I read with great interest the book review published this week in the wall street journal. The Economists’ Diet: The Surprising Formula for Losing Weight and Keeping It Off is the book title written by two economists: Chris Payne and Rob Barnett. Both Chris and Rob suffered from obesity and managed to lose a combined weight of 120 pounds. They did not follow a particular diet or exercise program but rather applied what they know best: economic principles to build healthy habits and keep the weight off. Continue reading “Modern Economics Has Given Us Abundance and Obesity” →

The Nobel prize in medicine and physiology has been awarded this year to three American scientists for discovering the underlying molecular mechanism of biological clocks. Biological clocks allow us to follow a circadian rhythm that allows numerous body functions to synchronize to the light-dark cycle on earth. Biological clocks control our sleep pattern, as well as metabolism, energy expenditure, and body weight. A mismatch between these internal clocks and our lifestyle or external environment results in disease and lack of well being. Experiments in mice showed that altering feeding time from dark to light phase results in weight gain. Furthermore, mice fed a high fat diet ad libitum develop obesity. Mice fed the same diet over an 8-hour period only restricted to the dark phase did not gain weight. In addition, genetically engineered mice that lack the circadian clock in adipocytes tend to consume more calories during the light phase and develop obesity. Interestingly, the overall calorie intake does not change in these mice. These experiments show that a temporal change in feeding disrupts energy balance resulting in obesity.

When you eat may be as important as what you eat. More than 90% of our patients at Houston weight Loss Surgery Center skip breakfast. Patients who skip breakfast graze on food throughout the night because of decreased satiety and increased hunger. Studies in humans have shown that overweight individuals lose more weight when consuming most of their calories in the morning. Furthermore, fasting glucose and blood triglyceride levels tend to decrease by consuming a big breakfast and a small dinner without changing the total daily calorie intake. Indeed, we recommend to our patients to avoid carbohydrate consumption at dinner time as it serves no other purpose than fat accumulation. Conversely, a breakfast rich in complex carbohydrates provides excellent hunger control throughout the day and increased satiety around dinner time.

There is strong evidence that link circadian rhythms and energy metabolism. Every organ in the body has a biological clock that works synchronous with the master clock in the brain. Future research will unravel more details about this delicate and complex rhythmic physiology. Living in synchrony with these internal clocks optimizes your metabolism and may help you lose excess weight or prevent obesity from developing.

Magid Ezzati is the leading author of a recent article published in Lancet. The study is titled “ Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19·2 million participants”. The objective of this analysis involving around 200 countries is to analyze the worldwide trends in body weight over the past 40 years. The purpose of the analysis is to help public health policy makers develop strategies and implement policies to curb the obesity epidemic.

Dr. Ezzati, from the School of Public Health at Imperial College London in the United Kingdom, alarmingly concluded that if present trends continue, not only will the world not meet the World Health Organization obesity target of halting the rise in the prevalence of obesity, but more women will be severely obese (BMI greater than 35) than underweight by 2025. In 2014, about 266 million men and 375 million women were obese in the world, compared with 34 million men and 71 million women in 1975.

It is interesting to notice that results vary widely across countries. For instance women in Singapore, Switzerland, Japan, the Czech Republic, Belgium, and France had almost no increase in average BMI (less than 0.2 kg/m² per decade) over 40 years. On the other hand, more than one in four severely obese men (27.8%) and 18.3% of severely obese women in the world live in the United States. Public health officials ought to look at these numbers and start implementing new policies to control this epidemic. Bariatric surgery is currently the only effective treatment for obesity. However, in the United States only 1% of the severely obese patient population undergoes weight loss surgery every year. Obese individuals are contributing to skyrocketing rates of type 2 diabetes, hypertension, gastro-esophageal reflux disease, cancer…These rising trends are starting to affect our life expectancy as a society. New reports from the CDC are showing a rise in age-adjusted death rate for the first 9 months of 2015 compared to the same period in 2014. Stroke, diabetes and heart related disease have most notably increased. These obesity related problems would lead to dramatic consequences in health care. From a financial point of view, the cost of taking care of obesity related comorbidities have reached an astronomical level of 200 billion dollars per year in the US alone. By 2020, the cost of diabetes care alone may reach 500 billion dollars. Bariatric surgery by itself is not a solution for the billions of obese individuals all over the world. Dr. Ezzati explains that people living in countries like France and Switzerland are more likely to eat fresh and unprocessed food and to eat in moderation. Other lifestyle related factors are also at play and must be analyzed and implemented through public health policies. Prevention of weight gain should be the guiding principle. Individuals, families, communities, towns and countries must emulate a healthier lifestyle than what we currently have. For these lifestyle changes to take effect the US government must intervene to change the food environment. For today’s food environment exploits people’s biological, psychological, social, and economic vulnerabilities, making it easier for them to eat unhealthy foods… Currently, in the US, government intervention is hampered by a complex array of obstacles: Personal freedom, food industry lobby, food advertising laws, access to fresh produce… Meanwhile, the burden of obesity according to Dr. Ezzati will continue to rise unabated across the world. Today, we urgently call for regulatory actions from government along with full  cooperation from industry and society to overcome the obesity epidemic.

More than 500 million people worldwide suffer from obesity. Obesity is a complex medical disease that is poorly understood. Scientists have not yet established a biological cause for obesity. Obesity has a strong genetic component involving several genes that regulate body weight, appetite and energy metabolism. However, the identification and characterization of a cause effect relationship between certain gene expression and obesity in humans has remained elusive until few days ago.

A new study published in the New England Journal of Medicine, demonstrates a causal relationship between a gene variant and fat accumulation in adipocytes. This fascinating article by Claussnitzer and colleagues is titled FTO Obesity Variant Circuitry and Adipocyte Browning in Humans. FTO gene has been associated with obesity but so far FTO mechanism of action has not been understood. The authors propose that certain variants of the FTO gene change the basic function of human adipocytes from fat storage to fat burning. When exposed to a high-fat diet, adipocytes in white adipose tissue store fuel as triglycerides for later use. In contrast, brown adipocytes in the inter-scapular regions of infants, young adults, and some older persons generate heat by burning fat. A third type of adipose tissue, often called “beige,” or “brown-like” fat, is found in some white adipose tissue depots. Beige adipocytes like the brown ones have thermogenic properties. They can burn fat. It has been hypothesized that obese persons have fewer beige adipocytes and therefore are primed to gain weight on high-fat diets.

By showing that FTO gene controls adipocyte development into either a white (fat accumulating cell) or beige (fat burning cell), this original study explains the strong genetic association between obesity and FTO gene. The study offers a potential biologic pathway that leads to fat accumulation in adipocytes. Future research will focus on how FTO, which is highly expressed in several tissues, can affect other organs. The creation of a knock-in mouse with high-risk FTO alleles should facilitate the determination of the contribution of these gene variants to obesity. It would be interesting to study gastric bypass or gastric sleeve surgery in a knock-in mouse model with high-risk FTO alleles. Will the surgery be less effective? Or will the neuro-hormonal changes induced by weight loss surgery trump the FTO induced reduction in energy metabolism?

Our knowledge of obesity and weight loss surgery mechanism of action remains at its infancy. Obesity is a complex disease with many overlapping pathways that control appetite, weight and energy metabolism. It is quite amazing that a simple procedure like gastric sleeve can overcome all these pathways to achieve significant and durable weight loss. One cannot but wonder about the central role of the stomach and more specifically the gastric fundus in energy metabolism. The simple resection of gastric tissue, following gastric sleeve surgery, changes the interaction between ingested food and gastrointestinal tract. This change results in decreased appetite, weight loss and improved blood sugar control. Bile acid metabolism, colonic intestinal flora, gastro-intestinal motility as well as a number of hormones like GLP-1, PYY and Ghrelin levels are altered. How and why do these changes occur when the stomach is resected is still a mystery. Despite the obesity epidemic affecting millions of people, the only effective treatment available in the twenty first century is a surgery that we don’t understand how it works. This is no surprise as we are just starting to understand the role of the gastrointestinal tract as an endocrine organ. Bariatric surgery has been assumed to work by restriction and malabsorption for the past 50 years. Nutrient sensing and the resultant complex array of signals that reaches the brain, pancreas, liver and the rest of the intestines are very new concepts. Total deaths from diabetes alone are projected to rise by more than 50% in the next 10 years. Hopefully our understanding of gut physiology and its role in blood sugar regulation and energy metabolism will keep up with the rise of gut related disorders like diabetes and obesity. In future blogs I would like to share with you some of my views about the role of the stomach in nutrient sensing and processing and how Gastric fundus invagination, a novel weight loss procedure, is at the center of all this.

“God grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.”

Chronic stress is synonymous with 21^st century living and Houston ranks among America’s most stressful cities. According to Forbes magazine, Las Vegas is the most stressful city in the country, followed by Los Angeles, California, and Houston, Texas. Stressful Houstonians are paying a huge price with their health. Chronic stress is associated with many health issues namely obesity, diabetes, hypertension and heart disease. While stress is unavoidable in our life, coping with stress is a must know skill to survive and thrive in our modern society. Many people resort to unhealthy habits like smoking, drinking, and overeating that have deleterious effects on the long run. At Houston Weight Loss Surgery Center, stress management is an INTEGRAL PART of the weight loss treatment plan that we offer to our Houstonian patients.

In 1943, at the peak of WWII, Reinhold Niebuhr, a pastor, theologian and philosopher from New England wrote this prayer: “God grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.” In one sentence, Reinhold Niebuhr summarized the 4 pillars for coping with stress:

• Avoid the stressor
• Alter the stressor
• Adapt to the stressor
• Accept the stressor

It is easier said than done. However, understanding and facing stress rather than stewing in anger and frustration is your only way out. For overeating for hours in front of a TV will only damage your health. Overeating to comfort yourself is the worst coping strategy you adopt for dealing with stress. Soothing your pain with junk food, high sugar, and high fat comfort food will invariably develop into an addiction. An addiction that has fueled the rise of obesity to an epidemic level. You can take action today. Cope with stress and don’t let it control your life.

Here are five effective tips:

1. Take care of your body and your body will take care of you.
2. Exercise: Best antidote for stress. Pick an activity you like, hook up with an exercise buddy to motivate you, and make exercise part of your daily routine.
3. Spend some time in nature: get some fresh air and some sun.
4. Meditate: Visualize calm. Transport yourself to a happy place 5 minutes everyday. Boost your spiritual side; Get in touch with your inner self. Religious people are happier than atheists in stressful environments. We need religion more than ever these days.
5. Develop a hobby: Take your mind of negative thoughts and engage in a creative or competitive activity.

JAMA, the journal of the American medical association describes our time as “The age of obesity and inactivity” and we all know it:

• 2/3 of adults and 1/3 of children and adolescents are now classified as obese or overweight.
• The cost of treatment of obesity related conditions has reached 10 % of the total US medical expenditure.
• Obesity is reversing all the gains made in the past 100 years by lowering cholesterol, hypertension and smoking rates.

What We Should Do?

The answer is simple: Eat Less and exercise more. 25% of American men and 43% of women attempt to lose weight each year. Of those who succeed 5 % manage to keep it off for the long haul. 45 million Americans belong nowadays to a health club as opposed to 23 million in 1993. $19 billion per year are spent on gym memberships. A Houston heart survey showed a 10% increase in regular exercise from 1980 till 2000. Yet, obesity figures in Houston more than doubled in that same time frame.

Why is our body fighting against our own good health?

In an article published in 2011 in the New England Journal of Medicine, Dr. Proietto, from the University of Melbourne, showed that multiple compensatory mechanisms encouraging weight gain, persist for at least 1 year after weight loss. He followed 50 overweight individuals for approximately one year after putting them on a very low calorie diet for several weeks. Hunger and satiety hormones were monitored. Dr. Proietto showed that following diet induced weight loss, hunger hormones go up and satiety hormones go down. In other words, every time you lose some weight following any kind of diet you feel hungrier than before. The more you lose weight the harder it is to maintain a low calorie diet. Furthermore, your metabolism goes down as you lose weight. Your body goes into an energy conservation mode making it harder to shed additional pounds. In this fight between you and your own body, guess who wins? 95% of all those who attempt to lose weight by diet and exercise end up gaining it back. The reality is that very few of us can overcome our basic biology to maintain the weight loss.

At Houston weight loss surgery center, we clearly differentiate between preventing weight gain and treating excess weight. We strongly recommend eating less and exercising more to stay fit, and healthy. If however you are already overweight, weight loss surgery is the only effective treatment for durable weight loss. Bariatric surgery prevents the compensatory changes that accompany weight loss. You are no longer fighting your own body. The struggle against obesity becomes a journey. A journey, we are privileged to be part of. If you are overweight and you are trying to lose weight please give us a call at 281.205.3205

Obesity is neither a cosmetic issue nor a psychological problem. It is very important for our patients to understand that obesity is a CHRONIC PROGRESSIVE MEDICAL DISEASE. Our understanding of obesity, energy metabolism and weight control has greatly evolved over the past few years. We now understand that many hormones control body weight and obesity is the result of an imbalance in these complex hormonal systems.

Therefore, obesity is no longer viewed as a consequence of over-eating, self-indulgence or lack of self-control. Rather, obesity is the result of multiple environmental and genetic factors that disrupt a variety of hormonal systems that control body weight and energy metabolism. The disruption of these hormones results in the progressive body fat accumulation.

In the United States, 68% of all adults are overweight. The environment in which we live (Sedentary and stressful lifestyle in addition to a highly processed diet low in fruits, vegetables, legumes, seeds, nuts, and quality proteins) puts us at risk for excessive fat accumulation. Accordingly, overweight individuals are victims of an “obesogenic” environment. Overweight patients are not culprits and should not feel guilty about their weight problem. 

To summarize, obesity does not simply occur because you eat more food. Therefore, the solution to obesity is not as simple as lowering your food intake. Any long-term and effective solution for obesity has to address the underlying cause: Disrupted Hormones. If you are concerned with your weight, please contact us so we can determine the best weight loss solution for you.