Thursday, March 31, 2011

Obesity Is Last on List of Concerns

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.

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Wednesday, March 16, 2011

Bariatric Surgery: A Primary Treatment for Type ll Diabetes

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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Wednesday, March 2, 2011

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

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.

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