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There’s surprising new demand for a type of medical specialty that never existed before – LifeZette
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Americas obesity epidemic has created a new specialization in medicine the primary care physician with obesity specialization. But will it deliver on promises to improve health care for the overweight patient?
Research shows that highly restrictive dieting hasnt solved obesity; over 95 percent of dieters regain the lost weight. Long-term weight loss requires a comprehensive lifestyle change that patients may not be willing or able to make, or they might simply need the guidance of a primary care physician who has experience in supporting the overweight patient in every aspect of hishealth.
Related: The Stress Fighters That Can Save Your Life
The American Medical Association reclassified obesity as a disease in 2013, paving the way for more attention to obesity. The need for a PCP-obesity specialist emerged from the lack of attention general primary care physicians give the condition.
One-third of Americans are obese and 60 percent are overweight. Of the obese population, only one-third are told they are obese by general PCPs, who often spend less than 10 minutes with their patients. Annual health care costs for obese patients is $190 billion.
Overweight patients have so many complications with multiple health and organ systems, Dr. Dyan Hes, medical director of Gramercy Pediatrics, told LifeZette. There is no system that obesity does not effect. Obesity doctors are trained to see the nuances or small changes, sometimes before other doctors see it or it becomes a full-blown problem.
Patients have long contended their doctors either ignore their weight or blame every situation on it.
Obesity is linked to heart disease, diabetes, high blood pressure, high cholesterol, cancer, stroke, breathing and sleeping issues, skin problems, arthritis, andorgan damage to the gallbladder, kidneys, liver and colon.
Proponents argue the emergence of the PCP-obesity specialist will destigmatize obesity and allow doctors to educate patients and intervene earlier, especially with children who are overweight.
Critics who believe obesity is the result of choice and poor lifestyle say the reclassification of obesity as a disease will give patients an excuse and allow them to eschew responsibility for their behavior. They also argue it drives greater health care costs because it promotes expensive surgeries and pharmaceutical drugs aimed at obesity.
Obesity specialist Dr. Adrienne Youdim, an associate clinical professor of medicine at UCLA David Geffen School of Medicine, disagrees.
Obesity drives up health care costs, she told LifeZette. Patients have more complications and medication use from their illnesses. Cancer patients who are obese are more likely to die from the cancer. Also hospitalized patients tend to have prolonged hospital stays.
Youdim also notesthatwhen patients do lose weight, their needs change rapidly. Medication dosage, insulin use, and responses to treatments need to be monitored more aggressively than the patient maintaining a steady weight.
Patients have long contended their doctors go to two extremes in working with them, either ignoring their weight completely or blaming every situation on their weight.
Related: How Unfit Kids Can Compromise Our Nation
Jane Eiden (not her real name), of Iowa City, Iowa, believes the PCP-obesity change is positive. She manages diabetes, high blood pressure and high cholesterol and says she receives highly contradictory information from doctor to doctor. She also spends a great deal of time telling one doctor what another recommended.
Im way past worrying about losing weight, she told LifeZette. At age 65, Ive been to nutritionists, counselors, and exercise trainers with no weight loss for more than a few months. Now, I need to focus on keeping these conditions at bay for the best quality of life I can have.
Obesity specialists undergo sensitivity training aimed at helping them establish compassionate relationships with their patients, as well as training in nutrition, exercise science, and behavioral coaching. The American Board of Obesity Medicine certifies physicians as obesity specialists.
"Doctors seem more likely to blame any and all health problems on weight," Cynthia Moeser of Dallas, Texas, told LifeZette. She experienced excruciating neck pain, and a young student doctor suggested it was weight-related. She pointed out her problem wasn't in her knees, which might have been impacted by weight, but he continued to blame her weight.
As to the question of the effectiveness of obesity PCPs, she feels patient choice is a key to acceptance of the new trend. "If I were forced to go to an obesity doctor, it would feel shaming. If it was my choice, it wouldn't be shaming."
Pat Barone is a professional credentialed coach and author of the Own Every Bite! bodycentric re-education program for mindful and intuitive eating.
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There's surprising new demand for a type of medical specialty that never existed before - LifeZette
Long-Term Weight Loss: It Took 10 Years Of Focus For This Woman To Lose 190 Pounds – Huffington Post Canada
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Who: Jennifer Noyes Occupation: Homemaker City: Thunder Bay, Ont. Age: Age 42
By The Numbers: 386.7 pounds at my heaviest. I currently weigh 196.5 pounds for a total weight loss of 190 pounds. I am 5'6".
The Weight Gain: I have been overweight my entire life. I weighed 200 pounds when I was 12 years old. Being teased a lot in school, I tried starving myself or only eating a couple of crackers a day, but the weight kept creeping up.
Final Straw: After hearing a hurtful comment from a family member, I cried for weeks and came to the realization that I wasn't leaving the house for fear of running into people I know. I was unable to walk a few steps without having a hard time breathing. I needed to be there for my children, I needed to be around to watch them grow up. I knew deep down inside that I needed to change.
The Plan of Attack: I decide to rejoin TOPS (Take off Pounds Sensibly), as the weekly weigh-ins and informative meetings helped keep me accountable. My weight loss took 10 years, as I averaged losing roughly 20 pounds a year.
I started to cut back on portion sizes and I made healthier choices when it came to food. I traded in full-fat foods for lower-fat foods but never deprived myself of anything. I just ate in moderation.
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Long-Term Weight Loss: It Took 10 Years Of Focus For This Woman To Lose 190 Pounds - Huffington Post Canada
Controversial weight loss procedure now available – FOX31 Denver
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FOX31 Denver | Controversial weight loss procedure now available FOX31 Denver It allows them to really be successful long term, especially when you have somebody that has a lot of weight to lose, Dr. Sullivan said. Eric Wilcoxon is a patient from Missouri who participated in the clinical trials with Dr. Sullivan, and still ... |
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Controversial weight loss procedure now available - FOX31 Denver
Fasting: Pros and Cons for Weight Loss – Newsmax
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Proponents of intermittent fasting contend that this popular way to lose weight is better than conventional dieting. But this type of diet isn't necessarily best for everyone, a top expert says.
Fasting is currently one of the newest diet fads and, while there are studies showing benefits, there are also potential downsides, Dr. Kent Holtorf tells Newsmax Health.
A recent University of Illinois at Chicago study finds intermittent, or alternate-day fasting, was equal in results to calorie counting when it came to weight loss, along with keeping off the excess pounds.
The study, which followed 100 obese people for a year, found that those who engaged in intermittent fasting lost 6 percent of their body weight, while those who ate a calorie-restricted diet lost 5.3 percent, not a statistically significant difference, the researchers say in JAMA Internal Medicine.
Holtorf is the Los Angeles-based medical director of the Holtorf Medical Group and a founder and director of the nonprofit National Academy of Hypothyroidism. He also has appeared as a medical expert on several TV shows, including The Today Show, Good Morning America, and ABC News.
Here are excerpts from his recent interview with Newsmax Health.
Q: What exactly is intermittent fasting?
A: The idea is to intermittently significantly reduce calories in a strategic way to reduce overall caloric intake instead of eating less per day. One common method is called the 5:2 diet, which involves significant caloric restriction two non-consecutive days per week while eating normally the other five days.
Q: How did this type of diet catch on?
A: Several studies were published showing that severe periodic calorie reduction had been shown to have many benefits including changing gene expression and stimulating cell repair, reducing the risk of Type 2 diabetes, improving cholesterol, lowering the risk of cholesterol levels, reducing heart disease and cancer risk and even extending lifespan.
Q: What do you think of intermittent fasting for weight loss?
A: There is a large amount of research supporting the safety and efficacy of intermittent fasting. If an individual fasts for a designated period of time, weight loss is to be expected as caloric intake has been reduced; however, research finds fasting offers long-term benefits including reduction of inflammation and improvement in mood. For example, a randomized, clinical trial of 71 people who followed intermittent fasting for three months lost an average of 5.7 pounds while the weight of the control group, which didnt alter their eating habits, lost no weight. Those in the fasting group saw a reduction in blood pressure, body fat, and waist size.
Q: What effect does intermittent fasting have on mood?
A: Going without food for 10-16 hours causes the body to release fatty acids known as ketones. According to Mark Mattson, a senior investigator for the National Institute of Aging, who has done extensive investigation on the health benefits of intermittent fasting, ketones have been shown to protect memory and learning function as well as slow disease processes in the brain. Ketones are also shown to boost the bodys formation of particular stress reducing neurotransmitters, such as serotonin and GABA, which helps you stay calm under stress and have fewer cravings.
Q: What are the drawbacks of using this type of diet for weight loss?
A: While it can be a way to jumpstart weight loss and have health benefits, studies also show that it can permanently reduce metabolism (calories burned per day). The metabolism may not go back to normal when normal eating is resumed unless steps are taken to prevent or reverse the drop in metabolism. Thus, fasting or so-called yo-yo dieting can contribute to long-term weight gain, wiping out the short-term health benefits of fasting.
Q: Are there any groups for which this may be a particular problem?
A: This is shown to be more of an issue for women because women's bodies appear to perceive fasting as more of a threat of starvation and respond by lowering metabolism to survive the perceived famine. This is especially true if a woman has any signs of low thyroid, including low body temperature, depression, cold intolerance, PMS, cold extremities or suffers with fatigue.
Q: So is there any one best diet out there for everyone?
A: Studies show that most diets are successful short-term but most suffer from equal long-term failure. But thyroid evaluation and optimization, if low, can increase the likelihood of successful weight loss whether via fasting or other diet plan.
2017 NewsmaxHealth. All rights reserved.
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Fasting: Pros and Cons for Weight Loss - Newsmax
Melissa From ‘My 600-lb Life’ Looks Totally Different Today See Her Weight Loss! – Life & Style Weekly
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Life & Style Weekly | Melissa From 'My 600-lb Life' Looks Totally Different Today See Her Weight Loss! Life & Style Weekly Melissa weighed over 600 pounds on the TLC reality show, and later shocked viewers by losing over 500 pounds following gastric bypass surgery. But, her weight loss journey didn't end with her episode on the reality show, and fans are curious to know ... |
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Melissa From 'My 600-lb Life' Looks Totally Different Today See Her Weight Loss! - Life & Style Weekly
Bariatric surgery has evolved over time – Baltimore Sun
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Obesity is a growing problem in the United States and Americans have increasingly turned to surgery to help them lose weight. Nearly 200,000 people now get bariatric surgery each year. The procedures have improved and evolved over the last decade. Dr. Gustavo E. Bello, a bariatric surgeon for the GBMC Comprehensive Obesity Management Program, discusses the latest in bariatric surgery.
In general, how has bariatric surgery changed in the last decade?
The field of metabolic and bariatric surgery has evolved significantly and continues to do so. Basic science and clinical research, along with new technology, have made weight loss surgery not only a safer strategy to fight obesity, but one that is overwhelmingly better and more efficient than any other. The field continues to expand globally and surgeons now have the ability to complete a much more thorough and specialized training process.
What are the main Bariatric surgeries now performed?
Laparoscopic sleeve gastrectomy and gastric bypass are the most commonly performed weight loss surgeries across the board. Together, they account for more than 90 percent of all bariatric surgical procedures. Laparoscopic sleeve gastrectomy, which sits comfortably in first place, has been around for nearly 14 years. It is a procedure that alters the capacity of the stomach by actually removing around 75 percent of its reservoir and leaving the rest of the anatomy intact. It also reduces the levels of Ghrelin, the so-called "hunger hormone," causing a profound and positive change in the relationship between patients and food. The Roux-en-Y gastric bypass, the second most popular, has been performed for more than 40 years now. It is a well-studied, researched and reliable procedure. It helps patients lose weight and get healthier by reducing the capacity of the stomach, by rearranging the intestinal transit that interferes with the different mechanisms involved with how food gets digested and absorbed and by altering and improving patient's metabolisms. A less used procedure is the the biliopancreatic diversion with duodenal switch, where part of the stomach is removed and the remaining portion is connected to the lower part of the small intestine. Doctors also have cut back on the use of gastric bands, or lap bands, when a surgeon places a band around the upper part of your stomach to create a small pouch to hold food. The band limits the amount of food you can eat by making you feel full after eating small amounts of food
Why is the once popular lap band rarely used anymore?
The adjustable gastric bands that were so popular about a decade ago, have fallen out of favor and are very rapidly fading away. In my opinion, there are actually many reasons why this is happening but the perception that bands are "less invasive" has kept them alive for many years. Compared to other options, a gastric band simply isn't a good and efficient enough procedure to help patients lose weight and get healthier. Also, the majority of patients struggle with poor quality of life and lack of long-term success which has become increasingly notorious lately with the rise and acceptance of sleeve gastrectomy.
Has bariatric surgery become more affordable and are more insurance companies covering it?
No doubt weight loss surgery is now covered widely by virtually every insurance with very few rare and disappointing exceptions. This has given almost every patient affected by obesity access to this great tool and treatment modality. The better understanding of the obesity epidemic and its detrimental effects on overall health have increased awareness and made us more proactive on addressing and treating it. Simplified pathways, better outcomes and shorter hospital stays have significantly lowered the overall cost of surgery and that is not counting all the health care cost savings that come with eliminating obesity.
Who qualifies for bariatric surgery?
For many years now, the overwhelming majority of insurance companies, including Medicare and Medicaid, have provided coverage for weight loss surgery to those patients with a Body Mass Index (BMI) of 35 Kg/m2 or higher and who can demonstrate that they suffer from an obesity-related medical problem, such as hypertension, diabetes, sleep apnea, liver disease, among others. This is often waived if the patient's BMI exceeds 40 Kg/m2.
What are the risks and potential complications of bariatric surgery?
Fortunately, bariatric surgery has become extraordinarily safe with extremely low mortality rates that are now comparable to much more commonly performed operations such as gallbladder removal and hip replacement. Of course it is not completely free of possible complications, including bleeding, infection and the exceedingly uncommon, but troublesome, leakage.
What do people have to do to prepare for bariatric surgery?
As good and as efficient weight loss surgery can be in helping patients lose weight and become healthier, it should not be forgotten that, in the end, it is just a great tool that must be used wisely and decisively by the patient to obtain desired results. Preparing well for this life-changing event is of utmost importance. It includes becoming more knowledgeable about nutrition, getting mentally prepared, committing to adopting new and better habits, and finding creative ways to increase physical activity.
What protocols do patients have to follow after surgery for long-term success?
It has been said that long-term success following weight loss surgery occurs in more than 85 percent of cases. Success on definitively eliminating obesity relies first on being well-prepared ahead of time by better understanding the impact that nutrition has in our overall health and being mentally ready to adopt new lifestyle changes. This allows patients to more easily adhere to any post-surgery guidelines and key principles that are necessary to achieve adequate and sustainable weight loss. This begins with following a postoperative diet for a few weeks to allow stomach healing, to then monitoring protein intake to secure adequate nutrition as well as proper hydration, compliance with vitamin intake and the increase of physical activity, among other lifestyle and behavioral changes.
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Bariatric surgery has evolved over time - Baltimore Sun
Inflatable weight-loss ‘pill’ that shrinks stomach helped patients lose average of 15kg – South China Morning Post
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Weight-loss balloons swallowed rather than surgically inserted in the stomach were shown to be safe and effective in preliminary trials, according to findings unveiled Thursday at a medical conference.
So-called intragastric balloons have been used for decades to help obese patients shed unwanted kilos. Inflated with water, the devices curb hunger and make it easier to diet by inducing a feeling of fullness.
Up to now, however, they could only be implanted in the stomach surgically, a costly procedure requiring general anaesthesia or sedation.
In a small trial led by Roberta Ienca, a researcher in experimental medicine at Sapienza University in Rome, 42 obese patients - 29 men and 13 women - were fitted with balloons that were swallowed in a pill-like form before being inflated with liquid.
A catheter is attached to the balloon, which is folded into a capsule, Ienca explained.
A doctor fills the balloon via the tiny tube, which is then removed via the mouth with a tug. This process takes just a few seconds, she added.
The body-mass index (BMI) of the volunteers varied between 30 and 45. The threshold for obesity is a BMI - ones weight in kilos divided by ones height in centimetres squared - of 30.
The balloons remained in the stomach for 16 weeks, during which time patients were put on a low-carbohydrate, low-calorie diet.
At the end of that time, an internal release valve automatically opens and drains the balloon, which is then excreted.
On average, volunteers shed more than 15kg, which amounted to 31 per cent of excess weight.
No serious side effects were reported.
After the trial, patients were transitioned to a Mediterranean diet, heavy on vegetables and olive oil, and light on protein and starch.
The new technique appears to be a safe and effective weight-loss method, Ienca commented in a statement.
Because the swallowable balloon does not require endoscopy, surgery or anaesthesia, this may make it suitable for a larger population of obese patients not responding to diet or lifestyle treatment.
It could also lead to significant cost savings, she added.
In itself, gastric balloons are not a long-term solution for weight loss, Simon Cork, a researcher in investigative medicine at Imperial College London who was not involved in the study, commented after reviewing the results.
Nevertheless, gastric balloons are still useful for some patients, and the introduction of a device which doesnt require surgery to implant is a positive step forward.
Developed by US-based Allurion Technologies, the system is already marketed in Europe in France, Italy, Spain, Belgium and Greece. It is also available in Saudi Arabia and Kuwait.
The company intends to begin the FDA approval process in the United States soon, Ienca said.
The findings were presented at the European Congress on Obesity in Porto, Portugal, which runs through May 20.
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Inflatable weight-loss 'pill' that shrinks stomach helped patients lose average of 15kg - South China Morning Post
New weight loss therapy offered in Colorado – FOX31 Denver
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FOX31 Denver | New weight loss therapy offered in Colorado FOX31 Denver It does really help people make those behavior changes so that they can have long term weight loss success. Dr. Sullivan said this balloon procedure is different from the liquid filled balloons because there is no surgery or downtime required. There ... |
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New weight loss therapy offered in Colorado - FOX31 Denver
5 Weight-Loss Mistakes You Didn’t Know You Were Making – Women’s Health
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Women's Health | 5 Weight-Loss Mistakes You Didn't Know You Were Making Women's Health But while sticking to a g-free diet might help you shed a few pounds at first, it's not a sustainable choice for keeping the weight off. In the long term, it doesn't really teach you anything about the diet, and, in fact, going gluten-free can put you ... |
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5 Weight-Loss Mistakes You Didn't Know You Were Making - Women's Health
Obesity as a disease – Tribune-Review
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Updated 23 hours ago
Doctors who specialize in weight loss say people need to view obesity as a disease, not as a reflection of lifestyle, to start to slow the spread of the dangerous condition.
Like other diseases, obesity has an agent food that in the right environment strikes genetically susceptible hosts and makes damaging changes to the way their bodies function, according to authors of a World Obesity Federation paper in the latest edition of journal Obesity Reviews.
The American health care system has not fully embraced that view, said Pittsburgh doctors who specialize in weight loss.
It's a major burden on people's health, on the economy and on society, and I don't think we have enough resources to tackle it, said Dr. George Eid, assistant director of Allegheny Health Network's Bariatric and Metabolic Institute.
More than a third of U.S. adults are obese, according to the National Institutes of Health. The mother of all diseases, as Eid calls it, increases risks of heart disease, diabetes, cancer, liver and kidney problems, stroke, mental illness and other deadly diseases.
The characterization of obesity as a disease goes back at least 250 years, to when Scottish physiologist Dr. Malcolm Flemyng said it tended to shorten life by obstructing the free exercise of the animal functions, according to the paper. The American Medical Association recognized it as a disease in 2013 and other organizations followed.
The Centers for Medicare & Medicaid Services eliminated language saying obesity is not a disease in 2004, but hasn't fully recognized it as a disease, according to the paper. Insurance coverage for FDA-approved weight loss medications remains spotty, doctors said.
Once obesity reaches a certain threshold typically a body-mass index of 30 it changes the body in ways that make it extremely difficult for people to return to a healthy weight, said Dr. Vicki March, medical director of the comprehensive weight loss program at Magee-Womens Hospital of UPMC.
Long-term studies have shown that obese people reach a set point weight to which their bodies tend to return gradually over time. At a BMI of 30, which would be about 200 pounds for someone who is 5'8, changes in metabolism and hormone production affect caloric needs, March said. People who lose dozens of pounds by limiting their calories to 1,500 per day might never return to eating 2,000 calories per day without regaining weight, she said.
At BMIs of 25 to 30, people can often reach a healthy weight through diet and exercise, she said.
Weight-loss medications, which are indicated for people with a BMI of 27 or higher, can help people lose up to about 15 percent of their body weight, she said. Those with a BMI above 35 often need surgery, she said.
Lynne Erlich, 72, of Robinson Township, tried every diet that came down the pike after she gained weight in her 50s and 60s following a divorce. Erlich, an administrator of liability for Eat'n Park, said she would lose 10 pounds and the weight would return, over and over.
She had high blood pressure and her knees hurt and she worried she would get diabetes. She asked her doctor about gastric bypass surgery, and underwent the operation five years ago. She lost 83 pounds.
Now she feels full after eating less food, she said. She runs up flights of stairs for exercise. She eats better, having made adjustments to her diet such as replacing mashed potatoes with mashed cauliflower. She participates in UPMC BodyChangers, a group networking program to support weight loss, and keeps her weight around 140 pounds.
I'm a much happier person, Erlich said.
Jim Delman, 62, of Bridgeport, Ohio, had the surgery after being overweight for most of his life. He graduated high school weighing 185 pounds and at his heaviest weighed about 420 pounds, Delman said.
The weight wore his knee down to the point where it would need to be replaced. He saw a need to change, and he and his wife both decided to try surgery. Dr. Eid performed bariatric surgery on him February of last year, he said. He lost 50 pounds before the surgery and since then has dropped his weight to about 172 pounds.
Now he rarely eats bread, choosing salads and vegetables instead. He drinks water instead of soda or beer. He said he went to the gym every day but one in April.
Doctors' discussions with overweight patients often go no further than telling them they need to lose weight, said Dr. Mark Woodburn, a primary care physician with Pittsburgh-based Genesis Medical Associates.
Of the 86 million Americans estimated to be obese, only about 3 million are treated for it, he said.
Imagine if that was our treatment rate for hypertension; you'd be an awful doc if you were only treating three percent of your hypertension patients, he said.
Each of the doctors said insurers rarely cover weight-loss medications, nor does Medicare.
Highmark Inc. spokeswoman Wendy Morphew said in an email that the insurer covers the drugs for people with severe obesity and in some cases for people with moderate obesity. Employers may choose not to include the drugs in their plans, Morphew said in the email.
UPMC Health Plan spokeswoman Gina Pferdehirt said in a statement that the insurer doesn't cover the drugs, but is considering it.
UPMC Health Plan is collaborating with physicians and our specialists to evaluate new and existing anti-obesity medications to determine what is both safe and effective for our members, Pferdehirt said in the statement.
Woodburn said he took an interest in treating obesity more aggressively after realizing how differently he was treating obesity than hypertension and other weight-related diseases. Now he said he makes a point of setting up follow-up appointments to talk about obesity, refers patients to dietitians and follows obesity treatment guidelines that he said many doctors haven't learned.
Any doctor can incorporate this, he said. You just have to be comfortable bringing it up with patients.
Wes Venteicher is a Tribune-Review staff writer. Reach him at 412-380-5676, wventeicher@tribweb.com or via Twitter @wesventeicher.
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Obesity as a disease - Tribune-Review