Wednesday, April 28, 2010

Canadian impressions

I have been attending the monthly lectures at University of British Columbia - and got a chance to talk today with a few key players today in Vancouver. There is strong advocacy for Diabetes and Obesity issues there. Many thanks for the time!

One great piece of info is this: (unfortunately it is likely too late for me to try to get there)

McGill - First Canadian Summit on Surgery for Type II Diabetes

PDF of Diabetes Report

Metabolic Surgery Article Links (from Summit Website)

Dr Christou is the McGill surgeon who is part of the team behind the landmark Quebec study showing tremendous survival benefit with Bariatric Surgery in Quebec. Dr Rubino from Cornell (see other postings below) is co-chair.

Canadians enjoy 2.7 years more (and healthier) life than those in USA
ScienceDaily (2010-04-28) -- Compared to their neighbors south of the border, Canadians live longer, healthier lives. Research has found this disparity between the two countries, suggesting that America's lack of universal health care and lower levels of social and economic equality are to blame.

Some useful links specific for Canadians ----

UBC Department of Surgery

Victoria - Drs Amson and Tang I think this is the only active program doing all types of Bariatric Surgery - but haven't met them personally yet.

BC Association of Bariatric Advocates

Vancouver's Lap Band center (False Creek Surgery Center)

Canadian Center for Functional Medicine

Obesity Help's BC messageboard

Thursday, April 22, 2010

Dr Foote's 8 Rules to Success

This is copied from my palm pilot, so
format is rough, but good stuff!!!

1 daily 3 small meals, 1 high protein snack
2 Lowfat solid food, 60 gr protein/d
--- Limit fatty, sugary to 1-2 x/mo
3 Eat slow, chew chew chew (20/bite)
4 NO liquids 15 prior, 45 m after meal
5 Avoid liquid calories
--(incl soups, smoothies, protein drinks, alcohol)
6 Drink 64 oz noncaloric liquids/day
7 Listen to your body (stop B4 pain!)
8 Exercise every day - schedule!

Wednesday, April 21, 2010

Starting to work toward Bellingham pilot surgical program!

Good news! I am going to be doing more outreach and consultation. We are going to set up some information sessions, and talk to whatever group would like to have more information about Medical and Surgical weight management.

We already have a draft pathway for both medical and surgical approaches.

Also, the Washington State chapter for the American Society for Metabolic and Bariatric Surgery is formally getting under way. We have filed the preliminary application, and will be setting up a charter, etc in the next few months. There is a lot of work to be done for advocacy in Washington State, and I am excited to be part of it!

Since printing materials costs money, and we are just piloting, I am expanding the LINKS to explore to make this a good portal to exploring the world of weight management.

also, this is fairly big news from the ASMBS website...

TWO MAJOR INSURERS NOW COVER LAPAROSCOPIC SLEEVE GASTRECTOMY Aetna, United Healthcare Each Change Policy to Cover Newer Method of Bariatric Surgery

Sunday, April 18, 2010

Habits - find ones that work for you. This is a process, one that can be polished with support group attendance, and paying attention to your experience. I found MBSR (mindfulness based stress reduction) to be helpful to have perspective and stay in balance (or keep working toward it!)

link to Dr Kabat-Zinn's program

Duluth Clinic program (where I did training in 2006)

Priorities - we don't always get our way, but the only way to make any progress is to honestly put effort towards our goals. Be honest with your priorities. Examples for me are especially exercise and meal planning.

MEAL REPLACEMENTS were one of the tools from reinforced at the ASBP (American Society of Bariatric Physicians) meeting I just attended in Seattle. They really help with meal planning, and many people ask me what I use - here are some links:

They are not cheap, but much better price by the box.

Genisoy Bars These are very nice chocolate mint, and pretty chewy.

BALANCE BARS in chocolate chip, honey peanut, and sometimes the Balance Bare are favorites for me - they give good satiety, and are tasty without being "irresistable"

Zone Bars - some are stocked at Costco (usually 2 box sets with Fudge and Peanut Butter), but I like the mint ones best. Target and Fred Meyer stores stock them here in Bellingham.

EAS shakes are a good protein source, and great before the gym.

These are just some of the things I use as an example - it takes time to shop around and find what you won't mind using every day, but won't lose control over. There aren't a lot of foods that I can stock up on without abusing, but these don't seem to tempt me much. If you find a food that you can't keep away from, don't try to keep a stock!!!

I don't count every gram of protein, or every calorie, but it is nice to have a label to read, and to have a pre-limited amount.

Wednesday, April 14, 2010

Will we see more directed care toward patients in hospitals to help shorten future admissions (or prevent them altogether)?

A consultation for smoking cessation or alcohol treatment has been shown to be more effective when initiated during a related illness.



Quoting from above link...
Bennett says her study suggests that insurance companies "should be covering gastric bypass surgery in women of childbearing age because of the potential to reduce complications if we can reduce their weight before they become pregnant." Treating the obesity before pregnancy, she adds, also has the potential of saving a lot of money on treatment of complications in mothers, fetuses and newborns."


"Prior research has shown that rates of gestational diabetes (which also causes complications in pregnancy) decreases after bariatric surgery, and that weight loss can increase fertility in obese women."

Saturday, April 10, 2010

Diabetes Surgery in those with BMI<35
This is the future, especially for ethnic groups who have organ damage from diabetes long before their weight attains the 20 year old "expert opinion" based NIH guidelines (BMI>35). Get ready for some evidence!

I hope to have more info on Dr Rubino's work to pass along after the ASMBS meeting in June.

Thursday, April 01, 2010

Bacon or bagels? Higher fat at breakfast may be healthier than you think

ScienceDaily (2010-04-01) -- According to a new study mice fed a meal higher in fat after waking had normal metabolic profiles. In contrast, mice that ate a more carbohydrate-rich diet in the morning and consumed a high-fat meal at the end of the day saw increased weight gain, adiposity, glucose intolerance and other markers of the metabolic syndrome.

Link to article