Nicholson Clinic Blog

Weight-loss surgery may help those with less-severe obesity shed pounds, but questions remain about long-term outcomes and whether some versions of the procedure are better than others. The conclusion was the result of a data review by researchers at the University of Southampton in England. Their findings were published April 15 in The Cochrane Library.

"[This paper] is not saying that we should be doing surgery for those with a BMI between 30 and 35. It's saying that, yes, surgery results in a greater weight loss, but is it worth it? We don't know," said Caroline Apovian, MD, director of the Nutrition and Weight Management Center at Boston Medical Center. She was not affiliated with the Cochrane review.

A National Institutes of Health 1991 consensus paper stated that bariatric surgery was appropriate for those with a body mass index higher than 40. It also noted those with a BMI between 35 and 40 who had serious weight-related illnesses could be considered. But the significant number of people who carry excess pounds combined with the development of safer, less-invasive procedures is leading some physicians to ask whether these recommendations should be adjusted.

"Eighteen years ago, procedures had a higher complication rate. The [gastric] band and sleeve didn't even exist. This should be studied," said Scott Shikora, MD, president of the American Society for Metabolic and Bariatric Surgery and director of the Weight and Wellness Center at Tufts Medical Center in Boston.

A 2004 consensus statement from the ASMBS suggested that bariatric surgery for patients with a BMI between 30 and 35 who have weight-related medical conditions may be indicated and needs study. A few research projects investigating the option as a treatment for people who have diabetes and a BMI as low as 30, including one project by Dr. Shikora, are either under way or being planned.

Some doctors say bariatric surgery for these patients could lower their chances of experiencing more severe weight-related adverse events.

"It means we're going to get to people earlier in the disease process," said Nick Nicholson, MD, medical director of the weight-loss surgery program at Baylor University Medical Center in Dallas and the Baylor Regional Medical Center in Plano, Texas. "[Surgery] is technically easier when they're at lower weights." On rare occasions, he has operated on patients with BMIs as low as 32 who had severe obesity-related complications.

But other physicians say unanswered questions remain on the longer-term effects. Some also feel the medical management used as a comparison in the reviewed studies was not as intensive as it could be -- giving the outcome advantage to surgery. And although the review found that surgery was more effective than medical management for weight loss, many would like to see analyses looking at differences in other factors, such as cost and adverse events.

"Surgery looks terribly promising, and I know it will play an important role. I don't think we know what the role is right now," said Tim Church, MD, MPH, PhD, director of preventive medicine research at Pennington Biomedical Research Center in Baton Rouge, La., who researches nonsurgical weight loss. "We spend 25 or 50 grand on bariatric surgery. We would never dream of committing even half that to a good behavioral intervention. Give me half that fee, and I will change someone's behavior and keep it changed."

Physicians who specialize in nonsurgical weight-loss strategies also say it is possible to lose large amounts of weight without an operation and expressed concern about patients having these kinds of procedures before exhausting other options.

"We can reverse many of the complications of obesity almost as effectively as bariatric surgery with a minimal rate of complications and cost," said Allen Rader, MD, secretary/treasurer of the American Society of Bariatric Physicians and the founder of Idaho Weight Loss in Boise. "We believe the treatment paradigm for obesity should be primary care physicians first, then referral to a bariatrician, then referral to the bariatric surgeon."

An article from Yahoo News has confirmed what we’ve known for a long time, obesity surgery is a low risk procedure.

From 2005 to 2007 a study focused on 10 US hospitals that specialize in weight loss surgery and found that the risks surrounding obesity surgery have greatly decreased. Considering the long term risk of heart disease and diabetes a medical procedure for weight loss is a much more attractive alternative. In fact, there is a greater risk of dying if you do not have surgical treatment.

Using the body mass index (BMI) calculation, one-third of American adults are obese, a BMI of 30 or more.

“In the past, now outdated bariatric procedures carried unacceptably high risks. The weight loss associated with the procedures was questionable, and the long-term health benefits were unproven,” wrote Dr. Malcolm K Robinson from the Harvard Medical School.

Now, the evidence shows that “surgery is safe, effective, and affordable,” because it can lower doctor visits, medication use and other medical expenses, Robinson wrote. However, “the expense of operating on the millions of potentially eligible obese adults could overwhelm an already financially stressed health care system.”

via Yahoo News

Food manufactures make a lot of claims on their packages, but it’s important to check the nutrition label so you can figure out what you are really getting. Take a look at this video from FOX News about how to identify fake food labels.

Watch on foxnews.com

Number of Servings
The first place to start when you look at the nutrition facts label is the number of servings in the package. The calories and nutrients must be multiplied by the total number of servings in one container. In the sample label, one serving of macaroni and cheese equals one cup. If you ate the whole package, you would eat two cups. That doubles the calories and other nutrient numbers, including the percentage of daily values as shown in the sample label.

Serving Size
Serving sizes are standardized to make it easier to compare similar foods; they are provided in familiar units, such as cups or pieces, followed by the metric amount, e.g., the number of grams. The size of the serving on the food package influences the number of calories and all the nutrient amounts listed on the top part of the label.

Calories
Calories provide a measure of how much energy you get from a serving of this food. Here’s a general guide to calories:

 

• 40 Calories is low
• 100 Calories is moderate
• 400 Calories or more is high

Get more information about nutrition facts on our blog post, How To Read The Nutrition Fact Label

Some key points to explore when chosing the "right" surgeon for your LAP-BAND surgery are:

   1. Attend a seminar
   2. Make sure your surgeon is experienced
   3. They should have a great team
   4. And have a proven track record

If you live in the Dallas / Fort Worth area Nicholson Clinic is a great choice for either your gastric bypass, Lap-Band surgery, or Sleeve Gastrectomy.

Dr. Nick Nicholson has been performing weight loss surgery for more than eight years. He leads a team hand-picked to provide the information and expertise his patients need for long-term success. These professionals include dietitians, gastroenterologists, primary care physicians, and a dedicated psychologist, all specializing in weight loss. Dr. Nick is active in several organizations, including the American Medical Association, Society of American Gastrointestinal and Endoscope Surgeons and the American Society for Metabolic and Bariatric Surgery.

Recently on TIME’s wellness blog they posted results from a study published by the BioMed Central (BMC) Public Health journal that children as young as 10- and 11-years-old can already be struggling with worries about the ideal body.

The study included a sampling of 4,000 students in Canada and concluded that 7.3% of the girls stated that they didn’t like the way they looked, while 7.8% of the boys reported dissatisfaction. While these overall stats do not reveal much, the real evidence was found in the trending of increased weight.

As the girls’ weight increased so did the percentage of respondents that stated they were unhappy about their body. For girls with normal body 5.7% reported being unhappy with their bodies. For those that were overweight 10.4% were unhappy. And those that were categorized as obese 13.1% were unhappy with how they looked.

However, the boys did not show such a drastic trend of increasing dissatisfaction as their BMI increased. Instead, boys were unhappy if they perceived themselves as too skinny or as overweight. What’s more, among the girls, but not the boys, those who had lower levels of educational achievement or lived in more rural areas were more likely to report feeling unhappy with their bodies.

You can read the TIME blog post here.

Persons considering taking over-the-counter or prescription medication that claims to aid with weight-loss might instead give it additional and very careful thought. The pills may indeed help you to lose the weight, but there are reports that it could wreak havoc on your body’s health in other areas.

The latest case in point involves alli, which has been heavily marketed in numerous stores, including big-box stores such as Walmart and Target. Alli (the generic name is orlistat) blocks some of that fat that you eat, keeping it from being observed by your body, helping you to lose weight. The medicine is intended to be taken in conjunction with a low-calorie, low-fat diet and regular exercise. The non-prescription weight-loss drug that was approved by the Food and Drug Administration is now being investigated by the agency following claims of liver damage. Regulators have said that they have received more than 30 reports of liver damage of patients taking alli and Xenical, the orlistat drug’s prescription version. Alli and Xenical are marketed by British drug manufacturer GlaxoSmithKline, and Xenical is manufactured by Swiss firm Roche.

The reports were submitted between 1999 and October 2008 and included 27 hospitalized patients and six who suffered liver failure. While the FDA has stated it has not established a direct link between the weight-loss drug when taken as prescribed and liver damage and has not ordered any recall or prevention of continued sales. Patients can continue to use either the over-the-counter or prescription versions as directed, if desired. The agency did say that consumers should consult with their health care professional if they are experiencing symptoms that are not considered typical from the drug’s use.

Does this mean you should stop taking these medications? The safest approach to ensuring your overall body’s health is to visit with your doctor if you have concerns about taking any medication, not these particular weight-loss medications. Another option is to consider a drug-free solution to weight loss, such as a weight-loss surgery. Call us today if you’d like more information about our bariatric surgery options and how they may provide you with a healthier lifestyle that doesn’t rely on over-the-counter or prescription weight-loss pills.

As children get ready to head back to the classroom, a new study finds school absenteeism is higher among overweight kids.

Obese fourth-, fifth- and sixth-graders miss an average of 12 school days over the school year -- about two days more than their normal-weight peers, according to research published in the August issue of Obesity.

"This is the first study of its kind," noted study author Gary Foster, director of the Center for Obesity Research and Education at Temple University in Philadelphia. "We're not saying that obesity leads to absenteeism, but whatever the relationship is, mathematically, as more kids get obese, more will be absent. That has lots of academic implications."

Foster and his team looked at 1,069 fourth-, fifth- and sixth-graders in nine inner-city Philadelphia elementary schools. More than 80 percent of these children were eligible for free and reduced-price lunches.

Homeroom teachers recorded the student's attendance for the school year, and the youngsters' weight was measured in the second semester. The kids were put into one of four weight categories: underweight, normal weight, overweight and obese.

The study found that obese children were absent significantly more than normal-weight children: 12 days versus 10 days over the school year. Even after the researchers adjusted for age, race/ethnicity and gender, obesity was still a significant contributor to the number of days a student was absent.

"This study suggests that it is possible that obesity prevention programs could have the effect of improving school attendance in addition to reducing weight-related health risks," said Dr. Thomas N. Robinson, an associate professor of pediatrics at Stanford University and director of the Center for Healthy Weight at Lucile Packard Children's Hospital at Stanford. "If obesity prevention also increases school attendance, even small improvements may produce very large benefits across the population as a whole."

The researchers don't know why obesity and absenteeism are linked, but Foster said the reasons are more likely to be psychosocial than medical, since there aren't as many medical issues at this young age. That said, childhood obesity has been linked with health problems such as asthma and type 2 diabetes.

"The most immediate problem for obese children is the reduced self-image and insecurity caused by explicit teasing or implicit disapproval from peers, parents and other family members," said Dr. Michael Dansinger, an obesity researcher at Tufts-New England Medical Center. "Obese children are often teased and bullied by other children, and this could certainly lead to extra days of missed school. Excuses for staying home from school become much easier to find if school is often unpleasant or scary," he said.

Foster suggested that future studies look more closely at the relationship between obesity and absenteeism, particularly since this is the first study to discover the correlation, and the study has some limitations. For example, even though the two extra days of school missed are statistically significant, it's unknown if they will have a great impact on a child's academic performance.

The researchers were also unable to show how obesity and school absenteeism were linked. This is partially because the children's weight and attendance were not recorded over time, Dansinger said.

"The researchers were unable to rule out the possibility that an underlying factor, such as relatively high or low family income, was a contributing cause of both obesity and absenteeism," he said. "Also, the researchers studied only inner-city children, a group with relatively low income and relatively high rates of absenteeism regardless of body weight. The link between obesity and absenteeism may differ somewhat for suburban, rural or private schools."

Still, the findings may encourage parents and the school system to work harder to keep children's weight in check. Foster recommends that parents be good role models, limit TV time, and create a healthy environment, including healthy eating and lots of physical activity.

"This study is just one view of the tip of the iceberg in which childhood obesity may have much more far-reaching negative effects on our society than any of us can imagine, and it should trigger us to be even more vigilant in finding solutions," said Robinson. "If more school absences are occurring now, these cannot be made up for in the future, and we may be losing a generation or two while waiting for action."

A girl’s night out may be a fun way to socialize with friends and become less stressed, but it also can pack on the pounds. According to a study recently published in the Journal Appetite, women are more likely to consume at least 100 more calories than they may typically eat. A combination of eating foods high in fat and calories that are often combined with alcoholic drinks can sabotage a woman’s will-power and temporarily derail a diet.

According to the study that observed the social eating habits of 469 young men and women, while women typically overindulged when meeting at a restaurant and having fun, the eating habits of most men doesn’t change regardless of who they are eating out with.

The study says that women consume an average of 609 on a ladies’ night out. Men, on average, consume 716 calories. Interestingly enough, the study also found that women tend to consume considerably less calories while on a date.

The key is to remain conscientious about what food choices you are making in a social setting and also to choose lower-calorie drinks rather than ones laden with creams and sugar. Nights on the town–regardless of whether it is for a date or outing with friends–can sometimes be challenging for those who have had weight loss surgery, such as gastric bypass, lap-band, or sleeve gastrectomy. If you’ve recently had a weight loss procedure, keep in mind that you can have plenty of fun and laughs when out and about. However, to avoid the potential of having the dumping syndrome characterized from sweating, fatigue and diarrhea from eating high-fat, high-calorie foods or even vomiting from overeating, choose what you eat–as well as how much–carefully. It is also recommended that both men and women avoid consuming alcohol after having weight loss surgery for the first year.

A spoonful of sugar may help the medicine go down, at least according to Mary Poppins, but it’s a big no-no according to the American Heart Association.

According to recent research, Americans are swallowing an average of 22 teaspoons of sugar on a daily basis. Most of it comes from soft drinks followed by sweets such as candy, cakes, cookies, donuts and pie. With that said, it’s no wonder that so many individuals are overweight in our society today.

Most women should intake no more than six teaspoons a day, about 100 calories, of added sugar. Added sugar means sweeteners and syrups that are added to foods during processing, preparation, or at the table. For most men, the recommended limit is nine teaspoons daily, or 150 calories, according to the AHA.

The guidelines don’t apply to sugars that are naturally found in fruits, vegetables and dairy products. So, how do you calculate your sugar intake? While the government doesn’t require labels on foods to differentiate added sugars from naturally occurring ones, in most cases your sugar intake is pretty obvious. To check for added sugar on ingredients, look for sugar, corn syrup, dextrose, evaporated cane juice, fructose and molasses.

While the AHA didn’t specifically recommend general limits for added sugar for children, it has provided statistics about their usual daily intake of added sugar by teaspoons. Compared to the 22 teaspoons of all people, youngsters ages 1 to 3 swallow about 12 teaspoons daily while the number soars to 21 teaspoons for the age group 4 to 8. For the age group 9 to 13, boys typically consume 29 teaspoons and girls 23 teaspoons. For Ages 14 to 18, the number increases to an average of 34 teaspoons daily for teenage boys and to 25 for teenage girls. For those 19 and older, males consume an average of 25 teaspoons and females 18 teaspoons.

Bad eating habits are hard to break and it can lead to health problems if they are not addressed properly. FOX News has a great article that lists 5 tips to overcome bad eating habits.

Bad Eating Habit No. 1: You Overeat
The explanation: You ignore the screams from your satiated stomach and continue to cram morsel after morsel down the hatch.

The root of the problem: A lack of discipline.

The solution: Overeating is often the result of intense hunger. To battle the binge, try to eat before you are overly famished. When eating, eat slowly and savor each bite. It takes the brain some time to register a feeling of fullness, so slowing your pace will keep your portions at a healthy size. Lastly, try to bring greater discipline into all areas of your life. Getting yourself organized is a great way to start.

Bad Eating Habit No. 2: You Dig Junk Food
The explanation: You rewrote the food guide to include only one major food group: junk food.

The root of the problem: Convenience.

The solution: There is a reason that junk food is called “junk.” Your typical junk foods are rarely nutritious while your typical snack foods are rarely satisfying, making it easy to overindulge. Much of the problem with today’s dieting lies with boredom. People get tired of eating the same food day after day, and junk foods offer a convenient escape. Don’t become a slave to this convenience. Healthy foods can offer the same variety as junk, but the motivation to opt for change will have to come from within. To get started, find inspiration for innovative foods from outside sources, like a cooking class. Who knows? You might even meet a cute lady friend along the way.

Bad Eating Habit No. 3: You’re a Speed-Eater
The explanation: Each and every meal is a time trial, and you’re constantly trying to better your best.

The root of the problem: Stress.

The solution: If you’re stressed on time or have a lot on your mind, chances are that it’ll show in your eating. Your solution then is to actively try and slow down. You can help yourself by avoiding finger foods. Instead, choose more complicated food items that will require utensils and time to finish. Tackle the root of the problem by learning some stress-reduction techniques like meditation.

Bad Eating Habit No. 4: You Eat Vegas-Style
The explanation: You’re a saint during the week but you let yourself go on the weekends.

The root of the problem: A lack of discipline.

The solution: Whether you are trying to lose weight or simply maintain it, five days of hard work can easily come undone from a weekend of bad binge eating. If eating out is your problem, eat lightly before you go out to lessen your hunger. And don’t restrict yourself too much during the week so that the weekend becomes less of a treat. Heck, even Dr. Ian lets himself go from time to time: “No one can eat healthy all the time. It’s just not practical,” he says.

Bad Eating Habit No. 5: You’re a Mindless Muncher
The explanation: The second you’re in front of a TV, you hit cruise control and stop paying attention to the food flowing into your mouth.

The root of the problem: Varied.

The solution: Spaced-out eating can be a symptom of various causes. Perhaps you’re stressed and attempting to take your mind off the burden or maybe it’s just convenient to eat your dinner with your favorite show. Whatever the reason, the habit needs to stop. Try and identify the root of the problem first, and if possible tackle that. Then do yourself a favor and separate food from television. If you must snack, have a suitable portion prepared before you sit down. At best, try to eat major meals only when you’re fully engaged.