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

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!

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!

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

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.

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.

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

Several interesting articles - obesity, health care, DM

This is a big stack of articles, but all worth a read!



Physicians Best Managers of Hospitals

Obesity is a Killer in Nonsmoking Women

Weight Loss Surgery effective against PCOS infertility

Obesity Help Seattle Event homepage

Pre-pregnancy diet effects offspring - Mouse study

Link Between Obesity, Chronic Illness, and Bullying?

Set Point for Mood?

Epidemic of Fatty Liver Disease

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!

Diabetes, Insulin, Obesity more linkage, also smoking...

New Article




smoking, satiety article

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

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.

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!

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!

IF YOUR DOC HAD A PILL THIS EFFECTIVE, HE OR SHE WOULD KNOW EVERYTHING ABOUT IT! Don't let them hide.

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.