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Tag: weight loss

Weight Loss Injection

May 10, 2023 1:06 pm

Semaglutide (Ozempic, Rybelsus, Wegovy, Saxenda) and tripeptide (Mounjaro) treat type II diabetes. They work thru several complex pathways. An observed side effect that has been noted in diabetic patients has been weight loss.

Some have been advocating using the class of medications for weight loss. However, Wegovy is the only medication approved for weight loss in non-diabetic patients.

There is a lot to be discussed here:

1-the use of the medications for weight loss is an off-label use (except Wegovy)- meaning that the FDA did not approve the medication as a weight loss drug.

The practical implication is that the medication’s safety and complication profile in non-diabetic patients looking to lose weight may be unknown and has not been studied.

2-The medication has become available thru compounding pharmacies. It is crucial to appreciate that compounding medications do not meet the same rigor and standards and may, in fact, not be the same formula as the FDA has stated.. This also means that a compounding pharmacy does not approve the medications in several states.

3-The most critical issue for me is the lack of a “long-term plan.” It is not clear what would happen when the patient stopped the medication. Will the patient experience weight regain? Will the patient require higher doses of the medication to maintain the weight loss, or will the medication stop working altogether? Unfortunately, we do not have these answers. For those skeptical about my questions, let me remind you that phentermine has significant side effects, and almost all patients experience weight gain when they have to stop the medication because of the cardiovascular complication of medication.

Physical Activity in US

November 28, 2020 1:41 pm

Physical activity in the U.S. varies based on geographic location, socioeconomic status and in comparison to other countries. It is important to know that physical activity is an important component of our well-being. However, this does not mean that going to the gym is the only way to be physically active.

Strain et al. Shows that different populations in different countries get their activity from different sources.

His research showed that the United States population ranked as a high-income country, ranks in the lower 1/3 of the number of countries surveyed with regards to the meeting minutes of moderate-to-vigorous physical activity (MVPA) per week.  This may be a contributing factor to the significant rise in obesity in the United States. Individually we should all aim to increase our moderate to vigorous activity significantly.

Gastric Balloon

March 12, 2019 9:10 am

Here we go again…. There is a new cure for obesity, Gastric Balloon, with minimal to no risk, is an outpatient procedure and/or can be done in the surgeons office with no anesthesia. Have we not similar claimed like this before (Adjustable gastric band) ?

Randomized sham-controlled trial of the 6-month swallowable gas-filled intragastric balloon system for weight loss published  in Surgery for Obesity and Related Diseases 14 (2018) 1876–1889, by Sullivan et. al  reports

“Conclusions: Treatment with lifestyle therapy and the 6-month swallowable gas-filled intragastric balloon system was safe and resulted in twice as much weight loss compared with a sham control, with high weight loss maintenance at 48 weeks.”

This sound very promising, however is very vague and leaves out significant, critical, and pertinent information.

The outcome of weight loss at 24 weeks was reported in Total Body weight loss % (TBWL%), Excess weight % (EWL), weight loss, and BMI change. Of those, the last three were statistically significant changes.

The outcome the weight loss was reported to be at 7% TBWL% at 24 weeks with some weight regain, with the patient employing post REMOVAL life style changes.

It is stated that the Gastric Balloon is temporary device that needs to be removed in 6 months and should  be considered in low BMI patients (<35kg/m2).  It is is important for those patients who are considering this temporary expensive measure for minimal weight loss to entertain the alternative of the same temporary results that may be obtained by lifestyle changes. These results may be maintained by a healthy lifestyle, exercise, and eating without the need for a device.

Liver Injury and Obesity

April 30, 2018 11:36 am

Liver is a vital organ. It has many roles in the physiologic pathways including protein productions, clotting function, iron metabolism, production of bile and cholesterol, etc. as well as metabolism and filtering of waste products. We should think of it as a refinery, for conversion of raw material from food to energy used by our body, in addition to a processing and distribution center for mineral, and nutrients. Liver injury can have devistating effects and long term ramifications if unchecked.

Liver is also very resilient and forgiving to stressors and injury. The liver will tolerate repeated insults caused by Medication (both prescription and over the counter) , obesity, Diabetes, alcohol, and herbal supplements, to name a few, but only if care is taken and the offending stressor is removed. During the injury phase, however, the liver may have a difficult time keeping up with bodily function needs due to loss of fully function cells.

The anatomy of liver can change from normal (both visually to the naked eye and under microscope) to mild inflammation and reverse back to normal if the underlying causes of injury are removed. IF, however, the anatomy of the liver changes with fibrosis, it crosses to an irreversible range where it can only be prevented from progressing rather than reversing.

Stages of Liver Injury and Fibrosis
Stages of Liver Injury and Fibrosis
Liver Injury and Obesity
example of liver fibrosis
Liver Injury and Obesity
example of liver fibrosis

In the obese population, Non-alcoholic Fatty Liver Disease (NAFLD) causes inflammation and a slowly diminishing functionality of the liver. NAFLD is the leading cause of liver disease in the U.S. Unchecked or untreated NAFLD can progress to NASH (Non-Alcoholic Steatohepatitis. NAFLD, or “fatty” liver disease, is an accumulation of fat within the liver. NASH is a progression that can lead to inflammation of the liver cells or advance to fibrosis and cirrhosis. In addition to liver injury, there is some evidence that NAFLD also correlates with cardiovascular disease.

Causes of NAFLD:

  • Obesity
  • Type 2 Diabetes Mellitus
  • Hypertension
  • High cholesterol
  • Sedentary lifestyle

Symptoms may include fatigue, right upper quadrant pain, and liver enzyme elevation.

During bariatric or weight loss surgery, we visualize and occasionally biopsy the liver to define the degree of injury, if identified. Following weight loss surgical procedures, a rise in liver function enzymes may be expected due to the processing of waste products following fat mass loss. However, long-term bariatric procedures can significantly improve NAFLD and NASH. Bariatric procedures require adherence to protein and supplement requirements and regular physician visits—the past blog of liver disease.

Weight loss surgical procedures improve liver function abnormalities.

Exercise Benefits & Events

August 09, 2016 2:25 pm

Exercise and it’s benefits for body, mind and weight loss can’t be over emphasized. Everyone can benefit from some form of exercise whether it be a brisk walk, chair exercises, exercise bands, aquatics, running, hiking or biking. As a family we try to exercise often and attempt to participate in at least one event a month or so.  These types of events tend to keep us more accountable and motivated.  The group atmosphere, energy and vibe only add to the experience. Listed below are some of our favorite exercise events.  We will update this list and add to it.

Physical Benefits:

  • Weight loss and maintenance can be a benefit of exercise. It also improves muscle function and strength.
  • Improves Type 2 Diabetes and Metabolic Syndrome
  • Reduces some Cancer Risk
  • Improved Cardiovascular Health
  • Improved “Good” cholesterol
  • Strengthens and improves Bone Health
  • Living longer
  • Improved Sleep

Mental Health Benefits:

  • Reduce Stress
  • Boosts Endorphins
  • Helps with Anxiety
  • Improved Self Confidence
  • Being in the Great Outdoors and Sunlight (increases Vitamin D)
  • Prevent Cognitive Decline
  • Sharpen Memory and Cognitive Function
  • Help with Addiction
  • Increase Relaxation

One important key note is to pay close attention to hydration with exercise, not only with fluids but electrolytes as well. Exercise increases fluid loss due to sweat and increase circulation to muscle.  You need to increase fluid intake to compensate for these losses.

Exercise events by the month:

June

The Los Angels River Ride is one of our families favorites.  Great ride for a great cause.

August

Luau 5K walk and fun run This is a fun family activity as they have a kids run and lots of activities.  It is also in Griffith Park which is a beautiful and treasured location.

September

The Prudential 401K Run is to promote saving for retirement and is a FREE event at the beautiful Rose Bowl

October

The Aloha Run brings a little Hawaiian feel to the fall.

JDRF One Walk fighting Type I Diabetes

November

City of Hope’s Walk for Hope 

December

Santa to the Sea (must bring a gift for a child)

Varying months depending on location:

Race for The Rescues

Walk from Obesity

Step Out Diabetes Walk

Get your Rear in Gear to fight Colon Cancer

CicLAvia a Los Angeles area quarterly biking event.

First Duodenal Switch Patient- Dr. Hess

April 05, 2015 3:35 pm

I had the opportunity to be in a meeting with Dr. Hess in November of 2004. He presented a lecture about the history of the Duodenal Switch and his collaborative work with Dr. Scopinaro, the pioneer surgeon of the Biliopancreatic Diversion. The BPD was the the foundation of the Duodenal Switch operation.  The first patient ever to have had the Duodenal Switch was a revision from a failed vertical banded March of 1988 by Dr. Douglas Hess.  At the time of this particular meeting (in 2004), the patient was 17.5 years post op.

Hess
First Duodenal Switch Patient by Dr. Hess

This is a copy of the slide that he shared with the surgeons present at the Duodenal Switch meeting  on November 21, 2004.