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NEW YORK (AP) As more Americans turn to surgery to lose weight, more of them are also returning for a second operation because the first isnt working.

Last year, an estimated 15% of the 252,000 obesity surgeries in the U.S. came after a previous surgery. That compares to 6% of the 158,000 surgeries in 2011, according to a surgeons group.

Weight loss surgery has proven to be an effective way to treat obesity and related conditions like diabetes. Methods vary, but the operations generally shrink the stomach to limit how much people can eat without feeling sick.

Many people achieve significant weight loss but results arent assured: Its still possible to overeat, restrictive devices can slip and stomachs can stretch back out and patients can regain weight over time.

That was the case for Kerrie Dutton, who had her first surgery four years ago.

At first, Dutton said she couldnt eat much without feeling sick, as expected. She quickly dropped about 100 of her 320 pounds. Then gradually, her stomach started stretching, and she was able to eat more again.

Going into the second year, I noticed that my weight was creeping up pretty quick, said the 29-year-old Dutton, who lives on New Yorks Long Island.

Duttons first operation was a newer procedure that cuts away part of the stomach and leaves a narrow sleevelike pouch. In October, she ended up converting to a more established surgery that reduces the stomach substantially more.

In the U.S., guidelines generally reserve weight loss surgery for the severely obese people with a body mass index of 40 or higher or those with a BMI of 35 and over who have a related health problem like diabetes or high blood pressure.

And the obesity problem in the U.S. isnt getting better. About 4 in 10 American adults are obese and nearly 1 in 10 are severely obese, according to the latest survey by government researchers.

The American Society for Metabolic and Bariatric Surgery doesnt provide a breakdown on which procedures are leading to subsequent operations. Dr. John Morton, a past president of the group and surgeon at the Yale School of Medicine, said its primarily patients who got an adjustable and removable band that restricts the size of the stomach. The bands popularity in the U.S. has waned significantly over the years.

ReShape Lifesciences, a medical device company that bought the Lap-Band system in 2018, said it doesnt believe removal of its bands has been fueling second surgeries. Dr. Mark Watson, who does banding at UT Southwestern Medical Center in Dallas, said another surgery could be avoided with proper care of the band, which may need adjustment to work.

Contributing to the growing number of returning patients is the sleeve, which now accounts for 61% of U.S. procedures. Surgeons say many patients opt for the sleeve because it seems less complicated and less drastic than the bypass, which staples the stomach into a small pouch and shortens the intestinal tract.

Some surgeons are beginning to acknowledge the sleeve may not be the best option for some, such as those who are severely obese.

Its been too broadly applied, said Dr. Stacy Brethauer, a Columbus, Ohio, surgeon and former president of the American Society for Metabolic and Bariatric Surgery, which tracks trends in procedures.

Since the sleeve is relatively new, there isnt strong data on how patients might fare over the long term, but Brethauer said surgeons have seen sleeve patients starting to return for a revision.

Prospective patients need to understand the options, surgeons say, since additional surgeries can increase the risk of complications. Dr. David Arterburn, a researcher who studies weight loss procedures at Kaiser Permanente in Seattle, suggests people consult surgeons who are comfortable performing different procedures.

Dr. Neil Floch, a surgeon in Norwalk, Connecticut, said the right procedure will depend on the persons situation: Its an individualized decision as to which surgery a particular person should have to get the best result.

After the sleeve, the most common procedure is the traditional gastric bypass. Its considered more effective partly because it also limits how much food is digested. Generally, both are considered safe and performed laparoscopically, or through small incisions.

The need for another surgery doesnt necessarily mean patients regret their decisions. Some say they got what they believed was the best option for them at the time.

Others like Anita Saah, a 45-year-old Rockville, Maryland, resident, may have taken a different route in hindsight.

In 2018, Saah opted for the sleeve because it seemed less risky than the bypass. She lost weight immediately but suffered severe dehydration afterward and was vomiting bile, likely because of her previous acid reflux issues.

In September, she had another surgery, this time a bypass. She hasnt had further complications and only wishes she understood how serious the acid reflux could become.

I wouldnt have had to go through two surgeries, Saah said.

___

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institutes Department of Science Education. The AP is solely responsible for all content.

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After obesity surgery, more patients returning for another - The Associated Press

March is National Nutrition Month. Dianne Neumark-Sztainer with the University of Minnesota talks about what healthy eating habits are, what parents can do to encourage their kids to have healthy eating habits and more.

Q: What are healthy eating habits?Dr. Neumark-Sztainer: Healthy eating habits involve a combination of things. One is enjoyable eating, such as eating family meals or eating at a social event. Another is intuitive eating or paying attention to our body's cues (e.g. when your body tells you youre full to stop eating). We can also engage in mindful eating when we pay attention to what we are eating and more fully enjoy the food that we are eating. Finally, it is important to eat a diet rich in fruits and vegetables, choose nutrient-dense foods, and avoid foods that are high in calories and low in nutrients.

Q: What are things parents can do to encourage healthy eating habits?Dr. Neumark-Sztainer: The four cornerstones I focus on in my book Im, Like, SO Fat! Helping Your Teen Make Healthy Choices about Eating and Exercise in a Weight-Obsessed World are the following:

Q: What are signs that someone may not have healthy eating habits?Dr. Neumark-Sztainer: Unhealthy eating habits may include under- or over-eating, not consuming enough healthy food each day, or consuming too much of one type of food or drink. There may also be a change in ones attitudes toward eating, such as not enjoying eating, fearing eating, avoiding eating with others or using food as a coping mechanism.

Think about whether there has been a change in your childs behavior (e.g., eating, level of activity, social interactions), mood (e.g., becoming more socially withdrawn) or physical appearance (e.g., weight change). As a parent, it is not your place to decide whether your child has an eating disorder that is for a professional. It is within your role as a parent to identify any possible problems; open doors for communication with your child; get your child to professional help for diagnosis as early as possible; and work as a collaborative player with members of the health care team if they decide treatment would be helpful.

Q: What should people do if they believe a loved one may have an eating disorder?Dr. Neumark-Sztainer: The chance for recovery increases the earlier an eating disorder is detected. Talk to the person in a manner that shows a great deal of caring, concern about specific behaviors and firmness about the need for help. Make sure to prepare for your conversation up front, write down what you want to say and practice on someone else.

Q: What are you doing to advance research on healthy eating habits?Dr. Neumark-Sztainer: At the University of Minnesota, we are conducting one of largest and most comprehensive studies on eating and weight in adolescents, young adults and families called Project EAT. The project involves the long-term study of two large cohorts of adolescents from the Twin Cities as they progress from adolescence through adulthood.

I currently have funding from the National Institutes of Health to learn more about how best to work with young people and families dealing with challenging life circumstances such as poverty, racism and exposure to stressful life events. We need to ensure that we are meeting the needs of our most vulnerable populations, because we are witnessing growing disparities and inequities in eating and weight-related problems. It is now clear that eating disorders influence young people from different social and ethnic/racial backgrounds and we need to learn more about how to ensure that the needs of all youth are being met.

A newer area of research that I am engaged in involves the study of yoga and how this practice can help with issues of body image, eating practices, and other measures of well-being. This interest stems from my own yoga practice and in-depth study of this practice.

Dianne Neumark-Sztainer is a professor and head of the Division of Epidemiology and Community Health at the University of Minnesota School of Public Health. Her research focuses on a broad spectrum of eating and weight-related outcomes including eating disorders, unhealthy weight control behaviors, body image, dietary intake, weight stigmatization and obesity.

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Talking healthy eating habits with U of M - UMN News

Evidence from decades of animal and human research points to wide-ranging health benefits of intermittent fasting, according to an NIA-conducted review of the research, published in the New England Journal of Medicine. Still, more research is needed to determine whether intermittent fasting yields benefits or is even feasible for humans when practiced over the long term, such as for years.

Intermittent fastingis an eating pattern that includes hours or days of no or minimal food consumption without deprivation of essential nutrients. Commonly studied regimens include alternate day fasting, 5:2 intermittent fasting (fasting two days each week), and daily time-restricted feeding (such as eating only during a six-hour window).

Hundreds of animal studies and scores of human clinical trials have shown that intermittent fasting can lead to improvements in health conditions such as obesity, diabetes, cardiovascular disease, cancers and neurological disorders. The evidence is less clear for lifespan effects. Animal studies have shown mixed results, with sex, food composition, age and genetics among the factors that influence longevity. Human trials have mainly involved relatively short-term interventions and so have not provided evidence of long-term health effects, including effects on lifespan.

The review authors are Rafael de Cabo, Ph.D., of NIAs Intramural Research Program (IRP), and Mark P. Mattson, Ph.D., formerly of NIAs IRP and currently a neuroscientist at the Johns Hopkins University School of Medicine.

Although intermittent fasting often results in reduced calorie consumption, weight loss is not the main driver of the health benefits observed in preclinical and clinical studies, according to the authors. Rather, the key mechanism is metabolic switching, in which fasting triggers the body to switch its source of energy from glucose stored in the liver to ketones, which are stored in fat.

Ketone bodies are not just fuel used during periods of fasting, the authors wrote. They are potent signaling molecules with major effects on cell and organ functions.

Ketogenesis, or the increase of ketones in the bloodstream, initiates activity in a variety of cellular signaling pathways known to influence health and aging. This activity enhances the bodys defenses against oxidative and metabolic stress and initiates the removal or repair of damaged molecules. The impact of ketogenesis carries over into the non-fasting period and can improve glucose regulation, increase stress resistance and suppress inflammation.

Repeated exposure to fasting periods results in lasting adaptive responses that confer resistance to subsequent challenges, the authors explain. The broad-spectrum benefits include not only disease resistance but also improved mental and physical performance.

The authors acknowledge impediments to widespread adoption of intermittent fasting: the ingrained practice in developed nations of three meals a day plus snacks (along with the ready availability and marketing of food), the discipline required to shift to a new eating pattern and the lack of physician training on intermittent fasting interventions. The authors suggest that clinicians who prescribe intermittent fasting encourage their patients to adopt a gradual, phased-in schedule in consultation with a dietitian or nutritionist.

In addition to the question of intermittent fastings long-term effects in humans, the authors point to two other areas requiring further research. Studies are needed to determine whether this eating pattern is safe for people at a healthy weight, or who are younger or older, since most clinical research so far has been conducted on overweight and middle-aged adults. In addition, research is needed to identify safe, effective medications that mimic the effects of intermittent fasting without the need to substantially change eating habits.

This review article and many of the research studies cited within were supported by NIA.

Reference: De Cabo R and Mattson MP. Effects of intermittent fasting on health, aging, and disease. New England Journal of Medicine. 2019;381(26):2541-2551. doi: 10.1056/NEJMra1905136.

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Research on intermittent fasting shows health benefits - National Institute on Aging

Alex Rodriguez is no stranger to a workout. The Major League Baseball superstar has played 22 seasons and put his body through the ringer when it comes to training and athletic prowess. But even since retiring from the sport, A-Rod hasnt shown any signs of slowing down or wanting to, for that matter.

Perhaps its the fact that he now finds himself betrothed to the ever-svelte and incredibly fit Jennifer Lopez, but the pair have been known to enjoy a sweat-fest together, often sharing their workout to their fans on Instagram.

Earlier this year they ditched sugar and carbs for 10 days (which is the very definition of hell), and now they are championing the latest fitness craze as their workout-of-choice: fasted cardio.

The term has been around for a while, dating back to 1999 when former competitive bodybuilder Bill Phillips published his book, Body for Life. But is it just a matter of waiting 30 minutes after your last meal, or is there more involved?

As the name suggests, the technique involves performing 20 minutes of intense aerobic activity after an overnight fast. Phillips believed this type of workout was more effective in burning fat than performing an entire hour of cardio post-breakfast, according to an article in Strength & Conditioning Journal.

For Phillips, his mentality was that exercising on an empty stomach means that stored fat is burned first, rather than the carbohydrates one would have consumed for their morning meal.

Bypassing your morning breakfast before hitting the gym wont harm you, but it also isnt entirely risk free. Those who do it may feel lightheaded, dizzy, or too weak to complete their workouts.

According to Dr. Ankit Shah, M.D., Director of Sports & Performance Cardiology at MedStar Health hospitals, the evidence is inconclusive. In an interview with Mens Health he said, Theoretically, when exercising in a fasted state, your body preferentially burns fat for energy as your carbohydrate levels and insulin levels are low when fasting. This can help trim your body fat percentage.

But Shah does not believe fasted cardio is a good long-term solution to fat loss. The reason for his view is that the body eventually burns fewer calories in an attempt to preserve stored fat.

As Brad Schoenfeld, Ph.D. suggests in the book Strength & Conditioning, Fat burning must be considered over the course of days not on an hour-to-hour basis to get a meaningful perspective on its impact on body composition.

Schoenfeld adds, As a general rule, if you burn more carbohydrate during a workout, you inevitably burn more fat in the post exercise period and vice versa.

In a 2016 study, scientists discovered that people who fasted may burn more fat, but other research conducted in subsequent years has shown no difference between fasted and fed cardio states.

Ultimately, theres a small chance you could burn a little more fat by doing fasted cardio but this isnt a proven strategy and its also one that could be unsustainable for most. If youre really focused on cutting fat, do the basic, known methods: cut out junk food and simply move more. Yep, its that simple.

As Shah advises, For most people, I recommend focusing on skipping that extra soda, cookie or bag of chips, and eating a well-balanced diet which includes a mindful caloric restriction. This should be combined with increasing the amount of aerobic exercise to achieve sustainable results with respect to aerobic fitness, weight loss, and cardiovascular health.

via gq.com.au

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What is fasted cardio? The diet that claims to burn fat fast - GQ India

The researchers wound up recruiting 61 volunteers, most of them middle-aged and inactive; all were overweight or obese. The study participants completed detailed questionnaires and online tests of their food preferences and behaviors, picking, for instance, between rapid-fire, on-screen pictures of different foods and also answering questions about bingeing on food and whether they found it hard to not overeat.

Fifteen of the volunteers then were asked to continue with their normal lives as a control group, while the other 46 began exercising, working out on exercise machines at a university facility five times a week for about 45 to 60 minutes or until they had burned about 500 calories per session. They continued this training for 12 weeks, eating as they liked at home.

Then everyone returned to the lab for weigh-ins and to repeat the original tests. Most, but not all, of the exercisers had shed a few pounds, while some of those in the control group had gained weight.

The men and women in the control group also showed little alteration in their feelings about food. But the exercisers reactions to pictures of and questions about high-calorie, fatty foods were new. They no longer found them quite so irresistible. In psychological terms, they showed less wanting for the most fattening foods.

Interestingly, their scores on measures of liking, or how much they expected to enjoy those same foods, remained unchanged and strong. They still felt that they would enjoy a cookie but did not feel quite the same drive to seek one out. They also reported fewer instances of recent binge eating.

Taken as a whole, these results suggest that, in addition to making us healthier, exercise might improve food reward and eating behavior traits linked to the susceptibility to overconsume, says Kristine Beaulieu, a research fellow and dietitian at the University of Leeds, who led the new study.

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How Exercise Might Affect Our Food Choices, and Our Weight - The New York Times

Like the readings on many bathroom scales that keep creeping up year after year, the rate of obesity in the U.S. continues to climb.

Government survey results released last week reveal the national obesity rate was 42%, which is higher than the 40% in a 2015-16 study, also done by the Centers for Disease Control and Prevention. The severe obesity rate was more than 9%, up from the 8% figure in the previous survey.

This information may have very well gotten just a cursory glance in light of all the recent attention paid to the spreading of coronavirus. But consider that being seriously overweight is a long-term medical concern that is affecting more children and adults as time goes on. Untreated obesity often leads to heart disease, diabetes, stroke and some types of cancer.

The report clearly indicates the trend isnt likely to fade away soon. Fifty years ago about 1 in 100 American adults were severely obese. Today obesity is 10 times more common.

A multi-pronged approach needs to rein in the growth of obesity.

Thorough education about the value of sound nutrition and exercise needs to come early and often, for everyone from young children to senior citizens. There is a lot of bad information circulating, including weight-loss scams that concentrate on the quick dropping of pounds rather than a sustainable way of living that means adopting sustainable good habits.

Government support of sound nutrition also needs to be front and center; if school lunches are allowed to be less nutritional than in the past, thats a real disconnect between cause and effect. After all, the U.S. Department of Agriculture is responsible for establishing the Dietary Guidelines for Americans, which is supposed to be the nations go-to source for nutrition advice. Support in communities designated as food deserts also should be a priority so theres access to nutritional food no matter where you live.

Medical providers need to keep stressing preventive measures with their patients instead of trying to fix problems after they are well-established. Along with that is providers taking a close look at family history, which can often determine a patients likelihood of problems. And of course, the more affordable preventive measures are for everyone, the better off we all are.

Obesity is not just a seasonal concern; its a long-term epidemic that will affect lives and the economy far into the future unless Americans and those in power pay more attention.

Mankato (Minnesota) Free Press

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Other View: Obesity a long-term health concern - Effingham Daily News

The American Counseling Association defines body image as an individuals evaluations and affective experiences regarding their physical attributes. Body image has become of particular interest over the course of the last few decades, with an increasing number of programs and workshops being implemented as part of high school and college curricula. The increased focus on promoting positive body image stems from societal standards and expectations around physical appearance standards that deem thinness as more attractive and healthier than other body types. With the mass use of social media among teenagers, such standards have become more widespread, and young individuals are increasingly engaging in unhealthy eating habits and excessive exercise in an attempt to acquire certain looks. While issues with body image are more common among women mostly because puberty, menopause and pregnancy are often accompanied by an increase in body fat it is important to highlight that these issues can affect anyone at any point in time.

When it comes to college students, studies have concluded that 85% of women believe that they are either overweight or seriously overweight, even though most of those who report such feelings are at a weight considered healthy for their age and height. While initially shocking, these statistics are not surprising considering the changes in lifestyle, stress and expectations that characterize the transition from high school to college. For many, moving to college marks the first time someone is living away from a controlled and monitored environment. While at home parents typically provide healthy meals and monitor their childs eating, college students are free to choose when, what and how much to eat. This can easily lead to overeating and indulging on desserts available at the dining hall or to skipping meals, both of which are potentially harmful. Additionally, stress from adjusting to a new environment can fuel certain eating habits that might trigger weight loss or gain. For first-year students these issues become real before they arrive on campus, with internet forums, peers and even family members discussing the famous freshman 15. A term that refers to the weight that individuals tend to gain their first year of college, the "freshman 15" has fueled body dissatisfaction among this cohort, even though multiple studies have found that the average weight gain for first-year students is only 2.7 pounds.

Knowing that body dissatisfaction can lead to low self esteem, higher rates of mental health problems and a propensity to eating disorders, there have been worldwide efforts to diminish diet culture and increase acceptance of different body types. On campus, the Brandeis Counseling Center and Health and Wellness Promotion partnered to create Brandeis Body Positive, a program that trains staff, faculty, and students to facilitate a group curriculum addressing body image, intuitive self-care, and community building for various campus audiences, per the Brandeis website. Their first workshop, The Words We Say, took place this past Thursday, and two other events are scheduled for later in the semester. The Justice spoke via email to Leah Berkenwald 07 and Rachael Puccillo, the main organizers of this movement, to gain insight on the planning process, the communitys response and the future of the program.

Per Puccillo, an eating disorder specialist at the BCC, planning for the Body Positive Brandeis began in the spring of 2019. Attempting to bring an inclusive body positivity program to Brandeis and drawing on the experience of Berkenwald at Cornell University, the team agreed to use the Body Positive curriculum as a foundation. The Body Positive, Berkenwald explained, is the first organization to create a body image curriculum that is modern, progressive, weight-neutral, and inclusive of all genders, sexualities and racial/ethnic identities. Founded by Connie Sobxzak and Elizabeth Scott in 1996, The Body Positive implemented a new online learning platform in 2018 that offers training for individuals looking to become Be Body Positive Facilitators from the comfort of their communities. The Body Positive curriculum focuses on the five core competenciesreclaim health, practice intuitive self care, cultivate self love, declare your own authentic beauty and build community as stated on their website.

While the initiative at Brandeis is fairly new, Puccillo noted in an email to the Justice that several staff members have engaged in building and developing the program. Many of them have suggested that their views on body image have expanded and that they are more aware of the impacts of sizeism and diet culture than they were prior to doing this work. Brandeis staff members are not the only ones partaking in the implementation of the program: both graduate and undergraduate students are welcome to apply to be student facilitators and help with the organization of events. Indeed, Puccillo shared her excitement over student involvement in the program, stating that while it might take some time and guidance, the current leaders would love to see Brandeis Body Positive become a fully peer led and student sustained organization in the future.

As for other long-term goals, Puccillo explained the teams desire for the program to become fully integrated into the larger social justice mission of the University. This entails creating a safe space for discussion and fostering compassion, curiosity and awareness among students when body image and sizeism issues occur, she said. While conversations about these issues might be difficult, there are certainly ways to ensure the dialogue encourages open mindedness and respect. Puccillo recommends that individuals read up on and educate themselves fully about the myths we adhere to around food behavior and body image. Doing so has a self-reflective component that can help people identify their own biases in a way that allows them to critically evaluate their own experiences with body image. Because most people rely on the internet or the media to obtain information, it is important to note that such mediums can be both a source of detrimental comparison and false information and a platform to share information and access helpful resources.

Apart from educating ourselves and reflecting on our own experiences, it is important to become aware of unintentional discrimination against certain body types, according to Berkenwald, who highlighted the importance of recognizing what it feels like to show up to class or a community event only to find that you literally do not fit. Identifying such instances and changing our perception of discrimination and sizeism as a whole is a community wide effort. Only as a community, Berkenwald added, can we make the changes that are necessary for ALL students to feel like theyand their bodiesare valued and welcomed on our campus.

Making changes to our relationships with our bodies at the individual level can also contribute to a more accepting campus. Whether it be by going on a walk with a friend, making a list of things you like about yourself, appreciating all that your body does everyday and/or surrounding yourself with positive people, we can all improve our perceptions of our body. It can also be helpful, per Berkenwald, to:

"1) Separate 'health' from 'appearance' or 'weight.' A lot of folks conflate these terms, but health is independent of body size and shape. Try to separate in your mind what you are doing to improve your health versus what you are doing to improve or change your appearance. If you want to change your appearance, that's okay, but own it. Do not conflate weight, muscularity or beauty with health. To learn more, check out the Health at Every Size movement, a weight-neutral approach to health.

"2) Start paying attention to 'fat talk,' or the pattern of self-denigrating talk about our bodies and eating and exercise habits. Research has proven that hearing this kind of talkeven for just 3 minutes has a negative, causal, effect on your body image. Those who participate in fat talk conversations experience more negative impact than those who listen but do not participate. To protect yourself, avoid participating in these conversations. To protect everyone around you, intervene by changing the subject or asking others to stop.

"3) Expose yourself to images of different body shapes and sizes. Look at these images until you no longer feel uncomfortable. By learning to see the beauty in others' "imperfect" bodies, you can more easily see it on your own.

"4) Curate your media consumption to include influencers promoting body diversity and acceptance, and avoid those who are promoting a specific body type. Be aware that many 'wellness' influencers are really selling weight loss, not wellness. Look at their messages with a critical eye."

Brandeis Body Positives next event will take place on March 19. Whether you are someone who currently struggles with body image, know people who do or simply want to learn more about this issue, participating in Brandeis Body Positive workshops is a great way to obtain accurate information and partake in a welcoming and accepting environment.

If you need to talk to someone immediately, please call one of the following resources:

BCC after hours: 781-736-3785

Brandeis 6TALK: 781-736-8255

National Suicide Prevention Lifeline: 800-273-8255

National Eating Disorders Association Helpline: 800-931-2237

Self-harm Hotline: 800-273-TALK

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Brandeis Body Positive is here! - The Justice

On TLCs My 600-lb Life, viewers learn nearly everything about the patients of bariatric surgeon, Dr. Nowzaradan where they live, where they grew up, how they grew up, and more.

Not much is known, however, about the doctor himself.

Find out a bit more about this world-renowned surgeon who is helping people change their lives.

Dr. Now feels that patients need to understand that losing weight is mostly a mental battle. It takes a big change in ones mind to get our bodies to catch up.

Severe obesity is a complex physical and psychological condition with many components, he told People in 2017. Not realizing how much of their struggle is psychological and not just physical can be the biggestobstaclefor change withpatients.

Many refuse to admit they have any emotional compulsions or compulsivepsychologicaldisorders driving them to overeat.

However, once we removed the physical compulsion to eat with weight loss surgery, we have our best window to get them to see that and address those issues that will lead to long-term success for them.

One point Dr. Nowzaradan makes to his patients frequently on the program is the importance of support, especially from ones family, and especially on weight loss journeys as arduous and overwhelming as his patients, who start at such high weights.

Families can either be enablers or encouragers. Having a supportive family for patients on a weight loss journey is an important component to their success, Dr.Nowzaradan said in his conversation with People.

If they dont have that, its almost impossible for them to be successful in the long term, unless they remove those people from their environment. So they either have to change their dynamic with those enablers or separate from them if they want to succeed.

There have been a few patients I felt I could no longer help, Dr. Now shared. I will always be available if they need me. If they wont stick to the program, at some point, I can longer help them and they are taking resources from someone else who needs it.

As for the doctors medical status, his wife of 27 years, Delores, filed for divorce in 2002.

The couple oldest child is Jonathan, CEO of Megalomedia, a Texas-based media company. Its in great part because of Jonathan that My 600-lb Life made it on the air at TLC.

He told The Austin Chronicle in 2007, The people who are over 700 pounds think that theyre the only person on the planet like that. But there are millions, some people suspect in the tens of millions, of people in America. We want them to know that not only are they not alone, but there are doctors who will help. Dont give up, and dont just decide to die.

The doctors two other children, Jenniferand Jessica, both work in the arts.

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'My 600-lb Life': Is Dr. Now Married And Does He Have Children? - Showbiz Cheat Sheet

Consuming excessive amounts of sugary foods and beverages has been linked to many adverse health effects, including diabetes, depression, and heart disease (1, 2, 3, 4).

Cutting down on added sugars may reduce your risk of these negative effects, as well as obesity, a condition that can put you at risk of certain cancers (5, 6, 7).

Sugar substitutes may be an appealing option if youre trying to reduce your sugar intake. Yet, you may wonder how popular artificial sweeteners like sucralose and aspartame differ and whether theyre safe to use.

This article explores the differences between sucralose and aspartame.

Sucralose and aspartame are sugar replacements that are used to sweeten foods or beverages without adding a significant number of calories or carbs.

Sucralose is widely sold under the brand name Splenda, while aspartame is typically found as NutraSweet or Equal.

While theyre both high-intensity sweeteners, they differ in terms of their production methods and sweetness.

One packet of either sweetener is meant to mimic the sweetness of 2 teaspoons (8.4 grams) of granulated sugar, which has 32 calories (8).

Interestingly, though its calorie-free, sucralose is made from common table sugar. It debuted on the market in 1998 (9, 10, 11).

To make sucralose, sugar undergoes a multistep chemical process in which three pairs of hydrogen-oxygen atoms are replaced with chlorine atoms. The resulting compound is not metabolized by the body (11).

Because sucralose is incredibly sweet about 600 times sweeter than sugar its often mixed with bulking agents like maltodextrin or dextrose (9, 11).

However, these fillers typically add a few, yet insignificant, number of calories.

So while sucralose itself is calorie-free, the fillers found in most sucralose-based sweeteners like Splenda provide about 3 calories and 1 gram of carbs for every 1-gram serving (12).

Maltodextrin and dextrose are typically made from corn or other starch-rich crops. Combined with sucralose, they contain 3.36 calories per gram (12, 13).

That means one packet of Splenda contains 11% of the calories in 2 teaspoons of granulated sugar. Thus, its considered a low calorie sweetener (8, 12).

The acceptable daily intake (ADI) of sucralose is 2.2 mg per pound (5 mg per kg) of body weight. For a 132-pound (60-kg) person, this equals about 23 single-serve (1-gram) packets (9).

Given that 1 gram of Splenda contains mostly filler and only 1.1% sucralose, its unlikely that many people will regularly consume amounts beyond these safety recommendations (14).

Aspartame comprises two amino acids aspartic acid and phenylalanine. While these are both naturally occurring substances, aspartame is not (15).

Although aspartame has been around since 1965, the Food and Drug Administration (FDA) did not approve it for use until 1981.

Its considered a nutritive sweetener because it contains calories though only 4 calories per gram (9).

Being 200 times sweeter than sugar, only a small amount of aspartame is used in commercial sweeteners. Like sucralose, aspartame-based sweeteners usually contain fillers that mellow the intense sweetness (9).

Products like Equal therefore contain some calories from fillers like maltodextrin and dextrose, though its an insignificant amount. For example, one single-serve (1-gram) packet of Equal has only 3.65 calories (16).

The ADI for aspartame, which was set by the FDA, is 22.7 mg per pound (50 mg per kg) of body weight per day. For a 132-pound (60-kg) person, that equals the amount found in 75 single-serve (1-gram) packets of NutraSweet (9).

For further context, one 12-ounce (355-ml) can of diet soda contains about 180 mg of aspartame. This means that a 165-pound (75-kg) person would have to drink 21 cans of diet soda to surpass the ADI (17).

Almost 99% of the contents of a Splenda packet comprises fillers in the form of dextrose, maltodextrin, and moisture. Only a tiny amount is the intensely sweet sucralose (14).

Similarly, aspartame-based sweeteners contain some of the same fillers.

Thus, while aspartame- and sucralose-based sweeteners share some of the same fillers, Splenda does not contain aspartame.

Sucralose and aspartame are artificial sweeteners. Fillers help mellow their intense sweetness and add a few calories. Splenda does not contain aspartame, though it has fillers that are also found in aspartame-based sweeteners.

A lot of controversy surrounds the safety and long-term health effects of artificial sweeteners like sucralose and aspartame.

The European Food Safety Authority (EFSA) reviewed over 600 studies on aspartame in 2013 and found no reason to believe it isnt safe for consumption (10, 18).

Sucralose has also been thoroughly researched, with over 100 studies pointing to its safety (19).

Specifically, there have been concerns about aspartame and brain cancer yet extensive studies have found no link between brain cancer and consuming artificial sweeteners within safe limits (17, 19, 20, 21).

Other side effects associated with the use of these sweeteners include headaches and diarrhea. If you experience these symptoms consistently after consuming foods or beverages containing these sweeteners, they may not be a good choice for you.

Furthermore, recent concerns have been raised regarding the negative effects of the long-term use of artificial sweeteners on healthy gut bacteria, which are needed for optimal health. However, the current research was conducted in rats, so human studies are needed before conclusions can be made (14, 22, 23, 24).

Several human studies have linked aspartame to glucose intolerance. However, a lot of this research has focused on adults with obesity (25, 26, 27).

Glucose intolerance means that your body cant metabolize sugar properly, causing elevated blood sugar levels. More research is needed to understand the long-term effects of sugar substitutes on sugar metabolism both in adults with and without obesity (25, 26, 27, 28).

Additionally, some research has found that the long-term use of aspartame may increase systemic inflammation, which is linked to many chronic illnesses like cancer, diabetes, and heart disease (17, 29).

Lastly, recent research suggests that sucralose may have unwanted effects on your metabolism. Yet, other evidence associates consuming artificial sweeteners in place of sugar with modest weight loss of 1.7 pounds (0.8 kg) (27, 30, 31, 32).

Therefore, more research is needed on the long-term health effects of artificial sweeteners.

The European Union banned the use of all artificial sweeteners in commercially prepared baked goods on February 13, 2018 (10).

This is because some sweeteners like sucralose and aspartame or Splenda and NutraSweet may be chemically unstable at higher temperatures, and their safety at these temperatures is less researched (30).

Therefore, you should avoid using aspartame and sucralose for baking or high-temperature cooking.

Some studies link the use of aspartame, sucralose, and other artificial sweeteners to adverse health effects. These may include an altered gut microbiome and metabolism. You should avoid baking or cooking with artificial sweeteners at high temperatures.

Both aspartame and sucralose were developed to provide the sweetness of sugar without the calories. They are both considered generally safe for use within their stated safe limits.

Sucralose is a better choice if you have phenylketonuria (PKU), a rare genetic condition, as aspartame contains the amino acid phenylalanine.

Additionally, if you have kidney issues, you should keep your aspartame intake to a minimum, as this sweetener has been linked to added kidney strain (33).

Moreover, those taking medications for schizophrenia should avoid aspartame altogether, as the phenylalanine found in the sweetener could lead to uncontrolled muscle movements, or tardive dyskinesia (34, 35).

Both sweeteners are considered generally safe. That said, their long-term effects are not yet well understood.

Sucralose may be a better option for those with kidney issues, those who have the genetic condition phenylketonuria, and those taking certain medications for schizophrenia.

Sucralose and aspartame are two popular artificial sweeteners.

Both contain fillers like maltodextrin and dextrose that mellow their intense sweetness.

Theres some controversy regarding their safety, but both sweeteners are well-studied food additives.

They may be appealing to those looking to decrease their sugar intake thus potentially decreasing their risk of certain chronic conditions like diabetes and heart disease.

However you go about it, reducing your added sugar intake may be a good path to better health.

If you choose to avoid sucralose and aspartame, there are many great alternatives on the market.

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Sucralose vs. Aspartame: What's the Difference? - Healthline

YOU NEED AN ABDOMINAL COMPRESSION GARMENT

Patients undergoing gastric bypass surgery lose a significant amount of weight on a monthly and yearly basis. The drastic changes in body composition often leave behind loose skin and sagging tissues, which is why some weight loss surgeons recommend that patients wear an abdominal compression garment. Compression garments worn during the weight loss phase and after the weight loss cycle is complete can support healthy circulation and contribute to predictable aesthetic results.

As you can see in the sample price table above, Gastric Sleeve Surgery in Turkey cost is 80% more advantageous than European countries. Due to the price advantage and hundreds of successful surgery references, Turkey is the most preferred country in this regard. It costs from 5500 Euro to 7900 Euro in European countries. But in Turkey it costs from 4000 to 4500 Euro. Moreover a clean environment, Standards of Turkish Hospitality and positive surgery results worldwide. 3.5 Hours flight from UK to Turkey, a journey with entertainment. In this way, you will have the opportunity to take a short vacation in Turkey before and after the surgery. You can get the most accurate and up-to-date price after your first consultation with your doctor.

Weight loss surgery can be life changing for many patients and offers numerous physical and emotional benefits. Your weight loss surgeon will guide you through the recovery process and also provide you with recommendations for specific lifestyle changes that will help you continue to lose weight until you reach your goal, and then keep the weight off for the long term. Here are some things you can do to get the best possible results with weight loss surgery:

Change your meal frequency your stomach will be smaller after lap band or gastric bypass surgery, so you will need to eat smaller meals throughout the day. Making the lifestyle change of eating small meals every couple of hours may be necessary for you to get all the nutrients you need without compromising your weight loss results. Change your diet many weight loss patients need to make significant changes to their diets in order to achieve the results they want. You will need to eat more nutrient-dense foods regularly and make sure that you are eating higher-quality, unprocessed foods as well. It is also important to avoid unhealthy snacking between meals. Making changes to your diet and eating habits is critical to weight loss success.

Maintain a consistent exercise regimen whether you enjoy walking, swimming, or going to the gym, you will need to add some type of physical activity to your days for better overall health. Losing the weight may prompt you to take better care of yourself, and exercising regularly is a good way to maintain a healthy lifestyle.

Some weight loss surgeons recommend wearing an abdominal compression garment throughout the course of the weight loss program because the garment can improve circulation while holding the tissues in place as you lose weight. It can also help in improving your posture as your body changes. Even though you are not undergoing liposuction or any type of surgery that involves modifying the tissues, your body will be changing and shifting as you continue losing body fat.

You may feel better overall with that extra support around your midsection, especially if you are noticing loose skin due to the weight loss. Laparoscopic gastric bypass is performed by inserting a video camera into a small abdominal incision. This will provide an enlarged view of the internal organs that the team will observe on a monitor. The entire procedure is performed inside the abdomen after the insertion of a gas allowing its expansion. Gastric bypass is a technique that uses two approaches: food restriction by creating a small gastric pouch and by bypassing part of the stomach and small intestine. This procedure reduces the stomach to the size of a small gastric pouch <30 cc. What remains of the stomach (95% of the part of the new stomach, left image) is not removed but is completely separated from the gastric pouch.

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Gastric Sleeve Surgery In TURKEY! - ZOBUZ - Zobuz

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