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Excess weight complicates joint, orthopedic issues
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Orthopedic surgeons, rheumatologists and physicians specializing in rehabilitation medicine know that the knee joint has to support the force of three to six times one’s weight.
The impact of extra weight is also multiplied on other joints, including those of the back, hips and ankles. The results of this increased wear and tear are impressive; for example, men who are just 40 pounds over their ideal body weight have a five-fold increase in osteoarthritis.
This close link between obesity and osteoarthritis is well documented. Of course, the incidence of severe osteoarthritis in people that are one hundred or more pounds overweight is exponentially higher, and the age of onset is much earlier. As always in medicine, unless patients and their doctors attack the root cause of their disease, in this case arthritis, medications and other therapy will only temporarily alleviate the pain and will allow for permanent injury to the bone and cartilage to eventually occur. For patients who do not yet require surgery to replace damaged joints, substantial weight loss has been shown to alleviate the debilitating symptoms of osteoarthritis.
Studies have documented that seventy percent of patients that were taking medications for joint pain had no pain and were off all arthritis medications after weight loss surgery. Another published study documented that 58 percent of patients undergoing weight loss surgery complained of chronic low back pain, but this number decreased to only 20 percent after surgery.
The N.E.W. Program specializes in both surgical and non-surgical methods of permanent weight loss and patients often come in to see our specialists, or are referred by their physician, specifically due to chronic joint pain.
In fact, at The N.E.W. Program, patients have often been referred by orthopedic surgeons specifically in order to lose weight prior to joint replacement surgery. Surgical complication after orthopedic surgery is higher in severely obese individuals and recovery from joint replacement is more difficult in obese patients.
A patient who is unable to undergo joint replacement due to excess weight is a prime example of a person who needs surgical weight loss. By now, everyone is aware that osteoarthritis will often improve with good weight control. For those people who are severely obese and are suffering from chronic joint pain, surgery for permanent weight control may be the best option to improve the results of their medical or surgical therapy.
Laparoscopy effective tool in weight-loss treatment
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Laparoscopy is where surgeons perform abdominal operations through smaller incisions, using specialized instruments and magnification cameras, in order to optimize patient outcomes and comfort. Gallbladder surgery was one of the first laparoscopic procedures developed because of the skills involved are relatively basic to learn. Whereas gallbladder surgery is routine among most practicing surgeons, other procedures are much more advanced and require specialized training.
Our surgeons have taken the time to develop the special expertise necessary offer minimally invasive surgery to our patients. The field has become far too complex to learn during the course of most general surgery residency programs. In fact, the field of advanced laparoscopic surgery is now recognized as a specialty to itself – with one-year training programs to teach surgeons the special skills.
Why perform surgery laparoscopically?
Study after study has documented the benefits of laparoscopic surgery. Most obviously, post-operative pain is significantly decreased. These incisions cut very little muscle and thus cause much less pain than the traditional incisions used for surgery. This not only translates into improved patient comfort, but there is a decreased risk of developing pneumonia and other lung problems because breathing and coughing is so much easier without significant pain.
Because laparoscopic cameras magnifying the images on a large TV screen, we can see the intestines and internal organs much better than through a traditional incision with our unassisted eyes. This allows for an exactness in operating that cannot easily be replicated with the unaided eye. This creates a difference in incisions between the open and laparoscopic approach to weight loss surgery.
Minimally invasive surgery techniques have cut recovery times for many operations from weeks (or months) to days. The more “cutting” done by the surgeon, the higher the stress response the body undergoes. With a higher stress response there is an increase in heart and kidney problems as well as a decrease in immune function. Also, with smaller wounds, there is a much smaller chance to develop significant infections. And with less trauma there is also a decreased formation of internal scar tissue, or adhesions. Of course, cosmetically, the incisions after laparoscopy are often barely visible after they have completely healed.
The N.E.W. Program offers surgical and has non-surgical programs to help you restore control over your lifestyle and better manage your weight. As with any bariatric procedure, lifestyle modifications are paramount to achieving weight loss success after a revision and our comprehensive aftercare program will set you in the right direction.
If you think that you may benefit from one of these procedures, or would like to learn more about them, please call our office at (949) 722-7662 with any questions or to set up an appointment with our surgeons to see if you are a candidate. Don’t be afraid to ask for help. The N.E.W. Program will work with you to get you where you’ve always wanted to be – on the road to permanent weight loss.
Revisions can provide new hope in wellness journey
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In life, second chances don’t come along very often. When they do, you need to jump at them and take advantage of the opportunity. To be a candidate for a bariatric surgery revision should be viewed as a second chance to return to a healthier, more active way of life. But how does one know if they are a candidate for a revision?
Dr. Justin Braverman
Have you regained some of the weight you initially lost after surgery? Did you not lose as much weight as expected? Are you struggling to maintain your current weight? Can you eat larger portions and eat much faster? If you answered yes to any of these questions, you may be a candidate for a revisional bariatric procedure.
There are many possible causes of weight regain after successful weight loss surgery. Obviously, proper eating and exercise habits are paramount to success, but sometimes there is an anatomic cause for the weight regain. Although these problems only rarely happen, changes to your surgical anatomy can derail your success. The good news is that there are a multitude of options to treat these issues, and our staff at The N.E.W. Program will work to help you develop the proper eating and exercise patterns that will lead to long-term success.
The three most common bariatric operations (Band, Bypass, and Sleeve) all cause weight loss by essentially the same mechanism, helping a patient eat slowly and feel full with a smaller portion. Although it is a powerful procedure, the Band has the most variable amount of weight loss success of the three operations. There is a small minority of band patients who do not achieve their desired results, and their weight may hit a plateau higher than their goal.
If this describes your situation – Do Not Fret! There are options and you can convert to a gastric bypass or gastric sleeve. The surgeons at The N.E.W. Program have performed many band-to-bypass or band-to-sleeve operations. In expert hands these are safe operations with outstanding results. Converting to another type of procedure can give you the jump start you need to get back on track and lose the rest of your excess weight. As an added benefit, changing to a gastric bypass will help treat the metabolic diseases associated with excess weight, like diabetes and high cholesterol, which perhaps were not controlled by the band.
After gastric bypass or sleeve gastrectomy, although rare, some patients can experience dilation, or stretching of the small pouch. If this has happened, portion size gets larger, you can eat faster, and appetite returns too quickly after a meal. To determine if this is a possible cause of weight regain, an outpatient endoscopy is performed. This is a painless, 10-minute procedure where a small camera is placed through the mouth and the size of the stomach is measured.
If the pouch is too big, we can fix it. There is a variety of surgical options that can repair the anatomy, restoring the feeling of restriction to give you the leverage you need to refocus your lifestyle and better manage your weight.
Traditionally, the primary way to restore the size of a dilated stomach pouch was to operate and surgically “cut and sew” the pouch back to its original size. Often times covered by insurance, this technique is still frequently used. It is a safe and effective way to fix dilations, and weight loss with this option can be significant.
Today we have even safer and less invasive procedures. An adjustable band can be placed over a previous bypass or sleeve. During this procedure there is no cutting of the stomach or intestines. Since the band is adjustable, it can be tightened over time, putting the patient in control of portion size and appetite in order to help lose the regained weight.
The N.E.W. Program is also proud to offer the ROSE procedure. This is latest technique in minimally invasive surgery, and truly at the forefront of the field of bariatrics. In fact, the surgeons at The N.E.W. Program were one of the first to perform the ROSE procedure in the U.S. The technique is termed “Natural Orifice Surgery” because the entire procedure is performed through the mouth with no incisions. The ROSE device allows the surgeon to place stitches on the inside of the stomach to reduce the size of the pouch. Patients wake up from the procedure and immediately notice a change in appetite and portion size. With no incisions there is less pain and faster recovery time. In fact, the ROSE procedure is usually performed on an outpatient basis and patients are back to work in 1-2 days. Results are similar to the other traditional forms of revisions, with a much lower chance for complications.
The N.E.W. Program offers all reasonable surgical revision options and has non-surgical programs to help you restore control over your lifestyle and better manage your weight. As with any bariatric procedure, lifestyle modifications are paramount to achieving weight loss success after a revision and our comprehensive aftercare program will set you in the right direction.
If you think that you may benefit from one of these procedures, or would like to learn more about them, please call our office at (949) 722-7662 with any questions or to set up an appointment with our surgeons to see if you are a candidate. Don’t be afraid to ask for help. The N.E.W. Program will work with you to get you where you’ve always wanted to be – on the road to permanent weight loss.
Metabolism an individual factor in wellness journey
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Weight loss/gain, exercise and our individual metabolism rates can sometimes seem like a confusing Rubik’s Cube as we seek our paths to wellness. No one ‘answer’ exists, but understanding the factors involved in weight maintenance and metabolism will serve as a road map to your golden treasure chest.
Dr. Justin Braverman
The Mayo Clinic’s online health site explains that metabolism is the process by which your body converts what you eat and drink into energy. During this complex biochemical process, calories in food and beverages are combined with oxygen to release the energy your body needs to function. Even when you’re at rest, your body needs energy for all its “hidden” functions, such as breathing, circulating blood, adjusting hormone levels, and growing and repairing cells.
The number of calories your body uses to carry out these basic functions is known as your basal metabolic rate (BMR) — what you might call metabolism. Several factors determine your individual basal metabolic rate:
- Your body size and composition. The bodies of people who are larger or have more muscle burn up more calories, even at rest.
- Your sex. Men usually have less body fat and more muscle than do women of the same age and weight, burning more calories.
- Your age. As you get older, the amount of muscle tends to decrease and fat accounts for more of your weight, slowing down calorie burning.
Energy needs for your body’s basic functions stay fairly consistent and aren’t easily changed. Your basal metabolic rate accounts for about 60 to 75 percent of the calories you burn every day.
Most experts agree that weight training and aerobic exercise will increase metabolism both while you are exercising and after your exercise activity is done. They disagree, however, on how long after exercise your metabolism remains increased.
When you are exercising aerobically, your focus should be on burning calories and working your cardiovascular system. Because it takes more calories to exercise, your metabolism is sped up during the activity. When you are lifting weights or doing other resistance work, focus on the activity itself which not only burns calories but increases muscle strength, tone and endurance.
The combination of aerobic activity and weight training will result in a body that has more muscle and less fat – so the end result will be a higher metabolism.
The N.E.W. Program’s weekly workshop series continues Tuesday when Dr. Justin Braverman, presents “Exercise, Metabolism and Prevention of Weight Gain.” The workshop will be presented at 5:30 p.m., Tuesday, May 4 at our Newport Beach location.
Controlling stress a factor in controlling weight
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The journey to wellness involves the mind, body and soul. While the previous statement sounds cliché, it reveals the hard truth that many factors – other than food and exercise – can play prominent roles in our health and wellness. External stress can trigger a series of events that may come back to haunt you on the scale.
Stress contributes to weight gain in several ways. Cortisol is a stress hormone. When we’re under stress, the fight or flight response is triggered in our bodies, leading to the release of various hormones. Whether we’re stressed because of constant demands at work or we’re really in danger, our bodies respond like we’re about to be harmed and need to fight for our lives. To answer this need, we experience a burst of energy, shifts in metabolism and blood flow, and other changes.
A recent study done at the University of Rochester looked at workplace stress levels and how they can have an effect on weight. For complete article, visit the Pittsburg Post Gazette.
The N.E.W. Program’s Lifestyle Management Program is designed to provide the coaching and insight needed to make the key changes needed to succeed. The N.E.W. Program offers dedicated assistance with lifestyle modification and many other programs such as structured support groups, exercise groups, and private consultations with a dietitian and physicians, all at the center, on a daily basis.
‘Tune-Up’ can put weight loss back on all cylinders
Posted by: | CommentsSuccessful weight loss clients, whether they use surgery for leverage or not, identify new habits and a new lifestyle that results in a healthier stable weight and a better ability to live the life that they’ve wanted. Of course, finding the habits that work requires some up-front practice. Even though everyone enjoys healthier living, staying healthy requires maintenance.
Dr. Justin Braverman
Sometimes a person will be doing well and then either hit a plateau or, for some reason, begin to regain weight. If this has happened to you, it’s important to recognize it and then get back on track. The need to get back on track is something everyone experiences now and then in life and to make the process easier we have developed a simple program to assist our clients. The N.E.W. Tune-Up Program is designed specifically to help you get back on track quickly and to regain your success.
This program is short and focused. It is not for people that need to establish a completely new lifestyle from scratch, but instead it helps people who already know what lifestyle they want get back there quickly. The program focuses on maximizing weight loss, permanently.
Through The N.E.W. Tune-Up Program we will help you reset your goals and re-establish the lifestyle patterns you need to maintain permanent success.
The Tune-Up Program is a structured eight-week nutrition and exercise coaching program. It includes an initial comprehensive primary client assessment that consists of an executive medical evaluation, an evaluation of eating patterns and baseline activity level, and a comprehensive nutritional assessment.
It begins with a one-week metabolic re-adjustment followed by a structured nutritional progression over the next three weeks. The meal replacements used for the nutritional progression, the vitamins and all nutritional supplements needed to complete the entire program are included. Regularly scheduled nutrition re-assessment and dietary coaching will help clients develop the eating patterns and choices necessary for weight loss success.
Weekly Lifestyle Management workshops, exercise group meetings, and support group sessions are also provided to help clients develop the necessary tools to maintain permanent weight control. Finally, at the end of the eight-week program a thorough medical re-assessment will be completed.
If you have hit a plateau, or even regained some weight, remember that this happens to almost everyone in our society now and then. Realize that the important thing is to not be too hard on yourself, and consider using our Tune-Up Program to help you get back on track. The first step towards better health and a return to a healthier lifestyle is to recognize that it is something you want. Once you know this, give us a call, we’ll be glad to help.
Healthy balance yields weight loss, wellness
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Successful long-term weight control is only possible by living a lifestyle that results in a healthy balance between the average amount of calories eaten and the average amount of calories “burned” through activity. Considering all the possible foods that are available, and all the possible activities to do, it is certain that there are many lifestyle combinations to choose from.
To improve your quality of life you must change your lifestyle. Clients of The N.E.W. Program have decided to change their lifestyle and control their weight, whether through the non-surgical or the surgical weight loss program, and our Lifestyle Management Program is designed to give them the coaching and insight needed to make the key changes they need to succeed.
The Structured Lifestyle Management Program includes a combination of:
- Medical, psychological, nutrition and exercise evaluations
- Weekly lifestyle management workshops
- Weekly support group meetings
- Weekly exercise group meetings
- One-to-one nutritional consultations
- One-to-one exercise consultations
- One-to-one nutritional consultations
- Special presentations and events
The N.E.W. Program’s weekly workshop series continues Tuesday when John Jolliffe, MFT, presents “Speed Up Weight Loss by Slowing Down.” The workshop will be presented at 5:30 p.m., Tuesday, April 27 at our Newport Beach location.
Weight-loss efforts combat chronic pain
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This cycle is one everyone recognizes – when we hurt for a period of time, we are less active and tend to put on weight. In turn, the extra weight makes us hurt more.
Excess body weight puts greater physical strain on the joints and muscles. The “daily grind” of just moving around can especially affect the lower extremities, including the hips, knees, ankles and feet. In fact, among the patients we evaluate before surgery at the N.E.W. Program, severe pain is most often reported in the knees, lower back, feet and hips, in that order. Many have already had knee and hip replacement surgery.
Chronic pain problems and obesity go hand-in-hand. Excess weight slows you down. You get less exercise, less activity in general.
In a study of patients at a local pain clinic,. more than 63 percent of chronic pain patients had moderate to severe obesity. Did the weight cause the pain, or vice versa? Cause and effect doesn’t matter much, although 41 percent of these patients said they were overweight before the onset of their pain. The rest claimed that their weight gain occurred after their pain started.
Medications used to treat pain may work at first, but they ultimately lose their effectiveness and require greater dosages. Some pain medications also lead to weight gain. Gradually increasing physical activity, not medication, is the primary way professionals treat chronic pain. This is often a very difficult goal when pain is severe, especially in a patient with excess body weight.
In many cases, patients find not only significant reductions in extremity pain following weight-loss surgery, but increased activity as well. Some, who were candidates for knee or hip surgery, no longer need it after weight loss.
In a recent study done at the N.E.W. Program, a group of our patients wore pedometers which measure the number of steps taken each day. Patients wore them and recorded their daily steps for one month before and five months after bariatric surgery.
The pedometer reading is an excellent indicator of activity level. Most of our patients increased their activity by more than 100 percent within 6 months after surgery, compared with pre-surgical readings These new results were presented at a San Diego meeting of the American Society for Bariatric Surgery.
When there is excessive body weight, the most effective way to prevent or reduce chronic pain is to lose weight. This is particularly true for those with morbid obesity. In this case, bariatric surgery is a powerful tool to combat chronic pain.
Program choice crucial in weight-loss journey
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Surgery for obesity is recommended by the American College of Physicians (ACP) if you have a BMI greater then 40 or a BMI greater then 35 and an obesity related co-morbidity such as elevated cholesterol or high blood pressure.
Published medical literature does show a mortality benefit from cardiovascular disease after significant weight loss. Co-morbidities such as diabetes mellitus, elevated cholesterol, hypertension and sleep apnea generally improve after gastric bypass. Other complications from obesity such as stress urinary incontinence (urinary leakage with coughing or sneezing), non-cardiac shortness of breath, asthmatic symptoms and joint pain and stiffness also improve dramatically.
Dr. Tracy Siegfried
When choosing a bariatric surgical program where and by whom your surgery is performed can make a significant difference in your outcome. The association between superior experience and lower mortality is well documented. In one study, the mortality was 5 percent among patients of surgeons who had performed fewer then 20 procedures per year and near zero for those treated by clinicians who have done greater the 250 surgical procedures annually.
Another to factor to consider is whether a surgeon performs the operation laparoscopically for the majority of procedures. When you interview prospective surgeons ask their percentage of transition from laparoscopic to open incisions. The ACP guidelines observe that critical differences are not limited to the surgical skill but extend to more comprehensive aspects of the providing program.
Better outcomes depend also on the capacity of the systems of care, from the pre-operative evaluation to the post-operative follow-up. Many surgical groups do not have comprehensive pre-operative evaluations or extensive close follow up care, which is critical to long term success after your procedure and weight loss.
And lastly, your surgery should be performed at a COE, “Center of Excellence” as designated by the American Society for Bariatric Surgery. These centers are evaluated extensively by the society and must meet rigorous criteria in order to maintain a COE classification.
This article was written by Tracy Ann Siegfried , M .D., Bariatric Internist for The NEW Program in Newport Beach, Calif. The NEW Program at South Coast Medical Center offers state-of-the-art weight loss treatment for people who are at least 100 pounds above their ideal body weight. The N.E.W. Program is the most comprehensive weight loss surgery program in the region.
Losing to gain: Quality of life prime weight-loss perk
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Bariatric surgeries have become common and highly successful surgical procedures for the treatment of morbid obesity, where weight excess is more than 100 pounds over ideal body weight. Many success stories have been presented in the print, radio and television media. These features tend to focus on the sheer numbers; 100- to 300-pound weight losses are, indeed, impressive. At The N.E.W. Program at South Coast Medical Center, however, we prefer to look at aspects of weight loss that do not get the same hype — quality of life issues.
Dr. Brian Quebbemann
Losing 100 pounds or more is no small accomplishment. It improves the patient’s self-image, confidence and energy. A typical patient has a number of medical conditions that are made worse by the condition of obesity. Sleep apnea, high blood pressure, diabetes, weight-bearing joint disease, elevated lipids and disrupted liver function, plus many other maladies are exacerbated by the mere presence of obesity.
Sleep apnea is an excellent example. An obese patient with this condition NEVER gets a restful night’s sleep. Even when treated with a device that aids in breathing during sleep, patients tested are proven to get less than adequate REM sleep when compared with normal individuals. This will lead to daytime sleepiness, and worse, drowsiness when alertness counts the most – when driving. Patients with this condition are constantly dragging through each day, fighting off dozing and often failing to do so.
Diabetes is also prevalent in obese patients. At treatment costs that often exceed $50,000 per year, this debilitating disease causes early death and significant loss of function in daily activities. The neuropathy that accompanies diabetes leads to pain in the feet and legs, mobility and ultimately can result in skin ulcers and even amputation of the limb. Both diabetes and sleep apnea are cured or resolved in over 90 percent of all patients undergoing bariatric procedures.
Ask any patient who has “crossed over” into the healthy quality of life that ensues following weight loss surgery and they will tell you, “I wish I’d done this 10 years ago.” Canes and walkers often are discarded when the arthritic conditions associated with obesity gradually fade away. Women unable to conceive children due to hormonal imbalances return to the clinic to show off their pregnancies – overjoyed by the realization of an event they had given up on as impossible before. Patients who have been on as many as 10-15 medications per day for high blood pressure, diabetes, high cholesterol, fluid retention and asthma (to name a few) often eliminate ALL of these medications, replaced with multivitamins, calcium, iron and B vitamins. A very fair trade, most would admit.
Ironically, you would expect the monthly spending budget for this new, thinner person to be much better; however, it isn’t for all expenses. While the cost of groceries and dining out is reduced significantly, this saving is more than offset by the new passion the patient now has — shopping for clothes!
Since weight and inches are lost quickly, a person may only be able to wear a new article of clothing for a few times before it becomes too large for them. Some savvy shoppers have taken to second-hand clothing outlets to buy their “interim” apparel, while others are overjoyed to shop in “normal-sized” boutiques for the first time in their lives. Once again, consensus would be that this is a very fair trade, indeed.
The NEW Program at South Coast Medical Center offers state-of-the-art weight loss treatment for people who are at least 100 pounds above their ideal body weight. The N.E.W. Program is the most comprehensive weight loss surgery program in the region. Our program features an exceptional comprehensive pre-operative education plan, state-of-the-art surgical care, the talents of skilled bariatric surgeons and a life-long aftercare program.
To find out if you are a candidate for weight loss surgery attend an upcoming free community lecture on the benefits of weight loss surgery or visit us at http://thenewprogram.com.
