Fear of Cancer After A Sleeve Gastrectomy

The Truth About Reflux After The Sleeve Gastrectomy

 

In my humble opinion and observance of patients over a period of working in the field of bariatrics for 13 years; in the rush to seek a quick fix operation to experience rapid weight loss many people overlook the negative side effects of the procedures.

gastric sleeve

It is recognised that some of the main complications of the sleeve gastrectomy and the gastric bypass are leaks and internal hernias but since the rise of the sleeve gastrectomy procedure some studies are showing a post sleeve acid reflux rate of between 20-30%. The question and concern is, that this form of acid reflux can be the cause of oesophageal cancer. So could this mean that in the weight loss surgery world we are creating a whole generation of sleeve patients with a lifetime risk of cancer?

GERD

In a recent edition of the Bariatric News Dr Robert Rutledge who has pioneered the mini gastric bypass procedure explains that a primary cause of gastric cancer is commonly caused by the bacteria H. Pylori and that patients who were likely infected were at a higher long term risk of developing gastric cancer. He advised that if surgeons are worried about gastric cancer they should look for Heliobacter Pylori and treat it appropriately. In his opinion the sleeve is creating moderate to severe acid reflux with oesophagitis in a moderate to large percentage of patients. General surgeons know that this is a pre-cancerous and potential cause of oesophageal cancer.

 

 

At the moment the data is limited for the gastric sleeve but in 20 years’ time we could see acid reflux rates as high as 50% so the question is patients considering the gastric sleeve procedure should be concerned about long term oesophagitis which is an unequivocal precursor to cancer.

 

Fear of Cancer After The Sleeve Gastrectomy

The Truth About Reflux After The Sleeve Gastrectomy

 

In my humble opinion and observance of patients over a period of working in the field of bariatrics for 13 years; in the rush to seek a quick fix operation to experience rapid weight loss many people overlook the negative side effects of the procedures.

gastric sleeve

It is recognised that some of the main complications of the sleeve gastrectomy and the gastric bypass are leaks and internal hernias but since the rise of the sleeve gastrectomy procedure some studies are showing a post sleeve acid reflux rate of between 20-30%. The question and concern is, that this form of acid reflux can be the cause of oesophageal cancer. So could this mean that in the weight loss surgery world we are creating a whole generation of sleeve patients with a lifetime risk of cancer?

 

GERD

In a recent edition of the Bariatric News Dr Robert Rutledge who has pioneered the mini gastric bypass procedure explains that a primary cause of gastric cancer is commonly caused by the bacteria H. Pylori and that patients who were likely infected were at a higher long term risk of developing gastric cancer. He advised that if surgeons are worried about gastric cancer they should look for Heliobacter Pylori and treat it appropriately. In his opinion the sleeve is creating moderate to severe acid reflux with oesophagitis in a moderate to large percentage of patients. General surgeons know that this is a pre-cancerous and potential cause of oesophageal cancer.

 

 

 

At the moment the data is limited for the gastric sleeve but in 20 years’ time we could see acid reflux rates as high as 50% so the question is patients considering the gastric sleeve procedure should be concerned about long term oesophagitis which is an unequivocal precursor to cancer.

 

Weight Loss Surgery Improves Pain and Physical Function

According to a study titled, “Change in Pain and Physical Function Following Bariatric Surgery for Severe Obesity” published in JAMA, it found that a large percentage of patients with severe obesity that underwent bariatric surgery experienced improvement in pain, physical function and walking capacity over three years.

The study was designed to record and report changes in pain and physical function in the first three years following bariatric surgery and to identify factors associated with improvement. Up to date the authors had noted that variability and durability of improvements in pain and physical function following a gastric bypass or gastric band had not been well documented.

Stairs

The study was conducted at ten hospitals between February 2005 and February 2009 and led by Dr Wendy C King from the University of Pittsburgh, along with her colleagues they examined changes in pain and physical function in three years after bariatric surgery.

 

There were 2,458 patients included in the study, 70% underwent the gastric bypass and 25% had the gastric band procedure. Among the primary findings through three years of follow up approximately 50-70 percent of adults experienced clinically significant improvements in perceived bodily pain and physical function and in objectively measured walking capacity. Approximately three-fourths of participants with severe knee and hip pain experienced improvements in osteoarthritis symptoms.

Hips and knees

The study found that between year one and year three, rates of improvement significantly decreased for bodily pain and physical function but improvement rates for walk time, knee and hip pain, knee and hip function did not!

 

Indications that were associated with pre surgery to post surgery improvements at years one, two and three were:

  • Younger age
  • Male sex
  • Higher income
  • Lower BMI
  • Less depressive symptoms pre surgery
  • No diabetes
  • No swelling or ulcerations of the legs

This study’s large geographically diverse sample, inclusion of multiple validated measures of pain and physical function, longitudinal design and three year follow up make it one of the most informative studies following gastric bypass and gastric banding.

Reference: JAMA 2016;315(13):1362-1371.doi10.1001/jama2016.3010

Title: Change in Pain and Physical Function Following Bariatric Surgery for Severe Obesity

Authors: Wendy C King, Jia-Yuh Chen, Steven h Belle, Anita p Courcoulas, Gregory F Dakin, Katherine A Elder,David R Flum, Marcelo W Hinojosa, James E Mitchell, Walter J Pories, Bruce M Wolfe and Susan Z Yanovski

 

Mindful Eating With A Gastric Band

 

What is hunger?

So now that you have a gastric band let’s talk about hunger:

Your Hunger

The first thing is to learn to recognise both physical and emotional hunger. You are probably wondering how do you recognise physical hunger and differentiate between the two? When you are physically hungry the hunger builds up gradually and when you eat this leads to a feeling of satisfaction. In contrast emotional eating builds suddenly and once you eat it leads to feelings of guilt and shame. Emotional hunger cannot be satisfied and despite eating the emotional hunger persists as food is not designed to satisfy emotions.

 

Healthy Mind

In order to develop a better understanding of emotional hunger you need to identify what the triggers are that lead you to eating:

 

  • How you feel, where you are and exposure to certain foods may trigger an urge for food
  • Triggers that start a food & eating behaviour fall into two groups:
  • Food ~ Usually high fat & sugar processed foods
  • Feelings ~ Happy, sad, angry, grieving
  • Situations ~ Watching TV, trip to the cinema, long journeys & even after exercise.

Triggers start a series of events much like a line of dominos falling. Learn to recognise, understand & manage what triggers your eating behaviour. This takes practice!

 

Identify your “trigger” feelings e.g. anger, hurt, exhaustion, sadness, happiness.

Remember….

 

  • These are simply emotions
  • They cannot “make” you do anything
  • These feelings have no power
  • YOU have control over your actions

Recognise the emotion for what it is

Recognise some types of food you choose may lead to overeating

Actively decide not to be fearful of food & eating

 

  • Change a situation or routine to manage it
  • Plan ahead and ask yourself, “What could I do instead?”
  • Recognise that food will never permanently satisfy emotion
  • Once you have identified the emotions that trigger your desire to eat, you can find other ways to comfort, nurture, calm & distract yourself without turning to food and eating

Thinking of Food 2

CHANGE

 

  • Having a gastric band means that you will need to accept and work with change of different types:
  • Physical Change, Emotional Change, Relationship Change, Social Change & Behavioural Change

 

STEP ONE – ACCEPTANCE

 

  • Accept that change is not just about reduced size
  • Accepting behavioural change includes food & eating behaviours
  • Accept that change is hard work & ongoing

 

CHANGE

 

STEP TWO – RECOGNISE

 

  • Change may be uncomfortable
  • For many of us it is more comfortable to remain as we are, exerting no effort.
  • Changing in size and shape is not always comfortable and may trigger difficult memories

 

At the start of every day, make yourself some promises, set yourself some goals:

 

  • I am going to change because………….
  • I am WORTH it because…………………
  • I WILL change to achieve………………
  • TODAY I am going to…………………….
  • TODAY when I achieve……… I will praise myself
  • I ACCEPT I may lapse & that is ok – I will use it as an opportunity to learn more about myself

 

Remember the Eight Golden Rules to be successful with your gastric band and along with being more mindful and developing coping strategies for when the emotional hunger creeps in you be in control of your mind, band and your life!

 

  • Eat three or less meals per day.
  • Do not eat between meals.
  • Eat slowly and stop when no longer hungry.
  • Focus on quality, nutritious food.
  • Avoid calorie containing liquids.
  • Do some form of activity for 30 minutes a day.
  • Stay active throughout the day.
  • Stay in contact with your clinical team.

 

 

Can A High Protein Diet Improve Sleep?

Improve Your Sleep While You Lose weight On a High Protein Diet

 

In a study published in the American Journal of Clinical Nutrition overweigh and obese adults who are losing weight on a high protein diet are more likely to sleep better according to researchers from Purdue University.

 

Wayne Campbell, a professor of nutrition science said “Most research looks at the effects of sleep on diet and weight control, and our research flipped that question to ask what are the effects of weight loss and diet — specifically the amount of protein – on sleep.”

Sleep

“We found that while consuming a lower calorie diet with a higher amount of protein, sleep quality improves for middle-age adults. This sleep quality is better compared to those who lost the same amount of weight while consuming a normal amount of protein.

 

“The paper’ ‘Higher-protein diets improve indexes of sleep in energy-restricted overweight and obese adults: results from 2 randomized controlled trials’, focuses on a pilot study found that in 14 participants, consuming more dietary protein resulted in better sleep after four weeks of weight loss.

 

In the main study, 44 overweight or obese participants were included to consume either a normal-protein or a higher-protein weight loss diet. After three weeks of adapting to the diet, the groups consumed either 0.8 or 1.5kgs of protein for each kg of body weight daily for 16 weeks. The participants completed a survey to rate the quality of their sleep every month throughout the study. Those who consumed more protein while losing weight reported an improvement in sleep quality after three and four months of dietary intervention.

Diet and sleep

A dietitian designed a diet that met each study participant’s daily energy need and 750 calories in fats and carbohydrates were trimmed per day while maintaining the protein amount based on whether they were in the higher- or normal-protein group. The sources of protein used in the two studies varied from beef, pork, soy, legumes and milk protein.

 

“Short sleep duration and compromised sleep quality frequently lead to metabolic and cardiovascular diseases and premature death,” said Jing Zhou, a doctoral student in nutrition science and the study’s first author. “Given the high prevalence of sleep problems it’s important to know how changes to diet and lifestyle can help improve sleep.”

 

Campbell’s lab also has studied how dietary protein quantity, sources and patterns affect appetite, body weight and body composition.

 

“This research adds sleep quality to the growing list of positive outcomes of higher-protein intake while losing weight, and those other outcomes include promoting body fat loss, retention of lean body mass and improvements in blood pressure,” Campbell said. “Sleep is recognized as a very important modifier of a person’s health, and our research is the first to address the question of how a sustained dietary pattern influences sleep. We’ve showed an improvement in subjective sleep quality after higher dietary protein intake during weight loss, which is intriguing and also emphasizes the need for more research with objective measurements of sleep to confirm our results.”

 

Reference: The American Journal of Clinical Nutrition

 

AMJ Clin Nutr: March 2016 Vol 103 no3 766-774 doi:10.3945/ajcn 115-124669

 

Title: Higher-protein diets improve indexes of sleep in energy-restricted overweight and obese adults: results from 2 randomized controlled trials’

 

Authors: Jing Zhou, Jung Eun Kim, Cheryl Armstrong, Ningning Chen and Wayne Campbell

 

Your Partner Could Be Making You Fat!

Partner’s lifestyle has greater influence on obesity risk

The lifestyle a person shares with their partner has a greater influence on their chances of becoming obese than their upbringing, research suggests.

By middle age, choices made by couples – including those linked to diet and exercise – have a much greater impact than the lifestyle each shared with siblings and parents growing up.

Although by middle age siblings have a shared risk of being obese, this is mostly attributable to their shared genetic inheritance rather than any habits instilled during their shared upbringing.

Researchers say the study will help scientists better understand links between obesity, genetics and lifestyle habits.

Its findings reinforce the message that lifestyle changes in adulthood can have a significant impact in tackling obesity, regardless of a person’s genetic profile.

fat couple 1

The team analysed data provided by 20,000 people from Scottish families. They compared people’s family genetics and home environments in childhood and adulthood and related these to measures linked to health and obesity.

A total of 16 measures were considered including, waist to hip ratio, blood pressure, body fat content and body mass index.

The information was originally gathered as part of the Generation Scotland project – a national resource of health data that helps researchers to investigate genetic links to health conditions.

The study has been published in the journal PLOS Genetics and was led by Professor Chris Haley of the Medical Research Council’s Human Genetics Unit at the University of Edinburgh.

Professor Haley said: “Although genetics accounts for a significant proportion of the variation between people, our study has shown that the environment you share with your partner in adulthood also influences whether you become obese and this is more important than your upbringing. The findings also show that even people who come from families with a history of obesity can reduce their risk by changing their lifestyle habits.”

Source:

University of Edinburgh

 

Are Fat Babies Healthy Babies?

Understanding risk factors that contribute to childhood obesity

As the rate of obesity in the U.S. population has risen dramatically, more and more children are becoming overweight at younger and younger ages. Understanding the factors that contribute to childhood obesity and identifying ways to prevent its development are critical to stemming the historically high prevalence of childhood obesity and of associated health problems like type 2 diabetes. Two articles receiving online publication in the American Journal of Preventive Medicine describe systematic reviews of the results of studies investigating either risk factors that contribute to childhood obesity or interventions that could prevent it during the first 1,000 days of life – from conception to age 2.

Pregnant

“We know that obesity is notoriously difficult to treat, and evidence suggests that reducing risk factors for childhood obesity during pregnancy, infancy, and early childhood could prevent children from becoming overweight in the first place,” says Elsie Taveras, MD, MPH, chief of General Academic Pediatrics at MassGeneral Hospital for Children (MGHfC) and senior author of both papers. “While our reviews were able to identify a few early-lifetime risk factors and interventions that appear to have some effectiveness, the studies we found were quite limited in both the factors that were examined and the interventions that were tested.”

The childhood obesity risk-factors review led by Jennifer Woo Baidal who is an assistant professor of Pediatrics at Columbia, MD, MPH – previously an MGHfC General Academic Pediatrics research fellow and now with the division of Pediatric Gastroenterology at Columbia University Medical Center – analyzed the results of 282 studies published from 1980 through 2014. Across all of the studies, only a few factors were consistently associated with an increased risk of a child being overweight or obese at the end of the study periods, which ranged from age 6 months to 18 years. Maternal factors were smoking, elevated prepregnancy weight and excess weight gain during pregnancy; factors applying to children were high birth weight and rapid weight gain during the first months after birth. While the largest number of studies focused on breastfeeding, evidence for any impact on obesity risk was inconsistent.

big baby 1

The review of intervention studies was led by Tiffany Blake-Lamb, MD, MSc, an obstetrician in the Massachusetts General Hospital Vincent Memorial Department of Obstetrics and Gynecology, and examined 34 articles published during the same time period that reported on the outcomes of 26 unique interventions. Neither of two prenatal interventions – one that included dietary advice, coaching, and exercise during pregnancy, and one focused on treating women with mild gestational diabetes – appeared to alter the incidence of obesity among offspring.

Two of six interventions that began during pregnancy and continued into infancy, both of which involved home visits focusing on the mother’s diet and infant feeding, reduced the risk of overweight in later years. Other interventions that had some success focused on the mother’s physical activity and diet, parenting practices related to the feeding of children, and behavioral counseling. Interventions featuring the use of high-protein and enriched formulas actually increased the risk of obesity, while the use of formulas with hydrolyzed protein, which is believed to promote infant satiety, stemmed infants’ rate of growth during the first year of life.

The authors were surprised that none of the studied interventions targeted helping mothers achieve a healthy weight before the start of their pregnancy, preventing prenatal and early-life tobacco exposure, or reducing the introduction of sugary beverages. Many interventions related to infant feeding focused solely on breastfeeding and did not include strategies to prevent obesity in formula-fed infants. Although the effective interventions were applied in settings ranging from the home to the community, the complexity of factors contributing to obesity risk suggests that interventions need to extend beyond simply the diet and activity levels of individual children and mothers.

“While most interventions that have been completed to date focus on individual behavioral change, it is clear that multiple and overlapping factors contribute to obesity risk,” says Blake-Lamb, who is also a fellow with the Kraft Center for Community Health Leadership at Partners HealthCare. “The limited success of these interventions suggests that many, and possibly more influential, factors related to social influences and the community environment – including food subsidies and fast-food marketing – may have a powerful impact on the risk of childhood obesity. Future interventions should address multiple obesity risk factors and be based on conceptual frameworks that recognize the multi-layered and inter-generational complexity of factors contributing to obesity risk.”

Taveras adds, “Future research focused on risk factors during pregnancy should examine the mechanisms through which those factors lead to obesity risk and how successful interventions alter those mechanisms. A broader investigation of the impact of diet and feeding practices, and perhaps their effects on the infant microbiome, could identify new targets for intervention, and while maternal risk factors are clearly important, future studies also should examine the role of fathers and other caretakers in obesity risk. Studies also need to include populations that are more diverse in terms of both racial/ethnic backgrounds and socioeconomic status.”

Source:

Massachusetts General Hospital