Wednesday, August 31, 2011

Weight Loss Counseling Directed at Neurobehavioral Processes

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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Monday, August 15, 2011

Leaks after Bariatric Surgery May Be Better Predicted and Managed

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.

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