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Dr Steve
08-21-2008, 12:48 PM
What do you think about the lap band? I weigh 350 lbs and am 5' 6" and have tried everything to lose weight...

My surgery professors in medical school used to make fun of the whole "bariatric (weight loss) surgery" movement; they'd say "people are fat because they eat too much." and "you can't fix a social problem with surgery". However, the field has advanced a lot since its early days (I went to medical school a lonnnnngggg time ago) and the field of bariatric surgery enjoys much more prominence and success these days.

If everything else fails, and I mean everything else, then certain patients may be a candidate for some sort of surgical intervention. This should only be done on adults who are at least 100 lbs overweight or have a body mass index (BMI) of 40 or greater. (You can calculate your BMI by clicking HERE (http://www.nhlbisupport.com/bmi/).)

There are two major surgical procedures done these days for obesity, one is the gastric bypass, and the other (and there are others, too) is the Laparoscopic Gastric Banding Surgery (LGBS). The gastric bypass does just that...bypasses the majority of the stomach and dumps food directly from a little stomach pouch into the small intestine.

Here's what the gastric bypass looks like:
http://www.uihealthcare.com/depts/med/surgery/weightloss/images/rouxen.jpg

The LGBS is done with a laparoscope, and basically puts an inflatable hoop around the stomach to make a little pouch. It looks like this:

http://gastricbandindia.files.wordpress.com/2007/02/gastric-banding.gif

The benefits to LGBS include less invasive surgery, reversibility, adjustability, and decent (though less dramatic) results. From an aesthetic point of view, I am not enthused with surgery that changes the anatomy of the human body drastically without some sort of extreme need. All that extraneous stomach tissue hanging around after the bypass gives me the creeps.

People can lose an average of 1-2 lb/week with the LGBS but it ain't a magical solution. You can defeat it by drinking milk shakes, ensure and other high carb, low residue foods (they just slip through the pouch and into the main stomach). Any program that offers you a surgical solution to obesity had better have a very comprehensive and long-lasting dietary counseling program or they won't get the kind of results that most people are looking for.

I heard one surgeon put it this way: you'll lose about 40% of the weight you really want to lose with the band...the rest you still have to do yourself. Diet and exercise are still the key, even when your stomach is 1/8th the size it was before.

Hope this helps.


your pal,


steve

yojimbo7248
08-21-2008, 12:54 PM
I would prefer a lap dance.

MobCounty
08-21-2008, 01:07 PM
Not that it makes them bad people, [I'm a reformed fatty myself] but most perpetually obese people stay obese because not being obese, takes a long time and it's hard work.

I spend time with fat asses who say they diet all the time and can never lose any weight, that its' their thyroids, or they were born that way etc. etc.. And, they totally believe it.

..but if you get a chance to watch them, they stealth eat, consciously or subconsciously all sorts of crap to keep their energy up.

Last I remember, no diet includes power bars.

People who claim they can't lose weight, just need to admit they don't make choices that won't let them lose weight. A few hours of courage to get a lap band is not what's needed to make a lifestyle change..

My two cents,
MC

Dr Steve
08-22-2008, 07:43 AM
Not that it makes them bad people, [I'm a reformed fatty myself] but most perpetually obese people stay obese because not being obese, takes a long time and it's hard work.

I spend time with fat asses who say they diet all the time and can never lose any weight, that its' their thyroids, or they were born that way etc. etc.. And, they totally believe it.

..but if you get a chance to watch them, they stealth eat, consciously or subconsciously all sorts of crap to keep their energy up.

Last I remember, no diet includes power bars.

People who claim they can't lose weight, just need to admit they don't make choices that won't let them lose weight. A few hours of courage to get a lap band is not what's needed to make a lifestyle change..

My two cents,
MC

There was this really cool study once, where they used a urine test (called "doubly labeled water assay") that can estimate to within about 10% how many calories someone ate in the last 24 hours. Then they gave some obese people these diaries and had them write down exactly how much they ate over 24 hours and measured their actual intake using the doubly labeled water. The results were very revealing: the average intake was something like 4000 calories/day but the reported FOOD intake added up to only 1600 calories/day.

Their conclusion was not that overweight people are liars, but rather some of them at least have a problem in actually estimating how much they're eating. My mother in law swears she only eats one meal a day, but we went on vactation with her and saw what this meant...she starts her "meal" at 7am and continues to eat constantly until the "meal" ends at around 11pm when she goes to bed. She is completely oblivious to it, too.

Current research is focusing on the 'satiety hormone'...that trigger in the brain that tells you that you're full...that allows you to correctly estimate how much food to eat in a day. One drug, Rimonabant, worked on cannabinoid receptors in the brain (the same ones marijuana hits and causes the munchies). Blocking these pleasure receptors decreased appetite, but also caused all kinds of weird side effects that kept it from being released in the US market.

More on this as I get more information.

MobCounty
08-22-2008, 08:37 AM
There was this really cool study once, where they used a urine test (called "doubly labeled water assay") that can estimate to within about 10% how many calories someone ate in the last 24 hours. Then they gave some obese people these diaries and had them write down exactly how much they ate over 24 hours and measured their actual intake using the doubly labeled water. The results were very revealing: the average intake was something like 4000 calories/day but the reported FOOD intake added up to only 1600 calories/day.

More on this as I get more information.

Wow, thats pretty cool.
I always hear my friends and family say, 'I don't eat anything and I still get fat'. My mother is a great example. She even got lipo, because she could not lose the weight, it just 'stayed on' no matter what. Her doctor says she needs to lose weight, she knows she needs to lose weight, but she still grows.

I got her started on the fat smash. Calling her periodically helped to keep her on track, and last reports she lost a few pounds, but 'it was not working that well'.

Then we went on a week vacation with the family. She ate with the plan, but also ate around the plan. Her portions were still too big. She'd 'try' some of the good salad dressing, but she wouldn't call it a eating. She likes to think anything under a tablespoon does not count. She's also have a 'healthy' snack bar (or two) between meals instead of an apple. The only time she would think she was going off the diet was when she had a drink or two.

and she swears she's dieting.. I believe she honestly thinks she is eating nearly nothing a day. However watching her, I know she is still doing 2500-3000+ calories a day.