Wednesday, December 07, 2011

Below is the email I am sending out to Bellingham PeaceHealth St Joseph Medical Center Physicians and Allied Health Practitioners today...

Dear Colleagues,

It has been an honor to work with you all these last 2 ½ years. Though I have consulted on over 200 patients for obesity and metabolic issues, we have only been able to take 12 to surgery here locally, because of a variety of factors beyond my control. My practice closes this Friday. Dr. Bachman has agreed to take over my charts for clerical continuity, with the understanding that specialty Bariatric care is appropriately referred to regional providers. I include a partial list below, and encourage you to use these providers for your own liability protection when patients are complex.

I have been asked to start a Bariatric Surgical program at Billings Clinic in Montana, to complement their World-Class Endocrinology service. I will still get to do Trauma and General surgery as well, so will be fully engaged and supported in a tertiary center.

My only regret is knowing that many will continue to suffer and die needlessly without treatment here in Bellingham. Many just do not have the resources to travel. Most patients now do have excellent coverage – it simply is a matter of finding the location that accepts it.

I hope to keep making my blog a valuable place to send patients to explore links and resources
And my Twitter is @bonuslife

Again, many thanks for being so supportive. Please continue to speak up for this group that is so stigmatized and unfairly marginalized by society and industry. Your compassion alone makes a difference, your timely referral saves lives!

To quote Goethe – “Knowing is not enough, we must apply. Willing is not enough, we must do”
Or to paraphrase - Actions speak louder than words!!!
Sincerely, gratefully,
Walt Medlin


University of Washington – has 4 world class surgeons who I know well. They are the best of the best.
800-326-5300 for Medicon, or 206-598-2274 for the clinic.
( based in Edmonds, with office also in Barkley area.
Drs Landerholm, Billing, and Crouthamel are excellent, though a bit controversial with same-day surgery for sleeve gastrectomy.
I do not believe they take Medicare, but do have preferred provider status with PeaceHealth. 800-558-6514 our local Medical program with Dr Tony Burden (at Lakeway entrance to I-5 N) 676-1696
Dr David Lauter comes up from Bellevue, and does take Medicare with his Center of Excellence at Overlake in Everett has until recently been only Lap-Band (which is falling out of favor). Drs Michaelson, Chock, and Montgomery are now adding full spectrum care, including Sleeve Gastrectomy and Gastric Bypass. They are a great clinic, and nearest actual OR facility. 800-350-2263 Group Health covers many of our Whatcom County neighbors, and does a great job, though the out-of-pocket expense is >$1,400

Swedish, Virginia Mason, Evergreen and Northwest Hospitals all have excellent programs as well, with Center of Excellence certification.

Madigan Army Medical Center is actually a national leader. I highly recommend them for your patients with Veteran’s benefits (and spouses)

Dietitian Support - Rachel Akins RD at South Campus has extensive experience with the Group Health Program. is a Seattle based telephone Dietitian counseling service that I have used with great results. They are very cost effective, though not usually covered by insurance (4 sessions are less than $300 though!)

Psychological Support – Marlene Sexton LMFT has been our local professional, and runs a highly regarded support group as well.

Free support group (which all post op patients should attend at least a few times each year) is 7PM the first Wednesday each month at the HEC.

Saturday, November 05, 2011

Shame on you KIRO-TV!

This is the most frequent comment after the article/video - and that about sums it up...

Join the Obesity Action Coalition - we need to fight ignorance with education. Stigma is being used here to fuel sensationalism, but we can use this as a starting point for engagement. If KIRO has integrity, they will follow this up with a series of the VALUE of care for Metabolic and Obesity related conditions and mortality.

KIRO-TV Seattle piece that will raise your blood pressure!

I grew up with this sort of loaded language around gender and racial discrimination being widespread. Now those are reduced a bit, or hidden under deeper "coded" language in the media, or hidden from the public view. Discrimination with weight is still open, raw and ugly... and allowed because it is still a commonly held view.

The worst thing about this is the sexism - the hissing voiceover that implies spoiled lazy women, and reeks of the old "welfare queen" name calling. Our country is defended by WHOLE FAMILIES who make sacrifices, and they deserve to be treated with dignity.

I have been interviewed several times for TV and print. It is obvious that those interviewed here were given the impression that this was going to be a fair piece. I dare KIRO to release the full unedited interview tapes, so we can see how this trap was set. Investigative journalism should not be cowardly.

Wednesday, November 02, 2011

Very Sad - Meds have risks, too

This is not to minimize risks of surgery....

I have had several patients with increased Blood Pressure as a side effect of Phentermine.

Death of Bubba Smith - coroner report on E Online

Saturday, October 29, 2011

Hormonal impact on dieters regain - more evidence

Australian Study of long term hunger hormone changes after Diet

"Our study has provided clues as to why obese people who have lost weight often relapse. The relapse has a strong physiological basis and is not simply the result of the voluntary resumption of old habits," he said.
Dr Proietto said although health promotion campaigns recommended obese people adopt lifestyle changes such as to be more active, they were unlikely to lead to reversal of the obesity epidemic.

Caregivers are slowly getting the word - but ingrained opinions will still be shaping (distorting) medical practice for some time... Institutions have to help change practice with guidelines and with appropriate coverage. Hopefully Secretary Sebelius of HHS will show leadership!

Friday, October 28, 2011

Stigma allows Georgia to Discriminate against Obese

It is hard to believe a State could get away with cutting access to care across the board to any other disease.

CNN Video - thanks to ASMBS for spreading

"Sorry, we no longer can afford chemo, we won't pay"

"You made a decision to become pregnant, we won't pay"

"You crashed your car while over the speed limit, we won't pay"

"Cardiac stents have a rate of restenosis and failure, we won't pay"

We will look back at this years from now with the same disbelief that we have now for other forms of institutionalized discrimination.


Sunday, October 02, 2011

Adjusted or Maladjusted?

Appetite is so much more than just hunger. Stress creates a desire for food in my life that is recognizably different from sustenance. Luckily, I get to have a front row seat to the struggles of others - sort of a built in support group. Life is always going to be a challenge, but the self image we take forward has a lot of influence.

My attitude will never be sunny all the time, but if I can trust myself to listen, the down days won't spiral out of control. Unrealistic expectations get me in trouble, but happen less as experience finally gives me perspective. Those with innate maturity are lucky!

Anyhow, hope this helps if you are having that sense of being overwhelmed...

What it means for me in practical terms is relieving stress (mostly with exercise) and using Mindfulness to recognize the opportunity here and now to simply be with the situation, without struggling - even if just for one breath (and it's always one breath!)

Thursday, July 28, 2011

Mild Obesity much more Risky in South Asians...

This is one of the primary reasons I relocated to Bellingham. This article confirms in Canada what the research in India and China have been saying for several years.

McMaster University research for increased susceptibility in South Asians with mild obesity

Unfortunately, the epidemic of Diabetes and Metabolic Syndrome seems to be ignored by the politicians and public health officials in British Columbia. Other provinces recognize the role of surgery in effective treatment, and the need for large scale, coordinated efforts to combat this. Maybe it is latent racism against immigrants, because the medical leaders in Vancouver are certainly fighting the good fight to make the facts known in the halls of power.

What needs to happen is for the community to speak out - and be heard "loud and clear"...

"Many Canadians of South Asian descent -- as well as those of Aboriginal, African and Chinese descent -- are experiencing historic levels of risk for heart disease and stroke. It is only through research like this that we can learn how better to treat and prevent these diseases, so lives are not cut short," said Mary Lewis, vice-president, research, advocacy and health promotion of the Heart and Stroke Foundation of Ontario. "The Heart and Stroke Foundation of Ontario is proud to support such important work."
Dr. Arya Sharma, director of the Canadian Obesity Network and a co-author of the study said: "This study helps explain why South Asians experience weight-related health problems at lower BMI levels than Caucasians. For the clinician, this also means that individuals of South Asian heritage need to be screened for the presence of heart disease and diabetes at lower BMIs."

Indeed - screening and research are important - but deploying known effective tools should not be delayed. Lives are being lost unneccesarily - every day. Why doesn't BC allow 5,000 operations per year, instead of 50?

We are killing ourselves with inactivity and obesity related diseases

Importance of muscle mass in insulin resistance

GET TO THE GYM, OR DIG A DITCH!!!! Anything to build muscle...

Declining US life expectancy from middle aged inactivity and obesity

Wednesday, July 27, 2011

Gastric Bypass food preference changes?

Study from UK for fat intake

Lots of people talk about how food tastes a bit different. I thought my cheese habit was high fat, but maybe it's still better than it used to be!

Tuesday, July 19, 2011

When will Obesity become a conservative hot button?

Conservatives should care about obesity for their own valid reasons

When they run the country "like a business" we had better make sure our employees (and wards) are cheap to keep, and very productive! It's not cost of health care that's a problem, it's lack of value.

We will get more "Bang for the Buck" from Evidence based medicine - and obesity care has the very best evidence! (thanks to Dr Dixon, as well as Dr Rubino, Cohen, Schauer, Morton, Shikora, Pories, Sugerman, Buchwald... too many to list on one screen!)

Looking forward to visiting ANYONE in DC willing to take leadership on access to care. Many thanks to Rep Edolphus Towns for giving us a great start on the Obamacare side. You sir, are a leader!

Thursday, July 14, 2011

Dentists and Diabetes detection

Here is a nice article, with several older related articles on the sidebar.

Look back to older posts for the millions of undiagnosed diabetics in the literature.

Periodontal disease, and point of care Hemoglobin A1c testing

Wednesday, July 13, 2011

Incontinence treatments - not all benign

Careful of the implants...

I have seen too many women getting consultation for bariatric surgery who had unsuccessful bladder slings, when the intraabdominal pressure of obesity was a more likely cause.

Monday, July 11, 2011

Exercise, baby! No, really...

To fight obesity, even babies should exercise

I really like this... free range toddlers sounds a bit dangerous, but most of us were pretty wild and roamed free as kids. I definitely spent much more time in front of the TV with each year.

Thursday, July 07, 2011

Caregiver shortages

This is only one factor leading to problems. Productivity and limited hours and aging population will have effects, too.

Health Reform leading to increasing shortages of Providers

Wednesday, June 22, 2011

So much news - here's a taste! (more to follow)

I have a lot of stories and updates from last week's meeting of the ASMBS and Monday"s OAC Capitol Hill visit...

Things to give news on:

Essential Health Benefit - next few months are crucial for access to care! - Expect this to be the theme of many future posts.
PLEASE lend your voice - it really makes a difference when legislators hear directly from you!!!

The CHOICE Campaign is one way to have immediate impact Click here to sign the open letter

Rural access to care - new ASMBS President Dr Robin Blackstone is personally involved in making the Center of Excellence system work for patients and programs.

Surgery for Metabolic Disease in Class I Obesity (BMI 30-35), and the limitations of BMI to make individual health decisions
There are large studies underway which likely will deliver the highest level of evidence to support care - but they are not yet completed. Many other studies without true randomization already clearly show benefits.

Duodenal Switch - getting much more exposure in debates and as viable alternative to Gastric Bypass in selected groups

State by state advocacy and networks growing

New national advocacy programs and networks of organizations working together

As we always expect - vigorous exchange of ideas for new approaches and tools - this is maybe more conservative than in previous meetings, but there is still a lot of work going forward

Excellent basic science keynote and public health keynote

Recession seems to be impacting growth, but perhaps less enthusiasm for the Adjustable Gastric Band is slowing some programs, also.

Gastric Plication / Imbrication experience growing - promising data even over several years in some overseas reports

I have several pages of notes, that may just get put up with minimal editing to at least minimize my procrastination! It is a blog, after all, not an epistle!

Forgive me for "dropping names" in future posts, but so many of these folks work so tremendously hard and are so smart - they deserve massive credit!!!! My only worry is incomplete notes - don't want to offend anyone by failing to recognize!

Sunday, June 05, 2011

Canadian First Nations - rising Diabetes rates over 20%

A diabetes epidemic is affecting First Nations people, especially women in their prime reproductive years, according to a new study in CMAJ (Canadian Medical Association Journal). The incidence of diabetes was more than 4 times higher in First Nations women compared to non-First Nations women

First Nations Diabetes in Canada

"What is clear is that the rapid appearance of type 2 diabetes particularly among First Nations people and other indigenous and developing populations has been precipitated by environmental rather than genetic factors," state the authors. "Its long term solution will require effective primary prevention initiatives that are population-based and driven by public health and community initiatives."

Maybe the authors would like to consider the genetic vulnerability of the First Nations ethnic groups, as we are seeing in South Asian ethnic groups... Then we could consider the combination of environment and genetics - acknowledging the complexity of the epidemic.

The community initiatives are building, but only with advocacy.

Male Testosterone recovery after Gastric Bypass

Testosterone recovery in Men

There's an older article on the blog about erectile dysfunction and recovery, this is a bit different, and newer.
One of these is the older article - I didn't dig back thru my old posts to compare...

Utah testosterone study

Boston/Philadelphia Urology study on sexual function

Breast Cancer Death Risk - proven almost 70% worse in Obese

Breast Cancer survival difference

but is this an appropriate conclusion? You be the judge!

She (study lead auhor Christina Dieli-Conwright, PhD ) continued, "With the obesity epidemic on the rise, weight management programs using exercise and diet are vital in cancer prevention and survivorship."

Clearly to withold Weight Loss Surgery in such a patient is discriminatory based on Evidence. That's the evidence that all our insurance companies and hospitals are not mandated (yet) to follow.

Please raise your voice - join the OAC (Obesity Action Coalition), write a letter every week to a hospital board member, an elected official, an HR executive. Retweet! anything helps - and silence kills

Friday, June 03, 2011

Striking Genetics Editorial, and bigoted comments

Genetics editorial

This is a fairly simple editorial to help explain the susceptibility to obesity, but look at the seething hate and ignorance in the comments.

Wow, we have a long way to go. I got real grief from a nurse the other day because she believes the risks are too high. Well, it's better to show 'em than tell 'em! When we get good results over and over, I feel sure she will believe.

Unfortunately, Bellingham has long been neglected for dedicated Bariatric care, so a lot of patients have been "ad hoc" treated. Our docs are generally only seeing a patient rarely, and the treating surgeons are quite varied, from all around the seattle area and even North America - from Ohio to Mexico, even a few who went to Spain.

Wednesday, June 01, 2011

A Long Way to Understanding Obesity

Here is a little secret your doc won't easily give up... We know a LOT about HOW diseases happen, but we don't know exactly why! What is the difference? Well, just because I can't tell you how you got appendicitis - doesn't mean we can't save your life from it.

Not all diseases are preventable all the time, or I wouldn't be up at night taking out appy's! Also, diseases that we have known causes for still happen.

My point is that childhood obesity EFFECTIVE TREATMENT should not wait for full understanding. Keep working on it, scientists, but let's get the multidisciplinary treatment teams together and do something in the meantime.

If your kid needed a life saving kidney transplant, how old would you require him or her to be to prepare and consent for surgery?

Childhood Obesity Research - YAY!

Wednesday, May 25, 2011

Lethal Inactivity - Beyond Exercise

Dr James Levine - Mayo Clinic Article NYT

I have read ( and probably blogged) about his research before. This is particularly good.

I had a "standing desk" in Duluth, and it was wonderful. Almost made one of his homemade treadmill desks - just for 1 mile per hour non-exercise energy expenditure.

This is how we redesign our society from the bottom up!

Dietitian's dilemma

Many very certain lectures have been given on this subject.... - Beware certainty! Even though I am quite certain of the data with bariatric surgery, we are only beginning to understand HOW things work.

High fructose may not be the answer

Also, beware the non-surgeon's lack of data on the single case, short term success (also frequently brought out for lectures to convince you that it's just a willpower problem)

Yale's Rudd Center on regain risk

Unfortunately, the Rudd Center doesn't seem to get quoted on the relative success rate of surgery at 20 years (still an average of 50% excess weight off) versus their database of 800 patients (collected from around the world) at one year...

Ask your dietitian for long term data in their practice!

Weight Loss Surgery superior for Diabetes, Heart Disease?

Cardiovascular superior results

Your primary doc will soon be following the data in "Pay for Performance" Unfortunately, too many people die needlessly every day of disease that was avoidable with CURRENT evidence and techniques.

As Dr Adams says in the article - while surgery will always have some risk, in those with Type 2 Diabetes, the non-operative risk is actually much higher.

I am continuing to offer physician education in clinics, as well as at conferences, dinners, and elsewhere. Please encourage your primary and specialty providers to educate themselves!

I recently heard an esteemed local endocrinologist make the excuse "well, I don't know much about surgery". I am scandalized that one could purport to be an expert in a disease and be willfully ignorant of a therapy that could put over half of his patients into full remission. Yes, discrimination is that strong even among docs!


Tuesday, May 17, 2011

Older patients benefit from surgery

Minnesota study of over 65 patients

I have operated on several patients as old as 73 - definitely have to take extra time for individual goals and risks, but these folks are often the ones with the very worst mobility limitations, and daily pain.

Sunday, May 15, 2011

Diabetes - Quote from the National Institute of Health

Gastric bypass and other bariatric surgeries to treat extreme obesity may resolve type 2 diabetes independently of weight loss, opening the door to discovery and to new therapeutic options for some individuals.

Diabetes strategic research plans for NIH

Article about the strategic plan

NIH Obesity Strategic Plan

Then they go on to mostly talk about strategies that don't involve remission... well, be glad you have control over your own health in some way. People feel disempowered because insurance is difficult, but there are almost always options.

Science Genetic Control of Diabetes

It's great that research will be taking us forward. Years will pass, and if you are diabetic right now, the disease is hurting you faster than the research will produce more than the tools we have in front of us. If you want your diabetes in remission, there is a tool available.

Science Insulin Sensitivity

Good Reason to wear your CPAP!

Mortality of sleep apnea in elderly improves with CPAP use

Of course, probably the best thing is to put the disease into remission.

This would be a great study for the very elderly with gastric plication... We are certainly reluctant to do anything with patients over the age of 75 - will try to get more information on these issues at the upcoming ASMBS (American Society for Metabolic and Bariatric Surgery) meeting.

Tuesday, May 03, 2011

Mice aren't all the same either!

Turns out we don't even know as much as we thought about mice... and so many are out jumping to conclusions on very little detail in humans. Let's be careful with the knowledge we have - life doesn't have many guarantees.

Not all skinny mice live longer

Monday, May 02, 2011

Liposuction for shaping, not for fat reduction

This is clarifying - we have seen it individually - nice to know that there is a study to validate.

Fat comes back other places after liposuction

Polycystic Ovary Syndrome (PCOS) and Infertility Links

We are learning more about the vulnerability of different people to certain diseases. Why some are Diabetic with just modest excess weight is one of the most important.

Fat tissue is an active endocrine organ - making and processing signals that the body uses to regulate energy sensitive tasks, especially. Female and even male fertility are very sensitive to these changes, but not in the same way for everyone.

PCOS and diabetes risk - characterizing the mechanisms

Obesity Action Coalition review article on Infertility

Wednesday, April 27, 2011

Technology that will make a real difference - comfort and colonoscopy

As someone who has done hundreds of colonoscopies, I am really looking forward to this finding its way into our working endosuites.

As someone who has had 3 colonoscopies, I hope my next one can be done without sedation.

Advanced Colonoscope using fiberoptic nanotechnology

Monday, April 25, 2011

Canadian Outreach Day Plans

Saturday May 21 we are planning an outreach day in the Vancouver area. More to follow as times get set, and invites sent out.

Here is one of the recent Vancouver Sun articles on WLS... 2011 is ticking by.

Access issue in Lower Mainland BC worsens

Sunday, April 17, 2011

Call for "Dirty Dozen" Ignoring Evidence for Diabetes, Obesity Access to Care

I have been saving some of these up last few weeks on call - hoping to get PeaceHealth to change its out of date access to care restrictions that are anything but "evidence based" (quote from PeaceHealth Mission Statement)

If you want to send me your organization's absurd restrictions, I will post a "dirty dozen worst plans in Washington State' after the ObesityHelp meeting in Seattle this June.

HERE ARE SOME GREAT EXAMPLES OF THE EVIDENCE TO FOLLOW (just in case any executives happen to read this post)

ASMBS statement for Access to Care

Britain's National Health Service Diabetes Study

Wow! Here's a great quote from a socialized medicine perspective!
Alberic Fiennes, a bariatric surgeon and chairman of the National Bariatric Surgery Registry (NBSR) Data Committee, said the treatment should be made more widely available on the NHS.

"An approach that limits treatment to a fraction of those who would benefit is one which the NHS will rue in years to come as these patients become an unsustainable burden on the health service," he said.

"Prevention strategy alone has proved ineffective; there are at least two generations of morbidly obese patients who are now presenting with diabetes, stroke, heart disease and cancer for whom preventative measures are utterly irrelevant."

International Diabetes Federation Statement

IDF press release

Increased Heart Disease Risk for Teens

Arkansas State Employee coverage

Tuesday, April 05, 2011

Pregnancy, newborn risks, hysterectomy risks

I am always talking with my OB/Gyn colleagues about preoperative liquid diets like we use for Bariatric surgery to get "room" to work inside the abdomen. Here is data to show that the heavier abdomen is truly a more hostile surgical environment.

If you want to find out more about a 2-4 week high protein, low calorie liquid diet, I will try to post on that with a later edit to this date... or you can call our office 360-752-9888.

Articles from UK

Wednesday, March 30, 2011

Why everyone has to learn about QALY

This is ridiculous - to not consider the cost of a medication, but then demand that other types of care be subjected to "cost effectiveness" tests... We need a level playing field for what value taxpayers and patients are getting - Quality Adjusted Life Years, or QALY is the way to do that.

Please see the quote from Dr David Flum at University of Washington in the article from day 1 of the NYC Diabetes Conference.

A billion dollars for less than 2 more months of life?

The data is Here... more NYC Summit

Nobel Laureates speaking as keynotes, Swedish long term data

I think we can say definitively that the science is in! There is always more to learn for exact mechanisms, and refining techniques. Insurers and the government may hedge because of perceived costs, but for most individuals the question is answered. Your life and health are better with surgical control of Diabetes and Obesity. To deny this is to simply put money ahead of people...

even the American Heart Association recognizes the benefit

News from NYC Diabetes Summit

Cost effectiveness of surgery for Diabetes

Monday, March 28, 2011

Profound Emotional Suffering - worldwide now

It is inspiring to see a researcher who is so sensitive to the impact of society's dysfunctional judgements. So many of us internalize that incredibly demeaning and disempowering hatred. I guess the only upside is what going through hell can teach you about compassion...

Traditionally tolerant societies showing intolerance, anti-obesity attitudes

Sunday, March 27, 2011

Brain response article

There are a lot of related links to older articles on the sidebar, too.

enhanced reward response in vulnerable children with family history of obesity

Science is just beginning to appreciate individual genetic neural and behavioral variability - we are all similar, but not the same!

Tuesday, March 22, 2011

Mortality of medications

I get asked about the mortality of surgery quite often, but will your diabetes doc tell you the mortality rate of their treatment?

Turns out some meds increase the death rate

excess DEATHS with popular Diabetes meds

Here are some selected quotes from the link----

"431 excess deaths for every 100,000 patients who receive rosiglitazone rather than pioglitazone"

"Given that there are about 3.8 million prescriptions for rosiglitazone dispensed annually in the United States, "the effect on public health may be considerable," they warn."

In an accompanying editorial, Victor Montori and Nilay Shah from the Mayo Clinic in the US argue that the rosiglitazone story "says much about how healthcare has become less about promoting patients' interests, alleviating illness, promoting function and independence, and curing disease, and much more about promoting other interests, including those of the drug industry."

Somebody correct my math - that gives 16,378 deaths from this med....

NOW - if we do the math for DEATH from gastric bypass, that is 0.003, or 3 per thousand. if 3.8 million diabetics all had surgery, the mortality would be 11,400 - BUT the diabetes resolution rate is almost 90%! So at the end of a year (using a conservative 80%) then over 3 million people would be off ALL diabetic meds.


Of course, to get that done, a thousand surgeons would have to operate on almost 400 diabetic patients a year, every year for a decade - which is about double the current rate of bariatric surgery for obesity.

Monday, March 21, 2011

Good update on technology

No magic bullets in the pipeline

This is an article from the New York Times that summarizes the limitations of many promising advanced innovations. What we have is actually pretty great with gastric bypass and related operations, and it will be pretty hard to actually "beat" them in the long term.

Toughest study yet on Gastric Banding problems

This may have some of the limitations pointed out by the Allergan rep, but still, there are more problems with Bands than we were hoping for. While Gastric Bypass has its very real risks, the weight loss and Diabetes control are far superior..

I think the perspective of most surgeons is that the average person greatly overestimates the short term risks, but underestimates the long term consequences of the choice. This doesn't mean "be afraid", it means "be prepared".

Sunday, March 06, 2011

self compassion

worth living as your own best friend

This perfectly echos the "take Responsibility, but don't need Blame and Shame" message we have been saying for years

Very nice to see it validated!

Monday, February 28, 2011

Dr Rubino's study

You could fly to New York and participate...

Can't wait for results!

We are very quickly headed toward individualized access to care, guided by disease and risk, rather than a BMI number...

Thursday, February 24, 2011

Role for Plication? Preop Weight for other procedures.

I think any program would more highly recommend gastric bypass, which has a proven track record, and durability. But, if the patient won't accept the best, we should still offer options.

These sisters have been in the news for their transplant - I didn't realize they had an obesity issue. Thanks to Dr Bachenberg for sending me the link!

Need to lose major weight to qualify for an operation

I have yet to see the research article this newspaper refers to, but it is not a surprise. Programs see this, and my recent visit to my old program in Duluth confirmed our experience there. Many Band patients are quite happy though, and I will continue to place them, with as much informed consent as humanly possible.

Gastric Bypass more effective than Band

Saturday, February 19, 2011

Great Jane Brody Advice

She has been writing sensibly about healthy living for a long time - I remember articles from my college days.

This one is just a great summary - so often things are made over-complicated.

New Government Guidelines

Bioenterics Intragastric Balloon Removal Video

We plan to offer removal for those who have had them inserted out of country.

Saturday, February 12, 2011

Why I had Weight Loss Surgery

Rising Rates of Stroke in Middle Age

It's not quite as dramatic a risk factor as Diabetes, but my Hypertension scared me to death. It's much better controlled now, so I'll probably get hit by a bus!

Seriously though, these risks are important. Real lives are destroyed. When we talk about "comparing the relative risk of surgery to that of non-surgery" keep articles like this one in mind.

Shout out to all who attended the benefit last night for Ali McCabe in Duluth - sorry to miss the party!

Tuesday, February 01, 2011

Need for systematic disease management

The biggest problem here is a lack of an integrated health system that keeps the medical "to do" list prioritized based on evidence based impact. Instead we play "whack-a-mole" with whatever happens to stay on the patient's mind...

Gestational Diabetes and later risks

126 Million Americans with Diabetes or Glucose Intolerance

America does have awesome medical capability, we just don't deliver it where it's needed! This is where other systems get a lot more bang for the bucks they put in.

Monday, January 24, 2011

Economic Study of Obesity Cost

Very High cost of obesity to the Individual

Very sorry that this is not common knowledge....
So many patients don't think they are worth the investment, or that they will see benefit.

Paying for healthcare goes against the grain for many of us - but the hard truth in this economy is that help is NOT necessarily on the way from government, employers, or institutions (argh!)

What is to be done? We have to work in a community for advocacy, but not expect immediate results.

In the short term, my goal is to provide service as affordably as possible. This means keeping materials and handouts fairly basic, and depending on people to use online access to "extras" Every cost moderating decision we make helps keep us from having a "gold plated" price structure. We aim to be a bit like Costco - clean, friendly, value based. If you want posh surroundings, we can recommend a couple of really nice hotels!!!

Friday, January 21, 2011

Diabetes and Breast Cancer Survival

We are learning more every year about increased incidence, and increased lethality of many types of cancer with rising BMI, especially from younger ages.

link to article

There's a lot to be studied before making conclusions about what might be the cause, much less what might be an effective intervention. These articles always end with "keep good blood sugar control", but who knows if that will change anything. I certainly wouldn't endorse Bariatric Surgery in a particular disease finding, but we DO know that overall survival increases after surgical intervention from the Swedish Obese Subjects (SOS) trial, and from large studies by Dr Christou in Quebec and Dr Buchwald in Minnesota, among many others..

Tuesday, January 18, 2011

Breakfast yes, maybe not breakfast feast!

It's so easy to go overboard...
I think we are metabolically more complex than the argument that all calories are treated exactly the same, but look out for anyone who is selling a diet based on some magic "combination" or timing that is going to let you consume twice as much!

Article on "Big" breakfast not being helpful for later reduction

Thursday, January 13, 2011

Treat Sitting Like Carbs?

sounds like a good idea - looking to see more studies to reinforce

article link

I had a "standing desk" in my office in Duluth, mainly to keep myself alert, but plan to build one to use in Bellingham (my accountant has a nice one)

Monday, January 10, 2011

Obesity Discrimination in Presidential Politics

Awareness coming to the media

As a professional, I have experienced hiring discrimination based on obesity, and it's probably even worse with working class jobs.

Governor Christie is a multi millionaire!