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Oct 17 - weight loss reduction 3.doc

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Physical Education and Sport
Scott Forbes

Oct 17 - Weight Loss Strategies and Risk Reduction Choices Surgery • Restrictive • malabsorptive Medications (bray and Ryan 2007) • inhibitors • appetite suppression Surgery... not for everyone For obese patients with • BMI > 40 kg/m^2 • BMI between 35-40 kg/m^2 with comorbidities that are known to improve with weight loss Adjustable Gastric Banding AGB Pro’s • Simple and relatively safe • Major complication rate is low • No altering of the natural anatomy • Very short recovery periods AGB Disadvantages • About 5% failure rate due to: balloon leakage, band erosion/migration, deep infection, weight loss but less maintenance Vertical Banded Gastroplasty Bands and staples are used to create a small stomach pouch VBG Pro’s • Completely reversible • Body anatomy is left intact • No dumping syndrome • No nutritional deficincies VBG Con’s • Need strict patient compliance to diet • No malabsorption • vomiting if food isn’t properly chewed or if food is eaten too quickly • also known as Stomach stapling (Use to be most popular technique. • VBG Advantages • No dumping syndrome • No nutritional deficiencies/malabsorption • VBG Disadvantages • Needs strict patient compliance to diet • High fiber foods and foods with a more dense, natural consistency can become very difficult to eat, while highly refined foods cause little discomfort. Most people who regain any weight lost after surgery do so because choosing "healthier" foods are harder to digest, while "junk" food pass easily. • VBG is in no way a magic bullet or pill. It must be emphasized that lifestyle changes, i.e. diet and exercise, are absolutely imperative for weight loss to occur and be maintained. Realistic expectations are imperative. • Reversal of a VBG requires a much more complex and intensive surgical process than getting the VBG. When removal of a polyurethane band is involved (polyurethane was predominantly used in the 1980s and 90s), it likely has built substantial scar tissue that must also be removed, depending on how long ago the VBG took place. Removal of the staples involves stitching the previously separated parts of the stomach back together. For these reasons, a reversal should only be considered if there are serious medical complications. • Vomiting and severe discomfort if food is not properly chewed or if food is eaten too quickly. • Not adjustable (as with the Adjustable gastric band (aka "Lap band")). • As with any surgical procedure, there are risks of complications. It has been observed that approximately one in every hundred patients undergoing VBG die within a year. There may also be other medical complications down the road, but the risk is relatively low. Roux-en-Y Gastric Gastric Bypass Roux-en-Y : stomach bypass : large portion of stomach and duodenum are bypassed RGB Pro’s • Greatly controls food intake • Reversible in an emergency (though procedure should be thought of as permanent) RGB Con’s • Staple line failure • ulcers • Narrowing/blockage of the stoma • vomiting if food isn’t properly chewed or if food is eaten too quickly Post RGB • Sugary food leave the stomach quickly • Intestine swells causing cramping and pain • Other symptoms include: fast heart rate, sweating, nausea, diarrhea, vomiting • Dumping syndrome occurs when the contents of the stomach empty too quickly into the small intestine. The partially digested food draws excess fluid into the small intestine causing nausea, cramping, diarrhea, sweating, faintness, and palpitations. Dumping usually occurs after the consumption of too much simple or refined sugar in people who have had surgery to modify or remove all or part of the stomach. • Dumping syndrome is an effective result of the gastric bypass system which alerts the body of inappropriate eating. Dumping syndrome is described as a shock-like state when small, easily absorbed food particles rapidly dump into the digestive system. This results in a very unpleasant feeling with symptoms such as a cold clammy sweat, pallor, butterflies in the stomach and a pounding pulse. These symptoms may be followed by cramps and diarrhea. This state can last for 30-60 minutes and is quite uncomfortable. • That was the clinical description of dumping. • This is what I experience when I dump: shortly after eating a food I don’t tolerate (sugar, milk, sugary milk products or starchy carbs) I begin to feel a bit disoriented, maybe dizzy and then an overall sense of confusion or panic takes over my mind and body. This is a mild state of delirium. Then I begin sweating. Profuse sweating that can completely soak my hair, my clothes; it drips and glistens on my skin. During this state of sweaty panic I feel like I’m out of my mind! A few times during extremely dramatic dumping episodes I literally thought I was dying, the state of distress was that severe. Biliopancreatic Diversion BPD Advantages • Significant malabsorptive component • Better chance of sustained weight loss • Ability to eat larger quantities of food and still lose weight BPD Disadvantages • Better chance of chronic diarrhea, stomach ulcers, more foul smelling stools and flatus • Higher risk of nutritional deficiencies such as vitamins and calcium Malabsorptive operations, such as biliopancreatic diversion (BPD), restrict both food intake and the amount of calories and nutrients the body absorbs. In a BPD procedure, portions of the stomach are removed. The small pouch that remains is connected directly to the final segment of the small intestine, completely bypassing the upper part of the small intestines. A common channel remains in which bile and pan
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