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Category: Obesity

Shared Success Story- Theresa & Rodney (Duodenal Switch)

August 05, 2017 8:41 am

Life before surgery seems like a lifetime ago for both my wife and I. Being extremely overweight is not only a burden on your general health but a burden on your lifestyle in general. You have the awful label of being called obese, or morbidly obese. This is such a wonderful word that makes you feel as if you have been judged a misfit in society. We were both overweight all of our lives and had done all of the diets known on the planet throughout the years. Some worked a little some not at all and we always found ourselves back to where we were before and usually larger than that. The main focus though as we were getting older was our health. For Theresa it was very difficult. Along with being over 400 pounds she had a severe case of asthma which caused her episodes where she felt she was going to suffocate. She also had very little muscle mass which made it very difficult to get up and down from seating or lying positions. Theresa had her surgery in February of 2014 and not a moment too soon. If she had done nothing it is a good chance that she was facing a horribly short future. She also has a slight heart murmur which did not bode well for a person with her weight. She did not have diabetes thank goodness but her A1C was on the rise as was her BP. She did have sleep apnea as well and had to have a CPAP machine.

I was also severely overweight, my highest weight was nearly 400 pounds and on surgery day I was 355 pounds. I was also under the illusion that I had more control over my weight and that once Theresa had her surgery I would just be able to diet and exercise my way to a healthy weight. I was able to do this in my younger years to a certain extent and I was naive enough to think I could continue to do so. How wrong I was. I had found that no matter how much diet and exercise I did my weight would drop a bit at first but then stall and I would have to essentially starve to lose any more and of course that just makes for a bad outcome. My A1C shot up to 7.6 and this was with 1000mg of metformin a day! My BP was very high with both numbers over 100, well over. This is with a high dose of BP meds. I had a severe case of sleep apnea and could not even consider sleeping without a CPAP machine with a high pressure. I have an artificial hip that was being burdened by my 350 pound plus frame and would probably need to be replaced sooner rather than later. My future was not looking good. Dying before I was 60 seemed like a reality for me and that is not the future I was hoping for. The decision to have weight loss surgery for the both of us was tough. You of course hear the nay sayers spout what a cop out it is and it’s the easy way out! You are just weak and just simply need to not eat hamburgers, French fries and donuts. Just stick with non-fat and low calories and you will reach the promised land. What a load of BS.

Theresa-Rodney-Before
Theresa-Rodney-Before
Theresa-Rodney-After
Theresa-Rodney-After

Once you wrap your head around the fact that your body is wired in such a way that it will always seek a higher weight every time you lose weight, it’s time to consider the type of surgery. Everyone has heard of the Gastric bypass and that seemed to be the path at the time of Theresa’s surgery. The thing about Theresa and what I admire very much is her persistence and her ability to research to the point where a decision is spot on. She looked at all of the four possible surgeries and quickly realized that the Duodenal Switch was a no brainer. It had the greatest measure of success in the long term as well as short term. Reading about the process and talking to others who have had the surgery it became clear that it was the right choice. Finding out where to go and have the surgery was a real challenge. We were lucky to find Dr. Ara Keshishian and have the ability to travel to his location to have the surgery.

Theresa’s Stats                                                       Rodney’s Stats

Surgery Weight: 410                                                                   Surgery Weight: 355 Pounds

Total Weight Loss: 215 pounds                                                 Total Weight Loss: 170 Pounds

Surgery Type: Duodenal Switch                                               Surgery Type: Duodenal Switch

Surgery Date: February 2014                                                   Surgery Data: May 2016

Surgeon: Dr. Ara Keshishian                                                   Surgeon: Dr. Ara Keshishian

Life after surgery is an amazing series of challenges, changes, and a journey that transforms your life in a huge way. For Theresa, it was freedom. Freedom from the overbearing weight she was carrying that kept her from essentially moving or doing anything but staying at home. We did very little outside of the house before surgery. Only the necessities of shopping and keeping up the house on the inside and out. Even that was difficult and went by the wayside all too often. Of course eating out was easier than going to the grocery store and that made the scale just go higher. After surgery, Theresa began to lose weight and you could see day by day the changes. After the first month, you could see a dramatic change not only in her look but the fact that she was moving again! She had dropped 35 pounds in that first month and it made a huge difference. As the weight kept coming off over the next few months we began doing things we have not done before. We started to do a lot of walking and a lot more things around the house that needed to be done. Shopping became a breeze and we ate out a lot less. The dramatic change was in her health. A number of changes for the better were happening on that front. The main one and a huge relief was the asthma. It simply was no longer there. She was no longer short on breath and was simply out moving me! I could barely keep up with her. She also had a bad case of psoriasis which before surgery she could do nothing about. Since the surgery it has disappeared. It might be due to the increased in vitamins, particularly the D vitamin. Her sleep apnea went away and now she is healthy and happy. It is almost difficult to describe the changes until you see them for yourself.  For Theresa it has been a life changing experience that has transformed the both of us in ways we never imagined. Theresa eats a normal diet and after 3 ½ years post op she fluctuates about 5 pounds either way. It is amazing.

For me it was not what I expected. What I mean by that is, learning to eat is a challenge. With the Duodenal Switch you are not only eating less, but what you eat is tremendously important to the success of the transformation. With the other surgeries, Lap Band, Bypass and Sleeve you do not have the degree of malabsorption. You simply eat less and you lose weight, but you are still essentially “on a diet”. With the Duodenal Switch you have to consider the malabsorption and think protein first and for most. Once you get past the first month of eating small amounts and what you can while your innards heal you need to learn what to eat and is it enough protein. You may also have to contending with the fact that you have an aversion to foods you ate before. I, for one, could not even eat cheese, and chicken. I pretty much lived on scallops, crab, shrimp and protein drinks for the first three months. Nuts were also a good source of the protein when you get to that stage. This does change and things do go back to normal as far as the taste changes, but it takes a few months. The weight in that first month pretty much peeled off. I was dropping like a pound a day. It was incredible. You think that this is going to be a breeze and you will drop it all in no time! Then that 4 week somewhat of a stall occurs. From what I can tell, everyone experiences it in one form or another. It freaks you out because you start to think about the past where you would work your butt off and either gain or drop and ounce or two.  But I was lucky, my wife had gone though it two years before me so she was there to explain that it was normal. The whole “this is a journey thing”, and she was right! At the time though I was listening to the negative voice in my head from the past. That is where the support from the many groups come in. You see that pretty much everyone has the same ups and downs and then your body gives up the farm and you drop a bunch of weight in a weeks’ time. There is really a lot of science behind it. Researching and reading about this particular surgery and how it works will benefit you while you go through the process. Another important thing we face with this surgery is the necessity of Vitamins. Thank goodness for my wife and the DS groups and of course my surgeon. You will not be without knowledge if you actively join the different groups and do your research on the vitamins. I am still learning about what my body needs and am looking forward to my labs in the next month to see where I may be deficient. I have also come to realize the importance of drinking water and avoiding dehydration. I never used to drink it much before the Duodenal Switch, but since the surgery I find it aids heavily in the success if you drink it and drink a lot of it.

To conclude this has been a journey and one I wish I could have done a lot sooner in life, but it is never too late. Today Theresa and I are at weights that we are happy with and our bodies are happy with. We are more active then we have ever been before together. No more days idle in front of the television with large amounts of fast food and drinks. That is what we used to look forward too. Now we cannot wait until we go out and do something. We are not running marathons or anything but we are active and enjoy being so. We no longer have the ailments we had before surgery. Theresa’s asthma is practically nonexistent, living in the northwest with fires in the summer she may have a bout or two. Nothing even close to what she has before and a simple inhale and its gone. Both of us no longer need a CPAP! The freedom to simply lay your head on the pillow and sleep is amazing and wonderful. All of the medication we had prescribed for us are gone as well. My A1C was 5 on my last set of labs and 5.3 on the one before that. Theresa’s is the same and has been for three years. BP is normal and my hip is holding steady. Oh, and another cool thing about it is you can actually shop for clothes anywhere! Your sizes will shrink but we have found we have become quite the clothes horses since losing all this weight. It makes it fun to be able to fit into a size you haven’t seen since who knows when.

Life is always a challenge for many reasons but to remove the burden of the weight simplifies things just a bit. It is a decision we will never regret and wished we had made a long time ago. We both owe our lives firstly, to having Duodenal Switch surgery. Secondly, and most important – was in seeking out the best surgeon we could find, and that was without a doubt, Dr. Ara Keshishian. As a surgeon he is thorough, meticulous, constantly learning and keeping up on the latest research;as a person he is easy to talk to, very approachable, and genuinely cares about his patients before, during and after the surgery process. We could not imagine choosing anyone else.

Shared Success- Samantha had a Sleeve to Duodenal Switch Revision

July 14, 2017 9:30 am

After struggling with obesity for most of my life I was finally fed up. I had heard about weight loss surgeries before but was always under the common misconception that it was for people who wanted the “easy” way out of a hard situation. I had been working out and reducing calories and tried every popular diet and trainer you could think of. I was still huge and each time I would stop one of these extreme programs I would only end up larger than I was before.

My husband’s cousin had the sleeve surgery and she raved about it. Watching her success is what started to open my mind to surgery, but I was only considering the sleeve gastrectomy. I went to a center in another state that offers Duodenal switch, lapband, RNY and the sleeve. The surgeon I met with strongly suggested RNY to me, but I was stuck on the sleeve. I didn’t want my intestines touched period. I had the sleeve surgery on October 9, 2013.

My high weight was 402 lbs and I weighed 343 on the day of my sleeve surgery. I actually did well with the sleeve and was able to get down to 218 as my lowest. However it was still much like dieting. It was so stressful. After a while my body wouldn’t drop the weight regardless of how little I ate and exercised. I was eating 800-1200 calories a day and low fat meals and working out and kept slowly gaining weight. I was frustrated  and honestly I gave up. My reflux wouldn’t go away so I visited a bariatric surgeon in my area who suggested that we essentially re-do the sleeve surgery to make my sleeve small again so that I would eat less and lose weight again. I got a second opinion and that surgeon suggested I revise to RNY. I went to obesity help’s website to explain my situation and a lot of people with much more experience than me HIGHLY urged me to see Dr Keshishian before making a decision. He was said to be an expert in revision weight loss surgery. I almost cancelled my appointment and didn’t have hope with this doctor either, but since I was in a dead end I went anyway. Dr Keshishian told me it wasn’t my fault. WHAT!? I had never heard that before. I usually get the shame from doctors who assume I must not be trying or that I am secretly eating something wrong. He ordered tests and told me it was “simply science” and I just LOVED him! I had a stricture in my Sleeve that needed to be repaired so since I needed surgery anyway I decided to go ahead and revise to a surgery that has the highest success rate, Duodenal Switch.

Before Sleeve to Duodenal Switch revision
Before Sleeve to Duodenal Switch revision
after Sleeve to Duodenal Switch revision
after Sleeve to Duodenal Switch revision

I was so scared of my intestines being cut and Dr. Keshishian eased my fears. I wish I had went that route the first time but then I might not appreciate it like I do now. Duodenal switch is the ONLY surgery I would recommend to anyone. As Dr K says it’s simple numbers. It’s the surgery with the highest percent of excess weight lost and kept off. I was 252 before my revision from Sleeve to Duodenal Switch and I am just at a year out and today I weigh in the low 190’s and I am still losing. Dr K’s goal for me was about 180. My goal is about 175.  I eat more fat now than I ever did even when I was 400 lbs. I enjoy what I eat and I enjoy exercising and most of all I get to enjoy seeing results from my hard work. Food no longer causes me stress and anxiety. I know with 100% certainty that I made the right decision. Thank you Dr. K for your great skill and I don’t mean just with the knife but with the way you are able to make a high anxiety situation seem like no big deal.

 

After Sleeve to Duodenal Switch Mud Run
After Sleeve to Duodenal Switch Mud Run
After Duodenal Switch Mud Run
After Duodenal Switch Mud Run

Back on Track 2017 Giveaway

January 10, 2017 10:03 am

back-on-track-2017-keshishian
back-on-track-2017-keshishian

Let’s get back on track 2017 after the holiday season! The holidays were wonderful but if you find yourself with a few extra souvenirs don’t feel alone. The average American gains between 1-8 pounds during the holiday season and I am no exception. Let’s get back on track 2017 together.

Time to clear out the kitchen! Disposing of temptations and high trigger foods is the first step to getting back on track. If the food isn’t easily acquired then it is less likely to be consumed.

Stock up on high protein and whole, unprocessed foods that are low carbohydrate and nutrient dense. When quality foods are easily available we are more likely to stay on track with the types of foods we should be eating. Simple sugars/carbohydrates are the biggest culprit of holiday weight gain. We need to go back to the basics of hydration, high protein, low carbohydrate/sugar, vitamin/mineral supplements and exercise. Simple sugars and carbohydrates are easy for our bodies to use and absorb and cutting them back can jump start your weight loss. Each individual needs to identify the daily carbohydrate intake that works for them. Some people stay under 50 grams of carbohydrates daily. You may also need to look at your protein and fat intake. All excess nutrients absorbed have the potential to turn into fat mass and inhibit weight loss. Metabolism video.

Hydration is an important ways to start getting back on track. Water is essential to life functions. The brain is 85% water, blood is 80% and muscle is about 70% water. Hydration aids in digestion, eliminating waste, byproducts and toxins. It also can decrease the feeling of hunger. Lack of hydration can increase fatigue which can lead to craving high carbohydrate foods to increase energy.

Protein’s importance in almost every bodily function and muscle mass can not be ignored. High quality complete Protein sustains muscle mass during weight loss, aids immunity, antioxidant function, and enhances leptin and insulin function. Filling up on protein first will help with carbohydrate carvings and give a sustained satisfied feeling. A prior blog post gives additional information on the importance of protein and the effects of protein malnutrition. WLS makes daily protein intake important but especially after Duodenal Switch, protein is a necessity of daily life.

Vitamins, minerals and supplements will ensure the body has the nutrients it needs to function adequately and can keep cravings at bay. Deficiencies in vitamins and minerals can cause cravings for foods. Vitamin and minerals are essential to muscle function, red blood cell production, bone health, and numerous other physiologic functions. We may all slack off on our supplements occasionally but now is the time to get back into the habit of daily vitamins and mineral supplements. A daily vitamin, mineral, and supplement routine is a lifetime commitment after Duodenal Switch or any WLS. Here is a list of commonly used supplements.

Exercise can increase weight loss, overall well being, mental well being, mood, alertness, improve digestion, improve sleep, and increases energy levels. Exercise does not have to be a daunting task. Simply adding 15-30 minutes of activity can give added benefits. Yoga, walking, dancing, lifting weights, hiking, and sports activities can be included or added to more traditional forms of exercise. There are many free online videos for all types of exercise available.

Finding a new hobby can keep both your hands and mind busy, curbing the unconscious eating of foods that are high in sugar and carbohydrates. Adult coloring books, drawing, painting, knitting, crocheting, sewing, dance lessons, gardening, learning to play an instrument and many others are great ways to use your time and expand your quality of life and brain function. New hobbies can also help establish new coping skills.  Our previous post on Coping Skills After Bariatric Surgery can be found here.  There are a whole host of online videos for “how to” on new hobbies.

Teaming up with others can also help increase weight loss and compliance. Support from friends, family and other groups will assist you. There is a whole gamut of support group online and in person. If you have fallen out of the habit of attending our support group or webinars get back to them. You can find our schedule and announcements regarding webinars here. Our Central Valley Bariatric Facebook page also gives daily inspirational messages, protein recipes and articles and any new information or research available. There is also our Duodenal Switch Facebook Group. Anything that increases accountability is a benefit and motivates us to stay on track.

Experiment with new recipes and flavors that are bariatric friendly and within your dietary needs.  There are so many options for quick and easy meals.  We have several recipes on our page for all stages following weight loss surgery and Duodenal Switch. However, there are endless option on the internet in Paleo, low carb, and high protein type recipes.

In the spirit of new starts and getting back on track 2017, we are having a giveaway with the basics to get back into the swing of things. This year we are looking for before and after weight loss surgical journeys.  Share your weight loss journey! Don’t be shy, your journey can inspire others and/or motivate yourself. To enter the Back on Track 2017 Giveaway, please submit your weight loss surgical journey with before and after pictures to [email protected] or you can also post your before and after pictures on our Facebook page. You will also need to sign a release for the use of your story on our website. We will draw 2 names from those that enter by announcing it on our FaceBook page or by e-mail on January 31, 2017. You must submit your mailing information to [email protected] in order to claim the prize.

give-2Baway
give-2Baway

Please check with your physician before starting a new supplement and follow laboratory studies for adjustments in supplements. Vitamin information here. Mineral information here.

Causes and Perception of Obesity

December 12, 2016 7:34 am

Introduction

Society has long ignored the scientific causes of obesity and formed their perceptions based on personal attitudes. There are a number of  factors that have been identified that contribute to the epidemic of obesity. Unfortunately, there continues to be a public perception of obesity being a “personality” disorder. Quite frequently patients are told “…just eat right and exercise, and everything will be fine.” We all know that is not the case. One of the poster presentations during the 2016 Obesity Week was on the subject of causes and perception of obesity. This topic is always an important talking point at these meetings and there seems to be some changes in viewpoint of the general population.

Title
Title

This was a large study conducted over a long time frame with a relatively decent population size.

Study
Study

The study showed a slow but steady improvement in the perception by the general population in recognizing the multifactorial nature of obesity with less personal blame on the patient. The pace of change in perception has been positive, however, there is a still large gap for improvement. There is hope for the future of a correlation of causes and perceptions of obesity.

Blame-bad-choices
Blame-bad-choices
obesity-narrative-trends
obesity-narrative-trends
blame-patient
blame-patient
IMG_5281
IMG_5281

Summary

We, as a healthcare providers and society, are making improvements in educating, awareness, and perception of obesity but we still have work to do.  In this changing healthcare environment, we can not let these gains in perception slip back to old patterns and biases. We need to maintain our diligence, education and our forward thinking to continue the positive and factual perception of obesity.

Gut Biome and Body Fat

October 06, 2016 7:02 am

gut-biome
gut-biome

The Gut Biome and body fat link continues to be an interesting and new front in the science of obesity.  Although we know more factors in obesity it has remained an elusive multi-factorial process. The following article is yet another piece of the puzzle.

Study finds link between faecal bacteria and body fat “Researchers at King’s College London have found a new link between the diversity of bacteria in human poo – known as the human faecal microbiome – and levels of abdominal body fat.
The research, published today in Genome Biology, also provides further evidence of possible genetic influences on obesity, through heritable bacteria found in the faecal microbiome.”

View the rest of the article here. The research paper here.

Our past posts on gut biome and probiotics here

Grandfather’s Obesity May Affect Grandchild’s Health

July 21, 2016 2:36 pm

A father’s metabolic health can be passed from generation to generation, affecting not only his children but more importantly his grandchildren, suggests a study. According to the study published in the journal Molecular Metabolism, parental obesity can have harmful effects on future generations. “A baby’s health has long been considered the mother’s responsibility as soon as she falls pregnant. Now, we’ve found powerful evidence, in a mouse model, that father’s nutrition and metabolic health can influence his sons and even his grandsons,” said Catherine Suter, Associate Professor, Victor Chang Institute. Read more…

Original research article here.

Photo credit: iPhoto
Photo credit: iPhoto

Shared Success Story- Heidi

June 02, 2016 7:59 am

My name is Heidi and this is my weight loss journey. I had been struggling with my weight for years and was actively researching different surgical procedures available. I was also trying everything to lose the weight on my own. My wake up call to take action was one night when my husband said, “I’m worried about you and want you around for a long time.” I knew I had to do something. If someone loved me that much I needed to love myself enough to change.

before image back
Before Duodenal Switch
before image side
Before Duodenal Switch
After Duodenal Switch Imaga
After Duodenal Switch with my beautiful son

So the very next day I made an appointment with my Primary Care Physician who recommended Dr. Ara Keshishian. That afternoon I called Dr. Keshishian’ office, scheduled a consultation and began what was about to be one of the greatest journeys of my life. I was approved within a month and ready to go.

In 2012, I had my Duodenal Switch with the great Dr. Keshishian. I was hopeful post op and determined to succeed. I knew with my husband’s and family’s love and support I could do it. I wanted to lose the weight for me, my husband and our future children so they had the healthy, happy mom they deserved. My Surgery weight was 220 ( Started at 230) I reached my goal at 10 months post op at 125lbs. Since having my DS I have had 1 (almost 2) amazing son’s. Duodenal Switch made this possible. I have my older son and I am currently 8 months pregnant with my 2nd son. Duodenal Switch did not just allow me to lose the weight that kept me from living life but it allowed me to get healthy and live life to the fullest. I am grateful everyday for my DS, my amazing husband, my boys, and Dr. Keshishian.

I am simply blessed. Would I do it again? In a heart beat.
Starting weight- 230
Surgery weight- 220
Goal Weight- 125
Current-130

Minimally Invasive Weight Loss Surgery

May 17, 2016 9:02 am

Minimally Invasive does not mean better, easier, proven outcomes or good excess weight loss. Weight loss surgical patients  should be careful of catch phrases such as “less invasive”, “simpler”, “shorter recovery”, “outpatient” and many others that had been used to  described procedures with less than optimal outcome.  We should not forget the lessons learned from adjustable gastric banding which was also promoted as  ” less invasive, simpler to perform, and be done as an outpatient with a short recovery “.  We all know how that story has panned out. The overwhelming majority of patients who had an adjustable gastric banding  have undergone revision, had it removed or had additional surgeries following the complications  which were associated with this simple procedure.

When evaluating outcome data for weight loss surgical procedures, it is important to bear in mind that the long-term success of these procedures will take years to document.  More often than not the early weight loss is significantly better than the long-term stable weight loss. This has been clearly documented in the case of the adjustable gastric banding and the gastric bypass and laparoscopic sleeve gastrectomy operation. Duodenal switch , as described by Dr. Hess using the percentage based technique, has the best long-term documented success of all of the weight loss surgical procedures.   The scientific data reports 20+ years of  successful excess weight loss with a Hess Duodenal Switch procedure.   There has been an alternative proposed to Duodenal Switch recently, the SIPS and SADI  procedures.  As I have already stated in the past, these are not the same as the duodenal switch operation.  Any suggestion or innuendos that SIPS/SADI is the same as the Duodenal Switch is deceptive and misleading.    We have also seen attempts to use the same catch phrases as described above to promote these unproven procedures. The published data that’s been reported with SIPS/SADI is mostly short-term in small population studies.  There are no long-term studies that have documented the efficacy of the SIPS/SADI procedure and “simpler” or minimally invasive does not mean better.

Enhanced Cognitive Function after Bariatric Surgery

March 18, 2016 6:51 am

The adverse effects of obesity reduce the body’s natural potential of optimal physical, mental health and cognitive function. Obesity is associated with a greater risk of health problems such as hypertension, stroke, diabetes, and sleep apnea. These issues attribute to an increased risk of dementia and cognitive dysfunction.

Glucose homeostasis plays a key role in the neural mechanisms of the brain. Insulin signals nutrients by circulating within the body in proportion to body fat mass. In addition to other regulatory mechanisms, this allows the brain to control feeding behavior by stimulating energy storage and metabolic homeostasis. Metabolic imbalances modify insulin sensitivity and lead to impaired glucose output inhibition [Qatanani and Lazar et al., 2007 (1)].

System effects of free radicals
System effects of free radicals

Free radicals are formed when weak molecular bonds are split. Their instability causes them to attack neighboring stable molecules and lead to a chain reaction of disturbing living cells. Antioxidants, such as vitamins C and E, defend the body from the damaging effects of free radicals by acting like scavengers. They protect cells from tissue damage that can potentially lead to disease.

Moreover, insulin resistance links oxidative stress, which is the continuous imbalance between free radical production and the body’s antioxidant defenses to detoxify its harmful effects. Enhanced oxidative stress is a result of accumulated fat, which impairs the secretion of insulin and damages glucose uptake in muscle and fat. Increased oxidative stress is the underlying cause of pathogenesis in vascular cell walls that lead to the development of cardiovascular problems, plaque formation. Data suggests, in a study conducted by Dr. Convit (2) in 2002, that management of blood sugar levels may enhance memory and possibly decrease the risk of Alzheimer’s disease.

In congruence with these findings, added stress due to excess weight can negatively affect the anatomy and physiology of the body. A study in 2010, led by Dr. Thompson (3), concluded that obesity is associated with “atrophy in brain areas targeted by neurodegeneration: hippocampus, frontal lobes, and thalamus” [Raji et al., 2010 (3)]. These brain regions play a critical role in the maintenance of memory, executive function, and sensory interpretation, respectively.

Central respiratory function is also disrupted by the mechanical effects of obesity. Reduced lung expansion is especially destructive during sleep. Obstructive sleep apnea is a disorder where breathing stops for brief periods because of an obstructed upper airway. Excess weight and increasing body mass index (BMI) restricts expansion of the chest wall and increases airway resistance, which decreases lung volume [Zammit et al. 2010 (4)]. This boosts respiratory muscle workload for consistent breathing. Complications of sleep apnea include fatigue, heart problems, metabolic syndrome, and more.

Cognitive impairments lead to deficits in executive function, response, reflex time, planning, and memory [Spitznagel et al. 2013 (5)]. Blood sugar levels, oxidative state, respiration and other mechanisms influence our cognitive abilities. Weight loss from bariatric surgery may reduce the comorbidities of an obese patient. The primary outcomes are improvements with diabetes, blood pressure, glucose levels, sleep apnea, BMI, and excess weight resolutions.

Schematic of how cognition is effected by obesity. Source (1)
Schematic of how cognition is effected by obesity. Source (1)

Weight loss surgery reverses the stressors of the body to permit the development and preservation of cognitive function. By improving anatomical aspects of physical health, the overall mental well-being of patients is remarkably enhanced.

A number of studies have looked at the short [Gunstad 2011(6)] and intermediate  [Alosco 2013, (7)] term improvement in memory function after weight loss surgery

Thank you to Contributor: Mariam Michelle Gyulnazaryan

References for Cognitive Function

  1. Qatanani M, Lazar MA. Mechanisms of obesity-associated insulin resistance. Genes & Dev. 2007; 21: 1443-1455.
  2. Convit A, Wolf OT, Tarshish C, de Leon MJ. Reduced glucose tolerance is associated with poor memory performance and hippocampal atrophy among normal elderly. PNAS. 2013; 100 (4): 2019-2022.
  3. Raji CA, Ho AJ, Parikshak N, Becker JT, Lopez OL, Kuller LH, Hua X, Leow AD, Toga AW, Thompson PM. Brain structure and obesity. Hum Brain Mapp. 2010; 31(3): 353-364.
  4. Zammit C, Liddicoat H, Moonsie I, Makker H. Obesity and respiratory diseases. Int J Gen Med. 2010; 3:335-343.
  5. Spitznagel MG, Alosco M, Strain G, Devlin M, Cohen R, Paul R, Crosby RD, Mitchell JE, Gunstad J., Cognitive function predicts 24-month weight loss success following bariatric surgery. Surg Obes Relat Dis. 2013; 9(5): 765-770.
  6. John Gunstad, Gladys Strain, Michael J. Devlin, Rena Wing, Ronald A. Cohen, Robert H. Paul, Ross D. Crosby, James E. Mitchell, 2011, ‘Improved memory function 12 weeks after bariatric surgery’, Surgery for Obesity and Related Diseases, vol. 7, no. 4, pp. 465-472
  7. Michael L. Alosco, Mary Beth Spitznagel, Gladys Strain, Michael Devlin, Ronald Cohen, Robert Paul, Ross D. Crosby, James E. Mitchell, John Gunstad, 2013, ‘Improved memory function two years after bariatric surgery’, Obesity, vol. 22, no. 1, pp. 32-38
  8. Furukawa S, Fujita T, Shimabukuro M, Iwaki M, Yamada Y, Nakajima Y, Nakayama O, Makishima M, Matsuda M, Shimomura I. Increased oxidative stress in obesity and its impact on metabolic syndrome. J Clin Invest. 2004; 114(12): 1752-1761.
  9. Mitchell JE, de Zwaan M. Psychosocial assessment and treatment of bariatric surgery patients. 2011;6: 103-109.
  10. Nguyen JCD, Killcross AS, Jenkins TA. Obesity and cognitive decline: role of inflammation and vascular changes. Front Neurosci. 2014; 8: 375.
  11. Chan JSY, Yan JH, Payne VG. The impact of obesity and exercise on cognitive aging. Front Aging Neurosci. 2013; 5: 97.