Bradley Waggoner, MD

Sleeve Gastrectomy Can Lead To Significant Weight Loss and Improved Health

Sleeve gastrectomy is typically considered as a treatment option for bariatric surgery patients with a BMI of 60 or higher. It is often performed as the first procedure in a two-part treatment. The second part of the treatment can be gastric bypass.

Studies have demonstrated that patients lost an average of 55% of their excess weight.* A clinical study on sleeve gastrectomy showed the below health benefits.

Health Problem	Result After Sleeve Gastrectomy
	Resolved	Improved
Type 2 Diabetes	56%	37%
High Blood Pressure	49%	29%
High Cholesterol	43%	38%
Obstructive Sleep Apnea	60%	33%
Source: Realize

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^*Source: Realize®

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If you are considering weight loss surgery, you owe it to yourself to choose a physician who is not only highly skilled, but caring and compassionate as well. Many physicians out there will treat your obesity. Dr. Waggoner will treat you!

To contact us for more information and/or to reserve your seat for the next free seminar, please click here.

New Eating Device Retrains Dietary Habits and Helps Children Lose Weight

A new computerized device that tracks portion size and how fast people eat is more successful in helping obese children and adolescents lose weight than standard treatments, according to research published on bmj.com¹.

The Mandometer device, a portable computerized weighing scale, was developed at the Karolinska Institutet in Stockholm. It helps to retrain individuals to eat less and more slowly by providing real-time feedback during meal times. The device plots a graph showing the rate at which food actually disappears from the plate, compared to the ideal graph programmed in by a food therapist.

Childhood obesity is an increasing global problem and there is little evidence to support one specific treatment program. While it is unknown whether specific eating patterns are common in all obese people, in this study the patients ate large portions very quickly.

Researchers at Bristol Royal Hospital for Children and the University of Bristol, led by Professor Julian Hamilton-Shield, carried out a randomized controlled trial of 106 obese patients aged between 9-17 years.

One group of participants received Mandometer therapy to lose weight and the other were provided with standard care. Both groups were encouraged to increase their levels of physical activity to 60 minutes of exercise a day and to eat a balanced diet based on the Food Standards Agency "eatwell plate."

Participants were assessed after 12 months and followed up at 18 months. During the research period they were also regularly monitored and offered telephone support and encouragement.

After 12 months, the Mandometer group not only had a significantly lower average body mass index and body fat score than the standard care group, but their portion size was smaller and their speed of eating was reduced by 11% compared with a gain of 4% in the other group. Levels of 'good cholesterol' were also significantly higher in the Mandometer group.

The improvement in body mass index was maintained six months after the end of treatment, suggesting an element of longer term behavioral change, add the authors.

"Mandometer therapy, focusing on eating speed and meal size, seems to be a useful addition to the rather sparse options available for treating adolescent obesity effectively without recourse to pharmacotherapy," say the authors.

They acknowledge that the Mandometer requires further evaluation in other settings and with different groups of patients, but conclude that "Retraining eating behavior and reinforcing feelings of satiety, however, does seem to improve weight loss in obese adolescents."

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¹ http://www.bmj.com. Full text of this study can be found at the BMJ Journal's website.

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If you are considering weight loss surgery, you owe it to yourself to choose a physician who is not only highly skilled, but caring and compassionate as well. Many physicians out there will treat your obesity. Dr. Waggoner will treat you!

To contact us for more information and/or to reserve your seat for the next free seminar, please click here.

Joslin Study Identifies ‘Good’ Energy Burning Fat in Lean Adults

Finding May Lead to Treatments for Obesity, Diabetes

Researchers at the Joslin Diabetes Center¹ have demonstrated that adult humans still have a type of “good” fat previously believed to be present only in babies and children. Unlike white fat, which stores energy and comprises most body fat, this good fat, called brown fat, is active in burning calories and using energy. The finding, reported in the April 9th issue of The New England Journal of Medicine, could pave the way for new treatments both for obesity and type 2 diabetes.

Scientists had thought that brown fat only existed in humans during childhood and was mostly gone by adulthood. The paper shows that brown fat not only exists in adult humans, but also for the first time, that the fat is metabolically active.

“The fact that there is active brown fat in adult humans means this is now a new and important target for the treatment of obesity and type 2 diabetes,” said C. Ronald Kahn, M.D., senior author and Head of the Joslin Section on Obesity and Hormone Action and the Mary K. Iacocca Professor of Medicine at Harvard Medical School.

Obesity is a major risk factor for type 2 diabetes. According to the researchers, the idea behind a new therapy would be to find a way to stimulate brown fat growth to both control weight and improve glucose metabolism.

“Not only did we find active brown fat in adult humans, we found important differences in the amount of brown fat based on a variety of factors such as age, glucose levels and, most importantly, level of obesity,” said lead author Aaron Cypess, M.D., Ph.D., a Research Associate and Staff Physician at Joslin.

Not surprisingly, the study found that younger patients were more likely to have larger amounts of brown fat, and the brown fat was more active during colder weather, keeping with its role of burning energy to generate heat. Brown fat was also more common in adults who were thin and had normal blood glucose levels.

“What is of particular interest is that individuals who were overweight or obese as measured by higher Body Mass Index (BMI) were less likely to have substantial amounts of brown fat,” said Kahn. “Likewise, patients taking beta-blockers and patients who were older were also less likely to have active brown fat. For example, individuals both over age 64 and with high BMI scores were six times less likely to have substantial amounts of brown fat.”

The findings, particularly those having to do with BMI, suggest a potential role for brown fat in regulating body weight metabolism, the paper says, suggesting that higher levels of brown fat may protect against age-related obesity.

According to the paper, the researchers are hopeful that an increased ability to measure brown fat mass and activity in vivo in humans will lead to a better understanding of its role in physiology and its potential as a target for therapy of obesity and other metabolic disorders.

This study answered those questions thanks to the use of modern imaging technology.

The researchers analyzed a database of 1,972 patients who had undergone positron emission tomography/computed tomography (PET/CT) scans for a variety of reasons over a three-year period. They identified substantial brown fat deposits in 7.5 percent of the female patients and over 3 percent of males.

“These numbers clearly represent an underestimate, since PET/CT can only detect collections of brown fat cells of a certain size and activity, and could miss smaller and less active deposits,” Kahn explained.

In addition, the researchers identified 33 other patients whose pathology records had indicated the presence of brown fat in their necks in the same places where the PET/CT scans had identified the largest concentrations of brown fat. They tested the tissue of two of those patients and detected the presence of a special heat-generating protein called UCP-1 that is unique to brown fat.

“These findings suggest that there is previously unrecognized, heat-generating brown fat in many adults,” Dr. Cypess said.

“This study, by demonstrating the presence and physiological activity of brown fat in adult humans, shows that this tissue may provide a novel and valuable target for interventions, pharmacological and environmental, to modulate energy expenditure,” said Francesco Celi, M.D., of the Clinical Endocrinology Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, who wrote an accompanying editorial but was not involved in the Joslin study.

Dr. Kahn said there is a good possibility that brown fat may be present in significant amounts in much higher percent of the population, but that it may be more spread out and not as easily seen on imaging in many cases. Most of the deposits found on the scans were located in the neck region.

“In the real world, there has been a long debate as to whether brown fat exists in adult humans and whether it was important physiologically,” he said. “This study demonstrates that it is both present and appears to be physiologically important in terms of body weight and glucose metabolism. We hope this opens up a new therapeutic area for obesity and type 2 diabetes by modifying the activity of brown fat.”

In a study published in August 2008, Dr. Kahn and others showed that a protein, BMP-7, known for its role in inducing bone growth, can also help promote the development of brown fat in rodents. And, a 2007 study led by Dr. Kahn found clusters of brown fat cells dispersed between bundles of muscle fibers in strains of mice resistant to obesity and diabetes.

The current study was supported by the Clinical Investigator Training Program, Beth Israel Deaconess Medical Center - Harvard/MIT Health Sciences and Technology, in collaboration with Pfizer Inc. and Merck & Co.; as well as with grants from the National Institutes of Health and the Eli Lilly Foundation.

Others participating in the research were Allison B. Goldfine, M.D., Yu-Hua Tseng and Alessandro Doria, M.D., all of the Joslin Diabetes Center Research Division; Sanaz Lehman, M.B., B.S., Gethin Williams, M.B., B.S., Ph.D., Ilan Tal, Ph.D., and Dean Rodman, M.D., all of the Division of Nuclear Medicine, Beth Israel Deaconess Medical Center; Frank C. Kuo, M.D., of the Department of Pathology, Brigham and Women’s Hospital; and Edwin L. Palmer, M.D., of the Division of Nuclear Medicine, Massachusetts General Hospital.

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¹Joslin Diabetes Center. April 8, 2009.  "Joslin Study Identifies "Good" Energy Burning Fat in Lean Adults" <http://www.joslin.org/1083_4684.asp>

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Patients choose Bradley Waggoner for LAP-BAND® System Surgery because not only does he have extensive training in advanced Laparoscopic surgery and Laparoscopic Bariatric surgery, but because he truly cares about the well-being of his patients.

Dr. Waggoner understands that no two patients are the same. Even though he may perform the same weight loss surgery on two patients, he will develop a customized weight loss surgery program for each one.

If you'd like to set-up an appointment to further discuss your weight loss surgical options, please contact us, or attend one of our free weight loss surgery seminars.

Study Finds Waist Size is a Predictor of Heart Failure in Both Men and Women

Adding to the growing evidence that a person’s waist size is an important indicator of heart health, a study led by investigators at Beth Israel Deaconess Medical Center (BIDMC) has found that larger waist circumference is associated with increased risk of heart failure in middle-aged and older populations of men and women.

The findings, published online in the April 7 Rapid Access Report of the journal Circulation: Heart Failure, showed that increased waist size was a predictor of heart failure even when measurements of body mass index (BMI) fell within the normal range.

“Currently, 66 percent of adults in the United States are overweight or obese,” explains Emily Levitan, ScD, the study’s first author and a Research Fellow in the Cardiovascular Epidemiology Research Unit at BIDMC. “Knowing that the prevalence of heart failure increased between 1989 and 1999, we wanted to better understand if and how this increase in obesity was contributing to these rising figures.”

A life-threatening condition that develops when the heart can no longer pump enough blood to meet the body’s needs, heart failure (also known as congestive heart failure) is usually caused by existing cardiac conditions, including high blood pressure and coronary artery disease. Heart failure is the leading cause of hospitalization among patients 65 and older, and is characterized by such symptoms as fatigue and weakness, difficulty walking, rapid or irregular heartbeat, and persistent cough or wheezing.

The researchers examined two Swedish population-based studies, the Swedish Mammography Cohort (made up of 36,873 women aged 48 to 83) and the Cohort of Swedish Men (43,487 men aged 45 to 79) who responded to questionnaires asking for information about their height, weight and waist circumference. Over a seven-year period between January 1998 and December 2004 the researchers reported 382 first-time heart-failure events among the women (including 357 hospital admissions and 25 deaths) and 718 first-time heart-failure events among men (accounting for 679 hospital admissions and 39 deaths.)

Their analysis found that based on the answers provided by the study participants, 34 percent of the women were overweight and 11 percent were obese, while 46 percent of the men were overweight and 10 percent were obese.

“By any measure – BMI, waist circumference, waist to hip ratio or waist to height ratio –our findings showed that excess body weight was associated with higher rates of heart failure,” explains Levitan.

Further breakdown of the numbers showed that among the women with a BMI of 25 (within the normal range), a 10-centimeter higher waist measurement was associated with a 15 percent higher heart failure rate; women with a BMI of 30 had an 18 percent increased heart failure rate. In men with a BMI of 25, a 10-centimeter higher waist circumference was associated with a 16 percent higher heart failure rate; the rate increased to 18 percent when men’s BMI increased to 30.

Furthermore, adds Levitan, among the men, each one-unit increase in BMI was associated with a four percent higher heart failure rate, no matter what the man’s waist size. In women, she adds, BMI was only associated with increased heart failure rates among the subjects with the largest waists. Finally, the authors found that the association between BMI and heart-failure events declined with age, suggesting that the younger the person, the greater the impact of weight to heart health.

“This study reinforces the importance of maintaining a healthy weight,” says Levitan. “Previous research has looked at various types of heart disease and related health issues, and no matter the particulars of the study, they’ve all been pretty consistent in determining that excess body weight increases a person’s risk of heart disease.”

Study coauthors include BIDMC investigators Murray A. Mittleman, MD, DrPH (senior author), Amy Z. Yang, BA and Alicja Wok, DrMedSci.

The study was supported by grants from the National Institutes of Health, the Swedish Research Council and the Swedish Foundation for International Cooperation in Research and Higher Education.

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¹Beth Israel Deaconess Medical University. April 7, 2009.  "Study Finds Waist Size is a Predictor of Heart Failure in Both Men and Women" <http://www.bidmc.org/News/InResearch/2009/April/WaistSizePredictorofHeartFailure.aspx>

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If you are considering weight loss surgery, you owe it to yourself to choose a physician who is not only highly skilled, but caring and compassionate as well. Many physicians out there will treat your obesity. Dr. Waggoner will treat you!

To contact us for more information and/or to reserve your seat for the next free seminar, please click here.

Study Reveals Weight Loss Surgery May Significantly Reduce Low-Back Pain

In order to assess the relationship of obesity to low back pain, researchers at the University of Southern California analyzed the outcome of 38 consecutive patients with low back pain who underwent bariatric surgery over a period of six months.¹

The results of this study, Prospective Assessment of Axial Back Pain Symptoms before and after Bariatric Weight Reduction Surgery, was presented by Paul Khoueir, MD in April of this year. Thirty patients were female and eight were male with ages ranging from 20 to 68 years old.

The following outcomes were noted postoperatively:

• There was a decrease in mean weight from 144.52 ± 41.21 kg preoperatively to 105.59 ± 29.24 postoperatively
• There was a decrease in BMI from 52.25 ± 12.61 kg/sq m preoperatively to 38.32 ± 9.66 postoperatively
• The mean reported pain scale decreased by 44 percent
• SF-36 physical health component increased by 58 percent
• SF-36 mental health increased by 6 percent
• Patient postoperative ODI score for physical disability decreased 24 percent

“Although past research has certainly shown that obesity is a risk factor for poorer outcome in patients undergoing spine surgery, this study provides evidence that substantial weight reduction following bariatric surgery results in moderate reductions in preexisting back pain within six months of weight loss ... While this initial research is promising, larger long-term trials are needed to prove the efficacy of this treatment,” stated Dr. Khoueir.

To learn more about obesity surgery options such as the LAP-BAND System, attend one of our free weight loss surgery seminars.

Dr. Bradley Waggoner of Cypress Bariatric & General Surgery hosts free LAP-BAND System Seminars each month from his Bariatric Clinic in North Houston.

¹Source: Newswise.com