Sleep Apnea and Obesity

If you find yourself waking up every morning feeling grumpy and drowsy every afternoon, and are struggling with your weight, you may have a form of sleep apnea.

With the staggering increase in obesity numbers, the rate of sleep apnea cases has climbed as well. Obstructive sleep apnea, the most common form of sleep apnea, is caused by extra tissue in the upper airway that collapses and literally blocks the airflow to the lungs.

If you have any of the following risk factors or symptoms, you may have or you may develop sleep apnea in your lifetime.

Sleep apnea is commonly found in:

• Males
• Post-Menopausal Women
• Obese individuals
• People with a neck size over 17

Symptoms of sleep apnea include:

• Snoring
• Acting grumpy, impatient, or irritable
• Being forgetful
• Feeling drowsy or falling asleep during the daytime
• Headaches that are hard to treat
• Depression
• Witnessed episodes of irregular breathing while sleeping

One of the main treatment goals for patients with sleep apnea is losing weight to decrease the number of apnea spells during the night. Sleep apnea is commonly linked to heart disease and high blood pressure – both of which are also improved by weight loss and healthy lifestyle changes. If you have sleep apnea and a BMI over 35, you may be a candidate for bariatric surgery.

Lose Weight at Penn Medicine

Learn about medical weight loss in Philadelphia, and the Penn Bariatric and Metabolic Surgery Program at a free information session about weight-loss surgery in Philadelphia.

There, you will hear about your weight-loss surgery options, and how Penn can help you lose weight and get healthy for good.

Register for a free information session today.

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Obesity Facts

Did you know that by losing just 5 to 10 percent of your total body weight, you can bring about significant health gains?

Gains including:

• Lowered blood pressure
• Reduced cholesterol levels
• Reduced risk of type 2 (adult onset) diabetes
• Less chance of stroke
• Decreased complications from heart disease
• Reduced overall mortality

“These operations and the weight loss that comes with them have amazing and almost instant dramatic and rapid results,” says Gary Korus, MD, bariatric surgeon at Penn. “We see a change in some medications within days of surgery. Some of our patients report they were given the ‘okay’ to stop taking certain medications very early in their weight-loss journey.”

Facts About Obesity and Weight Loss in America

Obesity in America is a growing epidemic. Did you know?

• The normal amount of body fat is between 25 and 30 percent in women and 18 and 23 percent in men. Women with more than 30 percent body fat and men with more than 25 percent body fat are considered obese.
• More than a third of U.S. adults — over 72 million people — are obese, according to the Centers for Disease Control and Prevention (CDC). In a study recently released, the rate of obesity in adults in the United States is expected to reach 42 percent by the year 2030. If obesity rates remained stable, instead of increasing, $550 billion could be saved in healthcare expenses over the next 20 years.
• Morbid obesity is defined as having a body mass index (BMI) of more than 40. For men that equates to approximately 100 pounds overweight for women, 80 pounds overweight.
• Severely obese women may experience infertility and pregnancy problems, polycystic ovary syndrome and sexual dysfunction.
• In the United States, roughly 300,000 deaths per year are directly related to obesity, and more than 80 percent of these deaths are in patients with a BMI over 30. For patients with a BMI over 40, life expectancy is reduced by as much as 20 years for men and five years for women.
• According to the CDC, 17 percent of U.S. children are obese.

The most common causes of obesity are overeating and physical inactivity. Other factors that can
contribute to obesity include:

• Genetics (such as leptin deficiency)
• Slow metabolism
• Medications
• Psychological factors
• Diseases (hypothyroidism, Cushing syndrome)
• Ethnicity
• Childhood weight

The Penn Metabolic and Bariatric Surgery team understands that, for many people, the decision to have weight-loss surgery can be a difficult one. That is why the Penn Metabolic and Bariatric Surgery Program is committed to providing prospective and current patients with all the information they need to make informed choices.

Bariatric surgery is not about improving physical appearance, it's about improving overall health.

Clinically severe (morbid) obesity is a chronic disease that can cause a host of health problems and shorten a person's life.

Bariatric surgery offers a way to sustain weight loss and improve obesity-related medical conditions.

Get more information about weight-loss surgery at Penn

Learn if bariatric surgery is right for you by attending a free information session about the Penn
Metabolic and Bariatric Surgery Program.

At this free session, you will learn more about weight-loss surgery at Penn, and meet physicians and team members from the Penn Metabolic and Bariatric Surgery Program.

Register for this free event here.

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Facts About Obesity

Did you know that by losing just 5 to 10 percent of your total body weight, you can bring about significant health gains?

Gains including:

• Lowered blood pressure
• Reduced cholesterol levels
• Reduced risk of type 2 (adult onset) diabetes
• Less chance of stroke
• Decreased complications from heart disease
• Reduced overall mortality

“These operations and the weight loss that comes with them have amazing and almost instant dramatic and rapid results,” says Gary Korus, MD, bariatric surgeon at Penn. “We see a change in some medications within days of surgery. Some of our patients report they were given the ‘okay’ to stop taking certain medications very early in their weight-loss journey.”

Facts About Obesity and Weight Loss in America

Obesity in America is a growing epidemic. Did you know?

• The normal amount of body fat is between 25 and 30 percent in women and 18 and 23 percent in men. Women with more than 30 percent body fat and men with more than 25 percent body fat are considered obese.
• More than a third of U.S. adults — over 72 million people — are obese, according to the Centers for Disease Control and Prevention (CDC). In a study recently released, the rate of obesity in adults in the United States is expected to reach 42 percent by the year 2030. If obesity rates remained stable, instead of increasing, $550 billion could be saved in healthcare expenses over the next 20 years.
• Morbid obesity is defined as having a body mass index (BMI) of more than 40. For men that equates to approximately 100 pounds overweight for women, 80 pounds overweight.
• Severely obese women may experience infertility and pregnancy problems, polycystic ovary syndrome and sexual dysfunction.
• In the United States, roughly 300,000 deaths per year are directly related to obesity, and more than 80 percent of these deaths are in patients with a BMI over 30. For patients with a BMI over 40, life expectancy is reduced by as much as 20 years for men and five years for women.
• According to the CDC, 17 percent of U.S. children are obese.

The most common causes of obesity are overeating and physical inactivity. Other factors that can
contribute to obesity include:

• Genetics (such as leptin deficiency)
• Slow metabolism
• Medications
• Psychological factors
• Diseases (hypothyroidism, Cushing syndrome)
• Ethnicity
• Childhood weight

The Penn Metabolic and Bariatric Surgery team understands that, for many people, the decision to have weight-loss surgery can be a difficult one. That is why the Penn Metabolic and Bariatric Surgery Program is committed to providing prospective and current patients with all the information they need to make informed choices.

Bariatric surgery is not about improving physical appearance, it's about improving overall health.

Clinically severe (morbid) obesity is a chronic disease that can cause a host of health problems and shorten a person's life.

Bariatric surgery offers a way to sustain weight loss and improve obesity-related medical conditions.

Get more information about weight-loss surgery at Penn

Learn if bariatric surgery is right for you by attending a free information session about the Penn
Metabolic and Bariatric Surgery Program.

At this free session, you will learn more about weight-loss surgery at Penn, and meet physicians and team members from the Penn Metabolic and Bariatric Surgery Program.

Register for this free event here.

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4 Tips to Help Your Kids Avoid Obesity

Will your children inherit your weight issues?

Today’s parents have many challenges before them. Many work full time, maintain a home and choose the best schools for their kids. In many families, the daily “to dos” and time management challenges can make eating healthy and exercising a low priority.

Studies have shown that overweight parents often have overweight children. The health risks associated with being overweight are passed down through generations.

While most parents understand that the best healthy habit they can give their child is to lead by example, parents often struggle to do this when it comes to eating healthy and exercising regularly.

Here are some ways you can be a healthy example for your family. Chances are, if you lead, they will follow.

Make time to sweat

Many parents report they rarely have time for themselves or to focus on their own health. They are busy working, taking kids to activities and helping with homework. But, if parents take time for themselves, they are showing their kids it’s important to focus on “me time,” too.

“Regular exercise is a great way to help control your weight. It also can improve other areas of health, relieve stress and improve sleep”” says David B. Sarwer, Ph.D. associate professor of psychology and director of Penn’s Stunkard Weight Management Program.

Stop negative self-talk

While you might not be convinced your kids hear everything you say, chances are they are watching you, the way you treat yourself and the comments you make about your weight.

“For many moms, it a struggle to engage in healthy behavior and not share their frustrations with family members. However, using words like ‘diet’ and ‘fat’ are not the best words to use in front of children and adolescents “ says Dr. Sarwer. “But many kids – especially girls – hear those words from mom and internalize that negative self-talk.”

Instead, make a commitment to living well because you want to be healthy and strong – not because you are “fat.”

“Eating healthy isn’t just about losing weight, it’s about adopting a new lifestyle to keep yourself as healthy as possible for both you and your family,” says Dr. Sarwer.

Make family time active

After a long day, it’s hard to get motivated to do anything more than put dinner on the table and hang out in front of the television. Instead of falling into this cycle, commit to doing an activity together after dinner or plan trips out that involve exercise.

“The spring time is a great time to get outdoors and get moving,” says Dr. Sarwer. “It’s a busy time of year for charity walks and 5k races, and a great time to start spring sports.”

Or, take the kids to the park, get out the bikes for a family bike ride, or plan a game of old-fashioned tag.

“Even dancing around the house for 20 minutes to your favorite music can be great exercise” according to Dr. Sarwer.

Get cooking

Kids love to help out – especially in the kitchen. Take their interest as an opportunity to teach them about food, food groups and planning nutritious meals.

“Make your meals colorful with lots of vegetables,” says Dr. Sarwer. “Try to have a variety of lean meats and fish throughout the week and let your kids take part in meal planning for the whole family.”

Cooking with kids can be fun, rewarding and provide a lesson that lasts a healthy lifetime.

Do you lead your family in healthy eating and fitness? What do you to do keep your family fit?

Get more information about weight-loss surgery at Penn

Learn if bariatric surgery is right for you and attend a free information session about the Penn Metabolic and Bariatric Surgery Program.


At this free session, you will learn more about weight loss surgery at Penn, and meet physicians and team members from the Penn Metabolic and Bariatric Surgery Program.


Register for this free event here.

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Best Exercises for Knee Pain

It’s a dilemma many overweight people face: They want to exercise, but their knees or other joints hurt too much to do anything strenuous.

Rather than get caught in cycle of not exercising because your knees hurt  and your knees hurt because you are not exercising, here are some exercise ideas for your aching knees.

Spinning® / bike riding

Any activity that takes pressure off of your knees and back is a great exercise. When you are fitted properly for a bike and ride in a safe, correct way, your knees are protected. That’s because most of the weight falls on your seat – not on your knees like in walking or running. And, if you’re wearing special shoes fit for your body, they can help center the pressure on the ball of your foot and take the pressure off of your knees.
Pros: Spinning classes are easy to join in and follow.
Cons: Bike equipment can be expensive, need to join a gym for classes.

Swimming / water aerobics

If you think swimming and water aerobics is for sissies, think again! Water exercises are extremely beneficial because the water acts as natural resistance to your body. When you work out in the water, your body is tasked to push against that resistance and build muscle. At the same time, the water makes you buoyant and takes pressure off of your joints.  This is why so many fitness experts refer to swimming as the perfect aerobic exercise.
Pros: An all-around great exercise for cardiovascular and muscular strength, easy on joints,
Cons: Must have access to a pool.

Walking

Most experts agree that walking is one of the best forms of exercise. You can do it anywhere, it costs nothing but a good pair of shoes and you can do it in any climate. When beginning a walking program, start slow – walk only 20 to 30 minutes at a time, three to five times a week. Gradually build up endurance by walking longer and more frequently.

And if your knees are aching, visit a shoe store that offers shoe-fitting consultation. Finding the right support and cushion can help minimize your knee pain.
Pros: Can walk anywhere – no gym needed!
Cons: Must invest in a good pair of walking shoes.

Do you suffer from knee pain? What exercises have you found to be "nice to your knees?"

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Sleep Less, Eat More

Cara Stewart, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, discusses a recent study that suggests a link between sleep deprivation and calorie consumption.

Approximately 20 percent of Americans get six or less hours of sleep a night, according to the National Sleep Foundation. That figure raises concern given new research that sheds more light on the major toll sleep deprivation can take on your health.

A recent study showed that people who slept less ate more, suggesting a link between sleep deprivation and obesity. The study, conducted by researchers at the Mayo Clinic, followed sleep and eating patterns of 17 healthy young men and women for 11 days.

For the first three days, researchers measured calorie consumption and energy expenditure to establish a baseline. For the remaining eight days, half of the participants slept normally while the others got just two-thirds of their normal sleep. Eating habits remained unchanged in both groups. The findings revealed that those in the sleep-deprived group consumed an average of 549 more calories a day.

Although the study was small, it supports earlier research that linked chronic sleep deprivation with a variety of adverse health effects and illnesses, including cardiovascular disease, diabetes and obesity.  Larger scale studies are needed to confirm these findings and better understand exactly why sleep deprivation leads to increased calorie consumption.

In the meantime, it seems safe to conclude that sleep is an important part of your healthy lifestyle. Just by getting in bed on time, you can cut calories without even trying. Now that’s a diet that is hard to beat!

To learn how to improve your sleep habits, click here.

- Cara Stewart, RD, LDN

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Having a Baby After Weight Loss Surgery

Cara Stewart, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, and Monica A. Mainigi, MD, fertility specialist at Penn Fertility Care, provide important information for women trying to become pregnant and maintain a healthy pregnancy after weight loss surgery.

Many women struggle with fertility as a result of their weight. In fact, obesity puts women at greater risk for ovulation dysfunction and menstrual irregularity, both of which can interfere with fertility. In addition, obesity can lead to an increased risk of miscarriage and decreased success with fertility treatments. For overweight women who are having a hard time conceiving, weight loss surgery may be an option to consider.

For women considering pregnancy after they have had bariatric surgery, it is important to keep the following information in mind.


Fertility boost
Obesity can interfere with hormone production, making it more difficult to get pregnant.  Weight loss after bariatric surgery can lead to regular cycles and ovulation, and improved fertility. In fact, a 2005 study published in the Journal of Clinical Endocrinology and Metabolism found that surgical weight loss for women with PCOS often resolved their reproductive and metabolic abnormalities. 

Healthier pregnancy, healthier baby
After weight loss surgery, medical conditions such as high blood pressure and diabetes are significantly improved or resolved leading to a lowered risk of developing serious complications during pregnancy or delivering a baby born with complications.  Many women are still obese after weight loss surgery which places them at a higher risk for gestational diabetes and preeclampsia, but the risk is far less than before surgery.  Pregnant women who have had bariatric surgery should see a high-risk obstetrician to best manage prenatal care.

Give it time
It is important to wait at least 18 months after surgery to start trying to get pregnant. In the period immediately following gastric bypass or sleeve gastrectomy, rapid weight loss causes stress on the body, including diminished nutrition intake, which can cause complications for an expecting mother and growing baby. Effective contraception is absolutely critical for women pursuing weight loss surgery.  For women with an adjustable gastric band, fluid may be removed from the band during pregnancy to accommodate the need to eat more calories.

Keep supplementing
Good nutrition is especially important for women trying to conceive.  After weight loss surgery, patients are at a higher risk for deficiencies of certain nutrients, including vitamin B12, folic acid, calcium, iron, and vitamin D. It essential to continue taking vitamin and mineral supplements as recommended by the bariatric team.

Be ready for weight gain
After having weight loss surgery, it can be difficult to accept that pregnancy is a time when it is normal, healthy and necessary to gain weight.  Healthy weight gain during pregnancy is important to nourish a growing baby, but work with the program dietitians to avoid unhealthy weight gain during pregnancy.

The Penn Metabolic and Bariatric Surgery Program offers lifelong follow-up care and nutritional support for patients who have had weight loss surgery. Women considering pregnancy after weight loss surgery should discuss their plans with the bariatric surgery team.

For more information on fertility services at Penn Medicine, visit the Penn Fertility Care website.

- Cara Stewart, RD, LDN and Monica Mainigi, MD

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Bariatric Surgery's Halo Effect: Weight Loss for the Whole Family

Bariatric surgery improves the health and well-being of those who undergo surgery, but a recent study at Stanford University School of Medicine shows the positive impact actually extends to the entire immediate family. 

Researchers found that one year after a family member's gastric bypass surgery, other obese adults in the family lost an average of eight pounds and obese children had a lower body mass index than expected for their growth curve. The family members and children that participated in the study accompanied the bariatric patient to all pre- and post-operative clinic visits, including diet and lifestyle counseling. 

Adult family members reported improved eating habits with less uncontrollable eating, emotional eating and alcohol consumption. Both adults and children reported a significant increase in their activity levels. 

The results of this study come as no surprise to members of the Penn Metabolic and Bariatric Surgery team who have witnessed this pattern many times. After bariatric surgery, patients often report that their pursuit of a healthier lifestyle spurred changes for their whole family, including kitchen cabinet makeovers, healthier home-cooked meals and family fun nights that involve physical activity.

Family members and friends are always welcome to attend Penn Metabolic and Bariatric Surgery Program information sessions and support groups to help their family members and to help themselves as well. 

Note: The study was published on Oct. 17, 2011 in the Archives of Surgery. 

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Providing Support, Education and Advocacy for People with Obesity

Rebecca Dilks, RD, LDN, research coordinator at the Center for Weight and Eating Disorders and member of the Penn Metabolic and Bariatric Surgery team, explains the mission of and Penn's involvement with the Obesity Action Coalition.

Obesity is a disease and its patients require support, education and access to treatment. Several members of the Penn Metabolic and Bariatric Surgery team had the privilege of learning about expanding access to obesity treatment, ending weight bias and preventing obesity through education, awareness and advocacy at the 28th annual meeting of the American Society for Metabolic and Bariatric Surgery, the largest bariatric society in the world.

At the annual meeting, we learned about the Obesity Action Coalition's (OAC) website, magazine, newsletter, support groups and other methods being used to increase education about obesity, including a "Walk from Obesity." It was clear to us that the OAC offers a unique opportunity for bariatric health care providers and patients to team up and improve the lives of people affected by obesity. In fact, we were so impressed by the OAC that several members of the Penn Metabolic and Bariatric Surgery Program joined the coalition.

A major focus of the OAC is advocating for widespread recognition of obesity as a disease. Patients can be denied access to important medical treatments, including medically managed weight loss or bariatric surgery, because insurance companies do not recognize obesity as a disease. The OAC wants to change this by encouraging patients and providers to contact elected officials, legislators and employers and emphasize the importance of treating obesity as a disease. They also provide guidance for those seeking insurance coverage for bariatric surgery.

With tools provided by the OAC, people affected by obesity can help eliminate the negative stigma and encourage key decision makers to recognize obesity as the medical disease that it is.

We encourage you to consider joining the OAC as part of your bariatric surgery experience with the Penn Metabolic and Bariatric Surgery Program.

For more information about the Obesity Action Coalition, visit the website.

- Rebecca Dilks, RD, LDN

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Considering bariatric surgery? Quit Smoking. Today.

Anyone who smokes knows they should kick the habit. But quitting smoking is especially important for people considering bariatric surgery. The guidelines for bariatric surgery require patients to quit smoking 60 days prior to surgery.

The health consequences of smoking are well known and well documented, but these dangers are amplified for people with obesity. Along with the associated higher risk for cancer, heart disease and stroke, smoking increases the risks associated with surgery, including anesthesia-related complications, infections, heart attack, stroke, pneumonia and death. It also slows down healing time by narrowing blood vessels, restricting blood flow to the surgical site.

Smoking after bariatric surgery puts patients at significantly higher risk for a host of complications, such as ulceration of the gastric pouch, gastritis, infection and increased shortness of breath.

It is never too late to quit and Penn has several options to help people break their smoking habit. The health benefits of smoking cessation occur almost immediately and have a long-lasting impact.

Effects of quitting smoking* after:

• 20 minutes: Heart rate and blood pressure drop.
• 12 hours: Carbon monoxide level in the blood drops to normal.
• 2 weeks to 3 months: Circulation improves and lung function increases.
• 1 to 9 months: Coughing and shortness of breath decrease; cilia (tiny hair-like structures that move mucus out of the lungs) start to regain normal function in the lungs, increasing the ability to handle mucus, clean the lungs and reduce the risk of infection.
• 1 year: Excess risk of coronary heart disease is half that of a smoker.
• 5 years: Risk for cancer of the mouth, throat, esophagus and bladder are cut in half; cervical cancer risk falls to that of a non-smoker; stroke risk can fall to that of a non-smoker after two to five years.
• 10 years: Risk of dying from lung cancer is about half that of a smoker; risk for cancer of the larynx and pancreas decreases.
• 15 years: Risk for coronary heart disease is that of a non-smoker's.
  

For smokers who are interested in bariatric surgery, enroll in a smoking cessation program to begin the quest to a healthy lifestyle.

Local resources:

• Penn’s Comprehensive Smoking Treatment Program: A multidisciplinary team of specialists offers state-of-the-art, individualized treatment to help smokers quit safely and comfortable.
• Quit Smoking Program at Pennsylvania Hospital: The respiratory care team offers a five week program with counseling and support to help smokers overcome their addiction.
  
• Pennsylvania’s Free Quitline: The Philadelphia Department of Public Health offers a variety of resources to help residents quit smoking, including a free one-month supply of nicotine patches through the PA Free Quitline telephone counseling program at 877-724-1090.
  

Additional resources:

• American Cancer Society, 800-ACS-2345
• American Lung Association, 800-586-4872
  

Get help to begin the journey to health - today!

*American Cancer Society, Guide to Quitting Smoking.

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Weight-Loss Surgery Can Help Control Diabetes

Cara Stewart, RD, LDN, a member of the Penn Metabolic & Bariatric Surgery team, explains the importance of diabetes management and the impact of bariatric surgery on blood sugar control.

November is American Diabetes Month as designated by the American Diabetes Association. It is a time to raise awareness about diabetes, its potentially serious complications and effective management strategies.

For people with diabetes, it is important to keep blood sugar levels within a healthy range to prevent damage to blood vessels and nerves. Properly managing blood sugar levels involves making healthful food choices, being physically active, and using medications as prescribed. For people with diabetes and obesity, bariatric surgery may be an option to improve and potentially cure diabetes.

A recent meta-analysis of data published in The American Journal of Medicine reveals the significant impact of bariatric surgery on type 2 diabetes. According to the data, type 2 diabetes was resolved in 84 percent of patients who underwent gastric bypass surgery. For these patients, blood sugar often normalized within days or weeks after surgery, even before they lost significant amounts of weight. Type 2 diabetes was resolved in 48 percent of patients who underwent adjustable gastric banding surgery. For these patients, their type 2 diabetes resolved following post-operative weight loss.

A team of researchers at Penn Medicine is currently conducting a National Institutes of Health funded-study to determine if bariatric surgery, either gastric bypass or adjustable gastric banding surgery, is more effective than lifestyle modification at reducing weight and ultimately treating type 2 diabetes.

To learn more about the Penn Metabolic & Bariatric Surgery Program, please visit www.PennMedicine.org/bariatrics.

- Cara Stewart, RD, LDN

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