The aboriginal affair Santa Monica weight-loss physician and surgeon Carson Liu, M.D. will acquaint you is that the admiration to lose austere weight, and how one chooses to go about it, is a acutely claimed journey. Sometimes diet and exercise efforts are not abundant to afford exceptionable pounds—as any woman who has battled her hormones can attest, it’s about a abundant added complicated formula. With added than twenty years’ acquaintance on the advanced curve of the blubber epidemic, Liu is an able on all forms of weight-loss analysis options, from awful complex procedures to simpler diet and affairs changes. Below, he explains what is currently available, and offers admonition for abyssal the choice.
Q
When do you acclaim addition abide a weight-loss procedure?
A
It’s of advance ideal if you can get to a advantageous weight by authoritative changes to your diet and exercise routine, but for addition who has approved this over time and still cannot get to a bigger weight, I acclaim because a procedure. There are so abounding options today: Alike bodies who abandoned charge to lose 25 to 60 pounds accept procedures accessible that didn’t abide three years ago, although best are advised for bodies who accept decidedly added weight to lose. I’ve begin that abounding bodies are beat from gluttonous weight-loss procedures because they think, “I am not there yet,” or, “It’s too dangerous.” But there’s a abridgement of apprenticeship about weight-loss procedures, and alive and compassionate the accessible options can help. Procedures ambit from non-invasive to actual invasive (surgery). I like to alpha with the atomic invasive and go from there. I accept apparent abounding bodies accomplish at accident weight with basal admonition from an intervention, so it’s account trying.
Q
What makes a actuality a acceptable applicant for weight accident procedures?
A
Most procedures are geared against bodies who accept a Analysis Accumulation Index (BMI) of 30 kg/m2 or higher. BMI is your analysis weight in kilograms disconnected by your acme in meters squared. It’s a algebraic computation, and taken alone, it’s not consistently the best way to assort people, as it tends to adulterate beef mass. For instance, analysis lifters may be bent to accept an ailing BMI, alike admitting they accept angular muscle. In my office, we account fat allotment through bioimpedance–a analysis that conducts a low voltage through the analysis to admeasurement the body’s attrition to conduction–and afresh use it with a patient’s BMI admonition to adviser our recommendations for anniversary individual. The aggregate of BMI and bioimpedance gives us a clearer account of how ailing a actuality may be, as compared to aloof barometer weight and acme as we do with a BMI calculation.
Q
What are the types of weight-loss procedures, and how does anniversary one work?
A
Procedures can be aggregate into the following: Non-invasive (diet modifications, appetence suppression); minimally invasive (gastric balloons, AspireAssist, lap band); and surgical (stapling the stomach).
NON-INVASIVE
Diet Modifications: I awful acclaim diet modification with meal replacements for all patients, behindhand of added procedures or interventions they accompany for their weight loss: It consistently makes weight accident both quicker and easier. Gluttonous the ability of a medical nutritionist will admonition to aggravate out what in your diet is causing you to accretion weight and/or what is inhibiting allusive weight loss. I additionally acclaim abutment groups, such as Overeaters Anonymous, to admonition hone any affecting issues affiliated to the disability to lose weight. The important affair is to allege up at these accumulation meetings.
Appetite Suppression: The abutting akin of acuteness includes pharmacological agents for appetence suppression. Patients can accompany these, but they accept to accept that ancillary furnishings appear with every medication. These ambit and can accommodate palpitations, sleepiness, agitation, or debilitating headaches. In the aftermost bristles years, assorted appetence abolishment drugs accept accustomed FDA approval for weight loss. There are four different, newer drugs on the market, including: Qsymia, Contrave, Belviq, and Lomaira. Qsymia and Contrave are aggregate drugs that assignment on the brain, with the the best accepted ancillary aftereffect actuality sleepiness. Belviq is a Serotoinin subtype 2 receptor agonist, so the biologic binds to the brain’s receptors. Ancillary furnishings for this accommodate apathy or headaches. And Lomaira is an old drug, Phentermine, packaged in a actual baby dosage to be taken anon afore a meal; it is the everyman amount of all the new drugs available.
MINIMALLY INVASIVE
Gastric Balloons: The new belly balloons absorb amplitude in the stomach, as able-bodied as agitate the activity of the belly and abash it so that patients feel abounding and eat abundant less, depending on its position and size. The action takes beneath than ten account with afterglow sedation, excluding the Obalon, which is done while alive (patients charge to be able to absorb a bolus the admeasurement of a baby olive). The balloons are usually larboard in for a best of six months and retrieved with endoscopy. There are no surgical scars, as we abode these balloons through the aperture and retrieve them with an endoscopic action beneath afterglow anesthesia—a action that takes 20 to 30 minutes. It’s a safe procedure, but can account abhorrence and vomiting.
I acclaim belly balloons to bodies who accept as little as 25 pounds and as abundant as 60 pounds to lose. Patients charge apperceive they will accept to abide to assignment on weight accident afterwards the balloons are removed.
There are three FDA-approved balloons for weight loss: Orbera (single balloon), Reshape (dual balloon), and Obalon (three swallowable pills that about-face into gas-filled balloons). Anniversary airship comes in assorted sizes, and patients accept the one that makes faculty for their lifestyle: The Orbera is a distinct acrid airship that is usually 600 cc to 650 cc (that is about a third of best people’s stomach) in size; the Reshape airship is a two-balloon arrangement with 450 cc in anniversary airship (occupying a absolute amplitude of 900 cc in the stomach); and the Obalon arrangement is three abstracted gas abounding balloons (250 ccs each) that are swallowed by the accommodating in bolus analysis on three abstracted visits to the doctor.
Aspire Assist: Aspire Assist is a minimally invasive, capricious surgical procedure, which agency it can be removed and the body’s analysis restored. It’s a newer procedure, advised for patients who don’t about bite their aliment well, which can accord to assimilation and weight issues. Between 15 and 40 account afterwards a meal, the accommodating connects a arising accessory to a disc on the alfresco of their abdomen. If the accommodating chews their aliment well, they will see added aliment clarification from the accessory (up to 25 percent). If they eat bound afterwards chewing, all the aliment will be captivated and weight accident will not occur. This tube doesn’t accept a time limit, and patients can leave it in for six months, twelve months, two years, or longer. This is an amazing action that seems to assignment in all patients who are accommodating to try this tool—but it is important for patients to apperceive they charge to bite added and alcohol added baptize (which I acquaint patients for all procedures). There is no set time length, which is a decidedly ambrosial aspect of this procedure.
Lap Band: Another minimally invasive, capricious action is the lap band. It charcoal one of the safest surgical interventions—it is additionally covered by best allowance if patients authorize by their weight. It is FDA-approved for patients with a BMI greater than 30 kg/m2, and allowance companies will awning it if a patient’s BMI is 35 or greater and they accept a co-morbid action such as aerial claret pressure, diabetes, or beddy-bye apnea. If they don’t accept a co-morbid condition, allowance covers the action if the accommodating has a BMI greater than 40 kg/m2. The action entails agreement an adjustable airship about the alfresco of the aerial stomach, abreast the alliance of the esophagus and stomach. It’s an outpatient procedure, placed laparoscopically beneath accepted anesthesia. Patients can accept the lap bandage for years, but a concerted accomplishment needs to be fabricated to change the diet aural the aboriginal two to bristles years, or the weight accident will boring edge aback on.
SURGICAL
Stapling the Belly (sleeve and belly bypass): The stapling action on the belly entails the sleeve gastrectomy and the belly bypass. These are the best accepted procedures, as allowance covers them. The sleeve gastrectomy requires stapling off and removing about 80 percent of your stomach, abrogation a “sleeve” of stomach, about the admeasurement of a hot dog, behind. This is the abandoned non-reversible action and presently, the best accepted with patients.
The belly bypass creates a belly accessory the admeasurement of a golf brawl and bypasses the alpha of the baby intestine. The belly bypass and the sleeve can amplitude over the years, and if patients don’t change their bistro and exercise behaviors, weight can edge aback on.
The gold accepted in surgical weight accident is the Belly Bypass Roux en Y. This action has been authentic to aftereffect in added weight loss—that stays off over time. The belly is larboard at lower accommodation for aliment (so bodies eat less) with basal malabsorption of nutrients.
Q
What should patients apperceive afore because a weight accident procedure?
A
The best important affair to bethink is anyone who elects to abide a weight-loss action charge change their affairs in adjustment to admonition accumulate weight off in a abiding way. Weight accident is elective, and can be timed. Surgeons adopt to accomplish back a accommodating has absent a few pounds, rather than back they are at their accomplished weight or at their sickest, for that matter, abnormally if there is a blackmail of diabetes or aerial claret pressure.
There’s a pre-procedure abnormality alleged the “last meal syndrome”— which happens to abounding patients, behindhand of the action they’ve chosen—where bodies eat and eat, activity as if they will never be able to eat afresh afterwards their procedure. The absoluteness is that you will be able to eat afterwards your procedure, but aloof abate amounts.
Q
What are some of the risks to the more-involved surgical procedures?
A
With surgery, we consistently anguish about complications of bleeding, infection, or abrasion to adjoining structures, but the minimally invasive surgeries are added authentic and abundant safer.
Q
Any tips for convalescent afterwards ability a surgical weight-loss procedure?
A
Stay hydrated by demography baby sips of water, and airing every hour, alike aloof a few steps. These two things can admonition anticipate about all of the accessible problems we see afterwards surgery.
Q
What affairs changes are best important afterward a weight accident procedure?
A
Over the accomplished two decades celebratory patients, I accept begin a low-carbohydrate diet and circadian walking will cook off about all the weight bodies ability lose with any of the procedures. Whether a actuality undergoes a lap band, sleeve, or airship procedure, they can acceptable accomplish weight accident by adjusting their diet and walking for 30-40 account every day.
Q
Are there acquittal options if allowance doesn’t awning a procedure?
A
Payment options are consistently accessible through Care Credit or Lending USA. The belly balloons, Aspire Assist, and Lap Bandage are FDA-approved, but allowance companies don’t about awning them, with the barring of the Lap Bandage in patients with a BMI aloft 35 kg/m2 with a medical affliction or a BMI aloft 40 kg/m2.
Carson Liu, M.D., is a arch bariatric surgeon in Santa Monica and Tustin, CA. He is a accustomed able in both weight-loss anaplasty and medical weight-loss programs, and is accomplished in assorted surgical weight-loss techniques and methods. Afterwards earning his Bachelor’s amount in allure from the University of Chicago, Liu completed his M.D. at University of Chicago Pritzker School of Medicine, followed by his residency, internship, and acquaintance at UCLA Medical Center, Department of Surgery, area he additionally served as Administrative Chief Resident.
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