Posted on April 12, 2011 in Clinical Trials, Latest News, Vitamins and Supplements
Our patients often wonder if prescription drugs or medications are absorbed differently after weight loss surgery, and do they need to adjust their dosage.
The answer is no.
Prescription Medications and Drug Absorption
Patients who undergo a Lap – Band procedure will not have any of the small intestines bypassed, so they shouldn’t worry about medication absorption. Many will ask why we place them on supplemental vitamins and calcium if the upper portion of the small bowel is not bypassed like after the Roux-en-Y Gastric Bypass. The answer to that question is many patients don’t eat a balanced diet which is high in iron such as green leafy vegetables, or avoid some food groups such as milk products which are high in calcium. About one out of every three Weight Loss Surgery patients are found to have low iron, calcium or “B” vitamin on the pre-op labs we perform. In addition over 50% of women over age 50 who haven’t had weight loss surgery will develop osteoporosis in their lifetime, so taking supplements is a good idea.
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Posted on April 5, 2011 in Clinical Trials, Gastric Bypass Surgery, History of Weight loss Surgery, Lap Band, Latest News
J. K. Champion MD FACS, Clinical Professor of Surgery, Mercer University School of Medicine
Director of Bariatric Surgery, Emory-Dunwoody Medical Center in Atlanta Georgia USA
Obesity has reached epidemic proportions in the United States and Western Europe in the past decade, and has now begun to effect Asian populations as high calorie convenience “fast foods” and lack of exercise become more common in modern society. Morbid obesity now occurs in approximately 5% of western populations, and weight loss surgery is increasingly being utilized to treat the issue successfully because medical approaches have demonstrated a 95% long term failure rate. This presentation reviews the currently established surgical options for bariatric surgery with the history of their evolution, and future areas for development and research.
Current operations for weight loss are based on two mechanisms of action: either gastric restriction or intestinal malabsorption, or a combination of the two. Gastric restriction relies on a small proximal gastric pouch of less than 30 cc and stabilization of the outlet with a prosthetic band. Examples include the Vertical Banded Gastroplasty (VBG) and the Laparoscopic Adjustable Gastric Band (Lap-band) or Swedish Band. Gastric restrictive procedures are simpler to perform with less risk, but are associated with less weight loss and higher revisions rates compared to other bariatric procedures.
The Roux-en-Y gastric bypass combines gastric restriction with some intestinal malabsorption to increase weight loss, by excluding a length of proximal small bowel from the common digestive tract. Controversy exists over the appropriate length of the small bowel bypass and technical aspects of the procedure due to a lack of prospective controlled trials to objectively compare outcomes with changes in technique. Hybrid operations result in greater weight loss and more sustained weight loss, but are associated with greater risk, including micro-nutrient deficiencies and difficulty accessing the distal stomach.
Purely malabsorptive procedures like the Bilio-pancreatic Diversion (BPD) and Duodenal Switch (DS) utilize a long bypass of the small bowel to the terminal ileum to form a common channel for digestion of only 50-100 cm. While popular in Western Europe and certain limited centers in the US, they are considered experimental by most bariatric surgeons due to their high risk of chronic diarrhea and protein malnutrition.
Laparoscopic approaches to perform all the currently accepted bariatric operations have led to an exponential increase in patient and surgeon interest since 1995. The laparoscopic approach has reduced wound morbidity and recovery time from surgery.
Future areas for expansion and research include the novel introduction of Gastric Pacing and Vagal Nerve Stimulation for weight loss utilizing an implantable gastric stimulator. Endo-luminal procedures for gastric restriction which will be accomplished by a totally endoscopic approach are in the development stage and will probably be introduced with the next 12-24 months.
The field of Bariatric Surgery is currently undergoing an evolution towards less invasive techniques with a variety of opportunities for research and development.
Posted on March 17, 2011 in Gastric Bypass Surgery, Latest News, Weight loss Support Group
FILLING THE VOID:
Dealing with Emotional Hunger
Atlanta Bariatric Support Group
J. K. Champion MD FACS and Susan Champion
Hunger and eating often have nothing to do with food in patients who have the metabolic disorder called “morbid obesity”. Recognition of the lack of association between “head hunger” and a physical need for nutrition is an important step in developing a successful approach to maximize weight loss after bariatric surgery.
Emotional Eating
“Head hunger” is a popular term discussed on Internet support groups describing a real entity, which is better classified as “emotional hunger”. Food is comforting and can serve the same purpose as a drug in dealing with our emotions. This action is usually sub-conscious, but becoming aware and recognizing the behavior gives patients the power to change old habits. This process of regaining control over your life is called “behavior modification”, and it is crucial to long-term success after weight loss surgery.
The disease of morbid obesity has slowed the body’s metabolism down to the point that most people need only 1000-1200 calories daily to maintain their weight after bariatric surgery. They don’t have the luxury of eating chocolate when sad, or nervously snacking on junk food when dealing with stress, anger, or boredom. Many patients with morbid obesity are not over-eaters, but are “foragers” or “grazers”, who eat not when they are hungry, but when they are stressed emotionally. This insidious weight gain is usually around 10 pounds per year, which over a decade adds up to being 100 pounds overweight again. (more…)
Posted on March 15, 2011 in Gastric Bypass Surgery, Latest News, Weight loss Support Group
ATLANTA BARIATRIC SUPPORT GROUP
J K CHAMPION MD
POST-OP NUTRITIONAL SUPPLEMENTS AND MONITORING
Problems with nutrition or malnutrition can develop after surgery for morbid obesity. The absorption or intake of vitamins, minerals, and nutrients may be reduced enough to adversely effect your health. These problems can usually be corrected with supplements if detected early. This is why we emphasize periodic nutritional monitoring with blood tests for life, so deficiencies can be addressed. Occasionally (1/200) nutritional problems fail to respond to supplements and a reversal of weight loss surgery is indicated, although there is increased operative risk with subsequent surgery.
The purpose of this post is to emphasize the importance of taking vitamin and calcium supplements after surgery and having routinely yearly blood monitoring by our office to try and avoid complications. We are seeing a lot of patients not taking supplements and refusing to keep follow-up appointments, or be monitored by their local physician, despite everyone signing a contract to comply. Permanent irreversible damage to your health, or even death can result from failure to follow post-op instructions.
Lets review our recommendations for nutritional supplements and monitoring:
Vitamins:
Vitamins are organic chemicals needed in small amounts to assist in normal metabolism that cannot be manufactured in the body. They must come from outside. They assist our body to function normally and severe irreversible damage can occur from deficiencies
Examples
B vitamins; thiamine B1, riboflavin B2, niacin B3, pyridoxine B6, cobalamin B12
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Posted on March 10, 2011 in Clinical Trials, Lap Band, Latest News
A SINGLE CENTER EXPERIENCE WITH THE FDA CLINICAL “B” TRIAL FOR THE LAPAROSCOPIC ADJUSTABLE GASTRIC BANDING SYSTEM FOR MORBID OBESITY IN THE U.S.
Presented at SAGES 2004
J.K. Champion MD, Mike Williams MD
Emory-Dunwoody Medical Center, Atlanta Georgia USA
Background: The laparoscopic adjustable gastric banding system (Lap-band) underwent two multi-center clinical trials with controversial results in the United States before its approval in July 2002. We report our single center experience with the device over a 51 month period.
Materials: From 5/99-3/01, 17 patients participated in a FDA approved clinical “B” trial of the Lap-band (Inamed, Carpenteria, Ca) with IRB endorsement at a single institution. There were 2 males and 15 females, ages 23-55 (mean = 41), with a mean BMI of 44 (range 36-53), and mean weight of 120 kg (range 93-154). Bands were placed in a peri-gastric (15) or pars flacida (2) position utilizing a calibration balloon inflated to 20cc. Band adjustments were made in small frequent intervals in the office without fluoroscopy as advocated by O’Brien. Yearly barium swallows, labs and visits were requested.
(more…)
Posted on March 8, 2011 in Clinical Trials, Gastric Bypass Surgery, Latest News, Revision Bariatric Surgery, Techniques
Emergency Care of the Bariatric Surgery Patient
JK Champion MD FAC
Clinical Professor of Surgery, Mercer University School of Medicine
Director of Bariatric Surgery, Northside Hospital
Atlanta GA USA
(**Also see our PDF Chart Treatment of Bariatric Patients for Medical Professionals)
Complications and surgical emergencies are a fact of life bariatric surgeon is unavailable, necessitating the on-call general surgeon to manage a complex situation for which they may have limited prior experience. The average incidence of in-hospital complications after bariatric surgery as reported by Livingston [1] is approximately 10%, and The American Society for Bariatric Surgery Centers of Excellence Program reports a 90 day incidence of readmissions of 4.7% and re-operation rate of 2.6% in its initial review of the first 106 centers approved. These numbers probably reflect an ideal and underestimate the true incidence depending on the geographic area, availability of resources to manage the bariatric patient, and the demographics of the patient population. If the bariatric surgeon in your area operates on high risk patients; those with a BMI > 60, age over 50, have multiple co-morbidities (especially pulmonary, cardiac or hypertension), are male gender, or revision patients, there is increased morbidity and mortality risk with these factors [2,3].
Bariatric Emergency
Bariatric surgical patients differ from the average general surgery patient in that the complications may present with minimal physical signs and symptoms, they are difficult to evaluate due to the patients body habitus and inability to fit on many diagnostic exam tables, and the patient deteriorates rapidly and has very little reserve to weather a catastrophic illness. The best opportunity to improve outcomes is in the first 6-12 hours, and after 24 hours the morbidity and mortality escalate rapidly.
Bariatric Emergencies:
The surgeon on-call will usually be called on to deal with one of three life threatening surgical emergencies: bleeding, leaks, or obstructions [4-6]. The initial phone call typically won’t alert you to the underlying problem, other than the patient is “sick”. I propose to provide an overview, then take each of the three surgical emergencies and provide guidelines outlining what are you likely to be called for, how will the patient present, can you identify the problem short of a re-exploration, and emergent treatment and surgical management.
Surgeons will be told a patient has bleeding, unstable vital signs or sepsis, abdominal pain, or vomiting. These may be subtle and non-specific initially, but serve as “red flags” that a serious problem may be developing and deserve prompt evaluation and assessment.
Medical Professionals, Doctors, Surgeons
Bleeding is self evident. Unstable vital signs or sepsis are defined as fever > 101° F, hypotension, tachycardia > 120 for four hours, tachypnea, decreased urinary output or rise in BUN and creatinine. Abdominal pain and colic which lasts more than four hours, or vomiting that lasts more than four hours also constitute a call for prompt treatment. Patients who present with the previously listed complaints deserve a prompt evaluation, and the evaluations must not delay treatment unduly. Options include: (1) a physical exam and vital signs which may require a serial exam over the next 6-12 hours, (2) labs to include a CBC and comprehensive chemistry profile, (3) X-ray evaluation to consider an abdominal series, CT of abdomen and pelvis with oral contrast, gastrograffin swallow or barium UGI with small bowel follow through, and ultrasound of the gallbladder, (Note: the patient may not fit on exam table) (4) EGD. All diagnostic studies are frequently negative, so a normal study rules out nothing. (more…)
Posted on March 3, 2011 in BMI, Clinical Trials, Gastric Bypass Surgery, Lap Band, Latest News
Lap-band Surgery for Weight Loss: Is it Right for You?
JK Champion MD FACS
Videoscopic Institute of Atlanta
Atlanta GA
Patients often ask; “Which surgery is best for me?” How do you decide whether to have a Lap-band or a Gastric Bypass?
Time Magazine Obesity 2004
Many patients considering an Adjustable Lap Band (Adj. Lap Band or LapBand) favor it based on it is simpler and has lower risk compared to the Gastric Bypass. The Lap-band doesn’t involve stapling or cutting the stomach or intestine, so the risk of infection or leakage is reduced. The operation time and hospital stay is generally shorter. That’s the good news. The bad news is weight loss is less, improvement in health issues is less, and the risk of having another procedure or surgery related to the Band is higher compared to the Gastric Bypass.
What are factors to consider and are there patients we don’t like to see have a Lap-band?
- Lap-bands have better results in patients whose BMI is less than 50. Ideally around 35-40 BMI and 100 pounds or less overweight. The average weight loss with a Lap-band is around 50% of the excess weight and only half the patients will maintain the weight loss over time. The weight loss with a Gastric Bypass is around 75% of excess weight and 90% remain successful over time.
- Sweet eaters shouldn’t consider a Lap-band since it doesn’t restrict sweet intake the way a Gastric Bypass does. About 50% of Lap-band patients will regain a significant amount of weight due to snacking and sweets over time.
- Diabetics and patients with high cholesterol do better with a Gastric Bypass. Around 90% of Gastric Bypass patients will leave the hospital after 48 hours off medication and insulin for diabetes, and 80% will lower their cholesterol without medications. The Gastric Bypass alters the way the intestine recognizes sugar and reduces the absorption of cholesterol and fat. Improvements can occur after a Lap-band, but depend on substantial weight loss and dietary compliance.
- The Lap-band is dependent on absolute compliance with the diet and regular exercise to maximize weight loss. Patients who are “poor” rule followers don’t do well.
- The Lap-band is a good choice for older or very high risk patients, who even a modest weight loss, will benefit. The risk of dying from a Lap-band procedure is about 1/1000 and for the Gastric Bypass around 3/1000.
In summary, we like the Laparoscopic banded Gastroplasty in patients with a BMI less than 50 who aren’t diabetic or have high cholesterol, and whose diet is typically big meals of meat and veggies. Sweet eaters, snackers and grazers can easily defeat the operation.
Posted on February 10, 2011 in Exercise, Latest News, Weight loss Support Group
PLATEAU’S
Plateaus are normal!!! And unavoidable!! After weight loss surgery or anytime you are dieting
- Bariatric surgery is an aide to dieting it is a tool.
- If you do not follow the guidelines for eating and exercise you will have a less successful outcome or you can out right fail with your weight loss.
There is a 10% failure post op in long-term weight loss. It is almost always due to patient noncompliance.
Two major factors in Plateau’s
- No exercise (Exercise will increase metabolism and build muscle mass which burns more calories)
- Snacking or failure to eat 3 meals plus a snack per day at regular intervals (eat every 4 hours)
Plateaus occur as calories decrease and your metabolism drops in response.
This is your body adjusting to change.
Plateau’s can occur at anytime after weight loss begins and can last 3 days to 3 weeks.
- Balancing Weight loss Plateaus
TO GET OUT OF PLATEAU’S
EXERCISE (MIN. 20 MINUTES 5 DAYS A WEEK)
EAT ON REGULAR SCHEDULE (EAT REAL FOOD)
DO NOT WEIGH YOUR SELF BUT ONCE A WEEK
OFTEN YOU WILL SEE A DROP IN INCHES RATHER THAN A DROP OF POUNDS ON THE SCALE.
BODY’S REMODEL DURING WEIGHT LOSS TO: 75% FAT AND 25 % MUSCLE
YOU HAVE 18 MONTHS TO LOSE AND CHANGE HABITS DON’T WASTE IT!!!!!!!!
Posted on February 8, 2011 in Exercise, Gastric Bypass Surgery, Latest News, Nutrition, Vitamins and Supplements, Weight loss Support Group
SUCCESS HABITS OF LONG TERM GASTRIC BYPASS PATIENTS
OBESITY SURGERY, 9, 80-82, 1999
A survey of post-op gastric bypass patients by a bariatric surgery group in Salt Lake City revealed 6 common habits shared by the people who maintain long-term successful weight loss (defined as at least 74% of excess weight).
The 6 common habits for success are as follows:
1.EATING; eating 3 well balanced meals and 1 snack per day consisting of 3 servings of protein, & vegetables & 2 servings of bread or starch, & 1 serving of fruit.
2. DRINKING; on average drank 40 –64 oz of water per day and no carbonated beverages! 74% did not drink alcohol and 55% did not drink fruit juice.
3. VITAMINS AND SUPPLEMENTS; (see also Bariatric Patients Weight Loss Supplements) Bariatric Patients took daily multiple vitamin, calcium, and iron if needed.
4. SLEEPING; slept 7 hours per night and reported energy level as high on average.
5. EXERCISE; (See Dr. Champion’s Exercise Group) average of 4 x a week for 40 minutes. *A key factor in ability to maintain their weight loss!
6. PERSONAL RESPONSIBILITY; took personal responsibility for staying in control. Weighed-in weekly and allowed themselves only a few pounds leeway. Attitude that their weight was up to them and the surgery was only a tool to help them maintain a healthy weight.
(See about joining Dr. Champion’s Bariatric Weight Loss Support Groups)
NON-SUCCESSFUL GROUP: The unsuccessful group regained an average of 50 lbs (both averaged losing 100 lbs initially) and all demonstrated an absence of at least one of the 6 common habits. THE MOST COMMON WERE LACK OF EXERCISE, GRAZING AND SNACKING, AND DRINKING REGULAR NON-DIET CARBONATED DRINKS! THE FIRST POSTOP YEAR IS A CRITICAL TIME THAT MUST BE DEDICATED TO CANGING OLD BEHAVIOR AND FORMING NEW LIFELONG HABITS.
Posted on February 3, 2011 in Gastric Bypass Surgery, Latest News, Weight loss Support Group
Medications after Bariatric Surgery: Do’s and Don’ts
Atlanta Bariatric Support Group
JK Champion MD
We are frequently asked questions about medication use after weight loss surgery. Patients want to know:
1) Why they shouldn’t take aspirin or anti-inflammatory medications
2) Are there other medications Bariatric Patients should avoid?
3) Whether medications they are routinely on will be absorbed normally or will the dose need to be changed. (more…)
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