When bariatric surgery is performed in centers that measure long-term results, most patients are found to have little risk of developing significant mineral or vitamin deficiencies if they follow the nutritional and supplement guidelines. The two main procedures performed worldwide are the gastric Sleeve and Gastric Bypass result in significantly weight loss, around 75% of excess weight, but carry some risk for developing nutritional deficiencies if you don’t follow a healthy diet and don’t take your vitamin and mineral supplements as directed.

The fact is, however, many patients struggling to lose weight are already deficient in Vitamin D and other nutrients before they have surgery. Vitamin D is important in absorption of calcium and is also important in maintaining a healthy amount of calcium in your bones. After surgery, adequate intake of calcium is important. Foods with high calcium content include milk, cheese, cottage cheese, yogurt, broccoli, tofu, greens and eggs. These healthy foods should make up a part of the weekly diet for all patients.

As an additional precaution, all gastric bypass and gastric sleeve patients should take between 2,000 and 5,000 IU (International Units), or about 100 micrograms of supplemental Vitamin D per day. In addition, Dr. Q recommends patients take 1000-to-2000 mg of supplemental calcium daily. This can be in the form of calcium carbonate (such as TUMS®), or calcium citrate. Calcium citrate has better absorption than calcium carbonate and may be advantageous for people who have had kidney stones in the past.

Calcium deficiency can result in osteoporosis and osteopenia — or weakening of the bones.  Although most patients after a gastric bypass will not develop calcium deficiency, the change in calcium absorption is unpredictable, so all patients should have their calcium levels evaluated annually.

Numerous studies have shown that successful weight loss after bariatric surgery improves arthritis and decreases joint pain. Patients should support these positive results through careful attention to nutrition and appropriate Vitamin D and Calcium supplementation.

By now, everyone is aware that excess weight will threaten your health.  It’s in the newspaper and on television, the internet and radio.  Hardly a week goes by where a new report on the hazards of excess weight doesn’t hit the national media.

The media has focused on adverse health consequences associated with excess weight, but the truth is that the primary problem caused by severe obesity is the inability of many overweight people to live life to the fullest.  The more overweight a person is, the more difficult it becomes to enjoy normal activities; to walk up stairs comfortably, to easily get in and out of a car and to sit in a booth at a restaurant are some of the constant restrictions felt by obese people every minute of their lives. 

What can be done?  How can this excess weight be controlled and how can a severely overweight person experience that healthy feeling, that “normal life” again?  Of course, the answer is permanent weight loss.  But, how is this achieved?  Fortunately, the truth is finally being published in the major medical journals and reported in the national media.  The truth is that for people suffering from severe obesity, the only highly successful method to achieve substantial permanent weight loss is through weight loss surgery.  This has been demonstrated over and over again in scientific studies (as opposed to the misleading reports promoted by diet companies).  So, knowing the truth about weight control for people 80 pounds or more overweight, what are the key questions?  The questions are obvious; “Is weight loss surgery safe?” and “Where should I go for surgery?”

The Gold standard for weight loss surgery is Laparoscopic, or minimally invasive, weight loss surgery.  At The N.E.W. Program Laparoscopic Gastric Bypass has been performed safely in patients weighing over 700 pounds.  Almost every patient who has surgery for weight loss is able to have surgery successfully using these minimally invasive techniques.  The need to perform these surgeries by the traditional, large-incision method generally indicates that the surgeon is poorly trained in laparoscopic surgery and probably should not be performing weight loss surgery at all.

With Laparoscopic Gastric Bypass, Laparoscopic Sleeve Gastrectomy and Laparoscopic Gastric Band surgery, the complication rate should be very low.  The vast majority of patients should never need to be in the intensive care unit (ICU) after surgery and should be able to go home after only one night in the hospital.  Recovery should take about one week.  Finally, the mortality rate from this surgery should be well below 1 out of 200, or less than 0.5%.  In over 2000 procedures, there has never been a single death due to a leak or other complication after weight loss surgery at The N.E.W. Program.

After thinking through these facts, it is clear that severely obese people who wish to gain permanent control of their weight should consider surgery.  Of course, before deciding on which surgeon to see, be sure to ask about their statistics, and write them down.  If the surgeon ends up performing open, large-incision surgery more than 2% of the time, be wary.  And of course, don’t be afraid to ask about that surgeon’s mortality rate, complication rate and the chance of ending up in the ICU.  Always remember, it’s your life.  If done right, surgery for weight loss can be done safely and effectively, with a fast recovery.  The long-term goal is to improve your health and help you to regain that healthy feeling, that “normal life” again.

An article titled “Are Diet Pills the Answer to Weight Loss Struggles?” was recently posted in the Harvard Medical School Adviser.  This article posted a question about weight-loss pills; “Do they work? Are they safe?”

The answer given was that advertising claims such as “Exercise in a bottle” are, “for the most part” too good to be true.  Well, I have one comment and that is Shame on the Harvard Medical School Adviser for trying to come off as so objective that it cannot even render a definite opinion on this clear-cut subject.

The article explains that claims on nutrient and herbal products are not required to be verified by the FDA.  The FDA can, and has in some extreme cases, removed these products from sale; an example is the ban on the sale of Ephedra in 2004 after several deaths. Unfortunately, there are numerous other ephedra-like supplements that are playing off the frustration that so many people have with the commonly available, traditional, strict diet plans.  People that are desperate to lose weight often seem willing to blow large amounts of money on just about anything that promises a quick-and-easy solution to their problem.

Even after the ban on ephedra, these ephedra-like compounds such as ephedrine, norephedrine and methylephedrine, are available on the Internet and in stores, as are supplements containing caffeine and caffeine-like compounds such as guarana, yerba mate and others.  These compounds are highly concentrated and are, in my opinion, drugs. None of these drugs has ever been truly tested for effectiveness and the claims made are simply ridiculous.  Not only that, but there are potential adverse health consequences for taking these ineffective drugs that have never been identified.

So, why are these drugs allowed to be sold?  The standard answer is because there is an FDA loophole that allows herbal remedies that don’t claim to cure medical conditions to be sold.  The real answer is that these drugs are Big Business!  This is a $200,000,000.00 (that’s 200 Million Dollars) per year market in America alone.  Bottom line, the snake oil salesmen are alive and well in America; in fact they are richer than ever before.

It’s time that legitimate medical professionals start to confront these frauds in terms that are appropriate.  Identify them for what they are, scams that waste your money and provide false hope and may, in fact, hurt people in the end.  Rather than stating that “people should be cautious about using” these drugs, as is stated in the article, the medical community should state unequivocally that these drugs have never been shown to have any benefit whatsoever, and in fact may be quite dangerous and until their safety and efficacy has been shown, people should never take these supplements, under any circumstances, period.

Numerous health issues have been given the national spotlight in recent years.  Some, like AIDS, have resulted in strong political demonstration while others, like multiple sclerosis, have resulted in quiet but powerful movements.  Both of these, as well as several other high-profile diseases, have generated hugely successful fund-raising efforts headlined by civic leaders, celebrities and professional athletes.  Sympathy and compassion have been generated for those suffering from these ailments, and rightly so.  These are indeed severe medical conditions resulting in disability, and sometimes death.  There is, however, a far more prevalent disease which also carries profound consequences, and which results in disability and, often, early death.  In fact, it is the leading cause of preventable death in the United States and the most prevalent “epidemic” in America today.  This is the disease of obesity; a disease that most of society does not truly understand and does not readily speak about. This is a quiet epidemic, and it now affects over 95 million Americans, or about 40% of the population!

Many studies, including studies of families and studies of identical twins, have demonstrated a strong genetic predisposition associated with obesity.  Other studies have demonstrated alarming new trends, such as childhood obesity now presenting in societies that have never had a measurable problem with obesity.  An ominous and alarming fact is that childhood obesity typically leads to severe obesity as an adult.  And for severe obesity, study after study has demonstrated an amazing lack of long-term success with even the most intensive behavioral modification programs. These reports, and numerous other well-designed studies, clearly show that we are facing a true epidemic.

But identifying obesity as an epidemic does not mean we cannot influence its course by changing our behavior. Obesity, like many other diseases, would dramatically diminish or resolve completely, if most people changed their behavior such as adherence to a very low-calorie diet and an increase in exercise.  Of course, this is also true about many other diseases such as many cancers and diabetes.  Most type 2 diabetics will have complete resolution of their diabetes if they adhere to a low-calorie diet, increase their exercise and lose weight.  Nevertheless, we treat diabetes aggressively with medication, and respect it as a disease, despite our inability to treat it effectively through behavior modification.  Lung cancer is an even more obvious example of a preventable disease.  This form of cancer would almost cease to exist if tobacco smoking were eliminated.  However, we permit smoking, and we treat lung cancer aggressively and with compassion for those afflicted.  Obesity, like diabetes and lung cancer, is a devastating disease and we should treat those afflicted aggressively and with the compassion they deserve.

The main problem with treating obesity lies in the fact that successful medical treatment for severe obesity remains elusive.  There are no medications proven to be successful with severe obesity.  If we had medications that effectively controlled excess weight, then severe obesity would be treated as any other disease, and we would expect physicians to treat it aggressively.  Unfortunately, this lack of successful medical therapy has enhanced the prejudice against those people suffering from obesity, not only throughout our society, but also within the medical community.  This prejudice is compounded by the fact that very few medical doctors have received any formal training in the treatment of excess weight.  This embarrassing professional neglect has left the door open to opportunists who prey on desperate people suffering from obesity by promoting ridiculous diet formulas, useless weight loss pills, and strict diet plans that are almost impossible to follow.

The only truly good news is that there is a very successful treatment for severe obesity, called bariatric surgery. In fact, all scientific studies on modern bariatric surgical procedures have shown that the majority of people with severe obesity will be effectively and safely treated by undergoing one or the other of these procedures.  Unfortunately, due to the bias against people with obesity, these highly successful treatments have either been neglected or have had to withstand substantial criticism.  This has resulted in a situation where the vast majority of patients who would benefit from these procedures are either not referred for evaluation or are actively discouraged from exploring this option.

Fortunately, scientists are working to define the physiologic causes for obesity and new medications are being tested which may become effective for certain people. However, for the time being, the medical community must recognize the need for aggressive treatment of patients with severe obesity and be willing to refer patients to surgeons who focus on obesity as a distinct medical illness. Unless effective surgical treatment for severe obesity is used aggressively, hundreds of thousands of people that could benefit from these treatments will continue to suffer.

Everyone now knows that being overweight leads to numerous disease processes.  What most overweight people do not realize is that their size severely limits the ability of physicians to even tell them what’s wrong.

A new study has just revealed that the number of inconclusive imaging tests, CAT scans, MRIs, X-rays, etc…, has doubled in the last 15 years because many patients are too big.  In other words, radiologists are unable to accurately use these tests to make a diagnosis because the patient is simply too large.

Over the years, physicians have become increasingly dependent on testing like mammograms and CAT scans, called radiological imaging, to assist in their ability to diagnose many diseases.  Of course, a physical examination is always important, but a physician needs to be able to feel abnormalities when examining a patient and this is often impossible to do when the patient is obese.  When the doctor cannot tell what is wrong after examining a patient, an X-ray or other test is typically scheduled, but now we are learning that even these tests are inaccurate in larger people.

The reasons for this are many.  For example, it takes a much stronger “X-ray” to penetrate, or look inside, the body of a patient who has a large amount of fat; and, the quality of the images obtained decreases as the patient gets larger.  In some cases, even though the dose of radiation is dramatically increased, the images obtained are “fuzzy” and do not help to diagnose the patient’s problem.  Another example is ultrasound which is used to diagnose breast cancer, gallstones and many other disease processes.  Ultrasound sends high-frequency sound waves through the patient, where they bounce off internal organs, like a submarine’s sonar.  The ultrasound machine detects the returning sound waves and creates a picture of the organs.  Unfortunately, the thicker the patient is, the less the sound waves are able to penetrate, and the image quality is poor.

When radiologists are trying to obtain the tests they need, the problems caused by excess weight involve much more than difficulties interpreting poor quality images.  Special beds, extra personnel and “super-sized” wheelchairs are needed just to move patients safely when performing these tests.  There has even been a rise in the number of injuries sustained by hospital employees while transporting heavy patients.  Due to the extra equipment and personnel required, it typically takes longer to complete the tests, causing further delays in these patient’s diagnosis and care.

What has now become evident is that, not only do obese people have increased health problems due to their weight, but physician’s abilities to diagnose these disease processes is severely limited.  A large patient can no longer walk into a hospital and expect the best quality care because X-rays, CAT scans and other imaging studies are unable to detect and diagnose the problem.  Unfortunately, with the incidence of obesity on the rise, we can expect this situation to only get worse.