Governor Christie’s Lap Band

I applaud New Jersey Governor Chris Christie’s announcement that he has undergone lap band surgery to help manage his weight.  As a public figure and politician, Governor Christie is uniquely positioned to help champion obesity awareness, and to spread the message that bariatric surgery is not the easy way out for patients who struggle with weight.

 

“It’s not a career issue for me,” said Christie. “It is a long-term health issue for me and that’s the basis on which I made this decision. It’s not about anything other than that.”

 

Several studies have shown that patients with a body mass index (BMI) over 40, or BMI >35 with a major medical problem associated with weight (diabetes, high blood pressure, sleep apnea, heart disease) have a significantly reduced life expectancy.  One study shows that patients meeting the above criteria have only a 30% chance of living beyond age 65.

 

Bariatric surgery has not only been shown to help patients lose significant weight, but many patients have complete resolution of their medical problems, including diabetes, following the procedures.  Bariatric surgery has even been shown to reduce the risks of colon and breast cancer.

 

Surgery is not the easy way out.  It is a tool to help patients reach their weight loss goals, to prolong their lives, and to help improve quality of life.

 

According to the U.S. Food and Drug Administration, obesity is the second-leading cause of preventable death in the United States, after smoking.  I not only appreciate Governor Christie’s willingness to share his story as a public health issue, but I empathize with the fact that his weight has been such a topic of public discussion.

Dr. Metz

Are you kidding, Dr. Gupta?

In the article I’ve referenced below, the author states that weight loss does not help reduce heart diesease in obese patients with type II diabetes.

“An intensive lifestyle intervention focusing on weight loss did not reduce the rate of cardiovascular events in overweight or obese adults with type 2 diabetes, according to final results of the randomized controlled Look AHEAD trial.”

If you read further in the article, you will notice that patients in the study, all of whom underwent extensive lifestyle modification, had a 6% excess weight loss at 10 years.  For a patient that is 200 lbs overweight, that’s a weight reduction of 12 pounds.  Seriously?  Our bariatric patients lose an average of 50-85% excess weight (100% in a select few) after surgery, and most of them have full resolution, or at least significant improvement, of diabetes, high blood pressure, sleep apnea, and, yes, heart disease.

We have known since the NIH studies of the early 1990’s that lifestyle modification alone is not successful when it comes to long term weight loss, so why should we think that medical problems associated with weight would be resolved through those tactics?

Only bariatric surgery has been shown to help patients achieve sustained, long-term weight loss and resolution of co-morbid conditions.  The type of article that I have shared below, only serves to perpetuate the belief that weight is a non-treatable disease, and that medical problems, like diabetes and heart disease are not winable battles.

On the contrary, with dedication, motivation, meticulous surgical technique, and long-term follow-up with a Center of Excellence Bariatric team, we can attain succesful weight loss, resolution of numerous medical problems, and increase our national life expectancy.  Let’s work together to beat these diseases!

http://www.medpagetoday.com/TheGuptaGuide/Endocrinology/40083

dr-gupta

Weight Loss No Help for Heart in Diabetes

Workouts after surgery

I was delighted to see one of my patients at the gym this evening during my workout!  I hope that our brief chat was as rewarding for her as it was for me, as I got to see her transformation, progress, and dedication to her health; and she got to see that I practice what I preach!

Tonight’s workout focuses on muscles of the back and those pesky tricep muscles on the backs of the arms.  As always, to improve cardio fitness, I try to do the exercises in a continuous loop with no rest between sets.  Please do not attempt any of these exercises without clearance from your doctor–(I don’t count!)

Warmup on recumbent bicycle–10.5 minutes with increasing resistance every minute for the final 8 minutes.
Joint warmup (see previous entry for description)

pull ups: 4 sets of 10 (ok to use weight assisted)
dumbell overhead tricep extensions: 4 sets of 10
flutter kicks: 4 sets of 20

rest 1 minute

standing cable cross pull downs: 3 sets of 10 (ok to do seated)
hanging oblique knee ups: 3 sets of 10

rest 1 minute

rope tricep pulldowns: 3 sets of 10
incline cable row: 3 sets of 10
dumbell shrugs: 3 sets of 10

rest 1 minute

hanging leg lifts 3 sets of 10
floor wipers (leg lifts forward, side, side) 3 sets of 10

Stretch/cool-down

Exercise and Recovery Fuel

Although I am not a proponent of exercising to the point of vomiting, every once in while, when reaching for that target heart rate, one can over estimate one’s lactate threshold.  Today’s workout was a combination of outdoor cardio and indoor strength training.  The maintenance of heart rate at target ((220-your age) x 85%) is very helpful in achieving the combination of fat burning and cardio fitness.  This target heart rate can be reached through traditional cardio activity (running/biking/swimming) or even through strength training.

 

Today’s Workout:

 

Outdoors:

Mountain Bike Buffalo Creek—1 hour to summit (almost barf), 2 hour descent

 

Indoors:

Barbell bench press–4 sets of 10

Barbell curls—4 sets of 10

Ab wheel—4 sets of 10

Above exercises done without breaks between sets

 

Rest 1 minute

 

Pushups 25—3 sets

Dumbell curls—3 sets of 10

Floor wipers (leg lifts, left/right/center counts as 1 rep)—3 sets of 10

 

Almost Barf

 

Recovery Meal:

2 pieces of filet of sole in mushrooms, lemon, and black pepper

Steamed Broccoli with light soy sauce

1 glass of skim milk

 

Do NOT Barf!!

Today’s workout and a tasty recovery dinner

Today’s workout incorporates both strength training and cardio.  As always, remember to warm up and cool down before and afterward, and do not attempt any of these exercises without clearance from your physician (I don’t count!)

Cycle–5 minute warmup, 15 minutes at target heart rate (THR), max heart rate for 2 minutes, recover 1 minute, max 2 minutes, recover 1 minute, warm down 2 minutes.

Strength training:
Pullups (assisted with gravitron is perfectly fine): 15
Bent Over barbell row (supported is fine): 10 reps
Dumbell overhead tricep extensions: 12 reps
ab wheel or leg lifts: 12 reps
Repeat entire cycle 4 times with no more than 30 seconds between cycles, no rest between exercises to keep up heart rate

This entire workout, including warmup, cycling, and cool down, can be performed in under 45 minutes.

Recovery meal:
Fresh tuna steak with sesame, garlic, and light soy sauce–
Spray non-stick Pam or other calorie-free substitute into large pan
Sautee thinly sliced garlic until slightly browned
After marinating tuna in 2 inch by 3/4 inch slices (I am a surgeon, after all!), add enough sesame seeds to partially cover fish
Pan sear fish on each side
Serve

Roasted vegetables-
Preheat oven to 400 degrees
In a baking pan, place vegetables of choice.  I used eggplant, Brussel sprouts, and portobello mushrooms
Add 1 tbsp of extra virgin olive oil
1 pinch of kosher salt
roast uncovered for 1 hour (I put up the veggies before I started my workout!)

Enjoy!

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