The 7 Steps that Stop Us from Keeping Our Weight Off after a Diet

Why do we seem to always return to our previous body weight no matter how many weight loss programs we try?

The hormone called leptin is the key to this dilemma. At the recent world congress on interventional therapies for type 2 diabetes Dr. Leibel from the Columbia University Medical Center explained that our bodies are programmed to protect themselves from starvation not obesity. The challenge humans have faced throughout history is to survive despite times of famine.

Food being too easily available has not been our problem until the last few decades.
The body is tuned to defend our body weight and preserve our stored calories so we do not run out of energy in times of famine.

Here are 7 steps that keep us returning back to our previous weight each time we diet.

1). The more calories we store as fat in our fat cells the larger the fat cells become. As the fat cells become larger they put out more and more of the hormone leptin.

2). Each time we gain weight the leptin level increases and our brains are reset so our weight setting goes up to a new level.

4). This means our weight settings will go up and up each time we gain weight.

5). Unfortunately, weight setting in the brain only resets upward and does not reset downward!

6). Any fall in the level of fat we have decreases the amount of leptin and our brains will trigger mechanisms such as hunger, delay in satiation of food and decreased muscle activity to preserve our stored calories and restore our weight to the previously set level.

7). When we start to lose weight our metabolism slows down and we use 10-15% less energy so we do not use the stored calories any faster than absolutely necessary.

All of these steps serve to maintain our body fat so we have the energy we need to stay alive as long as possible during times of famine.

Unfortunately, when food is too plentiful such as we see in our time these steps work against us as we lose weight and try to keep it off.

If you have struggled to lose weight and keep it off you now understand why it is so difficult to maintain the lower weight. Fortunately, the surgical procedures we use in bariatric surgery counteracts many of these mechanisms and at least 80% of our patients keep their weight off long term.

Testimonial: Kyle Harrington Shares His Gastric Bypass Results

Kyle Harrington is 34 and a science teacher of 4th, 5th, and 6th graders. He is also a father of twins, Jacob and Lilly, but he weighed 415 lbs and was struggling to do the things he needed to do. Fortunately, his wife and family were very supportive when he decided to have a Roux en-Y gastric bypass by Dr. Myers at Fresh Start Bariatrics at Riverside Methodist Hospital.

He did a great job before his bariatric operation losing 30 lbs so he could have his operation more safely. He weighed 385 lbs. at the time of his operation in December, 2009. He says having his operation was a “God send”. Kyle now weighs only 190 lbs!

He says he had a couple of “bumps” in the road including severe gout as he was losing his weight requiring prednisone and other anti-gout medicines. Also as he lost his weight it became clear he had a deformed coccyx that made it impossible to sit down. This was so difficult he had to have it removed by Dr. Myers surgically.

Now he is off several medicines including Benicar, Allopurinal, Cholchicine, Midrin, and the gabapentin he had been taking for fibromyalgia. He no longer has high blood pressure and is no longer having migraine headaches he no longer needs his CPAP machine for sleep apnea.

Now he is active in Scout’s and can even sit down in a normal position at the campsites!

Congratulations, Kyle, you have worked hard to get your best result from your operation and may God bless you and your family as you enjoy your fresh start life with your wife and twins.

Patient Testimonial Sleeve Gastrectomy

Cheryl Dalton had a laparoscopic gastric sleeve operation only 7 days ago by Dr Myers at Fresh Start Bariatrics at Riverside Methodist Hospital in Columbus, Ohio. She now explains how her postoperative pain has been managed.

Patient Testimonial after Robotic Gastric Bypass on How Her Pain is Controlled

Jill Ehrhart had a robotic Roux en-Y gastric bypass just 9 days ago by Dr Myers at Fresh Start Bariatrics at Riverside Methodist Hospital in Columbus, Ohio. She explains what she experienced and how her pain is controlled after her operation.

Many Paths Before Meeting Criteria for Bariatric Surgery

I have to admit I am somewhat absent minded. On occasion I will be driving along thinking about something else and miss my exit. Before I realize it I have gone quite a distance and when I finally become aware of my surroundings I ask myself, “How did I get here?” I think some of my patients are like that. They are amazed that they have arrived at a weight that is starting to harm their health.
There are many reasons people become over weight. Sometimes I hear someone explain that they had to be on steroids for their asthma and gained a lot of weight. Occasionally I hear the person had a car accident and was immobile for months and gained allot of weight at that time. Others tell of a traumatic episode in their life such as the loss of a child, a parent or even a divorce that led to depression and they started to gain weight while depressed and on antidepressants.

Dr. Tell, the psychologist that works with our program tells me that over 60% of the women in a bariatric surgery practice have been sexually abused as a child or young adult. Sometimes obesity is a way of keeping themselves at a distance from men and keeping themselves felling safe. However by the time they seek help from a bariatric surgeon they have often dealt with the trauma and are married and have healthy marriages and families but they feel trapped in their own body.

Often men tell me they were very active in sports during their teens and or while they were in the military but became much less active as the entered into the work force, found a sedentary job and have gained some weight nearly every year since then.

Women explain they gained weight with each child and now after their last child the weight seems to just keep coming. Or they gained weight during a depression following a miscarriage or stillbirth.

Still others have told me they were always heavier than their peers and cannot remember a time when they were not heavy or that food was used to manipulate them as a child and they just feel driven to eat to prove they are in control of this area of their lives.

Regardless of how a person of size arrived at their weight they usually seek help when their activity level and health are deteriorating. They often feel trapped and desperate and feel their life is slipping away from them.
What is important is that there is hope because with bariatric surgery obesity and related medical problems such as type 2 diabetes can be reversed.

I see it happen every day and I love to hear the stories of how lives are changed and how fun life is again. They tell me of new jobs, having children and having more energy to do the very things they thought they would never be able to do again. I remember John who had not been able to go on the yearly golf trip with his brother for years and the year after surgery he had lost so much weight he was able to take his brother golfing again and oh by the way he is getting married! I remember Molly who was so depressed with her life that she spent most of her time at home in bed but now she has lost all of her excess weight and is salsa dancing again and Sandy who after getting rid of most of her diabetic medicines and losing most of her extra weight took ball room dancing lessons and was recently a champion at a regional competition!

Some of my patients do crazy things like jumping out of perfectly good airplanes, run marathons or going across valleys on zip lines. There are so many stories and so many changed lives. Life can be great again and you can begin to live again. Bariatric surgery can be your fresh start to life. I see it happen every day.

Patient Testimonial / Gastric Bypass / Betty McCauley

See other testimonials on my YouTube channel. Go to Google and enter "DrSteveMyers YouTube".

Obesity Causes Diabetes / Diabetes Causes Obesity

Although Type I diabetes, previously called juvenile diabetes, is a serious problem of inadequate production of insulin, in this posting we will primarily be speaking about type II which is 90-95% of all diabetes. Whereas most Type I diabetics are not obese, Type II diabetes is frequently associated with obesity. In fact, the curve associated with the increase in frequency of obesity parallels the increase in type II diabetes. That makes perfect sense since patients who suffer from obesity develop resistance to insulin resulting in increasing blood sugar levels. Most people understand that they increase their risk of developing Type II diabetes as they increase their weight and the longer they are heavy the more likely they will develop Type II diabetes.

What is surprising to people is that the reverse is also true; the treatment of Type II diabetes causes obesity. When your blood sugar is high we try to lower the blood sugar by taking diabetic pills or insulin to lower the blood sugar. However, the glucose does not just disappear. Many of the medicines drive the glucose into the cells of the diabetic so the glucose can be used for fuel. Unfortunately, many medicines including Insulin, Glyburide, Glucotrol, Amaryl, Pranlin as well as Starlix, Actose and Avandia drive glucose into fat cells increasing the amount of calories stored as fat. As a result the person becomes heavier. This in turn causes more insulin resistance requiring more diabetic medicine to keep the blood glucose down! How frustrating is that; obesity causes type II diabetes and type II diabetes make the obesity worse.

Patient Testimonial Reversing Diabetes with Gastric Bypass

Christopher Anderson had a robotic gastric bypass by Dr Myers just one week ago and now is off of all of his diabetic medicines. Chis shares his story.

Patient Testimonial after lap gastric bypass

John Lyle has lost 143 lbs just 1 year following lap RNY gastric bypass. His knees are much better and he is having a positive effect on his daughter.

Tree Reasons Type II Diabetes is Often Reversed by Gastric Bypass

How a gastric bypass can reverse diabetes Here are thee reasons

1). Early after the operation carbohydrate intake is minimal so the glucose level remains low. In fact in our practice I have patients on a very low carbohydrate diet, (650-800 calories per day), for 1 to 2 weeks before surgery primarily so they have an opportunity to use up the stored calories in there liver, (glycogen), which results in loss of water stored in the liver and the reduction of the size of the liver. This allows me to work more easily under the left side of the liver where the upper part of the stomach lives. This makes the operation easier for me and safer for my patients. What I have observed is that frequently many of my patients no longer need their diabetic medicines even before surgery as long as they continue to consume very few carbohydrates. The reduction in the amount of carbohydrates consumed is clearly an important component in this process that continues even after their operation since it takes several weeks or a few months for the amount of carbohydrate a person consumes increases and stabilizes at a new lower amount.

2). Second, since obesity is the most important reason most of our patients
develop diabetes, losing weight and keeping it off decreases the obesity and the patients lose their resistance to insulin which was caused by their obesity in the first place. Therefore the amount of insulin they are able to make is frequently enough to keep their glucose in the right range. Unlike the previous two components that decrease the blood sugar right after surgery this component takes time to show the beneficial effect of weight loss but by the time the patient is able to consume a more normal amount of starch and sugar he or she has lost enough weight to no longer need their diabetic medicines because of the loss of insulin resistance from the resolution of their obesity. This is why with some patients we need to slowly decrease the amount of diabetic medicine they are on over several weeks or even a few months.
It is important to understand that not everyone will have resolution from their diabetes. About 15 to 20 percent will still need to be on some diabetic medicines after a gastric bypass operation. The longer a person has type II diabetes the less likely it is that they will resolve their disease. However I have seen some patients resolve their diabetes after a gastric bypass operation even after 10 or 15 years of diabetes. Nevertheless even if the diabetes is not completely resolved it is much easier to manage and usually a person needs to be only on a pill they can take by mouth and they will not need to take insulin shots.

3). Finally, of these three most common operations, (gastric bypass, gastric sleeve, adjustable gastric band), the gastric bypass has an additional component that helps the diabetic. It is the hormone change that occurs after a gastric bypass. Probably the most important of these changes is the increase in a hormone like substance from the last part of the small intestine and the first part of the large intestine called GPL-1 (Glucagon Like Polypeptide-1) which increases the amount of insulin a gastric bypass patient sends into the blood stream after consuming carbohydrates.
Instead of giving yourself an injection of Byetta or Symulin, which is the injectable form of GLP-1, after a gastric bypass operation your body produces more GLP-1 on its own in response to ingesting carbohydrates resulting in better production of insulin and improved use of insulin where the insulin does it’s work.
This begins immediately after the operation and is part of the reason that many diabetics that still needed some diabetic medicines before surgery even while they were on a very low carbohydrate diet will leave the hospital after their gastric bypass operation on no diabetic medicines at all and have normal blood glucose.

If a person of size has had diabetes for 10 or 20 years, sometimes the insulin producing cells of the pancreas have been so severely damaged that they are no longer able to produce enough insulin to meet their needs even if they lose their excess weight and therefore lose the insulin resistance that comes along with obesity. Nevertheless I have observed amazing results even when I did not expect them. Even if all the patient who has had diabetes for many years are not able to stop all of their diabetic medicines, generally they are on alot less medicines and their diabetes is much easier to manage. They still should be able to maintain a HbA1c
of 6 or less.

The gastric bypass operation is a wonderful tool for persons of size who want to improve or reverse their Type II diabetes.

Diabetes Reversed by Bariatric Surgery as Viewed by Dr. Myers, Assistant Mike Palasek, RN, CRNFA

Mike Palasek. RN has been working with me as the surgical assistant for over 10 years. He is great help and has helped me with every bariatric operation that I have performed and that is over 1,000 operations. Mike has a “bird’s eye view” of how our diabetic patients do after surgery. He sees each patient after surgery in the office shortly before I see them and records their medicines and how they are doing with their weight and glucose readings. He often speaks to prospective patients who attend our Fresh Start Educational Seminars before I start my part of the presentation. I have heard him say, “I have been a nurse for over thirty years. When I first started nursing I had no idea we would be operating on people to improve their medical problems such as diabetes and high blood pressure. When I was first a nurse I gave insulin for diabetes but no one ever got better and off the insulin injections. We gave pills for high blood pressure but no one ever got off of their blood pressure pills. For me, as a nurse, it is very satisfying because instead of just managing these and other medical problems in our patients we are actually seeing these problems resolve. Now I see people getting off insulin and other diabetic medicines and it is not uncommon for patients to no longer need any medicines for diabetes. Patients who needed 3 or 4 diabetic medicines or are on an insulin pump before surgery are no longer on any of these medicines and they are no longer taking any insulin. It is surprising but we often see patients that are taking 70 or 100 or even more units of insulin every day prior to surgery taking no diabetic medicine or insulin at all with normal blood sugars. As a nurse, that is really rewarding.”

Robotic Gastric Bypass

Gastric Bypass Testimonial Deb Hoffman

Debbie Hoffman explains the results she has experienced 2 1/2 years after her Lap RNT gastric bypass operation. She has lost 131 lbs and kept it off.

For more patient stories from our practice by googling DrSteveMyers and selecting my YouTube channel.

App for a Smart Phone Can Help Bariatric Patients

Jennifer Kanagy was seen in my office this week and explained that she had found a new App that had been helpful to her. It has a name that could insult anyone!

FatSecret.com alows you to manage your calories, protien, fat, calories and exercise.

Download app
Bring up daily food guide
click scan
scan bar graph
Obtain nutrition info
change size of portion
collect info about food consumed
etc.

Jennifer hopes this is helpful for others on their bariatric surgery journey.

Kathy Tells How Her Type II Diabetes was Resolved with a Robotic Gastric Bypass

Diabetes Improvement Barely Mentioned

Recently on a Sunday in late winter I stepped off the escalator on the second level of our local Barnes and Nobles book store at Easton in Columbus, Ohio and my eye caught a large group of books on the medical self just in front of me. I counted 23 books about diabetes and as I looked further no other medical subject devoted so many books to one disease. Not heart disease, not high blood pressure, not even cancer. As a busy bariatric surgeon caring for diabetic patients nearly every day, I was intrigued.

After bariatric surgery amazing things happen to improve the lives of diabetic patients. Usually I see patients with type II diabetes discontinue all of their diabetic medicines soon after bariatric surgery. Less frequently patients who have had diabetes for many many years see improvement in their diabetes, discontinue insulin but still need some diabetic medicines that they take by mouth. In fact, it is extremely rare for a patient NOT to either resolve or improve their diabetes after bariatric surgery.

Filling my arms with a copy of each of these books, I headed for the store’s coffee shop and began to read. I tuned the pages of these books for references to the amazing things I was seeing following bariatric surgery. Surprisingly, I found very little. In fact I found only three books that even mentioned bariatric surgery and only one mentioned bariatric surgery could improve diabetes.

Why is there so little information in most books about diabetes about the amazing improvement for diabetics after bariatric surgery?

I will share more thoughts about this dilemma in postings over the next week.

See patients telling their stories on YouTube by googling DrSteveMyers and selecting my channel.