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.



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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!)

Risks of meds - new data

Pancreatitis and pancreatic cancer risk with newer Diabetes Meds

Recent articles Bariatric/Obesity care and access

Hypertension

STOP Obesity Alliance Director Christine Ferguson, J.D.

Importance of Acceptance vs Rejection

Obesity in Pregnancy - Infection Risks

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!