Best Syndication, 22 March 2009

It is not easy to lose weight. There is no facile way, they all require lots of good will, self-abnegation and patience. The result is well worth it, though. Being slimmer means better health, easier moving, higher self-esteem, not to mention great look.

People who lost a lot of weight might find it difficult to deal with it afterwards. Extended skin is the major problem. It is too loose after having lost serous weight. Also fat deposits are visible in some places.

Losing weight, no matter if through exercising, diet or cosmetic surgery, is only the first part of all the changes.

Unfortunately there are no exercises which would bring loose skin back to its “normal� state. Cosmetic surgery brings hope, though. It can give you the body you’re desperate to have.

There is a selection of possibilities to remove loose skin and fat deposits, tighten muscles and give the good-looking body contours. It is the final step in the weight-loss procedure.

A tummy tuck (or abdominoplasty) is a procedure that tightens the skin and supporting tummy muscles; it also removes fat deposits.

Buttock fit refines the shape of the buttock area in order to eliminate fat.

Tight lift is usually performed on the inner tights. This is where stubborn fat tends to sit.

Liposuction is a procedure where a small stainless tube is used to collect fat that sits under the skin.

Breast lift is needed when lots of weight has been lost and then the breasts look unattractive. The procedure can bring them to the correct position. Also men can undergo this operation if they’ve got extended and saggy skin in the breast area.

Body contouring can be a combination of the above procedures. Cosmetic surgeon will analyse the body to see what’s needed.

WCBS-TV New York, 16th March 2009

In general, patients who underwent gastric bypass surgery lose unwanted weight (typically 60 to 70% of the excess weight) and stop suffering from obesity-related diseases. A few years after the procedure, though, something might change and those patients need more help.

Tammy Blakeney had a weight-loss operation ten years ago, when she was 30. She weighted 400 pounds and had problems with blood pressure and sleep apnea. What’s more, in her family there was a history of heart disease.

The surgery worked well for Tammy for both reasons, weight-loss as well as health issues. She lost 100 pounds in four months after the surgery, and after a year she lost another 100 pounds. She started feeling the difference: the sleep apnea stopped after she lost about 80 ponds, also her blood pressure came back to normal.

A few years later, though, Tammy started to feel something changed. She started putting on weight again, as she lost the feeling of being full after only a small portion of food, her body couldn’t absorb minerals and had other indestinal diseases.

The reason of the problem wasn’t that she was overeating but that her internal anatomy had changed.

“In some patients the actual outlet does enlarge. In some patients the pouch enlarges, and in some patients there’s really not a significant anatomical change, but there’s a functional change. In other words, where there used to be scar at the outlet, that scar’s gone away and there’s nothing to keep things in the pouch,” said Dr. Mitchell Roslin of Lenox Hill Hospital.

Gastric bypass surgery consists on forming a small pouch of the stomach which is attached to the small intestine so that there’s less chance to absorb calories.

There is chance that the pouch or the opening enlarges with the time. That’s when patients lose the feeling of being full so quickly and food is being transferred undigested into the intestine.

To cure this situation a lap-band, an inflatable and adjustable donut. It can constrict the pouch and the opening to start losing weight again.

“And I’m losing weight again. I’ve lost over 70 pounds. I have more energy. I’m able to work out. Good thing, it’s a good thing,” Tammy said.

Looks like there is a new way of weight-loss.

Carol Poe, a 60 year-old mother-of-two, tried everything to lose weight. She tried dieting, exercising, batriatic surgery. These methods were not effective and Carol decided to undergo the most radical treatment – brain surgery.

She was desperate to lose weight. At her heaviest, she weighted 490 pounds, and, as she says, she provoked constant interest in every aspect of her life.

Mrs. Poe, after having tried every possible way of losing weight, knew her problem had to be connected with her brain.

She is the second person in the USA to have deep brain stimulation for weight-loss. There are parts of the brain that control specific behavior. “So what they’re going to do is … insert needles into the part of my brain that controls the food,” said Carol. “And then they’ll put wires underneath my scalp, and it’ll go down on each side of my clavicle, [where] I’ll have a battery pack.”

Deep brain stimulation is successful in Parkinson’s disease ad epilepsy by eliminating or reducing the tremors and ticks. It influences behavioural problems such as obsessive compulsive disorder and depression, and now also weight-loss.

Dr. Julian Bailes from West Virginia University says the new procedure is not for overweight but for obese patients. He reminds this disease reduces life expectancy of 20 years and is associated with other diseases such as diabetes or heart disease.
Dr. Bailes stresses that only patients who went through every other treatment, including weight-loss surgery, qualify for the study. Before the procedure, all patients have a detailed psychiatric evaluation.

“She has a good profile,” Bailes said of Poe. “She’s failed the best surgery that we know of, which is gastric surgery. … So I think it is the best chance for them, for her.”

Obviously, there are risks associated with the surgery. The minor problems might be infections or hemorrhaging but patients might also be paralysed or even die.

Carol was awake during the surgery as there are no pain receptors in the skull or brain, and only a topical anesthetic wash was applied to her scalp.

The surgery was carried out by Drs, Michael Oh and Donald Whiting. They drilled about 10 cm into Carols’ brain on both hemispheres, making sure they only affect hypothalamus that is associated with stomach. Then, they introduced a wire that carried an electrical impulse. The aim was to alter the level of electricity giving the patient the feeling of being full.

Dr. Oh followed the surgery on a computer to help find the point where to introduce the electrodes.

Carol said the surgery did not hurt. During the procedure doctors asked her if she felt hungry or full and if she was cold or hot.

The operation lasted three hours. Carol stayed in the hospital for a few days. Three weeks after the operation, the voltage going into her brain was turned on and increased over time.

Doctors say, there won’t be noticeable changes in Mrs. Poe’s weight until several months have passed. But a month after the procedure, she already lost three pounds.

Carol has to keep a detailed record of what she eats and drinks every day so that doctors can see her progress. If it proves to be an effective method of weight-loss, it might become widely available.

NHS Choices, 3rd March 2009

Experts say obese children should be given possibility to beat diabetes by undergoing gastric banding procedure. Also paediatricians are of the opinion that more radical treatment in this matter is needed from NHS, otherwise the children will suffer serious health problems in the future.

In the recent studies a group of 73 teenagers took part. The studies were carried out by Dr. J. Shields and colleagues from the Royal College of Paediatrics and Child Health in London, the University of Birmingham, the University of Bristol and the Bristol Royal Hospital for Children. All patients had type 2 diabetes and were treated in a variety of ways, such as medicines, diet, physical exercise to lose weight and diabetes. Many patients gained weight rather than lost it which shows ineffectiveness of the treatment.

Weigh-loss procedure was not object of the research. Only one obese child, who failed medical treatment, waited for the operation.

Initially, the patients went through monthly surveillance of paediatricians. They were carried out by the British Paediatric Surveillance Unit to identify cases of diabetes.

Information about diabetes was collected: the type of diabetes, details of diagnosis, family history, BMI (body mass index), etc. A year later a questionnaire with questions about insulin, blood glucose, height, weight and comorbidity was sent.

In the report the information about the weight, height and blood pressure was included, and how they changed over the year.

At the beginning of the research, the average age of the patients was 13.6 years. The average BMI was 32.5.

A year afterwards, the patients gained an overage 3.1 kg. 67% of the teenagers managed to reduce their BMI. Only 11 children (15%), though, managed to lose some weight.

At the beginning of the study 47% of the patients were treated with Metformin, while 17% changed diet and lifestyle. A year later, only 8% of the children continued the diet, whereas 61% started receiving Metformin.

No improvement in the BMI was reported with the group who kept diet. Only 58% of the adolescents improved their blood glucose level.

The report of the study says that the BMI does not improve much after the medical treatment of the type 2 diabetes and that “overall change in BMI in the group was disappointing, given that lifestyle modification is central to the management of type 2 diabetes.

According to the researchers, the study shows weaknesses in the way children with diabetes are treated in the UK. Also “given the increasing prevalence of type 2 diabetes in paediatric practice, these poor weight-management figures and evidence of poor metabolic control indicate an urgent need to develop specific strategies to deal with this relatively new patient group�. These strategies should feature “culturally sensitive lifestyle and behaviour changes as the cornerstone of therapy�.