Gastric Banding (The LAP-BAND System)

The LAP-BAND System, otherwise known as Lap Band or Lapband, is a device that can be placed around the first part of the stomach during "key-hole" (laparoscopic) surgery for weight loss. The device is actually an adjustable band made of flexible, silicone material. A thin tube connects the band to a port placed under the abdominal skin at the time of surgery. The port allows a surgeon to inflate or deflate the band around the stomach without further surgery, and hence maximise a person's weight loss following the procedure.

The LAP-BAND System (Lap Band) works by forming a small pouch before food passes into the main stomach. This pouch holds less solid food than the stomach, so it makes the person feel “full” earlier. Food in the pouch is emptied more slowly than from the stomach, so the person may also feel “full” for longer following a meal.

The effectiveness of the system does require modification of a person's diet. In particular, high-energy drinks (such as protein shakes, smoothies, meal replacements) should be avoided because they pass straight through the small pouch and do not cause the sense of fullness that leads to weight loss.

There are a number of factors to consider when deciding if this procedure is appropriate. The major indication for laparoscopic banding surgery is for morbidly obese patients to lose weight. The following are some of the main criteria are used to assess if the LAP-BAND System (Lap Band) is appropriate:

 

The LAP-BAND System has been shown to effectively cause weight loss in morbidly obese patients. The average patient will lose 87% of their excess weight after having the LAP-BAND System inserted. This should be compared to a person trying to lose weight by diet, exercise and medication therapy – where the average person will only lose 21% of their excess weight.

Large studies have shown that the average person will lose 23kg following this surgery at 2 years, and up to 43kg at 5 years post-operatively.

The major benefit of the LAP-BAND System is weight loss. It has been used effectively in Australia since 1994. The operation to insert the LAP-BAND System is called gastric banding surgery. This surgery is the simplest of all types of surgery performed for obesity. It is also considered the safest surgery for weight loss. In most cases, patients who have this surgery will only be in hospital for 24 hours.

Following the surgery, a number of other medical problems will be improved in conjunction with weight loss. Studies of patients who have received gastric banding surgery show improvements in the following diseases after 2 years:

Laparoscopic gastric banding surgery for the placement of the LAP-BAND System is a complex procedure. Despite this, the overall rate of complication is low. Every type of surgery carries risk. The risk of death within 30 days of this procedure is very low – less than 0.5%.

The main problems that may occur after surgery are infection (of the wound or the lungs), blood clots (in the legs or lungs) and collapse of the lungs (from the anaesthetic).

There are some specific problems that may occur following gastric banding surgery. In 5 – 10% of patients the band may slip downwards or the pouch of the stomach may dilate. In these situations, another operation is required to adjust the band position. In less than 2% of patients the band may erode into the lining of the stomach. This is a serious complication but is uncommon.

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The formula for calculating your body mass index is:
BMI = weight (kilograms) / (height (metres) * height (metres))

For example:
A man who weighs 85 kilograms and is 1.8 metres tall would have a BMI of
BMI = 85 / (1.8 * 1.8)
BMI = 85 / 3.24
BMI = 26.2

This information will be collected for educational purposes, however it will remain anonymous.

   Kral J. ABC of Obesity: Management: Part III – Surgery [5th article in series] British Medical Journal. 2006; 333; 900-3. Available online [http://www.bmj.com]Sjorstom L, Lindroos A, Peltonen M, Torgson J, Bouchard C, Carlsson B, et al Lifestyle, diabtes and cardiovascular risk factors 10 years after bariatric surgery. New England Journal of Medicine. 2004; 351(26): 2683-93.O’Brien P. (2007) The LAP-BAND Solution – A partnership for weight loss.Northern Rivers General Practice Network (cited 12th December 2007) What GPs should know about lap banding. Available online [http://www.medicineau.net.au/clinical/obesity/obesit3160.html]Allergan Australia (2007) About laparoscopic gastric banding [cited 11th December 2007] Available online [http://www.gastricbandingsurgery.com.au/about_gastric_banding.php]Wilkinson, S. (cited December 21st 2007) Obesity Surgery: Lap-Band Surgery, Am I a suitable candidate? Available online: [http://www.tasmaniaobesitysurgery.com.au/lapband.html]National Health and Medical Research Council (2003) Clinical Practice Guidelines for the management of overweight and obesity in Australia [update 19th March 2004] Commonwealth of Australia, Department of Health and Ageing [Available online: www.obesityguidelines.gov.au ]O’Brien P. Treatment of mild to moderate obesity with laparoscopic adjustable banding or an intensive medical program: a randomized trial. Annals of Internal Medicine. 2006; 144(9): 625-33.Colquitt, J. Clegg, A. Loveman, E. Royle, P. Sidhu, M. (2005) Surgery for morbid obesity. [Cochrane clinical review] Available online: [http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD003641/frame.html]Morris, P. Wood, W. (2000) [2nd edition] Oxford textbook of Surgery: Chapter 25; Surgery for Obesity [chapter author Grace, M.] Oxford University Press: Oxford.Allergan Australia (2007) About laparoscopic gastric banding [cited 11th December 2007] Available online [http://www.gastricbandingsurgery.com.au/about_gastric_banding.php]Allergan Australia (2003) LAP-BAND Data Sheet.

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LDL (Low Density Lipoprotein) Cholesterol Lowering

 

LDL cholesterol lowering drugs are commonly prescribed to people with high levels of LDL (low density lipoprotein) cholesterol.

When too much LDL cholesterol is present in the blood, it can begin to build up in the inner walls of the arteries that feed the heart and brain. Together with other substances, it can form atherosclerotic plaques, a sort of thick, hard deposit that can clog arteries and lead to problems such as coronary heart disease and stroke.

Previous research has demonstrated that lowering LDL cholesterol reduces the progression of heart disease and death rate.   

Cholesterol is a waxy, fat-like substance that is naturally found in the body's cell walls. The level of cholesterol in the body is determined by two things: the amount of cholesterol that we absorb in our intestines, and the amount that we produce in our liver. Having some cholesterol in the body is normal and healthy - we need it to produce certain hormones, vitamin D, and bile acids that help to digest fat.

If we have too much cholesterol, it can build up in arteries and lead to coronary heart disease and many other serious conditions. There are two major types of cholesterol found in the blood: low-density lipoprotein (LDL) cholesterol, sometimes referred to as 'bad' cholesterol, and high density lipoprotein (HDL) cholesterol, or 'good' cholesterol.

LDL cholesterol is called 'bad' because it is a major contributor to the development of atherosclerosis - the sticky plaques that can form inside blood vessels and contribute to problems like stroke. HDL cholesterol is 'good' because it helps remove cholesterol from these developing plaques, taking it back to the liver to be excreted from the body in bile. Levels of HDL in the body can be raised by things like exercise, and lowered by smoking.

Why lower LDL cholesterol?

Lowering LDL cholesterol levels in the blood can have a number of positive effects for your health, including: Reducing the number and extent of sticky cholesterol plaques on artery walls; Stopping existing plaques from rupturing, which can cause problems with formation of blood clots; Decreasing the risk of developing problems such as heart attack and stroke.

This information will be collected for educational purposes, however it will remain anonymous.

  

How can my level of LDL cholesterol be lowered?

Other than drugs, there are a number of lifestyle changes that can be made to help lower LDL cholesterol levels. These include:

Healthy Eating: A low-fat, high fibre diet, staying away from greasy foods and eating more vegetables, can drastically improve cardiac health. For more details and help with regards to diet, see you general practitioner. Fish Oil and Fish: Eating fish twice a week helps to lower cholesterol levels. This can also enhance the effects of medication. Plant Sterols: These can be found in some margarines and help reduce the absorption of cholesterol. Stop Smoking: Stopping smoking is vital to cardiac health as well as overall well-being. It is strongly encouraged that all patients quit smoking. There are various methods for helping with this that can be discussed with your GP. Physical Activity: Moderate to intense physical activity of at least 30 minutes should be undertaken on most, if not all, days. Weight Reduction: While this should come from improved diet and exercise, weight reduction plays an important role in the reduction of LDL cholesterol levels. Alcohol: Alcohol should be drunk in moderation, especially if you have a high level of triglycerides.Salt: Reducing salt intake has been shown to lower high blood pressure, and thus reduce general cardiovascular risk.

Sometimes, though, these lifestyle changes are not enough, and your doctor might prescribe a type of cholesterol-lowering drug to help lower your cholesterol levels.

The most commonly used type of cholesterol-lowering drugs are called statins (sometimes also known as HMG CoA reductase inhibitors). Other drugs used include fibric acid derivatives, bile acid sequestrants, cholesterol absorption inhibitors, and nicotinic acid. These drugs act in different ways, and produce different degrees and types of cholesterol lowering.

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CHD or CHD risk equivalent:
- Coronary heart disease
- Carotid artery disease (symptomatic)
- Peripheral arterial disease
- Abdominal aortic aneurysm
- DiabetesBP >140/90 or on antihypertensivesYounger than 45 for men or 55 for women.45 or older for men or 55 or older for women.

Use the table above to work out how many points you have.

If you have 6 points or over then you are Category 1.

If you scored 2 to 6 points then you are Category 2.

For people who are Category 2 you need to use our Ten year risk tool to work out your Cardiovascular disease ten year risk. If your risk is less than 10% then you are Category 2b. If your risk is 10% or greater then you are Category 2a.

If you scored less than 2 points then you are Category 3.

LDL goal: <100 mg/dL
If your LDL level is greater than this you should consult you local health professional who can give you advice on lifestyle changes and/or medications that may be beneficial.LDL goal: <130 mg/dL
If your LDL level is greater than this you should consult you local health professional who can give you advice on lifestyle changes and/or medications that may be beneficial.LDL goal: <130 mg/dL
If your LDL level is greater than this you should consult you local health professional who can give you advice on lifestyle changes and/or medications that may be beneficial.LDL goal: <160 mg/dL
If your LDL level is greater than this you should consult you local health professional who can give you advice on lifestyle changes and/or medications that may be beneficial.

This information will be collected for educational purposes, however it will remain anonymous.

Many trials have been conducted to look at the benefits for patients of taking cholesterol lowering medications. Some of the results are summarised below:

The Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis in Myocardial Infarction 22 (PROVE IT-TIMI 22) trial in Boston compared a high-dose statin treatment to a low-dose statin treatment. The higher dose provided greater protection against death, heart attack, chest pain requiring hospital admission, and stroke; and improved outcomes over two years among patients with acute heart disease. Another group of researchers from the United States showed in their trial, the Treating to New Targets (TNT) trial, that intensive lipid-lowering treatment provides more significant clinical benefit compared with a lower dose of statin drug. The Heart Protection Study in the UK showed that lowering LDL cholesterol from below 3 mmol/L to below 2 mmol/L reduced the risk of heart disease by about one quarter.

Overall, the results of these trials suggest that intensive therapy to lower LDL cholesterol levels is beneficial in treating both acute and stable heart disease. They also suggest that high-risk patients may benefit from more extensive lowering of LDL-cholesterol than was once thought necessary.

For more information on cholesterol, including the health effects of high cholesterol and ways to lower cholesterol levels, as well as some useful tools, see Cholesterol.Brown AS, Bakker-Arkema RG, Yellen L, et al. Treating patients with documented atherosclerosis to National Cholesterol Education Program-recommended low-density-lipoprotein cholesterol goals with atorvastatin, fluvastatin, lovastatin and simvastatin. J Am Coll Cardiol. 1998; 32: 665. Cannon CP, Braunwald E, McCabe CH, et al. Intensive versus moderate lipid lowering with statins after acute coronary syndromes. N Engl J Med. 2004; 350(15): 1495-504. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA. 2001; 285: 2486-97. Heart Foundation Australia. Lipid Management Guidelines 2001. Medical Journal of Australia. 2001; 175: S57-S88.Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high risk individuals: A randomised placebo-controlled trial. Lancet. 2002; 360: 7-22M. Kastelein JJ, Isaacsohn JL, Ose L, et al. Comparison of effects of simvastatin versus atorvastatin on high-density lipoprotein cholesterol and apolipoprotein A-I levels. Am J Cardiol. 2000; 86: 221. LaRosa JC, Grundy SM, Waters DD, et al. Intensive lipid lowering with atorvastatin in patients with stable coronary disease. N Engl J Med. 2005; 352(14): 1425-34. Ray KK, Cannon CP, McCabe CH, et al. Early and late benefits of high dose atorvastatin in patients with acute coronary syndromes: results from the PROVE IT-TIMI 22 trial. J Am Coll Cardiol. 2005; 46(8): 1405-10. Sacks FM, Tonkin AM, Shepherd J, et al, for the Prospective Pravastatin Pooling Project Investigators Group. Effect of pravastatin on coronary disease events in subgroups defined by coronary risk. Circulation. 2000; 102: 1893.Wood D, De Backer G, Faergeman 0, et al. Prevention of coronary heart disease in clinical practice: recommendations of the Second Joint Task Force of European and other Societies on coronary prevention. Eur Heart. 1998; 19: 1434-503.

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Liposuction

Liposuction is a cosmetic surgery procedure which involves the removal of excess body fat from under the skin from various parts of the body using a cannula and a suction device. The most common areas that are treated are the abdomen, thighs, buttocks, arms and neck. Liposuction is the most popular cosmetic surgery performed worldwide and is usually done to improve the appearance of distorted body shapes and remove pockets of fat that are difficult to eliminate with diet and exercise. It is also known as body contouring as it can be used to contour the chin, neck, cheeks, ankles, calves, and breasts. It should not be considered as a method of weight loss.

The first liposuction procedures were performed in the early 1980s and were done under general anaesthesia, however they were often associated with serious complications and a high risk of death. New treatments have revolutionised liposuction and it is now considered to be a very safe procedure that can be performed in an office environment with minimal recovery time.

There are a number of liposuction techniques that may be used depending on the site and how much fat is to be removed. They include:

tumescent liposuctionwet liposuctionsuperwet liposuctionultrasound assisted liposuctionpower assisted liposuctionlaser assisted liposuction

Tumescent liposuction is the most common type of liposuction. It involves injecting a large amount of fluid (3-4 times the volume of the fat being removed) made up of a salt solution containing a mix of local anaesthetic and epinephrine into the areas before the fat is removed. The anaesthetic numbs the area and the purpose of the epinephrine is to minimise bruising, swelling and blood loss. Injection of the fluid creates space between the muscle and fatty tissue for the cannula. This form of liposuction usually takes longer than others as the fluid must be injected slowly. However it has the fastest recovery time and least amount of complications.

The super-wet technique is similar to tumescent liposuction except that not as much fluid is used, the amount of fluid injected is about equal to the amount of fat to be removed. This technique takes less time however it usually requires sedation with general anaesthesia.

Ultrasound or ultrasonic-assisted liposuction (UAL) is a fairly recent technique introduced in 1996. It involves exposing fat cells to ultrasonic vibrations which supposedly liquefy fat cells, thereby facilitating aspiration.  This can be done internally through the cannula which transmits ultrasound vibrations under the skin, or by external exposure. This technique may be useful in the removal of fat from dense or fibrous areas of the body such as the upper back or male breast tissue. UAL is often used in conjunction with the tumescent technique or in follow-up procedures. Little benefit is achieved from this procedure and it has been associated with cutaneous burns and higher risk of seroma formation.

Power-assisted liposuction (PAL) is a new technology which utilises a motor-driven, reciprocating cannula attached to a standard aspirator. This reduces the workload on the surgeon as it limits the physical movements that must be made. In addition, it allows the surgeon to remove fat more completely in tight areas where forceful cannula movements are difficult because of physical space constraints. This new technology has been shown to have significant benefits over traditional cannulas.

The newest liposuction technique is Laser-assisted liposuction which works by focusing low energy waves from a laser onto the parts of the body that require treatment. This causes the fat cells to weaken and burst. Like UAL this technique can be used in conjunction to other liposuction procedures. This technique has the advantage of producing much less swelling and bruising and hence a faster recovery time.

Liposuction is a cosmetic surgery used to remove localised accumulations of fat that are resistant to diet and exercise. Liposuction is not a weight loss strategy, substitute for exercise or cure for obesity. It also does not have any effect on cellulite or stretch marks.

Generally anyone with good health physically and mentally can have the procedure done however a patient must go through extensive counselling prior to undergoing surgery to ensure they are suitable.

An ideal candidate for liposuction would have:

normal-weight or slightly-overweight with localised pockets of excess fat in certain areasgenerally healthy and doe not have significant medical problemselastic skinrealistic expectationsis over 18age is not a major factor, although older persons with diminished skin elasticity may not have the same results as persons with tighter skinhas tried diet and exercisehas a stable weight and has a regular exercise routinedoes not suffer from diabetes, coagulation disorders, cardiovascular disease or any infectious diseaseis not pregnant

These are only a guide; however patients that fill these criteria will have a more optimal result.

Liposuction is also suitable for the treatment of other conditions such as breast reduction in men, gynecomastia, removal of lipomas and angiolipoma, hematoma evacuation and improving hyperhidrosis of axillae.

Prior to admitting a patient for a liposuction procedure, a medical history, physical examination and psychological assessment must be undertaken.

Liposuction is contraindicated in patients with severe cardiovascular disease, severe coagulation disorders including thrombophilia, and during pregnancy.Patients with any history of the following conditions must receive medical clearance before undergoing liposuction:

bleeding diathesisembolithrombophlebitisinfectious diseasespoor wound healingdiabetes mellitusheart problemshigh blood pressureDiabetesAllergic reactions to medicationsPulmonary problems  Smoking, alcohol, or drug use

Surgery may be performed in an office, an outpatient facility, or a hospital. Usually liposuction of smaller volumes are done as an outpatient while larger volumes require a stay in hospital to monitor fluid levels and if patients are suffering from any other medical conditions. Depending on how many sites will be treated, the surgery time may range from 1-4 hours.

Markings are made on the skin as a guide to where fat is to be removed. Depending on which procedure is used a general anaesthetic is administered, or for the tumescent technique, a fluid consisting of a salt solution or local anaesthetic and epinephrine is injected into the area being liposuctioned. Small incisions are made in the skin through which a cannula is inserted. The cannula is attached to vacuum pump which can suction out the fat cells as the surgeon moves it back and forth. After the fat is removed, small drainage tubes may be inserted which remove any blood and fluid which has accumulated. If a lot of fluid is lost then a blood transfusion or IV fluid replacement may be needed.

Volumes of fat removed should not exceed five litres especially in patients with comorbidities. Generally, removal of larger volumes is associated with a higher risk of complications mainly due to the fact that this requires general anaesthesia as opposed to local anaesthesia.

Following surgery, bandages are applied to stop any bleeding and keep pressure on the area. These usually are left on for about two weeks. Depending on the extent of the surgery and how much fat was removed the patient may be required to stay overnight in hospital.

It must also be determined whether any previous abdominal surgery has been performed and any problems from past surgical procedures that may influence complications.

Medications that affect blood clotting such as aspirin, anti-coagulants, non-steroidal anti-inflammatory agents and vitamin E, as well as other vitamins and herbs must be ceased two weeks prior to surgery. Depending on the extent of the liposuction to be done, the contraceptive pill may have to be ceased as well.

Physical evaluation

An assessment of general physical health is necessary to determine whether a patient is a suitable candidate for surgery. The specific sites that are being considered for liposuction are examined for potential problems. Skin tone and elasticity is assessed as well as the presence of hernias, scarring, cellulite and stretch marks. If patients have poor skin elasticity they are informed that following surgery they may have skin draping which may need further surgical correction.

Psychological assessment

Inquires are made about diet and exercise habits and any history of weight gain and loss as this can affect the long term success of the procedure. Patients are counselled on the limitations and risks associated liposuction. Their expectations are determined to ensure they are realistic and are aware that full results may take up to 12 weeks to be seen. Liposuction does not result in any significant weight loss and patients should also be aware that fat removed may return if excess weight is put on.

Blood tests

Some general blood tests are carried out to ensure potential candidates are in good health. Selection blood tests to be performed depends on the type and extent of the liposuction procedure and the conditions revealed in the history and physical examination. Usually a complete blood cell count with quantitative platelet assessment, prothrombin time, partial thromboplastintime, liver function tests, pregnancy test for women of child bearing age are performed.

Some common minor side effects that can occur which are usually not permanent or life threatening and are a normal consequence of the surgery include:

Bruising which should fade after a few weeksSwelling which should subside gradually over a month or twoScars varying in size depending on the particular procedure but should fade over the weeks. Scarring depends on the individual as it is partly dependent on heredity. In some people it may take up to a year to heal.Pain which should be temporary and can be ontrolled by either over-the-counter medicationNumbness which may persists for a few weeksLimited mobility 

Liposuction is associated with several risks and complications, many of which are rare and are dependant on the extent and type of procedure. As there is no central registry for reporting of these it is difficult to ascertain the likelihoood or frequency of them. It appears that prolonged procedures and aspirate volumes greater than five litres seem to be associated with higher complication rates. Limiting the volume of aspirate and using local rather than general anesthesia can reduce the risk of some of the major complications such as embolism and death.

A national survey of plastic surgeons found that the most common complications were:

contour irregularitiesunplanned hospital admissionsprolonged swelling

Other complications include:

patient dissatisfactionunfavorable aesthetic results- irregularities in the skin surface following excessive or subdermal liposuction asymmetry, dimpling, lumpiness and waviness and skin laxityhyperpigmentationscarring- incisions usually heal however patient can develop hypertrophic scarring following inadvertent injury to overlying skin through superficial liposuction or UALhematomasseromasinfectionsskin burns, particularly in the use of UAL devicesSkin necrosis- superficial liposuction, overzealous subdermal fat thinning, liposuction in areas of prior incision scars, and UAL can result in partial-thickness and full-thickness skin necrosisnecrotizing fasciitiscerebrovascular accident or transient ischemic attackpulmonary thromboembolismpulmonary fat embolismbleeding, especially if large amounts of fat are removedShock if not enough fluid is replaced during the surgeryFluid overloadtransfusion complicationdeep vein thrombosisDrug toxicity, the patient can react to the anaesthetic or epinephrinetoxic shock syndromeNerve damagethoracic and abdominal cavity perforationaortic perforationacute renal failure

Overall revision or re-operative rates range from 5-15%. Rates of serious or fatal complications are in the range of 0.02% to 0.3% and are predominantly attributed to pulmonary embolus, fat embolus, abdominal perforation, anesthesia.

Following surgery compression garments are applied to the areas that have been treated to reduce swelling and support the skin as it readjusts to the new contour. These usually need to be left on for 2-3 weeks. There is likely to be swelling, bruising, pain and numbness for a few weeks after surgery. Pain medication can be prescribed as well as antibiotics to prevent infection.

Patients can return to work and resume their normal activities within a few days after the procedure. Strenuous excercise should be avoided however walking soon after surgery is advised to prevent blood clots. It may take up to 3-6 months to see the final result of the surgery as swelling subsides and skin contraction occurs. The final outcome generally depends on age, skin elasticity, volume of fat removed and the area it is removed from, with the best results are generally seen in younger patients of normal weight and who have had a small volume of fat removed. Maintaining a healthy lifestyle with regular excersise all aid in improving the final outcome.

For more information on obesity, health and social issues, and methods of weight loss, as well as some useful tools, see Obesity and Weight Loss.  Coleman WP, Glogau RG, Klein JA, Moy RL, Narins RS, Chuang T, Farmer ER, Lewis CW, Lowery BJ and the Guidelines/Outcomes Committee. Guidelines of care for liposuction. American Academy of Cosmetic Surgery.Flynn TC, Coleman WP, field LM, Klein JA and Hanke CW. History of liposuction. Dermatol Surg.; 2000; 26(6); p. 515-520.http://www.plasticsurgery.org.au/procedures/liposuction.htmlSattler G. Advances in liposuction and fat Transfer. Dermatology Nursing; Apr 2005; 17(2); p. 133-139.Jayashree V and Mysore V. Microcannular tumescent liposuction
Indian Journal of Dermatology. 2007; 73 (6); p. 377-383.Guidelines for Liposuction Surgery. 2006. The American Academy of Cosmetic Surgery.
Available from: http://www.cosmeticsurgery.org/Media/2006 Liposuction Guidelines.pdfKatz BE, Bruck MC, Felnsfield L and Prew KE. Power liposuction: a report on complications. Dermatol Surg; 2003; 29; p. 925–927.Prado A, Andrades P, Danilla S, Leniz P, Castillo P and Gaete F. A prospective, randomized, double-blind, controlled clinical trial comparing laser-assisted lipoplasty with suction-assisted lipoplasty. Plastic & Reconstructive Surgery. 2006; 118(4); p. 1032-1045.Matarasso A and Hutchinson OHZ. Liposuction. JAMA. 2001; 285(3); p. 266-268.Flynn TC and Narins S. Preoperative evaluation of the liposuction patient. Dermatologic Clinics. 1999; 17(4); p.729-734.Cowles RA. Liposuction. Updated 5/3/2007 http://www.nlm.nih.gov/medlineplus/ency/article/002985.htm updated 5/3/07

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Moving more may lower stroke risk

Here’s yet another reason to get off the couch: new research findings suggest that regularly breaking a sweat may lower the risk of having a stroke.

A stroke can occur when a blood vessel in the brain gets blocked. As a result, nearby brain cells will die after not getting enough oxygen and other nutrients. A number of risk factors for stroke have been identified, including smoking, high blood pressure, diabetes and being inactive.

For this study, published in the journal Stroke, Michelle N. McDonnell, Ph.D., from the University of South Australia, Adelaide and her colleagues obtained data from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. REGARDS is a large, long-term study funded by the NIH National Institute of Neurological Disorders and Stroke (NINDS) to look at the reasons behind the higher rates of stroke mortality among African-Americans and other residents living in the Southeastern United States.

“Epidemiological studies such as REGARDS provide an important opportunity to explore race, genetics, environmental, and lifestyle choices as stroke risk factors,” said Claudia Moy, Ph.D., program director at NINDS.

Over 30,000 participants supplied their medical history over the phone. The researchers also visited them to obtain health measures such as body mass index and blood pressure. At the beginning of the study, the researchers asked participants how many times per week they exercised vigorously enough to work up a sweat. The researchers contacted participants every six months to see if they had experienced a stroke or a mini-stroke known as a transient ischemic attack (TIA). To confirm their responses, the researchers reviewed participants’ medical records.

The researchers reported data for over 27,000 participants who were stroke-free at the start of the study and followed for an average of 5.7 years. One-third of participants reported exercising less than once a week. Study subjects who were inactive were 20 percent more likely to experience a stroke or TIA than participants who exercised four or more times a week.

The findings revealed that regular, moderately vigorous exercise, enough to break a sweat, was linked to reduced risk of stroke. Part of the protective effect was due to lower rates of known stroke risk factors such as hypertension, diabetes, obesity and smoking.

“Our results confirm other research findings but our study has the distinct advantage of including larger numbers, especially larger numbers of women as well as blacks, in a national population sample so these provide somewhat more generalizable results than other studies,” said Virginia Howard, Ph.D., senior author of the study from the School of Public Health, University of Alabama at Birmingham.

The researchers also looked at the data according to gender. After the researchers accounted for age, race, socioeconomic factors (education and income) and stroke risk factors, the results revealed that men who exercised at least four times a week still had a lower risk of stroke than men who exercised one to three times per week. In contrast, there was no association between frequency of exercise and stroke risk among women in the study. However, there was a trend towards a similar reduction in stroke risk for those who exercised one to three times a week and four or more times a week compared to those who were inactive.

“This could be related to differences in the type, duration, and intensity of physical activity between men and women,” said Dr. Howard. “This could also be due to differences in the perception of what is intense physical activity enough to work up a sweat.”

The results should encourage doctors to stress the importance of exercise when speaking with their patients, Dr. Howard said.

“Physical inactivity is a major modifiable risk factor for stroke. This should be emphasized in routine physician check-ups along with general education about the benefits of exercise on stroke risk factors including high blood pressure, diabetes and being overweight or obese,” she said.

The study suggests that men should consider exercising at least four times a week. 

REGARDS will continue to assess stroke risk factors to look for long-term patterns in the study population. “Findings from this study, including the current physical activity results, will ultimately help us to identify potential targets for immediate intervention as well as for future clinical trials aimed at preventing stroke and its consequences,” said Dr. Moy.

Source National Institue of Neurological Disorders and Stroke

Article Date: 23/7/2013

View the original article here

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Morbid obese women on the rise

A Deakin University study has found that the rate of morbid obesity in women increased by almost 70 per cent over a 10 year period.

Researchers with Deakin’s School of Medicine monitored the height and weight of 1,494 women in 1993-1997 and 1,076 in 2004-2008 to determine any shift in body mass index (BMI). They found the average BMI increased from 26 to 27.1, while the rate of morbid obesity rose from 2.5 per cent to 4.2 per cent of the women in the study.

With obesity continuing to be one of the biggest health issues facing Australians, Deakin’s Associate Professor Julie Pasco said it was important that we monitor not only the growing rates of obesity generally, but also keep a close eye on the rates of morbid obesity.

“We tend to monitor obesity based on the proportion of the population whose BMI exceeds 30. What this fails to measure is the number of people who are morbidly obese, that is those whose BMI in greater than 40,” Associate Professor Pasco explained.

“It is important that we monitor the growing number of people who are morbidly obese as the adverse health risks amplify as the level of obesity increases.

“Obesity-related health expenditure exceeded $8billion in 2008 and we are seeing service providers increasingly having to invest in equipment designed to accommodate the morbidly obese. It is therefore not unreasonable to expect that with rates of morbid obesity on the rise, the direct and indirect costs will also increase.”

For this study the researchers set out to determine how the prevalence of morbid obesity, as indicated by a BMI greater than 40, had changed over a decade among women living in south-eastern Australia.

The study looked at the BMI of women involved in the Geelong Osteoporosis Study (see more about this study below), during two time periods, ten years apart. Height and weight measurements for 1,494 women (aged 20—94 years) during 1993—1997 and for 1, 076 women (aged 20—93 years) during 2004—2008, to see if there had been any changes in BMI.

The researchers found that average BMI increased from 26 in 1993-7 to 27.1 in 2004-8. The prevalence of morbid obesity increased from 2.5 per cent to 4.2 per cent of the women in the study. The increase in BMI and prevalence of morbid obesity were seen for all ages and across the socioeconomic spectrum.

“The results of our study highlight the growing problem of morbid obesity,” Associate Professor Pasco said.

“The challenge continues to be to identify and implement effective strategies for the whole community that will shift the scales in the direction of lowering the rates of obesity and most particularly morbid obesity.”

Source: Deakin University Australia

Article Date: 23/4/2013

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Consumers largely underestimating calorie content of fast foodnbsp;

People eating at fast food restaurants largely underestimate the calorie content of meals, especially large ones, according to a paper published on bmj.com.

From 2006 to 2010 many American states and cities passed laws requiring chain restaurants to print calorie content on menus. The US Patient Protection and Affordable Care Act of 2010 included a provision that will require all restaurant chains with more than 20 US Sites to print calorie content on menus.

Previous research has shown that adults and children underestimate calorie content often by large amounts. However, these studies did not monitor consumer choices at restaurants or focused on a narrow range of fast food restaurants or individuals.

Researchers therefore carried out a large cross sectional study of repeated visits to fast food restaurant chains in 89 restaurants across the New England region of America: McDonald’s, Burger King, Wendy’s, KFC, Subway and Dunkin’ Donuts. At the time of data collection, none of the chains routinely printed calorie content on menus.

Researchers enrolled a diverse group of adults (>18 years old), adolescents (aged 11-20) and school age children (3-15 years old). They collected receipts from participants to calculate the calorie content of their meals, and they administered a short questionnaire which included a question asking participants to estimate the calorie content of their meal. Parents provided answers for the school age children. The final sample size was 1877 adults, 1178 adolescents and 330 school age children.

Among adult participants, 65% were either overweight or obese, as were 34% of adolescents and 57% of school age children. Less than one quarter of participants reported noticing calorie information in the restaurants, and less than 5% reported using it to help them choose their meal.

The mean calorie content of meals was 836 for adults, 756 for adolescents and 733 for children. On average, adults, adolescents, and parents of school-age children underestimated calorie content by 175 calories, 259 calories and 175 calories, respectively. Two thirds of all participants underestimated the calorie content of their meals with approximately one quarter underestimating the calorie content by at least 500 calories. Participants consuming high calorie meals underestimated by a greater amount than small calorie meals. Underestimation was greater among Subway diners than at any other chain. Adults and adolescents eating at Subway underestimated by 20% and 25% more than those at McDonald’s.

(Source: BMJ)

For more information on obesity, health and social issues, and methods of weight loss, as well as some useful tools, see Obesity and Weight Loss.For more information on nutrition, including information on types and composition of food, nutrition and people, conditions related to nutrition, and diets and recipes, as well as some useful videos and tools, see Nutrition. 
Article Date: 24/6/2013

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Recommended calorie information on menus does not improve consumer choices

Despite the lack of any concrete evidence that menu labels encourage consumers to make healthier food choices, they have become a popular tool for policymakers in the fight against obesity.

Carnegie Mellon University researchers recently put menu labels to the test by investigating whether providing diners with recommended calorie intake information along with the menu items caloric content would improve their food choices. The study, published in the American Journal of Public Health, showed that recommended calorie intake information did not help consumers use menu labeling more effectively.

“There have been high hopes that menu labeling could be a key tool to help combat high obesity levels in this country, and many people do appreciate having that information available. Unfortunately, this approach doesn’t appear to be helping to reduce consumption very much, even when we give consumers what policymakers thought might help: some guidance for how many calories they should be eating,” said the study’s lead author Julie Downs, associate research professor of social and decision sciences in CMU’s Dietrich College of Humanities and Social Sciences.

For the study, Downs and the research team analyzed the purchase behaviors of 1,121 adult lunchtime diners at two McDonald’s restaurants in New York City. To explore the potential interaction between pre-existing menu labeling and the addition of recommended calorie intake information, three groups of diners received different information: (1) recommended daily calorie intake; (2) recommended per-meal calorie intake; and (3) no additional information. Survey data also was gathered to capture the diners’ understanding of calorie consumption.

The results showed no interaction between the use of calorie recommendations and the pre-existing menu labels, suggesting that incorporating calorie recommendations did not help customers make better use of the information provided on calorie-labeled menus. Further, providing calorie recommendations, whether calories per-day or per-meal, did not show a reduction in the number of calories purchased.

“People who count calories know that this is a pretty labor-intensive exercise,” Downs said. “Making the information available on menus may have other beneficial effects, such as motivating restaurants to change their formulations. But it may be unrealistic to expect many consumers to keep such close, numeric track of their food intake by using the labels directly.”

Source Carnegie Mellon University

Article Date: 22/7/2013

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Just weight until menopause

Women tend to carry excess fat in their hips and thighs, while men tend to carry it on their stomachs. But after menopause, things start to change: many women's fat storage patterns start to resemble those of men. This indicates that there's a link between estrogen and body fat storage. This connection is well documented, but the underlying mechanisms remained poorly understood until now.

New research conducted by Sylvia Santosa, assistant professor in Concordia University's Department of Exercise Science and Canada Research Chair in Clinical Nutrition, gives us a new look at the connection between fat storage and estrogen. By examining the fat storage process at a cellular level, Santosa and co-author Michael D. Jensen of the Mayo Clinic in Rochester, Minnesota, reveal that certain proteins and enzymes are more active in post-menopausal women. These proteins correspond with fat storage. Their findings were published in the March 2013 issue of Diabetes.

"The fat stored on our hips and thighs, is relatively harmless," explains Santosa, who is also a member of Concordia's PERFORM Centre for better health through prevention. "But the fat stored around the abdomen is more dangerous. It has been associated with diabetes, heart disease, stroke and even some cancers. When post-menopausal women put on more abdominal fat, they dramatically increase their risk for these health problems. Given these dangers, it is very important to understand the how the lower levels of estrogen associated with menopause changes where fat is stored."

Santosa's research compared fat storage in pre- and post-menopausal women. The 23 women who participated in the study were in the same age range, and had similar Body Mass Indices and body fat composition. These similarities allowed Santosa to isolate the effects of estrogen on fat absorption and storage.

She and Jensen were able to examine the activity of certain enzymes and proteins that regulate fat storage in post-menopausal women's abdomens and thighs. By considering these factors together rather than in isolation, the researchers determined conclusively that the overall fat storage "machinery" is more active in post-menopausal women. In other words, these cells now store more fat than they did before menopause.

In addition, post-menopausal women burned less fat than their pre-menopausal colleagues. These changes mean that their cells are not only storing more fat, but are also less willing to part with it. This combination is a recipe for rapid weight gain. "Taken together, these changes in bodily processes may be more than a little surprising – and upsetting – for women who previously had little trouble managing their weight," comments Santosa.

Though the increased cellular activity revealed by this study was not specific to the abdominal region, more fat stored overall means more abdominal fat. Evidence of changes in the fat storage pathways after menopause is an important contribution to understanding why post-menopausal women begin to put on more visceral fat.

Says Santosa, "the information revealed by our study is valuable not only to post-menopausal women and their doctors, but to obesity studies more generally. A clearer picture of which proteins and enzymes increase fat storage makes those productive targets for future medical advances in the fight against obesity."

(Source: Concordia University : Diabetes)

For more information on menopause, including symptoms and management of menopause, as well as some useful animations and videos, see Menopause.
For more information on obesity, health and social issues, and methods of weight loss, as well as some useful tools, see Obesity and Weight Loss.
Article Date: 11/4/2013

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7 Breakfasts Under 500 Calories

At only 70 calories, an egg is a great way to get lean protein into breakfasts under 500 calories.

Image: Clipart.com Listen up breakfast skippers -- it's time to start eating that all-important morning meal. Get your day off to a great start with these ideas for breakfasts under 500 calories.

PB and Apple
Natural peanut butter, 1 Tbsp.
Whole-wheat English muffin
Apple, 1
1% milk, 1 c.
416 calories

Waffle and Yogurt
Whole-grain waffles, 2
Light syrup, 1 Tbsp.
Light vanilla yogurt, 6 oz.
Banana, 1, small
414 calories

Starbucks
Fruit, Yogurt & Granola Parfait
Nonfat cappuccino, tall
400 calories

Jamba Juice
Bright Eyed & Blueberry yogurt blend smoothie
380 calories

Oatmeal with Cherries
Oatmeal, 1 c.
Dried tart cherries, ¼ c.
Brown sugar, 1 tsp.
Cinammon, dash
1% milk, 1 c.
371 calories

McDonald’s
Fruit and yogurt parfait
Fruit and walnut salad, snack size
370 calories

Bagel Breakfast
Whole-wheat mini bagels, 2
Whipped cream cheese, 2 tsp.
Egg, 1, hard-boiled
Orange, 1
369 calories

Brown Betty for Breakfast
Apple, cored and sliced, microwaved for three minutes and topped with:
Raisins, 1 Tbsp.
Almonds, chopped, 1 Tbsp.
Walnuts, chopped, 1 Tbsp.
Light vanilla yogurt, 8 oz.
362 calories

Did you know? You can plan your own calorie-controlled breakfasts using the simple, free tools at About.com's Calorie Count.

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How Many Calories Should I Eat?

Q: How many calories should I eat? I am a 32-year-old man.

A: That answer varies a little based on your lifestyle. It also depends on whether you are hoping to simply avoid weight gain or you want to lose weight. A male between the ages of 31 and 35 who is sedentary -- meaning you get less than 30 minutes a day of moderate physical activity -- can consume roughly 2,200 calories per day and maintain your weight, according to USDA recommendations. If you are active, you can consume between 2,400 and 3,000 calories daily without experiencing weight gain.

You can calculate your BMR (basal metabolic rate) using a simple math formula and factor in your own personal activity level. If you want to lose weight (and save yourself some math), check out Calories Needed for Goal Weight at About.com's Calorie Count. Simply enter your current weight and your goal weight to find out your caloric recommendations.

If you do want to lose weight, most people find it most comfortable to cut a set number of calories (around 250-500) per day, rather than making drastic dietary changes. Another option is to burn more calories with exercise, or, ideally to do a combination of both (e.g. cut 250 from your diet and burn an extra 250 with activity). As a rule of thumb, 3,500 calories is equal to one pound, so if you cut or burn a total of 500 calories daily, you could lose one pound a week, which is a safe rate at which to lose.

The following resources can help you understand your caloric needs a little better:

About.com's Calorie Count offers a way for you to enter your personal information to find your daily calorie expenditure. The site also offers free tools to track your caloric intake throughout the day with an online food diary and keep up with your "burn" (the calories you use up).

You may also find mypyramid.gov helpful.

Losing weight by cutting calories isn't just about eating less, but also getting the most "bang" for you calorie buck. It's important to educate yourself on nutrition and healthy food choices. After all, if you're only going to "spend" a certain number of calories each day, you'll want to use them on the most healthful, nutritious foods.

Source:
MyPyramid.gov. Inside the Pyramid - How many discretionary calories can I have?. 11 Sept 2008.

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The Secret to Six-Pack Abs

I wish I had a nickel for every time a woman asked me how to get a flat stomach or six-pack abs. It's one of the most common fitness goals for women. Here's a tip: You can't go to the corner of the gym and do crunches until you're ready to throw up and expect to get flat abs... even if you do it 7 days a week. And who would want to do that, anyway?

Why doesn't this approach work? Because muscle doesn't own the fat on top of it. Hmmm. One more time: Muscle doesn't own the fat on top of it. Think about it. If you see a body builder standing in front of the mirror doing bicep curls, what do you think his goal is? I'll give you a hint. Do you think he is trying to make his bicep bigger or smaller? Why bigger, of course! So why is it, then, that so many people believe they can make their stomach smaller by working their abdominal muscles? Hopefully a light bulb just came on in your head. So then...

HOW DO YOU GET THAT LEAN LOOK?

By having the right body composition. A lean look (and six-pack abs) come from having low body fat. Truth is, everyone has a six pack. Some just have more layers of fat covering it than others. The key to getting a flat stomach is to set your sites on having less body fat so that your six pack can show.

You have three choices for defining your fitness goals as it relates to body composition. You can lose fat, build muscle, or maintain your body. There is a big difference between muscle and fat. For starters, one pound of muscle burns 35 - 75 calories a day. One pound of fat burns 8 calories per day. Whoa! That's what "muscle is calorie-burning machinery" means. Secondly, fat doesn't turn into muscle. They are two different things.

If you want six-pack abs, your goal is to lose body fat. To lose body fat, you must be in a caloric deficit. That simply means taking in less calories every day than you spend in energy. While you're doing that, you want to maintain your muscle mass with resistance training. This is when fat melts away from your body, effectively changing your body composition.

HOW DO YOU MAINTAIN A CALORIC DEFICIT?

You can lower your caloric intake and/or increase your caloric output. The basic formula for figuring caloric intake for a deficit is your current weight in pounds times 15 minus 500 equals the number of calories to eat per day. [Current Weight x 15 - 500 = Daily Caloric Intake] This is a basic formula that you may need to adjust based on your activity level and your current body composition (now that you know the difference between calories burned by muscle versus calories burned by fat). Any activity you can add to your daily routine will help increase your caloric deficit and give your body fat no choice but to melt.

It doesn't hurt to work your abs. Your abs are part of your core and a strong core will help you lessen the risk of injury and help you be stronger for your everyday life in and out of the gym. And once you see your six-pack starting to emerge, you will want them to "pop" and be more defined. However, crunches and ab machines are not the secret weapon for fighting belly bulge. Monitoring the amount of calories you eat is the key. Simply put, you can't out-exercise a bad diet.

Stacie Dickerson is the CEO of the Healthy Lifestyle Institute for Women. Access their free article archive, become a member absolutely free and get your health & fitness tools at  http://hliwconnect.com/.

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3 Reasons to LOVE Your Workout: Confessions of a Fitness Addict

I sometimes get strange stares when I tell people I love to workout. But it's true! I look forward to that time of day when I can step away from everything else and just concentrate on my body. I have truly become an addict. I get cranky when I miss a workout and my day somehow feels incomplete. I absolutely love the feeling I get from working out.

You, too can love your workout. The longer you stick with it, the more engrained it will be in your habits and the more results you'll see. Even in 6 weeks, the results can be dramatic.

What are 3 things you can love about your workout?

1-Relieves stress

Exercise lowers cortisol, a stress hormone. You can take what could be a negative emotion like anger, frustration or anger and use it as fuel for your workout. You can successfully redirect that negative emotion into a positive outcome.

Exercise is also a great distraction to get your mind off problems and put you in a better state to be able to deal with them. If nothing else, it can get you out of the four walls you normally stare at, giving you a fresh perspective.

That deep breath and sense of calm you get while doing cardio is hard to replace with anything else. Everything feels clear - your lungs, your skin, your thoughts. It's a great time to think as you're pounding away the miles.

2-Feels great

Have you ever heard anyone say, "Man, I sure do regret that I worked out today." Probably not! But you most likely have heard someone talk about how proud she was that she DID workout today or three times this week.

It just plain feels good to workout. Exercise increases endorphins which are your body's "feel-good" chemicals. There is often a feeling of euphoria with working out; a "high." Who can't use some of that? There is a sense of accomplishment and pride that comes with it. It's what keeps people coming back time after time... and the fact that they like the way their clothes are fitting and the positive comments they are receiving from people who are noticing a change in them.

Besides, when else do you get to listen to obnoxiously loud music in the middle of the day? Playlists make great workout buddies. You can adjust your music to the type of activity you're doing, the speed at which you want to do it and your overall mood or the mood you want to have. Music is a great pick-me-up. At the end of a workout, not only will you feel good from the workout, but from the music as well.

3-See progress & succeed at something

When you work out consistently, you will see progress. You'll see progress towards your goals whether that be fat loss or muscle gain. You'll also notice that you can do things today that you couldn't do last month. You'll notice you can go longer, faster and at a higher resistance doing cardio and that it becomes easier. Maybe last week you couldn't walk on the treadmill and carry on a conversation without being winded but now you can talk with ease. Maybe you started out doing a chest press with 10 pounds and now you use 20. Progress means success. And we all like the feeling of success. If you succeed in one area, it gives you confidence to succeed in another.

Did anything of those sound familiar? You've probably heard or experienced some or all of these things already.

And here's a bonus reason to love your workout:

When you workout, it gives you added incentive to stay on your meal plan. If you go to the gym an hour a day, there are still twenty three hours in a day to screw up your results. Who wants to work that hard in the gym just to blow it with her diet? Working out regularly adds some incentive to eat right.

Stacie Dickerson is the CEO of the Healthy Lifestyle Institute for Women. Access their free article archive, become a member absolutely free and get your health & fitness tools at  http://hliwconnect.com/.

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Weight Loss Surgery - A Rising Trend

Are you tired of constantly combating with the heavy bulge? Are you fed up with the repeated attempts of dieting and exercising? Most experts agree that a balanced diet along with regular exercise is the optimum way of losing weight, but the customary path to weight loss doesn't work for everyone.

With obesity on its peak, many countries are evolving as growing hubs of the billion dollar global market for weight loss surgery. A large number of weight loss operations are carried out in popularity in the urban centers all across the world. Today, people are getting more and more conscious about the way they look and how the present themselves to the world. Moreover, the people who are obese do not have just the extra kilos that they need to shed out. They are usually suffering from other weight related co-morbidities too.

Smoking greatly increases the risks from surgery by astringent blood vessels and reducing blood flow. Most surgeons will carry out surgeries on people who have been non-smokers for at least a few months before the surgery. A history of drug or alcohol abuse can also increase the risk for complications and surgery failure. Obesity surgery can be performed on adults between the ages of 18 to 65 although it's becoming more common among adolescents to consider a bariatric surgery.

Undergoing an obesity surgery is an emerging trend among youngsters nowadays. They look at it as a shortcut for losing weight. Moreover, people don't mind paying up, hoping that they will look slim and trim after the surgery. However, a surgery should be considered as an option only if non surgical and natural dieting methods fail.

An increasing number of high profile politicians, Bollywood actors and actresses and even business tycoons are opting for this procedure as they can afford it. Patients usually lose approximately 36% to 90% of their excess body fat in six months to two years of undergoing such surgeries. Bariatric surgery has proven a reduction in the rate of mortality from 40 percent to 23 percent.

In medical language, obesity is considered as a 'killer lifestyle' disease. According to the World Health Organization, approximately 1.2 billion people worldwide are recorded as overweight.

It is important to consult a bariatric surgeon before being a part of this growing fad. It is not just about looking good. There are a number of post surgical restrictions to be considered. If you are unable to follow them properly then it may to lead to weight regain and other complications.

Undergoing a weight loss surgery is a growing fad amongst youngsters today. The article above highlights the importance of consulting a good bariatric surgeon before making this decision.

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