Hello Everyone,

SWLC is proud to announce the publication of our 2^nd clinical research report in the prestigious “Obesity Surgery Journal” in September of 2011.  This study shows that the Lap-Band procedure can be safely performed in out-patient facilities – even for patients who would otherwise be considered high risk due to sleep apnea or respiratory problems. If you are a health care professional or you would like more information about this research report, please go to the SWLC HCP section.

This study documented that Laparoscopic Adjustable Gastric Banding (LAGB) can be safely performed in an outpatient facility in a group of patients at high risk for sleep apnea. This review was conducted in association with Dr. M. Kurrek, Dr. A. Kiss and Dr. S.L. Dain & Dr. Z. Wojtasik and myself from the Surgical Weight Loss Centre (SWLC). We reviewed 2,370 patients who undergone Lap-Band surgery between 2005 and 2009 who were classified as high risk for sleep apnea or met at least three STOP-BANG criterias.

A total of 746 of the 2,370 patients (31%) met criteria for or were at high risk for sleep apnea. There were no deaths and no cases of respiratory failure or re-intubation. The 30 day anesthesia related morbidity was less than 0.5%.

This clinical report was conducted due to the controversy that exists regarding perioperative management of patients at high risk of sleep apnea.

For more information on the clinical study, tables, figures and references, visit http://bit.ly/p2Vh5p.

Happy reading!

Dr. Cobourn

Link to Article | http://www.latimes.com/health/boostershots/la-heb-global-diabetes-20110914,0,3956419.story

Written by: Jeannine Stein

WEDNESDAY, September 16th, 2011 (LA Times)—–Diabetes isn’t just a problem in the U.S.–about 366 million people worldwide have the disease, says the International Diabetes Federation.

In addition, 4.6 million deaths are attributed to diabetes, and healthcare spending has grown to a staggering $465 billion.

The figures were released Tuesday in Lisbon, Portugal, at a meeting of the Assn. for the Study of Diabetes, in advance of the United Nations Summit on Non-Communicable Diseases Monday and Tuesday in New York. The IDF, an umbrella group of more than 200 national diabetes associations in over 160 countries, will release its Global Diabetes plan this weekend, outlining steps to combat the diabetes epidemic. The entire Diabetes Atlas, which includes breakdowns by region, will be available in November.

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Link to Article | http://www.sportsnetwork.com/merge/tsnform.aspx?c=sportsnetwork&page=cfl/news/news.aspx?id=4434781

Written by: Ted Michaels

WEDNESDAY, Sept 7th, 2011 (Sports Network)— Mike Jovanovich knew exactly when it happened.

The former offensive lineman, who graduated from Boston College, signed as a free agent with the Seattle Seahawks in 1992. He joined the Hamilton Tiger- Cats after being released by Seattle, and also played for the Toronto Argonauts, Ottawa and Montreal.

Like many of his peers, Jovanovich waged a running battle with his weight, during and after his playing days.

“My first year as a freshman at Boston College, I weighed 300 pounds,” he told Inside the CFL. “At the end of my playing days there, I weighed 285 pounds. In my CFL days, I played around 300-305 pounds.”

Then, he admits, the problems started.

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Link to Article | http://www.drsharma.ca/obesity-the-stigma-of-bariatric-surgery.html

THURSDAY, July 14th, 2011 (www.drsharma.ca) — That overweight and obese individuals face weight-bias and discrimination is no secret. It is also no secret that individuals who lose weight often experience significant positive changes in how they are treated by family, friends, colleagues and perfect strangers.

Interestingly, however, it turns out that these ‘positive’ attitudes to people, who lose weight, may very much depend on how these individuals actually managed to do so.

Thus, a study by Jasmine Fardouly and Lenny Vartanian from Sydney, Australia, just published in the International Journal of Obesity, suggests that knowing how the weight loss came about significantly determines the changes in weight bias following weight loss.

Read the rest of this entry »

Link to Article | http://www.drsharma.ca/why-i-support-bariatric-surgery-part-5.html

FRIDAY, May 27th, 2011 (www.drsharma.ca) — Yesterday’s post was a brief overview of how bariatric surgery works and why it helps most people sustain weight loss by affecting key determinants of ingestive behaviour (hunger, appetite, satiety, reward, etc.).

Today, however, I want to look at why surgery is anything but a ‘quick fix’ or an ‘easy way out’ and why, despite all of its potential benefits on quality of life, comorbidities and mortality, surgery is by no means a ‘guarantee’ for success.

While ’success’ with bariatric surgery is certainly not guaranteed (and for some patients, as with any drastic treatment, things can sometimes go horribly wrong), most patients do remarkably well, including – and this may surprise readers – patients with emotional eating or eating disorders.

Read the rest of this entry »

Link to Article | http://www.drsharma.ca/obesity-why-i-support-bariatric-surgery-part-4.html

THURSDAY, May 26th, 2011 (www.drsharma.ca) — In previous posts this week, I discussed the risk and potential benefits of bariatric surgery and explained why for someone with severe obesity and significant comorbidities, current evidence comes down heavily on the benefit side, whereas for someone with obesity but no complications, the risk/benefit ratio may not be all that positive.

In today’s post, I would like to look at why bariatric surgery works and hopefully dispel some common misconceptions about what bariatric surgery actually entails.

However, to fully understand why bariatric surgery should even be considered an option, we need to first understand why it is so difficult to lose weight and keep it off.

Read the rest of this entry »

Link to Article |  http://www.drsharma.ca/why-i-support-bariatric-surgery-part-3.html

WEDNESDAY, May 25th, 2011 (www.drsharma.ca) — So now, that we have extensively discussed the issue of risk in previous posts, let us turn our view to the benefits of bariatric surgery.

In this discussion let us be very clear about the following:

1) Bariatric surgery does not, nor is it intended to, address the many ‘root causes’ of obesity. Its only raison d’être is to help patients with weight-related health problems sustain a degree of weight loss that is, for the vast majority of people (i.e. 19 out of 20), simply impossible to sustain with diet and exercise alone.

2) To be honest, bariatric surgery is not even about weight loss! To put it bluntly, the real reason to even consider bariatric surgery is because of its positive impact on comorbid conditions (which is why I refuse to call it weight-loss surgery or WLS). While many patients appreciate the fact that bariatric surgery may help them attain and sustain a lower body weight – the real benefit, at least from a medical perspective, can only be measured in improvements in health and quality of life. In fact, if ‘bariatric’ surgery only improved health (with no weight loss), it would still be a worthwhile intervention.

3) I have already addressed the issue or surgical risk vs. the risk of not having surgery in previous posts. Thus, readers will recall that even the surprisingly small risk of undergoing laparoscopic bariatric surgery, may exceed the risk of not having surgery in obese people, who are otherwise healthy. These are NOT the folks who should be strongly considering surgery. On the other hand, the more obesity-related complications the patient has, the smaller the relative risk of undergoing surgery. So, I am by no means advocating for simply operating on anyone who is obese. In any obese patient without comorbidities or significant impairment of quality of life, even the rather small risk of surgery is clearly not worth taking.

4) Surgery is not for everyone. As pointed out in previous posts, we turn away many patients, who may meet both the BMI and medical criteria for surgery because we do not think that they will be able to make or sustain the considerable lifestyle changes that are required for surgery to ’succeed’. Some patients may slip through the ‘cracks’ because they manage to convince (I will not say intentionally mislead) us to think they will cope, when they clearly will not. But we certainly do our very best to try and identify such patients and turn them away from surgery.

5) Surgery is invasive and traumatic! It impacts dramatically on normal gut anatomy and function. Whether it just restricts normal passage of food through the gut (as in adjustable gastric banding), reduces the size of the stomach (as in sleeve gastrectomy), or additionally reroutes food through the gut (as in gastric bypass or biliopancreatic diversion), surgery has a profound, and in most cases, permanent impact on the anatomy and functioning of the digestive system. Tampering with an essentially ‘healthy’ gastro-intestinal system should never be considered trivial. This amazingly complex system has evolved through eons of human evolution to serve one of the most important biological functions – to digest and assimilate our food and drink – our only source of nutrients and calories. The expectation that this system can simply be surgically tampered with, without some very significant and sometimes dramatic consequences, is both naive and irresponsible. Of course bariatric surgery entails risk and there are very real consequences – the only question is whether or not these risks and consequences outweigh the risk and consequences of leaving things as they are – a question that I will address in the following.

With these caveats out of the way, let us look at the potential benefits of surgery (and, please remember, I AM NOT A SURGEON!).

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Link to Article | http://www.drsharma.ca/obesity-why-i-support-bariatric-surgery-part-2.html

TUESDAY, May 24th, 2011 (www.drsharma.ca) — Yesterday’s post was about the widespread misconceptions around the risk of having bariatric surgery compared to the risk of not having surgery.

I pointed out that for a severely obese person with clinically significant end-organ damage, the risk of death without surgery within 1 year is about 10 times that of dying of the surgery itself.

Having looked at the risks, today, I wanted to discuss the ‘benefit’ side of the equation – after all, no one would consider even the safest surgery, if there was no benefit to having it.

But before I go into the discussion of benefits, I thought it may be worthwhile to discuss how we (both experts and non-experts) tend to perceive risk and why we are so easily bound to kid ourselves, even when we know the numbers.

The fundamentals of how human psychology tricks us into falling widely off the mark, when it comes to interpreting risk was described in a classic paper by Daniel Kahneman and Amos Tversky published in Science in 1974 (Kahneman went on to get the Nobel Prize for economics in 2002).

As pointed out in this seminal paper, based on a remarkably solid body of empirical psychological research (consistently replicated ever since), we all tend to make ‘gut’ decisions according to the following three principles:

1) Representativeness (or as Dan Gardner calls it, “the rule of Typical Things”)

2) Availability or recall of instances (”Example Rule”)

3) Anchoring

We tend to use all three rules to assess risk or judge probability – even when we know the numbers and statistics. Read the rest of this entry »

Link to Article | http://www.drsharma.ca/obesity-why-i-support-bariatric-surgery.html

MONDAY, May 23rd, 2011 (www.drsharma.ca) — Let me start this post with a few disclaimers:

1) I am not a surgeon and do not get paid based on whether any of my patients decides for or against surgery.

2) The average BMI of patients seen in our program is 49.7 kg/m2 – the average patient is just below 40 years of age. Most have substantial health problems – many cannot work or perform even simple tasks of daily living because of their weight – most have tried every commercial diet or pill they could lay their hands on – they are all ‘experts’ on weight loss.

3) Many have significant psychosocial problems and mobility issues that may have contributed to their weight gain – these are dealt with by an interdisciplinary team of psychiatrists, psychologists, occupational and physiotherapists, nurses and dietitians – treatments that start months before any patient is considered a candidate for surgery.

4) I do not for once believe that bariatric surgery addresses any of the ‘root causes’ of severe obesity and I am sure that none of my surgical colleagues believe it does. As I often tell my patients, “the surgery is on your gut and not your head”.

5) Our program regularly talks patients, who come to us wanting surgery, out of surgery, if we feel that it is not in their best interest or unlikely to have a successful outcome – to these patients we offer the best non-surgical care we can – but of course, many are disappointed.

And yet, our program regularly performs bariatric surgery and prepares patients for it in a process that can often take 6 months or longer. We proactively discuss surgery with all patients, who meet the criteria for surgery – both the pros and the cons. We offer comprehensive dietary, psychological and medical support to all patients who decide to undergo surgery but make it very clear that surgery is not a ‘cure’ and that patients have to make substantial lifestyle changes in order to be ’successful’ (we measure ’success’ in improvement in comorbidities and quality of life – not in pounds lost!).

With these caveats out of the way, I would today like to dispel some common myths about bariatric surgery and discuss why for many patients with severe obesity, it is in fact a very realistic and successful option.

Read the rest of this entry »

Link to Article | http://www.newscanada.com/print-july-canadians-are-motivated-to-lose-weight-despite-setbacks-68484

TUESDAY, June 14th, 2011 (www.newscanada.com) — A new survey from the Canadian Obesity Network–Réseau canadien en obésité (CON–RCO) found that 84 per cent of Canadians with severe obesity are motivated to lose weight and eight–in–ten respondents say their main motivating factor is to improve their overall health. This is not surprising given that 75 per cent report having one or more accompanying conditions, including high blood pressure, high cholesterol and diabetes.

Lucille Bisignano is familiar with the motivation to lose weight to improve her overall health. “In addition to being severely obese I was also living with diabetes and high blood pressure, taking countless medications. I had seen a number of doctors and dietitians about my weight but nothing worked for me. I knew I needed to make a change and that’s when I decided to undergo the gastric banding procedure. Since having the procedure, I’ve lost over 190 pounds. As a result of my weight loss, my blood pressure has stabilized, my diabetes is in remission and I no longer have to take any medication.”

Many Canadians face the same struggles that Lucille did in achieving sustained weight loss. Sixty-one per cent of Canada’s severely obese population report that weight loss is an uphill battle for them as they have too much to lose, and four in 10 feel discouraged about trying another weight loss program for fear of failing again.

Dr. Christopher Cobourn is the medical director and surgeon at the Surgical Weight Loss Centre. He sees hundreds of patients each year who want to lose weight, but struggle.

“Many patients who come into my office are frustrated and depressed with their repeated failure to sustain weight loss,” says Dr. Cobourn. “It’s critical that these patients understand that there is no ‘one–size–fits–all’ approach to weight loss. Only after understanding all the treatment options, including surgery and medically–assisted weight loss procedures, can these patients make an informed decision. This allows them to feel empowered to live their life without being controlled by their weight issues.”

In Canada, there are different medically–assisted weight loss procedures available, including: the gastric balloon, laparoscopic adjustable gastric banding (or gastric banding) and gastric bypass. You can learn more about these procedures online at www.yourmomentoftruth.ca.