Anyone who's struggled with reaching or maintaining a healthy weight probably has heard comments like, "If you want to lose weight, just eat less and exercise more" or "Losing weight is all about willpower." But weight loss is much more complicated. Genetics, socioeconomic status, mental health issues, such as depression and anxiety, and certain medications can affect your ability to lose weight and keep it off.

That's why weight loss requires a complex, multipronged approach, including nutrition education, consulting a dietitian, joining a support group and possibly taking medications or undergoing weight-loss surgery.

Are you ready?

You have to be mentally ready for weight-loss surgery. Some people reach a turning point when they can't bend over to pick up a child, have to ask for a seat belt extension on an airplane or experience a hospitalization. The reasons people consider weight-loss or bariatric surgery are as personal and varied as the people themselves.

You may have considered weight-loss surgery for years, but it takes that turning point to push you to contact your healthcare professional about the procedure. If you've reached that turning point, here are some things to consider.

What weight-loss surgery does

Weight-loss surgery helps you lose weight and lowers your risk of medical problems brought on by obesity, including:

• Cancer
• Heart disease
• High blood pressure
• High cholesterol
• Infertility
• Obstructive sleep apnea
• Stroke
• Type 2 diabetes

Candidates for surgery typically have tried to lose weight by improving their diet and exercise habits.

How weight-loss surgery works

The surgery helps you lose weight in two ways:

1. By physically limiting the amount of food your stomach can hold, which decreases the number of calories you can eat
2. By shortening or bypassing the small intestine, which reduces the amount of calories and nutrients your body can absorb

The two most common bariatric surgery techniques are:

1. Gastric bypass
   Following this surgery, swallowed food will go into a small stomach pouch and then directly into the small intestine.
2. Sleeve gastrectomy
   With this surgery, about 80% of the stomach is removed, leaving a tube-shaped stomach about the size of a banana.

Both procedures are performed laparoscopically, which involves inserting surgical instruments through multiple small incisions in the upper abdomen. No bariatric surgery is without risks, which can include infection, blood clots and adverse reactions to the anesthesia.

What to expect from surgery

The benefits of weight-loss surgery include:

• Substantial weight loss, with people often losing 60% to 80% of their excess body weight within the first year after the procedure.
• Improved overall health and reduced or resolved obesity-related health conditions like Type 2 diabetes, high blood pressure, sleep apnea and joint pain.
• Enhanced quality of life, including higher energy levels, increased self-esteem and the ability to participate in activities you may have avoided.

You need to understand that bariatric surgery isn't a quick fix, and you won't reach your goal weight overnight. Even with surgery, your body mass index, or BMI, still may be considered overweight, but that doesn't mean the surgery wasn't successful. Losing a significant amount of weight still is transformative and life-changing.

There's also a potential financial cost to weight-loss surgery. The surgery itself typically is covered by insurance. In most cases, the removal of excess skin on the stomach and arms isn't covered by insurance. But this additional surgery, performed by a plastic surgeon, can greatly improve your self-esteem and body image.

Bariatric surgery gives you a tool for long-term weight management, but it requires a commitment to lifestyle changes, including a balanced, nutritious diet and regular exercise. You'll need to watch not only what you eat but also how much because the surgery can restrict the quantity of food your body can handle.

Five years after surgery, people typically have kept off 50% of the weight they've lost by embracing a new lifestyle and way of eating, and staying active.

If you've been considering bariatric surgery, contact your healthcare team to discuss if it's a good option for you. Once you've made a decision, they'll connect you with a weight management team, including a dietitian, and behavioral health and exercise physiology professionals to support you through this life change.

Kathriena Greenwell, M.D., is a bariatric surgeon in La Crosse, Wisconsin.

This article first appeared on the Mayo Clinic Health System blog.

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Extra weight was ruining Scott Decker's health and draining his bank account. Bariatric surgery helped Scott lose the weight and set the course to a healthier, happier life.  

Carrying extra pounds was taking a big financial toll on Scott Decker, of Bloomer, Wisconsin, and the excess weight was on track to cost him a lot more.

"I was spending $1,500 a month on insulin," Scott says. "I had type 2 diabetes, sleep apnea, high blood pressure, joint pain and fibromyalgia."

At 48, Scott says he knew his mounting health problems could shorten his life. He tried multiple diets without lasting success, and he realized he had to make a change. Scott reached out to Mayo Clinic Health System to explore the possibility of bariatric surgery.

"My mother passed away at 68 from diabetes," he says. "I didn't want to be 50 years old and another statistic."

Preparing for success

For his evaluation, Scott saw David Ciresi, M.D., a bariatric surgeon at Mayo Clinic Health System in Eau Claire, Wisconsin. Dr. Ciresi found that Scott met the requirements for bariatric surgery established by the National Institutes of Health, which include having a body mass index of 40 or greater, or 35 with obesity-related medical conditions, such as diabetes, high blood pressure or sleep apnea. Just as important, though, was Scott's readiness to do the work required to succeed in his weight loss.

"You're not doing a patient any favors by performing bariatric surgery if they're not prepared to adopt all of the lifestyle changes needed to be successful," Dr. Ciresi says.

"You're not doing a patient any favors by performing bariatric surgery if they're not prepared to adopt all of the lifestyle changes needed to be successful." — David Ciresi, M.D.

To help him get ready, Scott went through a six-month evaluation and education process before the surgery. Then, in February 2016, Scott underwent Roux-en-Y gastric bypass — a minimally invasive, laparoscopic procedure. It involved stapling off the top of the stomach, leaving a pouch about the size of an egg, and then bypassing the first three feet of the small intestine to reduce the calories absorbed as food is digested.

Enjoying the results

Scott says the results after surgery were dramatic. He lost 130 pounds, most within the first six months, and has now reached his goal weight of 195. As his ailments and need for medication dropped away, his efforts began to pay off, literally.

"The first month, I put $1,500 in my savings," says Scott, who owns and operates his own machine shop. He and his wife of 26 years, Rhonda, raised two sons and recently took temporary placement of two younger relatives. The extra money has been a big help to the small-business owner and family man.

His improved health also has led to a greater enjoyment of life. Scott, an avid outdoorsman, says he used to worry that a low blood sugar incident out in the woods might be the end of him. But while deer hunting last fall, his hunting buddy was the one having trouble keeping up.

"It's amazing how much weight actually changes your health. This has been life-changing. I would do it again tomorrow." — Scott Decker

"He said, 'You don't have to run through the woods.'" Scott says. "I said, 'I'm not. I'm just 130 pounds lighter.'"

These days, Scott finds he sometimes has to introduce himself to people he has known for years, as they often don't recognize him due to his weight loss. And he appreciates the simple pleasure of buying a pair of average-sized jeans off the rack. But it was the potential health benefits that originally inspired him to have bariatric surgery, and seeing them become reality, that has been the big payoff.

"It's amazing how much weight actually changes your health," Scott says. "This has been life-changing. I would do it again tomorrow."

HELPFUL LINKS

• Read more about bariatric surgery.
• Learn about different kinds of weight-loss surgery.
• Explore Mayo Clinic Health System.
• Connect with others talking about Bariatric Surgery on Mayo Clinic Connect.
• Request an appointment.

The post Bariatric Surgery Generates Far-Reaching Benefits for Scott Decker appeared first on Mayo Clinic News Network.

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ANSWER: Before you have weight-loss surgery, it’s important to understand what to expect and to prepare yourself, physically and mentally, for what’s ahead. Working with a counselor for several months prior to the procedure can help set you up for long-term success following your surgery.

“Bariatric surgery” is the broad term used to describe all types of weight-loss surgery, including gastric bypass, gastric sleeve, placement of an adjustable gastric band and a procedure known as a duodenal switch, among others. Although the techniques used in each vary, all are considered major procedures that can pose serious risks and side effects. Going through counseling beforehand can help identify if having such a significant surgery is the best choice for you.

Weight-loss surgery changes the body’s anatomy and biology in a way that helps people lose weight. But in many ways, the long-term outcome of any bariatric surgery depends less on those changes than it does on a person’s behaviors and lifestyle.

In preparation for surgery, you will work with a counselor who specializes in helping people prepare for weight-loss surgery. He or she can identify and assess risk factors that could make it hard for you to make the lifestyle changes you need to in order to lose weight and keep it off long-term.

In most cases, the sessions before surgery include a weight-loss component. In fact, many insurance companies now require a medical weight-loss program before they will approve payment for bariatric surgery.

For many people, difficulty managing weight is the result of problematic eating or activity habits, like skipping meals or evening snacking. Working with a counselor can help you change habits, decrease emotional eating, self-monitor your eating and activity patterns, and find ways to stay motivated for healthy lifestyle changes. Counseling sessions before surgery also can help improve mood, manage substance use, and teach stress management techniques so you are better equipped to handle the surgery and maintain a healthy lifestyle afterward.

Counseling sessions before bariatric surgery may be conducted one-on-one, or you may be part of a group preparing for surgery together. Many people find group sessions to be quite useful, as it gives them an opportunity to connect with others facing similar circumstances and share ideas.

Some health care organizations, including Mayo Clinic, offer follow-up counseling sessions to help keep people on track after bariatric surgery, as well as to catch any problems or complications that may arise. These sessions also provide an opportunity for you to learn more about support services and healthy living resources in your community.

Research shows that about 70 to 80 percent of those who have bariatric surgery are successful at losing weight and keeping it off five years after gastric bypass surgery. But the stress and busyness of life can sometimes make long-term weight loss difficult. Over time, you may notice that you’re slipping back into eating and lifestyle habits that are not as healthy. Staying in touch with your providers after surgery, or seeking help if you start to notice that you’re reverting to old habits, can help refocus your efforts and keep you healthy.

For many people, working with a counselor before and after bariatric surgery is extremely helpful. Talk to your health care provider about counseling options he or she would recommend. Going through this process can be an excellent way to set the stage for weight-loss success. — Karen Grothe, Ph.D., Psychiatry & Psychology, Mayo Clinic, Rochester, Minn.

The post Mayo Clinic Q and A: Work with counselor before weight-loss surgery for success appeared first on Mayo Clinic News Network.

Precision medicine ... also called individualized medicine ... got special attention recently when President Obama announced a Precision Medicine Initiative and called for the creation of a national biobank. On this week's program, Dr. Keith Stewart, director of the Mayo Clinic Center for Individualized Medicine, discusses the biobank and what it might mean for the future of health care. Also on the program, Mayo Clinic psychologist Dr. Karen Grothe explains the importance of a psychological evaluation when planning weight-loss surgery. And preventive medicine specialist Dr. Phil Hagen talks about how Mayo Clinic and Google have teamed up to increase the odds of finding realiable health information on the Web.

Myth or Matter-of-Fact: Precision medicine can help predict diseases you're likely to get.

Mayo Clinic Radio is available on iHeart Radio.

Click here to listen to the program on Saturday, April 25, at 9:05 a.m., and follow #MayoClinicRadio.

To find and listen to archived shows, click here.

Mayo Clinic Radio is a weekly one-hour radio program highlighting health and medical information from Mayo Clinic. The show is taped for rebroadcast by some affiliates.

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Miss the show?  Here's the podcast. MCR PODCAST April 25 2015

Myth or Matter-of-Fact: Precision medicine can help predict diseases you're likely to get.

To listen to the program at 9:05 a.m. Saturday, April 25, click here.

Follow #MayoClinicRadio and tweet your questions.

Mayo Clinic Radio is available on iHeartRadio.

Mayo Clinic Radio is a weekly one-hour radio program highlighting health and medical information from Mayo Clinic.

To find and listen to archived shows, click here.

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Better Sleep Without Pills

Older adults often report a good night’s sleep is hard to come by. In an eight-page Special Report on sleep, the February issue of Mayo Clinic Health Letter covers changes in sleep that can occur with aging and how to get better sleep without taking pills.

Poor sleep isn’t an inevitable part of aging. Yet, older adults are twice as likely to be prescribed a sedative medication for insomnia as are young adults. These medications ― zolpidem (Ambien, others), eszopiclone (Lunesta) or zaleplon (Sonata) ― aren’t meant to be used beyond four to eight weeks. Many older adults use them for months or years even though these medications can cause unwanted side effects including residual sleepiness during the day, dizziness, lightheadedness and mental impairment.

Mayo Clinic Health Letter covers several nondrug approaches and strategies that have proved to help relieve insomnia. Strategies include:

Exercise: Evidence shows that incorporating regular exercise into the daily routine improves sleep. Exercise increases the amount of energy expended, and the amounts of “feel-good” hormones (endorphins) the body produces. Both are likely to lead to better sleep.

Food and drink: Reserving caffeine for the morning may be helpful, but some studies show little difference between good and poor sleepers in terms of caffeine intake. It may just be that some people are more vulnerable to the effects of caffeine. Alcohol before bed, especially in large amounts, may help with falling asleep, but has a tendency to cause more fragmented sleep. Heavy meals right before bedtime can keep some people from falling asleep.

Daylight exposure: Light and bright surroundings make people feel alert and awake. Likewise, receiving little daylight or living in a dim environment interferes with nighttime sleep and daytime functioning. Being outside in the late afternoon can help avoid premature sleepiness. If being outside isn’t an option, a doctor might advise light therapy.

Rituals around sleep: A mostly consistent bedtime and wake-up time help reinforce the sleep-wake cycle and promote better sleep. Reading, taking a warm bath or shower or listening to soothing music can ease the transition between wakefulness and drowsiness.

Sleep restriction: Temporarily restricting time in bed, for example by going to bed one hour later than normal bedtime, can help break the insomnia cycle. This moderate sleep deprivation promotes deeper and sustained sleep.

Relax: Evidence indicates that one behavior most strongly associated with poor sleep is the habit of worrying, planning and thinking about important matters at bedtime or right before. Finding ways to relax at bedtime can produce substantial improvement and help reduce the need for sleeping aids. Techniques might include visualization or meditation.

Doctors Developing Less-invasive Procedures to Treat Obesity

Surgery to alter the digestive system is one of the most effective ways to address severe obesity. But, bariatric surgical interventions are costly, often irreversible and carry the risk of short- and long-term complications.

Doctors continue to develop new approaches to reduce risks and costs while maintaining the benefits of the surgery. The February issue of Mayo Clinic Health Letter covers the most common surgeries as well as new incision-free approaches.

Roux-en-Y gastric bypass: The most commonly performed bariatric surgery, the Roux-en-Y procedure drastically reduces the size of the stomach and allows food to bypass a segment of the small intestine. The bypass often leads to the loss of 30 to 35 percent of preoperative weight one year after the surgery and remarkable improvements in cholesterol levels and blood pressure.

Sleeve gastrectomy: The stomach is reduced from a large pouch to a tube. It restricts the amount of food that can be eaten at one time. Two years after surgery, typical weight loss is 20 to 25 percent of the presurgery body weight. A newer operation, it’s the second most commonly performed bariatric surgery.

Laparoscopic adjustable gastric banding (LAGB): An inflatable band is placed around the uppermost part of the stomach and stitched in place. The band is inflated and limits the amount of food that can be eaten. Because LAGB doesn’t involve cutting organs, it’s associated with a lower risk of death than some other surgical approaches. It has been associated with significant complications, and weight loss results generally aren’t as good as with other surgical options.

Mini-gastric bypass: This is similar to the Roux-en-Y procedure but simplifies the rearrangement of the small intestine, making it a less-complex procedure. Long-term results aren’t known yet, but research to date shows that about 95 percent of patients lose about half of their excess weight by 1.5 years after the procedure.

Endoscopic procedures: In the newest approaches to bariatric procedures, doctors make changes to the stomach and small intestine using tools inserted through the throat (endoscopically). These procedures can be performed on an outpatient basis and tend to be associated with quicker recoveries when compared to surgery. They aren’t routinely performed yet and most remain under investigation. As results and knowledge about the techniques become more widely known, it appears these endoscopic procedures will become more common. Generally, they aren’t expected to produce weight-loss results that match those of surgical procedures. Ongoing investigations are aimed at identifying what subgroups of patients might benefit most from less-invasive approaches. Candidates include those with moderate obesity, children and adolescents, or at-risk superobese individuals as a bridge to bariatric surgery.

Preventing Nausea after Surgery

Nausea and vomiting after surgery affect more than 30 percent of people and can lead to complications ranging from inhalation of stomach contents to injury to the surgery site. Nausea and vomiting most typically occur after general anesthesia, where patients are unconscious during surgery. The likelihood of postoperative illness increases with longer procedures and time spent under general anesthesia.

The February issue of Mayo Clinic Health Letter covers medications and drug-free options to reduce the risk of nausea after surgical procedures.

Certain factors may increase the risk of feeling sick after surgery. They include being female, having a history of nausea and vomiting after surgery, having a history of motion sickness and being a nonsmoker. Older adults, however, tend to have less difficulty with postoperative nausea and vomiting.

Prior to general anesthesia, a patient’s risk factors for postoperative nausea are considered, along with the type of surgery being done. Generally, patients are given one or two medications intravenously at the beginning of general anesthesia. Dexamethasone is a corticosteroid that is thought to reduce the inflammation that occurs with surgery and works as an anti-emetic. The second medication, droperidol (Inapsine), interferes with the blood substance dopamine by disrupting the message that could signal the onset of nausea and vomiting. Another anti-emetic, ondansetron (Zofran), may be given just prior to the end of anesthesia for patients considered at high risk for nausea and vomiting. A serotonin antagonist, it blocks serotonin from relaying impulses that would induce vomiting.

In addition, some patients find a skin patch to treat motion sickness (Transderm Scop) applied before surgery to be helpful.

Nondrug approaches may be beneficial, too. One involves stimulating the P6 acupuncture point on the wrist. It’s located three finger-widths up from the inside of the wrist joint. Specially designed wrist strips can be applied like bandages before or after surgery. Studies have shown that stimulation of this acupoint  helps reduce the risk of nausea and vomiting with minimal side effects. Acupuncture at P6 also can help.

Aromatherapy also can relieve postoperative nausea. A recent study found that essential oil of ginger or a blend of essential oils ― ginger, spearmint, peppermint and cardamom ― significantly reduced nausea after surgery and reduced the requests for anti-nausea medications.

The nonprescription product QueaseEase is an easy-to-use aromatherapy option. It’s formulated to calm nausea associated with surgery and anesthesia. Other individual essential oils such as spearmint or ginger also may be helpful.

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Mayo Clinic Health Letter is an eight-page monthly newsletter of reliable, accurate and practical information on today’s health and medical news. To subscribe, please call 1-800-333-9037 (toll-free), extension 9771, or visit www.HealthLetter.MayoClinic.com.

About Mayo Clinic
Recognizing 150 years of serving humanity in 2014, Mayo Clinic is a nonprofit worldwide leader in medical care, research and education for people from all walks of life. For more information, visit 150years.mayoclinic.org, www.mayoclinic.org and newsnetwork.mayoclinic.org.

MEDIA CONTACT: Ginger Plumbo, Mayo Clinic Public Affairs, 507-284-5005, Email: newsbureau@mayo.edu

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The recurrence of diabetes was mainly influenced by the patients' longstanding history of Type 2 diabetes, explains Yessica Ramos, M.D., an internal medicine resident at Mayo Clinic in Arizona and study lead. "This suggests that early surgical intervention for obese people with diabetes can improve the chances for remission of the disease."

Ramos and colleagues at Mayo Clinic studied records of 72 patients with Type 2 diabetes who had undergone a Roux-en-Y gastric bypass procedure (the most common form of gastric bypass surgery in which part of the patient's stomach is used to create a new, smaller stomach pouch) between 2000 and 2007. Of those patients, 66 (92 percent) experienced reversal of their diabetes at some point following the surgery.

However, 14 of those same patients (21 percent) experienced a recurrence of their Type 2 diabetes within three to five years, according to the researchers who studied their blood work. Both groups of patients – those whose diabetes was reversed, and those whose diabetes returned – regained similar amounts of weight post-surgery. Those whose diabetes was reversed lost more weight originally and maintained a lower mean weight throughout the five years of follow-up.

The Mayo researchers found that the longer the patients had diabetes previous to their weight loss surgery, the higher the probability that their diabetes would recur. In particular, patients who had diabetes for longer than five years before their surgery were 3.8 times more likely to experience a recurrence of their diabetes, compared with patients who had less than a five-year history with the disease.

"Providers and patients need to be aware of this information to have a better idea of the expected outcome and to be able to make an informed decision about pursuing gastric bypass surgery," says Ramos.

The study was presented at the annual meeting of the Endocrine Society annual meeting in Houston June 23-26.

###

About Mayo Clinic:

Recognizing 150 years of serving humanity in 2014, Mayo Clinic is a nonprofit worldwide leader in medical care, research and education for people from all walks of life. For more information, visit 150years.mayoclinic.org, www.mayoclinic.org and newsnetwork.mayoclinic.org.

Media Contact: Lynn Closway, Public Affairs, 480-301-4222, Mayo Clinic

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