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Week 83 - 3 Hip Surgeries, massive infections and 235 Pounds lost!

Yo-Yo Dieting and Diabetes After Bariatric Surgery

Yo-Yo Dieting and Diabetes After Bariatric Surgery obesityhelp.com/articles/yo-yo-dieting-and-diabetes-how-repeated-weight-loss-weight-gain-affects-blood-sugar April 1, 2019 Yo-Yo Dieting and Diabetes 6April 1, 2019 Would it be better if you lost weight and regained it, or didn’t lose it at all? Yo-Yo Dieting and Diabetes Currently, almost 50 percent of women and 20 percent of men report wanting to lose weight per the National Health and Nutrition Examination Survey (NHANES). (Dennett, 2017). Unfortunately, roughly eight to ten percent of those who lose weight will regain that weight within a year. Weight cycling means losing weight, regaining it, and repeating the cycle. When this weight loss is the result of dieting, the process is often called “yo-yo dieting.” Yo-yo dieting could increase the risk of insulin resistance and diabetes. There are several proposed mechanisms by which weight cycling likely contributes to diabetes. In an evolutionary model, if the food supply is limited, the response to a change in food availability is to gain a lot of weight when food is abundant. (McNamara, 2016) Recurring attempts to diet signal the body that food supply is low and can lead a dieter’s body to store more fat, than if the food was always abundant. Greater fat storage increases insulin resistance. When your cells are less able to use insulin effectively, blood glucose rises. The act of weight loss, and specifically the loss of muscle with weight loss, triggers the body to fight back by increasing hunger, slowing metabolism and encouraging fat storage. When the diet is over, the body regains fat first and fat overshooting, regaining more fat than was originally lost, and results in a slowed metabolism. This fat overshooting with each cycle of weight loss and regain can contribute to an overall increase in weight over time. That increased fat storage directly affects insulin resistance, causing an increased risk for diabetes with each cycle. How Neurons Control Energy Balance How neurons control energy balance isn’t fully understood, however, studies link weight cycling and adverse health outcomes like the development of metabolic syndrome associated with conditions such as type 2 diabetes, cardiovascular disease, and hypertension. (Shoefield, 2017) While losing weight can help to reduce insulin resistance in the short term, yo-yo diet weight gain over time increases the risk of heart disease and diabetes. The cycle of weight loss and regain seems to speed the development of diabetes. More research is needed, but some limited evidence also suggests that low carbohydrate diets may also lead people to become less tolerant of glucose and develop diabetes. (Brueck, 2019) Weight Loss and Regain After Bariatric Surgery The yo-yo dieting cycle is broken because of three specific changes after bariatric surgery. Patients feel fuller with a limited amount of food, causing less calorie intake. Appetite is reduced due to smaller stomach volume, also contributing to less caloric intake. Lastly, the stomach produces less ghrelin (the hunger hormone). Studies show bariatric surgery can induce a significant and sustainable remission and improvement of type 2 diabetes and other metabolic risk factors in severely obese patients. Surgery within five years of a diagnosis of diabetes leads to long-term remission of diabetes in many patients (Brethauer, 2013). Gastric bypass results in significant sustained weight loss. It has also been shown at greater than 10 years, outcomes show improvement and remission of obesity-related co-morbidities like sleep apnea, hypertension and high cholesterol (Kothari, 2017) Commit to Lifelong Changes Obese individuals who undertake weight loss efforts should be ready to commit to lifelong changes in their behavioral patterns, diet, and physical activity. (Weight cycling. National Task Force on the Prevention and Treatment of Obesity., 1994). If the diets you’ve been trying result in short-term loss followed by weight regain you may be placing yourself at greater long-term risk. Don’t feel shame about eating and dieting. Many people are struggling, instead, consider a better long-term option of bariatric surgery over repeated gain and loss to avoid the long-term health complications of diabetes. Patricia mathis ABOUT THE AUTHOR Patricia Mathis is a Nurse Practioner at Overlake Medical Clinics Metabolic and Bariatric Surgery in Bellevue, WA. Patricia's clinical interests include preventive care, patient education and metabolic and bariatric surgery. She believes in treating her patients as she would want for a loved one. She cares about each patient and each outcome. She will empower you with the knowledge to make educated healthcare decisions and support you in these choices. Related Posts

Week 54 of my VSG surgery

The true connection between poverty and obesity isn’t what you probably think

The true connection between poverty and obesity isn’t what you probably think Are poorer people more likely to be obese? Statistics show otherwise. (Michael S. Williamson/The Washington Post) By Tamar Haspel Columnist, Food July 20, 2018 How do we fight the intractable, devastating public health problem that is obesity? It’s a conversation I’ve had many, many times, and invariably someone suggests that we have to fight obesity by fighting poverty. Increase the minimum wage, ensure decent housing, provide medical care. If we lift people out of poverty, the obesity problem will ease. It’s an idea invariably put forth by people who care deeply about both issues, but it has a problem: The evidence doesn’t support it. In the United States, the poorest are not the fattest; that dubious distinction goes to the middle-income tier. [Fact-checking ‘Eating Animals’: What the film gets right and wrong] The difference isn’t large. If we look at people with income below 130 percent of the federal poverty level (which translates to $32,630 for a family of four), 39 percent of them are obese, vs. 41 percent for people with income between 130 percent and 350 percent of poverty level ($32,630 to $87,850). Cynthia Ogden, of the Centers for Disease Control and Prevention, warns against reading too much into that two-point difference — we can look at the two groups as just about equally fat — and points to more pronounced differences when we look at specific groups. Take women. Among Hispanic women, the lowest-income third does indeed have the highest obesity rate (48.7 percent). Among white women, the low and middle tiers essentially tie (at 42 percent and 42.5 percent, respectively). Among black women, who have the highest obesity rates overall, the low-income tier also has the lowest obesity rate (55.8 percent). Men look quite different. Overall, the low-income tier has the lowest obesity rate (31.5 percent) — and that’s true of both white and black subgroups. I could go on. But better that you do it, by visiting the CDC’s compilation of the data. I’ll just repeat that the poorest Americans do not have the highest obesity rates. It’s not true of adults, and it’s not true of children. This doesn’t mean obesity is unrelated to class. There most definitely is a class element, but it’s not the poor vs. the rest. It’s the poor and the middle vs. the top. According to Ogden, the CDC’s income classifications break the population into approximate thirds. With the exception of black men, the wealthiest third is never the heaviest. But when we move on to education, the two-thirds/one-third divide is even clearer. The obesity rate of college graduates is 27.8 percent, and the same for men and women, compared to just about 40 percent for the rest of the population. College graduates are about a third of the population. Not exactly the same third as the high-income third, of course, but there’s a strong correlation. In a rough way, I think we can say that there’s about a third of the population that manages to navigate our food environment a bit better than the other two-thirds. [The truth about organic produce and pesticides] As much as I’d like to see us, as a society, fight both poverty and obesity, the idea that we can somehow boost everyone into the socio-economic top third is a Lake Wobegonian fantasy where we’re all way above average. Besides, even if we could, it’s not like the top third is a smashing public health success. A 30ish percent obesity rate looks good only when you compare it to the 40ish percent of the rest of the country. And another besides — while we see the correlation between obesity and class, we don’t know whether it’s class that’s causing the lower obesity rates. “All of the work that I’ve seen is all associations. It’s not causal work,” says Ogden. All you can do is hypothesize, because “you can’t set up a controlled trial.” A market in New York advertises that it accepts SNAP, formerly known as food stamps. (Spencer Platt/Getty Images) And hypothesizing happens. Many of the hypothesizers look to data on people who get SNAP benefits (Supplemental Nutrition Assistance Program, formerly known as food stamps), versus those who qualify for them but don’t collect them, because those benefits are, essentially, an income boost. Craig Gundersen, an economist at the University of Illinois who studies SNAP, says he believes it’s “generally the case” that, if you gave poor people more money, they’d be less likely to be obese, and cites data that show SNAP recipients have “the same, or lower, rates of obesity” compared to SNAP-eligible people who don’t get the benefit. But it turns out that experts disagree — vehemently — about this, with some contending that SNAP recipients have worse diets and higher obesity rates. It all depends on how you slice the data. It’s hard to parse an academic fight over data analysis and pull out a ringing endorsement for the theory that poverty drives obesity — or doesn’t. [Moby caught flak for saying food stamps shouldn’t pay for junk food. But he’s right.] It’s certainly possible that having more education and income arms you to better navigate our food environment. It’s also possible that being obese makes you downwardly mobile, and the causality works the other way. Or maybe a little bit of both. But, when the poorest aren’t the most likely to be overweight, it’s clear that there are plenty of other factors at play. I think we have to step away from the hypothesis that poverty is a primary driver of obesity. We need a new hypothesis (besides the one about food access, which I’ll tackle next month). And, wouldn’t you know it, I’ve got one! It’s about as straightforward and obvious as obesity hypotheses get: Humans are simply ill-equipped to deal with a landscape of cheap, convenient, calorie-dense foods that have been specifically engineered to be irresistible. The inability to navigate our food environment is as near-universal as inabilities get. Sugar-sweetened drinks like these may have more to do with obesity than income level. (Toby Talbot/AP) Focusing on that inability, though, seems like blaming the victim. The last thing people dealing with obesity — let alone the one-two punch of poverty and obesity — need is to be told is that it’s their fault. But think about it this way. The people engineering the food that’s all around us are doing it with the specific intention to override ordinary human willpower. (Read Michael Moss’s excellent book, “Salt Sugar Fat: How the Food Giants Hooked Us,” on that subject.) They’ve been spending billions of dollars on it. Is it any surprise that they succeed? In what may be a first for this column, I have a sports analogy. Let’s say you play Serena Williams at tennis. You are, of course, trounced. Do you blame your forehand? At some level, sure. But the real problem is that you have absolutely no business going up against the best in the world. Those food engineers with the billions of dollars? They’re Serena Williams. We’re just us, and our willpower is our forehand. The food environment has overpowered the lowest socio-economic tier. It has overpowered the middle socio-economic tier. It has overpowered, to a slightly smaller degree, the top socio-economic tier. The food environment, not poverty, is the culprit. More from Food: Fact-checking ‘Eating Animals’: What the film gets right and wrong The truth about organic produce and pesticides Moby caught flak for saying food stamps shouldn’t pay for junk food. But he’s right.