Bradley Waggoner, MD

Benefits of Bariatric Surgery May Outweigh Risks for Severely Obese

Bariatric surgery can result in long-term weight loss and significant reductions in cardiac and other risk factors for some severely obese adults, according to a scientific statement from the American Heart Association.  

The statement, published in Circulation: Journal of the American Heart Association, is the first by the American Heart Association focused solely on bariatric surgery and cardiac risk factors, according to lead author Paul Poirier, M.D., Ph.D., director of the prevention/rehabilitation program at Quebec Heart and Lung Institute at Laval University Hospital in Canada.   

"The statement is not an across-the-board endorsement of bariatric surgery for the severely obese,” Poirier said. “It is a consensus document that provides expert perspective based on the results of recent scientific studies.” 

Bariatric surgery encompasses various procedures that decrease appetite while restricting food intake and/or causing food to pass through the gastro-intestinal tract without being fully absorbed or digested. The American Heart Association has long considered bariatric surgery an option to be evaluated carefully based on each patient’s medical profile.

Source: Reprinted with editorial adaptations from materials provided by American Heart Association. http://www.newsroom.heart.org/index.php?s=43&item=1275

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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 Isolated Weight Loss Following Bariatric Surgery Results in Significant Improvements in Knee Pain, Stiffness and Function

Another new study released in February, 2011 analyzed the effects of isolated weight loss via bariatric surgery on knee osteoarthritis. The study involved 24 obese patients with knee osteoarthritis who were scheduled to undergo bariatric surgery. Patient weights and knee symptoms were recorded before the surgery and 6 and 12 months after surgery. Patients were not prescribed exercise or physical therapy, anti-inflammatory medications or knee injections post-operatively.

The study found that isolated weight loss following bariatric surgery resulted in significant improvements in knee pain, stiffness and function.

“Other studies have looked at the effect that a combination of weight loss, diet and exercise had on knee arthritis, but it was difficult to say which of these factors contributed the most to reducing knee pain,” says Christopher Edwards, co-investigator and a fourth year medical student at the Penn State College of Medicine. “Our study should send a message to patients, health care providers, and payers that weight loss is an important consideration in the treatment of knee arthritis.”

Source: Reprinted with editorial adaptations from materials provided by American Academy of Orthopaedic Surgeons. http://www6.aaos.org/news/Pemr/releases/release.cfm?releasenum=966

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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.

Weight-Loss Surgery May ‘Remodel’ Heart

A study published in the Feb. 8 issue of the Journal of the American College of Cardiology, followed more than 400 severely obese people who had gastric bypass surgery, which reduces stomach size. Two years later, patients’ body mass index (BMI) fell from an average of nearly 48 (morbidly obese) to about 32. Their average weight loss was about 100 pounds.

Echocardiograms, or ultrasounds of the heart, also showed a “remodeling” of their heart structure, including a reduction in the left ventricular mass and right ventricular cavity area.

Those reductions in heart mass and volume indicate a heart that’s less stressed, isn’t having to work as hard pumping blood and has returned to a more normal shape and function, states Dr. Sheldon Litwin, senior study author and chief of cardiology at the Medican College of Georgia.

Source: Health.com - Obesity News & Headlines, Weight-Loss Surgery May 'Remodel' Heart by Jenifer Goodwin. http://news.health.com/2011/02/03/weight-loss-surgery-may-remodel-heart/

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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.

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.

New Study May Explain How Weight-loss Surgery Reverses Type 2 Diabetes

A team of researchers, led by a UC Davis veterinary endocrinologist, has shown for the first time that a surgical procedure in rats that is similar to bariatric surgery in humans can delay the onset of type 2 diabetes.¹ The researchers also have identified biochemical changes caused by the surgeries that may be responsible for that delay.

Findings from the study, published online in the journal Gastroenterology, should help researchers identify strategies for preventing and treating type 2 diabetes, a chronic condition in which the body is unable to properly metabolize sugar and fat, leading to serious complications including heart disease, blindness and kidney failure.

Type 2 diabetes affects more than 21 million people in the United States, where it results in more than $150 billion in direct and indirect annual costs, according to the National Institutes of Health.

“Bariatric surgery currently is considered to be the most effective long-term treatment for human obesity and often leads to marked improvements in diabetes,” said the study’s lead author Peter Havel, a professor with joint appointments in the School of Veterinary Medicine and Department of Nutrition.

“It has been thought that reduction of blood sugar, which indicates a reversal of type 2 diabetes, in patients following bariatric surgery was due to post-surgery weight loss,” Havel said. “This study, however, supports the observations from a number of earlier clinical studies reporting that diabetes is often improved prior to substantial weight loss. It also suggests that endocrine changes in hormones produced by the gastrointestinal tract may contribute to the early effects of bariatric surgery, in addition to the later effects of weight loss.”

"This study confirms our clinical observations that metabolic regulation -- specifically homeostasis of glucose -- occurs quickly after gastric bypass surgery," said Mohamed Ali, an associate professor of gastrointestinal surgery and a specialist in bariatric surgery at UC Davis Health System. "It's clear from the outcome that something physiologic is at work with controlling diabetes that is not related to weight loss.

“UC Davis has the perfect environment for collaboration between basic and clinical scientists to take this discovery to the next step, which is identifying the molecular signals that set these physiologic changes in motion," said Ali, who was not a participant in this study, but has collaborated with Havel on previous research.

About Bariatric Surgery in Humans
In severe cases of obesity -- usually when the patient is 80 to 100 or more pounds overweight -- bariatric surgery is used to alter or reconstruct the stomach and/or the intestinal tract. In such cases, obesity is not just a weight issue but also a life-threatening health problem that often leads to type 2 diabetes, heart disease and sleep apnea.

There are several types of bariatric surgeries available in the United States. The most commonly performed surgical procedure, known as Roux-en-Y gastric bypass surgery, limits the amount of food the stomach can hold and reroutes the digestive tract, resulting in changes in intestinal function and hormones produced by the gastrointestinal tract.

In 2008, about 220,000 people with severe obesity in the U.S. had bariatric surgery, according to the American Society for Metabolic and Bariatric Surgery.

The New Study
Havel and colleagues set out to test a hypothesis that certain bariatric surgical procedures were successful in improving type 2 diabetes, at least in part, because the procedures increased the flux of unabsorbed nutrients to the far end of the small intestine and, in doing so, triggered increased secretion of two hormones. Those hormones -- glucagon-like peptide-1 (GLP-1) and peptide-YY (PYY) -- are known to have a role in controlling food intake and improving insulin secretion and insulin sensitivity, thereby helping to stabilize blood sugar levels.

To test the hypothesis, the researchers carried out a surgical procedure known as ileal interposition in a line of rats that were predisposed to obesity and type 2 diabetes. The rat model, developed in Havel’s laboratory, was known as the UC Davis Type 2 Diabetes Mellitus (UCD-T2DM) Rat. The pathology of type 2 diabetes in these animals is more similar to type 2 diabetes in humans than other existing rodent models of the disease.

The ileal interposition procedure involves relocating a short portion of the small intestine known as the ileum further forward in the intestinal tract. Then the researchers compared how long it took for the animals to develop diabetes, compared with a control group of rats that had surgery but without rearrangement of the intestines.

They found that the rats receiving the ileal interposition surgery developed type 2 diabetes 120 days later than did the rats in the control group. Furthermore, by the time the rats were one year old, 78 percent of the control group rats were diabetic while only 38 percent of the rats that had received the ileal interposition procedure had developed diabetes.

Havel said the delay in onset of diabetes in the rats would be similar to delaying the age of onset of diabetes by approximately 10 years in a person, which would be expected to significantly decrease the amount of time for diabetic complications to develop, and to reduce the health care costs associated with treating this costly and prevalent disease.

The researchers also found that, when compared with the control group, the rats receiving the ileal interposition surgery had:

• lower fluctuations in blood sugar levels;


• improved insulin production, making them better able to metabolize sugar; and


• decreased levels of lipids (cholesterol and triglyceride) in the bloodstream,which are known to be risk factors for cardiovascular disease in humans.

“In addition, results from the study also demonstrated that the ileal interposition surgery increases production of bile acids, which are involved in fat metabolism and can increase the production of GLP-1, the hormone that improves insulin secretion and insulin sensitivity,” Havel said. “This could contribute to the delay in the onset of type 2 diabetes that we observed in the rats in this study.”

He noted that further studies are needed to better understand how surgically induced improvements of metabolism can be achieved in order to discover new methods for preventing and treating type 2 diabetes. Havel, postdoctoral researcher Bethany Cummings and their colleagues have received funding from a National Institutes of Health Challenge Grant to continue to pursue research on the effects of bariatric surgical procedures in the UCD-T2DM model of diabetes.

Collaborating with Havel on this study were Cummings, Kimber Stanhope, James Graham, Jennifer Lee and Helen Raybould, all at UC Davis; April Strader of Southern Illinois University School of Medicine; and Denis Baskin of the Department of Veterans Affairs Puget Sound Health Care System and the University of Washington, Seattle.

Funding for the study was provided by UC Davis, the National Institutes of Health and the American Diabetes Association.

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¹University of California/UC Davis. http://www.news.ucdavis.edu/

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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!

Contact Bradley Waggoner, MD:

• If you are ready to set-up an appoint to discuss your weight loss options.
• Reserve your seat at the next free informational seminar outlining your obesity surgery options (including lap-band system procedures) and meet Bradley Waggoner in person.

If you'd like to set-up an appointment to further discuss your weight loss surgical options, 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.

Findings Show Gastric Bypass Surgery May Help Resolve Erectile Dysfunction

Losing weight can help resolve erectile dysfunction in obese men, according to findings presented at the American Urological Association (AUA) 2008 Annual Meeting.¹

Morbid obesity can cause sexual dysfunction independent of other common contributors, including diabetes, hypertension, and smoking. In this study, from researchers in Boston and Philadelphia, sexual function was normalized in some men who underwent Gastric Bypass surgery for weight loss.

"This study [95 patients underwent gastric bypass surgery for weight loss] shows that weight loss and other risk factors that are alleviated by weight loss, may be keys to restoring sexual function," said Anthony Y. Smith, MD, from the University of New Mexico, in Albuquerque, a member of the AUA Public Media Committee. "These results give men another reason to improve their health by losing weight."

For more information on weight loss surgery options such as Gastric Bypass Surgery or Lap-Band System Surgery, contact Bradley Waggoner.

¹Source: Medscape Medical News