Weight-loss surgery safe, but sleep apnea increases risk

Weight-loss surgery isn't risk-free, but a new study suggests that in the hands of a skilled surgeon, it may be safer than previously thought. However, some people -- including those with sleep apnea or a history of blood clots -- are more likely to have problems with surgery than others, according to a study published this week in the New England Journal of Medicine.



"The overall conclusion that we reached is that bariatric-surgery safety is actually quite good," said Dr. Bruce Wolfe, a professor of surgery at the Oregon Health and Science University.



In the past, bariatric procedures have been associated with death rates of 2 to 3 percent and complication rates of up to 24 percent. However, the obesity epidemic is fueling a rise in such surgeries, prompting concerns about their safety. In 2005, 171,000 people underwent bariatric surgery, more than 10 times the number that had the procedure in 1994.



To assess the safety of such operations, Wolfe and his colleagues looked at 4,776 patients in the first month after having a bariatric procedure. They found that 4.3 percent of patients had a serious problem, such as a blood clot or needing another operation, and 0.3 percent, or 15 patients, died within a month after surgery -- a complication rate similar to other types of surgery.



Four main factors seemed to increase the risk of complications, including sleep apnea, severe obesity, a history of blood clots, and an inability to walk at least 200 feet prior to surgery. Health.com: 10 easy food swaps cut cholesterol, not Taste



Sleep apnea is a common disorder in the obese (about half of the patients in the study had the condition). Excess weight in the neck region can contribute to sleep apnea, which is characterized by snoring and the collapse of the upper airway during sleep, sometimes hundreds of times a night.

Sleep apnea causes sleepers to snort and gasp for breath and is associated with high blood pressure, vascular changes, and a greater risk of heart disease. "We assume (the effects) are related to why it is a surgical risk," Wolfe says.




Surgeons at Brigham and Women's Hospital, in Boston, Massachusetts, have been performing bariatric surgery with good results since 1995, said Dr. Malcolm Robinson, an assistant professor of surgery at Harvard Medical School, who practices at the hospital and wrote an editorial accompanying the study. "As the art of bariatric surgery has evolved, it's become safer, and this study is proof of that evolution," he said.



Even with the risks of an operation factored in, bariatric surgery can be a lifesaver, particularly for people who are very obese. Such patients are at high risk of death due to obesity-related illnesses, such as heart disease and type 2 diabetes. Such surgery is recommended only for those with a body mass index greater than 40, which would be 248 pounds or more for someone who is 5 feet 6 inches. If other health problems, such as diabetes, are present, surgery may be recommended for someone with a BMI of 35 or higher (217 pounds or more for someone who is 5 feet 6 inches). Health.com: The slimming power of mint



"[Research suggests that] surgery increases survival and makes people live longer, even taking into account mortalities," said Wolfe.



The patients in the new study were treated between 2005 and 2007 at 10 centers with a large volume of bariatric procedures. In all, 33 highly skilled surgeons, who were certified by the Longitudinal Assessment of Bariatric Surgery Consortium, conducted the operations. Robinson says that the study's low complication rate might not be the standard at all centers.



Plus, the study could not determine if one type of bariatric procedure was better than the others. Most of the patients had one of three procedures: an open Roux-en-Y, in which a small pouch is created that bypasses the stomach and attaches to the upper intestine; a Roux-en-Y conducted laparoscopically, in which a camera, light, and instruments are threaded through a small incision; or laparoscopic adjustable gastric banding, in which an adjustable band is wrapped around the stomach to create a small pouch, which then empties into the larger portion of the stomach.



The death rate was 2.1 percent with the open Roux-en-Y and 0.2 percent with the laparoscopic version. (Some patients who underwent the open Roux-en-Y had health factors that put them at greater risk for complications.) There were no deaths associated with laparoscopic adjustable gastric banding.



Some doctors avoid using the adjustable band procedure because they think it needs to be adjusted or removed too often, and because they believe the weight-loss results aren't as strong, according to Robinson. Others prefer it, saying it's safer and just as successful in terms of pounds lost.



Wolfe says he doesn't recommend one gastric procedure over the other. However, patients at a higher risk for complications may be advised to choose a lower-risk procedure like banding, he said. Health.com: Cut up to 900 calories with simple substitutions



Even though the complications from bariatric surgery are rare and usually reparable, patients can take certain precautions to ensure an even safer recovery.

Patients who have experienced blood clots prior to the surgery were more prone to having them again, regardless of the kind of operation, said Wolfe. He said that the increased risk of complications in patients who were so heavy they couldn't walk was not surprising.




"It's believed to be important that after surgery, patients walk around to reduce blood clots," Wolfe said. "But if a person is unable, they presumably are at a higher risk for blood clots."



Patients should lose some weight before surgery because it can lower the risk of complications, experts agree. "That goes along with our finding that the very highest weights or severity of obesity is associated with greatest risk," said Wolfe. Health.com: How crash diets, like the master cleanse, harm your health and heart



He recommends losing 10 percent of one's body weight before surgery to help speed recovery. "[But] a low BMI didn't automatically mean the complication rate is lower," he cautioned. "Other factors are involved."



When choosing a hospital for the surgery, experts recommend considering the center's expertise, equipment, dietary program, nonphysician health-care providers, and the anesthesiologists' skill and experience (it is harder to administer anesthesia to heavier patients).



The researchers plan to follow 2,400 patients for several years after surgery to determine the long-term complications and benefits of the different procedures.

By Heather Mayer

How to Lose Weight - The Basics of Weight Loss

Despite the way it feels, losing weight isn't a mysterious process. It's a simple matter of burning more calories than you eat. But, if it were really that simple, none of us would have a weight problem, would we? Weight loss can be such a struggle that we start thinking we have to do something drastic to see results -- diets, pills or those weird fitness gadgets on infomercials that promise instant success. The true secret to weight loss is this: Make small changes each and every day and you'll slowly (but surely) lose those extra pounds. The key is to forget about instant results and settle in for the long run.

Rules of Weight Loss

To lose one pound of fat, you must burn approximately 3500 calories over and above what you already burn doing daily activities. That sounds like a lot of calories and you certainly wouldn't want to try to burn 3500 calories in one day. However, by taking it step-by-step, you can determine just what you need to do each day to burn or cut out those extra calories. Below is a step by step process for getting started.

1. Calculate your BMR (basal metabolic rate). Your BMR is what your body needs to maintain normal functions like breathing and digestion. This is the minimum number of calories you need to eat each day. Keep in mind that no calculator will be 100% accurate, so you may need to adjust these numbers as you go along.
2. Calculate your activity level. Use a calorie calculator to figure out how many calories you burn while sitting, standing, exercising, lifting weights, etc. throughout the day. It helps to keep a daily activity journal or you could even wear a heart rate monitor that calculates calories burned.
3. Keep track of how many calories you eat. You can use a site like Calorie Count or use a food journal to write down what you eat and drink each day. Be as accurate as possible, measuring when you need to or looking up nutritional information for restaurants, if you eat out.
4. Add it up. Take your BMR number, add your activity calories and then subtract your food calories from that total. If you're eating more than you're burning, (your BMR + activity is 2000 and you're eating 2400 calories) you'll gain weight. If you're burning more than you eat, you'll lose weight.

Example:

Mary's BMR is 1400 calories and she burns 900 calories in daily activity with regular exercise, walking around and doing household chores. To maintain her weight, she should be eating 2300 calories but, after keeping a food journal, Mary finds that she's eating 2550 calories every day. By eating 250 more calories than her body needs, Mary will gain one pound every 2 weeks.

This example shows how easy it is to gain weight without even knowing it. However, it's also easy to lose weight, even if the process itself can be slow. You can start by making small changes in your diet and activity levels and immediately start burning more calories than you're eating. If you can find a way to burn an extra 200 to 500 calories each day with both exercise and diet, you're on the right track. Try these ideas:

Instead of...	Do this...
An afternoon Coke	Drink a glass of water. (calories saved: 97)
An Egg McMuffin	Eat a small whole wheat bagel +1 Tbsp of peanut butter (calories saved: 185)
Using your break eat sweets	Walk up and down a flight of stairs for 10 minutes (calories burned: 100)
Hitting the snooze button	Get up 10 minutes early and go for a brisk walk (calories burned: 100)
Watching TV after work	Do 10 minutes of yoga (calories burned: 50)

Total Calories Saved: 532 (based on a 140-pound person)

How Much Exercise Do I Need?

Exercise is an important weight loss tool, but how much you need varies from person to person. The ACSM's weight loss guidelines suggest at least 250 minutes per week, which comes out to about 50 minutes, 5 days a week. If you're a beginner, start small (3 days a week for 20 to 30 minutes) to give your body time to adapt. Don't forget, things like walking, taking the stairs and household chores can burn more calories as well. Learn more about getting started with exercise.

By Paige Waehner

Lose Weight Naturally

A new diet pill or miracle weight-loss product seems to hit the shelves every day -- only to be quickly followed by news about health risks, or worse, a recall from the FDA. So what else can you do to aid your dieting efforts when the tried and true method of eating less and moving more isn’t enough, but you don’t want to resort to risky diet supplements? A few natural remedies, when combined with proper nutrition and exercise, may be just the answer.

By Vicki Salemi

an introduction to a new weight loss aid

As the UK’s leading pharmacy-led health and beauty retailer, Boots aims to provide you with all the latest health news, as well as expert information and advice about new healthcare products, such as the soon-to-be-released alli weight loss capsules.
alli is a weight loss aid designed to help adults lose excess weight. alli (orlistat 60mg) is the first pharmacy-only weight loss aid available. alli capsules can now be introduced over-the-counter to overweight adults with a Body Mass Index (BMI) of 28 or above and will soon be available in UK pharmacies for the first time.
Boots is pleased to hear that this weight loss aid is to be made available through pharmacies to help many people in the UK who may struggle with weight loss. According to a recent study by Mintel, 40% of British adults are trying to lose weight. Many of these people will soon be able to use alli as a weight loss aid if they are overweight with a BMI of 28 or above.

How do alli capsules work?
alli capsules work by reducing the amount of fat from the food you eat being absorbed into the body. You can prevent about a quarter of the fat consumed in any one meal from being absorbed when taking alli, so when added to a reduced calorie, lower-fat diet, the capsules can help you lose fifty per cent more weight than by dieting alone.
For example, for every 2lb of weight loss you achieve through healthy eating, alli could help you achieve a further 1lb weight loss.
The active ingredient in alli capsules is orlistat 60mg, which acts locally within the digestive system to prevent fat absorption. There is minimal absorption of the active ingredient orlistat into the bloodstream. Orlistat has been available on prescription for more than 10 years and its safety and efficacy is well documented through data from more than 100 clinical trials.
The recommended dose of alli is one 60mg capsule taken three times daily with meals containing the recommended amount of fat. Always read the label. Find out more about how the alli weight loss aid works.

Is alli suitable for me?
alli is suitable for people who, in medical terms, are classed as moderately to severely overweight or obese. This means adults with a BMI of 28 or above; a person with a BMI of 25 or above is deemed 'overweight', whereas a person with a BMI of 30 or more is classed ‘obese’.
alli is a weight loss aid for overweight adults of 18 or over. If you think alli might be suitable for you, our guide ‘considering alli’ might be useful. Alternatively, why not discuss alli with your Boots Pharmacist.

Information from Boots