Weight Loss or Bariatric Industry Strategy Blog

An Overweight Child Is Not Doomed for Life

2012-01-19T12:00:00.000-08:00

Of course, we all know that there is a childhood obesity problem. In 2010, it was estimated that about "17 percent of American children ages 2-19" were overweight. Further, it is believed that if a person is overweight or obese during childhood, it will usually lead to overweight or obesity during adulthood. This in turn will lead to overweight and obesity related health problems. However, a recent study indicates that even if a person is overweight during childhood, losing the weight later can reduce obesity health-related problems.

The study was reported in The New England Journal of Medicine. The study consisted of an analysis of four other studies combining results gathered in the U.S., Australia United States, and Finland. The researchers concluded that "Overweight or obese children who were obese as adults had increased risks of type 2 diabetes, hypertension, dyslipidemia, and carotid-artery atherosclerosis. The risks of these outcomes among overweight or obese children who became nonobese by adulthood were similar to those among persons who were never obese."

So, an individual is not doomed if he or she was obese during childhood. That person can take action to lose the excess weight, and endeavor to maintain a healthy weight. This will lessen the health problems associated with overweight and obesity during adulthood.

In addition to the health concerns indicated above, some experts believe that obesity is associated with an increased number of falls, as we get older. In fact, one study concluded "that obese older adults were anywhere from 12 per cent to 50 percent more likely to suffer a fall over two years than their normal-weight peers.”

Therefore, losing excess weight in adulthood after being overweight as a child is both possible and advisable. Primary care physicians, bariatricians, bariatric surgeons and other health care providers have it in their power to persuade and enable overweight adults -- including those who were overweight or obese during childhood -- to achieve a healthy weight.

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Diet and Exercise Can Cause a Decline in Harmful Pro-Inflammatory Cytokines

2012-01-04T07:54:00.000-08:00

If a person is obese, most health experts would probably agree that losing weight might improve the individual's health. But none of these experts would suggest that they know all the reasons for the health improvement. However, experts are learning more about adipose cells and how they can do harm to the body.

Adipose cells are known to secrete substances called cytokines. Some of the cytokines are pro-inflammatory. And inflammation can be detrimental to a person's health. Therefore, because of pro-inflammatory cytokines, someone with excess adipose cells -- such as an obese individual -- is at a higher risk than normal of experiencing health related problems. A recent study was undertaken to determine if increased exercise and a healthy diet could cause a decline in pro-inflammatory cytokines.

Cytokines can be anti-inflammatory or pro-inflammatory. As stated above, some of the cytokines that adipose cells secrete are known to be pro-inflammatory. Tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) represent known pro-inflammatory substances.

The pro-inflammatory study mentioned above was done by scientists at the University of California. Study participants were breast cancer survivors with an average age of 56. The study, which lasted 16 weeks, promoted an increase in physical activity and a healthy diet. With the diet and exercise intervention, there was a lowering of the levels of IL-6 and TNF-alpha, and the study participants lost weight.IL-6 and TNF-alpha are important because these cytokines are felt to be associated with cancer, insulin resistance and components of the metabolic syndrome.

Although the levels of other cytokines, including interleukin-8 (IL-8), were not drastically affected by exercise and diet, the study's results add support to the belief that diet and exercise can lead to weight loss which can reduce the production of harmful pro-inflammatory substances in the body. The study results should bolster bariatricians' and bariatric surgeons' dedication to helping their patients lose weight.

Endoscopic Bariatric Therapies

2011-12-20T06:10:00.000-08:00

Bariatric surgery is a very effective weight loss treatment. Non-surgical weight loss approaches, including pharmacotherapy, diet, exercise and lifestyle modification, are, many times, less effective than weight loss surgery. But weight loss surgery has more associated complications than non surgical methods. Fortunately, experts are exploring treatment options that mimic bariatric surgery while reducing the associated complications. Some of these options could prove to be good weight loss approaches.

Many of the options can be classified as endoscopic treatment options or EBTs. A task force was formed to investigate these options. Members comprising the taskforce are drawn from two well known organizations. These organizations are The American Society for Gastrointestinal Endoscopy (ASGE) and The American Society for Metabolic and Bariatric Surgery (ASMBS). EBTs are "performed entirely through the gastrointestinal (GI) tract using flexible endoscopes." Usually there is no surgical incision associated with EBTs. Many EBTs mimic the functions of bariatric surgery.

Bariatric surgical procedures can be put into two broad categories. The procedures are either restrictive or malabsorptive. For example, the adjustable lap band is restrictive since it restricts the amount of food that can pass through the band. And gastric bypass surgery is both restrictive and malabsorptive. It is restrictive since it shrinks the size of the stomach, reducing the amount of food one needs to eat to feel full. And bypass surgery is malabsorptive, since the surgery reroutes the small intestine in a way to cause food to bypass parts of the small intestine, allowing fewer calories (and other nutrients) to be digested.

EBTs may be put into three categories. They may be restrictive, malabsorptive , or neuro-hormonal. An example of an EBT that fits into the restrictive category is the gastric balloon. This device is first placed in the stomach, endoscopically, then filled with a liquid or air. When the gastric balloon is filled, an individual’s stomach feels full with less food. A complex version of this EBT is in research at ReShape Medical, Inc, headquartered in San Clemente, California.

An example of an EBT device that may be classified as malabsorptive is the Endobarrier. Produced by Lexington, MA based GI Dynamics, the Endobarrier is a liner for a segment of the small intestine. Similar to the gastric balloon, the Endobarrier is placed in the small intestine endoscopically. The device is engineered to create a barrier between the food one eats and the intestinal walls. After insertion, food digestion is delayed in a fashion similar to gastric bypass surgery.

And finally, an example of an EBT that can be classified as neuro-hormonal is VBLOC. VBLOC was developed by Minnesota based EnteroMedics Inc. VBLOC is a system placed in the digestive system, endoscopically, to block signals sent from the digestive system, via the vagus nerve, to the brain. The signals include messages associated with hunger, satisfaction and fullness.

As EBTs are developed, tested, and proven effective, medical weight loss options might be enhanced. Both patients and weight loss service providers could benefit. Medical and surgical weight loss service providers should monitor the progress made in EBT research, so that the providers will know when they might offer the EBT as part of their services, or give advice regarding appropriate EBT application.

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Would FDA Approval of Obesity Drugs Help Reduce Health Care Costs?

2011-12-06T11:39:00.000-08:00

There is renewed attention being given to three obesity drugs that recently received a thumbs-down by the FDA. The drugs are Qnexa, produced by Vivus, a California based company, Lorcaserin, manufactured by Arena Pharmaceuticals, Inc. , a California based company, and Contrave, produced by California based Orexigen Therapeutics, Inc. If either of the three drugs eventually receives FDA approval, given the health care cost of obesity, we might assume that the use of the drugs would likely reduce the cost of health care. However, at least one study indicates that weight loss drugs don't necessarily reduce health care costs.

The study was done in Australia. The researchers looked at the costs associated with treating ailments associated with body weight, including hypertension, Type ll diabetes, colon cancer, and heart disease. The two drugs used in the study were Sibutramine (Meridia) and Orlistat (Alli and Xenical).

The researchers concluded that the use of Sibutramine and Orlistat reduced "body weight related disease burden ... by 2% and 1% respectively." Therefore, the researchers concluded that for Australians, weight loss treatment using Sibutramine or Orlistat is not cost effective, because of the modest weight loss, likely weight regain, and a lack of adherence to the regimen.

Although the Australian study may show that some obesity drugs don't reduce health care costs, having one or more of the three drugs, Qnexa, Lorcaserin, or Contrave, available for use as an approved obesity drug will likely encourage medical weight loss providers to find ways to maximize the effectiveness of the drug or drugs. This effort may reduce health care costs.

The Australian results should motivate medical weight loss providers to determine the cost effectiveness of the obesity drugs currently in the FDA pipeline. And when appropriate, depending on which drugs are approved, a provider should of course choose the drug that gives maximum weight loss. The provider should also use proven long term behavior modification treatment approaches to minimize the risk of weight regain, and maximize adherence to the weight loss maintenance program.

Parents' Weight Loss: A Weapon in Childhood Obesity

2011-11-20T18:56:00.000-08:00

We’ve all heard that the physical environment we live in greatly effects our lifestyle, and that environment plays a significant role in the worldwide obesity and overweight problem. Indeed, we are influenced by what we are exposed to. For example, if we are consistently surrounded by unhealthy food, we will eventually eat the food. Likewise, if those around us are overweight or obese, we will more easily accept our overweight or obese state, and do little about it. However, if our environment is filled with healthy food and healthy weight people, we might just eat more healthy food and seek a healthy weight.

In fact, a study has shown that when one person in a family loses weight, others in the family may be enticed to follow suit. Further, the study researchers suggest that if parents in the home engage in physical activity and eat healthy diets, these actions could influence the children in the household, providing a weapon in the fight against childhood obesity.

The study was done by a group from the Stanford University School of Medicine. The researchers concluded that "performing a gastric bypass operation on one patient has a halo of positive effect on the weight, eating habits, activity level, and health behaviors of the entire family.”

Further, the researchers suggest that the childhood obesity rate in families where the mother has had gastric bypass surgery is 52% lower than for "the same mothers before the surgery." The study demonstrates that one person’s weight loss -- at least weight loss resulting from gastric bypass surgery -- has an effect on other members of the family. And the effect no doubt extends to weight loss resulting from other weight loss methods, since all weight loss methods require lifestyle changes. And it’s the lifestyle changes that the family member sees on an ongoing basis.

Therefore, getting parents to make healthy lifestyle changes may be an approach to getting children to make healthy lifestyle changes. And if the parents' lifestyle changes lead to weight loss, the children’s lifestyle changes will likely lead to weight loss and healthy weight control.

Telemedicine Improves Gastric Bypass Surgery

2011-11-03T05:39:00.000-07:00

Today, bariatric surgery is becoming a more acceptable treatment for some forms of obesity. And the surgery is effective. In many cases, bariatric surgery leads to more weight loss than diet, exercise or drugs. Gastric bypass surgery is probably the most popular form of weight loss surgery, and telehealth may be a way to make the surgery more effective.

Telehealth is defined as "the use of telecommunication technologies to provide health care services and access to medical and surgical information for training and educating health care professionals and consumers, to increase awareness and educate the public about health-related issues, and to facilitate medical research across distances."

Telemedicine, a subset of telehealth, may be defined as “[t]he use of medical information exchanged from one site to another via electronic communications for the health and education of the patient or healthcare provider and for the purpose of improving patient care. Telemedicine includes consultative, diagnostic, and treatment services.” And a recent study concluded that telemedicine can be an important part of preoperative and postoperative consultation for the gastric bypass patient.

The study was carried out by a set of Midwestern Veterans Affairs Medical Centers (VAMCs). Twenty eight patients who lived an average of 324.5 miles from a bariatric surgery center comprised the subjects in the study. All the patients were high risk patients.

When compared to gastric bypass patients not in the study, the VAMCs patients fared very well. Indeed, it was concluded that ‘[a] cooperative network using teleconference and computerized records facilitated bariatric surgery in high-risk, remotely located VA patients with high patient satisfaction and without compromising surgical outcomes.’ The use of telemedicine eliminated 19,000 miles and 69 days of travel.

The study provides evidence that telemedicine can help a bariatric surgical patient and the surgical team manage preoperative preparation and post operative weight loss and weight maintenance. The results should be of interest to all bariatric centers -- surgical and non-surgical. Many bariatric centers already put special emphasis on counseling. Telemedicine approaches could improve that counseling.

Centers that don’t already do so might consider using telemedicine as a tool in motivating and imparting useful information their patients. Having telemedicine in place for counseling might boost a patient's chances of meeting weight loss goals. And telemedicine could enhance a center's reputation.

Revisional Bariatric Surgery Using Natural Orifices

2011-10-01T02:07:00.000-07:00

Bariatric surgery has proven to be a very effective weight loss treatment. Gastric bypass surgery is the most popular form of the surgery -- at least in the U.S. However, the surgery can cause complications. And revisional surgery is sometimes necessary to address these complications. Incisionless surgery has been used, successfully, to perform this surgery.

M.A. deWolfe of the Brody School of Medicine in Greenville, NC, reported that an "endoscopic tissue plicating device" was used to reduce the size of an expanded pouch. The device is the StomaphyX (TM) Endoplicator. The surgery was performed on a patient, who had undergone gastric bypass surgery 12 years earlier. There were no complications associated with the revisional surgery, and a year after the surgery, the patient's satiety returned and the patient had lost 45 pounds.

We have talked about the StomaphyX device before on this blog. The device is an incisionless surgical tool created by EndoGastric Solutions ™. We indicated that the tool could be used in bariatric revisional surgery. We also suggested that incisionless surgery reduces the trauma, recovery time, and complications a patient can experience after weight loss surgery.

The above referenced study appears to show that the StomaphyX device holds promise, since the surgery leads to weight loss. Indeed, as we've previously stated on this blog, incisionless surgery might be a successful approach to primary bariatric surgery.

One of the deterrents to bariatric surgery is the amount of invasiveness associated with the most effective forms of the surgery -- gastric bypass for example. Therefore, employing incisionless weight loss surgery for the primary procedure could be a good thing for prospective patients as well as the surgical weight loss center. And this procedure could be a positive step forward for bariatric surgery.

At any rate, bariatric surgical centers should consider natural orifice procedures for revisional surgery. If managing the complications isn't effective. revisional surgical using devices such as StomaphyX could offer a viable alternative.

Some Obese Persons Are Healthy and Only Need Minimum Activity to Stay Healthy

2011-09-17T07:06:00.000-07:00

An expert in Alberta, Canada suggests that some obese persons are healthy, and that it is a waste of money to subject these persons to drastic weight loss measures such as weight loss surgery. The researcher, Dr. Arya Sharma, of the University of Alberta, evaluated the health of obese persons, and established five stages of obesity to help assess the health of obese persons. These stages are incorporated in a system called the Edmonton Obesity Staging System (EOSS). In the system, healthy obese persons are put at the lower stage.

The EOSS stages go from zero to four. An obese person put at stage 4 is considered to be most unhealthy. The health of the obese person is based on BMI and other considerations including the nature of the comorbidities accompanying the obesity. So, obese persons at stage four are the most unhealthy and obese persons at stage zero are judged healthy in the system.

Another study indicates that individuals can improve their health by engaging in as little as fifteen minutes a day. Therefore, healthy obese persons can likely maintain or improve their health with this minimum amount of physical activity. The study was done at Taiwan's Institute of Population Science.

The study was carried out by Taiwan’s National Health Research Institutes. The study consisted of more than 400,000 subjects. The Taiwan experts concluded that a person can add three years to his life with the minimum exercise. The implication is that anyone can improve his or her health by engaging in frequent physical activity. So, perhaps minimum exercise is the only recommendation that should be made to those obese persons at stage zero of EOSS.

Because exercise can help keep us all healthy -- including those of us who are overweight or obese -- it is imperative that we all emphasize the importance of some physical activity, even if it is only fifteen minutes a day. And bariatric surgeons and bariatric physicians should work together to identify those obese individuals who are healthy, and counsel those individuals to maintain a healthy lifestyle, including physical activity, to improve or maintain good health.

Weight Loss Counseling Directed at Neurobehavioral Processes

2011-08-31T09:34:00.000-07:00

Counseling for weight loss is an important part of many weight loss programs. Indeed, physicians are asked to provide weight loss counseling to their patients. And recent research suggests what the focus of that counseling might need to be.

Research at Rush University medical Center in Chicago, Illinois, indicates that counseling should be based on neurobehavioral processes or "ways in which the brain controls eating behaviors in response to cues in the environment." Because traditional weight loss methods emphasize healthy personal choices and willpower, counseling directed at neurobehavioral processes is a different approach to weight loss.

There are three behavioral processes commonly associated with eating too much and being overweight. These are "food reward," "inhibitory control," and "time discounting." Food reward includes the pleasure we receive from the food we eat and the drive we have to eat the food we like. Inhibitory control pertains to our ability to regulate our food intake. And "time discounting," in a nutshell, is our tendency to seek instant rather than delayed gratification. We would much rather eat high calorie food today than engage in healthy habits that will likely benefit us later in life.

According to the research, to attack the food reward impulse, high-fat foods should be removed from the overweight person's environment, and the overweight person should use shopping lists when buying food in the grocery store. To improve inhibitory control, the overweight person should avoid buffets, and restaurants. And to overcome the tendency to discount time, the overweight person should focus on reaching short-term goals that will lead to weight loss, rather than concentrating on long-term weight loss success. For example, the person can endeavor to eat a "healthy dinner on three nights a week."

Perhaps, the 5A counseling model, which has been shown to improve counseling, could be used to focus on the three important neurobehavioral processes, and greatly enhance the success rate of weight loss programs. Using the 5A process, a physician would Assess, for example, the risks associated with an overweight individual’s behavior, Advise the individual to modify certain behaviors in support of weight loss, Agree to and help to put goals in place, Assist in determining what barriers exist, and getting needed support, and Arrange for ongoing follow-up activities.

Since it has proven to be effective, the use of the 5A counseling method with a focus on the neurobehavioral processes that play a role in how we eat may offer an avenue to successful weight loss. This would benefit both the patient and the weight loss practitioner.

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Leaks after Bariatric Surgery May Be Better Predicted and Managed

2011-08-15T17:46:00.000-07:00

Bariatric surgery is becoming more common today. According to HealthGrades, “because of … favorable outcomes, the number of bariatric surgeries has continued to steadily increase in recent years.” The FDA has lowered the BMI guidelines for lap band surgery, therefore, bariatric surgery will likely become more common in years to come. And complications will likely continue to be associated with all forms of bariatric surgery.

However, some types of the surgery give rise to more serious complications than others. For example, a higher rate of severe complications results from gastric bypass surgery, where the small intestine is rerouted, than from gastric band surgery. To accomplish the rerouting, the small intestine is re-attached. And this re-attaching can lead to postsurgical leaks. However, because the leaks can be serious, new research may benefit the patient who has to deal with these leaks.

A study referenced in a recent report entitled “Management of postsurgical leaks in the bariatric patient,” concluded that “endoscopically placed covered esophageal stents,” that were ‘used to exclude the leak site,' allowed oral nutrition and speeded up healing. Managing these leaks is important, since as the report states, these postsurgical leaks, attributable to surgical technique, and other factors, can lead to major comordities and mortality.

Another study entitled, "Understanding the significance, reasons and patterns of abnormal vital signs after gastric bypass for morbid obesity,” found that “sustained tachycardia [a faster than normal heart rate] with a heart rate exceeding 120 bpm appears to be an indicator of anastomotic leak.”

The two above-mentioned studies show how research is leading to procedures that can allow bariatric surgical providers to better manage and anticipate leaks that might occur after bariatric surgery. The procedures that can grow out of these studies could help reduce bariatric surgical morbidity and mortality. These procedures would benefit both the patient and the bariatric surgical team.

Realize Band's Possible Contribution to the Type ll Diabetes Fight

2011-07-31T16:38:00.000-07:00

Currently, many Americans are having to live with diabetes. And Type ll diabetes is on the incline among children. In some cases, bariatric surgery is considered a feasible Type ll diabetes treatment. Studies show that for many persons with Type ll diabetes, the disease is resolved or more easily regulated following bariatric surgery. And relatively new research concludes that bariatric surgery is a more cost effective approach to Type ll diabetes than customary diabetes care methods for individuals with a BMI equal to or greater than 35. One form of bariatric surgery suggested for the treatment of Type ll diabetes is the adjustable lap band, including the less popular form of the band, the Realize Band.

Indeed, the Realize Band is worth considering for those Type ll diabetes individuals with a BMI greater than 35. According to a press release, “some patients prefer the Realize Band over the Lap Band [because] ... the injection port beneath the skin is smaller and less visible from the outside. In addition, the Realize Band comes with a comprehensive online weight loss program, which includes a personal plan, a nutritional plan, a fitness plan and a progress tracker."

In the past, we have stated that some experts contend that bariatric surgery might be used to treat illnesses besides weight loss. In support of this view, a few years back the American Society for Bariatric Surgery (ASBS) modified its name to include "metabolic." The modified name is the American Society for Metabolic and Bariatric Surgery (ASMBS) which recognizes non-weight-loss applications of gastric bypass surgery.

Employing bariatric surgery as a treatment option for diabetes, of course, will receive additional attention. And bariatric centers and other medical weight loss service providers should keep abreast of the advantages and disadvantages of bariatric surgery in the treatment of diabetes.

If the Realize Band is a good, cost effective treatment for diabetes, this surgical option will be an important service that bariatric surgical centers can offer. Offering the Realize Band, as well as other bariatric surgical options, as a treatment for Type ll diabetes could give a surgical center a competitive advantage while lowering the costs of Type ll diabetes. And because they might be part of the weight loss team, physicians specializing in medical weight loss can play an important role in informing the patient that the Realize Band, and other surgical options, might be a tool in Type ll diabetes treatment.

In-Between Weight Loss Approaches

2011-07-15T17:48:00.000-07:00

Bariatric surgery is often viewed as a more effective form of weight loss treatment than non-surgical methods. Non-surgical treatment methods include drugs and lifestyle modification. However, some researchers are working on treatment options that fit somewhere between bariatric surgery and other obesity treatments such as obesity drugs, diet, exercise and behavior modification.

One such device is the gastric balloon. This device is inserted into the stomach through the mouth, and then filled with a liquid or air. Once the gastric balloon is filled, an individual’s stomach feels full with less food. A more complex version of the gastric balloon is in research at ReShape Medical, Inc.

ReShape Medical is a medical device manufacturer headquartered in San Clemente, California. The company develops non-surgical weight loss devices. One of its devices is a dual gastric balloon apparatus. Since the device is inserted via the mouth, no surgery is required. Thus, dual-balloon implementation appeals to those patients who want to avoid bariatric surgery and the side effects sometimes experienced with the use of weight loss drugs.

Another non-surgical device for weight loss treatment is the Endobarrier. Created by Lexington, MA based GI Dynamics, the Endobarrier is a liner for part of the small intestine. Like the gastric balloon, the Endobarrier is inserted via the mouth into a portion of the small intestine. The device is designed to create a barrier between the food one eats and the intestinal walls. After insertion, food digestion is delayed in a fashion similar to gastric bypass surgery. According to GI Dynamics, the device provided “significant weight loss and diabetes improvement … when combined with certain diet and lifestyle modifications.”

Finally, Endosphere, based in Columbus, OH, has produced an endoscopically delivered weight loss device that is designed to slow the movement of food though one part of the small intestine. The company believes that slowing down the food will cause satiety signals to be sent out, thus reducing a person’s food intake.

If any one of these devices proves successful, the weight loss options for medical weight providers and their patients will be enhanced.

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Resist One Day Surgery for Some Bariatric Procedures

2011-06-30T15:49:00.000-07:00

According to a recent article in the Houston Chronicle, while Houston has a rising population, "there's a drop in the number of people using [Houston area] hospital beds and the length of time they spend in them." Among the reasons for the decline in hospital bed usage and length of stay are the tightened restrictions insurance companies have imposed on patient admittance and length of stay. Also among the reasons for the decline is improvement in technology used to treat patients. This improvement is evident, worldwide, in bariatric surgery. Indeed, advances in technology have helped to lower the length of stay associated with a number of bariatric surgical procedures.

Laparoscopic techniques are among the technologies that have contributed to this length of stay shortening. Today, some lap band procedures are done on an outpatient basis, with a patient’s hospital stay being one day.

Now, there is a push by some consultants to make gastric bypass surgery a one day event. However, experts insist that gastric bypass surgery requires a length of stay of at least two days.

Dr. John Morton, "director of bariatric surgery and staff at hospitals and clinics at Stanford University in California," insists that too early discharges would have serious consequences.

Reviewing 51,788 gassing bypass outcomes, Dr. Morton concluded "that patients who left the hospital on the day of the surgery were 12 times more likely to have serious complications than those who stayed for two days." And the 30 day mortality rate was higher for the patients who were released on the day of the bariatric surgery.

Of course, a decrease in hospital length of stay is a money saver in many cases. However, if reducing the length of stay causes complications, the shortened period would likely increase rather than decrease the cost of the surgery. So, the best practice, now, is probably to adhere to a minimum two day length of stay for gastric bypass surgery until the risk of serious complications is lowered.

An Automatic Food Diary

2011-06-17T16:06:00.000-07:00

Nonsurgical weight loss and weight management are difficult but possible. A national group called the National Weight Control Registry shows that it is possible to lose weight and maintain a goodly amount of the weight loss. And keeping a food diary is an important tool used by persons in the registry. However, food diaries are often inaccurate. But a physician suggests that a minor modification to food-diary use can increase a diary's accuracy.

The physician is Tim Harlan. And he writes in the Huffington Post that planning your meals is a key to improving the accuracy of the food diary. He calls the planning a way to create an automatic diary. That is, by planning next week's meals and snacks, a person can compute, in advance, the number of calories the person will ingest during the week. So, assuming the person sticks to an established plan, that person automatically has an accurate account of the calories in the coming week's diet.

Having an accurate accounting of the calories you take in is important in weight loss and weight control. Like everything else, if you don't measure it, you can't manage it. Indeed, to some extent, Harlan's advice reflects the sentiment of other weight loss experts. Some experts insist that in order to control your diet, you should adhere to a similar diet each day. Further, you should prepare your own meals and avoid eating out. These actions will give you an excellent opportunity to know your food calorie content, before you eat the food, enabling you to better count the calories.

Perhaps, weight loss providers should emphasize, even more, the importance of meal planning in weight loss and weight control. The providers could encourage an individual to spend some time during the weekend planning the next week's meals. And the providers could advise an individual to eat sparingly when away from home, since it may be difficult to determine the calorie content of food eaten in places other than the home. These actions could enable a person to more accurately account for the calories in their future diet. Thus, the person could obtain a more accurate food diary, and, perhaps, more weight control.

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PCP Practice Guidelines for Obesity Treatment

2011-06-01T08:18:00.000-07:00

Since a primary care physician (PCP) is the medical provider that most overweight or obese patients come in contact with, a set of tested weight loss clinical guidelines could improve the PCP's weight loss treatment. And the guidelines could include steps for bringing in other experts, when appropriate. These other experts might include bariatric physicians and bariatric surgeons.

Investigators at the University of Maryland established a project to create a program that could be used by PCPs to identify, evaluate, and treat obese adults. Sixty PCPs were surveyed to determine a set of clinical practice guidelines (CPGs).

A program was then developed based on the CPGs. The program was later given to 26 providers to use. After following the program, more than 70% of the providers indicated that the guidelines would improve obesity treatment. The providers also indicated that because of their use of the guidelines, the providers would be more likely to refer obese patients to a bariatric surgeon. We believe, however, that before a PCP refers a patient to a bariatric surgeon, the PCP should consult a bariatric physician. Further, we believe that the PCP guidelines should include steps for including bariatric physicians in the obesity treatment.

Since bariatric physicians are trained to treat overweight and obese individuals, these physicians can provide weight loss and weight management services that a PCP may not be equipped to provide, unless the PCP has been trained in bariatric medicine.

The American Society of Bariatric Physicians (ASBP) has established a set of practice guidelines for bariatric physicians. The guidelines include an "Initial Patient Work-up," consideration of "Medications and Other Therapeutic Modalities," and the establishment of a maintenance program.

So while obesity-treatment guidelines for PCPs are warranted, the inclusion of bariatric physicians in the overall weight loss and weight management process is worth considering in the guidelines. Overweight and obesity are enormous problems. And there are roles to play for the PCP, the bariatric physician, and the bariatric surgeon.

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Evidence Supporting the Safety and Effectiveness of Lap Band Surgery

2011-05-16T18:37:00.000-07:00

The US FDA embraced lap band bariatric surgery, to some extent, by lowering the BMI from 35 to 30 for persons with specific cormorbidities. However, there remain lingering opinions that the FDA should not have have lowered the limits, because lowering the limits will encourage some persons to seek lap band bariatric surgery, when non surgical weight loss approaches would be more appropriate. Further, there are some doubts that lap band surgery is effective, long term. Well, study results recently released, may give some relief to those who doubt the effectiveness of lap band surgery.

The study, abstracted in PubMed, suggests that lap band surgery is both safe and effective. In the study, a single surgeon in a community practice, 442 patients who had received lap band surgery were followed for about five years. The patients in the study had a mean BMI of 47. The results of the study were as follows: “The average percentage of excess weight loss was 27% at 6 months (n = 384), 38% at 12 months (n = 301), 44% at 18 months (n = 260), 48% at 24 months (n = 190), 51% at 36 months (n = 135), 58% at 48 months (n = 66), and 60% at 60 months (n = 31). By 60 months, 10% had failed to lose ≥25% of their excess body weight.”

According to the results, most of the patients receiving the surgery were able to maintain more than 25% of their excess weight loss after five years. There was also a low complication rate. These results are important, since they lend support to the use of the lap band for weight loss.

It's important to note that the researchers emphasize the significance of post-operative support for the weight loss surgical patients, stating that “the results depend heavily on meticulous long-term follow-up.” We believe that bariatric physicians can play an important role in the long-term follow process. Therefore, the expansion of patient access to lap band surgery can broaden the opportunities for bariatric physicians.

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Tags: business planning, strategic management, business strategy, environmental scanning

Exercise May Improve Cognitive Restraint

2011-05-01T13:25:00.000-07:00

Exercise, alone, will not enable one to lose and maintain weight loss long term. In fact, studies show that diet may be more important to weight loss than exercise. However, exercise should be an integral part of a weight-loss program, since it helps one maintain weight loss, long term. Indeed, exercise may improve one's ability to adhere to a diet by improving one's ability to restrain eating.

A study, reported in Medscape, concluded that exercise improves cognitive restraint. Specifically, the researchers suggested that "men who added exercise to dieting had increases in cognitive restraint and decreases in hunger. They also lost more weight than those who dieted without exercise."

Therefore, exercise is important in a weight loss program. So employing interventions that motivate an overweight individual to exercise is essential. A recent study, reported in ScienceDaily, showed that interventions directed at improving activities such as self monitoring and goal setting induce people to exercise, while interventions directed at providing knowledge and changing attitudes do not.

Thus, studies lend support to the importance of exercise as part of a weight loss and weight management program. Studies also highlight the importance of choosing the right kind of interventions to get a person to exercise, since interventions that cause a person to engage in physical activity are the most productive. Intensive counseling is an intervention that has been shown to change behavior.

So weight loss providers should target exercise with their counseling. Because, with increased exercise, there is a good chance an overweight individual can restrain food intake, thus improve weight loss and weight maintenance.

Most weight loss professionals agree that diet and exercise are indeed important in weight loss and weight management. But now we are learning that exercise improves one's ability to stay on a diet. This bit of knowledge might help weight loss providers better guide their overweight and obese patients.

Will Primary Care Physicians Counsel More Obese Patients to Get Bariatric Surgery?

2011-04-15T09:23:00.000-07:00

It’s been said that primary care physicians don’t counsel their patients on overweight and obesity enough. However, many believe that if physicians told their patients that they needed to lose weight the patients would take some action. But according to a survey referenced in USAToday, less than 50 percent of physicians discuss weight with their patients.

There are a number of reasons physicians don't discuss weight with their patients. One of the reasons given is a lack of appropriate skills on the physicians' part. Another is the lack of faith that an overweight or obese patient will do what's recommended. For these and other reasons, one has to wonder if more primary care physicians might find it easier to just refer an obese patient to a bariatric surgeon rather than trying to treat the patient's obesity.

According to a recent article in The Sunday Times, a study done in Ireland by the Trinity College Centre for Health Sciences, showed that “42% of GP practices in Dublin have referred patients for bariatric surgery.” Seventy five percent of the physicians prescribed weight loss medications, and 35% or less of the Irish GPs referred an overweight patient to a dietitian. The reasons the GPs gave for this practice were constraints on time and “limited access to a dietitian.”

One expert, quoted in the article, did agree that medications and bariatric surgery were overused. But he suggested that prescribing diet and exercise was useless because the practice did not lead to successful weight loss.

With the loosening of lap band surgical guidelines by the US FDA , we can speculate that more US primary care physicians might start counseling their patients to lose weight using surgery, rather than diet and exercise. In a lot of cases, weight loss surgery is the most appropriate weight loss method. But there are many cases where the combination of diet, exercise, and lifestyle modification is the best approach.

Primary care physicians should get the appropriate weight loss training. These physicians should be given the time to adequately counsel overweight and obese patients. And the physicians should be reimbursed for their time. Since most patients do listen to their physicians, intensive counseling may encourage a patient to dutifully follow a non surgical weight loss program -- at least until there is no doubt that the program is failing. Indeed, all weight loss approaches have a place in the fight. Therefore, health care providers should be equipped to help the patient decide when a specific weight loss approach is the right choice.

Obesity Is Last on List of Concerns

2011-03-31T06:23:00.000-07:00

A few months ago, results from a very revealing Pew Research Center survey were published. In the survey, 1503 adults were asked to choose, from a list of 22, the primary issues the president and Congress should work to resolve. And even though obesity is a pressing concern, obesity was last on the list. Only 19% of the respondents felt that obesity was the primary issue. While adults are concerned with a number of important issues today, it is surprising that obesity was last on the list.

Number one on the list was the economy. This is not surprising since so many people are out of work or worried about being out of work. In fact, jobs was number two on the list of issues, while Medicare and health care costs were seven and eight, respectively.

What's interesting about the top issues on the list is their relationship to obesity. Reducing obesity would positively affect all of these items -- especially the economy. According to a study sponsored by Allergan, a maker of a lap band, obesity costs the US economy over $70 million per year. While Allergan is perhaps biased in favor of a large obesity economic impact, since the impact would increase the market for lap bands, another study concluded that obesity costs the US more than $147 billion per year.

At any rate, reducing obesity would likely lower health care costs. Reducing health care costs would benefit the economy and other issues, worldwide, and in the US. Moreover, reducing health care costs would leave additional funds in many US employers' coffers, since employers are among the biggest health care payers in the US. So these employers have a vested interest in lowering health care costs. Thus, employers should continue to invest in wellness programs to help lower employer health care bills.

Although the survey respondents considered obesity to be the least important concern that the president and Congress should work to resolve, President Obama and his administration have put a lot of emphasis on reducing obesity in the US. This emphasis is reflected in last year's health care law. For example, the law contains endorsements of obesity counseling and employer wellness programs.

The wellness program endorsement offers an opportunity for primary care physicians and bariatric physicians to partner with employers to forcefully address obesity, and help lower health care costs.

Bariatric Surgery, A Primary Treatment for Type ll Diabetes

2011-03-16T13:56:00.000-07:00

Bariatric or weight loss surgery is considered, by many, to be an important option for treating obesity. And recently, the FDA lowered the BMI guidelines for lap band surgery, a popular form of weight loss surgery. Up until the FDA's action, an individual's BMI had to be at least 35 before bariatric surgery would be indicated. Now, FDA lap band surgical BMI guidelines have a lower limit of 30, provided the patient has specific health-related comorbidities, including hypertension and diabetes. Further, the treatment usages for bariatric surgery could broaden. Studies are now underway to determine the effectiveness of bariatric surgery for type II diabetes.

It has been known for some time that bariatric surgery causes improvement in conditions associated with type II diabetes. In some cases, it appears that the surgery resolves the disease. Well, one study, being done at New York Presbyterian Hospital/Weill Cornell medical Center, is trying to determine if "bariatric surgery is the best option for type II diabetes."

As we indicated above, type II diabetes is one of the comorbidities among the FDA guidelines, used to justify bariatric surgery. The above mentioned study will be open to diabetic patients with a BMI as low as 26. Fifty patients are to be enrolled in the study. And among other things, the study leaders hope that their results will lead to improved methods of treating type II diabetes, and lead to a deeper understanding of how gut hormones respond to the food we eat. A better understanding of gut-hormone response to food could lead to improved weight loss and diabetes therapies.

The hormone, GLP-1 (glucon-like peptide 1), is one of the gut hormones being investigated by researchers. In fact, a group in the UK has concluded that within days after gastric bypass surgery, "improved insulin resistance, insulin production, and GLP 1 responses" occurred. And the group speculates that the increased insulin production may be associated with "enhanced ... GLP-1 responses."

The UK group also determined that lap band surgery led to type II diabetes remission in 72% of the gastric bypass patients, and in 17% of the lap band patients.

At any rate, one day there may be a legitimate basis for using some form of bariatric surgery as a primary treatment of type II diabetes. And presurgical and postsurgical medical intervention will likely be important to resolving the disease. So bariatric physicians, as well as bariatric surgeons, will be important actors in the process.

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Tags: environmental scanning, strategic management, balanced scorecard, business planning

Should Hypnosis Be Considered as a Potential Weight Loss and Weight Management Tool

2011-03-02T06:26:00.000-08:00

As we've said before on this blog, we believe that counseling could be a more important tool in weight loss and weight management. And since the passage of the new healthcare law, which requires weight loss counseling for obese adults and children over six, we believe that counseling will receive more attention, and that counseling will be used more by medical weight loss practitioners. Further, perhaps, hypnosis should be considered for increasing the effectiveness of the counseling.

Although hypnosis is not currently approved by the American Medical Association for clinical use, two hypnosis societies, the American Society of Clinical Hypnosis and the Society of Clinical and Experimental Hypnosis, maintain that there is "a body of evidence-based research documenting the cost effectiveness and efficacy of hypnosis in specific settings." One of the settings might be weight loss or weight management clinics.

The San Diego-based Edward Hypno-therapy clinic is planning to use the Hypno-band, a weight loss program based on hypnosis. According to the clinic, the program is "comparable [in effectiveness]… to gastric bypass or lap band surgery." Of course, this view is debatable, since, according to the Mayo Clinic, "hypnosis may help you shed a few extra pounds when it is used along with other weight-loss methods, such as diet and exercise. But there isn't enough solid scientific evidence about weight-loss hypnosis to recommend for or against it."

Still, a meta-analysis, documented in the Journal of Consulting and Clinical Psychology during 1996, suggested that with the addition of hypnosis in "cognitive-behavior treatments for weight loss" a person can lose twice as much weight as someone getting cognitive-behavior weight-loss treatments without hypnosis.

At any rate, a prudent medical weight loss practitioner might consider investigating hypnosis. And if that investigation shows that hypnosis could have a place in weight loss or weight management treatment, including hypnosis as a weight-loss tool may give the practitioner a competitive advantage.

Diet, Exercise, Lifestyle Modification Before Bariatric Surgery

2011-02-14T05:35:00.000-08:00

With overweight and obesity continuing to be worldwide problems, measures to deal with the problems are gaining an increasing amount of attention. And some of the guidelines that health care professionals commonly use to advise overweight individuals may receive modification. Usually, weight loss recommendations are guided, to a great extent, by Body Mass Index (BMI). For example, if the overweight person has a BMI less than 35, bariatric surgery is usually not recommended. Instead, the overweight person is told to follow a low calorie diet, increase physical activity, and modify his or her lifestyle.

But there is new thinking associated with bariatric surgery. The FDA is considering lowering the guidelines for lap-band bariatric surgery, as we recently stated on our blog. There is an opinion, held by some, that weight loss surgery is a better weight loss option than non-surgical approaches. And this opinion appears to be reinforced by some practices of the Tennessee Medicaid program, TennCare.

This state insurance program will cover lap-band surgery if a person qualifies. However, the program will not cover weight loss nutritional counseling. To some, this seems illogical, since counseling for overweight persons with a BMI between 30 and 35 is likely a safer, and less expensive approach to weight loss than weight loss surgery.

After the FDA's thoughts on possibly lowering the lap-band surgical guidelines were made known, the American Society of Bariatric Physicians (ASBP) issued a press release. The release suggests that it is inappropriate for the FDA to reject weight loss drugs, while seeming to embrace weight loss surgery, which is a more drastic approach to weight loss.

While it is true that people achieve weight loss success with bariatric surgery, diet, exercise and lifestyle modification can also lead to weight loss success.

According to Dr. Rena Wing, a speaker at the 2010 Obesity Society meeting, and one of the founders of the National Weight Control Registry, on average, individuals in the Registry maintained a seventy pound weight loss for more than six years. Further, Dr. Wing has outlined activities that these individuals engage in to maintain the weight loss. A low calorie, low fat diet, along with life style modification are significant components of the weight loss and weight maintenance activity set.

Therefore, perhaps the FDA should place more emphasis on diet, exercise and lifestyle modification, before lowering the bariatric surgery guidelines. The agency should point out non-surgical weight loss success, such as that demonstrated by the National Weight Control Registry.

And medical weight loss practitioners should work to change the mindset of stakeholders such as insurers and others who control or influence health care purse strings. These stakeholders should be shown the evidence supporting diet, exercise and modified-lifestyle programs that lead to successful long term weight loss and weight loss control.

Forming Partnerships to Fight Obesity

2011-01-31T14:30:00.000-08:00

Entering into an arrangement where organizations work together can be a good strategic approach for some organizations. The collaborative arrangement may be informal. Or the arrangement might be a formal partnership or even a merger. Sometimes these collaborative arrangements work and sometimes they don’t. We can recall the high expectations many had when AOL (American Online) and Time Warner merged. The merger was to allow, among other things, both companies to rise with the power of the internet. However, the merger didn't work, and was eventually dissolved.

But coming together to leverage resources and capabilities can be a good strategic move for many organizations in any industry. The highly respected, non-profit Robert Wood Johnson Foundation (RWJF) forms collaborative arrangements to further its mission. RWJF’s mission is to improve America’s health and health care. Reducing overweight and obesity is an integral part of improving America’s health. And RWJF typically partners with other non-profit organizations in this cause. But for-profit and non-profit organizations can also form working relationships with each other.

“Florida Hospital, Sanford-Burnham Medical Research Institute (Sanford-Burnham), and Takeda Pharmaceutical Company Limited, [recently announced] that they have signed a research agreement to form a collaboration to discover and evaluate new therapeutic approaches to obesity.”

Florida Hospital, a non-profit hospital, is located in Orlando, Florida. It was founded over 100 years ago. The non-profit Sanford-Burnham Medical Research Institute has locations in Florida and California. And Takeda is a pharmaceutical company with headquarters in Japan.

Perhaps, the collaboration between these three organizations will be worthwhile. The partnership might further the advancement of approaches to weight loss and weight management.

It is generally assumed that for-profit and non-profit organizations have different motivations: For-Profit organizations want to make a profit, and Non-Profit organizations tend to have some type of community service as their purpose.

But for-profit organizations can do good things for the community while making a profit. And non-profit organizations can create needed excess revenue (or profit), while serving the community. Ardently addressing the overweight and obesity problem will benefit both for-profits and non-profits.

Therefore, for-profit organizations, such as Takeda, and non-profit organizations, such as Florida Hospital and Sanford-Burnham Medical Research Institute, have good reasons to want to develop effective weight loss products and procedures. Further, the Florida Hospital-Sanford Burnham-Takeda partnership might encourage standalone for-profit medical weight loss clinics to look for ways to partner with non-profit organizations to fight overweight and obesity.

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Tags: environmental scanning, balanced scorecard, swot, strategic management

Changing the Environments to Fight Childhood Obesity

2011-01-16T03:01:00.000-08:00

The environments, we normally occupy, expose us to the food we wind up eating. In fact, to a great extent, these environments dictate the kind of food we eat. For elementary school children, the two most important environments are the home environment and the school environment. Therefore, changing the food in these two environments is important to curtailing childhood obesity.

For some time, experts have suggested that elementary school cafeteria food in America’s schools should be improved to fight childhood obesity. And recently, President Obama signed into law a bill that increases elementary school children’s access to nutritious food. The name of the bill is the “Healthy, Hunger-Free Kid’s Act of 2010.”

The bill enlarges the number of children who will have access to federally funded meals. The bill also sets national standards for the food sold in school cafeterias. So indeed this bill will change the food in elementary school children's environment.

However, in order for the change in food to have the most effect, a concurrent change in the food made available at home must change for many elementary school children. This means that the whole family must agree to a weight loss or weight management program.

The role the family must play in maintaining a child's healthy weight is important. The family must create a home environment, where the child is exposed to healthy low calorie food. By creating, and maintaining, a healthy diet environment, the family will be working with the elementary school to lessen the rise in childhood obesity.

And where possible, medical weight loss practitioners should play a role here. The practitioners can get involved with community groups who are fighting childhood obesity. The practitioners can work with these groups to help them sync up with elementary schools in the childhood obesity fight.

Bariatric Surgery, A Possible Treatment for Obese Heart Failure Patients

2010-12-31T09:38:00.000-08:00

To be considered for bariatric or weight-loss surgery today, using the National Institutes of Health (NIH) guidelines, a person must have a BMI greater than 40 or a BMI greater than 35, with weight related comorbidities. The comorbidities include type II diabetes and sleep apnea and hypertension.

A Mayo Clinic study "found that morbidly obese heart failure patients who undergo bariatric surgery gain long lasting and meaningful improvements in diabetes symptoms and quality of life". The researchers also state that bariatric surgery could become part of the treatment for obese patients who experience heart failure if there are no contraindications for the surgery. The researchers point out, however, that most cardiologists don't "refer for obese patients with heart failure for bariatric surgery."

Of course, more study needs to be done to support enlarging the treatment options for obese heart failure patients. The study looked at only thirteen patients. But since weight loss has been proven to have positive effects on type II diabetes, hypertension and cholesterol, it is quite possible that weight loss and weight management would benefit heart failure patients who are obese. And indeed bariatric surgery would play a significant role here.

We should also point out that in addition to bariatric surgery, nonsurgical weight loss methods deserve some attention. If cardiologists partnered with physicians who are expert in nonsurgical weight-loss treatments, obese patients who have experienced heart failure, but don't qualify for bariatric surgery for some reason, could receive medical weight-loss treatment that could improve their diabetes symptoms and quality of life.

Perhaps bariatric surgeons and physicians who specialize in nonsurgical medical weight loss (bariatricians) should contact cardiologists, and try to enter into a relationship with them. This relationship would benefit the patient and the cardiologist. This relationship could also benefit the bariatrician by increasing his patient base.

(Please leave a comment by clicking on the "COMMENTS" link at the lower right part of this blog post. SUBSCRIBE to this blog by scrolling to the bottom of this page and entering your email address.)

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Tags: strategic management, balanced scorecard, environmental scanning

The CDC Underestimated the Overweight Problem

2010-12-17T05:46:00.000-08:00

In 2005, CBSNews reported on a study by the Centers for Disease Control (CDC) that showed "that people who are modestly overweight actually have a lower risk of death than those of normal weight." The CDC's conclusions created a lot of confusion, because they implied that being overweight was not the serious problem Americans had been led to believe. Well, a new study conveyed in the New England Journal of Medicine concludes that both obesity and overweight are "associated with increased all-cause mortality."

The study is further summarized on WebMD. Although the study pooled data from research where the subject population consisted of white adults, we believe that the results apply to most population groups. So, contrary to the CDC's 2005 conclusions, being just a little overweight increases your risk of death compared to someone of normal weight.

Indeed, the WebMD summary shows that if your BMI is between 25.0 and 29.9, your risk of death increases by 30%; if your BMI is between 30 and 34.9, your risk of death increases by 44%; if your BMI is between 35.0 and 39.9, your risk of death increases by 88%; and if your BMI is between 40 and 49.9, your risk of death increases by 251%.

Although the significance of being overweight is becoming more and more apparent, weapons to combat the problem are not being created fast enough. In fact, the number of weapons is decreasing. Sibutramine (Meridia) was recently taken off the market for health reasons, and two promising new weight loss drugs, qnexa and lorcaserin, were rejected by the FDA this year. Still, there are two recent bright spots in the fight against overweight and obesity.

The FDA is considering a reduction in BMI guidelines normally used for lap band surgery. Currently, it is recommended that a person have a BMI greater than 40, or a BMI between 35 and 40, with weight related comorbidities, in order to to be considered for bariatric surgery.

However, the FDA is considering lowering these guidelines by five points. Under the new guidelines, an obese person with a BMI of 35 would be a candidate for the surgery, and someone with a BMI between 30 and 35 would be a candidate, if the person has certain weight related comorbidities.

Another bright spot in overweight and obesity weaponry is the possible addition of a new FDA approved weight loss drug. The drug, contrave, has received the recommendation of an FDA panel.

However, even in light of these bright spots, there is a dearth of tools available to fight the overweight and obesity problems. So we must learn to use the tools we now have more effectively. This reality puts pressure on bariatric surgeons and physicians specializing in nonsurgical medical weight loss. This reality also offers opportunities for these two groups of physicians to work together.

Suicide Appears to be Linked to Bariatric Surgery

2010-12-02T17:35:00.000-08:00

Bariatric surgery has become the gold standard for treating morbidly obese patients (patients with a BMI greater than 40). And the number of patients obtaining the surgery increased at least tenfold between 1998 and 2008. Therefore, bariatric surgery has achieved prominence over the past decade. However, research done at the University of Pittsburgh, in Pennsylvania, suggests that suicide may be a significant complication of the weight loss surgery.

The research, which investigated a link between suicide and bariatric surgery, was highlighted in an October 2007 Medscape article. The title of the article was "Higher-Than-Expected Suicide Rate Following Bariatric Surgery." And a November 2010 Pub Med abstract entitled, "Risk of Suicide After Long-term Follow-up of Bariatric Surger y,” also documented work done at the University. The work was directed at examining the risk of suicide a year or more after bariatric surgery.

The 2007 investigation looked at data pertaining to obese residents in Pennsylvania who had undergone bariatric surgery between January 1, 1995 and December 31, 2004. During this period, there were 440 deaths among the bariatric patients. And at least 16 of these deaths were due to suicide.

"Based on statistics for the general US population," only two of the 440 deaths should have been attributable to suicide. Therefore, because of the increased number of suicides, some of the suicides are likely linked to the bariatric surgery.

The suicides occurred at least one year following the surgery. This leads to the conclusion that follow-up intervention, to bariatric surgery, may be crucial to long-term mental health, as well as physical health. In fact, counseling prospective bariatric surgical patients before the surgery is important, since some of the obese patients are probably suffering from depression.

Hence, primary care physicians and bariatricians could indeed play vital preoperative and postoperative roles in the overall obese patients' treatment. The physicians could work with the patients before the surgery, helping the patients prepare for the surgery. And the physicians could provide long-term counseling and other services after the surgery.

As some experts have said, non-surgical and surgical bariatric practitioners must work together to produce weight loss and long-term weight management among obese patients. This collaboration would be quite beneficial to the patients, since the non-surgical practitioner would be able to provide the patients with ongoing medical weight management support.

Seventy-Five Minutes of Activity Per Week to Fight Childhood Obesity

2010-11-19T17:25:00.000-08:00

Seventy-five minutes per week of physical activity could be an important weapon in the childhood obesity war. A recent study suggests that this amount of activity could improve the health of children by slowing the children's BMI increase.

The study, reported in Pub Med in 2009, was entitled, "Physical Activity Across the Curriculum (PAAC): A Randomized Controlled Trial to Promote Physical Activity and Diminish Overweight and Obesity in Elementary School Children." The study concludes that Seventy-five minutes per week of physical activity for children in elementary school could lessen the increase in child BMI.

Twenty-four elementary schools participated in the three-year study. In the study, second and third grade elementary school children were tracked for the three-year study period. And according to the researchers, the children's rising BMI slowed, while their academic performance also improved.

With emphasis on higher test scores, many school districts have reduced or eliminated the amount of physical activity their students receive in school. So allocating seventy-five minutes per week for physical activity could be a hard sell to school administrators. However, since the physical activity could improve academic performance, as well as health, getting the administrators to consider the activity might be less daunting.

Of course, more needs to be learned about the best ways to establish the seventy-five minutes per week activity program. However, if the program proves to be beneficial to children in the elementary school setting, more schools will likely institute the program.

Medical weight loss practitioners might consider becoming advocates for the program's institution in elementary schools. Supporting the program would allow the practitioners to help the community.

Medical weight loss practitioners would let the community know that weight loss professionals are intent on ending one of today's most vexing problems -- childhood obesity. At any rate, seventy-five minutes of physical activity per week could be a blow to childhood obesity.

Reducing the Desire for Sugar

2010-11-02T14:44:00.000-07:00

Increasing our understanding of how gastric bypass surgery affects the body could be important in non-surgical long-term weight loss and weight management. It is known that the surgery affects the body in a number of ways. For example, one of the effects of gastric bypass surgery is a reduction of type 2 diabetes symptoms in obese patients. Another effect may be a reduction in the desire for sugar.

A recent study concludes that gastric bypass surgery reduces the desire for sugary foods in obese rats. Understanding how the surgery reduces this desire, and whether this reduction extends to humans, may lead to less invasive methods that reduce the desire for sugar in humans.

Ingesting too much sugar is considered to be one of the causes of our overweight and obesity population. So much so that some governments are taking steps to reduce sugar consumption. And New York is attempting to eliminate the use of food stamps for the purchase of sugary soda drinks, since sugary soda drinks contain no nutritional value.

And some school districts have removed sugary soda drinks and other junk food from school vending machines, in part, to reduce sugar intake. But if we could reduce the desire for sugar in the first place, that, in itself, would likely reduce the amount of sugar we consume.

According to the above-mentioned study, gastric bypass surgery alters obese rats’ taste preferences, reducing their desire for sweets. While the surgery reduces the desire for sweets in obese rats, it does not reduce the desire for sweets in lean rats. The surgery also increases the glucose tolerance in the obese rats.

At any rate, a better understanding of how gastric bypass surgery reduces the desire for sugar could allow weight loss practitioners to improve weight loss and weight management in humans. Patients could reap some of the benefits of gastric bypass surgery without the associated costs and the trauma to the body.

Additionally, with the knowledge of how the surgery reduces the desire for sugar, medical weight loss practitioners could likely improve the success of non-surgical weight loss treatments, which would be good for the practitioners and the patients.

Understanding the Family Can Improve Weight Loss Intervention

2010-10-19T04:32:00.000-07:00

Understanding family dynamics can improve weight loss intervention programs. And this understanding can mean even more to single-parent households than dual-parent households, since single-parent household are generally hit harder by obesity.

A study, done by the National Health and Nutrition Examination Survey (NHAMES ), shows that single-parent households have higher levels of childhood obesity than dual-parent households. Further, lower income appears to be a factor in the elevated level of single-parent household childhood obesity.

While the researchers concluded that "children of single-parent households were significantly... more over weight than children of dual-parent households," more research needs to be done to determine why this is the case. And the researchers suggested that when obesity intervention programs are planned, parents ought to be included in the planning process, even though, often, they aren't.

Indeed, to fight obesity in the community, it is important to get families involved in the weight-loss process. Moreover, it is important to learn about the families and their culture. There is already ongoing research into how to get families involved in weight loss programs. For example, in our 9/3/2010 blog post, we reported on an obesity-fighting program that gets families in the community involved in the program by using dance as a primary vehicle. To promote involvement, gospel music, an important element in the families' culture, was the music the dancers danced to.

We believe that the gap in obesity rates between single-parent and dual-parent households can be closed by understanding both the single-parent and the dual-parent households. Understanding each family as a unique entity, and as a part of a culture and community, can enable obesity intervention designers to establish effective weight loss intervention programs. Medical weight loss practitioners can play a leading role in this endeavor.

Telephone-Delivered Weight Loss Counseling

2010-10-06T03:11:00.000-07:00

Many believe that long-term counseling could be an important element in long-term weight loss and weight management. And using the telephone to do the counseling could make the counseling more cost effective. An 18 month-long-Australian study is attempting to determine if telephone-delivered weight loss counseling intervention can be an effective weight loss approach.

The study’s primary purpose is to gain knowledge that might help improve the long-term treatment of type ll diabetes. Following a healthy diet and increasing one’s activity are among the most important elements in the treatment of the disease. In the study, over a period of 18 months, three-hundred adult participants will be subjected to intensive telephone-delivered counseling, focusing on getting the participants to improve their exercise and eating habits.

A final assessment of the participants’ health will be made at 24 months, or six months after the end of the formal study. The results of the study will make available the first real data on the effectiveness of long-term telephone counseling.

Counseling for weight loss is already assumed to be effective. For example, the recently passed US Health Care Reform requires that health insurers cover obesity counseling without any co-pays, co-insurance or deductibles. Also the well-known weight-loss company, Nutrisystem, includes counseling in the company’s Nutrisystem D program, a program designed to fight type ll diabetes.

And ongoing counseling, or some form of talk-therapy, is usually a component of a post-bariatric-surgical program. This component can be helpful in preventing future weight regain following the bariatric surgery. So weight loss counseling is, or will be, an integral part of the treatment for many persons in weight loss or weight management programs.

Using the telephone as the primary counseling communications device may be a simple, yet inexpensive, way to deliver important elements of medical weight loss health care. If long-term counseling via telephone proves to be effective, primary care physicians and other medical weight-loss practitioners may be more likely to include counseling in their patient care programs.

Health Care Reform to Require Obesity Counseling Insurer Coverage

2010-09-27T05:13:00.000-07:00

A number of rules associated with The US Health Care Reform, or the Patient Protection and Affordable Care Act, went into effect on September 23, 2010. One of the rules requires that services, associated with some of the preventive service guidelines established by the US Preventive Services Task Force, be covered by most insurers. And the insurers are to not require co-pays, co-insurance, or deductibles for the preventive services. One of the services is obesity counseling for adults, and another is obesity counseling for children over six years of age.

Physicians, however, may be reluctant to provide counseling for obesity. According to a report from the Penn State College of Medicine, physicians don't necessarily believe that offering weight-loss advice and counseling is a worthwhile activity in clinical practice. So even though insurers may cover the counseling intervention, many physicians might not do the counseling.

However, a study described in a June 2010 article of the "Annals of Family Medicine" may help change physicians’ opinions about weight-loss counseling. The article details a counseling study where urban preschool children were subjected to a counseling process that may help the researchers design "effective primary care based interventions." The counseling process focuses on the family and uses the "Five A’s" counseling approach derived from a counseling approach created by the National Cancer Institute. The five A's, in the approach, are "assess," "advise," "agree," "assist," and "arrange."

As part of the study, the urban childrens’ families were asked to fill out a lifestyle questionnaire, called FLAIR (Family Lifestyle Assessment of Initial Risk). And physicians associated with the study were trained to provide specific counseling "about the behavior selected for change," based on the questionnaire. Learning to provide more precise counseling, while including the family in the process, may enable medical practitioners to better counsel overweight and obese patients.

The study's researchers found that the families in the study responded positively to the counseling intervention -- parents and families being receptive to the intervention. Primary care practitioners and bariatric physicians should view the families’ response as positive. With expected insurer coverage, and promising counseling methods, counseling intervention could become a more important tool for physicians who need to help patients lose weight.

Lorcaserin Failed to Get FDA Advisory Panel Recommendation

2010-09-17T15:54:00.000-07:00

Ipsos Vantis, a pharmaceutical market researcher, estimates that "between one-half and two-thirds of primary care physicians would likely prescribe" any one of the three weight loss drugs currently in the pipeline. The three drugs are qnexa, manufactured by Vivus, lorcaserin produced by Arena, and contrave manufactured by Orexigen. However, as we reported recently, an FDA advisory panel rejected qnexa. And on Thursday of this week, an FDA panel failed to recommend lorcaserin.

One concern the panel had was whether persons taking lorcaserin might be "more likely to develop valvular heart disease." Lorcaserin suppresses the appetite in a way similar to the way the drug fenfluramine suppresses the appetite. And the FDA requested that fenfluramine be taken off the market in the 90s.

The drug was the "fen" part of the combination weight loss drug, fen-phen, which caused severe side effects in patients. However, even though lorcaserin has some things in common with fenfluramine, lorcaserin is said to have fewer and less severe side effects than fenfluramine.

The "phen" part of fen-phen was phentermine. Phentermine is one of the two drugs that comprises Qnexa, another weight loss drug an FDA panel recently rejected. And phentermine is still being prescribed for weight loss and weight management.

Although Qnexa was effective in weight loss, the panel had concerns about the drug when taken in high doses. And participants in qnexa-usage studies experienced thoughts of suicide, anxiety, palpitations, and problems concentrating.

If the FDA does eventually decide to approve lorcaserin or qnexa or contrave, it will be welcomed by the weight loss market. According to Ipsos Vantis, 'U.S. retail sales for any of these three drugs [could] exceed $400 million on an annual basis within 3-5 years of launch.'

And Indeed, if one of the three weight loss drugs gains FDA approval, the use of the drug in combination with exercise, diet, and counseling, could lead to long term weight loss for many patients. And this would be a good thing for both patients and medical weight loss practitioners.

Using Dance as an Adolescent Weight Loss Tool

2010-09-03T13:33:00.000-07:00

Bariatric surgery continues to gain popularity as a way to fight morbid obesity. The complication rate for the surgery is decreasing and the surgery appears to lessen the symptoms of diabetes in some obese persons. And as the obesity rate rises among adolescents, the surgery could be seen as a way to fight adolescent obesity. However, less drastic approaches to adolescent obesity should be improved and employed before resorting to bariatric surgery. Perhaps, culturally specific dance could be a more viable intervention than bariatric surgery.

In Mumbai, India, more and more adolescents are having bariatric surgery done as the obesity rates rise. Although bariatric surgery is probably the most effective form of weight loss, the surgery does have some drawbacks — especially forms of gastric bypass surgery. For example, an adolescent who has had gastric bypass surgery will never be able to eat normal meals without experiencing problems, the operation is not viewed as reversible, and without a good diet, weight might be regained.

Because adolescent obesity is increasing, bariatric surgery as an approach to childhood obesity could spread to other countries. However, adolescents have always been seduced by dance, so why not refine the dance intervention weight loss approach by making it pertinent to specific adolescent groups to maintain participant interest long term. That way, dance could possibly be effective in weight loss.

For example, a study done by C.J. Murrock and others at Case Western Reserve University indicated that culturally specific dance can be useful in weight loss. A community based partnership was formed with two churches within the African American community, a community hit hard by obesity. The participants danced to Gospel music. So the dance intervention was culturally specific, using an element that the participants were accustomed to. And dance, as an intervention, was effective in enabling the participants to use weight.

Dance, as a way to lose weight, is already an accepted weight loss method. And making the dance culturally specific could improve the effectiveness of the dance intervention. Bariatric practitioners could work with community groups to organize programs that encourage regular dance among adolescents.

Reimbursement Continues to Be an Issue in Weight Loss and Weight Management

2010-08-23T19:49:00.000-07:00

Insurance companies are more likely to reimburse weight loss surgery providers than non-surgery weight loss providers. And there is a reason for this difference in reimbursement practices: There is less of a proven payback for non-surgical weight loss protocols than for surgical weight loss protocols.

Indeed, researchers in France reported that "Bariatric surgery was associated with significant reductions in reported claims for short- and long-term health outcomes and reduced medication use for major disease categories." So reimbursing a bariatric surgical provider seems cost effective.

However, there may be hope for non-surgical weight loss and weight management treatment reimbursement. A 2007 study done at the University of Kentucky, Departments of Pediatrics suggested that there were improvements in the reimbursement rates associated with non-surgical weight loss treatment -- at least for children.

In fact, the researchers carrying out the study stated that while "preventive counseling [for weight management] has not been routinely reimbursed very well by third-party payors," there was "improved reimbursement rates for the evaluation and management of overweight children."

But still, it is apparent that the reimbursement level for non-surgical weight loss and weight management is not what it should be -- even for children. A docu-drama , entitled “Too Fat for Fifteen: Fight Back" aired on the Style network, suggests that insurance reimbursement for non surgical weight loss treatment is lacking, when it comes to treatment for childhood obesity.

One of the parents of a teen highlighted in the docu-drama stressed that “We want the insurance industry to provide some reimbursement for families.” The parent went on to say that “It’s better to make an investment in the child now than wait until their 20s and 30s when they have issues like cardiovascular disease and they need medications.”

But one of the reasons insurance companies are reluctant to reimburse non-surgical weight loss or weight management treatments is the dearth of proven non-surgical weight management protocols. However, ongoing exercise and dietary counseling, and other interventions, can lead to weight loss and weight management success. One of the students depicted in the docu-drama, so far, has lost over 51 pounds. This type of success will lead to improved reimbursement.

Sleeve Gastrectomy May Have an Important Side Effect

2010-08-05T07:30:00.000-07:00

Sleeve gastrectomy is a form of bariatric surgery where a small "banana like" stomach pouch is created to restrict food intake. The surgery is commonly one stage of a two stage bariatric surgical procedure. The second stage, for example, might be gastric bypass surgery. But a retrospective study, done by a group with The Bariatric Institute of Cleveland Clinic, Florida, concluded that laparoscopic sleeve gastrectomy (LSG) is a safe single-stage primary procedure. However, there does now appear to be reasons to be cautious about the surgery.

It has been known for sometime that some forms of bariatric surgery, including gastric bypass surgery, can increase the alcohol absorption rate. Some people who have bypass surgery experience the effects of alcohol quicker and longer than they did before the surgery, according a 2007 study done by John M. Morton, MD, of Standford University. That's why persons who have undergone gastric bypass surgery are urged to "keep an eye on alcohol intake." Indeed, 'one drink could be enough to place them at risk for a DUI,' according to Morton.

And a recent study confirms that, like gastric bypass surgery, LSG causes increased alcohol absorption. The study, done in Chile, studied twelve obese patients. The patients were given specific quantities of wine before and after LSG surgery. Researchers followed the twelve study participants for several months. At the end of the study period, the researchers concluded that the participants experienced "higher and longer blood alcohol values for equivalent amounts of alcohol."

Still, bariatric surgery is one of the most effective tools in the fight against obesity. Bariatric surgery leads to more instances of long term weight loss than other weight loss methods. And as we stated earlier, LSG can be a single-stage primary procedure, in addition to one stage of a two-stage bariatric procedure.

Finally, while laparoscopic sleeve gastrectomy may be an important surgical offering for those bariatric centers offering other forms of bariatric surgery, patients should be informed of the possible increased alcohol absorption. But even with this side effect, offering LSG could give a weight loss or bariatric center a competitive advantage.

Qnexa Is Rejected by an FDA Panel

2010-07-20T07:05:00.000-07:00

As reported before on this blog, there are at least three obesity drugs being reviewed by the FDA that show weight management promise. The companies, developing these drugs, are the California based, Vivus, Arena and Orexigen. Vivus manufactures the drug Qnexa. Arena makes the drug Lorcaserin, and Orexigen produces the drug Contrave. But Vivus, with its drug Qnexa, is currently dominating the news because Qnexa shows a good bit of promise as a weight loss drug. However, Qnexa was recently rejected by an FDA advisory panel.

Qnexa is a combination of two drugs: phentermine and topiramate. Phentermine was used in the obesity drug combination fen-phen. Fenfluramine and Phentermine were fen-phen. Fen-phen was taken off the market in the 90s, at the request of the FDA, because of severe side effects, including cardiovascular problems. But phentermine was the safer of the two drugs.

Although Qnexa was effective in weight loss, the FDA panel had some misgivings about the drug when taken in high doses. For example, a larger number of study participants withdrew from the drug's clinical trials than participants on a placebo.

Further, study participants on the drug experienced thoughts of suicide, anxiety, palpitations, and problems concentrating, in higher numbers than the placebo group. Also, the participants on the drug suffered four heart attacks, while the placebo group didn't suffer any heart attacks. Finally, the FDA panel questioned whether the drug might cause birth control prescription drugs to be less effective.

It is for these reasons that the panel is advising the FDA not to approve Qnexa. However, the vote was nine to seven against approval, representing a very close vote. In fact, some who voted against the drug indicated that the FDA could approve the drug, with regulations. So, Qnexa still has a chance of approval by the FDA.

If the FDA does approve the drug, it would enjoy a waiting market. The market for obesity drugs is potentially lucrative. And Qnexa could profit from the market. “JMP securities recently projected Qnexa's annual sales would hit $1.5 billion by 2015.”

With the weight loss industry in need of a safe and effective weight loss drug, weight loss service providers should closely monitor Qnexa. And if the FDA does approve the drug, these providers will have a new tool to use in the weight management fight.

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Tags: environmental scanning, strategic management, Vivus, Qnexa, opportunities, threats, trends

Changes in School Reduced Childhood Obesity

2010-07-06T16:09:00.000-07:00

As we have noted on this blog before, childhood obesity is a serious problem worldwide. And in the U.S., school districts are taking measures to deal with the problem. One of the measures being taken is an effort to make school cafeteria food healthier. Indeed, a recent study has shown that, along with taking other actions, putting healthier food in cafeterias can improve childhood weight management.

The study was a three year government study. The study's researchers made food and physical activity changes, and then followed 4,600 middle school students to examine the students' responses to the changes . The changes the researchers made included putting healthier food in the students' cafeteria, and improving the food available in other places the students might eat, such as snack bars, class events and vending machines. The students' school physical activities were also increased. These interventions improved the health of the students.

For example, the middle school students in the study experienced reduced fat in the abdomen and improved insulin sensitivity. And students in the study "who began the sixth grade overweight or obese were 21 percent less likely to be obese in three years."

School districts around the country -- and the world -- might review the study results and use them to enhance childhood weight management methods. Further, weight loss practitioners could work with school districts to help the districts establish healthier activities at the school site and the surrounding area. The weight management practitioners could also work with parents to help them introduce healthier diets and more physical activity in the home.

Reducing childhood obesity is important to schools and to parents. Since obesity can be an impediment to future success, bariatric or medical weight loss practitioners should be welcomed by schools districts and parents in the fight to curb obesity during the middle school years.

Finally, the above study indicates that successful childhood weight management can be achieved by combining healthy food with increased physical activity. Therefore, a weight loss center that effectively promotes healthy-food and increased-activity measures could legitimately market itself as a leader in understanding and fighting childhood obesity.

Exercise Is Necessary for Weight Loss

2010-06-20T07:47:00.000-07:00

A 2009 New York Time magazine article argued that exercise alone will not cause a person to lose weight -- long term. The author of the article stated that it is what you eat that counts, not how hard you try to work it off. In fact, It is generally accepted that exercise alone is not as effective, in losing weight, as exercise plus a low calorie diet. And recent studies confirm that exercise is NECESSARY in weight loss, along with diet.

Researchers at Oregon health sciences University showed that just limiting the number of calories you take in does not lead to noteworthy weight loss. The research was done using rhesus monkeys. One group of monkeys was fed a high calorie diet for several years, then put on a low-fat diet. And another group was given a low-fat diet and taught to exercise on a treadmill for an hour a day.

The group on the low-fat diet lost less weight than the monkeys on the low-fat diet plus exercise program. The researchers concluded that the body has a built-in mechanism that conserves energy when food is scarce. We've heard this before, but the study just confirms the importance of exercise and a proper diet in weight loss and weight control.

And concerning diet, research done by a group at the University of Rhode Island found that exercise plus a high fiber whole-grain diet might provide the maximum weight loss. A high fiber whole-grain diet supplies valuable nutrients as well as fewer calories than many diets.

At any rate, it appears that, to lose weight, it is important to combine exercise with a proper diet. And while diet alone probably won't give you long term success, a diet plus exercise can offer the kind of success you need, and the kind of success bariatric and weight loss centers can market.

Complicated Rules Can Hurt Weight Loss Programs

2010-06-06T04:56:00.000-07:00

No matter what weight loss program you subscribe to, for long term success, behavioral changes must be an integral part of the program. However, if the rules associated with the weight loss program are too complicated, the rule-complication could hinder the weight loss process. The rules might not be followed, thus causing the program to fail.

Researchers from Indiana University and the Max Planck Institute for Human Development in Berlin found that persons trying to follow a weight loss program with complicated rules are unable to adhere to such a program long term, because the participants are unable to recall elements of the program's process. For example, in a complicated diet, it is often difficult for a participant to decide what to eat.

In the study, the researchers looked at two weight loss diet programs. One was the Weight Watchers program, and the other was a popular German program called Brigitte. The Weight Watchers program was considered to be a complicated program, while the Brigitte program was considered to be simple. The researchers concluded that participants in the Brigitte program lost more weight than those in the Weight Watchers program, because the Brigitte program was less complicated than the Weight Watchers program.

Indeed, there is always something to be said for simplicity. And a straightforward, easy to follow diet is more desirable than a complicated diet. Further, the advantages of a simple diet might be a good reason to use a prepackaged meal replacement.

Using well designed prepackaged meals to replace normal meals has been shown to lead to weight loss. Meal replacements include shakes, entrees and bars. Prepackaged meals include meals made by Lean Cuisine, Healthy Choice and Nutrisystem.

With prepackaged meals, a dieter can simply pick up a meal without having to worry about the calorie or nutritional content, because well designed meals can be nutritious while containing low calories. These meals can be quite convenient. And a 2003 Pub Med report indicated that meal replacements can be employed safely to enable a person to lose weight and maintain the weight loss.

Since prepackaged meals are designed to contain good nutrition and low calories, they offer the simplicity that the German study results seem to call for. Medical weight loss service providers might want to emphasize the value of using prepackaged meal replacements, as part of a weight loss or weight management program.

A Critical Period in Which to Study Childhood Obesity

2010-05-27T19:09:00.000-07:00

Childhood obesity is an important problem worldwide. In the U.S., school districts and governments are establishing programs to fight the disease. First Lady Michelle Obama is one of the leaders of a program called "Let's Move" whose purpose is to fight childhood obesity. School districts are making cafeteria food more healthy. And to learn more about childhood obesity, researchers in Japan suggest that there is a critical period during childhood that might enable us to better understand some aspects of obesity.

The researchers believe that the period between 7 and 14 years of age is a key to understanding childhood obesity. The researchers looked at growth velocities during that age period. And they found that overweight children at the age of 14 had different growth velocities between the ages of 7 and 14 compared to non overweight children at 14.

For example, according to the study results, the boys with the greatest growth velocities between 7 and 11 years of age had the greatest risk of being overweight at the 14. And girls who experienced the greatest growth velocities between 9 and 10, and between 10 and 11, faced the greatest risk of being overweight at 14.

Using these results might enable weight loss practitioners to get a feel for who will be overweight at 14 years of age. The practitioner can work with the child and the child's parents to design diet and exercise programs to avoid or lessen the possible weight gain.

Since obesity can be an impediment to future success, parents should be interested in working with a weight loss provider to reduce the chances of their child's weight gain. Bariatric or weight loss centers could educate parents on what they should look for during critical periods. This collaboration between a family and a weight loss center would be good for the child.

And this kind of ongoing collaboration could provide the weight loss service provider with invaluable experience with childhood obesity. With this experience, and with some success, a weight loss center could legitimately market itself as a leader in understanding and fighting childhood obesity.

Worksite Wellness Programs Lose Effectiveness When Employees Are Away from the Worksite

2010-05-15T15:44:00.000-07:00

To improve the general health of their employees, employers often offer worksite wellness programs to their employees. Diet and exercise are important elements of these programs. The purpose of these programs is to lower health care costs by keeping employees healthy. However, for these worksite programs to be successful, the employees must spend most of their time at the worksite.

More and more, experts believe that wellness programs may enable organizations to be more profitable by improving employee health. In fact, according to the organization, U.S. Preventive Medicine, an effective wellness Program can yield a $1.00 to $3.00 return on investment.

And according to Right Management, a subsidiary of Manpower Inc., an organization’s wellness program can improve the organization’s competitive edge by increasing employee productivity and performance.

But it is important for the participants in a worksite wellness program to be onsite for the program to work, according to a study focusing on metropolitan transit workers in Minneapolis. Although the weight loss intervention program the transit workers were subjected to was a good program, the workers didn't spend enough time on the worksite for the program to have more than a negligent effect on the transit workers weight.

Nevertheless, it has been shown that effective wellness programs can be beneficial to the employer and the employee. The employer gets a more engaged and productive employee. And the employee will likely pay less out-of-pocket for health care, and the employee will have a higher quality of life.

Because wellness programs can be beneficial, medical weight loss centers might want to work with employers to find ways to extend the effects of wellness programs beyond the worksite. Using communication devices, for example, to stay in touch with employees, could be a way to extend the effects. Focusing on extending the effects of the intervention could become a weight loss center's niche. And focusing on this niche might give the service provider a competitive edge.

A Surgical Procedure Similar to Bariatric Surgery May Lead to Treatments for Diabetes

2010-05-04T10:25:00.000-07:00

In the past, we've talked about the use of bariatric surgery for weight loss. And we've talked about the possible use of bariatric surgery for diabetes treatment. Well, recently, a group led by a UC Davis veterinary endocrinologist was able to "delay the onset of type 2 diabetes" using a surgical procedure similar to that used in bariatric surgery.

Bariatric surgery is primarily used for weight loss. The two most popular forms of bariatric surgery are gastric bypass surgery and lap band surgery. Gastric bypass surgery does two things to address weight loss: The surgery shrinks the stomach causing a person to feel full with less food. And the surgery re-routes the small intestine to lessen the number of calories (and nutrients) the body absorbs.

In lap band surgery, an adjustable band is placed around the upper part of the stomach, forming a small pouch or "new smaller stomach." Since the new stomach is smaller than normal, a person feels full with less food.

Both gastric bypass surgery and lap band surgery have led to type 2 diabetes remissions. Indeed, although some studies show that less weight is lost after lap band surgery than after gastric bypass surgery, a 2-year study reported in The Journal of the American Medical Association (JAMA) indicated that obese patients with type 2 diabetes who had lap band surgery experienced higher diabetes remission rates than patients who used conventional methods to control diabetes. So gastric bypass surgery and lap band surgery have led to reduced type 2 diabetes symptoms.

The UC Davis group used the bariatric-like surgical procedure, mentioned above, on rats. And that procedure delayed the symptoms of type 2 diabetes. Further, the researchers identified biochemical changes, brought on by the surgery, that might be instrumental in delaying type 2 diabetes symptoms.

Diabetes is a serious illness throughout the world. And effective treatments are in high demand. Therefore, finding ways to delay and reduce the symptoms of type 2 diabetes is of utmost importance. And if a surgical procedure, similar to bariatric surgery, can be used as a treatment for type 2 diabetes, this procedure will likely be beneficial to type 2 diabetes patients.

Offering this procedure could possibly give a bariatric surgical provider a competitive edge. The provider could legitimately market surgical services for diabetes as well as weight loss. So bariatric surgical providers should view the UC Davis research results as a possible source of future opportunity.

Sugar, Our Health and Gary Taubes

2010-04-23T12:00:00.000-07:00

It is often argued that sugar contains empty calories and that we should limit our sugar intake. It has also been found that eating too much sugar can lead to overweight and even obesity. Further, obesity can lead to diabetes and other health problems. So, consuming too much sugar can lead to diminished health. Indeed, according to Gary Taubes, a well known opponent of sugar, too much sugar is one of the main causes of “metabolic syndrome, obesity, diabetes, and their associated chronic diseases.”

Gary Taubes’ 2002 New York Times article entitled, "What if It's All Been a Big Fat Lie?" was somewhat controversial. In the article, Taubes suggested that the medical experts who recommended a low fat, high carbohydrate diet caused the obesity epidemic. Taubes also suggested that diets such as Dr. Robert Atkins’ low carbohydrate diet might be a healthier diet than a low fat diet.

Taubes has indicated that sugars -- high-fructose corn syrup in particular -- are especially harmful. However, not all experts agree with many of Taubes’ opinions. But it is worth noting that Taubes appeared at the American Society of Bariatric Physicians (ASBP) Western Regional Obesity Conference held in Seattle, Washington in April 2010. Since ASBP is a respected organization, interested in credible weight loss and weight maintenance methods.

Sugar, including table sugar or sucrose, is a carbohydrate. Carbohydrates are converted by our body into glucose (a form of sugar). Glucose is used by our bodies' cells. However, if too much glucose is created, rather than used by the cells in our bodies, the glucose can cause damage to our nerves, kidneys, and heart. And some of the glucose might be stored as fat, causing us to gain weight.

So, even if sugars are not as harmful as Taubes suggests, too much sugar can cause weight gain. So, watching our sugar intake is probably a wise thing to do. And, again, Taubes’ appearance at the ASBP conference might mean that some experts might feel that his opinions could influence methodologies that could be beneficial to medical weight loss service providers and their patients.

Seaweed May Be Useful in Weight Loss

2010-04-13T13:22:00.000-07:00

Obesity drugs may someday become the important weight loss tool many believe they can be. With their ease of use, obesity drugs have an inherent advantage. However, these drugs, so far, have had associated side effects. But a fiber, found in a certain type of seaweed, may provide the ease-of-use advantage of obesity drugs without the accompanying side effects.

Researchers at New Castle University in the U.K. have found that the fiber, called Alginate, is found in commercially used seaweed -- and that the fiber can aid in weight loss. The seaweed fiber's effect is similar to that of the obesity drug Orlistat.

Both Orlistat and the seaweed fiber cause fat in the food we eat not to be absorbed by the body. Indeed, the seaweed fiber, a natural fibre found in sea kelp, stops the body from absorbing fat better than most anti-obesity treatments currently available over the counter."

In the past, obesity drugs have caused negative side effects for various users. For example, the drug Fen-phen was felt to be a useful obesity drug. Fen-phen consisted of two drugs, fenfluramine and phentermine. However, because Fen-phen caused heart related problems in some users, in 1997 the FDA requested that one of the two components of Fen-phen, phentermine, be taken off the market. Fen-phen was later removed from the market by the drug manufacturer, American Home Products .

And Meridia, another obesity drug which is manufactured by Abbott Laboratories, can cause side effects such as headaches, high blood pressure and constipation. And the consumer advocacy organization, Public Citizen, asked the FDA to have Meridia taken off the market.

Although in 2007, the FDA approved the GlaxoSmithKline obesity drug Alli, the over-the-counter form of Orlistat, the drug can reportedly cause side effects, including frequent stools and gas.

Therefore, obesity drugs have had their problems. So a dietary fiber that can be added to food could be an important weight loss tool. And research may show that the fiber has fewer side effects than Alli or other obesity drugs.

We believe this fiber should be monitored by those in the weight loss industry. Indeed, we believe that medical weight loss service providers should pay close attention to research associated with this fiber. A safe, effective, food additive could offer medical weight loss service providers an important weapon in the weight loss and weight management fight.

The Passage of the Health Care Bill Gives the U.S. an Opportunity to Combat Obesity

2010-04-01T07:18:00.000-07:00

With the passage of the Health Care Reform Bill, the U.S. federal government is poised to be more involved in the fight against overweight and obesity. Even before the bill became law, the first lady, Michelle Obama, took on a leading role in the fight against childhood obesity. She's been a key player in the "Let's Move" campaign which is a movement to fight childhood obesity. Finally, the U.S. federal government has already indicated that it will increase funding to fight obesity.

Elements of the new law will attempt to influence eating habits. There is language in the law requiring some eating establishments to give calorie- content information. "The health care law requires chain restaurants that have more than 20 locations to display calorie information next to the food item on the standard menu. "

The federal law also requires the inclusion of additional information suggesting that a normal daily caloric intake is about 2000 calories. Indicating normal daily caloric intake is felt to be necessary, since researchers have found that when they know what the normal caloric intake is, people eat less.

In addition to what the federal government is doing, lower level governments have also joined the fight against overweight and obesity. The Virginia state government has completed legislation to change the name of the "Virginia Tobacco Settlement Foundation" to the "Virginia Foundation for Healthy Youth." With the name change, the organization broadens its mission to fight childhood obesity, in addition to smoking.

In Ohio, the state government is working on legislation for "healthy choices for healthy children." The legislation will promote increased physical activity, physical education, and enhance the nutritional value of the food children eat in school.

As we said above, First Lady Michelle Obama is playing a leading role in fighting childhood obesity. And while the government can play an important role in childhood obesity, the fight against childhood obesity must begin in the home. Parents must guide their children in adopting healthy eating habits.

in fact, since obesity can be an impediment to future success, parents should be interested in joining the obesity fight. And weight loss centers (and health care professionals, in general) could work with parents to help them employ the best procedures for fighting childhood obesity. This kind of collaboration could help the community as a whole, and enhance a weight loss center’s local reputation.

Moreover, collaboration between weight loss centers and governments -- federal, state and local -- might be one of the best ways to beat overweight and obesity during childhood and adulthood.

Entelos, Inc. Develops a Simulation Process for Drug Treatment Analysis

2010-03-17T13:28:00.000-07:00

A while back, England's chief medical officer indicated that not having enough simulators for doctors to practice on could be harmful to patients. This opinion shows that using simulation has proven to be useful to some health care professionals. Further, Entelos, Inc., a California based company, is employing simulation to analyze drug treatment outcomes for diseases, including obesity and diabetes.

Simulation is often employed to improve skills. In the U.S. Space Program for example, simulation is used to train the astronauts. And a Yale University study showed that simulation can be used to increase a doctor's proficiency. In the study, student doctors were taught to successfully insert a catheter into a major vein of the body.

Modeling a drug treatment scenario and analyzing the outcome using simulation would be an effective way to determine appropriate treatment options for diseases. Entelos, Inc. has designed a biosimulation lab, called PhysioLab, that can simulate human disease, and disease treatments.

With the PhysioLab platform, a researcher can construct a virtual patient and carry out clinical trials for, say, an obesity drug, using computer modeling and simulation. In fact, the company was just given a U.S. patent entitled, “Apparatus and Methods for Assessing Metabolic Substrate Utilization."

For more information, interested organizations can contact Entelos, Inc. According to a statement on the company’s Website, “Access to Entelos expertise and technology is available through R&D partnerships, research agreements, licenses, and strategic alliances.”

We feel that simulation for obesity drug analysis would mean a great deal to the bariatric or weight loss industry. The weight loss industry has had a difficult time developing a safe and effective drug that can help a person lose weight. However, since the potential market for weight loss products, including obesity drugs, was estimated by some to be 59 billion dollars in 2009, a tool to improve the development of weight loss drugs would be a boon to the bariatric or weight loss industry.

Wellness Programs Are Beneficial to Employers And Employees

2010-03-02T05:31:00.000-08:00

In an effort to improve the general health of their employees, employers have been offering wellness programs to employees. Among the programs’ most important components are help with diet and exercise. These programs aim to keep employees healthy and lower health care costs. Medical weight loss centers may be able to play an important role in these programs by joining with organizations that deliver wellness programs and with employers who purchase the programs.

More and more, experts believe that putting wellness programs in place may enable organizations to be more profitable by improving employee health. In fact, according to the organization, U.S. Preventive Medicine, an effective wellness Program can yield a $1.00 to $3.00 return on investment.

And according to Right Management, a subsidiary of Manpower Inc., an organization’s wellness program can improve the organization’s competitive edge by increasing employee productivity and performance.

Further, some insurance providers see the benefits of offering wellness programs. CIGNA has just purchased Kronos Optiman Health Company, a Phoenix-based health and wellness company. This acquisition will enable CIGNA to expand its wellness program offerings, including its online services.

To make a wellness program more effective, program leaders will often ask for a participant's medical history, and inquire about family illnesses. As an incentive to employees, some medical information obtained may be used in decisions to lower or raise health insurance premiums, or establish monetary employee awards.

But using medical information to give monetary awards or raise or lower health insurance premiums may conflict with the Genetic Information Nondiscrimination Act of 2008. This act provides "protections against discrimination based on an individual's genetic information in health insurance coverage and employment settings."

But still, effective wellness programs are proving to be beneficial to the employer and the employee. The employer gets a more engaged and productive employee. And the employee will likely pay less out-of-pocket for health care, and the employee will have a higher quality of life.

Because wellness programs are beneficial, medical weight loss centers may be able to work with employers and wellness program organizers to help find ways to use the medical information without discriminating against any group or anyone in the group. It's worth a shot, and this activity may give a weight loss center a competitive advantage.

Body Fat Percentage May Be a Significant Problem

2010-02-13T07:14:00.000-08:00

As some in the media have reported, obesity may be leveling off in most segments of the U.S. population. Although about a third of the U.S. population is obese, obesity appears to be holding constant. This might mean that some of the efforts to head off obesity are working. But still, there might be an unseen problem -- hidden fat that is not usually measured. And bariatric centers might want to be at the forefront in the effort to tackle the problem.

According to the Mayo Clinic, a person can have a normal BMI (body mass index), but still be obese. The condition is called normal weight obesity. BMI takes only a person's height and weight into consideration, since BMI is computed by dividing a person's weight in kilograms by the person's height in meters, then squaring the result. Therefore, BMI does not measure the percentage of fat on the body.

Although BMI is sometimes controversial, it is probably the most used measurement of body weight. BMI categories have been established to indicate when a person is of normal weight (a BMI between 18 and 25), when a person is overweight (a BMI between 25 and 30), and when a person is obese (a BMI over 30).

Indeed, at most bariatric surgical centers, BMI is one of the key factors used to determine if a person should be considered for bariatric surgery. For example, at many centers, one must have a BMI of 40 or more before bariatric surgery is recommended. With a BMI less than 40, a person might be considered for bariatric surgery if the BMI is greater than 35, and the prospective patient suffers from comorbidities such as diabetes or high blood pressure.

However, the prospect of normal weight obesity may necessitate the inclusion of fat percentage measurements when assessing body weight. And this is where the expertise of bariatric centers could come into play. While there are home methods for calculating body fat percentage, at this time, the most accurate method is probably done in a facility equipped to make accurate body fat percentage measurements.

The relatively new finding by the Mayo Clinic that a person of normal weight could be obese identifies a problem that bariatric centers can equip themselves to handle. Centers should become knowledgeable about the current recommended fat percentages. The centers should also get involved in the ongoing research to nail down more accurate fat percentage classifications. At any rate, strategically inclined bariatric centers should prepare to play an important role in helping potential clients manage body fat percentage, as well as BMI.

Using the Pedometer and the Mandometer for Lifestyle Modification

2010-02-03T11:43:00.000-08:00

Lifestyle modification is a significant element in most weight loss or weight management programs. Lifestyle changes can lead to new habits that enable a person to lose and control weight. The use of two instruments -- one old and one, relatively new -- might be key instruments that can prompt an individual to modify the two most important weight loss and weight management activities. The two instruments are the pedometer and the mandometer. The activities are eating and exercise.

The pedometer is a tool that can be used by an individual to give the individual an accounting of the distance traveled based on the number of steps taken. The pedometer is said to have been around for well over two hundred years. Although older pedometers were mechanical, today's pedometers are usually electronic. The instrument is usually attached to the belt of a walker, jogger, or runner, giving step-count information to the wearer.

Since most people engage in walking, jogging, or running to lose or control weight, the pedometer can encourage a person to add steps to his or her daily activities.

The mandometer is a tool that can help a person change the way he or she eats. The mandometer was developed by two researchers at the Karolinska Institute in Stockholm, Sweden. The instrument is a portable electronic scale that is connected to a small computer. The scale weighs the food, in a plate for example, before any food is eaten, and continues to calculate the rate of change in the weight of the food as a person eats from the plate. The rate of change is correlated with eating rate. And the device shows a graph of eating rate, giving off an alarm when the rate is too high, indicating that a person is eating too fast.

This alarm is an attention-getter that encourages the patient, with a too-high eating rate, to lower his or her rate. Lowering the eating rate can be important in weight management and weight control. Changing the way we eat food is an important lifestyle modification. And using the mandometer to monitor eating rates appears to be an effective way to motivate better eating habits.

So the pedometer and the mandometer are possibly two important tools for lifestyle modification for weight loss and weight control. Indeed, these tools might enable a person to increase exercise activity and decrease eating rate.

Therefore, weight loss centers should view these tools as important weapons in the overweight and obesity fight. Along with their existing inhouse services, a center could recommend these tools as methods for weight loss and weight control.

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Using Telemedicine to Modify Lifestyle for Weight Loss

2010-01-24T16:17:00.000-08:00

In a November 25, 2009 blog post, we said that "telehealth has the potential to improve the treatment of obesity and obesity-related diseases such as diabetes." And we said that "telehealth devices may elevate the treatment of obesity by making it easier to modify lifestyle." Scientists at the University of Southern California lab are developing a wearable wireless monitoring device that may assist lifestyle modification for overweight and obese persons.

In the blog post mentioned above, we cited the Free Dictionary definition of telehealth as "the use of telecommunication technologies to provide health care services and access to medical and surgical information for training and educating health care professionals and consumers, to increase awareness and educate the public about health-related issues, and to facilitate medical research across distances." Well, telemedicine is a subset of telehealth. And the above-mentioned wearable device is a telemedicine device.

In the University of Southern California lab experiment, the monitoring device was used to detect what the teenagers ate and did while wearing the device. The device's output is sent via cell phone to the researchers. Because the information received by the researchers does not depend on self-reporting, the information is likely more accurate that self-reported information. Self-reported information is often inaccurate.

The wearable sensor sends the lab reports on such things as heart rate and physical activity. There are other devices that actually track calories burned. And, still, other devices are in development that may record video for further study. All these devices might allow weight loss and weight management counselors to have a better idea of what a client is doing. And this can enable a counselor to better personalize a weight loss or weight management program for a client, enabling the client to successfully modify a lifestyle.

The counselor can collect results, determine the appropriate weight program, or modify an existing program. The counselor can then determine what diet is most appropriate and what physical activity might be the most effective.

We think these telemedicine monitoring devices could be a important tool for weight loss and weight management. Bariatric or weight loss centers should keep abreast of these tools. Indeed, including some of these items in its arsenal may allow a bariatric or weight loss center to improve its weight loss services.

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Obesity Gives Rise to Disability

2010-01-13T13:46:00.000-08:00

Disability is on the rise among the elderly who don't reside in elder care facilities. According to a recent study, one of the reasons for this rise in disability is the rise in obesity. Indeed, there is a link between obesity and disability. But if more people adopt healthy living habits, this adoption could lower the levels of obesity, and thus lower the disability numbers.

The above-mentioned study was done by researchers from the University of Toronto, and the University of California at Berkeley. According to the study results, there has been a doubling of obesity over the past three decades. This doubling of obesity is associated with a rise in disability among those 65 and older. And many of these older persons are poor.

Of course, obesity-fighting treatments should be made available to all socioeconomic groups. This is especially true for the poor elderly. We believe that if this group is given access to obesity-fighting services, this group could make lifestyle changes that might lower obesity rates, and thus reduce disability levels. For this reason, we hope the current health care overall being debated will create a workable health care system.

A workable health care system would bring more of the poor elderly into the health care system. And these new entrants would increase the market for weight-loss tools, since losing weight is viewed as a way to address many health problems -- including disability.

The rise in obesity-related ailments is already an inducement to bariatric centers to refine their weight loss services. The rise in disability should be an additional motivator for these centers. Weight loss centers should emphasize the importance of a healthy weight in dealing with disability.

Weight loss centers should also prepare for the potential enactment of the health care overall. While there may be an assortment of problems with the reform under review, a workable health care system will widen the market for weight loss services. And this could benefit some weight loss centers, by giving the centers the opportunity to offer their weight loss services to more clients.

Gastric Bypass and Adjustable Lap Band May Be Cost Effective for Treating Type 2 Diabetes

2010-01-01T19:28:00.000-08:00

As we've all heard, today, more and more U.S. citizens are succumbing to diabetes. Furthermore, Type 2 diabetes among children is increasing. Some forms of bariatric surgery are being viewed as a viable treatment for Type 2 diabetes. Studies show that in more than two thirds of the study subjects with Type 2 diabetes, the disease was either gone or easier to control after weight loss surgery. And recent research indicates that gastric bypass surgery and the adjustable lap band are more cost effective in treating Type 2 diabetes than conventional diabetes treatment methods for persons with a BMI greater than or equal to 35.

We've noted before that some experts feel that bariatric surgery can be used for more than just weight loss. Indeed, the American Society for Bariatric Surgery (ASBS) changed its name to the American Society for Metabolic and Bariatric Surgery (ASMBS) to recognize non-weight-loss applications of gastric bypass surgery.

And the New York-Presbyterian Hospital/Weill Cornell Medical Center has started treating Type 2 diabetes using a modified version of the gastric bypass surgery used for weight loss. In the modified version of the surgery, nothing is done to shrink the stomach; only the small intestine is rerouted.

Using bariatric surgery to treat diabetes, no doubt, will receive more attention. And if it turns out that the surgery is a good, cost effective treatment for diabetes, the surgical option will become an important surgical service that bariatric surgical centers can offer.

Another item that favors surgery as a reasonable option for treating diabetes is research showing that insulin treatment for Type 1 and Type 2 diabetes causes some patients to gain weight. Gaining weight can be a negative factor in cardiovascular disease.

So depending on how viable the utilization of bariatric surgery is for treating diabetes, compared to insulin use, it may be reasonable, in some cases, to consider bariatric surgery for the treatment of diabetes for economical reasons.

Bariatric or weight loss centers should stay abreast of activities associated with the use of bariatric surgery for the treatment of diabetes. It might turn out that offering this treatment could give a weight loss or bariatric center a competitive advantage and help to lower the health care costs associated with Type 2 diabetes.

The Importance of Gut Bacteria in Weight Control

2009-12-17T06:25:00.000-08:00

In a 2008 study at The Washington University St. Louis Medical School, researchers indicated that trillions of bacteria live in our gut. These bacteria perform specific activities, including the extraction of calories from food and the management of nutrients. And while the bacteria are common to all people, each individual has a unique set of the bacteria. A more recent study done at Washington University showed that the composition of the bacteria plays an important role in weight control.

Working with mice, the researchers found that obese persons had more of the bacteria called Firmicutes in their gut, and fewer of the bacteria called Bacteroidetes. Firmicutes are associated with obesity and Bacteroidetes are associated with leanness. Furthermore, diet played a significant role in the number of Firmicutes and Bacteroidetes in the mice gut. Those mice who were fed a low-fat diet had more Bacteroidetes and less Firmicutes than the mice who were fed the high-fat diet.

Since diet plays an important role in the composition of gut bacteria in mice, there is a high probability that diet plays a significant role in the human gut bacteria composition. Firmicutes and Bacteroidetes also populate the human gut. The above mentioned studies provide more evidence that diet is the significant factor in controlling weight.

Of course, more study will enable the researchers to determine exactly what diets best control these bacteria in humans. This determination could lead to the creation of of more effective diets.

Organizations that provide meal replacements should be especially interested in creating more effective diets. Therefore, these organizations should be interested in the above mentioned studies. Understanding gut bacteria that function in the body to influence obesity or leanness might enable meal replacement producers to manufacture better diet products. And bariatric or weight loss centers could offer these improved diet products as part of their weight loss services.

Governments Fight Obesity

2009-12-06T12:03:00.000-08:00

Some experts believe that the government must play a large role in the fight against obesity. For example, the government can put pressure on neighborhood designers to get them to create plans that provide for more walking and bike paths in neighborhoods. These plans could put grocery stores, and other frequented neighborhood sites within a reasonable walking distance of residential areas. The government could also emphasize the importance of fighting obesity. And, fortunately, governments are becoming more proactive in the fight against obesity.

The U.S. federal government has indicated that it will increase funding to fight obesity. Further, the government has indicated that one of the important elements in the overhaul of the current health care system would be an initiative to boost the consumption of more nutritious food.

In addition to the federal government's increased activity in the fight against obesity, state governments are joining the fight. The Virginia state government has completed legislation to change the name of the "Virginia Tobacco Settlement Foundation" to the "Virginia Foundation for Healthy Youth." With the name change, the organization broadens its mission to fight childhood obesity, in addition to smoking.

In Ohio, the state government is working on legislation for "healthy choices for healthy children." The legislation will promote increased physical activity, physical education, and enhance the nutritional value of the food children eat in school.

As we can see, attention is being given to childhood obesity by governments. Although the federal or a local government can take action to combat childhood obesity, the fight against childhood obesity must begin in the home. And parents have the greatest influence on a child during the child's childhood.

Since obesity can be an impediment to future success, parents should be interested in joining the obesity fight. Bariatric or weight loss centers could work with parents in the community to educate them on the best procedures to use to help children maintain a healthy weight. This collaboration could help the community, and enhance a weight loss center’s local reputation.

Indeed, collaboration between weight loss centers and governments -- federal, state and local -- might be one of the best ways to beat overweight and obesity during childhood and adulthood.

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environmental scanning, strategic management, competitive analysis, strategic planning

Telehealth in the Obesity Fight

2009-11-25T09:02:00.000-08:00

According to the Free Dictionary, telehealth may be defined as "the use of telecommunication technologies to provide health care services and access to medical and surgical information for training and educating health care professionals and consumers, to increase awareness and educate the public about health-related issues, and to facilitate medical research across distances." Telehealth has the potential to improve the treatment of obesity and obesity-related diseases such as diabetes.

A recent study was done in Ottawa Canada to determine the effectiveness of telehealth for home health care. In the study, literature was analyzed to compare the benefits of treating diabetes using telehealth versus treating diabetes using common diabetes treatment procedures. It was found that patients who received treatment via telehealth had a higher quality of life, and experienced less hospitalization than diabetes patients receiving the normal diabetes treatment.

Although the leaders of the Canadian study indicated that more research needs to be done, as stated above, telehealth improved quality-of life and reduced hospitalizations. The use of telehealth also improved glycemic control and patient satisfaction.

A 2008 study was done in the United States to establish the effectiveness of telehealth in treating obesity. Three weight loss programs were compared. These programs were telehealth, traditional classes, and no program. The study looked at the amount of weight participants regained in each program. The study also assessed a participants' satisfaction with a given program, and the convenience of a program for the participants. Participants in the telehealth program lost slightly more weight than participants in the other two programs.

However, the difference in weight loss was not enormous. But the telehealth group found the telehealth program to be more convenient. And convenience is important in trying to modify a lifestyle. If one program is more convenient to follow than another, a person is more likely to follow the more convenient program.

Some companies are focusing on telehealth. One of these companies is Washington, D.C. based Telcare. Telcare is a medical devices company specializing in health information technology using cellular technology. In 2009, Tel care won the 'best in show' award for a telehealth device at the MoveTechFest Americas conference. The conference was held in Santa Clara, California.

Telcare's device works like a glucose meter. And the device wirelessly transmits diabetic information between the diabetic patient and medical professionals. The device is easy for the patient to use, it reduces complications, and the device may reduce the costs of diabetes by as much as 37%. There are plans to use the device to manage obesity, as well as other chronic diseases.

Therefore, this telehealth device, as well as other telehealth devices, may elevate the treatment of obesity by making it easier to modify lifestyle. Bariatric industry providers should pay close attention to telehealth methodology for fighting obesity.

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Podcasts as a Tool to Aid in Weight Loss

2009-11-13T18:56:00.000-08:00

In order to lose weight and maintain the weight loss, one must almost, always modify his or her lifestyle to be successful long term. Lifestyle modification generally includes a change in diet, and engagement in regular exercise. Because achieving weight loss and maintaining weight loss present mental and physical challenges, counseling intervention can be a useful tool. And a study, discussed in an October 2009 American Journal of Preventive Medicine article, has shown that podcasts or pre-recorded audio (or video) files can be an effective counseling intervention tool.

To determine the effectiveness of using podcasts for weight loss, in 2008 a 12 week study was carried out in North Carolina. The study consisted of 24 participants that were randomly assigned to one of two groups. Both groups were subjected to 24 weight loss podcasts over the 12 week study period. However, one of the groups was exposed to an enhanced weight loss podcast, based on social cognitive theory (SCT).

This theory, by Albert Bandura, postulates that one can learn new behavior through observation without imitating the behavior. Further, a person is likely to adopt the new behavior, if the behavior leads to positive outcomes.

Therefore, offering podcasts on behavioral changes that lead to weight loss may motivate an individual to the adopt the changes, if the changes, indeed, lead to weight loss. In the above-mentioned study, the SCT podcast group lost up to three more pounds than the group not using the SCT podcast.

Hence, we think that podcasts might be a useful weight loss tool. The CDC (Centers for Disease Control and Prevention) appears to agree that podcasting for weight loss may be useful. The CDC Website presents a podcast to help women maintain a healthy weight.

We believe that if podcasts and other lifestyle modification techniques are combined, the appropriate combination may prove to be a powerful weight loss and weight management method. Weight loss or bariatric centers that make use of effective weight loss tools elevate the centers' competitive advantage. And podcasts may be such a tool.

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The Obesity Society Reports on Qnexa, Contrave and Lorcaserin

2009-11-04T10:27:00.000-08:00

Information Uncover was represented at last month’s TOS (The Obesity Society) annual meeting in Washington, D.C. And one of the most exciting bits of news coming out of the meeting was the prediction that three obesity drugs, we’ve talked about on this blog, will likely be on the market within two years. These drugs are Qnexa, Contrave and Lorcaserin.

Qnexa is manufactured by Mountain View, California based Vivus. Contrave is manufactured by La Jolla, CA based Orexigen. And Lorcaserin is manufactured by San Diego, California based Arena.

Qnexa is a combination of two drugs: Phentermine and Topiramate. Phentermine was used in the obesity drug combination Fen-phen, an obesity drug combining Fenfluramine and Phentermine. Fen-phen was taken off the market in the 90s because the drug caused severe side effects -- including serious cardiovascular issues.

However, Phentermine was the safer of the two drugs in the Fen-phen combination. Phentermine is often prescribed today for short term weight loss. Furthermore, while Phentermine is combined with Topiramate in Qnexa, the serious side effects associated with Fen-phen have not been observed in Qnexa. In addition, Qnexa surpasses the FDA obesity drug guidelines.

Orexigen’s Contrave is also the combination of two drugs. These drugs are Naltrexone and Bupropion. Naltrexone is FDA approved for the treatment of alcohol dependence. And Bupropion is FDA approved for the treatment of depression. Contrave appears to have no serious side effects, and the drug satisfies FDA obesity drug guidelines.

Finally, Lorcaserin, produced by Arena, does not produce the weight loss percentages achieved by Qnexa and Contrave. However, Lorcaserin appears to be well tolerated, while satisfying the FDA obesity drug guidelines.

With the weight loss industry in need of a safe and effective weight loss drug, weight loss service and product providers are closely monitoring Qnexa, Contrave, and Lorcaserin. We believe that if these three drugs do come on the market within two years, their presence will give a needed boost to the weight loss industry. And a number of speakers at The Obesity Society's annual meeting seemed to agree with this opinion.

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Learning How to Treat Obesity from a UK NHS Program

2009-10-22T13:06:00.000-07:00

In our October 14, 2009 blog post, we discussed the Chronic Care Model as a tool to treat obesity. The model was developed by the MacColl Institute for Healthcare Innovation. Since obesity is viewed as a chronic illness, the model might be used to fight obesity. In the model, the obese patient plays the central role in the model. Now, a UK program is confirming the importance of the role the patient must play in obesity treatment.

The UK program is about one year old. The program is an “NHS [National Health Service] nurses led service” program. As the description indicates, nurses lead the program. The program emphasizes patient education as a way for the patient to establish a strategy for losing weight. Indeed, in the UK program, as in the Chronic Care Model, an educated patient with assistance from trained professionals can lead to weight loss.

As we mentioned before, the Chronic Care Model consists of six elements. These elements are: community resources and policies, the provider’s health care organization, case management, delivery system design, decision support, and self-management. And the self-management aspect of the Chronic Care Model is the most important element of the model.

It was pointed out in our Chronic Care Model blog post that some of the most important functions of the model are best carried out by trained non-physicians. And again, the UK program’s nurse leadership supports the belief that non-physician professionals can play a significant role in the treatment of a chronic illness such as obesity.

It appears that much is being learned about non-surgical, non-drug approaches to treating obesity. If research can continue to help improve these weight loss approaches, more obesity patients will be able to successfully deal with obesity on a long term basis. Of course, bariatric or weight loss centers should follow research in this area, and make use of applicable research results.

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Using the Chronic Care Model to Treat Obesity

2009-10-14T16:49:00.000-07:00

Obesity may be viewed as a chronic illness. Therefore, tools used to successfully treat chronic illnesses can be used to treat obesity. An effective tool for treating chronic illness is called the Chronic Care Model. The Chronic Care Model was developed by the MacColl Institute for Healthcare Innovation. The institute is based in Seattle, Washington. The institute developed the model to treat those illnesses that require an ongoing relationship between the ambulatory patient and the health care provider.

The model was developed more than a decade ago. In designing the model, the developers researched literature to uncover methods that could be used to improve the treatment of chronic illnesses. Over time, the model evolved to contain six key elements. These elements are: community resources and policies, the provider’s health care organization, case management, delivery system design, decision support, and self-management.

The first of the six elements is community resources and policies. This means that the health care provider should make use of existing community resources. Further, the provider should work to institutionalize policies that improve care. In making use of community resources, for example, a bariatric center could partner with a gym in the community to provide exercise to patients.

The next item on the list is the provider’s health care organization. Among other things, this item stipulates that the provider’s health care organization should actively support improvements in health care. And the provider’s organization should emphasize the use of quality measures in the application of health care.

Case management, the next list item, is meant to indicate that the provider should work with the patient to enhance the patient’s self-management. Self-management will be discussed below. Case management also entails follow-up to make sure the treatment is working. Case management also includes an effort to help guide the patient through the health care system.

The delivery system design is the next element on the list. It is essential, for example, that the delivery system be designed so that necessary resources be made available to the patient. In fact, implementing the delivery system so that both the provider and the patient have access to resources is important. In the system, evidence based treatment methods should be used. And many of these treatment methods ought to be delivered by non-physician members of the provider team. Because in some cases, it has been found that non-physician members can deliver certain services better than the physician.

Next, we have decision support. Evidence-based guidelines must be part of the health care provider's organization. Established education methods should be employed. And treatment guidelines and clinical information should be shared with the patient.

Last on the list is self-management. Indeed, it has been found that self-management is a necessary part of the Chronic Care Model -- more so than any other element. In self-management, the patient must be viewed as the central player in the ongoing treatment of the chronic illness. And as part of the process, the provider must be agree to relinquish some control to the patient.

Since the introduction of the Chronic Care Model, efforts have been made to determine if the model improves health outcomes and is cost effective. Although more work needs to be done to determine the cost effectiveness of the model, published reports appear to indicate that by using the Chronic Care Model, health care organizations can improve the treatment of chronic illness.

Since overweight and obesity may be viewed as a chronic illness, The Chronic Care Model is applicable in the treatment of the illness. It has been shown that for long-term success, a strong ongoing relationship between the individual attempting to lose or control weight and the organization providing the weight loss or weight management service is of utmost importance. And the Chronic Care Model emphasizes this relationship.

Indeed for obesity treatment, weight loss centers should review elements of the Chronic Care Model, and try to implement as many of the model's elements as possible, with an emphasis on self-management.

GENova Biotherapeutics Inc. and Bridge Bioresearch Plc. to Look for Obesity-Cancer Link

2009-10-05T05:07:00.000-07:00

We now know that obesity is highly correlated with a number of illnesses, including some cancers. Therefore, efforts that might shed more light on the relationship between cancer and obesity can be useful. New York based GENova Biotherapeutics Inc, which has a research focus on cancer, will collaborate with the UK based company Bridge Bioresearch Plc., which has a focus on obesity. The two companies will try to find links between cancer and obesity by sharing their research results.

Obesity has been found to play a role in a number of ailments. It is well accepted that these ailments include high blood pressure and high cholesterol. Moreover, the The Mayo clinic did a study and determined that obesity contributes to the need for hip replacement. And some experts indicate that there is a link between obesity and Alzheimer’s disease.

Further, researchers in the UK suggest that obesity is a bigger health risk, today, than smoking. In the UK, it is estimated that there might be as many as 19,000 British cases of cancers per year resulting from obesity. Finding links between obesity and cancer is almost as important as the link discovered between smoking and cancer, since obesity is associated with a number of cancers.

According to the National Cancer Institute (NCI), a U.S. government organization, obesity is related to a number of cancers. These include: "colon, breast (postmenopausal), endometrial, kidney, and cancer of the esophagus." According to the NCI, the link between cancer and obesity is not known. In fact, the NCI goes on to say, the link might be different for different cancers. And the NCI has ongoing studies to determine what these links are.

The collaboration between GENova Biotherapeutics Inc. and Bridge Bioresearch Plc. may add to results coming out of the NCI studies and other studies investigating the link between cancer and obesity. In fact, health care organizations that offer both weight loss treatment and cancer treatment might also add to the obesity-cancer link knowledge base.

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Weight Loss Through Lifestyle Modification Could Be Enhanced with Nutrisystem D

2009-09-27T07:22:00.000-07:00

Lifestyle modification, as a way to lose weight, is the most popular weight-loss method. It’s the most popular method because it's usually the easiest, least expensive, and safest way to lose weight. The main components of lifestyle modification for weight-loss generally include a modified diet and an exercise program -- diet being more important than exercise. And Nutrisystem has introduced a new program, called Nutrisystem D, that greatly improves a person's weight-loss chances, according to a recent study done at the Temple University School of Medicine.

The Nutrisystem D program is directed at overweight people, who have type 2 diabetes. As part of the program, a person receives 150 pre-packaged meals. The meals are portioned controlled. And the meals are designed to cause low rises in blood sugar.

The Nutrisystem D study done at Temple was led by Dr. Gary Foster. The study participants following the Nutrisystem program lost more than twice the weight as did participants who followed a diet designed for diabetics.

Using prepackaged meals as meal replacements has already been shown to lead to weight loss. Meal replacements include shakes, entrees and bars. And along with Nutrisystem's meals, pre-packaged meals include meals made by Lean Cuisine and Healthy Choice. With pre-packaged meals, a dieter can simply pick up a meal without having to worry about the calorie or nutritional content. And this can be quite convenient. Further, a 2003 Pub Med report indicated that meal replacements can be employed safely to enable one to lose weight and maintain the weight loss.

Nonetheless, staying on a diet long term -- even on a well designed diet -- can prove to be difficult. But modifying a lifestyle to follow a specific diet, long term, can be aided with external reinforcement from weight-loss counselors. And counseling is a part of the Nutrisystem D program. Since the Nutrisystem D program appears to be a good one, bariatric centers should take note of the program. Some of the procedures employed in the Nutrisystem D program may be adaptable to bariatric center programs.

Vivus Is Planning to Apply for FDA Approval for Its Obesity Drug Qnexa

2009-09-17T11:44:00.000-07:00

A few obesity drugs in the drug pipeline are continuing to show promise. The companies, developing obesity drugs, that have recently received attention include the California based companies, Vivus, Arena and Orexigen. Vivus manufactures the drug Qnexa. Arena makes the drug lorcaserin, and Orexigen produces the drug contrave. But Vivus, with its drug Qnexa, is currently dominating the news.

Qnexa is a combination of two drugs: phentermine and topiramate. Phentermine was used in the obesity drug combination fen-phen. Fenfluramine and Phentermine were fen-phen. Fen-phen was taken off the market in the 90s, at the request of the FDA, because of severe side effects, including cardiovascular problems. But phentermine was the safer of the two drugs.

Qnexa motivates weight loss by suppressing the appetite, and by making the user feel full. So far, the main Qnexa side effects are “dry mouth, tingling, constipation, altered taste and insomnia.”
And persons participating in Qnexa drug trials experienced an approximate 15 percent weight loss. This weight loss percentage greatly exceeds FDA guidelines. Further, Qnexa has the potential to reduce some risks associated with diabetes.

The market for obesity drugs is potentially lucrative, if an obesity drug is found that is safe and effective. “JMP securities recently projected Qnexa's annual sales would hit $1.5 billion by 2015.”

Based on trials results, Vivus expects to apply for approval from the FDA to market the Qnexa by the end of this year. The company is then planning to start marketing the drug by the end of 2010. Also, the company will start looking for collaborative opportunities to sell the drug.

With the weight loss industry in need of a safe and effective weight loss drug, weight loss service and product providers should closely monitor Qnexa and if reasonable, the companies should take advantage of collaborative opportunities.

(Please leave a comment by clicking on the "COMMENTS" link at the lower right part of this blog post. SUBSCRIBE to this blog by scrolling to the bottom of this page and entering your email address.)

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An Update on the GI Dynamics Intestinal Liner

2009-09-12T18:15:00.000-07:00

Last year we wrote that the company, GI Dynamics of Lexington, Massachusetts, presented a report on the results of tests done using an intestinal liner that duplicates some of the functions of gastric bypass surgery. We went on to say that the liner, called the EndoBarrier, reduces the amount of calories that the body absorbs from food that is eaten.

Further, we indicated that the liner is inserted endoscopically through the mouth, and placed in the small intestine, covering about two feet of the intestine. Finally, we said that test results indicated that the liner could cause weight loss and produce beneficial effects for those with type 2 diabetes.

The intestinal liner mimics some of the malabsorptive characteristics of gastric bypass surgery. Gastric bypass surgery is a combination of two weight-loss surgical procedures that reduce calorie intake. In one of the procedures, called restriction, the surgeon creates a smaller stomach using a portion of the original stomach. This smaller stomach restricts the amount of food a person eats, thus reducing calorie intake. In the other procedure, called malabsorption, the surgeon reroutes the small intestine so that food bypasses a portion of the small intestine, reducing the amount of calories (and nutrients) absorbed by the body.

Persons participating in intestinal liner tests were able to lose an average of 30 pounds and there was a decrease in the blood sugar level in study subjects. Thus, there was a lessening of symptoms associated with type 2 diabetes.

Last month, GI Dynamics reported that they have improved the therapeutic effects of the Endobarrier Intestinal Liner by combining the liner with the company's Endobarrier Flow Restrictor. This device is used to delay the stomach's emptying of food into the small intestine. This is known as gastric emptying or GE. And this device appears to enhance the effects of the Endobarrier.

If ongoing tests of the Intestinal Liner plus Flow Restrictor prove successful, the combination might be a safe and effective method for weight loss and weight maintenance. And a weight loss or bariatric center may be able to employ the device and gain a competitive advantage.

Environmental Change: A Weapon to Fight Obesity

2009-08-30T13:36:00.000-07:00

Environmental change as an effective and low cost approach to weight loss appears to be gaining more attention. Environmental change can promote lifestyle modification, which is the leading method used in weight loss and weight maintenance. The two key elements of lifestyle modification are diet and exercise. And environmental change can enable a person to lose weight by causing the person to modify his diet and exercise.

Along with overweight and obesity comorbidities such as high blood pressure and high cholesterol, we are now learning that the brain shrinks with overweight and obesity. And as overweight and obesity increase in children, we will likely see more brain shrinkage as these children reach adulthood. So it is important to attack overweight problems in children as well as in adults. And lifestyle modification appears to be a good weapon.

It is now believed that heavy-handedness is not as effective in helping children fight overweight and obesity as a soft-touch approach. In essence, children should not be restricted from eating certain foods. They should be taught to regulate their food intake and eat healthy food. And parents can help their children by exposing them to healthy food in the home. Indeed, modifying the home environment to be conducive to healthy eating and exercise may lessen the amount of overweight and obese children.

Furthermore, changing the workplace environment may lessen the amount of overweight and obese adults. A study by Justin Trogdon, a consultant at RTI International, indicated that “environmental change interventions in work sites may be more likely to be cost saving than high-cost, individually targeted behavioral change interventions...” The interventions include nutritional programs, on-site gyms, and weight-loss competitions. The competitions include “contests that give overweight employees money if they succeed in shedding extra pounds ...”

So, environmental change may be an important component of lifestyle modification in the home, and a cost effective component of lifestyle modification in the workplace. Environmental change can be an aide in weight loss and weight maintenance which can reduce health care costs for employers.

So weight loss service and product providers should emphasize the importance of environmental change as an element in lifestyle modification. These providers should work with parents and employers to initiate environmental changes that motivate exercise and a healthy diet.

(Please leave a comment by clicking on the "COMMENTS" link at the lower right part of this blog post.)

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Lifestyle Modification with Medical Counseling Can Lead to Weight Loss

2009-08-21T05:50:00.000-07:00

Lifestyle modification — including diet and exercise changes — is known to be the most utilized weight loss method. However, lifestyle modification doesn’t lead to long term weight loss for many obese persons. But a recent study done at the University of Kentucky shows that lifestyle modification -- specifically diet change -- utilized with medical supervision can lead to quite respectable weight loss for obese persons. And there may be ways to maintain the weight loss long term.

The study-participants' diet was modified with the use of meal replacements. And medical supervision was combined with the meal replacements. This combination enabled obese-study participants to lose up to 16 percent of their initial body weight. The participants in the medically supervised program “lost an average 43.4 pounds in 19 weeks.” The meal replacements in the study were shakes, entrees, and bars.

Indeed, it has been shown before that the use of meal replacements can lead to weight loss. Among shakes, entrees and bars, specific examples of meal replacements include Lean Cuisine and Healthy Choice packaged meals. The packaged meals enable a dieter to simply pick up a meal without having to worry about the calorie or nutritional content. And this can be quite convenient. Moreover, a 2003 Pub Med report indicated that meal replacements can be employed safely to enable one to lose weight and maintain the weight loss.

Still, maintaining the weight loss -- even with meal replacements -- can prove to be difficult. But modifying a lifestyle so that appropriate meal replacements are selected and used for the long term can be aided with external reinforcement from medical weight loss counselors. Bariatric centers can provide ongoing counseling to help the obese person continue to make the best choices and stick with a diet program. And long term counseling can be an important offering for a weight loss or bariatric services provider.

(Please leave a comment by clicking on the "COMMENTS" link at the lower right part of this blog post.)

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An Anti-Obesity Chewing Gum

2009-08-10T07:43:00.000-07:00

In the past, we have discussed lifestyle modification tools that can aid in weight loss. Now, the Switzerland based company, Ventana Biotech Inc, is working on another tool. The company is working on a chewing gum that might be an aid in weight loss. Of course, this wouldn't be the first time that chewing gum was employed to improve health.

Chewing gum is used to help smokers quit smoking. Chewing gum can serve as a substitute for smoking a cigarette, enabling a smoker to replace the smoking habit with chewing gum. Indeed, nicorette gum also gives the smoker a small amount of nicotine to reduce the effects of nicotine withdrawal.

And chewing sugar-free gum can help fight tooth decay. According to the American Dental Association (ADA), chewing gum containing the sugar substitute, xylitol, can prevent tooth decay.

Further, suggestions that chewing gum can be an aid in weight loss are not new. Contestants on the TV reality show, "The Biggest Loser," are told by the trainers and the nutritionists on the show to chew sugar free gum to help lose weight. And a 2007 Scotland study demonstrated that chewing gum can be an aid in weight management. Chewing gum can help as an aid in weight management because chewing gum can reduce hunger.

While chewing gum can reduce hunger, most chewing gum is not produced with an appetite suppressant as a key active ingredient. Ventana's gum contains an extract from the hoodia gordonii plant, and active ingredients in the plant can suppress appetite. Moreover, the gum is patented as an anti-obesity gum. The gum is currently in trials. And if the gum proves to be save and effective, Ventana hopes to license the gum to large pharmaceutical companies.

Indeed, if Ventana's chewing gum proves successful, it will be a useful tool for weight control. And the gum will be another weapon in the weight loss service provider' s arsenal.

(Please leave a comment by clicking on the "COMMENTS" link at the lower right part of this blog post.)
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Bariatric Surgery: An Option That Might Reduce Health Care Costs

2009-08-02T14:18:00.000-07:00

Most likely you've heard the following media report: Obesity accounts for $147 or almost 10% of the health care cost in the U.S. each year. You’ve also probably heard that the obesity market has unrealized potential. The potential is unrealized because most weight loss methods are not successful at providing long-term weight loss. However, since reducing obesity in the U.S. can reduce health care cost, finding ways to treat obesity is of the utmost importance. Perhaps, bariatric surgery could play a larger role in this treatment.

One obesity-related disease that has added to the increase in health care cost is diabetes. According to a 2008 Lewin Group study, the 2007 U.S. price tag for diabetes treatment was approximately $115 billion. And even when a diabetes patient has insurance, out-of-pocket cost for the patient can be significant.

For those with diabetes, losing weight can lead to a reduction in associated symptoms. Indeed, for morbidly obese persons with diabetes, appreciable weight loss can stop the progression of the disease in many cases. Therefore, weight loss methods that are safe and effective may be vital to reducing diabetes and health care costs.

There are three weight loss approaches. They are lifestyle modification, obesity drugs, and bariatric or weight loss surgery. Although bariatric surgery is probably the most effective method for treating obesity, patients receiving the surgery have experienced serious complications.

However, significant progress toward decreasing the bariatric surgery-complication rate has been made. For example, according to a HealthGrades study, patients who have bariatric surgery at five-star rated centers (as determined by HealthGrades) have a 67% lower chance of experiencing complications. And a new risk management system "presented ... at the 26th Annual Meeting of the American Society for Metabolic & Bariatric Surgery (ASMBS)" can reduce post surgical complications by 65%.

Therefore, bariatric surgery might play a more prominent role in the treatment of obesity -- and thus a more important role in the treatment of diabetes. This, in turn, could put a dent in health care costs.

Bariatric surgical providers should take note of the above-mentioned HealthGrades study and the above-mentioned risk management system. Adopting practices followed by five-star rated bariatric centers and following procedures related to risk management could improve surgical services, and give a weight loss surgical provider a competitive advantage.

(Please leave a comment by clicking on the "COMMENTS" link at the lower right part of this blog post.)
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Laparoscopic Vertical Gastroplasty

2009-07-23T06:20:00.000-07:00

A 2003 study, published in the Archives of Surgery, indicated that ‘vertical gastroplasty can benefit most patients with morbid obesity and should be more frequently used.’ And recently, the company, Power Medical Interventions(r), Inc. (PMI), introduced a medical device that facilitates a laparoscopic version of the surgery.

In vertical gastroplasty, a part of the stomach is stapled in such a way as to create a smaller stomach pouch. Vertical gastroplasty is a type of restrictive bariatric surgery which means that the patient’s food intake is limited by the surgery. Vertical gastroplasty is similar to sleeve gastrectomy.

In sleeve gastrectomy, a smaller stomach is made by sealing off part of the stomach using staples, and the unused part of the stomach is removed from the body. While vertical gastroplasty also seals off part of the stomach, resulting in a smaller stomach pouch, no part of the stomach is taken from the body in the surgery.

The device that PMI introduced is called the i60 Mid Cut device. The device can enable a doctor to perform vertical gastroplasty, laparoscopically, in approximately 30 minutes. As we’ve said before, laparoscopic bariatric surgery exposes the patient to less trauma and lowers recovery time.

As indicated on its Website, PMI is working on instruments that may allow vertical gastroplasty to be performed using a natural body orifice, such as the mouth, anus or vagina. Surgery using a natural orifice is often called Natural Orifice Translumenal Endoscopic Surgery or NOTES.

Laparoscopic vertical gastroplasty -- even laparoscopic vertical gastroplasty performed using NOTES -- is more evolutionary than revolutionary. Still, laparoscopic vertical gastroplasty is an important step toward developing less invasive, effective forms of bariatric surgery.

Medical device providers, working on bariatric surgical instrumentation, may help increase bariatric surgical options. These device providers' efforts can increase the surgical options that bariatric surgical providers may offer, increasing the surgical choices for prospective bariatric patients. (Please leave a comment by clicking on the "COMMENTS" link at the lower right part of this blog post.)

Opportunities to Fight Obesity May Become More Accessible

2009-07-13T06:45:00.000-07:00

Today, we talk a lot about the causes of obesity and the methods that may be used to treat obesity. However, we might be missing some important opportunities to combat the disease during its early stages. Moreover, accessing those opportunities may become easier to do.

A study, entitled “Adult Obesity and Office-based Quality of Care in the United States,” discussed in a recent issue of the journal, Obesity, indicates that opportunities to treat obesity during patient visits to health care providers are commonly missed. For example, when an obese patient goes in for a physician visit, the patient is often not provided counseling on weight loss methods. And this absence of counseling leads to poor health and higher health care costs.

We think that patient visits provide an opportunity for physicians, especially primary care physicians, to improve the health of many patients. But in order for primary care physicians to take advantage of this opportunity, barriers that inhibit weight loss counseling must be broken down. And these barriers exist from both the patients' and the physicians' perspective.

For example, a 2007 report asserted that many health care providers feel that patients are obese because patients don’t effectively use self-control. And many patients believe that it’s up to them to control their weight. Thus many patients don’t talk with their health care provider about methods to combat obesity.

Although these and other barriers do exist, we believe that rising health care costs will cause more people to recognize the importance of maintaining a healthy weight. And this will cause more people to talk with their health care providers -- especially primary care physicians -- about weight management. Further, more people will talk with their providers about weight management, because their employers will urge them to do so.

Indeed, a July 2009 Wall Street Journal article entitled, “When All Else Fails: Forcing Workers Into Healthy Habits,” reported that some companies are now compelling their employees to live healthier lifestyles, because if employees live healthier lifestyles, this will lower a company's health care costs. A healthy lifestyle includes getting periodic physicals, sticking to a healthy diet, and maintaining a healthy weight.

We believe that there will be an increasing focus on living a healthier lifestyle, by primary care physicians and by patients. And this increasing focus offers an opportunity for all weight loss providers, especially medical weight loss providers. These weight loss experts can form strategic alliances with primary care physicians and others who work with persons needing to lose or maintain a healthy weight.

(Please leave a comment by clicking on the "COMMENTS" link at the lower right part of this blog post.)
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Will the Demand Fall for Obesity Drugs?

2009-07-03T09:00:00.000-07:00

Obesity drugs are one of the three methods generally employed to fight obesity. And the obesity market is a huge market that may be worth more than 500 billion dollars in a few years. However, drugs that fight obesity, so far, have not been very successful. These drugs cause cardiovascular and mental problems. Moreover, the use of the drugs usually doesn’t lead to long-term weight loss. Therefore, some believe that the demand for obesity drugs may fall in coming years.

Experts in India have felt for some time that the demand for obesity drugs will be hampered by the failures associated with the drugs. Today, India experts believe that the obesity drug failures have already caused demand for the drugs to decline by 70%. Indeed, if the demand for these drugs is declining worldwide, it will be harder for drug makers to sell new drugs, even if the drugs safely lead to weight loss.

So, it is imperative that pharmaceutical companies engaged in obesity drug research concentrate on producing safe and effective weight loss drugs. Tesofensine and Qnexa are two obesity drugs, currently in the pipeline, showing promise, as we've mentioned in this blog before. Let's hope these drugs prove to be successful.

However, if they don't prove successful, this condition creates an opportunity for the other two areas of weight loss and weight management -- lifestyle modification and bariatric surgery. Efforts to enhance lifestyle modification methods are being studied. And minimally invasive weight loss surgical techniques are being developed.

So despite the obesity-drug pessimistic outlook, research is ongoing in all weight loss arenas that may improve our ability to fight the worldwide weight gain. And of course, weight loss facilities should be willing to play whatever role is necessary to enhance their ability to provide healthy weight loss programs.

(Please leave a comment by clicking on the "COMMENTS" link at the lower right part of this blog post.)
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Endoscopic Bariatric Surgery Offers Opportunities For Medical Device Providers

2009-06-24T13:34:00.000-07:00

It is estimated that by 2014, the weight loss market will be worth 586.3 billion dollars. Further, the United States is expected to be 43 percent of that market. However, to date, no weight loss method provides long-term weight loss without the potential of serious complications. So finding an effective long-term weight loss treatment is the goal of most of those in the weight loss industry.

Of course, the dearth of safe, effective weight loss treatments offers opportunities for medical device providers operating in the weight loss industry. This is especially true for that segment of the bariatric industry focusing on endoscopic bariatric surgery.

Indeed, there are companies working on medical devices for endoscopic bariatric surgery. One of the companies is BioEnterics. This company makes the Intragastric Balloon or BIB system. In this system, a balloon is filled with a saline solution after being placed in the patient's stomach. This balloon gives the patient a feeling of fullness. BioEnterics is based in Irvine, California.

Another company focusing on endoscopic bariatric weight loss devices is BaroNova Therapeutics, Inc, headquartered in Forster City, California. This company is working on a pill that is swallowed or placed in the stomach using an endoscope. The pill expands to make the user feel full.

Power Medical Interventions, Inc. of Longhorne, Pennsylvania, has made a stabling device that can be inserted into the stomach, using the mouth as the entry point. The device can be used to shrink the stomach. And GI Dynamics, a Lexington, Massachusetts company, has developed a sleeve that can be placed in the upper part of the small intestine to mimic the "bypass" part of gastric bypass surgery. The sleeve is called the EndoBarrier™.

Endoscopic surgical methods hold great potential for bariatric surgery. The surgery is less invasive, creating less trauma to the body. If some of the methods described above prove effective, it will be good for the weight loss industry. Further, the surgery could be less costly, enticing more persons who need the surgery to have the surgery. This increased number of persons seeking bariatric surgery would be a boon for bariatric surgery providers, and bariatric surgical medical device providers.
(Please leave a comment by clicking on the "COMMENTS" link at the lower right part of this blog post.)
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In the War on Obesity, Two Obesity Drugs Show Promise

2009-06-15T11:49:00.000-07:00

As we've said before on this blog, there are three approaches to weight loss and weight management. They are lifestyle change, including diet and exercise; weight loss surgery; and obesity drugs. Each approach has its pros and cons. The most important pro for each of the approaches is that each approach can lead to weight loss. However, the cons are quite troubling.

For example, lifestyle modification is difficult to adhere to on a long term basis. Bariatric surgery is only advocated for severe obesity, plus the surgery produces complications. And obesity drugs have engendered less than stellar weight loss results, while causing serious side effects, including cardiovascular problems and thoughts of suicide. However, there are at least two drugs now in the pipeline that show promise.

The two drugs are Qnexa and Tesofensine. These drugs have shown positive weight loss results. Both of these drugs motivate weight loss by suppressing the appetite. And Qnexa also makes the user feel full. Qnexa is made by Vivus, Inc., a U.S. biopharmaceutical company, and Tesofensine is made by Neurosearch, a Danish biopharmaceutical company.

Qnexa is a combination of two other drugs. One of the drugs is phentermine. Phentermine was the "phen" in the drug combination fen-phen, and Fenfluramine was the "fen." Fen-phen was taken off the market in 1997 because the drug caused severe side effects, including cardiovascular problems. So far, however, Qnexa does not appear to produce fen-phen like complications.

Recent phase ll results for Qnexa have been positive. The side effects seen, so far, include constipation, tingling and nausea. And while Qnexa gave positive weight loss results, the drug also reduced some indicators associated with type 2 diabetes.

Tesofensine was originally developed to treat Parkinsons and Alzheimer's diseases. Although the drug was disappointing in fighting those diseases, it proved helpful in weight loss. And Neurosearch has completed phase ll testing of the drug, and gained FDA acceptance for the drug's phase lll test plans.

Both of the drugs, Qnexa and Tesofensine, have made significant progress. And either one could be an impressive obesity drug. This is especially true for Qnexa, because this drug has the potential to fight both obesity and type 2 diabetes. Of course, we will need to wait for the completion of the planned tests.

With the weight loss industry in need of a safe and effective weight loss drug, weight loss service and product providers should closely monitor Qnexa and Tesofensine phase lll results.

(Please leave a comment by clicking on the "COMMENTS" link at the lower right part of this blog post.)
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TOGA Incisionless Bariatric Surgery

2009-06-08T08:32:00.000-07:00

Bariatric or weight loss surgery receives media attention, from time to time, because the surgery has shown to be effective in fighting obesity. Recently, a relative new bariatric surgical procedure was highlighted by the ABC network morning show Good Morning America (GMA). The surgical procedure is called Transoral Gastroplasty or TOGA. The TOGA procedure was created by Satiety Inc, based in Palo Alto, California.

TOGA is an incisionless surgical procedure. This means that the surgery is done using natural body orifices and pathways to access organs within the body. The TOGA procedure accesses the inside-of-the-stomach via the mouth and esophagus.

In the procedure, flexible stabling devices are introduced into the stomach, and the devices are used to bring sides of the stomach together so that the sides can be stapled together to create a small stomach pouch. Surgeons, performing the surgery, view their surgical actions inside the stomach using a lighted scope or endoscope.

An early use of the TOGA incisionless procedure was carried out at Barnes-Jewish Hospital in St. Louis, Missouri, as we reported in one of our August 2008 blog posts. The application of the procedure profiled on GMA was done at Cedars-Sinai Medical Center, located in Los Angeles, California. The TOGA procedure is estimated to cost somewhere between thirteen and twenty thousand dollars. And the procedure appears to be similar, in effectiveness, to lap band surgery.

Indeed, Transoral Gastroplasty will prove to be useful if the procedure produces long-term weight loss, while causing fewer complications compared to other forms of bariatric surgery. As indicated above, some U.S. facilities have used the TOGA procedure. Further study, which is ongoing, will determine if the procedure is a viable option for surgical weight loss providers to offer. At any rate, weight loss product and service providers should monitor TOGA study results.

(Please leave a comment by clicking on the "COMMENTS" link at the lower right part of this blog post.)

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Simulation Can Improve Laparoscopic Bariatric Surgery

2009-05-30T15:43:00.000-07:00

We have always believed in employing simulation as a way to improve skills. The United States Space program has used simulation as an integral part of space mission planning for many years. And recent studies demonstrate the usefulness of simulation in training doctors -- including doctors that perform laparoscopic surgery.

A recent study at Yale University demonstrated how simulation can be useful in training doctors. Using simulation, student doctors were trained to successfully insert a “central line” or catheter into a major vein of the body. So employing simulation to train doctors can be a smart thing to do. Moreover, in the opinion of some experts, not using simulation to aid in training doctors is a mistake.

England's chief medical officer recently stated that because doctors don’t have enough simulators on which to practice, patients are subjected to harm. Airlines use simulators to train their pilots. And because of their regular training on simulators, pilots are better trained to fly planes than surgeons are to perform surgery.

Simulation may be even more important in laparoscopic surgical training, since laparoscopic surgery requires a higher level of skill than open surgery. And laparoscopic bariatric surgery, performed by a skilled surgeon, generally produces less trauma for the patient. As reported in a Health Grades study, for those bariatric surgeries requiring hospital stay, the patient receiving laparoscopic surgery spends less time in the hospital than the patient receiving open surgery. Further, the complication rate for laparoscopic bariatric surgery is less than the complication rate for open bariatric surgery.

A recent study has shown that simulation can help a doctor acquire the necessary skills to gain laparoscopic surgical proficiency. Therefore, more medical device providers might want to consider building and making cost-effective simulators for laparoscopic surgical practice. The provider that creates the most useful, economical simulators for practicing laparoscopic bariatric surgical procedures will likely gain a competitive advantage.

(Please leave a comment by clicking on the "COMMENTS" link at the lower right part of this blog post.)

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Organizations Are Collaborating in the Fight Against Worldwide Obesity

2009-05-22T05:06:00.000-07:00

Obesity is a serious problem in the world. And experts throughout the world are trying to come up with ways to fight obesity. Organizations in the U.S. and in Europe are bringing knowledgeable groups together to find ways to combat the disease, because obesity increases the incidence of illness and strains a country’s health care budget. Bariatric or weight loss service or product providers could play an important role in this fight, since these providers have a grasp of what works and what doesn't.

In the US, the organization, Strategies to Overcome and Prevent (STOP) Obesity Alliance, is joining with consumers, health care providers, the government, businesses and others to come up with ways to fight obesity. And in Europe, “the UK National Obesity Forum (NOF) and the Belgian Obese Patients organization (BOLD) will” use results from a survey to gather information on fighting obesity.

Determining how to fight obesity is important since obesity is associated with a number of serious illnesses. For example, in the UK it is estimated that there might be as many as 19,000 British cases of cancers per year resulting from obesity.

That there is a high number of obesity-related diseases throughout the world is probably pretty much accepted now. However, maintaining a healthy weight as a way to prevent diseases is something we should focus on more. We have evidence to support the belief that losing weight and maintaining a healthy weight may enable an individual to avoid some diseases.

It is estimated, for example, that weight reduction through bariatric surgery has lowered by one-quarter the number of cases of diseases linked to obesity. So successfully combating obesity will increase health. And according to an Australian study, if we don’t successfully combat obesity, health care costs will rise worldwide.

To emphasize the importance of the obesity fight, some in the US believe that the US should “establish an End the National Obesity Epidemic (ENOE) task force.” It would probably be reasonable for this task force to collaborate with other organizations that are trying to find ways to fight obesity. Moreover, bariatric or weight loss service and product providers could join forces with obesity-fighting originations to try to find solutions to the worldwide obesity epidemic.

(Please leave a comment by clicking on the "COMMENTS" link at the lower right part of this blog post.)

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Food Played the Larger Role in America's Thirty Year Weight Gain

2009-05-13T10:22:00.001-07:00

We often say that lifestyle change is necessary for weight reduction. Lifestyle change usually includes diet modification and exercise. Diet and exercise are both important in weight reduction and weight control. However, some experts conclude that the number of calories we consume is more important than the exercise we get, when it comes to weight loss and weight control.

Of course, exercise is important for keeping the body in shape, and we should all engage in frequent exercise. Still, for weight loss or weight control, calorie intake appears to be the most significant factor. And a recent Australian study confirms the importance of calorie intake in weight gain.

We’ve all heard that the American sedentary lifestyle is a large contributor to the weight gain in American. We’ve heard that over the past few decades, Americans have spent more time working in offices than on farms and in factories. And leisure activities that include watching television and using a computer have replaced physical activity. Thus, sedentary activities have contributed heavily to Americans’ weight gain.

But according to the above mentioned Australian study, the weight gain in America over the past 30 years was due to an increase in calorie intake more so than a lack of physical activity. In fact, for American adults, there may even have been an increase in physical activity over the past 30-year period compared to previous years.

Therefore, the past 30-year American weight gain must be attributed to increased calorie intake. Moreover, according to the study, adults need to reduce their daily calorie intake by 500 calories to return the 1970 body weight numbers. And children should decrease their daily calorie intake by 350 calories.

These specific numbers should give weight loss centers calorie intake targets around which to design diets. Centers ought to design and market healthy diet programs that can reduce an adult’s calorie intake by 500 calories per day, and a child’s calorie intake by 350 calories.

(Please leave a comment by clicking on the "COMMENTS" link at the lower right part of this blog post.)

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Does Bariatric Surgery Volume Make a Difference In the Number of Surgery Related Complications?

2009-05-03T19:28:00.000-07:00

A resent study done by Dr. Edward H. Livingston, of the University of Texas Southwestern School of Medicine and Department of Veterans Affairs in Dallas, indicates that the complication rate for patients undergoing bariatric surgery is essentially the same at Center of Excellence (COE) facilities as at non-COE facilities. The study concludes that ‘Designation as a bariatric surgery center of excellence does not ensure better outcomes. Neither does high annual procedure volumes.’

A 2008 Health Grades bariatric study concluded that volume is very important in reducing the complication rate in bariatric surgery. The Health Grades study found that those facilities that had done at least 125 surgeries during a year had fewer complications than those facilities that had done 25 or less surgeries.

A 125-surgery-per-year minimum is an important element in the COE criteria established by both The American Society for Metabolic and Bariatric Surgery (ASMBS) and the American College of Surgeons (ACS). Moreover, Medicare will consider paying for bariatric surgery only if the surgery is performed at a COE facility, certified by the ASMBS or the ACS. So, there is support for the 125 per year bariatric surgical minimum as a basis for achieving surgical proficiency.

Based on the Livingston study, facilities performing less than 125 surgeries per year -- actually, an average of 79 surgeries -- have a complication rate similar to facilities performing 125 surgeries or more per year. Although this conclusion may reflect an accurate assessment of the study results, we don’t feel that the results necessarily mean that volume doesn’t count. The results may indicate that performing 79 surgeries per year is a good number from which to gain bariatric surgical proficiency.

However, we don’t believe that the Livingston study results mean that a bariatric center that performs 15 surgeries per year is likely to have a lower complication rate than a center that performs 125 surgeries per year. We do believe that volume counts. Further, we believe that emphasizing a high volume is a good marketing tool for a weight loss center to use as part of an overall marketing strategy.
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The NIH May Offer an Opportunity for Bariatric Centers

2009-04-22T06:48:00.000-07:00

The National Institutes of Health (NIH), a U.S. governmental agency, pays a lot of attention to obesity among groups of lower socio-economic status -- with good reason. Studies done by the NIH indicate that a disproportionate number of persons in lower socio-economic groups are likely to be obese. Further, research programs, focusing on obesity in lower socio-economic groups, are important to the whole society, since the whole society pays for obesity in health care dollars. Because solving the obesity problem is so important to our society, the NIH offers obesity related research grants that some weight loss centers may be able to obtain.

Although important to society as a whole, reducing obesity in lower socio-economic groups is also important to persons in the groups. But reducing obesity in these groups is difficult, since persons in these groups typically live and work in environments not conducive to healthy diets and exercise. Healthy food such as fruits and vegetables are often not readily available to persons in these groups. Places to exercise are also hard to come by for these persons. Therefore, these problems need to be addressed to improve the health of individuals in lower socio-economic groups.

Now while a reduction in obesity is important for good health, a reduction in obesity may also be important for increasing economic status. In the workplace, people who are obese are less likely to get promoted than people of normal weight. And people in the workplace who are obese are less likely to get support from their colleagues than people of normal weight.

So while it may improve health, overcoming obesity may also raise the socio-economic status of persons in lower socio-economic groups. And because socio-economic status may be more important to many people than health, emphasizing the socio-economic status-raising benefits of weight reduction rather than the health benefits may be a better motivator for weight loss. Of couse, research could determine if this is true.

The NIH sponsors community programs that enable researchers to learn more about obesity among ethnic minority groups, since occupants of these groups make up a large portion of the obese in the U.S. And many obese persons in ethnic minority groups have a lower position on the socio-economic ladder.

Therefore, some bariatric centers could play a role in research focusing on obesity within lower socio-economic groups. Moreover, there may be NIH grants that could aid the centers in this endeavor. Engaging in obesity research could enhance a center's reputation, add to the obesity body of knowledge, and give a bariatric center a competitive edge.
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The Use of Health Coaches May Create an Opportunity for Medical Weight Loss Centers

2009-04-13T04:55:00.000-07:00

For some time, companies have offered wellness programs to company employees. Wellness programs often stress a healthy diet and frequent exercise. Companies have sponsored these programs in an attempt to keep employees healthy, and possibly reduce health care costs. Now, a modification to company wellness programs may be creating an opportunity for medical weight loss centers.

Companies are now beginning to use health coaches in the wellness programs. Moreover, the companies are targeting specific diseases with the coaches. The targeted diseases include diabetes, cardiovascular disease, asthma, and depression. In some way, each of these ailments can be exacerbated by obesity. This is especially true for diabetes.

Recently, Service Corporation International (SCI) began focusing on diabetes in its health coaching program. And SCI expects to save $500,000 during the first year of its program's operation, because of the program's focus and the use of health coaches.

Other companies are also using health coaches to assist employees with wellness issues. UPS is one of these companies. With its program, UPS targets employees afflicted with heart disease and diabetes. And the coaches encourage the employees to stay on their diets or prescription drug regimens.

We believe that providing employees access to health coaches is relatively new for most companies. But providing this benefit may reduce a company's overall health care costs. And this reduction will help a company's bottom line.

We think that the growing use of health coaches by companies creates an opportunity for medical weight loss centers. We believe this to be the case, since weight loss centers focus on weight loss. And weight loss is a key factor in the illnesses targeted by company wellness programs.

Medical weight loss centers may have a competitive advantage in this area, because medical weight loss centers are more likely to have a medically supported program. Thus, health coaches from these centers are more likely to be using medically based procedures, which may make the procedures more credible to a company.
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Using Collaboration to Fight Obesity and Improve a Competitive Position

2009-04-01T08:22:00.000-07:00

Making use of collaboration can be an important component of an organization's business strategy. In this blog, we have often advocated collaboration between weight loss centers and other organizations as a way to improve a competitive position, while fighting overweight and obesity. A relationship formed between The National Institutes of Health (NIH) and the Subway Restaurant Franchise illustrates this kind of collaboration. NIH, Subway, and other organizations, have come together, under an NIH program called “We Can!,” to work with parents and children to fight childhood obesity.

The NIH is a component of an agency within the federal government. That agency is the Department of Health and Human Services. And the agency has the primary responsibility for medical research in the U.S.

The NIH is based in Bethesda Maryland. The organization, which had its start in 1887 in Staten Island, NY, works to determine the cause and treatment of rare and common diseases. The organization carries out investigations within every state in the U.S. and in other countries.

The We Can! program is education oriented. The program helps children who are 8 to 13 years old maintain a healthy weight. As indicated above, a number of organizations have joined the We Can! program. However, in our opinion, Subway stands out as a member of the program because of the organization's attention to weight loss.

Subway restaurants sell mostly sandwiches and salads. And the restaurant franchise is rapidly growing. Much of the growth is no doubt due, in part, to the marketing of low calorie sandwiches. Adhering to a low calorie diet can lead to weight loss success. Jared Fogle followed a low calorie diet heavily dependent on low calorie Subway sandwiches. Fogle lost over 200 pounds by eating Subway sandwiches and engaging in frequent exercise. His weight loss success is highlighted in Subway TV commercials.

We believe that the collaboration between the NIH and Subway will serve a number of useful purposes. The collaboration may entice more restaurants to vigorously market low calorie meals. And the federal government’s involvement with Subway -- and other organizations -- shows that the government views overweight and obesity as major problems.

Weight loss centers might want to consider getting involved with the NIH program. Moreover, weight loss organizations should always be on the lookout for collaborative opportunities that may help the centers fight obesity while strengthening a competitive position.
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Obesity Can Negatively Affect Multiple Sclerosis

2009-03-23T06:12:00.000-07:00

Multiple Sclerosis (MS) is a serious illness which affects the central nervous system. The components of the central nervous system include the brain and spinal cord. MS is an incurable disease, so any actions that can be taken to lessen the effects of the disease are worth considering. There is some evidence to support the belief that obesity worsens MS, or at the very least makes the initial MS diagnosis more difficult. So weight reduction among those obese persons with MS can improve the overall health of the MS sufferer.

CVS Caremark has established a program that addresses some chronic diseases, including MS. Registered nurses run the CVS programs. The nurses provide personalized information and education to the persons enrolled in the program. The nurses also monitor the enrollees to determine which of the enrollees need more attention.

The CVS program may offer a collaborative opportunity for bariatric centers. Bariatric centers could work with the organizations establishing programs to help obese persons who suffer from specific comorbidities, such as MS.

CVS, Walmart, Walgreens, and other organizations have established retail clinics. These clinics treat ailments such as ear and nose infections. The clinics also give flu shots. And some clinics address obesity. Therefore, these clinics may offer another avenue for bariatric physicians, weight loss centers, and others who offer weight loss services.
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Weight Loss Centers Could Benefit Obese Clients By Collaborating with Dentists

2009-03-14T07:16:00.000-07:00

Weight loss centers want to motivate their clients to lose weight. Providing the client with useful information can help the client understand the importance of losing excess weight and maintaining the weight loss. Thus, it may be worthwhile for weight loss organizations to collaborate with other health care organizations that are interested in getting people to maintain a healthy body weight.

It has been knows for sometime that obesity can increase the chances of periodontal or gum disease. The relationship between periodontal disease and obesity was further confirmed in a recent study. Since this relationship exists, dentists may want to encourage their patients to maintain a healthy body weight as a way to fight periodontal disease.

Periodontal disease is caused by plaque that has formed on the teeth. This disease can affect the gums and bone holding the teeth in such a way as to cause tooth loss. Dentists encourage their patients to brush and floss daily to retard plaque formation. Dentists commonly advise their patients to have their teeth cleaned by a dental office twice a year.

And dentists often encourage their patients to get periodic dental checkups. During these checkups, dental office personnel will usually inspect a patient’s gums to determine if there is any change in the way the gums fit around the teeth.

So dentists work diligently with patients to treat or help them avoid periodontal and other tooth related diseases. Hence, dentists might be amenable to working with bariatric or weight loss centers in an attempt to reduce the level of obesity. Moreover, some dentists might be willing to advise their patients that excessive weight gain can lead to periodontal disease. And some dentists might even be open to referring obese patients to specific weight loss facilities.

If some coordinated-care arrangement could be worked out between a weight loss center and a dentist, the coordinated activity could possibly help the patient. This type of collaboration could also benefit the dentist and the weight loss center.
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Calorie Information Can Help Control Weight

2009-03-05T18:00:00.000-08:00

A recent study has concluded that the most important factor in weight maintenance and weight loss is the number of calories taken in by an individual. We believe that this means that making calorie content information available, including the calorie content of restaurant food, is of paramount importance. Further, we believe that the number of calories needed per day to maintain a specific body weight should be readily available. Making these two bits of information easily obtainable could do a lot to curb obesity.

And curbing obesity is an important goal. The Mayo clinic did a study and determined that obesity contributes to the need for hip replacement. So the need for hip replacement is another risk factor associated with obesity, along with some forms of cancer, high blood pressure, high cholesterol and other ailments. Some experts indicate that there is a link between obesity and Alzheimer’s disease. And researchers in England suggest that obesity is a bigger health risk, today, than smoking.

To reduce smoking, the U.S. and other countries use ongoing programs to warn people of the risks associated with smoking. Since we know that taking in too many calories can lead to overweight and obesity, at the very least, indicating the calorie content of food should be a requirement. And letting people know, on a wide scale basis, the number of daily calories needed to maintain a specific body weight would encourage people to count the calories in their diet each day.

That data is now available on a limited basis. According to one source, an inactive male who wants to maintain a 165-pound weight would need a diet containing 2145 calories per day. With this kind of information and the calorie content of food, an individual would likely be more motivated to maintain a desired body weight.

If steps are taken to provide crucial calorie-related data in the places people eat, the information would arm people with the ammunition to take responsibility for maintaining a healthy weight. Wide availability of this information would also allow weight loss or bariatric centers to more effectively work with their clients to set understandable and reachable weight goals.
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Childhood Obesity Can Hinder Career Success

2009-02-26T07:40:00.000-08:00

Parents want their kids to be successful in life. And of course this includes success in a chosen career. Many parents will spend huge sums of money on private kindergartens, elementary, and high schools for their children. Some parents will pay for special tutorial programs to help their kids do well on the SAT and other college entrance exams. However, it is now becoming apparent that parents can help their kids succeed in life by also taking action to help their kids maintain a healthy body weight early in life.

A study done in Canada has shown that obese persons in the workplace receive less support from fellow workers. Obese persons are more likely to be absent from work. And when they are at work, obese persons are less productive than their more lean colleagues.

Some believe that obese persons are discriminated against in the work place, including being less likely to be hired, and less likely to be promoted than persons of normal weight. Therefore, the Canadian study and other obesity-related workplace observations should motivate parents to become cognizant of the long-term effects of childhood obesity. Childhood obesity may negatively affect a child's future career.

At least one state, Virginia, has started to focus on childhood obesity. Both of the Virginia legislative branches -- the House and Senate -- have passed bills to change the Virginia Tobacco Settlement Foundation to the Virginia Foundation for Healthy Youth. In its present form, the organization’s mission is to focus on anti-smoking. With the name change, the organization would enlarge its mission to fight childhood obesity in addition to smoking.

While Virginia's Governor has not yet signed the bill, Virginia has taken a large step toward fighting obesity. Virginia's action is not the first time a state has taken some action to address obesity. Twenty-seven states have put tariffs on vending machine items such as candy and soda in an attempt to reduce obesity.

Although a government entity can take action to combat obesity, the fight against childhood obesity must begin in the home. Parents have the greatest influence on a child during the child's childhood. And since obesity can be an impediment to future success, parents should be interested in joining the fight against obesity. Bariatric or weight loss centers could work with parents in the community to educate them on the best procedures to use to help children maintain a healthy weight. This collaboration could help the community, and enhance a center’s local reputation.
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Frequent Self-Weighing as a Weight Loss Tool

2009-02-18T06:48:00.000-08:00

The American Dietetic Association (ADA) recently released a statement asking that people dedicate themselves to engaging in healthful behaviors for a lifetime. Of course, this probably means that starting early in life, people should adhere to a healthy diet and exercise regularly. Obesity, early in life, often leads to obesity later in life. So tools -- especially simple tools -- that can help children and adults lose weight, or manage weight, would prove useful.

Not only would the tools prove useful in weight loss and weight management, the tools would also help save money. The organization, Health Advocate (TM), a group that focuses on healthcare, authored a report entitled, "Obesity in America: Workplace Solutions." The report suggests that employers should offer programs to help employees lose and maintain a healthy weight. The report goes on to say that offering cost-effective programs could actually help employers save money. It is estimated that employers spend in excess of $13 billion per year on obesity-related medical costs and lost productivity.

The three methods used to fight weight are lifestyle modification (focusing heavily on diet and exercise), obesity drugs, and weight loss surgery. Some behavior modification is commonly a part of all three methods. One way to modify behavior is to monitor some indicator of the behavior you are trying to modify. Weighing is often used to monitor weight to determine how well a weight loss program is working. Moreover, some experts believe that frequent self-weighing is a motivator for weight loss or weight management.

A study, reported on in the American Journal of Preventive Medicine, appears to indicate that weekly self-weighing, as a motivator for weight loss or weight management, is supported by evidence. However, the study goes on to say that more research is needed. The study makes the point that frequent self-weighing might cause psychological problems.

However, if frequent self-weighing is a powerful strategy for losing and maintaining weight, frequent self-weighing could be instituted early in life. And assuming that frequent self-weighing during childhood doesn’t do psychological harm, self-weighing during childhood could be useful in curbing adult obesity. Moreover, mass use of the tool throughout life could help reduce costs associated with obesity.

Bariatric or weight loss centers should take note of the self-weighing research. And if the research supports using self-weighing for weight loss and weight management, a center could work with its community to emphasize the importance of self-weighing as a way to improve health or maintain good health. Working with its community to try to improve health would enhance a center's image as a good corporate citizen.
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Minimal Access Bariatric Surgery

2009-02-10T15:44:00.000-08:00

According to surgeon John Morton, of Stanford Hospitals & Clinics in California, the creation of several small incisions to perform surgeries such as laparoscopic bariatric surgery will become less and less common, as surgeons make one or no incision to perform bariatric surgery. Using one or no incision will likely produce less trauma for a patient and shorten a patient’s recovery time. Morton calls the surgery that uses one or no incisions “minimal access surgery.”

Morton performed minimal access surgery to revise a gastric bypass surgery. The surgery was done with the aid of an endoscope that was inserted into the throat, past the esophagus, into the stomach. Using a method called StomaphyX, pleats were formed in the gastric bypass stomach pouch, drawing the walls together so that the pouch became smaller. We discussed this revision method in our August 2, 2008 blog post.

Morton has also performed lap-band surgery via one incision in a patient’s belly button. Therefore, while laparoscopic gastric bypass surgery is the most popular form of minimally invasive weight loss or bariatric surgery -- at least in the U.S., other forms of minimally invasive surgery are also being used.

As the different minimally invasive bariatric surgical methods gain more prominence, we will be able to compare the pros and cons of the different methods. And we will be able to compare the pros and cons of minimally invasive methods for bariatric surgery with open bariatric surgical methods.

At any rate, weight loss centers that want to use technology to reduce trauma, while receiving good surgical outcomes, should monitor and collaborate with organizations engaged in bariatric surgical technique development or use.
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Adapting to Genetic Make-up to Aid Weight Loss

2009-02-01T17:18:00.000-08:00

Lifestyle modification is an important tool in most weight loss programs. Lifestyle modification usually includes exercise and a calorie-restricted diet. And the calorie-restricted-diet part of a weight-loss program has been found to be more important than the exercise part of the program.

Hence, deciding on a workable calorie-restricted diet is very important in weight loss. However, some persons have great difficulty losing weight using a calorie restricted diet. But as reported by Massachusetts based Interleukin Genetics, Inc., genes may play in role in this weight loss difficulty for some persons.

Researchers at Tufts University in Boston, Massachusetts, including some from Interleukin Genetics, found that persons with a certain genetic make-up had more trouble losing weight on a calorie-restricted diet than persons who did not have the genetic make-up. However, when persons with the specific genetic make-up were put on a calorie-restricted diet that was low in glycemic content (the diet raised the blood sugar level very little), the persons on the diet had more success at losing weight. This may add support to the theory that understanding genetic make-up may be useful in weight loss.

More research is needed to confirm the theory, and to make good use of the research findings. Bariatric or weight loss centers should be especially interested in the findings. Diet is important in weight loss, even if you employ diet pills or you have undergone weight loss surgery. Therefore, understanding how genetic make-up can affect a diet is of utmost importance.
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