001 What is obesity, The tool of bariatric surgery, and Vision Statements

by reeger on June 24, 2013


In this episode 001 I review:
Obesity is a complicated chronic disease of energy imbalance where energy consumed (calories) is greater than energy expended (Calories burned) which results in excess body fat storage.

Obesity is NOT simply a lifestyle or behavioral choice.

Obesity is the result of complicated interplay between genetics, environment, metabolism, and emotions

Perhaps you have heard the expression when it comes to obesity: Genetics loads the gun. Environment pulls the trigger.
I would describe the situation in greater detail as follows:
Genetics makes the gun. Environment makes the bullet. Metabolism holds the gun. And Emotions pulls the trigger.

In medicine obesity is measured according to a persons BMI which is a calculation of dividing a persons weight by their height. A BMI greater between 25 and 29.9 is over weight. BMI > than 30 is considered obese.
Waist circumference is another way to measure obesity. Female >35 inches or 88cm, Men > 40 inches or 102cm


According to the WHO:
Worldwide obesity has nearly doubled since 1980.
In 2008, more than 1.4 billion adults, 20 and older, were overweight. Of these over 200 million men and nearly 300 million women were obese.
65% of the world’s population live in countries where overweight and obesity kills more people than underweight.
In 2011 More than 40 million children under the age of five were overweight.

In the US 1 out of 3 adults is either overweight or obese

Because a risk factor for being obese is simply being a human, obesity is an equal opportunity kind of disease: it does not care about your age, gender, race, income, or education.

Risks Obesity: Mortality and Morbidity
Morbidity: number of people Living with a disease.
People with BMI >30 have increased risks of developing numerous diseases that will effect not only their quantity of life but also quality of life. These diseases include:
T2DM, HTN, High Cholesterol, Heart disease, Stroke, Sleep apnea, Asthma, Osteoarthritis, GERD, infertility, incontinence, Fatty Liver disease, Gallbladder disease
Cancer especially colon, rectal, breast, pancreatic, kidney, endometrial, and esophageal

Mortality related to obesity:
Simply having BMI between 30-35 is a predictor of dying 2-4 years earlier than a normal BMI person.
and having a BMI 40-45 is a predictor of dying 8-10 years earlier.

Economics of Obesity:
21% of US health care costs are directly attributed to obesity and treatment of obesity related diseases
These are costs out of everyone pockets, especially the person who suffers from obesity.

Obesity is preventable and it is treatable.

Treatment options
Many obesity treatment options available:
4 Categories
1 Self directed Behavior Modification, nutrition adjustment, and increased physical activity
2 Commerical weight loss programs such as weight watchers and Jenny craig
3 Medical-provider supervised weight loss programs which may include use of weight loss medications.
4 Bariatric Weight Loss surgery

Which method or methods a person chooses is a personal decision but it is also one that should be made after consulting your medical provider. There is not always a right or wrong answer as there is no ONE treatment option for obesity.

Who might be a candidate for having bariatric surgery?

In 1991 the National Institutes of Health established criteria for candidacy for bariatric surgery including:
The vast majority of bariatric surgical programs follow these criteria:
So th
▪ No endocrine causes of obesity, I would add to this no untreated endocrine causes of obesity. Certainly there are many people who have hypothyroidism that may have lead to weight gain but when their thyroid levels are normalized they may still struggle with obesity.
▪ Their level of operative risk should be Acceptable.
▪ The persons is capable of Understanding the surgery and risks
▪ There should be no drug or alcohol problem
▪ No uncontrolled psychological conditions
▪ The person should have attempted and Failed at their attempts at medical weight-loss
▪ BMI 35-40 with significant obesity-related conditions (type 2 diabetes, high blood pressure, sleep apnea or high cholesterol)
▪ BMI >40, Severe obesity (or weighing more than 100 pounds over ideal body weight)

Benefits of surgery:
Weight loss: within 2-3 years after surgery one might expect to have lost 40-80% of their excess weight, depending upon the type of surgery and a persons compliance with post-surgical recommendations regarding nutrition, exercise, and behavior modification.

Additional benefits: remission of obesity-related disease

Risks for surgery:
As with all surgical procedures there are inherent risks associated with having surgery
Review these risks with your PCP and especially your bariatric surgeon.

After surgery there are numerous risks, some of those risks are dependent on the type of surgery a person has and some risks are the same with all the surgeries.

Of all the risks associated with life after WLS, I find the one that a person is the most concerned about is unsatisfactory weight loss and/or weight regain.
Unsatisfactory weight loss and/or weight regain is an important and complicated topic.
It is one that I will explore over time and in greater depth throughout the life of this podcast.

Types of Surgeries:
There a four main surgeries preformed today.

RYGB: Is generally considered the gold standard for weight loss
Surgically Reduces the stomach to the size to about the size of chicken egg and bypasss a portion of the small intestine.
Weight loss occurs through a combination of physical restriction, nutrient malabsorption, and metabolic-hormonal effects

Vertical Sleeve Gastrectomy:
Surgically removes approx 75% of the stomach, creating a narrow stomach tube also known as a sleeve. The result is a restrictive and metabolic procedure which together produces reduced physical hunger and increased physical satisfaction with smaller meals.

Laparoscopic Gastric Band: Surgical places a silicon band around the top of the stomach.
The band has inflatable pillows on the inside. T
he Band is connected to tubing which is connected to a port.
The port is sewn to the muscle wall.
Then during office visits and conversation with the LapBand provider, the pillows inside the band are either inflated or deflated depending on the persons needs and symptoms.
This is why the band is also called an Adjustable gastric band.
Traditionally the band has been considered a purely restrictive procedure but recent research indicates that the band works primarily through altering gut hormones to produce less physical hunger and more satisfaction

Biliopancreatic Diversion with Duodenal Switch. Surgically turns the stomach into a sleeve (similar to a vertical sleeve gasctrectomy) and also bypasses the small intestines like a RYGB but generally a greater percent of intestines are bypassed.
Weight loss occurs through a combination of physical restriction, nutrient malabsorption, and metabolic-hormonal effects.

So that is a very brief over view of obesity, its personal and global impact, and the surgical options for weight loss.
In future podcast I will be going over each of these surgeries in greater detail so stay tuned.
Next left move on the Mind section of the podcast

Bariatric surgery is a TOOL for weight loss

Bariatric surgery is not a cure for obesity.
The more a person understands this critical concept and exacts upon this truth every day, the more they will be successful in their goals.

And anyone who has had WLS will tell you, Bariatric surgery is not the easy way out!
I had a patient once tell me both frustration and in pride, Reeger I have to do everything everyday.
Meaning, she had had her surgery which had helped her lose a significant portion of her excess weight and to maintain her health and weight loss, she had to follow the nutrition guidelines, take her vitamins, drink her water, and exercise most days of the week.

I said, Yes! Congratulations! You understand that you have many tools to help, you understand which tool is right for which job, and you are using them correctly!

And so, how a person uses the tool of surgery is up to them. Just like when using a hammer, you can use the hammer to hit the nail on the head and get the job done right. Or you can use the hammer to hit everything but the nail, or you can simply ignore the hammer altogether. But don’t blame the nail when it can’t hammer itself in.
Knowing what tools you have and how to use the tool correctly is up to you.

Life after weight loss surgery invovles building a new you.

Just like a carpenter would never build a home with only a hammer, a person who has had weight loss surgery should consider all the tools in their tool box of life including their surgery, their support from their bariatric program, appropriate nutrition, daily exercise, counseling when needed, and healthy support from ones family and friends.
Pay attention to yourself, gives yourself the support and caring you need and deserve.

One of the struggles I observe is what I call the second place syndrome:
Many people put themselves second before their children, the spouses, their jobs, their ____ you fill in the blank.
I ask you to recognize SelfCare is not Self-ish.
I volunteered with a search and rescue for a number of years and one of the first rules in search and rescue is DO not become a victim. Meaning if you want to help people, do not place yourself in harms way, thus becoming another person needing to be saved.

I think this rule applies to ones day to day health, wellness, and weight loss goals.
We cannot help others if we are not healthy ourselves.
By taking care of yourself, not falling into the second place syndrome, you are able to be present for, and help those around you.
SelfCare is not Selfish.

Do you have personal vision statement?

Sometimes people think of vision statements are just for businesses, but I think personal vision statements are perhaps even more important for people than businesses. After all, This is your life we are talking about.

There is a quote that I just love. It goes:
If you don’t change your way, you are going to get to where you are going.

Do you know where are you going? Is it where you will want to be?
If the answer is Yes, then Great, Keep going!
If the answer is no, perhaps now is time to write your vision statement.
In either case, No matter where you are at in your life, creating your personal vision statement can help you get there because it lends power, focus, and commitment to achieving your goals.

There are a number different formats to follow when creating your vision statement.
It can be written in the first person with “I” statements: I am, I do, I have, I value, I will, etc…

Or it can be written in the future tense: I will be, I will do, I will have, etc…

A vision statement can also be written like a diary entry in the future. Put a future date on the top of the page, then write your future life as you see it. Include who you are, where you are, what you are doing, Who is with you, How you feel, and so on.

No matter what, Let your vision statement be reflection of you, what you value, what you are passionate about, what is your purpose, what gives you meaning and fulfillment, what you want in your life.

I have a dear friend named Angela. She is one of those go getter kind of people. One of her mottos in life is “plan it and it will happen” Your vision statement is you planning your life so that it happens as your desire.

There are no right or wrong answers. There is only you in your present and future perfection,
living your one and only precious life.

I believe in you.

Reeger Cortell, FNP-C

{ 2 comments… read them below or add one }

Cory Pelc January 6, 2017 at 6:12 pm

Just found the podcast and I am excited to catch up and listen in. Thanks for dedicating so much time to help people!


reeger January 12, 2017 at 3:31 pm

Hi Cory, I am so glad you found the podcast! Welcome and thanks for reaching out. : ) Reeger


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