Lap-Band and Weight Loss Surgeries?

This morning I was saddened to read that yet another woman died after going through lap-band surgery.

The Los Angeles Times reports that Paula Rojeski was 5 foot 5 and weighed approximately 180 pounds which is not significantly overweight in my opinion – at least not overweight enough to go under the knife.

One thing I learned at UCLA as a clinical dietitian is that there is a very fine line between surgery and death.  One should not consider anesthesia unless it is absolutely medically necessary.

Is it medically necessary to lose 30-40 pounds?  It is extremely healthful but not medically necessary.

Many people, including this woman yearned for a better life and thought this would be the magic to take her there.  Sadly, her life ended abruptly.

And the major issue not addressed regarding these surgeries is this:

They treat the symptom, not the cause

You lose weight since your stomach is the size of a walnut, but eventually research shows individuals gain the weight back within 5 years.

In addition, many patients who had this and bypass surgery are now presenting with multiple vitamin/mineral deficiencies, which are difficult to treat.

Healing your relationship with food and figuring out a plan with a qualified health care professional that will support you through the process is the most effective. 

I’ve had many clients lose 30, 50, 100 pounds over time.  Did they struggle?  Absolutely.  Was the process hard?  No question.  Making a lifestyle change is never an easy or a straight road.

We live in a world of instant gratification. 

I want the weight to come off NOW

The turtle wins the race with respect to weight management.  Losing weight where the body is not forced to change quickly allows fat versus muscle mass loss, allowing the body the dignity to change over time.

Why go under the knife to risk your life?  Sure, there are many qualified surgeons who can perform this surgery without complications but there is still the issue of why the problem occurred in the first place.

If you’ve got significant weight to lose, obtaining professional help and support to get you through the tough periods is necessary.

However, your life will be yours and is not put in someone else’s hands to decide your fate.

LAUSD turns down Jamie Oliver

You probably caught an episode or two of Jamie Oliver’s Food Revolution last season in which he successfully changed the school lunch program in West Virginia.  We watched him slowly and methodically change the heart and soul of a small town where obesity and health issues saddened even the most stoic.

This morning’s Los Angeles Times reports the show approached the Los Angeles Unified School District for this season and they were turned down.  They basically said “thanks but it could be too time-consuming.”

Half of my clients are children and adolescents who are struggling with their weight and health issues.  Statistics show this is the first generation of children who will live shorter lives than their parents.

When discussing how my young clients can change their eating, the most challenging meal is lunch at school.  Finding a healthy option is practically impossible when the choices are chicken nuggets, French fries, hamburgers, pasta and pizza.  A fruit or vegetable or even a salad is a rare find.

I analyzed a school lunch menu for a private school in Los Angeles a few years back.  The average lunch contained 1500 calories coming predominantly from fat and starchy carbohydrates.  I was flabbergasted and upon showing the analysis to the school they were as well…and their program was healthier than most.

Children will eat what you feed them.  Even if they rebel initially over time they will eat what is given to them.  How amazing an opportunity Los Angeles has been given to have Jamie Oliver overseeing and training employees how to make healthful delicious food. 

Hopefully the district will reconsider and allow this program, despite the industry glamour, to help create a change.  Our children and their health should be the priority – even if it is too “time-consuming.”  Our children’s time may run short and then who is to blame?

Ilogical Eating

Part of my job is listening to the intimate details of what my clients are eating or not eating.  One of the common threads I hear is something like “I made sure to eat my protein since I had a few slices of bread and dessert at the restaurant.”

While protein is important and does even out the blood sugar while increasing satiation, it can’t make up for overeating starchy foods.

Vice and Virtue   

A recent study reported by Jeannine Stein in the Los Angeles Times showed this exact concept.  Researchers asked participants questions regarding caloric content of “vice” foods like cheese burgers and cheesecake and paired them with other “vice” foods or “virtue” foods such as salads and vegetables.

When the participants paired the vice foods with the virtue foods they lowered the estimated caloric content of the foods.  They believed that adding the virtuous food someone lowered or made up for the over consumption of the vice food.

What was more interesting is that the participants who were dieters knocked off twice as many calories as the non-dieters.  It was almost as if the “virtue” foods cancelled out the calories of the “vice” foods.

Sorry but no Cigar

Unfortunately the body does not respond in this manner.  If you consume 3 slices of bread the body will still secrete insulin to cover that amount of carbohydrate.  If you are insulin resistant, you will gain weight over time even you pair an overabundance of carbs with protein.

If you eat a large Danish pastry for breakfast, combining it with 2 eggs will not cancel out the calories or somehow make the pastry healthier.

The Way Out

The only way to somehow make up for “vice” foods is this – if you have a day of eating more vice foods, follow it up with a few virtuous or clean eating days.  If you know you are going to eat off your regular eating regime or go to a party, plan for it and sandwich it in between clean “virtue” days.

It’s just like having money in the bank – you can’t withdraw unless you have credit.  Eating virtuously for the most part gives you credit and occasional withdrawals.  Keeping a positive balance helps with longevity and health.

Reasonable lifestyle eating includes vice foods within reason and understanding they are the exception and not the rule in fueling one’s body.

Juice equals Soda?

The last 2 lectures I gave were well received, with the individuals open to knowing new information except for one thing that touched a raw nerve – my assessment of drinking juice.  This morning’s Los Angeles Times sums up what I have been saying:  drinking juice is equal to the same amount of sugar as drinking a glass of soda.  This information has not been well received.  Many people like their morning juice!

What exactly are the experts saying? Dr. Charles Billington, a researcher in obesity at the University of Minnesota, quoted in the Times article, states that juice is “pretty much the same as sugar water.”  Think of all the oranges or apples you would have to squeeze to obtain a cup of juice.  You are drinking all the sugar from the juice minus the fiber that helps stabilize your blood sugar when eating the fruit. 

Earlier this year a new study showed that women drinking juice during their pregnancies have a 37% higher rate of gestational diabetes.  Numerous studies show that a high concentration of fructose not only increases fatty liver but also makes your brain deaf to leptin, the hormone that lowers your appetite.  Studies with children drinking juice show they are more than twice as likely to have weight issues as children who don’t consume juice.

So the bottom line on juice?  Enjoy once in a while but stick to drinking water or other beverages without the extra sugar.  Your body and liver will thank you!

Gestational Diabetes

Yesterday’s Los Angeles Times had a review on how treating both mild gestational diabetes in addition to gestational diabetes leads to less preterm births and fewer cases of problems with pregnancy and delivery.

Since pregnancy is a state of insulin resistance, many pregnant women are susceptible to blood sugar changes.  Women with gestational diabetes (diabetes brought on by hormones in pregnancy) have a high propensity to have diabetes later in life.  Gestational diabetes mellitus is defined as carbohydrate intolerance of variable severity with onset of first recognition during pregnancy.

Having gestational diabetes can almost be looked at as a blessing since it is a forewarning and can be treated.  If women with gestational diabetes change their diets and lifestyle both during pregnancy and afterward, they can avoid getting adult onset or Type 2 diabetes in the future.  Of course, this is not always the case, but a diet and exercise alteration now can deter or obliterate diabetes later in life for many women.

Treating gestational diabetes can be as simple as eating more protein with a balance of healthy carbohydrates from vegetables, fruits and dairy products with healthy sources of fats such as nuts, seeds, peanut or other nut butters and avocado. 

Checking the blood sugars one and a half to two hours after eating can also be helpful in terms of knowing how your food is affecting you right now.  It is important to get help from a Registered Dietitian who is familiar with diabetes in pregnancy and can help you stay on track.  I have more detailed information on pregnancy and gestational diabetes in my new book A Recipe for Life by the Doctor’s Dietitian, which became available last week.