LapBand Erosion

There are many terms that have become familiar to the lap band population because they are commonly used among doctors and patients.  One popular term is “LapBand” which stands for Laparoscopic Gastric Banding.  The term “LapBand Erosion” also became very popular among the banded patients as lap band message boards increased in popularity. The patients that already had the LapBand were concerned as“erosion” was often connected to topics such as de-banding or surgical removal of the band.  However, the term actually means that the stomach has developed a penetrating ulcer and has eroded (worn away) towards the balloon of the band.

How does Stomach Erosion happen in LapBand Patients?

Intragastric band erosions have been reported at rates that vary from 3 to 10% depending on the operatory technique or surgeon´s experience, the device used and the patient’s eating behavior.  There are several different and controversial theories for the cause of erosion:

•     The LapBand around the stomach gradually erodes into the stomach wall over time, and goes into the gastric lumen, as we have seen with other intrabdominal devices.
•     The stomach damage done during the LapBand procedure debilitates the layers of the stomach wall, resulting in erosion at a later time.
•     The sutures were placed too deep and trespassed all the wall layers of the stomach, causing micro perforations that generate leaking, infection and later erosion.
•     Events that happens inside the stomach, such as frequent vomiting, medications, ingestion of irritants as spicy or hot food, alcohol, etc. as well as a large adjustment to the band system, will produce an ulcer that penetrates toward the balloon of the band.

I believe the last theory is the most consistent and also the most frequently seen in the vast majority of patients with erosion.  Other theories,  such as a crease or a fold in the balloon, which may harm and erode the stomach lining, were not scientifically proven. We have seen erosion with all kinds of LapBands and with all kinds of balloons and find no correlation with the fold theory.

Once the erosion-ulcer is established it is not possible to cure the ulcer, not even by removing all the fluid in the band. Therefore the need to remove the band itself becomes imperative. I recommend the band be removed AS SOON AS POSSIBLE, not because this is an emergency in any way, but because there is a risk of increasing the ulcer’s size.  Removing the Lapband can help to decrease the risk of complications such as infection traveling along the hose to the port and to the skin, or stomach bleeding.

How Can LapBand Erosion be Prevented?

There are several ways to prevent erosion.  The first way that I personally recommend is to avoid “large fills” to the LapBand, in order to prevent vomiting or gastric reflux.  The second way that I recommend is to protect the stomach with anti-acids frequently, especially at bed time.  The third recommendation is to avoid alcohol, hot or spicy food, vinegar, soy sauce, and coffee.  Talk with your Doctor about the medications you are actually taking and ask about exchanging the ones that can hurt your stomach for others with the same effect but less stomach irriation.

ArturoRodriguez, MD

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Facebook makes you fat

Many times, when users are checking Facebook or surfing the Internet, they’ve also got a snack handy. But does Facebook make you more likely to be an unhealthy eater? A study that will appear in the June 2013 Journal of Consumer Research shows that while Facebook can boost self-esteem, it can also lower self-control at the same time, leading to dangerous behaviors such as binge eating.

Keith Wilcox of Columbia Business School and Andrew Stephen of the University of Pittsburgh wanted to test the effects of Facebook on users’ self-esteem and self-control. They studied two core groups of users: those who have strong ties to friends on their social network and those who don’t.

Wilcox and Stephen found that among users with strong ties to their Facebook friends, simply browsing the social network improved their self-esteem. However, the boost of self-esteem came with a caveat: lowered self-control.

For one study, they took a group of 84 U.S. Facebook users and split them into two groups: one browsed Facebook (but didn’t post content or interact with friends) ,and the other read CNN.com. Participants were asked to choose between two snacks: a granola bar and chocolate chip cookies. They found that users with close ties to their social network were more likely to choose cookies instead of granola bars:

The results of study three support for our theory that social network use can decrease self-control by enhancing self-esteem. Specifically, the results show that for those focused on strong ties while browsing Facebook, social network use enhanced self-esteem, making them more likely to make an unhealthy food choice compared to those who did not browse Facebook. However, the differences in self-esteem or self-control were not observed for those focused on weak ties while browsing the network.

Wilcox and Stephen dug a little further, seeing if Facebook use led to unhealthy habits such as binge eating and poor credit. They took 541 U.S. Facebook users (median age 32.06, 61 percent female) and had them take a survey about their Facebook usage, eating habits, and credit history.

The researchers threw out the outliers of those who were deemed underweight or severely overweight by Body Mass Index standards. They found that the more time the participants with strong ties to their online connections spent on Facebook, the higher their BMI was, and the more likely they were to engage in binge eating.

Next, they took 399 participants who owned credit cards to see if high amounts of Facebooking led to lower credit scores. Much like the deleterious effects of binge eating, the researchers found that those who spent more time on the social network also had more credit card debt.

In summation, the researchers found that users who spend a lot of time on Facebook, communicating with close friends, tend to also have lower levels of self-control (although, of course, that’s not always the case):

The effect of social network use on individuals’ abilities to exhibit self-control is concerning given the increased time people are spending using social networks, in part due to the worldwide proliferation of access to social networks anywhere anytime (i.e., via mobile smartphones, smart TVs, tablet computers, etc.). Even a small five-minute “dose” of social network use in our studies was enough to significantly lower self-control in subsequent choices and tasks. Heavy users likely expose themselves to multiple doses of this effect a day. Given that self-control is important for maintaining social order and personal well-being, this subtle effect could have widespread impact. This is particularly true for adolescents and young adults who are the heaviest users of social networks and have grown up using social networks as a normal part of their daily lives. Because of these factors, our findings have important policy implications. It would be worthwhile for researchers and policymakers to further explore social network use in order to better understand which consumers may be particularly vulnerable to suffering negative psychological or social consequences.

alfacebook

ArturoRodriguez, MD

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Americans fighting fat, but odds stacked against them

If you look hard enough, there are signs that Americans are finally getting the message about how heavy and out-of-shape they are.

Consumption of diet drinks is increasing, and the calories Americans consume from regular sodas are on the way down.

More than half of Americans (55%) say they are trying to drop some weight, up significantly from 43% in 2011, according to a recent survey conducted for the International Food Information Council Foundation.

But while the concern about obesity may have hit the national consciousness, it hasn't really shown up on the bathroom scale for most Americans yet.

The reality is that the nation is now entering a fourth decade of weight gain. The obesity rate — those who are 30 or more pounds over a healthy weight — stayed fairly level at 15% from 1960 to 1980.

Since then it climbed to 36% in 2010, an all-time high. If it continues to grow, about 42% of Americans may end up obese by 2030, according to a projection from researchers with RTI International, a non-profit organization in North Carolina's Research Triangle Park.

"If you go with the flow in America today, you will end up overweight or obese, as two-thirds of all adults do," says Thomas Frieden, director of the Centers for Disease Control and Prevention.

Obesity is "one of the few things that has gotten worse quickly," he says. "It really is a very serious health problem."

Obesity takes a huge toll on people's health. "Obesity is not just a cosmetic problem. It contributes to a long list of serious health problems — diabetes, cardiovascular disease, liver problems, degenerative joint disease, and even cancer," says Francis Collins, director of the National Institutes of Health.

Those extra pounds rack up billions of dollars in weight-related medical bills. It costs about $1,400 more a year to treat an obese patient compared with a person at a healthy weight, Frieden says. It costs $6,600 more a year to treat someone with diabetes, he says.

So where did we go wrong, and what will it take to reverse the trend?

National obesity experts say that over the past three decades, Americans' eating habits have changed dramatically. Food marketers, manufacturers and restaurants are selling us more food in bigger portions — and we're happy to wolf down much more than we used to.

The culprit behind the epidemic is that "we are eating significantly more calories now" than 30 years ago, Frieden says. "At its most basic level, obesity is a problem of calories."

A number of observers cite a litany of changes that have reshaped food consumption: Fast-food chains are pushing bigger hamburgers, beverages and servings of french fries; restaurants have doubled the portion sizes of their meals.

Meanwhile, jobs put fewer physical demands on workers, and physical education has been squeezed out of many schools.

These and many other changes, big and small, have led to "the perfect storm that has caused the obesity rate we have today," says James Hill, executive director of the Anschutz Health and Wellness Center at University of Colorado.

States, cities and communities have taken action across the country to reverse the trend. Schools are being pushed to offer healthier foods to kids, and programs such as first lady Michelle Obama's Let's Move are trying to get them to exercise more.

In one of the most high-profile efforts, New York City is putting a 16-ounce cap on sweetened bottled drinks and fountain beverages sold at city restaurants, delis, movie theaters, sports venues and street carts.

Though many people consider sugar one of the big villains, it doesn't bear sole responsibility, Hill says. "I'm not here to defend sugar," but the causes of obesity are more complex than just sugar intake, he says. Many Americans are following high-fat, high-calorie diets, and they are not moving nearly as much as they should, he says.

"There's a lot we don't know about obesity," Frieden adds.

usatoday.com

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Revealing the unexpected dangers of obesity

Researchers are increasingly interested in understanding the role of the olfactory bulb, which relays smell information from the nose to the brain, and contains one of the densest collections of insulin receptors outside the pancreas. The production of insulin, which is used to turn sugar into energy, is often impaired in obese people.

Debra Ann Fadool, a professor at Florida State University in the program in neuroscience and molecular biophysics, and Kristal Tucker, a research associate in pharmacology and chemical biology at the University of Pittsburgh School of Medicine, were studying the role of insulin in the olfactory system when they bred genetically modified "super-smeller" mice that could discriminate odors better than normal mice.

They observed that these modified mice were thinner than normal mice and appeared resistant to obesity, perhaps because the modified mice metabolized the fat differently. Even when they were fed a high-fat diet, they didn't put on extra fat. They also exhibited lower levels of insulin, glucose and leptin—chemicals that are usually elevated in obesity, said Dr. Fadool.

This observation led the scientists to remove the super-smeller mice's olfactory bulbs. When they did this, the mice ceased to remain resistant to obesity, Dr. Fadool said.

Further investigation found that the neurons in the bulbs of obese mice fired less frequently than in lean mice, suggesting that these mice didn't decipher odors as well, and they couldn't adapt well to different situations, such as an influx of insulin.

In another study, published last month in the Public Library of Medicine, they found that mice made obese on a high-fat diet also exhibited damped responses in their olfactory bulbs, suggesting obesity can disrupt the bulb's functioning.

It isn't clear how olfaction and body weight are linked. One theory: Excess fat and related hormonal changes could trigger changes in the olfactory system.

Another is that olfactory dysfunction comes first, and can cause or contribute to obesity, according to Dr. Tucker. In the future, targeting smell could be another approach to addressing obesity, she added.

"If you can modulate your olfactory function, it's possible it could be a future target for controlling food intake and metabolism," she said.

Obesity also influences sleepiness. Obese people often report feeling sleepier than their leaner counterparts. For a long time it was believed this was due to sleep apnea, a condition—common in the overweight—in which a person stops breathing repeatedly while sleeping.

But Alexandros Vgontzas, a sleep specialist at Penn State University, and others have found that the obese sleep worse and report being sleepy in the daytime—to the point of falling asleep at work or while driving—regardless of whether they have sleep apnea.

At the Associated Professional Sleep Society in Boston this summer, they presented data on 1,700 people they followed for 7½ years, studying the factors at work in those who reported significant sleepiness. Obesity, weight gain and depression were the biggest risk factors, they found. In addition, weight loss appeared to make people less sleepy.

"The weight gain and weight loss findings tell us it's indeed the obesity that makes you complain about sleepiness, not the other way around," said Dr. Vgontzas. This makes sense because fat produces certain molecules that are known to be sleep factors, he said.

These results could help clinicians treating patients with sleep problems, Dr. Vgontzas says. Rather than immediately treating an overweight person with what is known as a CPAP machine, a mask that forces air up the nose to improve breathing, the doctor should consider intervening to encourage weight loss instead, he said.

"It's a bad practice for sleep medicine physicians if someone comes with mild or moderate sleep apnea to stuff them with mask instead of [change] lifestyle," said Dr. Vgontzas.

Fertility is another area that obesity seems to disrupt. In a recent study of teenage boys, obese males had half the level of testosterone of lean ones, suggesting they could have problems with impotence and fertility later on, said Paresh Dandona, a professor and head of endocrinology, diabetes and metabolism at the University of Buffalo in New York state.

"It is still not fully appreciated that obesity could be a cause of sexual dysfunction and infertility," said Dr. Dandona. "It's a public health issue."

It isn't clear why there is a link, though it seems likely that the hormones produced by fat disrupt the typical balance of sex hormones, said Dr. Dandona.

online.wsj.com

ArturoRodriguez, MD

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Healthy schools, healthy weight

The foundation for lifelong good health is laid in childhood. And outside of home life, nothing provides more of an immersive experience for children than the time they spend in school. This means schools have a rich opportunity to improve youth health and tackle obesity at the ideal point in time—before problems take hold.

One of the main avenues that schools can use to positively affect health is also one most directly in line with every school’s mission: educating students. Nutrition and physical activity lessons can be woven into the curriculum—in core classroom subjects, physical education, and after-school programs—to teach skills that help students choose and maintain healthy lifestyles. In addition to teaching evidence-based nutrition and activity messages, school physical education should focus on getting students engaged in high-quality and regular activity.

Schools can also promote health outside of the classroom, by surrounding students with opportunities to eat healthy and stay active. To improve nutrition, schools can include healthier food offerings in the cafeteria and eliminate marketing of unhealthy foods. To improve activity, schools can develop safe walking and biking routes to school, and can promote active recess time.

Wellness programs for faculty and staff can also be integral to improving the school environment, not only serving to boost faculty and staff health but also building school-wide enthusiasm for student-focused programs.

Additionally, schools can serve as important data sources on student health. Anonymous, school-level information on markers like students’ body mass index (BMI) can help educators and policy-makers assess success of current programs and decide the direction of future programs.

With good evidence that school-based prevention programs can successfully—and without many added resources—help students to eat better, be more active, and achieve healthier weights, schools are poised to become an integral part of the fight against the obesity epidemic. As with education in general, the sooner we act, the better.

Fuente.- harvard.edu

ArturoRodriguez, MD

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Obama proclaims september as National Childhood Obesity Awareness Month

Declaring that obesity is “a serious public health issue that puts millions of our sons and daughters at risk,” President Barack Obama on Friday officially proclaimed September as National Childhood Obesity Awareness Month.

In his proclamation, Obama notes that while childhood obesity puts young people in danger of developing serious health conditions, Americans “are making real progress toward a healthier future for our children.”

For example, the president cites the Let’s Move! initiative, the campaign being led by his wife, First Lady Michelle Obama, that is working to reverse childhood obesity within a generation. Obama notes that for more than two years, Let’s Move! has worked with stakeholders to expand access to healthy food, promote physical activity and encourage healthy food choices.

Obama also notes that his administration is implementing new nutritional guidelines that require school meals to include more whole grains, fruits and vegetables and less fat and sodium. “These changes represent the first major revision to school meal requirements in more than 15 years, and they come on the heels of recent updates to the Federal Government’s Dietary Guidelines for Americans,” Obama adds.

In the proclamation, Obama also cites projects such as the HealthierUS School Challenge, the Presidential Active Lifestyle Award, the Healthy Food Financing Initiative and partnerships between Let’s Move! and community and faith based organizations.

“Each of us can play a role in ensuring our children have the opportunity to live long, healthy lives, and by joining together in pursuit of that mission, I am confident we can build a brighter future for America’s youth,” Obama proclaims.

preventobesity.net

ArturoRodriguez, MD

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Obesity Can Lower Children's IQ

Obese children, as well as kids with metabolic syndrome are more likely to be behind their normal-weight peers in spelling, mental flexibility, arithmetic and overall cognitive scores, researchers from New York University School of Medicine and the Nathan Kline Institute for Psychiatric Research, New York, reported in the journal Pediatrics.

The authors explained that there has been a dramatic increase in obesity rates in the USA over the past twenty years. The prevalence of metabolic syndrome among children has also risen significantly.

Metabolic syndrome is a cluster of health conditions, including high blood pressure (hypertension), elevated blood glucose levels, central obesity (too much fat around the waist), abnormal cholesterol levels, and insulin resistance. Metabolic syndrome is seen as a prelude to diabetes type 2.

Previous studies had demonstrated a link between metabolic syndrome in adults and cognitive deficits. This study has now shown that metabolic syndrome in teenagers is associated with even more extensive cognitive problems.

Dr. Antonio Convit, a professor of psychiatry and medicine at the NYU Langone School of Medicine, and team set out to determine what effects obesity and metabolic syndrome might have on teenagers. They compared 49 teens with metabolic syndrome to 62 peers without the disorder. All the children were matched socioeconomically.

They found significantly lower scores among those with metabolic syndrome in: Arithmetic, Attention and attention span, Mental flexibility, Spelling.
 

They also identified lower volumes of matter in the hippocampus and white matter integrity. The hippocampus is an area in the brain that regulates, learning, memory and emotion.

The authors wrote that according to their findings, obesity-associated metabolic dysregulation, which has not yet reached a level for a diagnosis of diabetes type 2, may also cause brain complications during a child's teenage years.

When considering early treatment options for childhood obesity, the researchers suggest that doctors should include therapies to improve brain function.

Dr. Convit said that further studies are required to find out whether obese teenagers might regain cognitive performance and structural abnormalities in the brain if their lose weight.

medicalnewstoday.com

ArturoRodriguez, MD

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Obesity: Is Fast Food Responsible?

The reasons for obesity are multiple and complex.  Despite conventional wisdom, it is not simply a result of overeating.  Research has shown that in many cases, the significant underlying cause of morbid obesity is genetic. Studies have demonstrated that once the problem is established, efforts such as dieting and exercise programs have a limited ability to provide effective long-term relief. 

Science continues to search for answers but, until the disease is better understood, the control of excess weight is something patients must work at for their entire lives.  That is why it is very important to understand that all current medical interventions, including the Lap Band, Gastric Sleeve and Gastric Bypass procedures should not be considered medical cures. Rather, they are attempts to reduce the effects of excessive weight and alleviate the serious physical, emotional and social consequences of the disease. 
Contributing Factors 

The underlying causes of severe obesity are not known.  There are many factors that contribute to the development of obesity including genetic, hereditary, metabolic, environmental, and eating disorders.  There are also certain medical conditions that may result in some special type of obesity, such as the long term intake of steroids and some diseases such as hypothyroidism and hyper-adrenalism.
Genetic Factors 

Numerous scientific studies have established that your genes play an important role in your tendency towards excess weight gain.  The body weights of adopted children show no correlation with the body weights of their adoptive parents, who feed them and teach them how to eat.  However, their weight does have an 80 percent correlation with their genetic parents, whom they have never met.  As well, identical twins with identical genes, show a much higher similarity of body weights than do fraternal twins.

Certain groups of people, such as the Pima Indian tribe in Arizona and the growing Mexican-American population have shown a very high incidence of severe obesity. They also have significantly higher rates of diabetes and heart disease than other ethnic groups. 

We probably have a number of genes directly related to weight.  Just as some genes determine eye color or height, others can affect the appetite by increasing the amount of secretion of the Ghrelin Factor by the stomach, or the ability to feel full, satisfied, or have an early age-related change in metabolism. Our fat-storing ability, and our natural activity levels may even be affected by some predetermined gene.
Environmental Factors

Environmental and genetic factors are obviously closely intertwined.  If you have a genetic predisposition toward obesity, then the modern American lifestyle and environment may make controlling weight more difficult.  Fast food, long days sitting at a desk or in front of a TV screen or monitor, and suburban neighborhoods that require cars all magnify hereditary factors such as metabolism and efficient fat storage.   For those suffering from morbid obesity, anything less than a total change in environment usually results in failure to reach and maintain a healthy body weight. 
Metabolism

We used to think of weight gain or loss as only a function of calories ingested and then burned. Take in more calories than you burn, gain weight; burn more calories than you ingest, lose weight. But now we know the equation isn’t that simple.  Obesity researchers now talk about a theory called the “set point,” a sort of Thermostat in the brain that makes people resistant to either weight gain or loss. If you try to override the set point by drastically cutting your calorie intake, your brain responds by lowering metabolism and slowing activity. You then gain back any weight you’ve lost.
Eating Disorders & Medical Conditions

Weight loss surgery is not a cure for eating disorders. And there are medical conditions, such as hypothyroidism, that can also cause weight gain. That’s why it’s important that you work along with your doctor to find out whether you have any conditions that should be treated with medication and counseling.

ArturoRodriguez, MD

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Strict laws on School Snacks

Adolescents in states with strict laws regulating the sale of snacks and sugary drinks in public schools gained less weight over a three-year period than those living in states with no such laws, a new study has found.

The study, published Monday in Pediatrics, found a strong association between healthier weight and tough state laws regulating food in vending machines, snack bars and other venues that were not part of the regular school meal programs. Such snacks and drinks are known as competitive foods, because they compete with school breakfasts and lunches.

The conclusions are likely to further stoke the debate over what will help reduce obesity rates, which have been rising drastically in the United States since the 1980s. So far, very little has proved effective and rates have remained stubbornly high. About a fifth of American children are obese, according to the Centers for Disease Control and Prevention.

Public health experts have urged local and state governments to remove competitive foods from schools, and in recent years states have started to pass laws that restrict their sale, either banning them outright or setting limits on the amount of sugar, fat or calories they contain.

The study tracked weight changes for 6,300 students in 40 states between 2004 and 2007, following them from fifth to eighth grade. They used the results to compare weight change over time in states with no laws regulating such food against those in states with strong laws and those with weak laws.

Researchers used a legal database to analyze state laws. Strong laws were defined as those that set out detailed nutrition standards. Laws were weak if they merely offered recommendations about foods for sale, for example, saying they should be healthy but not providing specific guidelines.

The study stopped short of saying the stronger laws were directly responsible for the better outcomes. It concluded only that such outcomes tended to happen in states with stronger laws, but that the outcomes were not necessarily the result of those laws. However, researchers added that they controlled for a number of factors that would have influenced outcomes.

Still, the correlation was substantial, researchers said, suggesting that the laws might be a factor. Students who lived in states with strong laws throughout the entire three-year period gained an average of 0.44 fewer body mass index units, or roughly 2.25 fewer pounds for a 5-foot-tall child, than adolescents in states with no policies.

The study also found that obese fifth graders who lived in states with stronger laws were more likely to reach a healthy weight by the eighth grade than those living in states with no laws. Students exposed to weaker laws, however, had weight gains that were not different from those of students in states with no laws at all.

The authors argued that the study offered evidence that local policies could be effective tools.

“Competitive-food laws can have an effect on obesity rates if the laws are specific, required and consistent,” said Daniel Taber, a fellow at the Institute for Health Research and Policy at the University of Illinois at Chicago, who was one of the authors of the study.

Still, many states have no laws at all regulating the sale of such foods, and the group that helped finance the study, the Robert Wood Johnson Foundation, argued that the results made the case for a strong national standard for snacks and beverages in schools. The United States Department of Agriculture has been developing new standards for some time, but they have yet to emerge.

Some experts argue that a real reduction in the obesity rate will come only when many more local governments adopt tough policies to change the food environment. Still others say that school is such a small part of a child’s day that healthier options will make little difference when coupled with a home environment with a lot of unhealthy choices.

nytimes.com

ArturoRodriguez, MD

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Drinking Water

ArturoRodriguez, MD

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New brain target for appetite control identified

Researchers at Columbia University Medical Center (CUMC) have identified a brain receptor that appears to play a central role in regulating appetite. The findings, published today in the online edition of Cell, could lead to new drugs for preventing or treating obesity.

"We've identified a receptor that is intimately involved in regulating food intake," said study leader Domenico Accili, MD, professor of Medicine at CUMC. "What is especially encouraging is that this receptor is belongs to a class of receptors that turn out to be good targets for drug development, making it a highly 'druggable' target. In fact, several existing medications already seem to interact with this receptor. So, it's possible that we could have new drugs for obesity sooner rather than later."

In their search for new targets for obesity therapies, scientists have focused on the hypothalamus, a tiny brain structure that regulates appetite. Numerous studies suggest that the regulatory mechanism is concentrated in neurons that express a neuropeptide, or brain modulator, called AgRP. But the specific factors that influence AgRP expression are not known.

The CUMC researchers found new clues to appetite control by tracing the actions of insulin and leptin. Both hormones are involved in maintaining the body's energy balance, and both are known to inhibit AgRP. "Surprisingly, blocking either the insulin or leptin signaling pathway has little effect on appetite," says Dr. Accili. "We hypothesized that both pathways have to be blocked simultaneously in order to influence feeding behavior."

To test their hypothesis, the researchers created a strain of mice whose AgRP neurons lack a protein that is integral to both insulin and leptin signaling. As the researchers hypothesized, removing this protein — Fox01 — had a profound effect on the animals' appetite. "Mice that lack Fox01 ate less and were leaner than normal mice," said lead author Hongxia Ren, PhD, associate research scientist in Medicine. "In addition, the Fox01-deficient mice had better glucose balance and leptin and insulin sensitivity — all signs of a healthier metabolism."

Since Fox01 is a poor drug target, the researchers searched for other ways to inhibit the action of this protein. Using gene-expression profiling, they found a gene that is highly expressed in mice with normal AgRP neurons but is effectively silenced in mice with Fox01-deficient neurons. That gene is Gpr17 (for G-protein coupled receptor 17), which produces a cell-surface receptor called Gpr17.

To confirm that the receptor is involved in appetite control, the researchers injected a Gpr17 activator into normal mice, and their appetite increased. Conversely, when the mice were given a Gpr17 inhibitor, their appetite decreased. Similar injections had no effect on Fox01-deficient mice.

According to Dr. Accili, there are several reasons why Gpr17, which is also found in humans, would be a good target for anti-obesity medications. Since Grp17 is part of the so-called G-protein-coupled receptor family, it is highly druggable. About a third of all existing drugs work through G-protein-coupled receptors. In addition, the receptor is abundant in AgRP neurons but not in other neurons, which should limit unwanted drug side effects.

http://medicalxpress.com

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Testimonial

ArturoRodriguez, MD

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Lapband

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The Impossible Hamster

 

 

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The European Way

 

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Panel Recommends More Testing for Obesity Drugs

Obesity drugs should undergo clinical trials to ensure that they do not cause heart attacks, federal advisers said Thursday, a requirement that could make it harder for such drugs to gain approval.

An advisory committee to the Food and Drug Administration voted 17 to 6 to require such studies, even if there were no apparent signs that a drug increased cardiovascular risk.

“Given the checkered history of weight-loss drugs, I think it is better to be prudent and err on the side of caution,” Dr. Sanjay Kaul, a cardiologist at Cedars-Sinai Medical Center in Los Angeles, said at the end of the two-day meeting in Silver Spring, Md.

But some committee members warned that such a requirement would increase the time and cost of developing weight-loss drugs, discouraging pharmaceutical companies.

“If the F.D.A. follows through with this vote, you’ve just added another big disincentive for the drug companies to come up with obesity drugs, and we desperately need new drugs,” said Dr. Ed J. Hendricks, an obesity specialist in Sacramento, who voted with the minority. .

The F.D.A. usually follows the advice of its committees but it does not have to.

It was not immediately clear how, if at all, the committee vote would affect the fates of two obesity drugs awaiting approval from the F.D.A. — Qnexa from Vivus and Lorqess from Arena pharmaceuticals.

Because one-third of American adults are obese and another third are overweight, some obesity specialists and patient advocates say new drugs are needed. Xenical from Roche is the only drug approved for long-term use.

The F.D.A. has been cautious about the drugs, in part because they might be used by many people who, because of their obesity, are already at an increased risk of heart attacks and other cardiovascular problems.

Two drugs associated with the fen-phen diet pill combination were removed from the market in 1997 because of damage to heart valves. In 2010, the drug Meridia from Abbott Laboratories was withdrawn after a clinical trial showed it increased the risk of cardiovascular problems in patients.

The F.D.A. now requires makers of drugs for Type 2 diabetes to rule out an increased risk of cardiovascular problems. That has delayed approval of some drugs and discouraged investment in diabetes-related start-ups by venture capitalists.

Lou Tartaglia, acting chief executive of Ember Therapeutics, a start-up company developing obesity treatments, said the risks of drugs should be assessed on a case-by-case basis. “Just because it is diabetes or obesity doesn’t automatically mean that alarm bells should be going off for cardiovascular risk,” said Dr. Tartaglia.

Mindful of adding time and cost to drug development, most committee members said that some of the testing for cardiovascular risk could take place after a drug was approved.

They also said drug companies might not have to do special cardiovascular trials if they can adequately assess cardiovascular risk in the trials they already do to win approval.

The committee was asked to vote only for drugs with no “signal” of cardiovascular risk. The F.D.A. said during the meeting that it had already decided that cardiovascular risks must be ruled out for drugs that have such a signal, like raising blood pressure.

One drug with a signal is Contrave, which is being developed by Orexigen Therapeutics. It was rejected by the F.D.A. in 2011 because it raised blood pressure and pulse rate.

To rule out the possibility that Contrave raises the risk of cardiovascular problems, Orexigen is now embarking on a clinical trial that is expected to include 10,000 patients, cost tens of millions of dollars and take at least two years.

Qnexa from Vivus also raised heart rate, prompting some analysts to question whether that would be a signal that would delay approval.

However, Qnexa lowered blood pressure. The same advisory committee last month discussed potential heart risks and recommended approval of Qnexa by a vote of 20 to 2. Committee members seemed to agree that Vivus could do a cardiovascular trial after approval.

Vivus declined to comment on Thursday, saying it was in a quiet period before the F.D.A. decision, which is expected by April 17.

Lorqess by Arena Pharmaceuticals drug was rejected by the F.D.A. in 2010, mainly because the drug caused certain tumors in rats. The advisory committee will discuss Arena’s new application for approval in May.

www.nytimes.com

ArturoRodriguez, MD

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Obesity and other targets of Children’s Museums

CHILDREN’S museums do not usually have exhibitions that involve crawling through a giant digestive system.

But such an installation — along with a play center where visitors learn the power of pedaling, bouncing and jumping and a place to meet superpowered vegetable heroes — is part of a larger effort by the Children’s Museum of Manhattan to help prevent childhood obesity.

While children’s museums are primarily known as activity centers to divert the younger set and to help form future museumgoers, they are increasingly focused on social outreach. “Part of our mission is to provide access,” said Andy Ackerman, executive director of the Children’s Museum of Manhattan. “Social issues, education, health and creativity — it’s all a continuum, and we can connect those domains and reinforce each of them.”

The Port Discovery Children’s Museum in Baltimore has adapted museum exhibits and programming for children with special needs. The Young at Art Museum in Davie, Fla., has an afterschool arts program for homeless students. The Providence Children’s Museum in Rhode Island helps children in foster care find permanent families. And the Children’s Museum of the Arts in Manhattan provides a place for foster-care children to reunite with their birth parents by making art together.

“As resources become more and more scarce, everybody’s looking to children’s museums to fill varying kinds of needs for children and families,” said Janet Rice Elman, executive director of the Association of Children’s Museums in Arlington, Va. “These are places where families can learn through play — from science to early literacy skills to parenting — in settings that are joyful.”

Many of these programs involve collaborations with other organizations that have specific expertise. The Children’s Museum of Manhattan on the Upper West Side, for example, developed its so-called EatSleepPlay effort with the National Institutes of Health and collaborates with the City University of New York on training at-home child-care providers in teaching literacy, math and science.

The Children’s Museum of the Arts in SoHo has joined with Henry Street Settlement’s Urban Family Center to bring free weaving, printmaking and sculpture to children living in transitional housing, culminating with a children’s art exhibition and a reception for families and friends. And the Boston Children’s Museum is joining with Head Start, Boston Public Schools and the City of Boston to prepare students for kindergarten.

“We want to be relevant to our communities,” said Jeri Robinson, the vice president for early childhood and family learning at the Boston museum.

Museums are also developing continuing relationships with outside experts. The Children’s Museum of Manhattan, for example, has worked closely with health advisers like Dr. Judith Owens, director of sleep medicine at the Children’s National Medical Center in Washington. Her research helped the museum develop the sleep section of the EatSleepPlay exhibition,  covering topics like preparing for sleep, what happens during sleep and how much sleep children need.

Rather than serving as just one more recreational option, children’s museums are recasting themselves as essential anchors in their communities — “the hub or the center,” Mr. Ackerman said.

“Educating through the arts,” he added. “That’s how you change behavior.”

The New-York Historical Society is seeking to educate with its new DiMenna Children’s History Museum, which opened last fall. Young visitors learn about prejudice by studying the life story of James McCune Smith, the first African-American to earn a medical degree. They learn about money and credit by visiting the Alexander Hamilton pavilion. “All of the exhibits we’ve developed are focused on teaching a skill or a behavior,” said Louise Mirrer, the president and chief executive.

The museums are also reaching beyond their walls to take their programming more aggressively into underprivileged neighborhoods. The Children’s Museum of Manhattan is replicating its exhibitions in East Harlem’s public housing. It sends two artists to Memorial Sloan-Kettering Cancer Center every week to work with children. And it is running health and literacy programs in the Bronx and New Orleans.

And children’s museums are making a concerted effort to draw specific groups of people who might otherwise not come through their doors. On Mondays, the Children’s Museum of Manhattan is open to children with autism and their families, as well as to school groups. “They need a quiet venue,” Mr. Ackerman said.

The ARTogether program at the Children’s Museum of the Arts brings foster children together with their biological parents to create art, led by a clinically trained, licensed art therapist. The museum recently expanded the effort to include families with children at risk of being placed in foster care. It has hired staff members who speak Mandarin and Cantonese.

“You can come to our space and participate alongside other folks who maybe aren’t having the same challenges,” said David Kaplan, the museum’s executive director. “You want to be supportive of families in the program but you want to be empowering them — you don’t want them to rely on you forever. Eventually you want them coming to the museum on their own terms and on their own time.”

In opening a larger space last fall, the Children’s Museum of the Arts hopes to generate more revenue to benefit children at risk, to provide a “nice, safe environment for people to come to,” Mr. Kaplan said.

Not only are children’s museums seeking to educate, they want their visitors to feel comfortable entering cultural institutions for many years to come and to see exhibitions that affirm their own experience. “The audiences who are living here want to be able to come here and see their lives reflected,” said Ms. Robinson of the Boston museum.

In some cases, the exhibits also take the visitors to places they have never been. The museum now features a Japanese silk weaver’s house that was a gift from Kyoto. “Many of our kids will never go to Japan,” Ms. Robinson said. “But they can have an authentic Japanese experience by coming to our house.”

www.nytimes.com

ArturoRodriguez, MD

md@thebariatric.com
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The best way to control your weight

 

 

ArturoRodriguez, MD

md@thebariatric.com
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LapBand: Truth or myth

I can’t have a Lap Band Surgery if I am not Super-Obese: Every day we do more Lap Band Surgeries in overweight and mildly obese patients, especially if they have a family history of co-morbidities such as Type 2 Diabetes, High Blood Pressure or High Cholesterol. The tendency world wide is that patients qualify for the Lap Band Procedures with BMI of 30 and above. The Lap band works also very well in patients who don’t want to gain weight but maintain in the weight they are and this is possible due to the Lap Band versatility to be adjustable to the patient’s needs.

You have to lose more than 10 pounds the first month after a Lap band Surgery: Yes, you do… The liquid diet should help you to lose much more than 10 pounds in the first month after surgery. When patients don’t reach this minimum it is because they are drinking many liquid calories and/or are not moving at all to burn the excess fat. Your goal after the first month of your surgery would be to lose at least 2 pounds per week and exercise will help you to reach this goal.

I am eating too much therefore I should go for a fill: Getting a lap band fill should not be based on the amount of food you are eating.  As long as you are losing weight or sizes, you won’t need a fill. If you are eating more, this could mean that you are moving or exercising more than you did before, or that you are making better choices about the foods that you are eating.  If you are in a plateau or gaining weight, then you should go for a fill. The purpose of the fill is to increase the restriction to food when you quit losing weight.

Should I expect to lose weight without exercising? You can lose weight without exercise if you are eating a very low calorie diet, but normally you will need some kind of exercise in addition to the diet to lose or maintain a healthy weight. Remember that the Lap band is a tool and you have to learn how to use it – this includes the change in the bad old habits.

I was expecting not to be dieting with the Lap Band Surgery.  The Lap Band procedure is a restrictive aid for treating excess weight and needs full cooperation from the patients in order to work as desired. Even in patients with a big fill, there are calories that will pass through easily, like ice cream or chocolates, and you can gain weight if you choose too many high-calorie foods. The key is: Follow a healthy, well-balanced, low-calorie food intake and also get active – do some kind of exercise to boost your health.

The Lap Band shows me when I am over eating and that is why I vomit all the time: History of vomiting is frequently found in patients that have to be de-banded because of Lap Band Erosion or Slippage. You have to learn to be satisfied before vomiting. If you are someone that vomits frequently, you may have developed a bad habit of over eating, not chewing well or eating too fast - and at some point you will end up hurting your stomach.

I don’t need fluoroscopy for a Lap Band fill: I recommend a fluoroscopic check-up done at least once a year.  Fluoroscopy helps us to detect early complications such as anatomical changes in your stomach and esophagus, and also the functional status of the Lap Band.

My friend has a very good fill with 3 cc and I do not: Stomachs differ in size from person to person, and everyone reacts differently to the Lap Band. You can’t compare yourself with anyone. That was Inamed’s big mistake: the Lap Band was made too short to fit all the patients’ stomachs, assuming that they were equal in size. This caused some patients to have complications such as disphagia (difficulty swallowing) after having the Lap Band for several months.

Support Groups and Message Boards are a waste of time: It is critical for the patients to have a supportive group if they truly want to succeed. I encourage all my Lap Band patients to join our Lap Band Message Boards where they can feel comfortable exchanging and sharing experiences in a friendly environment.

ArturoRodriguez, MD

md@thebariatric.com
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I'm Fat! Please Help Me!

SAN FRANCISCO (AP) -- A morbidly obese California man whose tearful, videotaped plea for help became a YouTube sensation may be getting the support he wanted.

The "Dr. Phil" show reached out to Livermore resident Robert Gibbs, 23, after he posted his three-minute video last week.

Gibbs mentioned the program in his clip, which has been viewed more than a million times and inspired more than four dozen recorded responses from viewers offering diet tips and encouragement.

A crew from the "Dr. Phil" show was scheduled to come to his house and film him on Wednesday, Gibbs told The Associated Press.

On the YouTube video, which he made the day before his birthday last Friday, Gibbs did not specify what kind of help he needed - just that he hoped someone knowledgeable about weight loss would see it and get in touch with him.

He also said he feared he would not live long enough to see his nephew and niece grow up or to have a family of his own. He estimated his weight to be between 600 and 700 pounds,

"I'm making this video because I don't know what else to do," he said on the video. "For everyone who is just going to make fun of me I really don't care. It doesn't matter. This is my last chance, my last hope, one of them at least."

Gibbs declined to be interviewed by the AP because he said he had an exclusivity agreement with "Dr. Phil."

Along with suffering from diabetes, Gibbs has sores all over his body and cannot stand for more than a few minutes at a time, KCBS-TV said. He spends his days watching television.

Read more: http://www.wptv.com/dpp/news/health/robert-gibbs-on-youtube-obese-man-asks-for-help-and-dr-phil-show-responds#ixzz1oRMyC7MK

http://guide2herbalremedies.com

ArturoRodriguez, MD

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Fast food shorten our lifespan

We all know a lot about the dangers and risks connected with eating in fast food restaurants. However, those harmful effects of consuming packed with calories and trans fats burgers and fries do not stop many of us from opening the doors of McDonald’s or Burger King restaurants again and again. At that, scientists do not stop adding new items to the list of dangerous effects of eating in those places. Here’s one more of those.

According to the findings of a research, carried out by a group of scientists at the Department of Medicine, Infection and Immunity at the Harvard School of Dental Medicine, fast foods speed up aging processes in the body and shorten our lifespan. This property is attributed to phosphates which play a role of flavor enhancers and preservatives in many today’s fast food restaurants. The researches found out that these elements and their compounds have sheer toxic effects on human body, especially in cases when fast foods are consumed on a regular basis.

The experiments with mice showed that those who are infected with high toxic levels of phosphates lived up to 25% longer. That is why the scientists recommend avoiding consuming meals enriched with phosphates. When consumed in small amounts, those elements can be removed from the body successfully, but greater amounts of phosphates lead to their being collected in the body, causing premature aging and possible death. Watch what you eat, my friends, and live a long and happy life!

http://guide2herbalremedies.com

ArturoRodriguez, MD

md@thebariatric.com
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One must eat to live...

ArturoRodriguez, MD

md@thebariatric.com
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966 calorie 'horrendous' burger

Healthy-food campaigners have criticised Burger King's newest snack which packs in an astonishing 966 calories.

The new Smoked Bacon and Cheddar Double Angus burger is the biggest and most fattening on the high street and has twice as many calories as a Big Mac from McDonald's.

The monster sandwich - which costs £5.29 and has a fat content of 58g - has left healthy eating crusaders furious.

Sue Baic, from the British Dietetic Association said: 'Of course foods like burgers can play a role in a balanced diet but this sort of massive portion size in a high fat and energy dense food  is really making it far too easy for us to overeat.

'The values given here don't even include the chips and shake or fizzy drink which many people will order with it. If you add a large fries and large coke to that you get almost 1600 calories in the one meal.'

It comes as the Health Secretary Andrew Lansley hands over £2bn to local cancels to tackle public health issues like obesity. Currently a quarter of adults are considered obese in the UK as are one in six children.

Obesity can cause a number of health problems including type 2 diabetes and heart disease. An obese person aged over 40 can expect to cut their life expectancy by seven years.

A spokesman for Burger King said they provided calorie information on their main menu boards and it was up to customers to make 'informed choices.'

They pointed out that McDonald's also sells a Big Tasty with Bacon, which has 890calories and 55g of fat.

They added: 'We also have lower calorie options on our menu including the sweet chili chicken wrap at 296 calories and our hamburger at 260 calories and 4g of fat.'

dailymail.co.uk

ArturoRodriguez, MD

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Calories

Information provided by: www.Weightloss.org

ArturoRodriguez, MD

md@thebariatric.com
http://www.thebariatric.com
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Phone: 011-52-81-8378-3177 Twitter: @bandagastrica
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Is Georgia's Anti-Obesity Campaign a form of bullying?

The Georgia anti-childhood obesity campaign featuring overweight children has been called shocking and sparked heated debate across the country. Now it has attracted the attention of the National Eating Disorder Association (NEDA), who has equated the advertisements to bullying.

“Every day we hear about the terrible rise in bullying within our schools, yet this ad campaign could actually promote and give permission to such behaviors among kids,” Lynn Grefe, president and CEO of NEDA, said in a press release. “Sadly, these ads will be successful in shaming children with weight problems and their parents, but will do nothing to promote and educate about wellness and emotional well-being. Shame on Children’s Healthcare of Atlanta … not shame on the local kids.”

Grefe also calls for an end to the campaign: “Responsibility starts with them pulling the ads.”

The Strong4Life campaign, sponsored by Children’s Healthcare of Atlanta, feature black-and-white images of overweight and obese children along with the tagline, “Stop sugarcoating it, Georgia.” In one of the commercials, an overweight teen asks his mother, “Mom, why am I fat?”

The campaign has inspired debate since its launch in September. Some have said the campaign could increase social stigma about weight, while others have said the campaign only highlights the problem without providing a solution.

“This is the shock-and-awe strategy. Overweight kids don’t think they’re not overweight. You’re not telling them anything they didn’t know,” Kerri Boutelle, an associate professor of psychiatry and pediatrics at the University of California, San Diego School of Medicine, who has researched how to curb children’s overeating, told Time, adding that the campaign is “very aggressive.”

Organizers of the campaign, however, are sticking by their plan. “We felt like we needed a very arresting, abrupt campaign that said: ‘Hey, Georgia! Wake up. This is a problem,’” Linda Matzigkeit, a senior vice president at Children’s Healthcare, who leads the system’s wellness projects, told The Atlanta Journal Constitution.

Martzigeit says there are no plans to pull the ads. In fact, Strong4Life is preparing to launch the next phase of its campaign — and critics of the first phase may not be as enthused about it either. “The whole goal of this is to get the discussion going,” she told the AJC. “I love that it sparks dialogue, and a great dialogue has two sides.”
What Everyday Health Readers Are Saying

Experts aren’t the only ones weighing in on the controversial campaign. Everyday Health readers left passionate comments — some supportive; others critical.

“These ads are fantastic. The people involved, kids and adults, should be thanked, applauded, and given all the support they need to become healthier,” an anonymous reader wrote. “I live in GA and sadly this message is right on target. We must get the childhood (and adult) obesity issue under control. My eight-year-old daughter has several friends who are obese. It breaks my heart.”

Others argued that the tactic of the ads may not get the desired effect. “I have been heavy most of my life and the more someone told you that you were fat the less you felt about yourself and the tendency to make yourself feel better you went to find some comfort food and usually it was not veggies,” wrote Lynda. “Telling anyone they are fat just makes it worse."

Many also commented that the message isn’t only limited to Georgia. The anti-obesity campaign is something that all states should take note of. “Hurtful? The rest of ‘middle’ America needs the same message, right in the ‘gut.’ Pun intended,” Ana Angel wrote.

What do you think of the ads? Are they helpful or hurtful? Tell us in the comments section below.

everydayhealth.com

ArturoRodriguez, MD

md@thebariatric.com
http://www.thebariatric.com
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Phone: 011-52-81-8378-3177

Calories

 

ArturoRodriguez, MD

md@thebariatric.com
http://www.thebariatric.com
http://www.bandstersforum.com
Phone: 011-52-81-8378-3177

Weight Loss: Mission Not Impossible

So it's just a few days into the new year and there's a good chance you've already broken your diet and also a good chance that you've concluded you will always break diets and that, despite all you know about the health risks of excess weight, despite the fact that you don't like the way you look and feel, you will never lose weight. And if you read the New York Times Magazine last Sunday, the cover article may have dashed the last shred of hope you had about this subject: it details research about how our brains and bodies conspire to hold on to every ounce we try to lose. Especially discouraging, Tara Parker-Pope, the author of the article and the Times' health columnist, a woman who knows more about nutrition and exercise than just about anybody, acknowledges that she is 60 lbs overweight and unable to lose it.

My practice certainly echoes the statistics Parker-Pope quotes in her article. Like the average American, many of my patients are slightly overweight in their 20s and 30s, gain weight throughout middle age (women, particularly at menopause), and re-gain any weight they manage to lose.

But, I do have several patients who have achieved lasting weight loss:

N, a man in his 40s, lost 50 lbs four years ago by running and cutting back on junk food.

M, a woman in her 70s, lost 50 lbs decades ago with Weight Watchers and now serves as a group leader in that program.

S, a woman in her 20s, has maintained her 40 lb weight loss by keeping track of her diet through dailyburn.com, learning how to cook healthy meals for herself, and a regular yoga and gym routine.

K, a woman in her 50s, lost 35 lbs seven years ago when she got the flu, stopped eating for a few days, and then, once she recovered, reflected on how much she normally overate. She also took up a new sport, SCUBA diving, that requires her to be fit.

C, a man in his 50s, lost 40 lbs eight years ago by walking miles every week and bringing lunch to work instead of eating take out.

A, a woman in her 50s, lost over 100 lbs with gastric bypass surgery. She now goes to the gym regularly and has drastically altered her diet.

And I could go on.

Doctors who focus on individual cases rather than statistics are sometimes accused of practicing "anecdotal medicine," ignoring the realities that studies of large populations reveal. But, in the matter of weight loss, I think individual cases are instructive. And what do they tell us? Patients like those I've mentioned, and others I've seen who've lost weight successfully, are similar to those enrolled in the National Weight Control Registry, a project involving people who have lost at least 30 lbs and kept it off for a year or more: they've used different methods to lose weight--some have followed structured diets, some not--but they have, I think, three important things in common:

They pay attention. Whether they are keeping food journals, weighing themselves every day, or simply planning meals, their weight loss goals are never far from their minds...ever.

They've found a reason to lose weight that is truly meaningful to them. Whether it's a new sport, a new grandchild, a health scare, or--most powerful--how much better they feel being thinner, they stay mindful of why they wanted to lose weight.

They take the long view. They lose weight slowly, roll with the ups and downs, steer clear of rigid goals and deadlines. They've signed up for a permanent change.

In a postscript Q&A after her Times Magazine article, Tara Parker-Pope said that the research she did into the grim prospects for weight loss success may have, ironically, given her efforts a boost in that she will, knowing more about the science of obesity, be less hard on herself.

I'm all for it. Absolutely, be less hard on yourself. Self-punishment only fuels overeating.

But know that there are exceptions to the statistics, and aim to be one of them.

Dr. Suzanne Koven
http://www.boston.com

ArturoRodriguez, MD

md@thebariatric.com
http://www.thebariatric.com
http://www.bandstersforum.com
Phone: 011-52-81-8378-3177

Frustrated purpose

 

ArturoRodriguez, MD

md@thebariatric.com
http://www.thebariatric.com
http://www.bandstersforum.com
Phone: 011-52-81-8378-3177