Keeping pounds off after weight loss win

Word Help written on a weight scale

How common is it to put the pounds back on after losing weight?
People with a significant weight problem who are highly motivated to lose weight using diet and exercise can almost always succeeded in losing some weight during the initial months of their attempt. If, however, you check with them again five years after starting the diet, about 95% of these people will have regained most or all of weight lost during the initial period.

Can our bodies actually resist losing weight?
Normally, a person’s body has a weight “set point,” that is, a weight at which the body prefers to stay. This set point is not set for all time and can change with life circumstances, including stress and age. At any given time, a person’s body resists change in weight, either gain or loss. When a person tries consciously to lose weight against the body’s desire to maintain its weight at that set point, the body slows its metabolism, so that the person has to reduce food intake much more than one would think in order to lose the desired amount of weight. Interestingly, the same thing occurs with weight gain. When people of healthy weight try, as part of an experiment, to gain weight by eating extra food, their bodies become very inefficient at using the extra food, and most of the additional calories are burned off as waste heat.

What is “resting metabolism”?
Resting metabolism is the rate at which the body uses energy (food calories) when not engaged in physical activity, for example in bed at night. The body reduces resting metabolism and makes more efficient use of food calories when a person diets to lose weight. There is no currently known safe and effective way to increase metabolic rate to help with weight loss. Some weight loss medications increase metabolism, but they only increase it a little, and their effects tend to wear off after about one year of use. In addition, for most weight loss medications, we do not have good evidence that they can be used safely beyond the first one or two years.

Do hormones play a role in weight gain and weight loss?ghrelin and leptin

There are a number of hormones that help the body communicate internally. Leptin helps body fat tissue communicate with the brain. When body fat tissue is excessive, leptin is relatively low. When body fat tissue is too low, leptin increases to tell the brain that the person needs to eat more. GLP-1 (glucagon-like peptide 1) helps the intestine communicate with the pancreas about when and how much insulin to secrete. It also communicates with the brain about feelings of hunger and fullness. When the body’s ability to regulate these and other hormones is disturbed, it can result in obesity. There are currently some medications that can help to adjust levels of GLP-1 and reduce weight, but the amount of weight loss is fairly modest. There are currently no medications that help with the leptin system or other hormone systems involved in regulating weight. Weight loss surgery has profound beneficial effects on hormone systems that help the body regulate weight.

How can weight loss surgery help?
After gastric bypass surgery, the average patient loses about 60% of his or her starting excess weight. It is then common to regain a little weight and to settle in having kept off about 50% of initial excess weight. So, if a person needs to lose 100 pounds to achieve healthiest weight, gastric bypass surgery is likely to help her or him lose about 60 pounds over the first year or 2 with a slight regain of weight after that, so that, for the long term, that person’s weight is down about 50 pounds compared with prior to surgery.

Weight loss surgery is much more successful at combating the body’s resistance to weight change than dieting. You might consider weight loss surgery if your body mass index (BMI) is over 40 or if it is over 35 and you have other weight related health problems such as diabetes, high cholesterol, high blood pressure, sleep apnea or serious arthritis in weight-bearing joints. A BMI over 40 amounts to about 100 pounds over healthy weight for men and about 80 pounds over healthy weight for women.

People who have weight loss surgery live longer, happier, healthier lives than people who meet the criteria and decide not to have weight loss surgery. People who have gastric bypass surgery are about 40% less likely to die over the next ten years than people who decide not to have surgery. Quality of life studies show that people who have had weight loss surgery are more satisfied with their lives than those who have not. Many health problems, like those listed above, go into remission or at least improve after weight loss surgery.

Weight loss surgery is, therefore, much more effective in helping seriously overweight people lose a substantial amount of weight initially and much more effective in helping people keep the weight off year after year and decade after decade.

Dr. Guilford Hartley is an internal medicine specialist and Medical Director for the Hennepin Bariatric Center. He has worked in the area of adult and adolescent obesity since 1988, focusing on finding the best solutions suited to individual patients’ needs and with emphasis on weight loss surgery for severely obese people as the safest and most effective treatment now available. For more information, go to www.hcmc.org/weightloss.

 

HCMC using real-time blood flow imaging to improve treatment for non-healing wounds

20160211_hcmc_330
HCMC is the first in Minnesota to use the LUNA Imaging System

Hennepin County Medical Center’s (HCMC) Center for Wound Healing and its Center for Hyperbaric Medicine are now using fluorescence microangiography – a new technology that can assess blood flow in chronic, non-healing wounds and diabetic foot ulcers. HCMC is the first in Minnesota to use the LUNA™ Imaging System during wound assessment.

Masters, Thomas#017
Dr. Thomas Masters

“The results of using LUNA have become so impressive that we can’t imagine caring for wounds without it. It’s quickly become an integral assessment tool,” explains emergency physician Dr. Thomas Masters.

Healthy blood flow or microcirculation is essential to healing wounds that can result from diabetes, a complication from a recent surgery, or even frostbite. Fluorescence microangiography with the LUNA system enables doctors to perform assessment of blood flow to the wound, utilizing real-time information to define treatment plans, optimize patient recovery and reduce the frequency of these complications. Complications from chronic wounds may include necrosis, infection, partial or total limb amputation and the need for repeat surgery.

“We already know that some diabetic and radiation wounds greatly improve when treated with hyperbaric oxygen therapy,” said Dr. Masters. “Having the LUNA diagnostic tool to visualize the results allows us to measure the successful healing process during treatment. Likewise, it can indicate when there’s irrevocable tissue death so unnecessary limb preservation efforts can be avoided.”

Procedures with the LUNA System do not involve the potential safety hazards associated with X-ray procedures and traditional contrast agents. Because the dye that’s used is processed in the liver, kidney function is not affected. This is significant for patients diagnosed with diabetes whose kidney function may be at risk.

“We care for many patients with diabetes who may already have compromised kidney function, so this was a very important factor to us,” said Dr. Masters.

HCMC has the only multi-chamber hyperbaric oxygen facility in the region that’s used for 24/7 emergency treatment of critically ill patients and those with limb or life-threatening infections.

Hyperbaric oxygen has long been recognized as an important adjunctive therapy for chronic medical conditions such as delayed soft tissue radiation injury and Wagner 3 or greater foot ulcers in diabetic patients. For more information, go to www.hennepinhealthcare.org

Is niacin breaking your heart?

Using niacin to improve cholesterol levels doesn’t reduce heart attack or stroke in high risk patients

We’ve all heard that lowering LDL or “bad” cholesterol levels and raising HDL or “good” cholesterol is good for the heart. When lifestyle changes have not been adequate, most treatment effort in the management of heart disease and stroke risk has focused on lowering the LDL or “bad” cholesterol using a class of drugs called statins. In recent years, the use of niacin – a vitamin B3 – in addition to standard statin therapy has been increasing in the U.S.   The main effect of niacin is in raising HDL or “good” cholesterol and this was hoped to result in improving heart attack and stroke prevention beyond what was obtained through the use of statins. But recently reported results from a large study state that the long-term effects of niacin do not lead to better outcomes.

Dr. Woubeshet Ayenew
Dr. Woubeshet Ayenew

“And in fact, niacin use may even be harmful,” explains Dr. Woubeshet Ayenew, a cardiologist at Hennepin County Medical Center, who is referring to a recent study in the New England Journal of Medicine that associated niacin with infections, skin problems, and diabetes complications. “While niacin can increase HDL levels and lower LDLs and triglycerides, these apparently favorable changes in the lipid levels did not reduce heart attack and stroke when high risk patients were followed on niacin over the long-term,” says Dr. Ayenew. “The effect or benefit of niacin on patients without prior vascular disease was not looked at in these studies.”

“In light of this research, high-risk patients with prior heart attack, stroke or diabetes with arterial blockages who are currently taking niacin with their statin should review their treatment plan with their provider.”

Dr. Ayenew also asserts that pursuing a healthy lifestyle is still the most beneficial and safest way to avoid cardiovascular disease.  If medications are needed to supplement healthy lifestyles, it does appear that statins are very effective and have a better safety profile compared to vitamin B3 or niacin.

Woubeshet Ayenew practices in HCMC’s Cardiology Clinic located in downtown Minneapolis, as well as HCMC’s Brooklyn Center Clinic.  He was the local principal investigator for the AIM-HIGH trial that looked at the impact of niacin on people with vascular disease. The cardiology clinic was recently identified as the number one rated cardiology clinic by patients for “overall provider experience” in Minnesota, according to results published by Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CGCAHPS), a tool used by the Centers for Medicare and Medicaid Services to collect patient feedback.

 

 

HCMC’s Center for Hyperbaric Medicine opens in June

HCMC will open the new Center for Hyperbaric Medicine, which includes a 60-ton hyperbaric chamber, on hospital’s main campus in downtown Minneapolis in mid-June. The 48-foot long chamber, which arrived in sections last November, replaces the current 49-year-old hyperbaric chamber located two blocks away.

HCMC will continue to have the only multi-chamber hyperbaric oxygen facility in the region that’s used for 24/7 emergency treatment of critically ill patients: usually victims of carbon monoxide exposure or life-threatening infections, but also cerebral gas embolism and decompression sickness (“the bends”).

“This new facility is one of the most thoughtfully designed multiplace chamber ensembles in the world for delivering critical care,” says Dr. Cheryl Adkinson, Medical Director of the Center for Hyperbaric Medicine. “From monitoring to communication, environmental control, and gas delivery systems – the arrangement and the individual capabilities of the three connecting chambers will provide maximum flexibility to simultaneously manage multiple combinations of critically ill and stable, scheduled patients.”

In addition to being a life-saving emergency treatment for some conditions, hyperbaric oxygen therapy is also used to treat radiation injuries, diabetic ulcers, and other chronic wounds.

“As our population ages and becomes more obese,  more and more people are suffering from diabetes and chronic diabetic foot ulcers” explains Dr. Adkinson. “Diabetes damages blood vessels, leading to low tissue oxygen levels and poor healing; however, by delivering high levels of oxygen to tissues of the body, many of these wounds can heal, preventing the painful and life-changing complications of amputation.”

The $10.9 million project was paid for by a combination of county, state, federal and hospital funding sources.  It included construction of a 10,278-square foot addition to the hospital’s main campus on 7th Street in Minneapolis. Patients from Minnesota, North and South Dakota, Western Wisconsin and the Canadian border are referred to HCMC for hyperbaric oxygen treatment. The facility has three multiple-person chambers as well as a single monoplace chamber.

This slideshow requires JavaScript.

HCMC is a leader in trauma and critical care medicine. The Level I Adult Trauma Center and Level I Pediatric Trauma Center opened a completely renovated Burn Center last fall, one of only two critical care burn centers in Minnesota verified by the American Burn Association (ABA) and the American College of Surgeons (ACS).  Over the past five years, all adult intensive care units have been relocated and renovated within the downtown facility and this year the Pediatric Intensive Care Unit will be renovated.

More information about the construction of the new hyperbaric chamber facility 

Free HCMC health screening at program kickoff event April 21

Take steps to better health!
Join the Brooklyn Center and Brooklyn Park Clinics and our community partners at the following two events for FREE food, prizes, and fun activities; blood pressure, glucose, and diabetes screenings; and to register for Step To It, a walking program from Hennepin County. Free and open to patients, families, and the public! Questions? Call 612-873-9947.

Step To It Challenge Kick-Off
Saturday, April 21, 1-3 pm
Brooklyn Center Community Center
6301 Shingle Creek Pkwy, Brooklyn Center

African Career, Education & Resource Fair
Saturday, April 28, 11 am-2 pm
Hennepin Technical College
9000 Brooklyn Boulevard, Brooklyn Park

Is weight loss surgery right for you?

Dr. Guilford Hartley

“Thirty percent of adults in the United States are overweight,” explains weight loss treatment expert Dr. Guilford Hartley in a recent Healthy Matters podcast. “And one person out of every 20 is overweight enough to be eligible for gastric bypass surgery.”

Gastric bypass surgery, gastric banding or sleeve gastrectomy makes the stomach area much smaller so less food can be absorbed. People lose weight rapidly the first year and a half after surgery. Up to 15 years post-surgery, most people retain a 50 percent weight loss.

Who should consider gastric bypass surgery?

“Anyone who is 80-100 pounds overweight, or anyone with complications from obesity like diabetes, high cholesterol, joint pain may be a candidate for surgery,” says Dr. Hartley.

” Obesity surgery is clinically proven to be effective, and it gives hope for those unable to reduce their weight through drugs or dieting.”

Informational classes are available at HCMC every Friday morning, where participants have the opportunity to meet with a bariatric surgeon and ask questions.  Call 61.2.873.6800 for an appointment.

HCMC named one of “America’s Best Hospitals”

Hennepin County Medical Center named one of “America’s Best Hospitals” for 15th consecutive year

U.S. News Media & World Report’s 2011-12 Best Hospitals rankings include Hennepin County Medical Center (HCMC) as a top hospital in diabetes and endocrinology care again this year, and names six other specialties at HCMC as high performing. The rankings are published annually published by U.S. News and World Report and are available online at www.usnews.com/besthospitals.

Out of nearly 5,000 hospitals evaluated across the nation, only 140 hospitals performed well enough to rank in a particular specialty. HCMC ranked 43rd in diabetes and endocrinology. Additional high performing specialties named at HCMC are Ear, Nose & Throat, Gastroenterology, Nephrology, Orthopedics, Pulmonology and Urology.
Continue reading “HCMC named one of “America’s Best Hospitals””