Story c/o The Daily Mail

The number of middle-aged men going under the knife in the name of beauty has risen by more than 140 per cent in just five years as they struggle to come to terms with “menopaunch”, reveals a new report.

Men aged over 50 are forking out as much as £3,700 and taking weeks off work to undergo liposuction and other procedures such as eye bag removal (blepharoplasty) in a bid to remove stubborn fat, according to a cosmetic surgery company.

Figures produced by The Harley Medical Group show that liposuction – including work done on the abdomen, flanks, chest and chin areas – accounted for 24 per cent of surgical procedures for 50-something men.

This was followed by blepharoplasty (21%), face lifts (14%), rhinoplasty (11%), tummy tucks (8%), neck lifts (7%), brow lifts (5%), chin implants (3%), otoplasty (2%), chin implants (3%) and otoplasty (2%).

Director of The Harley Medical Group, Liz Dale, said: “The idea of men letting themselves go with increased age is no longer accurate.

“We have seen a dramatic increase in the number of 50-something male patients coming into our clinics. Liposuction is the most popular procedure, accounting for 24 per cent of procedures amongst this group.

“Amount of fat removed can range from 50mls to three litres, or the equivalent of more than six pints.”

Surgeon Patrick Whitfield added: “Males account for a quarter of blepharoplasty procedures at The Harvey Medical Group with 60 per cent of those from the over-50s age group. In many cases, saggy skin around the eye area can add a decade onto a man.

“It’s extremely rewarding seeing a rather conservative 50s-something man, who will have often had his procedure done secretly whilst “on vacation”, bound out of the clinic after his sex-week post-operative check up with a new spring in his step and a glint in his eye.”

However, she stressed that liposuction should only be done for “stubborn fat” and was “not a quick cure for weight gain”.

She added: “Before accepting a patient for treatment, our surgeons will want to be sure that the patient has a healthy lifestyle and is fit for surgery.

“Surgeons will also want to be sure that the patient has taken measures to reduce his weight through fitness and a good, healthy balanced diet.

“Obese patients would most certainly not be operated on.”

Scientists say they may have found out why people get hungry at mealtime, why dieters who lose weight often gain it back and why certain types of stomach surgery help very obese people lose a great deal of weight.
The reason may be a hormone called ghrelin, which makes people hungry, slows metabolism and decreases the body’s ability to burn fat.
Ghrelin Levels
Ghrelin levels in the blood peak before meals and drop afterward. People given ghrelin injections felt voraciously hungry, and, when turned loose at a buffet, ate 30 percent more than they normally would.
Dieters who lose weight and then try to keep it off make more ghrelin than they did before dieting, as if their bodies are fighting to regain the lost fat, researchers are reporting today in the New England Journal of Medicine.
By contrast, the same study showed that very obese people who have an operation called gastric bypass to lose weight wind up with relatively little ghrelin, which may help explain why their appetites decrease markedly after the surgery. Sleeve Gastrectomy operations also remove the section of the stomach in which Ghrelin is produced
Below is an extract from a Scientific paper published in Obesity Surgery, Vol15, 2005
Sleeve Gastrectomy and Gastric Banding: Effects on Plasma Ghrelin Levels
F. B. Langer1; M. A. Reza Hoda1; A. Bohdjalian1; F. X. Felberbauer1;
J. Zacherl1; E.Wenzl1; K. Schindler2; A. Luger2; B. Ludvik2; G. Prager1
1Department of Surgery, Division of General Surgery, and 2Department of Medicine III, Division of
Endocrinology and Metabolism, Medical University Vienna, Vienna, Austria
Ghrelin, recently described as a hunger regulating peptide hormone mainly produced in the fundus of the stomach, is reported to be significantly increased in diet-induced weight-loss. Inconsistent changes in plasma ghrelin levels, however, were reported following different bariatric surgical procedures. Laparoscopic sleeve gastrectomy (LSG), which can be regarded as an advancement of the Magenstrasse and Mill procedure, has been introduced as the first part of a two-step laparoscopic gastric bypass in the “super-super-obese� (i.e. BMI >60 kg/m2) patients in order to reduce the perioperative risk. Furthermore, it has been applied as a definitive bariatric operation in a series of high-risk super-obese patients. Because the gastric fundus, known as the main localization of ghrelin-producing cells, is resected by sleeve gastrectomy, plasma ghrelin levels are expected to decrease following surgery. The aim of this prospective study was to determine the effects of laparoscopic sleeve gastrectomy (LSG) on immediate and 6 months postoperative ghrelin levels, compared with laparoscopic adjustable gastric banding (LAGB).
In this study in 20 morbidly obese patients, we found significantly reduced levels of plasma ghrelin following laparoscopic sleeve gastrectomy immediately after surgery and up to a period of 6 months. In contrast, plasma ghrelin was not changed postoperatively after LAGB and increased significantly after 1 and 6 months. In parallel, excess weight loss was more pronounced following LSG compared with LABG.        To our knowledge this is the first study investigating plasma ghrelin levels in sleeve gastrectomy.                                                                                                                               
Because ghrelin is supposed to be involved in the regulation of appetite, the effects of various bariatric operations on the plasma levels of ghrelin have been a focus of interest in a growing number of recentlypublished papers. While it has been shown that plasma ghrelin increases following diet-induced weight loss18 thereby potentially contributing to weight regain, the data on ghrelin after bariatric operations are inconclusive so far.
In contrast to LAGB, Roux-en-Y gastric bypass was found to decrease the plasma ghrelin level. To explain this discrepancy, it has been speculated that ghrelin-producing cells in the gastric fundus have no further contact with ingested nutrients resulting in an override suppression after RYGBP. In gastric banding patients, however, the ghrelin producing cells are not bypassed. Therefore, these cells remain to function, leading to increased ghrelin levels following LAGB, comparable to diet induced weight loss.                                                                                                          
Sleeve gastrectomy has been established as part of the BPD-DS. Only three studies of sleeve gastrectomy as sole bariatric intervention have been published so far, without focusing on changes of plasma ghrelin levels. In this series of LSG, the greater curvature and the gastric fundus as the main locus of ghrelin production were completely resected, forming a narrow gastric tube that permits oral intake of only small amounts of food. This extensive type of LSG may be understood as a restrictive procedure augmented by the reduction of the ghrelin producing tissue. While the majority of plasma ghrelin originates from the stomach, other locations of ghrelin secretion outside the gastric fundus have been reported. The restrictive effect on food ingestion after LAGB and LSG is comparable. In contrast to Adami, who found ghrelin levels following biliopancreatic diversion comparable to preoperativevalues only 2 months postoperatively, we observed no compensatory hypersecretion of ghrelin as stable low levels were found in the postoperative course up to 6 months following laparoscopic sleeve gastrectomy. This difference could be explained by the extent of gastric resection. In our series the complete fundus was resected, while the fundus was left in situ in the series of Adami
Within 6 months, LSG patients were able to reduce their weight in a more effective way than LAGB patients. In this series, LSG patients presented with higher preoperative plasma ghrelin levels compared with the patients of the LAGB group (109.6 ± 32.6 fmol/ml vs 73.7 ± 24.8 fmol/ml, P=0.005).
Postoperatively, LSG led to significantly decreased and stable plasma ghrelin levels at up to 6 months. In contrast, patients who underwent LAGB presented with significantly increased plasma ghrelin in the postoperative course. Because the restrictive effect regarding food intake is comparable between both methods, the superior effect on weight loss by LSG could be attributed to the permanently lower ghrelin levels preventing an increase in appetite as a compensatory mechanism.
In conclusion, we have demonstrated that in contrast to LAGB, ghrelin levels are significantly decreased following LSG immediately postoperatively, as well as up to 6 months postoperatively in morbidly obese patients. This is paralleled by a superior weight loss after LSG which might be related to the permanent decrease in ghrelin levels preventing a compensatory increase in hunger.
 

A recent edition of the Pretoria News featured an article on bariatric surgery, entitled “When diets and exercise fail, surgery can help”, written by Barbara Cole.

This article reported on how Natashua Fourie lost 34kg since last November, following keyhole laparoscopic surgery for morbid obesity. According to the report, the surgeons, who are authorised to perform such operations at St Augustine’s Hospital in Durban, have recorded even greater successes, including one patient who lost 120kg of weight after this type of operation.

As many Health24 readers also suffer from morbid obesity with BMIs exceeding 35, coupled with a variety of so-called comorbidities (other health conditions such as diabetes, sleep apnoea, painful joints, high blood pressure and impending heart disease), I decided to read up on the available scientific literature and to share my findings.

What do these operations entail?
Bariatric surgery involves a reduction in the size of the digestive tract to restrict how much food the patient can eat and absorb. Most of the present-day techniques reduce the size of the stomach.

For example, gastroplasty involves placing stainless steel staples across the top of the stomach, leaving a small opening so that only a small amount of food can pass into the stomach at any one time.

A gastric bypass, on the other hand, also entails a reduction in the size of the stomach (with the aid of staples) and connecting the part of the stomach that is still functioning to the small intestine (Krause, 2000).

Laparotomy vs. laparoscopic surgery
Initially, bariatric surgery always involved a laparotomy (surgical opening of the abdomen). But nowadays keyhole laparoscopic surgery, which only requires small incisions in the abdomen, has become more popular. The latter procedure is much less invasive and faster, thus exposing the patient to less risk during the operation.

In one study conducted at the University of California, researchers found that laparoscopic bypass surgery took less operation time, caused less blood loss, reduced the length of time that patients were in intensive care after surgery and the length of their stay in hospital (Nguyen et al, 2000).

An Italian study reports that, on average, laparoscopic procedures took 60 minutes to perporm compared to up to 3,5 hours for the more invasive, full-scale operations (Angrisani et al, 2007).

From the point of view of the patient undergoing surgery, it is evident that the more recent keyhole surgery techniques are faster and safer.

Can one expect the same weight-loss results?
A valid question is if the keyhole laparoscopic technique produces the same long-term results as the longer, more invasive surgical procedure.

A German research team, who studied 100 patients who underwent laparoscopic adjustable gastric banding, found that this procedure produced excellent results with an average weight loss of nearly 60% eight years post-operatively with reductions in BMI from 46.8 to 32.3 kg/m (Weiner et al, 2003). These researchers concluded that laparoscopic adjustable gastric banding is safe and has a lower complication rate than other bariatric operations.

Nguyen and coworkers (2000) also concluded that the keyhole technique produces the same initial weight loss as the more invasive surgical procedure.

Thanks to progress in the field of bariatric surgery, the keyhole operation appears to be faster and potentially safer than techniques that require full-scale opening of the abdomen, and this newer approach apparently also gives good weight-loss results.

According to the newspaper report, Natashua Fourie, who shed 34kg, was treated with the keyhole procedure. Her mother and a friend had the same operation and lost 29kg and 25kg, respectively.

Who qualifies for bariatric surgery?
In my reading of the scientific literature, a number of authors repeatedly stated that “bariatric surgery is NOT to be regarded as a cosmetic procedure, but as a life-saving intervention in patients who suffer from morbid obesity.”

It is very important to understand that individuals who only need to shed a few kilos or who have a BMI of less than 35 are usually not regarded as candidates for bariatric surgery. In fact, the majority of studies I investigated were treating patients with BMIs exceeding 40!

If your BMI is lower than 40, surgeons may, therefore, only consider you as a candidate for bariatric surgery if you have severe comorbidities such as diabetes mellitus, very high blood pressure or raised blood fat levels, and if you are at risk of suffering a heart attack.

In most cases, the decision to do a gastric bypass operation is determined by its effect on potentially life-threatening obesity and other risk factors.

If you do not suffer from morbid obesity and accompanying life-threatening conditions, then most surgeons would recommend that you use diet and exercise, plus medications such as Xenical, to lose your excess weight. COSMETIC BLISS NOTE: The insertion of a BIB Intragastric Balloon for candidates with a BMI which is not high enough to justify surgery is proven to give good weight loss results, and can be seen as a very useful tool in giving a six month “training period” in which eating habits and the relationship to food can be permanently changed.
Read the full story at
http://www.health24.com/dietnfood/Weight_Centre/15-51-2992-3081,41241.asp

Extremely obese people suffering from depression or anxiety tend to lose less weight after obesity surgery than mentally healthy people, researchers reported in a study that suggests such patients could benefit from treatment beforehand.

People diagnosed with mood or anxiety disorders on average lost 81 pounds six months after gastric bypass surgery compared to their counterparts who shed 86 pounds. Although both groups lost significant weight after surgery, people without mental health problems did slightly better. Researchers plan to follow patients for up to two years to determine if there’s a weight difference over time.

Many hospitals and insurers require surgery candidates to go through a psychological evaluation before obesity surgery to make sure they are mentally fit for the operation and the lifestyle change afterward. Depressed people aren’t automatically disqualified for surgery, but those who are suicidal or abusing drugs and alcohol are usually ruled out.

How depression and other mental health disorders are handled before obesity surgery vary widely by medical center.

Those with serious problems are usually treated before surgery. That could include antidepressants, psychotherapy or more family involvement, said the center’s director William Perry.

In the new study, Pittsburgh researchers interviewed 207 surgery candidates and found two-thirds had a history of depression, bipolar disorder, post-traumatic stress syndrome or panic attacks. The vast majority were women with an average body-mass index of 51. A person with a BMI of over 40 is considered morbidly obese.

After adjusting for age, gender and race, researchers compared weight loss six months after surgery. Patients with a history of depression on average weighed 322 pounds before surgery and 241 afterward. Those with no mental health problems weighed 303 pounds before the operation and 217 pounds afterward.

Having a history of mental health problems should not prevent people from getting obesity surgery, even though they may not lose quite as much weight as mentally healthy people, said Dr Philip Schauer, president of the American Society for Bariatric Surgery.

23rd July 2007
 

NHS doctors are increasingly under pressure to perform cosmetic surgery for women unhappy with their looks.

New research reveals that surgeons are being cajoled into offering patients thousands of pounds worth of treatment they do not need. It exposes the lengths to which some women go to persuade surgeons to operate on them for nothing – using ploys such as unflattering make-up and clothing.

The study, to be published in the British Journal of Plastic Surgery, finds that surgeons are turning a blind eye to health authority guidelines, justifying the use of treatments only in ” justified cases” because of pressure from patients.

The research team, led by Professor Peter Salmon of the University of Liverpool, found that some surgeons agreed to operate – despite knowing there were no medical grounds – because they could not face the time and misery involved in turning patients down.

The report describes a case in which a 37-year-old woman who demanded breast implants was referred to a psychologist and a psychiatrist, who both concluded she did not need them. Despite this, the surgeon went ahead. Another 27-year-old woman who demanded breast enhancement became so distressed when told a psychologist thought it was inappropriate that the surgeon caved in.

The Department of Health says it is up to health authorities to enforce their own guidelines to prevent overspends.

The top 10 most requested cosmetic surgical procedures on the NHS are
1: Tummy tucks
2: Mole removal
3: Breast enhancement
4: Scar removal
5: Nose job
6: Breast reduction
7: Acne scar removal
8: Correcting breast asymmetry
9: Ear pinned back
10: Removal of bags under eyes

The report states: “Surgeons described feeling pressurised by some patients’ emotional and insistent presentations, and believed some patients contrived their presentation in the attempt to elicit a surgical decision.”

I’ve been banded for almost four years now and have always been very happy with my band. I had never been able to lose weight on diets, but with the band the weight came off quite easily. Everything seemed to be going so well, after about the first two years I almost sort of *forgot* about the band on a day to day basis.

HOWEVER, I recently realized that it is important not to become complacent about the band!  Just a few days ago, while having lunch, I noticed that I had suddenly lost ALL my restriction, and it scared me because I knew that it had to be some kind of band problem with such a sudden onset.
Yesterday, I finally had an upper GI test done, and it turns out that I have a dilated pouch. Believe it or not, I was actually HAPPY to hear that news, because I was relieved that it was a problem that can be corrected without surgery.
My surgeon simply took all my fill out for two weeks to help my pouch shrink back down to proper size. I’m trying to give my band/stomach a break by trying to stay on liquids and soft food for that time period (plus I find it hard to eat enough liquids to pack on weight than I would if I were on solids, which is obviously a big concern while my band is empty!).
At the end of these two weeks I will hopefully be able to get a fill again.
I still feel the lap-band complications are not that bad compared to how bad things can get with a gastric bypass operation. One thing I found comforting
when I first realized something was wrong with my band but didn’t know what was going on was that, no matter what was wrong with my band, I knew it wasn’t something that truly posed a danger to my life or health.

Now, more than ever, from seeing how my urge to eat excessively has come back in full force since I lost my restriction, I understand that morbid obesity is not just a personality flaw or a lack of control, but a disease that needs to be treated by surgery.
However, even if I had to lose my band, I would seek out a surgeon to do the Sleeve Gastrectomy operation, rather than getting a bypass.

The sleeve gastrectomy seems to be becoming more popular nowadays.
Back when I was looking into weight loss surgery (which was only about five years ago, remember), nobody was even talking about the Sleeve gastrectomy as an option. My choice was basically between the lap-band or one of the drastic, risky bypass procedures (the RNY or the Duodenal Switch).
Back when I first started looking at weight loss surgery, I was rapidly soaring towards 400 pounds, and I knew I had to do SOMETHING to put an end to the madness. If the lap-band hadn’t been around at that time, I probably would have resorted to a bypass operation out of desperation back then. However, I’m only in my early 20s, so I would not have been very happy about having to condemn myself to live out the rest of my life (hopefully 50+ years!) with constant malabsorption of nutrients and vitamins. I don’t think that’s a healthy way to live in the long-term even though in some cases it may be necessary as a last resort for someone whose obesity will kill them soon.

So, even *if* I had to lose my band at this point or somewhere down the road, I’d be grateful for these years of service it provided me with, because it saved me from having to get a bypass operation back then when the bypass was pretty much the only option, and now we seem to have other promising options like the Sleeve gastrectomy that don’t require a drastic malabsorption component like the bypass does.
It’s amazing how much the weight loss surgeries have changed in just these past 5 or 10 years. In another five or ten years, who knows how many other major
changes might happen in the field? So, for that reason, I definitely am glad to have an option that is effective, but also relatively “gentle” and easily reversible, even though the trade-off is that we occasionally have to worry about issues like slippage/erosion.
http://www.lapbandtalk.com/f78/my-dilated-pouch-story-why-i-still-love-my-band-regardless-33335/
 

By Megan Rauscher – Scientific American June 18 2007

NEW YORK (Reuters Health) – Seriously overweight people who undergo gastric bypass surgery to shed pounds should try to make as many scheduled post-op doctors appointments as possible, according to a new study. It shows that follow-up care is a key component of the long-term success of the weight-loss surgery.
With gastric bypass surgery — the most common method of “bariatric” surgery — surgeons reduce the size of the stomach, which substantially limits the amount of food a person can eat.
“Weight loss following gastric bypass varies from patient to patient,” note Dr. Jon C. Gould and colleagues of the University of Wisconsin in Madison in a report to the annual meeting of the American Society for Bariatric Surgery. Continued and long-term follow-up care at a dedicated bariatric surgery clinic may impact the amount of weight that is lost, they add.
The investigators took a look back at 85 adults who had gastric bypass surgery at their center and found that the results were best in those who attended follow-up appointments for at least 3 years after they had the surgery.
Patients who attended every scheduled post-surgery follow-up appointment for 3 to 4 years lost 74 percent of their excess weight, whereas patients who kept every appointment for only 1 year lost 60 percent of their excess weight. Patients who missed appointments in the first year lost 56 percent of their excess weight.
“Our follow-up routine calls for visits at 2 weeks post-op, 6 weeks post-op, 6 months, and then annually after surgery indefinitely,” Gould noted in a telephone interview with Reuters Health. “If we identify problems, we bring people in more often.” The follow-up visits include meeting with a dietitian and medical health professional and often a health psychologist.
The most common reason given for missing scheduled appointments after gastric bypass surgery was lack of coverage by the patients’ insurance company.
“This study shows that the more you put into bariatric surgery, the more you get out of it,” Gould said in a written statement. “Patients must continue to attend their bariatric medical appointments and insurers should provide coverage for these visits.”
In 2006 an estimated 177,600 severely obese people in the United States had bariatric surgery, according the American Society for Bariatric Surgery estimates. About 15 million or 1 in 50 adults in the US have morbid obesity, which is associated with a number of other diseases and conditions including type 2 diabetes, heart disease, sleep disturbances, asthma, cancer, and joint problems.

Source: scenta  Date Published: July 04, 2007

Moisturisers and cosmetic surgery may now be left in the past as a compound in elderberries could potentially give a natural boost to the skin.

University of East Anglia (UEA) researchers, in conjunction with the Institute of Food Research, will further explore the benefits of the compound that also gives the berries their vibrant colour, known as anthocyanin.

In a 12-week trial starting in September, post-menopausal women will consume either extracts from elderberries or placebo capsules, and will have their skin’s structure and appearance measured with state-of-the-art equipment used by experts in skin science.

At the same time, researchers will also test whether the elderberry extract can reduce risk factors for heart disease.

Skin benefits of a healthy diet
Dr Peter Curtis from UEA, one of the leaders of the project, said: “We already know that a healthy diet can help protect against heart disease and skin damage, and that a mixture of similar food components have been shown to improve the skin’s structure.

“There is also evidence that the active components have anti-inflammatory properties, which may be important in helping people stay healthy.

“If the results of our study are positive, it may lead to innovations in skin health products and may also give us vital information about diets which promote healthier hearts,” Dr Curtis added.

The study will be carried out by a team of researchers led by Professor Aedin Cassidy at the University of East Anglia and Dr Paul Kroon at the Institute of Food Research.

GMTV    20 June 2007

Should Jemma Butler be allowed to have her stomach stapled? Tell us your thoughts here
Jemma Butler is only 25, but already weighs 32 stone and is desperate to lose weight. Two years ago she was told she only has 5 years to live, but her local NHS trust has refused to give her the stomach stapling operation she thinks will save her life. 

Jemma, aged 25 struggled with her weight since childhood and all through her teenage years.  Things came to a head about five years ago after a work-related injury.

She sunk into a deep depression, comforting herself with food.  Her weight ballooned to 30 stone, and in 2005, her doctors told her she had 5 years to live. Emma was on anti-depressants and had become increasingly isolated as her weight had increased.

She asked doctors to put her forward for a stomach stapling operation, and went on the waiting list.  After almost 2 years, she got a letter in November ’06,  telling her telling her she’d be removed from the waiting list, as she didn’t meet Health Commission Wales’ strict criteria for stomach stapling operations. 

Although her BMI is 70, she wasn’t suffering from the complications of obesity – heart disease, diabetes, sleep apnoea – and therefore didn’t qualify for surgery.  She appealed the decision, but in March 2007, she lost. 

She definitely considers herself an addict, although she’s finally trying to do something about it – she weighs somewhere between 32-33 stone, though she says she has lost some weight, as she’s been on a diet for 6 months.

Her doctor feels frustrated that she’s being denied the surgery. It would allow her to re-build her life, return to work, and reduce her chance of developing other complications.

More on http://www.gm.tv/index.cfm?articleid=26183

Story courtesy WOAI.com    Jun 23, 2007

More men are turning to botox injections.
For years women have turned to doctors to help them turn back the hands of time and now more than ever before, men are doing it too.
“We’ve seen a dramatic increase in the number of men coming in for both surgical and non-surgical procedures. I’d say we’ve seen about a 20 to 30 percent increase in the last two years,” said Dr. Matthew Mingrone, plastic surgeon.
People like Lawrence Deritis are having procedures.
He is 60-years-old.
“I want to look as good as I feel, so that’s important to me,” said Deritis.
He’s had a hair transplant and an eyelid lift to eliminate droopy eyelids.
Now he’s getting botox injections to soften wrinkles around his eyes and forehead.
“Their goals tend to be ‘I want to look vibrant, I want to look young and energetic because I have to compete with 20 and 30-year-old men now,” said Dr. Mingrone
Deritis spent more than seven-thousand dollars on cosmetic procedures and believes they’ve helped him look at least seven years younger.
He also encourages other men to investigate their age busting options.
“I get guys that look at me and go, ‘God I hope I look as good as you do when I get to be your age and I go, you can,’” said Deritis.
The American Society of Plastic Surgeons reports men had one-point-two million cosmetic surgery procedures in 2005.
The most popular procedures were liposuction, nose jobs and eyelid surgeries.