BaroNova?

Well this is something interesting?

• FDA has granted premarket approval to BaroNova for a device to treat obesity that is inserted into the stomach, where it delays gastric emptying. It is removed after 12 months.
• The device, called the TransPyloric Shuttle system, is placed and removed through the mouth in an endoscopic procedure.
• Approval was based on the company's 270-patient pivotal study in which people treated with the device lost three times more weight on average than patients who had a sham procedure in the control group.

 

Dive Insight:

Despite obesity prevalence at 39.8% in 2015-16, affecting about 93.3 million U.S. adults, according to the Centers for Disease Control and Prevention, therapeutic options have not made a dent. Conditions linked to obesity include heart disease, stroke, Type 2 diabetes and some forms of cancer.

Stubbornly high rates globally show the need for an effective treatment, despite substantial public health efforts to address the problem. Optimism at the start of the decade about progress has been tempered, according to a 2018 editorial in the Journal of the American Medical Association. The AMA recognized obesity as a disease in 2013. 

When lifestyle modifications are not enough, physicians may prescribe weight-loss medications or suggest weight-loss surgery. BaroNova's system offers a non-surgical option.

The BaroNova device is indicated to treat obesity in patients with a body mass index of 30-40 kg/m2. The company's clinical study met its primary endpoints for percent total body weight loss 12 months after the procedure and the proportion of subjects in the treatment group achieving 5% total body weight loss. Approximately 67% of people treated with the device lost 5% or more of their body weight, exceeding the pre-specified performance target of 50%. Forty percent (40%) of those treated with the device lost 10% or more of their weight.

The Mayo Clinic lists several surgical options to treat obesity. They include gastric bypass, in which the surgeon creates a pouch at the top of the stomach that is connected to the small intestine, allowing food and liquid to bypass most of the stomach. Other surgical approaches include gastric banding, where bands are placed at the top of the stomach to leave a small portion available for food. Biliopancreatic diversion and gastric sleeve procedures both involve removing part of the stomach.

Last week, FDA granted De Novo clearance to an edible hydrogel capsule that releases absorbent particles that swell in the stomach to create gel pieces with the firmness of plant-based foods, meant to create a feeling of fullness. The mechanical modes of action involve mean it's regulated as a medical device.

In 2015, FDA approved an implantable, vagus nerve blocking neuromodulation device from EnteroMedics, now known as ReShape Lifesciences. A pulse generator implanted under the skin in the abdomen sends electrical signals via wire leads and electrodes to the vagus nerve. 

Also in 2015, FDA approved two intragastric balloon devices sold by manufacturers ReShape and Apollo Endosurgery. In 2016, FDA approved a third balloon system, made by Obalon, that delivers three balloons in a swallowable capsule that are filled with air. 

In 2017, FDA alerted the public to complications with the liquid-filled devices, including four deaths tied to the Orbera balloon made by Apollo and one death linked to the ReShape balloon.

Other device-based treatments on the market include Aspire Bariatrics' AspireAssist that uses a surgically placed tube to drain some stomach contents and PureTech's edible hydrogel capsule, called Plenity, intended to create a feeling of fullness.

 

It's crazy to think...

(Me in 2003 with baby Juli)

That when I (and my husband) was going in to have my gastric bypass surgery, my kids were just little things or not even born yet. 

My daughter that's allowing me to share  (we have two doing this) -- she was born in 2002 and I had surgery in 2004.  She was just a toddler, in fact, I weaned her literally the day I went in for surgery.  She went on vacation with the inlaws and allowed me to relax post op instead of worrying about picking up, putting down.  Her entire childhood has been living with me and dad with our respective altered guts.

In the beginning, I thought that shaking things up would stop the genetic tornado we had going on with so much familial obesity, but I think our surgeries created a microscope of eating issues and only made it harder for the kids. 

Like the kids say:  we always have healthy food available, but we made a big deal about junk in the early years and I think that Really Caused A Problem with snacking, etc.  We didn't really mean to be the food police, but it happened.  I try not to NOW, but with another toddler that would eat nothing but Cheeto dust if allowed -- we have to be a bit careful, but not.  Does that make any sense?!

(Juli in September 2018, pre-program)

My daughter’s pre-op update

In her own words from her post with typos!  

(I will add my experiences of these processes as the Parent-Of-Patients soon. I HAVE SOME THINGS TO SAY.  It’s very hard to find time to write like I used to— I have been waiting for my smallest child to settle down and not find him on a ceiling fan.  This is being posted from the bathroom, with him.)

Anyway — her quick post from yesterday —

Update:

   About four months ago I made a huge decision that is going impact the rest of my life; I started to take part in the WLS program at Boston Children’s Hospital, which most of you know. In the beginning I had barely any idea of how any of this worked and if I would even be able to lose anything. What I didn’t know was the motivation that comes with having to meet with people, and having to have lost weight before the next monthly appointment to be able to stay/ move forward in the program. 

     At my first appointment with OWL (Optimal Weight loss for Life) which is the first step in the WLS program, I was really unsure how successful I would be in the month to come while she was explaining it. But, I went to my second appointment and I had lost 13lbs which was a HUGE accomplishment for me. After this appointment I was not only shocked at what I had done it motivated me to do more for my next appointment; at the third and final appointment with OWL I had lost 5lbs which is less than the first but still an accomplishment that I was content with, although I could have done more.

        Last month I had my first meeting with the WLS program; this is when it really set in that this was going to happen. At this appointment I met the team of doctors that I am going to be working with through out the next 6 months (if all goes as planned) this team includes a dietitian, social worker, Nurse Practitioner, Psychologist, and of course Surgeon. This first appointment with them went very well they approved me for the program and gave me goals and a cool binder that has all of the foods and drinks I should be eating and what I have to do to be able to do the surgery in the time frame that I would like to; all of this was to set me up for the month until my next appointment. At my next appointment I was unsure of how I did, I hadn’t weighed myself, I honestly thought I had gained; But I didn’t I lost 12lbs which really boosted my motivation and confidence levels because now I have lost a total of 30lbs which is absolutely crazy! I am currently waiting for my next appointment at the end of March where I am hoping to do even better than last time. I am very excited to see where the next few months take me and see what the progress is like so I can reach my end goal in the WLS program!

Weight Loss Surgery Changes the Way Our Bodies Sense Food

Weight Loss Surgery Changes the Way Our Bodies Sense Food.

Bariatric surgery alters patterns of digestion and absorption lower in the gut triggering production of higher levels of gut hormones, altering the way the gut senses food and nutrients.

Gastric bypass surgery causes type 2 diabetes to go into remission in most patients

Gastric bypass surgery causes type 2 diabetes to go into remission in most patients.

A new study published in Diabetologia (the journal of the European Association for the Study of Diabetes) has found that three quarters of individuals with type 2 diabetes (T2D) who were treated with obesity surgery known as Roux-en-Y gastric bypass surgery (RYGB) experienced diabetes remission within one year of treatment.

Plus Size Prom Dress

Shopping for a prom dress is never fun.  Nope.  Never.  No.  

At least that's the impression I have always had. 

I have been through three prom dress purchases with my own girls (and two of my own) -- and I'll tell you -- it would simply be a lot easier to slide into a size __ (...after trying on countless!) rather than having to dig through a vvveeerrrrrry limited number of plus-sized dresses and only getting to try on one or two.   All the girls in the dressing room are picking up size zeroes and twos and fours and some are in tears about needing to get the dresses altered to fit - because - they're just too big.  I am looking around at a sea of teenagers ALL. WEARING. THE. SAME. COLOR. (they always do this) and wonder why it's such a big deal.  (I know, because it's the PROM.  And YOU HAVE TO.  We all - mostly? - do it.)

After getting measured, we find that she's *exactly* a size __ and we ordered the dress she wanted out of the catalog.  It was a bit disheartening to think that the prom is this year - and she doesn't get the chance to do it next year in senior year when she might be post-surgery.  It would be kind of cool to slither into a smaller size, she knows that.  Someone will need to get married or something so we can all get fancied up in a year.  

SO ANYWAY.  We put $100 down, and have to pay the balance when it comes in.  Let's hope it fits!  She matches the EXACT MEASUREMENTS of the dress, sooooo......

 

 

It appears you have to pay to keep your blog active. Hello. *tap tap, is this thing on?*

BABY SHARK DOO DOO DO DOO

 

 

Baby Shark does what?

A post shared by MMBBGC (@mmbbgc) on Apr 12, 2018 at 3:17am PDT

I will find you, BABY SHARK makers.  

This is the first child of mine with early knowledge of YouTube. This kid (like millions out there, is obsessed with toy unboxing videos, specifically dinosaurs if you wanted to know...) and it's all. on. YouTube. 

Thousands of toy unboxing videos, from around the globe, made ... badly.  With the same background music.  "Look at this VELOCIRAPTOR!  LET'S CHECK OUT THE SET!"

I did not even know This Was A Thing, and I used to Make (bad) Review Videos (with no edits, because I don't know how) and here is my 2.5 year old telling me!! to "DINOSAUR SHOW!" and BABY SHARK.  

 

 

 

14 Years.

I didn't make a 12 or 13 year update?  Really?  It might be the distracted distraction: 

It occured to me that I don't have photos to share, partly because I have been sitting at the same. exact. weight. (within five or so pounds) for two-and-a-half years (*see distraction) and there's really nothing to update in that aspect.  

I started "this journey" more than 15 years ago.

 

My highest weight was 320 pounds.  I have reached a low weight of 145 lbs, once.  I gained over 210 lbs. while pregnant in 2006 and 2015. 

 

I have spent the majority of the last 14 years at or about 170 lbs.  

 

All of this is in the history here on the blog.

Self - last week

 

I would say that 170 is my eat-what-you-want and "don't do jack shit for cardio aside from chasing a hyperactive toddler/house cleaning and seizure" weight.

 

What do I eat?

 

Old-lady food.  I still loathe cooking.  I would not cook a thing, ever, if there weren't kids here.  I don't cook much anyway, since I was told "not to ever use a knife unattended" or "a stove," so, I just ... do, but I don't.  If money were no object, I'd be all over home delivery.

 

Coffee with almond milk, tea, whole grain toast, probiotic cottage cheese, frozen meals, chicken salad.

 

I mix it up with a take out meal about once a week, usually a cold sandwich like roast beef and all the veggies or a BLT.  

 

I regret most meals eaten away from home, so I am careful about food choices if we go out.  I trust no one not to kill me.  I dump on the most random things, or have awful reactions later, so I stick with what Should Work.  

 

I'd say I take in 1500 or so calories most days. Today?  

• Dave's Killer Bread + Light Butter
• Two bites protein cookie, the rest donated to the kid
• Frozen chicken a la king, tossed some of the chicken away
• And it's nearing 5pm.  Typical.  I'll eat dinner at bedtime.

 

 

Bob and I at his police graduation, 2017, his 14 years is next month

 

I have that excess 20- 25 lbs hanging around.  I know how to lose it. I don't do it. At least I have not in the last few years. With my last (POST WLS!) baby who is now eleven, I would get walking for miles, but I don't anticipate that happening anytime soon with my special-fall-on-the-ground-head-crack seizures that developed in the last few years (*see the timing correlation?) Well, at least I did it back then and did not realize I was falling down.

 

Christmas Day, 2017 - Myself and all the "kids"

 

I have two cardio machines in the house. I'm not using them and my excuse is the youngest child that climbs on them with me. (YOU HAVE TO KNOW HIM.  HE IS THAT CHILD.)  Getting up before he does or climbing out of bed after he sleeps to exercise is ... not tempting. I'm just not that into it, yet.  Clearly exercise is not a priority. 

 

I think that remaining upright -- is?

*On that topic which some of you don't like to read, but it's a huge part of my life/day -- I'm taking lots of medications, which need a little tinkering (again, usually once a year I'm in the hospital for a tune up) since I am obviously having lots of seizure activity.   I currently take ONFI, Topamax, Banzel, and as needed Lorazepam.  They are treating my various types of seizures.  I just tapered off of a huge amount of Keppra. I suspect these will change in the near future, because me.

 

People ask me if I blame my gastric bypass for this "condition" or it's increasing changes/etc.  No.  I was born with the brain malformation that causes seizures, and at this point in my life I believe I had seizure activity longer than anyone knew (maybe since I was very small, in the form of smaller seizures that no one noticed, I understand the symptoms now) -- but the gastric bypass caused a trigger by changing my gut.  The science shows that the gut can affect the brain -- and I feel that in some way the WLS lowered my seizure threshold by altering my gut, and making my malformation -- "turn on" and show it's full power.  I feel that there's a cure in my lifetime, if it's fecal transplants, brain stimulators or who knows what else - because there are many of us out there with post WLS seizures. 

 

What do you want to know about "long term" post weight loss surgery life?  

 

Any questions, I am a too-open book.  Ask here or Facebook.  Just don't sell me anything unless you plan on sending it to me free.

 

 

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Optimum Nutrition Protein Cake Bites

There was a time, long long ago, where I'd buy a bag of glazed mini-donuts and They Were My Crack.  That waxy chocolate covering -- and cakey interior -- a carby, sugary calorie death.

This is not that product.  That is what triggered me to PICK IT UP.

These "Protein Cake Bites" look suspiciously like a carby-sweet product on the packaging, but I'm going to tell you IT IS A TRICK.

What I found were miniature waxy glazed protein pucks.  The outside is a white yogurt covering with sprinkles, leading to a thick and pasty protein center.  (Not cake. Disappointment.)  It is like you took two scoops of protein, pressed them in an espresso maker with ... oil.  Maybe that's cake enough for you?   

The nutrition, better than cake.  Protein *first*, anyway.  Twenty grams of the stuff - if you eat all 240 calories and three pucks.  I do not feel I could eat more than one at a time, texturally it was a difficult sell.

I had one last night, one in the middle of the night and threw the last away.

For what it's worth, these are better as a snack in the middle of the night than something else (...even if it's not my thing) I might have sitting bedside.  I always have bedside OMG LOW BLOOD SUGAR snacks. They'd probably last a year.  

I have some other flavors to try and for photographing.  I'm a little disappointed because I wanted to enjoy these more.  YouTube told me I should.  

• Product - Optimum Nutrition Protein Cake Bites
• Price - About $2.10 per pack 
• Purchased - Local GNC, here's an Amazon link.
• Pros - Pretty little package, the graphic initially reminded me of donuts from 15 years ago, **sprinkles**, three separate protein snacks in one sleeve, a good to-go shove in your bag snack, 20 grams protein
• Cons - I can't with the texture.  Lots of carbohydrates if you're counting.
• Rating - Pending, based on the next flavor I try.  Maybe this was an off pack?

Bariatric Surgery Alters Gene Expression -- WHAT?

IS THIS GOING TO CHANGE MY 23 & ME?!  

Check it out. Follow.

So my big kids are off in college. (It's been a while since we chatted, internet?) My boy is seeking side photography jobs - and Instagram follows. Follow him and connect via:

 

 

Finally got my new Zeiss 24mm f1.8! The next few posts will be from my shoot with @crosbyevan using the new lens. #inspirationcultmag #streetdreamsmag #urbanandstreet #streets_vision #streetleaks #citylimitless #thecreatorclass #photography #sony #instagood #fstoppers #killyourcity #citykillerz #illgramers #way2ill #agameoftones #urbex #createexplore #exploretocreate #streetactivityteam #streetdreamsmag #neverstopexploring #ig_masterpiece #ig_exquisite #ig_shotz #global_hotshotz #superhubs #main_vision #master_shots #exclusive_shots

A post shared by Nolan Badore (@nolanbadore) on Mar 19, 2018 at 5:48am PDT

HOW MANY MORE? Found Tonight song, March For Our Lives ...

A portion of the proceeds from this record will be going to the March For Our Lives Initiative.

Donate now at https://marchforourlives.com/.

Download/Stream: https://Atlantic.lnk.to/FoundTonightID

Lin-Manuel Miranda & Ben Platt Found/Tonight

IT IS RESOLUTION TIME, BITCHES.

And guess what.

I refuse.  Again.

Resolutions fail.  And we PAY PEOPLE to help us fail.

Suck on that WEIGHT WATCHERS AND YOUR ZERO POINTS PLAN.  (AIN'T NOBODY CAN EAT THAT MUCH CHICKEN OR FRUIT COCKTAIL AND NOT GAIN WEIGHT.)

It's 2018.  I have not blogged in for-ever.  Here's something.

I've maintained this exact weight for two years.  (173 lbs since Elliott was born GOD DAMN IT)  I keep saying that "...if I would just exercise again" I'd be at goal weight immediately.  That is truth -- I have just spent the time peeling my most hyperactive child (of mine) to date from the furniture and ceiling while being sedated with more anti-epileptics and tapering from others.  See also, the spouse who has taken on two new jobs and working near two seven days a week since we last spoke at LEAST.

Maybe there is a "...motivation" in there somewhere.  Maybe it is to Get More Active So I Can See My Goal Weight More Clearly Again while still on too much medication?  That'd work.  I realize that I don't eat out of my range of calories much at all -- my weight does NOT change -- so obviously the movement needs to.So easy it's stupid.  I don't need to pay WW for that.  I just have to do it.  

 

Me, plus all of my crotch-spawn looking like zombies on the holiday.

 

 

 

 

 

Study - Alcohol abuse after gastric bypass - 1 in 5

ONE IN FIVE.  ONE. IN. FIVE.

http://www.soard.org/article/S1550-7289(17)30152-1/fulltext

One in five patients who undergo one of the most popular weight-loss surgical procedures is likely to develop problems with alcohol, with symptoms sometimes not appearing until years after their surgery, according to one of the largest, longest-running studies of adults who got weight-loss surgery.

The finding -- reported online today in Surgery for Obesity and Related Diseases, the journal of the American Society for Metabolic and Bariatric Surgery -- indicates that bariatric surgery patients should receive long-term clinical follow-up to monitor for and treat alcohol use disorder, which includes alcohol abuse and dependence.

"We knew there was an increase in the number of people experiencing problems with alcohol within the first two years of surgery, but we didn't expect the number of affected patients to continue to grow throughout seven years of follow-up," said lead author Wendy C. King, Ph.D., associate professor of epidemiology at the University of Pittsburgh Graduate School of Public Health. She and her team discovered that 20.8 percent of participants developed symptoms of alcohol use disorder within five years of Roux-en-Y gastric bypass (RYGB). In contrast, only 11.3 percent of patients who underwent gastric banding reported problem alcohol use.

Starting in 2006, King and her colleagues followed more than 2,000 patients participating in the National Institutes of Health-funded Longitudinal Assessment of Bariatric Surgery-2 (LABS-2), a prospective observational study of patients undergoing weight-loss surgery at one of 10 hospitals across the United States.

RYGB, a surgical procedure that significantly reduces the size of the stomach and changes connections with the small intestine, was the most popular procedure, with 1,481 participants receiving it. The majority of the remaining participants, 522 people, had a less invasive procedure -- laparoscopic adjustable gastric banding -- where the surgeon inserts an adjustable band around the patient's stomach, lessening the amount of food the stomach can hold. That procedure has become less popular in recent years because it doesn't result in as much weight loss as RYGB.

Both groups of patients increased their alcohol consumption over the seven years of the study; however, there was only an increase in the prevalence of alcohol use disorder symptoms, as measured by the Alcohol Use Disorders Identification Test, following RYGB. Among patients without alcohol problems in the year prior to surgery, RYGB patients had more than double the risk of developing alcohol problems over seven years compared to those who had gastric banding.

"Because alcohol problems may not appear for several years, it is important that doctors routinely ask patients with a history of bariatric surgery about their alcohol consumption and whether they are experiencing symptoms of alcohol use disorder, and are prepared to refer them to treatment," said King.

The American Society for Metabolic and Bariatric Surgery currently recommends that patients be screened for alcohol use disorder before surgery and be made aware of the risk of developing the disorder after surgery. Additionally, the society recommends that high-risk groups be advised to eliminate alcohol consumption following RYGB. However, given the data, King suggests that those who undergo RYGB are a high-risk group, due to the surgery alone.

The LABS-2 study was not designed to determine the reason for the difference in risk of alcohol use disorder between surgical procedures, but previous studies indicate that, compared with banding, RYGB is associated with higher and quicker elevation of alcohol in the blood. Additionally, some animal studies suggest that RYGB may increases alcohol reward sensitivity via changes in genetic expression and the hormone system affecting the areas of the brain associated with reward.

In addition to RYGB, the LABS-2 study identified several personal characteristics that put patients at increased risk for developing problems with alcohol, including being male and younger, and having less of a social support system. Getting divorced, a worsening in mental health post-surgery and increasing alcohol consumption to at least twice a week also were associated with a higher risk of alcohol use disorder symptoms.

King and her team found that although RYGB patients were nearly four times as likely to report having received substance use disorder treatment compared with banding patients, relatively few study participants reported such treatment. Overall, 3.5 percent of RYGB patients reported getting substance use disorder treatment, far less than the 21 percent of patients reporting alcohol problems.

"This indicates that treatment programs are underutilized by bariatric surgery patients with alcohol problems," said King. "That's particularly troubling given the availability of effective treatments."

---

Story Source:

Materials provided by University of Pittsburgh Schools of the Health Sciences. Note: Content may be edited for style and length.

---

Journal Reference:

1. Wendy C. King, Jia-Yuh Chen, Anita P. Courcoulas, Gregory F. Dakin, Scott G. Engel, David R. Flum, Marcelo W. Hinojosa, Melissa A. Kalarchian, Samer G. Mattar, James E. Mitchell, Alfons Pomp, Walter J. Pories, Kristine J. Steffen, Gretchen E. White, Bruce M. Wolfe, Susan Z. Yanovski. Alcohol and other substance use after bariatric surgery: prospective evidence from a U.S. multicenter cohort study. Surgery for Obesity and Related Diseases, 2017; DOI: 10.1016/j.soard.2017.03.021

Related articles

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MRI Machines and Crumbly Bits

I am in my third month of sciatica pain, the kind that makes you consider stomach ulcerations by taking All Of The Ibuprofen In The House over the course of the last twelve weeks.  

After two or three urgent care appointments and an orthopaedic doctor visit, I saw my primary care doctor and asked her what I could do.  I am no longer able to walk normally, lay down or sit.  It is a bit ridiculous how stupid this pain is, if I sit (like right his very moment) it takes me quite a long time to get out of this position and fix my hip, leg and back so that I can move at a decent pace.  If I stay moving, I'm okay.  It is unrealistic to stand and pace every minute of the day so I do get "stuck" like this a few times a day, particularly when this happens:

The primary care physician sent me for an MRI on my lumbar and sacral spine, and it's just a mess.  I already knew I had some degeneration, but it's gotten worse and obviously now there's a nerve root issue.

Super!  GREAT!  Fun!  Love it.  The problem here is that I want my normal range of motion and movement back (HA HA) and without pain relief that works, this is impossible.  Taking NSAIDS after gastric bypass surgery is asking for a bloody ulcerated gut death and I'm currently risking it just to lay down at night. 

I am not writing this for pity - there's a million of you out there with similar conditions, and I was told "GO EXERCISE, THAT WILL FIX YOU!" and yes, please, I want to, but HOLY HELL.  Exercising by just picking up a toddler's thrown breakfast is like being stabbed in the asscheek.  Picking HIM up?  YEEEOUCH.  

Forget pants.  Socks?  Nope.  

"Degenerative disc disease L3-SL L4-5 broad-based central and posterior paracentral disc
protrusion with mild to moderate indentation on ventral thecal sac centrally and
bilaterally slightly greater on the left, with contact on the descending left L5 nerve
root in the lateral recess.
Central and right posterior paracentral L5-S1 disc protrusion with mild indentation on
ventral thecal sac centrally and eccentrically to the right.
Minor L3-4 midline disc protrusion.

The Doctors - A Pacemaker For Obesity

Special Issues for Women After Bariatric Weight-Loss Surgery

Special Issues for Women After Bariatric Weight-Loss Surgery.

Special Issues for Women After Bariatric Weight-Loss Surgery

 

Diane E. Judge, APN/CNP

 

Be prepared to prevent or delay pregnancy and maintain bone health.

 

Bariatric surgery — operations such as gastric sleeve, gastric band, and Roux-en-Y gastric bypass that change the digestive tract — has enabled many obese people to approach and maintain a healthy weight while controlling life-threatening obesity-related medical conditions like heart disease, sleep apnea, diabetes, and high blood pressure. More than half of those who have benefitted from bariatric surgery are women, mostly in their childbearing years. If you are a woman considering bariatric surgery, you should be aware of some special issues.

Choose and Use an Effective Method of Pregnancy Prevention

It's generally a good idea to avoid pregnancy before most surgeries because of the stress placed on your body and the drugs that may be used during and after the operation. Most medical experts agree that women should delay pregnancy for 1 to 2 years after bariatric surgery. This type of surgery enables you to lose weight by altering your body's ability to absorb the nutrients in food — which also means that, if you get pregnant too soon, the fetus might not get the nutrients it needs to grow and develop normally. Once your nutrition has improved (usually with the help of a specialist such as a dietitian), your body can provide a better environment to support a healthy baby.

Even if you were unable to get pregnant before, you will need an effective method of contraception (pregnancy prevention). Women who are very overweight commonly don't release eggs from their ovaries, don't have regular periods, and have difficulty becoming pregnant. With weight loss after bariatric surgery, your ovaries may begin working normally again, making pregnancy possible.

The Most Effective Methods: IUDs and Implants

Whether you don't want to have children or you need to delay pregnancy for a while after surgery, consider one of the “get it and forget it” methods — the intrauterine device (IUD) or implant. These are the most effective methods available and do not require you to do anything other than decide to use them and have them placed (the IUD goes into the uterus, and the implant is inserted under the skin of the upper arm) by a clinician (doctor, nurse practitioner, nurse midwife, or physician assistant) during an office visit. There are several types of IUDs; the longest lasting can prevent pregnancy for up to 12 years. The implant works for up to 5 years. Either method can be removed in a brief office procedure if you are ready to get pregnant or want to stop using it. Your ability to become pregnant should return quickly.

Hormone-Containing Methods: Pill, Patch, Vaginal Ring, Shot

You can also choose to take a pill daily, use a contraceptive patch weekly, insert a vaginal ring monthly, or get a shot every 3 months. These methods are all considered safe after weight-loss surgery. However, some types of bariatric surgery (such as gastric bypass) may decrease the amount of hormones you can absorb from pills; therefore, pills may not work as well as other methods, and it's reasonable to suggest that you choose this option only if you are unable or unwilling to use other methods. The hormones in the patch are absorbed through the skin, those in the ring are absorbed through vaginal tissue, and those in the shot are absorbed from muscle or tissue under the skin. These methods do not depend on the digestive tract, so bariatric surgery does not affect how well they work. You should be aware, however, that some women gain weight with the shot.

If you are not satisfied with the contraceptive method you have chosen, talk to your clinician about changing methods until you find one you're comfortable with and can use correctly and consistently. If you are having unwanted side effects (such as irregular bleeding or spotting with the IUD or shot), check with your clinician to see if these problems can be controlled. Most side effects improve on their own after a few months of method use.

If You Do Become Pregnant

If you get pregnant within a year or two after bariatric surgery, you should work with a clinician and a nutrition expert to make sure you get proper nutrition. You will probably need to take nutritional supplements to provide the correct amounts of vitamins and minerals to the developing fetus. Regular blood tests to check nutrient levels will likely be recommended throughout the pregnancy.

Keeping Your Bones Healthy

Like all women who lose a large amount of weight, those who lose weight after bariatric surgery are apt to experience bone thinning, possibly causing bones to break easily. Although we generally think of osteoporosis (thinning bones) as something that occurs after menopause, even younger women can experience this problem after bariatric surgery. You will probably be advised to take calcium and vitamin D to help prevent bone loss, and the levels of these nutrients in your blood will be tested regularly. If you are postmenopausal (periods have stopped for at least 1 year), your clinician may recommend a test to check your bones before surgery and at regular intervals thereafter. As to when and how often these tests should be done, your clinician's recommendation should be individualized to you.

In addition to the above measures, if you are a smoker, quitting can help keep your bones healthy while also benefitting your health in other ways. Ask for help with smoking cessation; many effective options are available. Avoid excessive alcohol; you should not have more than 2 alcoholic drinks daily and not more than 7 weekly. Regular exercise also helps maintain bone strength.

In Conclusion

Bariatric surgery has many benefits for obese women who have been unable to lose weight and/or have health conditions caused or worsened by excessive weight. After surgery, delaying pregnancy for 1 to 2 years is advisable; you should choose a contraceptive method that will work for you. In addition, be aware that changes in how you absorb vitamins and minerals after surgery may make osteoporosis a possibility. Work with your bariatric surgery team on measures to protect your bone health.

Resources

Association of Reproductive Health Professionals: Choosing a Contraceptive Method

http://www.arhp.org/methodmatch

National Osteoporosis Foundation

https://www.nof.org/patients/treatment/nutrition

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From NYT - Why WLS Works When Diets Don't

Don't shoot the messenger, I'm sharing this for my blog's historical reference because it's AMAZING INFORMATION -- and even if you "don't agree," because it's not your experience, it's science!

Via New York Times - https://nyti.ms/2kBVirc

“Bariatric surgery is probably the most effective intervention we have in health care,” says Laurie K. Twells, a clinical epidemiologist at Memorial University of Newfoundland. She bases this bold claim on her experience with seriously obese patients and a detailed analysis of the best studies yet done showing weight-loss surgery’s ability to reverse the often devastating effects of being extremely overweight on health and quality of life.

“I haven’t come across a patient yet who wouldn’t recommend it,” Dr. Twells said in an interview. “Most say they wish they’d done it 10 years sooner.” She explained that the overwhelming majority of patients who undergo bariatric surgery have spent many years trying — and failing — to lose weight and keep it off. And the reason is not a lack of willpower.

“These patients have lost hundreds of pounds over and over again,” Dr. Twells said. “The weight that it takes them one year to lose is typically back in two months,” often because a body with longstanding obesity defends itself against weight loss by drastically reducing its metabolic rate, an effect not seen after bariatric surgery, which permanently changes the contours of the digestive tract.

In reviewing studies that followed patients for five to 25 years after weight-loss surgery, Dr. Twells and colleagues found major long-lasting benefits to the patients’ health and quality of life. Matched with comparable patients who did not have surgery, those who did fared much better physically, emotionally and socially. They rated themselves as healthier and were less likely to report problems with mobility, pain, daily activities, social interactions and feelings of depression and anxiety, among other factors that can compromise well-being.

Equally important are the undeniable medical benefits of surgically induced weight loss. They include normalizing blood sugar, blood pressure and blood lipid levels and curing sleep apnea. Although bariatric surgery cannot cure Type 2 diabetes, it nearly always puts the disease into remission and slows or prevents the life-threatening damage it can cause to the heart and blood vessels.

 

Even in the small percentage of patients who ultimately lose little weight after surgery, significant metabolic benefits persist, according to findings at the Cleveland Clinic. In a study of 31 obese diabetic patients who had not lost a lot of excess weight five to nine years after surgery, a “modest” weight loss of just 5 to 10 percent resulted in a reduction of cardiovascular risk factors and blood sugar abnormalities, Dr. Stacy Brethauer and colleagues reported.

For the two most popular surgical techniques — the gastric bypass and the gastric sleeve — “the metabolic benefits are independent of weight loss,” Dr. Brethauer said in an interview. Both methods permanently reduce the size of the stomach. However, the gastric band procedure, which is reversible, lacks these benefits unless patients achieve and maintain significant weight loss, he said.

Furthermore, as a study last year of 2,500 surgical patients at the Veterans Affairs Medical Center in Durham, N.C., found, those who underwent bariatric surgery had lower overall death rates up to 14 years later than comparable patients who did not have weight-loss surgery.

Experts in the field regard the reluctance of some medical insurers, including Medicaid programs in many states, to cover the cost of bariatric surgery as a penny-wise, pound-foolish position. Failing to reverse extreme obesity can end up costing far more per patient than the typical $30,000 price tag of bariatric surgery — sometimes even millions of dollars more.

 

Counter to popular impressions that most people treated surgically regain most or all the weight they lose initially, the latest long-term research has shown otherwise. In a decade-long follow-up of 1,787 veterans who underwent gastric bypass, a mere 3.4 percent returned to within 5 percent of their initial weight 10 years later. This finding is especially meaningful because the researchers at the V.A. center in Durham were able to keep track of 82 percent of gastric bypass patients, a task too challenging for most clinics.

The study, by Matthew L. Maciejewski and colleagues published in August in JAMA Surgery, found that 10 years later, more than 70 percent of surgical patients lost more than 20 percent of their starting weight, and about 40 percent had lost more than 30 percent. Gastric bypass, an operation called Roux-en-Y, resulted in a somewhat greater weight loss at 10 years than the newer gastric sleeve surgery and significantly more than the adjustable gastric band (Lap-Band) surgery, which “has fallen out of favor in the last two or three years,” Dr. Maciejewski said.

 

Bariatric surgery, regardless of the method used, is also much safer nowadays than it was even a decade ago, said Dr. Jon C. Gould, a surgeon at the Medical College of Wisconsin in Milwaukee who wrote a commentary on the V.A. study. However, he noted, the surgery is “vastly underutilized,” to the detriment of patients’ health and the nation’s health care costs.

“Less than 1 percent who would qualify for bariatric surgery are actually getting it,” Dr. Gould said. “Although the vast majority have health coverage, insurance companies and many Medicaid programs put it out of reach for most people by demanding that they already have several obesity-related health conditions and are taking a slew of medications to control them.”

 

For example, he said, to be covered for bariatric surgery, Wisconsin Medicaid requires that a person with dangerously high blood pressure has to be taking three or more medications for it and still not have a normal pressure.

He cited a further deterrent to bariatric surgery: “a perception that it’s dangerous and doesn’t work,” beliefs countered by the research findings cited above. Most of the surgeries are now done laparoscopically through tiny incisions.

 

Given the well-documented safety and effectiveness of bariatric surgery, it is now increasingly being performed in people whose obesity is less severe — those with a body mass index (B.M.I.) of 35 or perhaps even less — but who have a metabolic disorder like Type 2 diabetes related to their weight.

In recent years, the profession has promoted what Dr. Gould calls “centers of excellence,” where 100 or more bariatric operations are usually done in a year. Practitioners at these centers “learn from experience, share their knowledge and push for quality improvements,” he said.

Dr. Gould suggested that people interested in bariatric surgery seek out programs that have been jointly accredited by the American College of Surgeons and the American Society for Metabolic and Bariatric Surgery, which have combined forces to promote quality control.

While experts agree that money would be better spent on prevention than treatment, Dr. Twells pointed out that “we have yet to find a way to prevent obesity, and people whose health is compromised by their weight deserve to be treated by the most effective method we have.”

 

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