The discussion on intuitive eating continues this month.  Just to reiterate, intuitive eating can be defined as “an approach that teaches you how to create a healthy relationship with your food, mind and body.” Hopefully some of the information you have received during the last two months is beginning to change how you look and feel about eating. This newsletter will provide the last three principles pertaining to the practices of intuitive eating, I encourage anybody who would like more information on this topic to check out the website www.intuitiveeating.com. It will give more in-depth information to assist each one of us in finding our own level of intuitive eating and the balance between dieting and healthy living. Respect your body. Accept your genetic blueprint, there are some things that each of us can do to help promote health and weight control, but at the end of the day you have to be happy with your body and the gifts you have been given. Mostly, respect your body so that you can feel better about who you are and who you plan to become. Exercise – feel the difference. Forget the monotony. If regularly scheduled exercise is difficult, try to focus on becoming more active all throughout the day and how your body feels during activity.  If you focus on how you feel, such as energized & healthy, it can keep you more motivated than the number of calories burned. Honor your health. Remember that you have to find a balance between what your body needs and what your taste buds want. You don’t have to have a perfect diet to be healthy. Focus more on what you eat consistently rather than at one snack or meal time. Progress, not perfection, is what we’re looking for!

The discussion on intuitive eating continues this month. Just to reiterate, intuitive eating can be defined as “an approach that teaches you how to create a healthy relationship with your food, mind and body.” It is incredibly important for you to begin to trust yourself and your body to make the right choices for you when it comes to health and food. Your health care team can provide advice, but it is up to you to decide exactly what is going to work for you for long-term weight maintenance. Here are some further principles to getting you back on track with intuitive eating:

Respect your fullness. Pay attention to your body during meals, it will give you internal cues that will help you determine when you are satisfied. Sometimes it’s helpful to take a break during your meals to see exactly how full you’re feeling and if the food is still tasting as good as it was when you first started. Observe, Observe, Observe!

Discover the satisfaction factor. Other cultures do a good job of promoting pleasure in their pursuit of healthy living. As Americans often tend to overlook the power and pleasure of eating to truly nourish our bodies. Providing your body with what it wants is a powerful force in helping you feel satisfied with less; finding the balance between giving your body what it wants and what it needs takes a little bit of thought but is very rewarding.

Honor your feelings without using food.  Find ways to comfort, nurture, distract and resolve your emotions. We all experience different emotions throughout life; we all have different triggers and different ways of dealing with the stress. The bottom line is that food is not a cure for emotional stressors, it may provide short-term comfort but eventually you will be stuck dealing with feelings of guilt from overeating on top of the original emotions that led you there in the first place.

This discussion will continue next month. You can find more information about this topic as well as find books/CDs if you are interested at www.intuitiveeating.com.

Join us the 1st Wednesday of every month at our new gastric banding support group.

As part of our commitment to patient care and good clinical outcomes, we now host a gastric banding support group. Although, prospective patients are welcome to attend and observe, patient support groups are primarily geared for patients who have already had gastric band surgery. Designed to promote the well-being of patients, the meetings provide a forum to share experiences, have questions answered, and gain encouragement from their peers.

In addition to our monthly support groups, we hold informational seminars that are designed to give prospective patients the opportunity to learn more about gastric banding, speak with one of our physicians and a patient who had the procedure.

JOIN US!

1st Wednesday of every month
6:45-8:00 PM
Olympian Surgical Suites
1002 W. Interstate Drive
Champaign, IL 61822

Contact us for more information at 866-622-9222 or
e-mail us at info@illinoisbariatriccenter.com

This month will be the first in a three-month series on the principles of intuitive eating.  Intuitive eating can be defined as “an approach that teaches you how to create a healthy relationship with your food, mind and body.” Children are born with a keen sense of intuitive eating; as we grow up we are de-sensitized to our internal cues for hunger and   eating becomes more driven by external cues including money, emotions and weight.  Here are some of the principles to getting you back on track with intuitive eating:

1. Reject the diet mentality. Throw out the books and ads that offer you a false hope of losing weight quickly. It is important for you to realize that sustainable weight loss is lost slowly and is achieved & maintained by making permanent life style changes; including incorporating intuitive eating patterns into your life.
2. Honor your hunger. When you are truly physically hungry, you should provide your body with fuel. If you let yourself get overly hungry, you are setting the stage for overeating (a primal survival technique) and poor food choices. At first, it may be difficult for you to decipher between physical and mental or emotional hunger, but this is a skill that can be learned with close monitoring and regular meal patterns.
3. Make peace with food. Make a truce with food! If you tell yourself that you can or can’t have a certain food, that can often lead to intense cravings and increase the likelihood for bingeing. Find a balance between providing your body with the nutrients it needs and still enjoying your foods.
4. Challenge the food police.  It is important that you recognize there are no “good” or “bad” foods. The Food Police are rules that you may have learned during previous diet attempts; they often   provoke negative thoughts and feelings of guilt.  Instead, focus on having a positive mental dialect with yourself.  It is essential that you take a look at the “whole picture” when deciding where there are areas for improvement when it comes to your eating patterns.

This discussion will continue next month. You can find more information about this topic as well as find books/CDs if you are interested at www.intuitiveeating.com.

Get (& Keep) Moving!

Sometimes when we are so focused on our food intake or diets, it can be easy to lose sight of the other aspects of healthy lifestyle changes such as exercise and activity. These areas should never be neglected as physical activity is actually the best indicator of success with weight maintenance.

Exercise has many beneficial properties, including:

• Improves self-esteem & feelings of well-being
• Increases fitness level & helps manage weight
• Helps build/maintain bones/muscles/joints
• Enhances flexibility & muscle strength
• Lowers risk of heart disease, colon cancer and Type 2 Diabetes

In terms of weight management, most people can easily burn 200-300 calories each day through physical activity which would promote an extra pound of loss every two weeks. When considering this on top of what you may already be limiting in terms of calorie intake you could reach up to one-two pounds per week of loss.

When it comes to exercise, there are three main types that are beneficial to incorporate into your schedule, these include:

• Aerobics- speeds heart rate & breathing, improves heart and lung fitness; examples- walking, biking, swimming
• Resistance/Weight Bearing- helps build and maintain bones and muscles; examples- weight lifting, Pilates
• Balance & Stretching- enhances flexibility and stability, reduces risks for injuries; examples- stretching, yoga, dancing

Prior to beginning a new workout regimen, it’s important to discuss it with your physician. It’s equally important to remember to start slowly! This will reduce your risk for developing muscle soreness and injuries. It is important to make sure you are doing at least 10 minutes of activity at a time- any time frame smaller than that will not reap the same benefits. The general recommendation is for 30 minutes of moderate activity each day, but that can be broken down in to 10 minute increments throughout the day. Choose activities that you enjoy and can do regularly & keep it interesting by trying something different on alternate days!

May 2, 2006

Adjustable gastric banding is much more effective long-term than a very low-calorie diet for people who are about 50 pounds overweight, a study shows.

Medical guidelines support this surgical procedure — which puts a band around the top of stomach to create a feeling of fullness — in patients who are extremely obese, about 100 or more pounds over a healthy weight, or those who are almost as overweight and have serious medical conditions, such as type 2 diabetes.

Researchers at Monash University Medical School in Melbourne, Australia, recruited 80 patients who were on average 52 pounds over a healthy weight. Half had the laparoscopic adjustable gastric band surgery.

The other half followed a medical program that included a variety of strategies such as a very-low-calorie diet (500 calories a day) with liquid meal replacements, prescription weight-loss medication and behavioral therapies.

Findings in today’s Annals of Internal Medicine:

• After six months, both the surgery patients and the low-calorie dieters lost an average of 14% of their starting weight.
• After two years, the gastric band patients lost 22% of their starting weight. That was about 87% of their excess weight, or roughly 45 pounds. They also showed marked improvement in their health and quality of life.
• At the end of two years, the dieters had regained much of their lost weight but were still 5.5% below their starting weight. They had lost 22% of their excess weight, or about 12 pounds.

Researchers are still analyzing the weight-loss data. “I’m very happy that the gastric band patients are continuing to maintain their weight loss,” says lead author Paul O’Brien, director of the university’s Centre for Obesity Research and Education. Since the study, he received grants from INAMED Health, maker of the LAP-BAND® System.

In this study, the surgery was as safe as the diet program, but O’Brien notes the procedure does carry risks, and some may need follow-up procedures, such as readjusting the band position. The surgery costs $14,000 to $18,000 in the USA, he says.
Insurance companies vary widely in coverage of gastric banding or gastric bypass, a more complex surgery that creates a much smaller stomach and rearranges the small intestine. Average cost: $26,000. Under certain conditions, Medicare covers both surgeries.

Many surgeons in the USA use gastric bypass because bypass patients lose more weight overall and lose it faster, says Neil Hutcher, president of the American Society for Bariatric Surgery and a surgeon in Richmond, Va.

Thomas Wadden, an obesity expert at the University of Pennsylvania School of Medicine in Philadelphia, says gastric banding “is a very effective procedure, but it’s not a rational, cost-effective solution to the epidemic of obesity.”

“Because we have limited health-care dollars, we have to decide how best to invest them. Are we going to provide bariatric surgery for a relatively small number of people or instead invest in the prevention of obesity so our children hopefully won’t need this surgery?”

Copyright © 2006 USA Today. All rights reserved. Republished with permission.

As more people abandon New Year’s resolutions to lose weight and turn to obesity surgery, doctors are debating which type is safest and best.

And researchers are uncovering some surprising trends.

The most common method in the United States – gastric bypass, or stomach-stapling surgery – may be riskier than once thought. Yet surgeons still favor it for people who need to lose weight fast because of heart damage or other serious problems.

A gentler approach favored in Europe and Australia – an adjustable stomach band – can give long-term results that are almost as good and with far fewer risks. It may be the best option for children or women contemplating pregnancy, and is reversible if problems develop.

A radical operation – cutting away part of the stomach and rerouting the intestines – is increasingly being recommended for severely obese people. It gives maximum weight loss but also is the riskiest solution.

A large U.S. government study just got under way to compare all three options.

But regardless of which method is used, studies show an inescapable reality: No surgery gives lasting results unless people also change eating and exercising habits.

“The body just has many ways of compensating, even after something as drastic as surgery,” said Dr. Louis Aronne, director of the weight loss program at Weill-Cornell Medical College.

He is president of the Obesity Society, the largest group of specialists in bariatrics, as this field is known. The group’s recent annual conference in Vancouver featured many studies on surgery’s long-term effects.

Obesity is a problem worldwide. About 31 percent of American adults – 61 million people – are considered obese, with a body-mass index of 30 or more. That’s based on height and weight. Someone 5- foot-4 is obese at 175 pounds; 222 does it for a 6-footer.

Federal guidelines say surgery shouldn’t be considered unless someone has tried conventional ways to shed pounds and is at least 100 pounds over ideal weight, or has a BMI over 40, or a BMI over 35 plus a weight-related medical problem like diabetes or high blood pressure.

More people are meeting those conditions. A decade ago, less than 10,000 such surgeries were done in the United States. That ballooned to 70,000 in 2002 and more than 170,000 in 2005, says the American Society for Bariatric Surgery.

Doctors disagree over which is better: the most popular method, Roux-en-Y gastric bypass, or the adjustable band, which is rapidly gaining fans. Either can be done through a big incision, or laparoscopically with tiny instruments passed through small cuts in the abdomen.

In gastric bypass, a small pouch is stapled off from the rest of the stomach and connected to the small intestine. People eat less because the pouch holds little food, and they absorb fewer calories because much of the intestine is bypassed. They must take protein and vitamin supplements to prevent deficiencies.

The adjustable band has been available in the U.S. only since 2001 but far longer in Europe and Australia where it is dominant. It accounted for 17 percent of U.S. obesity procedures in 2005.

A ring is placed over the top of the stomach and inflated with saline to tighten it and restrict how much food can enter and pass through the stomach.

Deaths from the procedure are only 0.1 percent compared to about 2 percent for gastric bypass. One recent study of Medicare patients found deaths a year after gastric bypass as high as 3 to 5 percent.

The band’s reversibility makes it a better choice for children, some doctors say.

“It’s becoming more well-known and more accepted. Patients like it because it’s less invasive. It’s an easier surgical procedure. It’s safer,” said Georgeann Mallory, executive director of the bariatric society.

“To me it is a very straightforward decision,” said Dr. Paul O’Brien, director of the Centre for Obesity Research and Education at Monash University in Melbourne, Australia. “I would strongly recommend that the consumer consider the safest effective procedure first,” which is the band, he said.

American doctors have preferred bypass operations because they produce faster, greater weight loss. But new research by O’Brien and others calls that into question.

Combining results on 23,638 patients in 43 published studies, they found that bypasses beat bands for the first three years but were comparable after seven years, with excess weight loss of 55 percent for bypass and 51 percent for bands.

That impressed Dr. Edward Livingston, chief of gastrointestinal surgery at the University of Texas Southwestern Medical Center and chief of bariatric surgery for the Department of Veteran’s Affairs national system.

“I really was not enthusiastic about bands until I came to Dallas from Los Angeles and saw the results from the group that I joined, which where quite good,” he confessed. “What you can accomplish in a year with a gastric bypass you can accomplish in five years with a laparoscopic band.”

Results would improve if Americans copied the Australians and included in the price of the band any future adjustments, Livingston said.

“A key to the success of banding procedures is the followup and working with a patient on their compliance,” he said. “When they come in and they’ve sort of fallen off the wagon, you adjust the band. It really has an amazing effect.”

Bands also appear safer for women attempting pregnancy. Several years ago in Massachusetts, a woman and her 8-month-old fetus died of complications 18 months after gastric bypass surgery. Other pregnancy-related deaths have been reported.

In contrast, another study O’Brien and colleagues presented at the obesity meeting found that pregnancy outcomes for women with stomach bands were comparable to normal-weight women, and better than for obese women without bands.

Dr. Mitchell Roslin, chief of obesity surgery at Lenox Hill Hospital in New York City, did a band operation in October for Long Islander Donna Dotzler, who weighed 279 pounds, but wants to do a more drastic surgery for her husband.

“I gave up on New Year’s resolutions maybe five years ago,” said Jim Dotzler, who weighs 479 pounds. “I’m a smart guy. If this were a matter of willpower, I’d have taken care of this a long time ago.”

The operation Roslin has advised for him is BPD, which stands for biliopancreatic diversion, with or without a second procedure called a duodenal switch. Studies show it can cause loss of up to 80 percent of excess body weight for at least as long as 10 years afterward.

Surgeons remove three-fourths of the stomach to leave a sleeve- or banana-shaped organ that is connected to the small intestine, bypassing more of it than a standard gastric bypass does. It can be done in two operations a year apart to reduce its severity and the chances of death, which can be as high as 5 percent.

The “switch” preserves a valve that controls release of food into the intestines from the stomach. These operations account for nearly 5 percent of U.S. obesity surgeries and are growing.

On the horizon are other approaches, like vagus nerve stimulation, to control impulses to eat, and new drugs like rimonabant, which blocks a pleasure center in the brain that makes people want to munch.

“I see the future as combined therapy,” with surgery, medication and other approaches used simultaneously, said Aronne, the obesity society president. “Time will tell what works out best.”
Copyright © Associated Press Jan 1, 2006. Reproduced with permission of the copyright owner. Further reproduction or distribution is prohibited without permission.