014 Dr John Dixon Interview

by reeger on December 16, 2013

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john-dixonInterview with Dr John Dixon. Dr Dixon is the Laboratory Head of Clinical Obesity Research at the Baker IDI Heart and Diabetes Institute, Associate Professor and Head of the Obesity Research Unit, and the Obesity Assessment and Management Clinic at the School of Primary Health Care at Monash University, in Melbourne, Australia.

During this interview our talk centers often on the lap band but Dr Dixon also talks about RYGB and VSG so regardless of the type of surgery you may have had or are thinking of having, stay tuned because there is something for everyone on this podcast.  In this episode we discuss:

  • History of the band.
  • How the Band and all bariatric surgery works: The gut and brain connection: nerves, hormones, stretch receptors of the stomach all interact to send signals to the conscious brain to tell us when we are physically hungry vs satisfied.
  • Weight loss surgery is NOT about restriction or malabsorption; WLS works by changing the gut signaling.
  • Restriction? Hunger and satisfaction are NOT determined by the amount of restriction, whether that is regarding the Band, RYGB, or VSG. Dr Dixon discusses the study findings to prove this fact.
  • Set Point: this is the weight your body will defend. WLS helps push the bodies weight set point to a lower level, but where the new set point will be after WLS nobody can predict. The set point also naturally goes higher for all people over time, this natural physiologic rising to the set point is partly to blame for weight regain after WLS.
  • Is it ok to drink with your meals? Yes. Dr Dixon explains why and the research that support this.
  • Hunger vs Satisfaction: Understanding the difference
  • Band Zones: Green Zone: Reduced physical hunger, small whole food meals satisfy. Yellow Zone: Physically hungry, always looking for food. Red Zone: Frequent reflux, regurgitation, and/or night cough.
  • Stretch Receptors: The stomach has stretch receptors. If a band is chronically too tight, the stretch receptors above the band can become less sensitive to the presence of food. This can lead to additional eating, and over eating, as the person seeks the sensation of the presence of food above the band.  Yet another reason to be sure your band is not chronically too tight, or in the red zone!
  • Weight loss after WLS ideally is not a chore. It should occur relatively easily so long as the surgery does it job and the person does their job of increasing their activity and following proper nutrition.
  • However, there are always going to be responders (those who lose weight successfully) and non-responders (those who either do not lose weight or do not lose much weight). For the non-responders this does not mean failure, it simply means more treatment methods need to be engaged including medication, more behavioral therapies, more follow-up care, more education, and in some cases changing to a different surgical procedure (but this should always be the last resort.
  • Choosing which procedure: There is no way to predict who will respond to which surgery or not. Dr Dixon feels that which surgery a person has is not the most important question. All the surgical options for weight loss have their risks and benefits. Therefore, the most important aspects of surgical weight loss are life long follow-up, patient education, and that the person having the surgery choose which surgery they would like after they have learned about each procedure.
  • Weight loss after Surgery: Dr Dixon uses total body weight loss, not excess weight loss. He states that the research shows the average weight loss with a Band at 5 years is 20-22% of total body weight loss; Gastric Bypass results in 25-30% of total body weight loss but there is often some modest weight regain which ultimately results in an average weight loss of 25% over time, and Vertical Gastric Sleeve results in 25-30% of total weight loss in the first year but after the first year there is also some weight regain as well with the 5 year average weight loss after VSG being 22%.
  • There is no stand-out winner on which surgery is better.
  • Band Life Span: The Band has a projected very long life time. Bands that were placed in the 1980’s are still functioning.
  • Fluoroscopy is indicated for diagnosing a band problem, not for routine adjustments.
  • Does the band have a Honeymoon phase? Dr Dixon thinks a honeymoon phase exists with a RYGB, but not with a band.
  • For all forms of WLS, physical hunger does return, that is normal.
  • Women who are pre-menopausal are at higher risk for being in the red zone and problems of an overly tight band compared to men and post-menopausal women due to hormonal fluctuations. Therefore pre-menopausal woman should be careful to avoid overly tight, red-zone adjustments.
  • Lap bands are made of silicon and over time fluid very slowly leaks out of the band, 0.3-0.4ml over 1-2 years. The band is never “set and forget.” Over time it is normal to require a small adjustment of fluid to the band to compensate for the small amount of fluid that seeps out through the silicon membrane.
  • The Lap Band is like a tire on a high performance vehicle: In order to work properly it needs to be inflated to just the right level to work properly, not too much, not too little.

I Hope you have found this episode to be helpful.

Feel free to leave a comment or question below. If you find the show via iTunes, please leave a rating. This really helps with exposure of the show.

Happy Holidays everyone!

In Peace and with Connection,

Reeger

 

{ 1 comment… read it below or add one }

fred May 1, 2016 at 8:23 pm

Good stuff

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