Gov Chris Christie Has Lap Band, Speaks About Choice

New Jersey Governor Chris Christie just revealed that he underwent weight loss surgery in February. He kept his procedure a secret from all but a handful of people until now, but has decided to speak about his choice.  Christie chose Lap-Band surgery, and the Post reports that he has lost about 30 pounds so far.  Weight loss with Lap-Band surgery is generally more gradual than with other bariatric procedures, and our patients generally lose about one to two pounds a week.  It is the least-invasive procedure for weight loss and is entirely reversible.  During a Lap-Band placement, the stomach is partitioned into uneven compartments, leaving a small pouch (about 10% of the overall capacity) as the new reservoir for food. The smaller stomach size limits the amount of food eaten, and our patients feel less hungry throughout the day. The band can be adjusted right in our office, without further surgery. These adjustments are key to the success of the band, since the doctor and patient work together to find the optimal tightness for the band.

Christie has been open about his struggles to lose weight over the years. During an appearance on “The Late Show With David Letterman” in February – right before he underwent his Lap-Band surgery – he pulled out a doughnut and told the host his weight was “fair game” for comedians, who frequently make his size the butt of their jokes. Now, speaking of his decision to undergo surgery, Christie said: “I’ve struggled with this issue [obesity] for 20 years. For me, this is about turning 50 and looking at my children and wanting to be there for them.”

For ideal results, Christie will follow up with his surgeon regularly  and maintain a healthy diet and activity routine.  At the Olde Del Mar Surgical, we provide you with all the necessary tools to succeed. Our practice is built on the principles of providing the highest quality of patient care. You can learn more about our program and Lap-Band surgery by calling our office at 848-457-4917. We’re happy to answer any questions you have about the procedure, other weight loss options, and insurance.

Lap Band, Long Term Weight Loss Results

Surgeons who have been performing lap band surgery have found it to be a safe and effective option for many patients who have struggled to lose weight. Now, a new study adds evidence to the long-term safety and effectiveness of the band. Researchers from Australia have conducted a study following lap band patients who had their surgeries as long as 15 years ago. Dr. Paul O’Brien – an internationally known leader in lap band surgery – published his findings in the Annals of Surgery.

The patients he studied maintained an average weight loss of about 50 pounds—nearly half of their excess weight—for more than a decade after Lap-Band surgery.  Patients who had the lap band procedure 15 or more years ago maintained an average weight loss of 47% of their excess weight.  In terms of safety, O’Brien found there were no deaths from the band surgery in any of these patients, and no deaths from any revisional procedures that were later needed in about half of the patients. An important note about this study is how significantly the Lap-Band surgery has progressed from its introduction in 1993. In the earliest patients, it was found that about 40% of them eventually needed revisional surgery for band slippage or pouch enlargement. However, after changes were made in both the technique and technology involved in the band surgery, only 7% of patients required revisional surgery. Even those patients who required revisional surgery, showed no difference in the amount of weight they lost, compared to patients who did not have revisional surgery.

Dr George Fielding, a bariatric surgeon at NYU and a lap band patient said, “Dr O’Brien did my band 13 years ago, and my weight is stable. I’ve lost 110lbs. The most important part of this study is the demonstration of reduction in need for reoperation over the last few years. O’Brien’s results show that the band can be used, very safely, over a long time.” Many of our patients like the lap band surgical option because it is a less invasive option than gastric bypass, and is adjustable. With the Lap-Band, there is no stomach stapling, cutting or intestinal re-routing and the procedure is  reversible if necessary. At Olde del Mar Surgical, the vast majority of our weight loss procedures – the lap band as well as several other options – are performed laparoscopically. This means shorter hospital stays, earlier return to normal activities and less pain and discomfort for most patients.

New Study Results – Gastric Bypass and Insulin

At Olde del Mar Surgical, many patients arrive at our office suffering from both obesity and type 2 diabetes.  These patients are looking for the best surgery option to promote weight loss and improve their glucose control. Although different procedures are right for different patients, one that is particularly effective in addressing diabetes is gastric bypass. Recent research has shown that gastric bypass surgery can even reverse the condition in a matter of days. Now, a new study from the Cleveland Clinic may explain why. Insulin is made by the pancreas, and when pancreatic function declines, we have an insulin imbalance. The researchers found that gastric bypass changes hormones in the gut, which triggers the pancreas to start making insulin again – basically reversing the decline of the pancreas’ function. The results of this study offer hope for the many obese patients with type 2 diabetes who struggle with both their weight and controlling blood sugar.

In a 24 month sub-study of the STAMPEDE trial (Surgical Therapy And Medications Potentially Eradicate Diabetes Efficiently), the researchers evaluated the effects of weight loss surgery and intensive medical therapy on blood sugar levels, body composition, and pancreatic beta-cell function. They found that 41 percent of the patients in the sub-study who underwent gastric bypass saw their blood sugar levels back to normal. Only 6 percent who received intensive medical therapy achieved the same results.  Additionally, gastric bypass patients experienced a greater reduction in belly fat compared to the patients who underwent the gastric sleeve, leading the researchers to conclude that gastric bypass seems to uniquely restore pancreatic beta-cell function, presumably by targeting belly fat and modifying the hormones in the gastrointestinal tract. Further, bypass patients achieved near normal blood sugar levels following a mixed meal test at 12 and 24 months. These results were associated with a remarkable 5.8-fold increase in overall pancreatic cell function, compared to a 2-fold increase in the other treatment groups.

At Olde del Mar Surgical, Dr Bhoyrul and our team are dedicated to finding the weight loss surgery procedure best suited to each patient’s unique, individual needs.  We are proud to incorporate cutting edge research, such as this study, in our decision-making process.  To learn more about the surgery options we offer, please contact our office at 858-457-4917 today.

Gastric Sleeve: Lisa Lampanelli’s Weight Loss

Have you seen Lisa Lampanelli in the news lately? She’s a comedian and star of Celebrity Apprentice. But aside from her performance credits, Lampanelli has received a lot of attention recently because she has lost 80 pounds after undergoing gastric sleeve surgery.  Now 51 years old, she says she’s tried “every diet out there” without success, and has struggled with her weight since her teens. Fed up with yoyo dieting, and weighing 248 pounds, Lampanelli decided that bariatric surgery was the next logical step. Less than 6 months after her surgery, she was down to a size 12.  Inspired by her weight loss, Lampanelli’s husband chose to undergo the same procedure a few months later. “The doctor who did my procedure explained that obesity risks are much greater than the risks for this surgery. I was such an overeater. Now, I get full quickly – at three, four bites, I have to stop,” Lampanelli said in an interview with In Touch Magazine.

The procedure Lisa chose to have is called gastric sleeve surgery. While lesser known that the gastric bypass or lap band, gastric sleeve has been rapidly gaining in popularity in the last few years.  At Old Del Mar Surgical, we have been performing the gastric sleeve for years and are very happy with the results we see in our patients. You may hear about the gastric sleeve by its other common names: sleeve gastrectomy or vertical sleeve gastrectomy (VSG). During the sleeve procedure, Dr Bhoyrul removes approximately 80 percent of the patient’s stomach, leaving just a small piece of stomach that resembles a thin banana. The procedure works in part by providing restriction: the sleeve limits the amount of food that can be eaten at once, and helps patients feel less hungry. In addition to providing restriction, recent research has shown that the sleeve has beneficial metabolic effects as well.

Several major insurance providers cover the gastric sleeve and our staff is happy to help you figure out if your insurance company is one of them. You can learn more about the sleeve by calling our office at 858-457-4917.

The 4-8-12 of Working Out

Pick someone you know — anyone at all — and ask them this simple question: “Do you work out?”
This time of year, the answer will usually be “yes.”
It is in vogue to exercise and even more in vogue to run. But with New Year’s resolutions quickly fading, the real question is this: How do you turn a fad into a lasting, meaningful habit and a healthy lifestyle?
It all comes down to what I like to call my “4-8-12 Fitness Rule” © — a rule I’ve developed after 40 years of exercising regularly and talking with other people who do as well.
Scientific? No. Worth doing? Definitely.

Four

To establish a minimum baseline of fitness, a person needs to exercise about four hours a week.
Four hours per week is 240 minutes. Not bad, right? That’s a lot less time than most of us spend watching TV. Even better, you can break that down any way you want.
If you work out 40 minutes per day, six days a week, you got it. Or if you prefer, make it 60 minutes a day, four times a week. The choice is yours.
There’s also flexibility in the type of exercise you do. If you’d like to improve as a runner, then of course you should focus on running. But if you’d simply like to get in shape, you can do almost anything — yoga, swim, bike, lift weights, go for a brisk walk or even work in the garden.
Hurry up and stand still: Why runners need yoga
The point is, you need to be active on a regular basis. You don’t want to be a couch potato six days a week and then hike a mountain every Sunday.
Doing four hours a week is a starting point. You’ll feel good and who knows — you might even run a 5K or a 10K. Best of all, you’ll actually enjoy it.

Eight

Let’s say you want to get a bit more serious about your training — in other words, go from the bottom 25% of people in your age group to solidly in the middle.
The best way to get there is to double your workout time, from four to eight hours per week. Once again, you can do a whole host of activities, just longer and with more intensity.
Or if you really would like to focus on running, try spending at least 50% of your workout time on the treadmill or road. That’s just four hours a week.
If you want to take it to a higher level and start really competing in races, increase your training to 75% of your workout, or six hours of running per week.
By this point, if you’re maintaining a 10-minute pace, you should be running about 35 miles a week — enough to comfortably run a half marathon or maybe even finish a full marathon.

Twelve

By now, you probably get the drift.
To take fitness to the highest level possible, you have to increase your weekly time commitment to 12 hours. That boils down to two hours a day, six days a week.
At this point, you’ll also need to develop a rigorous, precise training plan, whether you’d like to focus on running or a full-body approach. We’re talking cross-training, speed workouts, longer runs, hill runs, yoga and weight lifting, among other things.
With that kind of effort, you’ll be in the top 10% of your age group. Running marathons will be second nature. Fitness won’t be a fad — it’ll be a lifestyle.
Yes, it is a lot of time. Yes, it’s a major commitment. But if you want that New Year’s resolution to really translate into a New You that’s here to stay, that’s what it’ll take.

This article was originally posted on CNN

New Diabetes Study – Gastric bypass surgeon sees overlap with the way that weight loss surgery cures diabetes!

For many years, weight loss surgeons have been fascinated by the rapid resolution of type 2 diabetes after gastric bypass surgery. It is not uncommon for diabetic patients to be off all their medications within 2 days of weight loss surgery. The most common theory is that weight loss surgery (especially gastric bypass) affects the production of intestinal hormones known as Incretins – these hormones (GLP- 1 is a well recognized incretin), seem to improve glucose control, as well as decrease hunger. Weight loss surgery has been shown to dramatically affect the intestinal production of these hormones, and, as a result of the reduction in blood sugar and appetite, diabetes improves and patients lose weight.

Amylin Pharmaceuticals have now launched a study of a medication that increase GLP-1, and, as a result, we expect that diabetic patients taking this medication may experience better blood sugar control and simultaneous weight loss. The study is open to diabetic patients taking Metformin (and essentially no other diabetic meds) who are otherwise healthy, and have not had weight loss surgery. Like most good studies, some of the patients will receive the medication, while others will receive a placebo, and all patents will continue to take their metformin. The study is fascinating, and in addition to potentially being a valuable addition to the way that we treat patients with diabetes, will continue to contribute to our knowledge regarding how weight loss surgery works and how diabetes may some day be cured.

For more information, contact Cynthia at (858) 926-2616 or visit www.ximedweightloss.com

Can Weight Loss Surgery Prevent Diabetes?

Studies have demonstrated again and again that bariatric surgery improves or resolves type 2 diabetes in many obese patients. Previously we shared the encouraging findings of the 2 year interim report of the APEX trial, which showed that as much as 95 percent of Lap-Band patients experienced improvement or resolution of diabetes at 2 years post-surgery.  Few studies, however, have looked at the effect of surgery on preventing diabetes — until now: A new study from Swedish researchers found that obese patients who had bariatric surgery had an 83 percent lower incidence of diabetes compared with a control group that did not have surgery.  The patients in the control group received standard medical therapy including diet and lifestyle recommendations. The surgery group consisted of over 1600 patients who had one of three kinds of bariatric surgery, with the majority undergoing a gastric banding procedure. About 10 percent had gastric bypass.

After following the groups for up to 15 years, the researchers found that those who had surgery lost on average 45 pounds, while those in the control group lost significantly less weight.  None of the patients had diabetes at the start of the study, but some had blood sugar levels that were considered pre-diabetic. These patients who had higher blood sugar levels reaped the greatest benefit from bariatric surgery in terms of diabetes protection, as surgery reduced their risk by 87 percent.  In roughly 10 of every 13 people who had weight loss surgery, type 2 diabetes did not develop. The researchers said that the risk reduction with surgery was at least twice as large as what they saw with the lifestyle interventions in patients in the control group with pre-diabetes.

More research is needed to determine which patients are most likely to benefit from bariatric surgery, in terms of diabetes prevention. You can learn more about the types of weight loss surgery offered at Olde Del Mar Surgical on our website or call 858-457-4917 to schedule a consultation with Dr. Bhoyrul.

Cost Effectiveness of Weight Loss Surgery: New Data

Weight loss surgery is a highly effective treatment for obesity, but for many patients, coming up with the finances for weight loss surgery can seem daunting. While many insurance companies cover weight loss surgery procedures, such as gastric banding, gastric bypass, and gastric sleeve, the process of obtaining approval can be long and sometimes confusing. Several recent studies, however, have shown that investing in weight loss surgery is a worthwhile venture, both for your health and your finances.

A 2011 study from Washington University School of Medicine in St. Louis found that bariatric surgery is not only cost-effective for treating people who are severely obese, but also for those who are mildly obese. Further, for the most severely obese patients, the study found that surgery goes beyond being cost-effective, and actually saves health-care dollars for those who have diseases related to their weight–such as diabetes, heart disease and high blood pressure.  The researchers used data from 170 different studies looking at the effectiveness of bariatric surgery and estimated and simulated the life expectancies and quality of life of people who underwent surgery versus people who did not. From this simulation, they found that surgery is cost-effective even for obese people with a Body Mass Index (BMI) below the current recommendation of 40 (or 35 if the patient has an obesity-related condition).

At this fall’s scientfic meeting of The Obesity Society, research was presented that echoes the findings of the first study: Weight loss surgery was cost-effective in all 11 studies that were analyzed, and some of the studies showed that surgery was actually cost-saving for obese patients with diabetes.  Studies such as these highlight the fact that obesity is an expensive disease. Patients who are severely obese have twice the medical costs of people of normal weight, according to a recent study. Weight loss surgery may be a larger cost in the short-term, but the reduction in obesity-related medical costs makes up for it down the road.

At Olde Del Mar Surgical, we are here to help you sort through the confusing insurance process or help you create manageable payment plans. Just schedule your initial consultation with Dr. Sunil Bhoyrul at 858-457-4917 and we will help you take care of the rest.

Sleep Apnea After the Lap Band

Lap-Band Surgery is effective in treating obstructive sleep apnea (OSA) in obese patients and improves overall sleep quality, found a new study. Obstructive sleep apnea is a condition in which the flow of air pauses or decreases during breathing while you are asleep because the airway has become narrowed, blocked, or floppy. These pauses are called episodes, and a person with OSA can have 30 or more of them in an hour, according to the National Heart Lung and Blood Institute. Sleep Apnea causes poor sleep quality that can lead to daytime drowsiness, fatigue, and moodiness. Untreated sleep apnea increases one’s risk of high blood pressure, heart attack, stroke, obesity, and diabetes, according to the National Sleep Society.

The new study, published by Florida Bariatric Surgeon, Dr. Mark Fusco, used 2 year interim data from the APEX trial, an ongoing 5-year, prospective, observational study of the Lap-Band AP system.  At 1 year after surgery, 36% of patients had resolution or improvement of OSA and by 2 years, this increased to 86%. The average BMI at 2 years for those that had resolution or improvement of OSA was about 36, representing a 20% loss of body weight. In addition to sleep apnea benefits, the patients in the study experienced improvement in other obesity-related comorbidities such as type 2 diabetes (96%) and hypertension (91%). The study authors concluded that the data shows that surgically-induced weight loss can affect the resolution or improvement of OSA and sleep-related quality of life, and that the degree of weight loss may be related to these changes.

For patients who suffer from obesity, weight loss surgery may be the best chance of improving the quality, and perhaps the quantity of life itself. Please contact our practice today to schedule a consultation and learn more about weight loss surgery.

Diabetes and the Lap Band: New Data

The APEX study is a 5 year study of the Lap Band. 2 years of that study have now been completed, and interim data is available. Many were excited to see that the two year results show that laparoscopic gastric banding is highly effective in treating obese patients with type 2 diabetes. The study found that two years following surgery, over 95% of the patients’ doctors reported improvement in patients’ glucose control, with 48.5% achieving diabetes remission and 47% showing improvement in hemoglobin A1c values. The interim report’s key finding is that the best opportunity for long‐lasting remission of type 2 diabetes calls for early surgical intervention, while beta cell function still remains.

The patients who experienced remission had greater weight loss, on average, at 2 years compared to the other patients, and had diabetes duration of just 4 years, compared to 6.7 years for the ‘improvement’ group and 9 years for the ‘no change’ group. The findings suggest that the main predictors of diabetes resolution following gastric banding are diabetes duration, amount of weight loss, and the severity of disease.

Currently, the American Diabetes Association estimates that an astonishing 25.8 million people in the United States have diabetes. With these numbers expected to increase over the next few decades, curing and treating diabetes is a top priority. While diet and weight loss are fundamental in the treatment of diabetes, lifestyle recommendations are often difficult to achieve and even more difficult to sustain. Weight loss surgery has been shown to be an effective method of achieving meaningful and long-lasting weight loss with improvements in diabetes.  In addition to the APEX study’s results, two recent studies published in the New England Journal of Medicine found that bariatric surgery is superior to medical therapy in treating obese patients with diabetes.

Dr. Bhoyrul is actively involved in the APEX study and is a co-author of the interim report.