STAMPEDE (Surgical Treatment and Medications Potentially Eradicate Diabetes Efficiently) included 60 patients between the ages of 30 and 60 years with a body mass index (BMI) of 35 or more and a history of at least five years of diabetes. Study participants were randomly assigned to receive conventional medical therapy or undergo either gastric bypass or biliopancreatic diversion.

The results were significant. At two years, diabetes remission had occurred in no patients in the medical therapy group versus 75 percent in the gastric-bypass group and 95 percent in the biliopancreatic diversion group. The results also showed that remission was independent of weight loss, suggesting that the positive outcomes are a result of metabolic changes achieved through surgery.

This line of thinking is supported by the International Diabetes Federation (IDF), an umbrella organization of more than 200 national diabetes associations in more than 160 countries. In late 2011 they issued a position statement supporting bariatric surgery to treat Type 2 diabetes in obese patients. The IDF statement was generated as a result of key thought leaders and organizations collaborating over the past five years. It was written by 20 leading experts in diabetes and bariatric surgery.

We are seeing positive changes in the conversation about bariatric surgery. STAMPEDE supports the new way of thinking– viewing it as metabolic surgery, a therapeutic intervention that can improve or resolve many metabolic conditions. In addition to addressing Type 2 diabetes, bariatric surgery can improve or resolve heart disease, hypertension, sleep apnea and high cholesterol.

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I’ve been performing robotic bariatric surgery for a little over two years now. In that time, I’ve performed approximately 75 robotic gastric bypasses and have been very impressed with the results.

Based on my positive experience I was happy to accept the invitation when Intuitive Surgical, creator of the da Vinci® Surgical System, contacted me about being certified as a proctor. As a proctor, I help train other surgeons on using the system, either going on-site to work with them in the operating room or allowing them to visit my OR in Maryville to watch me work. I am honored to be one of only a few certified proctors on the East Coast, and I’m glad to have the opportunity to support efforts to increase the use of this valuable tool.

Robotic surgery is better for patients. Because it requires only a few tiny incisions, patients experience less pain, a shorter hospital stay, and a quicker return to work time. I had one patient who was up and walking soon after surgery, walked out of the hospital under his own strength 24 hours after surgery, and walked more than a quarter mile the next day. Almost all patients report that they require no pain medication, an important benefit in light of the dangers associated with addiction to prescription pain medication.

Robotic surgery is also better for surgeons, offering enhanced 3D vision along with more precision, dexterity and control. It also causes less fatigue, allowing surgeons to better focus on the procedure without the physical stress often associated with bariatric surgery.

I’m convinced that robotic bariatric surgery is better for patients and surgeons, and I’m happy to be at the forefront of this new technology.

Are you considering surgical weight loss? Sign up for a free seminar to see if bariatric surgery is right for you.

When Milton Cooper of Maryville first came to our office, he was 39 years old and weighed 378 pounds. He first tipped the scales at over 300 pounds when he was only 18 and was diagnosed with diabetes about a year later. Cooper’s struggles with diabetes led his doctor to recommend weight loss surgery and ultimately brought him to us.

In Cooper’s words: “I was taking three to four insulin shots a day, plus diabetes medication, and still my blood sugar wouldn’t come down. I knew if I didn’t do something quickly my diabetes would catch up with me. Two days after my surgery, I was off all of my medications. Gastric bypass cured my diabetes. It has been amazing.”

Cooper says that, as was the case with him, a lot of men believe they were meant to go through life overweight and that our society doesn’t really push them to lose weight even if it could save their lives.

I performed Cooper’s gastric bypass procedure in March 2010. Now that he’s a much healthier 209 pounds – and off his diabetes, high blood pressure and high cholesterol medications – Cooper hopes to convince more men to consider the benefits of weight loss surgery.

“Now that I have had the surgery, I don’t see why any man wouldn’t want to do it,” says Cooper.

If you’re a “big guy” who’s struggling with health problems related to your weight, we encourage you to attend one of our free seminars to see if weight loss surgery is right for you.

Dr. Jonathan Ray  and I talk about the practice’s standing as a Bariatric Surgery Center of Excellence and the success our patients have achieved.

For more information and to sign up for a free informational seminar, visit http://www.foothillsweightloss.com.

I’ve been hearing about apps that purportedly do a very good job at helping people lose weight, so I decided to do a little research. In only a few minutes, I found apps that will provide yoga instruction, help you count calories, allow you to keep a food diary, prepare your own personal workout plan, calculate your heart rate, and much more. These apps can be helpful tools for keeping bariatric surgery patients motivated and focused on their success.

IPhone users may like Lose It! The company website describes the product’s benefits as follows:

“Despite what many ‘experts’ would lead you to believe, weight loss boils down to simple math: calories in vs. calories out. To shed pounds, you have to end each day with a calorie deficit. It sounds easy enough, but studies show that 63 percent of Americans grossly underestimate their daily calorie intake. In fact, the average American consumes a staggering 2,700 calories a day — for many Americans, that’s enough calories to gain up to 8 pounds every month!”

The site goes on to list the five pillars of the Lose It! strategy:

1. Embrace mindful empowerment. Take control of your body and the foods that you put in it.
2. Track your calories. There are no points or complicated algorithms to follow. But every snack, taste, and bite counts!
3. Track your habits. Spot behavior patterns that you can modify to help you meet your goals.
4. Track your exercise. Learn how to burn more calories in less time and boost your calorie burn.
5. Benefit from peer support. Your social network inspires you, keeps you accountable, and provides insight and advice.

I don’t endorse this product over any others, but its basic five pillars provide a sound basis for any weight loss plan.

If you’re interested in finding a weight loss app that works for you, the Android Market and the iphone store offer a host of good options.

If you’re ready to determine if weight loss surgery is the right step for you, register today for one of our free seminars.

In 2010, the American Diabetes Association published their position statement that said in part, “Bariatric surgery should be considered for adults with a BMI of 35 and above with Type 2 diabetes, especially if the diabetes is difficult to control with lifestyle and pharmacologic therapy.”

In March 2011, the American Heart Association issued a scientific statement indicating that bariatric surgery can result in long-term weight loss and significant reductions in cardiac and other risk factors for some severely obese adults.

Statement highlights include:

• “Bariatric surgery is a viable option for patients who are severely obese and are safe surgical candidates who have failed medical therapy for losing weight.”
• “When indicated, bariatric surgery often leads to long-term weight loss and significantly improved health.”
• “While there are risks, bariatric surgery is considered a relatively safe procedure, especially in centers that perform many of the procedures.”

Paul Poirier, M.D., Ph.D., director of the prevention/rehabilitation program at Quebec Heart and Lung Institute at Laval University Hospital in Canada and lead author of the statement, said: “Obesity has reached epidemic proportions in the United States, as well as in much of the industrialized world. The most rapidly growing segment of the obese population is the severely obese. The health consequences of severe obesity are profound. In comparison with normal-weight individuals, a 25-year-old severely obese man has a 22 percent reduction in his expected lifespan.”

Bariatric surgery is not for everyone, but as scientific evidence is bearing out, it can be an important life-saving procedure for the morbidly obese.

If you are obese and suffer from diabetes and/or cardiac risk factors, sign up for one of our free seminars to learn if bariatric surgery is right for you.

Sara Trombley, laparoscopic sleeve gastrectomy patient

Laparoscopic sleeve gastrectomy, also known as the gastric sleeve, was first introduced in 2005, and we’ve been performing the procedure since 2008. As of March 2011, we’ve performed 65 gastric sleeve procedures and are pleased with the results.

Melody Helms, who is both a Foothills patient and employee, lost 200 pounds following her gastric sleeve in March 2009. She’s maintaining her weight loss through exercise and making good food choices.

Sara Trombley lost 146 pounds following her gastric sleeve surgery in February 2008. About Foothills Weight Loss Specialists, she says, “They not only gave me back my life but gave me a life I didn’t think possible.”

Laparoscopic sleeve gastrectomy involves surgically removing 85 percent or more of the stomach, resulting in a new stomach roughly the size and shape of a banana. The procedure generates weight loss by restricting the amount of food (and therefore calories) that can be consumed. Also, because the procedure removes the portion of the stomach that produces ghrelin, the hormone responsible for appetite and hunger, the level of ghrelin decreases, resulting in a reduced appetite.

Laparoscopic sleeve gastrectomy differs from gastric banding procedures in that it does not require implantation of an artificial device, and it is not reversible.

The following are some of its advantages:

• Although the stomach is reduced in size and the amount of food that can be consumed is restricted, the stomach otherwise functions normally and most foods can be eaten in small amounts.
• There is no disconnecting or reconnecting of the intestines, which lessens the risk of complications.
• Because there is no intestinal bypass, patients are not expected to have complications associated with that procedure, which might include intestinal obstruction, “dumping syndrome,” anemia, osteoporosis, vitamin deficiency and protein deficiency.
• The procedure is performed laparoscopically – even on patients weighing more than 500 pounds.

If you’re considering laparoscopic sleeve gastrectomy or any other weight loss surgery option, register for a free informational seminar to determine which procedure is the best fit for you.

For these people, cosmetic issues may be the impetus behind the desire for surgery. For many, seeing the “before” and “after” photos of patients who have successfully lost weight makes it seem like looking better is the reason for having surgery. A desire to look good is never reason enough for surgery, however. Cosmetic benefits are only a positive side effect.

The main goals of surgery are to:

1. Improve your health. Following surgery, the resolution and improvement rates for adult-onset diabetes, hypertension, sleep apnea, gastroesophageal reflux disease and hypercholesterolemia are remarkable.
2. Improve your quality of life. Patients report that they not only get their life back, they get a life they never thought possible. Here’s what patients are saying:
   “I’m healthier now at 40 than I was at 20. I’m medication free.” – Barton Baskette.
   “I have tons of energy. Everything is new and exciting for me now.” – Jill Mayfield
   “My life after surgery has been a whirlwind of activity.” – Melody Helms
3. Increase your life-span. – Recent studies show that the risk of an early death for those struggling with obesity is twice that of a non-obese person. Following successful weight loss, the risk of death decreases by 89 percent.

If you’re considering weight loss surgery to fit into some “skinny jeans,” I ask you to also consider the benefits that improved health can bring to your life and the lives of the ones you love. To learn more, attend one of our free seminars to see if bariatric surgery is right for you.

The following gives you a quick snapshot of what to expect:

Step One: Educational seminar. Your first step begins with attending a free educational seminar, where you’ll learn about surgical weight loss options and meet other patients and our staff. Upcoming seminars and registration information are available here.

Step Two: Verification of insurance benefits. We will work with your insurance carrier to verify insurance benefits available for weight loss surgery.

Step Three: Initial consultation with surgeon, financial counselor and patient advocate. This is an important step that consists of the following components:

Step Four: Completion of supervised, approved weight-loss plan. Most insurance providers require documentation evidencing that you have followed a medically supervised weight loss program for at least six months prior to surgery. We can help you with that requirement.

Step Five: Nutrition and exercise consultation. Our dietitian will meet with you to discuss life after bariatric surgery, including changes to your digestive system and nutritional requirements; the use of multiple vitamin and mineral supplements; the importance of protein and adequate fluid intake; and any other concerns you may have. We also will discuss with you the importance of maintaining an active lifestyle and make suggestions for appropriate exercise and fitness routines. This is part of our multi-disciplinary approach, a critical component for weight loss success.

Step Six: Psychological evaluation. Our behavioral health specialist will meet with you at least twice prior to weight loss surgery to confirm that you are a good candidate for surgery and to help you establish a better understanding of the behavioral changes essential for long-term success. Meeting with a psychologist or psychiatrist before weight loss surgery is a requirement of most insurance carriers.

Step Seven: Clinical clearance and lab tests. Prior to surgery you will go through pre-operative testing which includes meeting with your anesthesiologist and undergoing lab work. You also will have an electrocardiogram (EKG) and/or a chest x-ray (CXR). You also will receive general information about what to expect throughout your hospital stay.

Step Eight: Insurance authorization. Once you have met the above requirements, we will work with your insurance company to obtain authorization for surgery.

Step Nine: Pre-operative education. We will meet with you prior to surgery to provide you with important pre-surgical instructions and to help you better understand what to expect following surgery.

Step Ten: Surgery. With no complications, you can expect to go home the same day of your band procedure; be in the hospital one night for a sleeve gastrectomy and two nights for a gastric bypass procedure. After being released from the hospital, you remain under our watchful care.

Your journey doesn’t end with surgery. Follow-up care is a critical component of the treatment process. I’ll discuss the specifics of that aspect of treatment in another post.

If you’re ready to take the first step, attend one of our free seminars to see if bariatric surgery is right for you.

This year’s show celebrated eight years of bariatric surgery and featured 38 post-surgery patients who had a combined weight loss of 4,585 pounds. To put it in perspective, mid-size cars and sedans have a weight range of 4,500 to 5,500 pounds.

Even more remarkable than the amount of weight lost is the dramatic change of lifestyle for our patients. It was moving to hear them share stories of newfound confidence, better health, and the ability to wear fashionable clothes. Here are a few of the highlights:

“When I went to see Dr. Ray, I told him I wanted to be able to cross my legs and tie my shoes and wear ladies’ dress boots. I’ve got on my boots now!” – Connie Rainer, Maryville, over 100 pounds lost since January 2009 surgery.

“My doctor told me that he wanted to see me in a sparkly red outfit with high heel shoes and enough confidence to strut my stuff. Doc, here I am!” – Gay Clapp, Corryton, 155 pounds lost since April 2009 surgery.

“I was taking three shots of insulin a day. Now I’m taking none.” – Larry Webb, Sevierville, 125 pounds lost since May 2009 surgery.

While surveying the crowd of patients gathered together to participate in the show, it was striking – and encouraging – to see the wide range of people that we help through weight loss surgery. Post-surgery patients varied in age from 18 to 60+, came from various cities throughout East Tennessee, and achieved weight loss from 50 to more than 200 pounds.

If you’re struggling with obesity, I hope that you’ll come see us so that we can see you on the catwalk in 2011. Sign up for a free seminar to learn more about your options.

Foothills Weight Loss Specialists patient Connie Rainer of Maryville proudly poses with her bariatric surgeon, Dr. Jonathan Ray, at our Eighth Annual Bariatric Fashion Show in December in Alcoa. Rainer has lost 104 pounds since her gastric bypass in January 2009.

Foothills Weight Loss Specialists patient Gay Clapp of Corryton shows off her new figure at our Eighth Annual Fashion Show in December in Alcoa. Clapp has lost 155 pounds since her gastric bypass in April 2009.