What Can We Learn From Bariatrics?
Last week, I had a chance to listen to a talk by the director of a Bariatrics clinic. Bariatrics is the branch of medicine that deals with all the aspects of obesity. Unless you live in a closet, you probably know that obesity has become a major problem in the United States, and around the world. In May, Gallup.com listed the obesity rate in America to be 27.7%, the highest since they began tracking obesity in 2008. There has been a 28% increase in obesity in adults worldwide, and 47% increase in children according to this article in Science Daily. Along with obesity, come a whole host of health issues which include cardiovascular disease, type 2 diabetes, and metabolic syndrome to name a few. The health care costs of obesity were estimated to add $190 billion to national health care costs as written in Forbes in 2012. Here’s how the Bariatrics program works.
Ultimately, the Bariatrics solution involves surgery, but there are several steps a patient goes through before it ever reaches that point. The patient must consult with their personal physician over a 6 month time period, with monthly check-ins, to see if they can lose weight through a combination of diet and exercise. This is a requirement by the insurance company. They do not want to pay for an expensive procedure unless all other options have been exhausted. If the patient is unsuccessful in their efforts, the process will move along to surgery. A psychological evaluation is also a requirement in combination with meeting a nutrition counselor. As far as surgery goes, there are three different options, the gastric band, the sleeve gastrectomy, and gastric bypass. According to the director, the band has lost favor over recent years and the program finds better results with the other two surgeries. The sleeve gastrectomy appears to be the surgery they recommend the most. It involves the partial removal of the stomach, leaving only a small, banana shaped stomach. The patient will feel full in a much shorter time, thus limiting the amount of food they consume. In Gastric Bypass, an egg shaped portion of the stomach is attached to the middle section of the small intestine, bypassing the rest of the stomach and the top of the small intestine. This limits the amount of food a patient can eat and absorb. The Gastric Band is placed on the upper portion of the stomach, limiting the amount of food a person can ingest. It is adjusted by injecting saline through a tube that is placed just under the patient’s skin. What do the results of these surgeries have in common? Forced calorie restriction! The following recommendations for nutrition and exercise are what I found most interesting.
They have patients follow a low carbohydrate/moderate protein diet with a good portion of healthy fats. No grains are allowed on the diet because they tend to be sticky and swell in the esophagus and stomach. This can counteract the shrinking of the stomach by expanding it. Patients are also advised to avoid crackers, chips, cookies, fruit juice, and other sugary drinks like soda. These foods and beverages all move quickly through the digestive system, negating the calorie restrictive effects of the surgery. Chronically high insulin levels caused by these foods will instigate fat storage and the patient will not have successful weight loss. Overeating will stretch the stomach and esophagus, also causing the procedure to fail. Apparently they will not perform the surgery on those who follow a vegan diet because they feel they won’t be able to get enough protein. They want the patient to at least be able to eat eggs and dairy for their protein sources.
Strength training is highly encouraged. The director recommended placing an emphasis on the eccentric (negative) phase of each lift. According to him, this will create a beneficial hormonal effect. He didn’t go into further details and I have no knowledge of this hormonal effect. I will have to research this and see if I can find anything. Ultimately, it’s just important to be strength training and building muscle, instead of losing it during the weight loss phase. Cardiovascular exercise in the form of easy walking is recommended for the first month after surgery while the patient heals. They insist that patients use cardio interval training once they are feeling better, for effective weight loss, in less time. He says there is no need for long, drawn out cardio sessions.
As I mentioned earlier in this post, a psych evaluation must be done before surgery is considered. A major concern after surgery is something called “cross addiction”, which is the replacement of one addiction with another. If someone is addicted to food, they may replace that addiction with drugs or gambling. The mental aspect of overeating, emotional eating, and poor nutrition choices must be addressed for ultimate success. The clinic has a support group that they like to have patients start attending before they ever have surgery.
Personally, I believe surgeries should be avoided at all costs. I have had several surgeries and there is always the possibility of complications when you go under the knife. These surgeries seem to be very extreme to me, but then again, I am not facing life threatening health conditions related to obesity. I know that sometimes, it is unavoidable, and extreme actions must be taken. But what did we learn here? Weight loss success in the medical environment is achieved with a low carbohydrate/moderate protein/moderate to high fat diet, strength training, cardio interval training, counseling, and calorie restriction. These are the experts of weight loss when obesity has become life threatening, and they talk about principles I have mentioned in some of my past blogs. Just maybe if you follow these principles the majority of the time, you too can have weight loss success, and spare yourself from seeing the inside of an operating room.