Life After Gastric Sleeve Surgery

The aftermath of a gastric sleeve procedure includes a week of liquid diet and two weeks of pureed food. Solid food can be eaten after that, but the stapled-together stomach incision will not heal for six weeks. Patients who smoke must quit for a month before, and at least a month after, the surgery.

Since the gastric sleeve is a relatively new variation on bariatric surgery, there isn’t a lot of backup data. But from what can be known at present, it appears that 30% to 50% of the excess body weight is shed in the first year, and in the single 6-year followup study, people kept 50% of their excess weight off. As with other procedures, it is possible to “eat through” the remodeled stomach. Overeating can stretch it out and undo the good that was accomplished.

How Popular Is Gastric Sleeve Surgery?

Less than two years ago, at the 24th European Childhood Obesity Group Congress, Dr. Pretlow learned this about the state of the art in bariatric surgery:

Bariatric surgery was claimed to be the treatment of choice for moderate to severe obesity in adolescents. Currently for adolescents bariatric procedures are 28% lapband, 29% sleeve gastrectomy, 18% RNY-bypass, and 18% other. Lapbanding in adolescents has a 25% failure rate pretty much fixed, and 40-50% of the lapbands need to be removed within 5-10 years.

An article published earlier this month describes how the popularity of gastric sleeve surgery has “skyrocketed”:

In the United States, it now makes up over 60% of all weight loss surgery procedures performed, up from 24% in late 2011…The overall short-term risk of gastric sleeve is similar to that of gastric bypass, higher than lap band and lower than duodenal switch. The overall long-term risk of gastric sleeve is lower than all other procedures.

Five years ago, disillusioned blogger Sue Joan characterized the sleeve gastrectomy’s claim to be less invasive as “so not true,” and said this is not widely known because nobody wants to admit that they made an expensive and irreparable mistake. She wrote:

Some of us call this the “conspiracy of silence,” the lack of negative information about weight loss surgery which leads 200,000 people a year to get cut without really knowing what the repercussions might be.

She mentioned an aspect that has not changed—the patient’s difficulty with eating bulky yet healthful foods like vegetables. In her view, it is all too easy for a person to give in to the impulse to favor soft and easily assimilated foods like ice cream and milkshakes. But the technology behind home juicing machines has improved since then, so maybe following a good diet is easier now. At any rate, Sue Joan quoted weight loss surgeon Terry Simpson, MD:

Success with weight loss surgery is 10 percent the surgery, 90 percent the patient.

Your responses and feedback are welcome!

Source: “Gastric Sleeve Surgery Facts,”, undated
Source: “Gastric Sleeve Surgery: Complete Patient Guide,”, November 2015
Source: “Suethsayings.”, 05/25/10
Image by Veterans Administration

Let’s Talk about Gastric Bypass Surgery

ICU roomHere’s the rundown on gastric bypass surgery, according to Cheryl Ann Borne, founder of the website My Bariatric Life. To qualify, a person needs a BMI of over 40, or a BMI of over 35 with a complication such as type 2 diabetes. Of course there is a physical exam and lab work, and the patient’s medical history is consulted because several risk factors could indicate that bariatric surgery would be unsafe. There is a psychiatric screening process, covering such matters as eating disorders and history of sexual abuse, depression, or other psychological barriers to success. This describes the preparation:

After you have been approved for gastric bypass, you will need to make lifestyle changes before your surgery. This may include losing weight, diet and fluid restriction, smoking cessation, counseling to prepare you for your post-surgery life, and perhaps beginning a program of exercise. Some health insurers require a mandatory weight loss during this period in order to qualify for the bariatric surgery.

But wait. Things now begin to sound complicated and contradictory, because we are also told that, “health insurers look for a medical history where diet, exercise, and medicine such as prescription weight loss, have been unsuccessful.” If one of the criteria is a history of unsuccessful weight loss attempts by other means, how can the patient then be expected to lose weight in order to be okayed for the surgery?

Whether the patient has or has not successfully lost weight before, this would be a good place to introduce W8Loss2Go, the smartphone application that helps people to stop eating between meals and gradually reduce amounts at meals.

Why Do People Choose Gastric Bypass?

In this field, long-term success is defined as achieving and maintaining a normal BMI for five and a half years. Within that time frame, the success rate for morbidly obese patients (defined as a BMI between 30-49) is said to be 93%, and the success rate for super-obese persons (defined as a BMI of over 50) is said to be 57%.

Compared to other surgical choices, it sounds pretty good. If the patient did everything correctly and followed the post-op protocol faithfully, she or he could expect to lose 60% of the excess weight she or he had been carrying. The most dramatic weight-shedding takes place during the first year, but with proper diet and exercise, continuing loss is expected in subsequent years.

How Does Gastric Bypass Work?

The method is in the name. Ingested food bypasses most of the internal territory it previously would have traversed. The lower end of the stomach is stapled shut, leaving the egg-sized top end, now called a pouch, as the functional part. From there, food is re-routed past areas where calories are normally absorbed, and dumped into the small intestine. Another source adds:

Today, almost all operations are performed laparoscopically: this means they’re done using cameras and instruments inserted into the belly through tiny ports. Instead of a large incision, the surgery leaves only the port scars, about a centimeter each in length.

What Will Life Be Like After a Gastric Bypass?

Recovery is equated with the ability to eat solid food, which might happen after a month or after as long as three months. To rehearse for this ordeal, a person could try going on a 3-month liquid diet, to see what happens. Who knows? It might turn out to provide enough of a boost that the person would decide to forget about surgery and continue to pursue alternate methods.

It is said that, for the first few months, the patient feels full all the time, whether or not a meal has been eaten recently. One startling detail is that if the patient fasts for eight hours (a normal night’s sleep), “incredible hunger will develop.”

Once the person is able to eat solid foods, it is much more useful to eat “heavy” foods (like meat or raw vegetables), because “soft foods” will cause the small pouch to empty too quickly, causing hunger too soon. This, of course, can lead to snacking and other counterproductive behaviors.

Patients are advised to engage in “water loading” before eating—“drinking water as much as possible and as fast as possible.” This helps to achieve the full feeling, so the person will eat less. But “water loading” is a technique that can work just as well for people with no surgery, except for the fact that many health advisors are against it, because it dilutes the stomach acids whose job is to break down the stomach contents into usable form.

The rules also note that post-op patients who exercise regularly have better success, as do those who participate in support groups. But again, this is true of anyone who aspires to lost weight, whether they have surgery or not.

The main thing to know is that this is not a reversible procedure. Once chosen, it is a choice the person is stuck with forever. There is a discouraging warning. Apparently, even those who carefully follow all the rules can expect 20% to 25% of the lost weight to have returned, after ten years. For someone who undergoes this kind of surgery at, say, age 20, this sounds rather grim. By age 30, they can expect to plump up again, only this time, there is no last-resort surgery to save them, because the most extreme measure has already been taken. Again, there is an opportunity here for W8Loss2Go to help stave off that inevitable moment when the pounds start to pile back on.

Your responses and feedback are welcome!

Source: “Gastric Bypass Surgery Facts,”, undated
Source: “How Gastric Bypass Surgery Works,”, undated
Source: “Is Bariatric Surgery the Solution to America’s Obesity Problem?,”, 04/04/12
Image by Quinn Dombrowski

Let’s Talk about Gastric Banding

grabCurrent information about gastric banding comes from Cheryl Ann Borne, the individual behind the website My Bariatric Life. A very useful page outlines the criteria and preparatory steps. Borne says:

After you have been approved for gastric band surgery, you will need to make certain lifestyle changes before your surgery.

Here is where the trouble begins. Some people are just so massive that any kind of surgical procedure would be ill-advised. Consequently, preparation might begin with the need to lose weight, just for the privilege of getting on the operating table. (One might ask, if the person was capable of losing weight, would she or he not have done so already, rather than put it off until staring surgery in the face?) Exercise might be required and diet will have to change.

This groundwork looks like a job for W8Loss2Go, which unfortunately did not exist when Ms. Borne was contemplating her surgery. However, Childhood Obesity News is acquainted with another bariatric surgery success story, Ellen Burne, who has said that such an app “would be an invaluable support for young people battling to get their weight under control.” W8Loss3Go could be very useful to a patient working to bring her or his weight down to the level where surgery is feasible.

The vertical banded gastroplasty used to be the procedure of choice, but laproscopic Adjustable Gastric Band surgery (AGB) has overtaken it. A silicone band encircles the top end of the stomach to create a pouch that can only hold an ounce of food. Borne says:

The silicone band can be adjusted via a plastic tube that runs from the band to just below the skin’s surface. Saline is injected by the bariatric surgeon through a port in the skin’s surface to make the band tighter. Saline can be removed to loosen the band.

In 2012, when AGB constituted 39% of the bariatric surgery market, a New York Times article described how the laparoscopic procedure started with five slits being made through the patient’s skin and underlying adipose tissue. The abdomen would be distended with a gas to give the surgeon room to navigate, and the surgical instruments, along with a mini camera, would be poked through the incisions. This account describes how the doctor “wrapped the band around the neck of [the patient’s] stomach and cinched it with a ridged buckle, like the type on swimming goggles.”

Gastric banding is the least invasive choice, and the only reversible one. Because it doesn’t really interfere much with absorption, vitamin deficiency is not a big concern. It is usually done on an outpatient basis, and the recuperation period is relatively short, generally permitting the introduction of solid food after a mere 6 weeks. On the downside, the gastric band “yields the least weight loss,” about 40% or maybe even 50% of the patient’s excess weight, on average.

Because the remaining pouch is so small, it is easy (in theory) for the person to feel full. A determined overeating addict can ruin it—but that is a subject for another post. If a person does it right and follows the rules, a great degree of success can be attained. That part about following the rules indicates that here, too, the W8Loss2Go app could have a role to play.

Your responses and feedback are welcome!

Source: “Gastric Band Surgery Facts,”, undated
Source: “Young, Obese and in Surgery.”, 01/07/12
Image by Christy Mckenna


Paradoxes of Bariatric Surgery

The world needs wider folding chairsDr. Pretlow has mentioned the costliness of bariatric surgery, which is quite a significant drawback.
In Britain, the National Health Service offers two varieties—the gastric band and the gastric bypass. The band option is simpler and less expensive. It is said that as many as two million people, or more than 5% of the adult population, could be eligible for weight-loss surgery because their condition is potentially life-threatening. In reality, only 8,000 people undergo bariatric surgery each year, which amounts to less than 1% of those who technically could be eligible under the guidelines.

In some quarters this is seen as regrettable, because as Tam Fry of the National Obesity Forum says, the surgery “pays for itself in two to three years,” presumably by reducing the number of doctor visits that the patients need to schedule for obesity-related reasons. (Other research puts that number at more like four years. Sadly, an insurance company is only interested in seeing a practically instantaneous return. Anything over 18 months, forget it.)

Some administrators feel that the under-utilization of the surgical option might result from the candidates’ inability to “make the lifestyle improvements required before having surgery.” How much more successful would their pre-surgery lifestyle improvement programs be if they all had smartphones with the W8Loss2Go app installed?

Access to Bariatric Surgery Limited in Wales

In neighboring Wales, journalist Graham Henry found a frightening trend. Funding is scarce, so the bar to admission is extremely high.

Present restrictions require patients to have a BMI higher than 50—and to suffer from other related health problems such as high blood pressure, diabetes or cardiovascular disease.

Wales can only afford bariatric surgery for 0.1% of the patients who qualify for the procedure. That’s one/tenth of a percent, so even a patient in desperate need is unable to find a place on the surgical schedule. But here is where the real sickness comes in. Because acceptance is extremely limited, the determination of some patients is twisted into a perverse effort to gain even more weight in order to qualify. They have to aspire to join the worst of the worst, to make themselves part of the most urgently threatened group. To win this lottery, some already morbidly obese Welsh people actively try to increase their Body Mass Index.

Losing Weight for Surgery in America

Meanwhile, across the ocean in Iowa, Charity Pierce (purportedly the world’s fattest woman at the time) was trying to lose 280 pounds in order to qualify for bariatric surgery. Ms. Pierce weighed 765 pounds at the time, and had been on earth for 38 years. A time came when she resolved to get down to a weight that might allow her to live through surgery. Once that was accomplished, she planned to eventually reach a svelte 200 pounds.

It would not be easy. This was a woman whose life experience—dysfunctional family, alcoholism, controlling father—checked several trauma boxes. Because of an accidental injury, Pierce had been confined to home since 2001. An uncredited story gives a sample of her multiple complications:

After having a 40-pound fleshy lump removed from her side in 2005 due to flesh-eating bacteria, she developed lymphedema in the back of her hip, an area that wasn’t affected before. She still has open wounds on her side that haven’t healed…The build-up of fluid in her left leg has left her virtually immobile and unable to care for herself.

This is also was someone accustomed to consuming 10,000 calories per diem. Pierce’s diet consisted of pizza, cereal, sandwiches, pastries, lasagna, doughnuts, popcorn, and chocolate. What turned her around? A marriage proposal from her 22-year-old fiancé. Meeting him changed everything, and was all the motivation she needed. She is quoted as saying:

Tony has given me hope for the first time in years and I’ll do whatever it takes to turn my life around.

Your responses and feedback are welcome!

Source: “Eating Addiction: There’s an App for That,”, 09/11/15
Source: “Weight loss surgery: Up to two million could benefit,”, 01/17/14
Source: “Obese are forced to get fatter to qualify for vital surgery, health experts warn,”, 02/04/14
Source: “Now That’s Motivation: Iowa Woman Hopes to Drop 565 Pounds to Marry Man of Her Dreams,”, 10/31/14
Image by Peter Stevens

Teens and Weight-Loss Surgery

my bedIn his Huffington Post article, “Eating Addiction: There’s an App for That,” Dr. Pretlow gave weight-loss surgery a mixed review. On the one hand, he credits bariatric surgery with being the only obesity treatment that has resulted in “significant long-term weight loss.” Up until now, that is. Thanks in part to the intense media focus brought to childhood obesity in recent years, many research avenues are being explored.

As for the disadvantages, Childhood Obesity News has discussed them before. The particular ones that Dr. Pretlow cites here are expense, risk (which, to be fair, has probably never been brought down to irreducible in any type of surgical procedure), and most daunting of all, the fact that between 20 and 30 percent of the patients do not ultimately benefit from the procedure.

It has become a truism in the field that severely obese teens are resistant to both lifestyle changes and medication, and that is why surgery works when it does. Still, psychological maturity is a recommended trait in surgical prospects. That quality is a lot to ask of teenagers, when so few adults seem to have attained it. People will eat right through the surgical rearrangements of their insides, or, even if they abstain from overeating, adopt another self-sabotaging addiction. There is no end to the mischief they can invent.

Some patients say they did not receive sufficient education or training on how to live in the appropriate post-op way. Maybe so, although it might be expected that a person would actively pursue knowledge and ask, “What must I do to assure that this procedure was not a total waste of time and money?” But they seldom do, especially teenagers. What patients mostly want is a fast-acting magic bullet, so they can quit thinking about the issue and get on with their lives.

All the more reason, incidentally, why assistive technology such as W8Loss2Go should be part of these individuals’ daily life resources. If 20 to 30 percent are failing to either lose weight or keep it off, they need all the help they can get.

The Risks of Bariatric Surgery

NBC’s Lindsey Tanner characterized surgery as a “drastic, last-ditch option” when discussing a study, funded by the National Institutes of Health, that included 242 morbidly obese adolescents who all had surgery at one of five participating medical centers. Tanner says:

Half the teens had at least four major illnesses linked with their excess weight. Three out of four had cholesterol problems; almost half had high blood pressure or joint pain; and many had diseased livers or kidneys…Major complications including accidental injury to internal organs occurred in just 8 percent of teens. Less serious complications including bleeding and dehydration affected 15 percent of kids during the first month after surgery.

Those misfortunes are easy to track, but the outcome is as yet unrevealed. If we are interested in knowing how those kids fare ten years down the line, we will have to wait to find out. However, it is already obvious that all over the world, more and more kids are precocious in a way that is not healthful.

Society is in a paradoxical situation. So much of our attention, in the form of both money and energy, is focused on how to delay aging. Ironically, at the same time, many things are going on that contribute to premature aging, in some cases freakishly so. Early puberty has become a “thing,” and so has its firm association with obesity. But that wasn’t bad enough. Now, teens are coming down with old folks’ diseases.

Your responses and feedback are welcome!

Source: “Eating Addiction: There’s an App for That,”, 09/11/15
Source: “Many health woes in teens seeking obesity surgery, study.”, 11/04/13
Image by Mark Hillary

The Progress of Weight-Loss Surgery

Medical_SurgicalDr. Pretlow is always focused on treating the underlying cause of obesity, rather than the symptom. As he mentioned in his Huffington Post piece, “Eating Addiction: There’s an App for That,” bariatric surgery is capable of facilitating long-term weight loss for some. But it is expensive, and risky in terms of potential side effects. Worst of all, 20% or perhaps even 30% of patients fail to lose weight, or else they gain it back.

Diabetic patients are likely candidates for bariatric surgery because the importance of regulating their metabolism overrides other considerations. “Sustained diabetes remission”  is the desirable outcome for such patients. It can be accomplished for the short term, and probably over the long term as well. For, Robert Preidt described how those who suffer from type 2 diabetes have gained a new lease on life, proven to last as long as nine years.

Of course, no intervention can always work for everyone. Sustained diabetes remission was found to be most attainable by patients who met three criteria: they had diabetes for less than 5 years before the surgery; their surgery was gastric bypass (not adjustable gastric banding); and they actually did maintain weight loss over a period of years.

The difference in effectiveness that resulted from the various types of surgery was apparent because, out of the subject pool of 217 patients, 162 underwent gastric bypass surgery, while 32 had the gastric banding, and 23 had sleeve gastrectomy. Research conducted by the Bariatric and Metabolic Institute of the Cleveland Clinic also showed a widespread, general benefit that affected most of the subjects:

Long-term follow-up showed that patients continued to have improvements in their diabetes, as well as a reduction in risk factors for cardiovascular disease.

About diabetic patients as a whole, lead investigator Dr. Stacy Brethauer finds that only about half of them are really able to optimally control their blood glucose level. But post-bariatric surgery patients, five years later, have an 80% level of control—a considerable improvement, and one that does not dissipate after a short year or two, but seems to stick.

Better yet, again after five years, about one-third of the patients in the study were able to manage their blood glucose without medication. Imagine the relief of not needing to shoot up with insulin anymore!

A New Surgical Weight Loss Method Shows Promise

Toward the end of 2013, the journal Gut published news of a procedure that at that point had only been tried on animals, and is still under development. Scientists from the Universityof Cincinnati and the Helmholtz Zentrum München (aka the German Research Centre for Environmental Health) worked together to develop this approach.

Because bariatric surgery can be very invasive and is often permanent, the goal is to find a method that is minimally invasive and reversible, and to obtain the benefits of current surgical interventions without the drawbacks. Rather than remove a piece of the patient, or sew things together, an extra piece is added to the patient’s interior with the following result:

The placement of a non-permeable tube in the small intestine leads to reduced nutrient absorption and consequently to reduced obesity and enhanced glucose metabolism…
Further studies now aim to clarify which influence this novel surgical technique has on the complex neuroendocrine network that controls energy metabolism.

The flexible device is known as a duodenal-endoluminal sleeve (DES), and it can reduce nutrient absorption in the intestinal lumen and also reduce reactive mucous membrane growth in other intestinal sections. It appears that these actions foster an improved utilization of nutrients. Animal studies showed that, as with bariatric surgery, obesity can be reduced, along with insulin resistance—but the tube is still not ready for human use.

Your responses and feedback are welcome!

Source: “Eating Addiction: There’s an App for That.”, 09/11/15
Source: “Weight-Loss Surgery & Long-Term Diabetes Control.”, 09/19/13
Source: “Weight loss through the use of intestinal barrier sleeves.”, 10/10/13
Image by Phalinn Ooi

Motivational Interviewing, Doctors, and Parents

44 - doctor dayMotivational interviewing is one of the tools of choice in the childhood obesity field. Why? Dr. Martin T. Stein suggests that, in primary care settings, childhood obesity is relatively unresponsive to more customary interventions.

Doctors are urged to incorporate motivational interviewing of parents in their evaluation and treatment of obese children. Reviewers have characterized the data on the effectiveness of motivational interviewing in primary care as “impressive.” But what is it? Dr. Stein says:

Motivational interviewing (MI) is a method of communication that involves techniques of reflective listening, shared decision-making, encouraging autonomy, and dialogue leading to behavior change.

He discusses a particular study in which primary care providers and registered dietitians were trained to train parents. The results demonstrated that, over 2 years, commitment to a structured motivational interviewing training program could result in a “modest but significant reductions in BMI percentile.” The original narrative of that study, by Kenneth Resnicow, Ph.D., and a large number of co-authors, can be found in the March issue of Pediatrics.

The study looked at 42 practices working with the parents of children ages 2 to 8. Primary care physicians and registered dieticians were trained by a psychologist and by a supplementary DVD to work with families.

The participants were divided into three different groups. Some had “usual care,” which meant standard educational materials that were handed out during routine visits. Some had 4 motivational interviewing sessions delivered by the doctor, and some had the 4 doctor sessions plus 6 sessions with a registered dietician. These latter two groups received counseling that was directed toward creating motivation for changes in behavior, and the professionals acted in collaboration with the families to “set action-oriented goals around discrete behaviors.”

The study is important because it is among the first to show that when used in primary care practices, motivational interviewing can make a difference. The lead author also sets great store by the fact that the number of training sessions and the overall amount of training are pragmatically possible in the real world.

Entire careers have been spent in studying the nuances of motivational interviewing, but for the benefit of health care professionals who want to give it a try, Healthy Jacksonville Childhood Obesity Prevention Coalition has boiled down the essentials to one instructional page, subtitled “Tips for Successful Physician-Patient-Family Interactions.”

Source: “Motivational Interviewing for Childhood Obesity: A Strategy for Pediatricians,”, 04/15/15
Source: “Motivational Interviewing and Dietary Counseling for Obesity in Primary Care: An RCT.”, 03/25/15
Source: “Primary Care Interventions for Pediatric Obesity: Need for an Integrated Approach,”, April 2015
Source: “Motivational interviewing can positively impact childhood obesity,” ScienceCodex/com, 05/04/14
Source: “Motivational Interviewing,”, 10/08/15
Image by eyeliam

Obesity and Making a Living

Ms Pat

Ms. Pat projects the opposite of approved corporate image.

Comedian Ms. Pat talks about how the local kids participate in the time-honored mischief of ringing doorbells and running away. She tells her son to stay out of it because, being so fat that his thighs rub together, he would be the one to get caught, and potentially shot, because some of the homeowners have guns. These are excellent reasons for a young person to avoid obesity, but it turns out that adult obesity can adversely affect a person’s life as well. As a professional comedian, Ms. Pat works in one of the few fields in which an obese woman can rise to the top.

But a tolerance for extra weight is not common even in the entertainment industry. Large actors and singers are unusual; a large dancer is impossible. Even at the edges of what could be considered entertainment, the job of flight attendant requires that the applicant’s weight be proportional to height.

Writing for, Dawn Brotherton recalls the 2013 discrimination lawsuit against an Atlantic City hotel where casino waitresses had to submit to weigh-ins, and were suspended if they gained too much. In a way, it is surprising that the case even went to court, because, as the judge pointed out when ruling against the waitresses, they had signed a contract agreeing that they understood the weight policy.

Weight in the Workplace

Conventional employers have many reasons for wanting their workers to maintain normal weight. They believe that decreased mobility can impact job performance by reducing productivity and increasing the likelihood of occupational injuries. According to their statistics, obese employees take more sick days and generally increase healthcare costs. There are also morale issues.

But consider the morale of the borderline or overweight person. Many workplaces could easily be called “obesogenic” environments. A Harvard study found:

Worksites often provide easy access to unhealthy foods in vending machines and limited access to healthier options, such as fruits and vegetables…Work environments can also increase the risk of obesity arising from job stress and work-related fatigue, which are linked to poor diets and reduced physical activity…Shift workers and employees working longer-than-usual hours every week have a higher risk of obesity.

Employers traditionally have not been concerned with taking their share of blame for factors, like poor scheduling, that add to stress. Contemporary obesity prevention programs are more effective when they try to create what the Centers for Diesease Control and Prevention calls a “culture of health.” The best results are obtained when the workplace does not lay the whole burden on the worker.

An effective program for “Total Worker Health” might include nutrition education, access to the advice of nutritionists or other types of counselors, more healthful food options in cafeterias and vending machines, a gym with a safe place to change clothes and store belongings, and reimbursement for exercise-related expenses.

Brotherton, the journalist mentioned above, mentions the current case of Elizabeth DeLorean, who is suing Coach, Inc., the purveyor of luxury fashion accessories. After a period of harassment and humiliation, in what she felt had become a hostile work environment, DeLorean was fired from the position of store manager after more than 10 years on the job. The company maintained that she was let go based not her weight, but on overall job performance. Since the matter is in litigation, we cannot learn much more at present. As Brotherton notes:

Michigan is the only state where weight discrimination is part of the civil rights law. It ranks right up there with religion, race, and height.

For that reason, many eyes are watching for the outcome of this case, which may have widely-felt repercussions.

Your responses and feedback are welcome!

Source: “Source: “The Champs.”, 02/20/15,”
Source: “Don’t gain weight while working at Coach, you might lose your job,”, 10/28/15
Source: “Toxic Food Environment – How Our Surroundings Influence What We Eat,”, undated
Source: “Worksite Obesity Prevention Recommendations: Complete List,”, undated
Image by Ms. Pat

Childhood Obesity News | OVERWEIGHT: What Kids Say | Dr. Robert A. Pretlow
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