Lite & Smart DIMENSIONS™ Patient Blog

Vital Signs. You can be sure these standard measurements of our most basic body functions (body temperature, pulse rate, blood pressure and respiratory rate) will be taken on just about every visit you pay to a physician. And with good reason. These metrics tell your doctor a lot about your overall health. If you’re body temperature is high, it may be the sign of an infection that needs further investigation. Or perhaps your blood pressure is creeping up, signaling issues with your heart that should be looked into. No matter the outcome, these vital sign metrics have become the standard of care because we KNOW they’re important in assessing human wellness. With that understanding in mind, I offer that BMI–a measurement for body fat based on an individual’s weight and height, be added as a standard “vital sign” measurement.

Time after time, science has studied and proven that the greater the BMI, the more at risk an individual is to a host of medical problems including diabetes, cancer, heart disease, stroke, depression, and the list goes on. Given these facts and proven studies, it seems appropriate, even essential to add a BMI measurement to a patient’s overall health assessment. So why don’t more doctors’ offices do it? Well, the answers can be complicated and varied but among the most common: Fear of offending patients.

You see, we doctors are people too. Most of us don’t set out to be offensive, it isn’t in our nature. For some reason, many have tied the overweight/obesity conversation to an uncomfortable, off-limits topic. As a physician who has cared for severely obese people during the majority of my surgical career, you could say I’ve learned how to talk to “them.” The secret to this skill? I talk to patients who are overweight and obese the way I talk to ANY other patient–with candid dialogue that includes listening, compassion and respect. It’s really that simple.

Adding BMI to a patient’s vital signs assessment removes the stigma from the conversation. Like blood pressure and heart rate, it simply becomes another important measurement that addresses overall health and allows physicians and their patients to openly converse about the topic of obesity. This way, it isn’t the physician assessing a patient based on the visual of their size, but rather the meaningful metric that indicates further medical investigation and treatment may be necessary.

If you’re overweight and wondering whether it’s affecting your overall health, talk to your doctor. Don’t wait for him/her to start the conversation. Doctors are on the right path to opening up to the obesity conversation with patients, but it can still be a delicate subject for some. Patients and physicians working together to create healthier lives is what medicine is all about. And we all have a responsibility to make that happen–guaranteeing our next generation of doctors and patients has open and honest dialogue about obesity as soon as signs present it as a potential health risk. The sooner, the better.

Most men and women suffering from obesity know how it feels to be judged by their physical appearance. The self-hating commentary coming from within many obese men and women is often repeated by the outside world. (more…)

Though bariatric surgery isn’t new to the weight-loss discussion, I still find the perception of it among the public remains fraught with misconceptions and misguided information. And of course, the main- stream media can sometimes seem to help and hurt the flow of accurate information on the subject, all at the same time. There have been plenty of news stories to demonstrate this in recent months. From news of the Journal of the American Medical Association (JAMA)-published study confirming bariatric surgery as having a positive effect on the reversal of type 2 diabetes to other reports of local weight-loss surgery programs accused of deceptive tactics that have allegedly lead to health complications and even deaths, the ping pong effect of information can leave many prospective patients simply standing still, scared to move in one direction or the other. Since our practice prides itself on accurate information and full-disclosure, I think this is a perfect place to shine a spotlight on some common myths and misconceptions in an effort to set the record straight.

Myth #1: Bariatric surgery carries a higher risk of death than any other surgical procedure. Sometimes, the media plays on our biggest fears in order to get attention and this is a myth that I want to dispel first and foremost. The truth is: every surgical procedure carries risks and sometimes, those risks can include death. But to suggest that bariatric surgery is “the riskiest” procedure out there is unreasonable. With most surgical procedures, risk is relative, meaning risks can increase or decrease based on many factors including a patient’s previous health history or the surgeon’s skill and track record. A prospective patient also needs to balance the risk of surgery with the risk of doing nothing or continued attempts at efforts that fail. Because there is also plenty of research to suggest that being more than 100 pounds overweight carries risks for many health conditions that can often result in premature death.

Myth #2: Traditional dieting and exercise programs work just as well as bariatric surgery. For few people, significant weight loss that can be maintained for five or more years is achievable through traditional dieting and exercise. But for those who are 100 pounds or more overweight, clinical studies have proven that traditional methods for keeping the weight off five years and longer is only successful in two percent of this population. For those who are 100 pounds or more overweight, bariatric surgery when coupled with a strong commitment to a healthy lifestyle has a five-plus year post-op success rate of 60% and up to 80% with the gastric bypass procedure.

Myth #3: All bariatric surgery programs are the same. A bariatric surgery program really isn’t a “thing.” Rather, it’s a group of highly-trained surgeons, clinicians and other caregivers who provide a specific type of service to a specific type of patient. That means–it’s made up of people. From program to program, those people have different sets of experiences–from the medial schools they attended, to the programs that trained them and the number of procedures they have performed, every program has a unique mix of these important attributes. Knowing what to look for in each is a critical factor in making the right choice as a patient. A good list of questions to ask and answers to look for can be found here.

As most everyone has a strong opinion about the topic of weight-loss surgery, making informed and well-guided choices is an important factor for prospective patients. If you or someone you know is “riding the fence” on their decision, unable to separate the fact from fiction in the bariatric surgery discussion, please point them to this post. We also offer informative support and information sessions where a wealth of factual clinical information is presented and actual patients discuss their experiences. You can find information about these sessions here.

As I surgeon, I’m often fascinated and sometimes disheartened by the lack of empathy some patients receive from others (medical professionals, colleagues, family members and friends) when it comes to their decision to undergo bariatric surgery. Yes, as with any surgical decision, bariatric surgery has risks. But when I think about all of the procedures available today for the many conditions that can potentially threaten our lives, I’m left wondering how much the public really knows about severe obesity and bariatric surgery as a potentially effective treatment for it.

A recent study published by the New England Journal of Medicine, one of the nation’s oldest and most prestigious medical journals, sheds significant light on the subject of severe obesity and gastric bypass surgery as an effective treatment option. You see in most cases of severe obesity, Type 2 diabetes is a significant factor. Science has proven that diabetes, especially when poorly managed, is a significant contributor to limb loss and in some cases, even death. The study’s researchers concluded that gastric bypass surgery is quite successful in the alleviation and reversal of Type 2 diabetes in the patients who were studied. This isn’t the first scientific study to support bariatric surgery’s effectiveness. There have been many others over the years.

Yet, when we filter all of this positive clinical data through the lens of public opinion, why is there still so much debate over surgical weight-loss as an acceptable option for treating severe obesity and the conditions that accompany it? I think the answer lies mostly in the dwindling but still widely held belief that obesity is a “lifestyle” disease. There is much clinical evidence (especially in recent years) to refute this belief, but I’d like to offer you a comparison to consider. Let’s take lung cancer as an example. This potentially deadly disease is also viewed by some as a “lifestyle” disease. Perhaps decades of smoking have lead to an individual being diagnosed with it. But when the diagnosis is given, and if the cancer hasn’t spread, surgery to remove the cancer may be offered as a solution and possible cure. Again, do the benefits of surgery outweigh the risks? That’s an individual decision of course, but science has certainly proven time and again that surgical removal of cancerous tumors before they’ve spread is an important factor in long-term cancer remission. To suggest that, just because this individual was a smoker, he or she doesn’t “deserve” to have surgery or is taking an “easy way out” is ridiculous when you look at it from this new perspective, isn’t it? In fact, it seems down-right cruel.

As a surgeon who has dedicated his career to serving the severely obese, “judgment” of how a patient came by their personal set of circumstances before they came to me is irrelevant. My job is to help them get better. To help them heal. To help them regain a healthy lifestyle. Perhaps the public could think about it from this perspective before they make snap judgments. There is no shame in choosing bariatric surgery as an effective tool in managing and reversing the effects of severe obesity. Studies have proven that it saves lives. What could be more important and worthy than that?

With recent news of Carnie Wilson’s decision to undergo a LAP-BAND procedure following her gastric bypass surgery 12 years ago, the risks and benefits of “follow-up” bariatric surgeries are being discussed in the media with renewed interest. While I appreciate healthy dialogue on the subject of weight-loss surgery, I also want that dialogue to be accurate. As we’ve discussed time and again in this blog and in our support groups, weight loss surgery is simply a tool. How a patient decides to use that tool is entirely up to them and those patient decisions have the largest impact on long-term outcomes.

When we talk about bariatric surgery as a “tool,” what we really mean is that it isn’t a “cure” for obesity. The stomach is a muscle. No matter what we do to restrict its capacity, without constant determination and rule-following on the part of the patient, that muscle can and will stretch over time. That’s when we see patients begin to regain the weight they originally lost with the procedure they chose. Now, this isn’t to say that second surgeries aren’t appropriate. For some people they certainly are. But, as we always tell our patients the first time around, ALL surgical procedures come with risks. To the extent we can minimize those risks by ensuring success with the first procedure, that is always our goal.

The most effective way to minimize the risk of needing a second bariatric procedure is four-fold:

1. Maintain an appropriate diet post-surgery: This includes following “rules” about intake quantity and timing as well as a focus on the quality of foods consumed.

2. Eat Slowly: While type and amount of food are important, how quickly food is eaten has a significant effect on long-term success. A good measurement to stick with is 1/2 a sandwich or 4 oz. of food over the course of an hour. Without focusing on this step, one will usually (within 2 years after weight loss) regain weight.

3. Exercise: You don’t need to run marathons. 30-minutes of brisk walking most days per week have helped many of our patients keep the weight off for more than a decade.

4. Get Adequate Support: Bariatric surgery is hard work. Surrounding yourself with people who are experiencing the same challenges can help get you through the rougher patches. We’ve got support groups throughout Southern California. Join one!

As a physician, I also understand that some of these suggestions are easier said than done. Some people need a plan of action. For those who prefer a more guided approach, we’ve partnered with MTEC to provide patients with customized diet and exercise plans, pre- and post-op. The plan will detail EXACTLY how much each patient needs to exercise and eat in order to meet their weight loss goals. And these plans are specially designed for patients at any stage of their weight-loss journey (pre-op, post-op, plateau or regain.)

While second surgeries are a reality for some, I encourage the public to be less inclined to shame the people who undergo them. This isn’t about taking the “easy way out,” “cheating,” or “being lazy.” It’s about getting healthy. I applaud ALL of my patients for taking on major challenges to change their lives. And there’s nothing lazy about that.

We hear often that bariatric surgery is a “quick fix” or an “easy way out.” Well, we’ve discussed time and again in this blog just how untrue those statements really are. Bariatric surgery patients MUST commit to hard work if they’re going to be successful in achieving lasting weight loss, ESPECIALLY after surgery. We know that the two most important ways to achieve success are through exercise and a proper diet. In honor of last month as National Nutrition Month, I thought it appropriate to dedicate this post to the nutritional factors that are most important in the life of a person who has undergone bariatric surgery.

Once a patient has achieved the milestone of a return to solid foods after surgery, they’re often faced with significant challenges. Whereas food choices before surgery weren’t usually something they heavily considered, now they must look at each piece of food they put into their mouths in a whole new light. While most good bariatric surgery programs will provide patients with their lists of food do’s and don’ts, there are some general rules to follow that we’ll outline here. That way, no matter where you’re at in your post-op journey, you can bookmark this blog post and refer back to it when the world of food options becomes too overwhelming.

• First and foremost, especially depending on your procedure type, you should ALWAYS take the vitamins and supplements your doctor has advised you to. Your nutritional needs are different now and they must be well-met in order for you to remain healthy.

• Taking in enough liquids is also important to the overall quality of your diet. Aim for 64 ounces each day.

• Whatever you eat, eat it slowly. The new pouch created for you is still a muscle. Stretching it beyond its capacity at each meal can result in “dumping” and eventually, can increase the size of the pouch, effectively reversing all the hard work you’ve put in so far.

• To achieve and maintain significant weight loss, higher levels of protein are recommended for most bariatric surgery patients. Great sources include lean meats and poultry, eggs and tofu.

• Soft cooked vegetables and fresh fruits are important components to a healthy, balanced diet.

• Milk and dairy items can be incorporated into a bariatric diet in the form of non-fat or 1% milk, Greek, non-fat or low-carbohydrate yogurts and low-fat cottage and other cheeses.

• Appropriate fats include olive or canola oil, nut butters and small portions of avocado.

• Your best bet with beverages are water and decaffeinated coffee or iced tea and sugar free drinks.

As important as the foods you should consume, so are the foods you should avoid when keeping with a bariatric diet.
These include:

• High-fat meats and fried foods.
• Whole milk, ice cream and milkshakes.
• Canned fruit in syrup.
• Sweets, French fries and sweetened cereals or granola bars.
• Caffeinated, carbonated and sweetened beverages, fruit juice and smoothies.

I hope you find this information useful as you continue to navigate your new lifestyle after bariatric surgery. With time, we can change our habits and much of what is outlined here will become second nature with commitment and practice. If you have any bariatric-friendly recipes or resources, please don’t hesitate to share them with us in the comments section of this blog or on our Facebook page. Together, we can help patients achieve the utmost success after surgery.

Our compassionate and knowledgeable staff understands the challenges our obese patients are faced with every day, and strive to make every weight loss journey a success story. Being confident and proud of your body can be quite difficult when you are obese. (more…)

Sadly, it is quite difficult to stop gaining weight. Weight gain often starts slowly and may not be noticed at first, but eventually the pounds start accumulating. (more…)

We read often about the health and weight-loss benefits of eating less and moving more. As a general rule, that statement can be effective. I also know that for most people who are 100 pounds or more overweight, “eat less and move more” is like telling them to try moving a continent with their finger tips. Not easy and even impossible for some. So when people commit to bariatric surgery as a tool to lose significant weight, they quickly learn that it too is not easy and requires a ton of personal commitment. But once that commitment is made and life after surgery becomes different than it is for people who haven’t had their stomachs surgically altered, what’s the best way to maximize the results? The answer: Eating and moving “right.” That’s a different idea than eating less and moving more. And we’ve teamed up with a team of metabolic experts to show our pre and post surgical patients exactly how to do it.

MTEC-which stands for Metabolic Testing and Exercise Center, with the help of me and my bariatric surgery team, has developed a weight-loss management system designed to enable patients to maximize the results of bariatric surgery. Think of this as a companion program to surgery that provides you with the knowledge and tools you need to be successful in reaching your surgical weight loss goals.

This is NOT another diet and exercise program. For most of our patients, those types of programs have failed them. This is an educational tool, designed specifically for you and your bariatric surgery. It provides you with daily guidance (before and after surgery) so that you can maximize weight loss and achieve your goal of keeping the weight off forever.

Because we understand that weight loss is difficult, we have designed this program to provide you specific tools that will help you achieve lasting and long-term results with as little time and effort as possible. That’s where the moving and eating “right” comes in. The MTEC program will show you the best way to prepare your body before surgery, the safest most effective way to recover after surgery and ultimately provide you with everything you need to know in order to achieve long-term success.

I encourage you to visit the special website designed specifically for those interested in maximizing their bariatric surgery success. There you’ll find more information on the program options, exactly what makes it different than those traditional exercise and weight-loss programs and how it can benefit you. I tell patients time and again, bariatric surgery isn’t a cure. It’s a tool. When used in conjunction with the exercise program we’ve helped develop specifically for our patients, it can be the missing piece to the puzzle when it comes to significant weight-loss that lasts a lifetime.

I am a very involved physician when it comes to my website and other online efforts. There are several reasons for this but the most important are: a) I want to make sure everything we transmit to the public is accurate and b) I enjoy hearing from patients and those interested in bariatric surgery. In fact, a significant majority of traffic to and page views on my website, www.smartdimensions.com, is from people who are interested in viewing the gallery/patient success story page. Of course, the most obvious explanation for this is that humans are visual creatures. It’s true. But over the years, I’ve found other equally fascinating reasons to explain the popularity of the “patient success story” in bariatric surgery.

Seeing is Believing. That statement couldn’t be truer than it is when we’re talking about bariatric surgery. This is a procedure that “shows” how well it works without words. Even patients in the midst of their weight-loss journey love looking at photos of the process. It’s visual encouragement for the brain. I have many patients tell me they didn’t realize how large they had become until they saw photos of themselves at a healthier weight. This all plays in to how strong our feelings and rationalizations can be when it comes to obesity. But in many ways, the pictures don’t lie.

A Visual Reward for Hard Work. Another reason I believe gallery photos are so popular is that patients see them as visual confirmation that hard work pays off. Whether you’re scheduled for surgery tomorrow, or post-op and a few days into your liquid diet, photos like these encourage and cheer you on through the tougher aspects of the process. Perhaps you already knew how difficult the journey would be. But when you’re actually on it, it can be a different story. Photos of “success” can provide the best dose of encouragement at a time when many patients need it most.

Truth in Advertising. There are millions of weight-loss products on the market that make claims about significant weight loss within weeks of using them. Their advertisements often show bikini-clad women with headlines claiming “30 pounds or more of weight loss in just a few short weeks.” I’ve found most people are quite skeptical of these ads. The biggest reason? Most who are severely obese are smart consumers. They’ve either researched these product claims and don’t believe them, or they’ve tried them just long enough to prove them wrong. But when it comes to the bariatric surgery photo gallery, we start speaking the same language. These aren’t bikini-clad 19-year-old women. In some cases, they’re healthier-weight men enjoying recreational sports again. In other cases, they’re women chasing their children at the park again. Those are the photos that speak to someone struggling to lose 100 pounds or more. These are people who simply want to get back to living a normal, healthier life that they can enjoy again.

The many reasons people enjoy viewing before and after bariatric surgery photos are as diverse as the people who have surgery. Obesity is a disease that transcends gender and race. Seeing photos of the many and different people that surgery can help is one way we rationalize how effective it is. Whatever your reason, I hope these photos provide you the optimism, encouragement and confidence at exactly the time you need it.