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She says her trainer Bob Greene turned her on to it and she loves the various options for total body workouts in one machine. Has she indeed tried dieting? We know that these things, that if they can affect weight loss can help. As an employee, she lives for herself. I mean if we're assuming that she really had this concerted effort at diet, it'd be nice to get more details on that, but we have what we have and the degree of activity; it is helpful.

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This helps the men in losing weight healthily without facing those hunger pangs. This is a specially designed plan for vegetarians. By the way, what kind of surgery are we talking about here? It kind of affects your eating habits basically. I'd like to know more about her eating habits, I'd like to know more about her exercise habits, her family history, if she's had any evaluation for her obesity.

As an employee, she lives for herself. She's not setting up the role model example for patients; she's not being asked to do that in her job. It's completely unacceptable for an employer to put somebody through that kind of Wouldn't she be better off skinny? There's nothing magic about being skinny. I think that being not morbidly obese would make her healthier. We can't make people skinny; that's not our business. I've never told anyone that they should have Bariatric Surgery.

I would tell them it's an option; it's probably the only option that will provide them with that long term significant weight loss that they seek, but being skinny is not something that we mention when we see patients because it's not, it's not meaningful.

What does that mean? Morbid means other illnesses are associated with that degree of obesity. He records this in the chart. She says that she has tried dieting before but it didn't really work and she doesn't exercise because she works at night and during the day she takes care of her kids.

She used to smoke and she heard all the admonitions about smoking so she stopped, and lo and behold, she gained weight. Does this kind of information help you in helping her? I mean if we're assuming that she really had this concerted effort at diet, it'd be nice to get more details on that, but we have what we have and the degree of activity; it is helpful.

Yes, quitting smoking, it's not an uncommon thing that people put on weight and she's still healthier quitting smoking. I mean it sounds like she's tried everything, or should she try harder? I've had patients who've come in after losing, who are several hundred pounds overweight and have lost pounds. It's difficult to maintain that weight loss for most people. Some can do it, but most can't. Lou is right; a person should have demonstrated a commitment to weight loss in the past in a healthy way, not in strange, unusual crazy fad diets, but in good healthy living.

I dieted, I exercised, I did all of it. I yo-yoed back and forth, up and down, different weights. I'd lost 40 or 50 pounds, and gained 40 or 50 pounds. You try different things and it doesn't stay off. Sophie does not think of herself as overweight. She talks to a doctor about it. She certainly doesn't think of herself as morbidly obese and she is asked about it. She is not diabetic; she doesn't have high blood pressure.

Everyone has been telling her to diet and exercise and that's all she's ever going to need. Is it realistic for people to be on her case to get on that diet and exercise thing or is that just not going to work?

We've had some bad experiences with the diet pills in the past. We know that these things, that if they can affect weight loss can help. Weight loss through any means will show an improvement in glucose control and blood pressure control. There's not a lot of magic about surgery in that regard. But also the weight loss results from these medications through these randomized studies for our patient population were really under whelming; that's part of the problem.

Sophie is still at work, still wrestling with this and her surgeon boss, co-worker talks to her again and he is worried he says now about her health because she's huffing and puffing around the ward when she walks trying to do her job. He keeps suggesting surgery. Now she's really thinking about it so she goes to her family and says my boss thinks I'm overweight. Do you think I'm that big and her family says no you are not.

How important is this? She and her doctor need to come to that decision. Is she someone you'd take and take to the operating room? People qualify on the basic, on the very basic level of body mass index. The National Institutes of Health say that people, who are body mass index of greater than 40; that's the definition of morbidly obese, are at the most basic level candidates for consideration for surgical treatment.

In other words, we're not going to be operating on people, who are 20 or 30 pounds overweight; that wouldn't be appropriate. So it's, that is a baseline screening criteria so I would say she is at the simplest level a candidate for the surgery, but taking her to the operating room; there's a long way to go before and if that would ever happen.

She's got a body mass index, which just barely tips her into this candidate for surgery class. If you wait very long and her body mass index goes to 50, or even 60, now she's not only a candidate for surgery, she's at extreme risk of dying during that surgery. Where's the breakpoint in there? There are about 10 to 12 million people who are really eligible for the surgery in America based on their weight and their conditions like diabetes and heart disease.

At our institution we tend to favor operating at the extreme end of the weight range; , pound patients because we know that that group clearly has all, all the bad effects of obesity; diabetes, hypertension, hearts that don't function well.

Obesity is a major problem in the United States and not everyone can make diet and exercise work. Diet pills don't seem to be the answer. Obese people then are left with the medical and social consequences of being fat and a lot of these are real.

Well let me tell you about Sophie because Sophie decides to go see a Bariatric Surgeon. So what questions need to be answered by Sophie before she gets the operation? Melissa At this point she's probably met the BMI criteria, but she and her doctor need to be satisfied that non-surgical approaches to weight control have not, not proven effective for her.

Has she indeed tried dieting? What types of diets or medications has she tried over the years? What has been her weight trajectory over time?

In considering that in conjunction with a good understanding of the potential outcomes, risks, and benefits of surgery and when she's satisfied that non surgical approaches have not proven effective and she's willing to accept the risks and likely outcomes of surgery, that she understands, that she can sense that she's opting for surgery and not doing it under duress from family or coworkers. First of all we're talking about Bariatric Surgery like its one thing.

In fact this is a cluster of operations that have evolved over the last 50 years really. You have to see the nutritionist twice when I was doing it. Seeing the psychologist they want to make sure that you're not a comfort food eater, you haven't been abused or eating food because of abuse or you're not an alcoholic.

I mean there are a lot of different things in your mind that you're going through when you're talking to the psychologist. How many people have had some sort of surgery for weight control in this country?

Every year about to , operations are now performed nationwide and that has just skyrocketed in the last 10 years. Sophie goes ahead and decides to try surgery and her surgeon and she decided to do something called Gastric Banding. What is it, how does it work, and why does it work? That band is connected to tubing which sits underneath the skin and the tubing gets inflated with water and the band shrinks or opens in size.

As the size of the band opens and closes with adjustments done in the doctor's office, the size between the top part of the stomach and the bottom part of the stomach changes as well. As that gets smaller and smaller it takes more time for food to go from the top part of the stomach to the bottom part of the stomach. People feel that they have restriction in what they can eat. That restriction is really the goal of an Adjustable Banding Procedure and that restriction is something that we aim for with those adjustments.

It takes a lot of time. I had to change my lifestyle. The operation is part; you're part of a team when you have the operation.

He comes to see his doctor, I'm sure you're seeing a nutritionist and social worker as they do in our program and you're part of a team that's affecting massive behavioral change. But the question is could you have done it without the operation? First of all, of everybody that comes to your office for this surgery and gets interviewed and has a psychological profile, perhaps does 6 months of intensive dieting What percent go to surgery, what percent do you say no you're not an appropriate candidate?

We haven't figured it out yet. I would say that most of your patients, most of my patients who come end up going on to surgery. She had the surgery and she lost pounds in a period of 16 months all right? I think I know the answer to this, but just reiterate this for me. Is that it, is she done? She doesn't have to do anything else? You know it takes much longer to lose the same amount of weight with an Adjustable Banding Procedure as it does with the Bypass so I was surprised that she lost so much weight in so little amount of time, but certainly it can happen in a motivated patient.

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