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

md@thebariatric.com
http://www.thebariatric.com
http://www.bandstersforum.com
Phone: 011-52-81-8378-3177
Twitter: @bandagastrica
Facebook: http://www.facebook.com/banda.gastrica

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.

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ArturoRodriguez, MD

md@thebariatric.com
http://www.thebariatric.com
http://www.bandstersforum.com
Phone: 011-52-81-8378-3177
Twitter: @bandagastrica
Facebook: http://www.facebook.com/banda.gastrica

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

ArturoRodriguez, MD

md@thebariatric.com
http://www.thebariatric.com
http://www.bandstersforum.com
Phone: 011-52-81-8378-3177
Twitter: @bandagastrica
Facebook: http://www.facebook.com/banda.gastrica

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

md@thebariatric.com
http://www.thebariatric.com
http://www.bandstersforum.com
Phone: 011-52-81-8378-3177
Twitter: @bandagastrica
Facebook: http://www.facebook.com/banda.gastrica