Bradley Waggoner, MD

FDA Expands Use of Banding System for Weight Loss

The Feb. 16, 2011, approval expands the use of the LAP-BAND to include obese individuals with a BMI of 30 to 34 who also have an existing condition related to their obesity.

The FDA approved the LAP-BAND in 2001 for use in severely obese patients with a body mass index (BMI) of at least 40, those with a BMI of at least 35 and who also have an existing severe condition related to their obesity, such as heart disease or diabetes, or those who are at least 100 pounds overweight. BMI is a general measure of body fat based on an individual’s weight and height.

“Obesity is a major public health concern in the United States,” said William Maisel, M.D., M.P.H., deputy director for science at the FDA’s Center for Devices and Radiological Health. “A healthy lifestyle and weight loss are keys to improvements in health and a person’s overall quality of life.”

Use of the LAP-BAND in patients with BMIs between 30 and 40 was examined in a U.S. study. Results showed that 80 percent of patients lost at least 30 percent of their excess weight and kept it off for one year. Some patients in the study lost no weight, while others lost more than 80 percent of their extra weight.

In the same study, more than 70 percent of patients experienced an adverse event related to LAP-BAND, most often vomiting and difficulty swallowing. The events ranged from mild to severe but most were mild and resolved quickly.

Seven out of 149 patients needed other procedures after implantation: four to remove the LAP-BAND, two for port revisions, and one to reposition the LAP-BAND.

The LAP-BAND works by limiting the amount of food that can be eaten at one time and increasing the time it takes for food to be digested, to help people eat less. It is placed around the upper part of the stomach during a surgical procedure. The band creates a small stomach pouch that holds a small amount of food.

The LAP-BAND should not be used in certain people, for example, those who are poor candidates for surgery, have certain stomach or intestinal disorders or an infection, take aspirin frequently, or are addicted to alcohol and/or drugs. It should also not be used in those not able or willing to follow dietary and other recommendations.

Source: Reprinted with editorial adaptations from materials provided by U.S. Food and Drug Administration. http://opa.yale.edu/health-medicine

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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.

Symptoms of Obese Heart Failure Patients Improved After Bariatric Surgery

A small Mayo Clinic study has found that morbidly obese heart failure patients who undergo bariatric surgery gain long-lasting and meaningful improvements in disease symptoms and quality of life. The results were presented today at the American Heart Association's Scientific Sessions 2010 in Chicago.

"This tells us that bariatric surgery may become part of the treatment of patients with heart failure and obesity if there are no major contraindications for the surgery — and that this might be especially important for patients with significant obesity," says the study's lead investigator, cardiologist Francisco Lopez-Jimenez, M.D.

He cautions, however, that because the study tested the effects of bariatric surgery on just 13 patients, "these results should be considered preliminary and suggestive of some benefit, but additional research is needed to confirm these results."

Although one-third of heart failure patients are obese, it appears that cardiologists do not often refer obese patients with heart failure for bariatric surgery, Dr. Lopez-Jimenez says.

The research team reviewed the outcomes of 13 patients, ages 44 to 64, who received bariatric surgery at Mayo Clinic in Minnesota between 1990 and 2005, as well as six heart failure patients, ages 52 to 72, who were followed in Mayo's Nutrition Clinic and did not receive the surgery.

In the group that received surgery, the mean body mass index (BMI) was 53, and in the comparison group, it was 42. After a four-year follow-up, mean BMI dropped in the surgery group to 37 and rose in the comparison group to 45.

Based on patient surveys, the researchers found that quality of life was significantly improved in those who received weight loss surgery, compared to heart failure patients who did not. Researchers also determined that symptoms such as swelling in the legs and labored breathing during exercise improved only in the surgery group.

Dr. Lopez-Jimenez points out that the health advantages seen in the patients who had bariatric surgery occurred even though most remained obese. "These patients had very advanced levels of obesity before the surgery, and although they lost significant amounts of weight, most remained obese. So, these good results suggest that the benefit does not require patients to reach a normal weight," he says.

Other authors of the study are William Miranda, M.D.; Michael Sarr, M.D.Maria Collazo-Clavell, M.D.; Matthew Clark, Ph.D. and Virend Somers, M.D., Ph.D.; all of Mayo Clinic, and John Batsis, M.D., Dartmouth-Hitchcock Medical Center.

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Mayo Clinic, (2010, November 14)

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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.

Gastric Bypass Alters Sweet Taste Function

Gastric bypass surgery decreases the preference for sweet-tasting substances in obese rats, a study finding that could help in developing safer treatments for the morbidly obese, according to Penn State College of Medicine researchers.

"Roux-en-Y gastric bypass surgery is the most common effective treatment for morbid obesity," said Andras Hajnal, associate professor, Department of Neural and Behavioral Science and Surgery. "Many patients report altered taste preferences after having the procedure."

This surgery involves the creation of a small gastric pouch and bypassing a portion of the upper small intestine. Unlike other weight-reduction methods, it produces substantial and durable weight loss and significant improvements in obesity-related medical conditions including diabetes.

Study results in obese rats suggest that post-surgery changes in the gastrointestinal anatomy affect change in the brain that relate to taste.

Obese rats given gastric bypass surgery showed a reduced preference for high concentration sucrose water when compared to obese rats that did not have surgery. Researchers observed a similar decrease in preference with other sweet-tasting substances, but not for salty, sour or bitter substances. Researchers observed no change in preference in lean rats that had gastric bypass surgery.

The obese rats used do not have the ability to produce the receptor for feeling satiated shortly after a meal because they lack the gut hormone CCK-1. As a result, these rats consumed larger meals and, over time, became obese and developed type-2 diabetes. Interestingly, previous studies lead by the Penn State investigators found an increased sweet preference in these rats, which is also often seen in people struggling with weight management.

"It appears that an uncontrolled appetite may get further boost from altered taste functions during development of obesity and diabetes," Hajnal said. "How much of this vicious circle is due to changes in the neurons inside the brain, which receive taste sensations from the tongue and report to the higher order motivational brain centers, we don't know."

The researchers recorded the activity of 170 taste-responsive neurons in the brain. These showed a shift in the neurons' firing activity similar to the behavioral response, which was measured in lick rates of the rats within a ten-second time period. Neurons in the obese rats' brain responded more vigorously to higher-concentration sucrose water placed on the tongue when compared to lean rats. These effects were reversed by gastric bypass surgery and matched the response of lean rats -- a preference for lower concentration sucrose.

The rats that had gastric bypass surgery lost weight comparable to humans who received the surgery -- 26 to 30 percent of their weight -- and maintained the loss for a long period of time after surgery. Following surgery, the obese rats also showed a higher tolerance for glucose, indicating improvement in diabetes.

"This supports the applicability of this rat model of Roux-en-Y gastric bypass to humans and also suggests that the observed taste changes following the surgery were not related to 'human factors' such as awareness and compliance to dietary and behavioral interventions," Hajnal said.

The researchers published their findings in the October issue of the "American Journal of Physiology, Gastrointestinal and Liver Physiology." The National Institute of Diabetes and Digestive and Kidney Diseases and the National Institute of General Medical Sciences funded this work.

"These findings confirm obesity-related alterations in taste functions and demonstrate the ability of gastric bypass surgery to alleviate these modifications," Hajnal said. "We do not suggest, however, that the findings reported in this paper are the only neural consequences of gastric bypass surgery related to altered postsurgical food preferences. Nevertheless, understanding the underlying mechanisms by which gastric bypass surgery affects taste may help in identifying therapeutic targets that mimic the beneficial effects of the surgery on appetite control and food choices, without the risks and complications of an invasive surgical procedure."

Further research is needed to determine what causes the neural and behavioral changes, according to Hajnal.

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Source: Reprinted with editorial adaptations from materials provided by Penn State University. http://live.psu.edu/tag/research

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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.

Patients With Diabetes May Need Fewer Medications After Bariatric Surgery

Bariatric surgery appears to be associated with reduced use of medications and lower health care costs among patients with type 2 diabetes, according to a report in the August issue of Archives of Surgery, one of the JAMA/Archives journals.

"The rapidly growing epidemics of obesity and diabetes threaten to overburden the world's health care systems," the authors write as background information in the article. "From an epidemiological standpoint, once these diseases develop they are rarely reversed. Dietary, pharmaceutical and behavior treatments for obesity are associated with high failure rates, and medical management of diabetes is also often unsuccessful. Despite many efforts to improve the control of glucose levels in diabetes, including clinical guidelines and patient and provider education, less than half of all patients with type 2 diabetes mellitus achieve the American Diabetes Association recommendation of a hemoglobin A1C level of less than 7 percent."

The use of bariatric surgery—that results in long-term weight loss, improved lifestyle and decreased risk of death—has tripled in the past five years, the authors note. Martin A. Makary, M.D., M.P.H., and colleagues at the Johns Hopkins Bloomberg School of Public Health and The Johns Hopkins University School of Medicine, Baltimore, studied 2,235 U.S. adults (average age 48.4) with type 2 diabetes who underwent bariatric surgery during a four-year period, from 2002 to 2005. They used claims data to measure the use of diabetes medications before and after surgery, along with health care costs per year.

Of the 2,235 patients, 1,918 (85.8 percent) were taking at least one diabetes medication before surgery, with an average of 4.4 medications per patient. Six months after surgery, 1,669 of 2,235 patients (74.7 percent) had eliminated their diabetes medications. Of the 1,847 patients with available data one year after surgery, 1,489 (80.6 percent) had eliminated medications; after two years, 906 of 1,072 (84.5 percent) had done so. This reduction was observed in all classes of diabetes medications.

"We observed that independence from diabetes medication was almost immediate within the initial months after surgery and did not correlate with the gradual weight loss expected," the authors write. "This supports the theory that the resolution of diabetes is not due to weight loss alone but is also mediated by gastric hormones, with the three most implicated being peptide YY, glucagonlike peptide and pancreatic polypeptide. As a known mediator of insulin regulation, glucagonlike peptide levels have been noted to increase immediately after bariatric surgery and may explain why surgeons have noted complete resolution of diabetes in some cases within days after surgery."

Health care costs averaged $6,376 per year in the two years before surgery, and the median or midpoint cost of the surgery and hospitalization was $29,959. Total annual health care costs increased by 9.7 percent ($616) in the year following the procedure, but decreased by 34.2 percent ($2,179) in year two and by 70.5 percent ($4,498) in year three.

"Based on these data, we have identified several important implications for health care delivery and public policy," the authors conclude. "Foremost, eligible obese patients should be properly informed of the risks and benefits of bariatric surgery compared with non-surgical health management. Health care providers should consider discussing bariatric surgery in the treatment of obese patients with type 2 diabetes. Health insurers, private and public, should pay for bariatric surgery for appropriate candidates, recognizing a potential annualized cost savings in addition to the benefit to health."

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Source: Reprinted from materials provided by JAMA and Archives Journals. http://pubs.ama-assn.org/media/

Journal Reference: Martin A. Makary; Jeanne M. Clarke; Andrew D. Shore; Thomas H. Magnuson; Thomas Richards; Eric B. Bass; Francesca Dominici; Jonathan P. Weiner; Albert W. Wu; Jodi B. Segal. Medication Utilization and Annual Health Care Costs in Patients With Type 2 Diabetes Mellitus Before and After Bariatric Surgery. Arch Surg, 2010; 145 (8): 726-731

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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 Finds Lap-Band Weight Loss Surgery in Very Obese Adults Improves Mental Health

One year after weight loss surgery with laparoscopic gastric banding, extremely obese adults demonstrate not only better physical health but also improved psychological health, a new study shows. The results were presented recently at The Endocrine Society’s 92nd Annual Meeting in San Diego.

“Surgical treatment, such as laparoscopic gastric banding, is increasingly recognized as the most effective means of achieving weight loss and improving blood sugar control in morbidly obese patients with Type 2 diabetes,” said study co-author Andrew Johnson, MD, of Southmead Hospital in Bristol, U.K.

“However, until now, the long-term psychological status of morbidly obese individuals undergoing gastric banding has been unclear despite its increasing use,” said Johnson, a consultant physician specializing in diabetes and endocrinology.

Laparoscopic gastric banding, also called the “Lap-Band” procedure, is a minimally invasive weight loss surgery. It involves repeated adjustment of a band to gradually make the stomach smaller and limit food consumption.

Four men and 21 women (ranging in age from 30 to 58 years) participated in the study and had the weight loss surgery. Of these 25 patients, 16 had Type 2 diabetes and nine did not. All had a body mass index (BMI, a measure of body fat) that classified them as morbidly obese.

Participants completed psychological testing before surgery and six and 12 months after surgery. These tests measured general anxiety and depression, quality of life, and social anxiety, that is, anxiety related to what others might think of one’s appearance.

Compared with before surgery, patients’ psychological test scores improved significantly at both six and 12 months after surgery. They had better psychological and physical quality of life, reductions in levels of general anxiety and depression, and reductions in their levels of social anxiety.

As shown in other studies, gastric banding significantly reduced BMI and hemoglobin A1c, a measure of blood sugar control over time.

“These results provide evidence one year after gastric banding that psychological health improves in parallel with physiological health,” Johnson said.

Researchers at the University of the West of England in Bristol also contributed to this study.

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Source: The Endocrine Society. http://www.endo-society.org

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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.

2011 Schedule Set for Free Weight Loss Surgery Seminars in Houston Area

 

"It’s not who you are that holds you back, it’s who you think you’re not."
~ Anonymous

 

Meet Dr. Waggoner And Learn More About
Your Weight Loss Surgery Options!

Houston Area: If you've been thinking about bettering your health and life-expectancy by having a surgical weight loss procedure, then we encourage you to attend our free weight loss surgery seminar.

Dr. Bradley Waggoner will host these seminars and will be on hand to answer all of your questions as they pertain to your weight loss surgery options such as Sleeve Gastrectomy, Gastric Bypass Surgery or LAP Band System Surgery.

Below are the Weight Loss Surgery Seminar dates for 2011. The seminars will be held at North Cypress Medical Center Hospital* in the Houston, Texas area.

Dr. Bradley Waggoner's Free Seminar Schedule Please Call 281-640-8373 to Reserve Your Space
January 2011
January 18	NCMC	6:00 pm
February 2011
February 12	NCMC	10:00 am
March 2011
March 1	NCMC	6:00 pm
April 2011
April 16	NCMC	10:00 am
May 2011
May 3	NCMC	6:00 pm
June 2011
June 7	NCMC	6:00 pm
July 2011
July 9	NCMC	10:00 am
August 2011
August 2	NCMC	6:00 pm
September 2011
September 10	NCMC	10:00 am
October 2011
October 4	NCMC	6:00 pm
November 2011
November 17	NCMC	6:00 pm
December 2011
December 20	NCMC	6:00 pm

Weight Loss Surgery Seminar Location:
North Cypress Medical Center Hospital
21214 Northwest Freeway
Cypress, TX 77429

For more information, directions, and/or to reserve your seat, please contact us.

Model Estimates Risks and Benefits of Bariatric Surgery for Severely Obese

A computerized model suggests that most morbidly obese individuals would likely live longer if they had gastric bypass surgery, according to a report in the January issue of Archives of Surgery, one of the JAMA/Archives journals. However, the best decision for individual patients varies based on factors such as age, increasing body mass index and the effectiveness of surgery.

An estimated 5.1 percent of the U.S. population is morbidly obese, often defined as having a body mass index (BMI) of 40 or higher, according to background information in the article. Available evidence suggests that dietary, behavioral and pharmacologic treatments frequently do not result in meaningful weight loss for individuals in this group. Bariatric surgery appears to be the only effective therapy for promoting clinically significant weight loss and improving obesity-related health conditions for the morbidly obese. However, the procedure is not without risk, including in-hospital death.

Daniel P. Schauer, M.D., M.Sc., of the University of Cincinnati Academic Health Center, and colleagues used two nationally representative surveys and a recent large observational trial to construct a model estimating the benefits and risks of gastric bypass surgery for individuals with morbid obesity. The model included data from almost 400,000 individuals nationwide to estimate the risk of death from obesity and its complications; data from 23,281 patients undergoing bariatric surgery to calculate in-hospital death rates following the procedures; and outcomes from participants in a seven-year study to determine the effects of surgery on survival and to calibrate and validate the model.

According to the resulting model, an average 42-year-old woman with a BMI of 45 would gain an estimated additional three years of life expectancy as a result of undergoing bariatric surgery; a 44-year-old man with the same BMI would gain an estimated 2.6 additional years.

Additional analyses revealed that younger women with higher BMIs are projected to gain the most life expectancy from surgery. Younger men with higher BMIs might also gain more life expectancy after surgery, but the gain would be less for men than for women in each subgroup. "Younger patients have lower surgical risk and more time over which to realize the benefits of surgery," the authors write. "For older patients, the gain is smaller, and for some, gastric bypass surgery will decrease life expectancy."

"The decision analysis presented here is a step forward in understanding optimal patient selection but also highlights some of the areas for which better data are needed," they continue. For instance, the risk-benefit balance changes based on how effective bariatric surgery is likely to be. More information is needed about how individual patient characteristics—for example, having diabetes—affect the efficacy of the procedure.

"In conclusion, while not all patients are guaranteed a good outcome, our model indicates that gastric bypass increases life expectancy for most patient subgroups; however, for those at high surgical risk or in whom efficacy of surgery is likely to be low, benefit will be minimal," the authors write. "We believe results of this analysis can be used to better inform both patients' and physicians' decisions regarding gastric bypass surgery."

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Story Source: Adapted from materials provided by  JAMA and Archives Journals.

Medical Advice Disclaimer: The content of this blog entry is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician, or other qualified health provider with any questions you may have regarding a medical condition.

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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.

Don't Wait Til New Years Day To Set Your Weight Goal Resolutions -- Attend A Free Weight Loss Surgery Seminar This Month

"I was always looking outside myself for strength and confidence
but it comes from within. It is there all the time."
~Anna Freud

Are you obese? Has your weight problem affected your health to the point where you cannot do those things with ease that you were once able to? Do you feel stressed thinking about the upcoming holidays and all the food temptations that will be presented during the next few months of nonstop holiday festivities and parties?

Do yourself a favor, stop the procrastination and start the healing. It'll be a difficult road and perhaps there will even be setbacks. As you've probably heard all ready, it took time to get where you are now and it'll take time to get where you want to be.

On November 18 at 6:00 pm, Dr. Bradley Waggoner will be hosting a free-weight loss surgery seminar located at North Cypress Medical Center in northwest Houston.

Among your options to consider is Lap-Band Surgery which will be a topic of discussion you won't want to miss. You'll be in good company along with fellow candidates who might ask questions you may not have thought to mention.

We at Cypress Bariatric & General Surgery are here to help, but you need to take the first step. You deserve to have the healthy life you dream of and it is in your power to achieve it.

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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.

Nutrition Tips: How to Eat Before You Have LAP-BAND System Surgery

LAP-BAND System surgery isn't a magic bullet -- you will have to eat differently to ensure lasting success. It'll be hard, but oh so worth it. In preparation for your weight loss surgery, the following are a few tips.¹

• Begin a practice of eating smaller portions of food. Use a smaller plate to portion out your foods and immediately put-up leftovers to eliminate grazing.

• Eat only when you are hungry, eat slowly, and stop before you are "full".

• Prepare and have on-hand small portions of healthy snacks in anticipation of your grazing triggers.

• When you eat, do only that without distractions. Don't eat while talking on the phone or watching T.V.

• Keep a bottle or thermal cup filled with water within reach. Get in the habit of drinking water regularly. Avoid colas, alcoholic drinks and large portions of full-strength juices.

• Again, a little preparation will have strengthen your resolve to eat right. Set aside time to prepare meals in advance and freeze them for those times when you are too tired to cook or haven't the time. This will help you beat the urge to order a pizza or make a pit-stop to a fast food drive-through.

• Get in the habit of setting out your multivitamin and other suggested supplements each night and place where you can't help but remember to take them (coffee cup, water bottle, by your keys, etc.).

Click here for more tips or for answers to questions you may have regarding your new eating lifestyle before and after LAP-BAND System surgery.

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¹Note: The information contained in this article is for educational purposes only and should not be substituted for medical advice or treatment. Your specialist will evaluate whether you are getting enough vitamin B12, folic acid, and iron at your regular check-ups. Your LAP-BAND post-surgical nutritional needs are of utmost importance, if you have additional questions, contact Dr. Waggoner's office.

Addressing Post-Operation Questions Concerning LAP-BAND System Surgery

In our last post, we addressed questions you may have regarding pre-operative procedures leading to LAP-BAND System Surgery. We invited you to come to our ongoing drop-in seminars that feature post-op patients who attend to share their experiences with you. Dr. Bradley Waggoner is also on hand at each seminar to address surgery specific questions. These seminars are held monthly. For the schedule, location, and contact information, click here.

Today, we will discuss questions you may be having regarding what to expect after your LAP-Band surgery:

Post-Operative Research
Approved by the FDA in June 2001, LAP-BAND System surgery is the safest, least invasive and only adjustable surgical treatment for morbid obesity in the United States. One of the questions foremost in your mind after the safety issue (of which you can read more about here and even view a short video), is the amount of weight loss you can anticipate losing with Lap-Band surgery.

The Weight Loss Question
Of course, weight loss results will vary and the pounds won't come off by themselves. A weight loss of 2-3 pounds a week in the first year after the surgery is possible, but one pound a week is more likely. Remember, that you should loose weight loss gradually to prevent health problems and to reduce the possibility of having the dreaded saggy skin folds.

The main goal is to have weight loss that prevents, improves, or resolves health problems (like diabetes, for example) connected with severe obesity.

Other Questions
Additional questions like, will I be sick a lot after the operation, recovery time and more are covered in this FAQ.

Questions? Let us be of service to you. Contact us or give us a call at 281.640.8373 if in Houston, or dial toll free at 866.938.5677.