University Health System Blog

Dr. Shawn Tsuda answers the question: “Gastric banding surgery for teens: Is it effective for weight loss?”

A new study shows that gastric banding surgery may help teenagers lose weight more effectively then medical treatment with lifestyle changes alone.

Obesity among adolescents continues to rise and 75 percent of obese children eventually become obese adults. For certain, teens who suffer from severe obesity, defined as a body mass index greater than 35 kg/m2 or worse, surgery for weight loss may represent the only effective means of preventing the health problems associated with their weight.

Surgery is not risk free and any decision to use a restrictive operation such as laparoscopic adjustable gastric banding must be approached with care. At our university adolescent weight loss program, a multidisciplinary team of bariatric surgeons, pediatric surgeons, pediatric heart doctors, endocrinologists, social workers, psychologists, and dieticians evaluate obese teens and their families to assure that the decision to move ahead with weight loss surgery is a safe and desirable one.

For those patients who are good candidates, the tool of gastric banding in conjunction with diet and exercise can provide a healthier future.

The School of Medicine offers free weight loss seminars on the first Thursday of every month that will answer your questions about weight loss surgery and to find out if you’re a good candidate for gastric banding surgery.

Shawn Tsuda, M.D. is vice chief for bariatric surgery at University Health System and the University of Nevada School of Medicine in Las Vegas. Dr. Tsuda completed his fellowship training in minimally invasive and bariatric surgery at Harvard Medical School. He is board certified in general surgery. More information on the University of Nevada School of Medicine Weight Loss Surgery Center.

Have a health question? University Health System doctors answer select questions from readers like you.

Dr. Shawn Tsuda answers the question: “Can you be considered obese if you have a normal body weight?”

If you are what is considered an ideal body weight, according to the Metropolitan Life Insurance tables from the 1940s, you will generally not be considered overweight or obese.

The Centers for Disease Control (CDC) defines being overweight and obese by a body mass index (BMI). BMI is a person’s weight in kilograms divided by their height in meters squared.

BMI is a better value for measuring a person’s weight compared to actual weight in pounds. This is because a 210 pound man who is 6 feet 6 inches tall is probably more lean than a 210 pound man who is 5 feet 6 inches tall.

The CDC defines a normal weight as a body mass index between 18.5 and 24.9. Overweight is between 25 and 29.9. Obesity is defined as a BMI greater than 30 and morbid obesity a BMI greater than 40.

The problem with body mass index is that it does not directly measure fat content.

However, it is still a valuable tool because for most people other than very muscular body builders or athletes, a BMI suggesting overweight or obesity means that medical problems and a shortened life expentancy comes along with it.

A diet and exercise plan and in some cases, surgical treatment for morbid obesity, can resolve medical problems, improve quality of life and avoid premature death.

Shawn Tsuda, M.D. is vice chief for bariatric surgery at University Health System and the University of Nevada School of Medicine, in Las Vegas, Nevada. Dr. Tsuda completed his fellowship training in minimally invasive and bariatric surgery at Harvard Medical School. He is board certified in general surgery.

Have a health question? University Health System doctors answer select questions from readers like you.

Dr. Aditi Singh answers the question: “Can you be overweight because of a slow metabolism?”

Yes, but this is rare.

Obesity is a chronic disease that is increasing in prevalence in children and adults in the U.S. In the last two to three decades, the prevalence of becoming overweight or obese has been increasing. There are various factors that effect body weight, including metabolism, diet and physical activity.

Metabolism is the process by which the body converts what you eat to energy for the body to utilize (”food into fuel”). This energy is vital for the body to function. The amount of calories your body needs for basic functions, such as breathing and sleeping, is your basal metabolic rate.

Your basal metabolic rate is influenced by your age, which slows down as you get older. It’s influenced by gender, with males having a higher rate than females. It is also influenced by the proportion of your lean body mass, for example, your metabolic rate tends to be higher if you have more muscle mass.

Certain medications can also be responsible. Genetic factors also play a role in obesity. There are also medical conditions that may contribute to obesity, including Cushing’s syndrome and hypothyroidism, which slows metabolic activity.

However, compared to lifestyle factors, these are rare. Most cases of obesity are related to sedentary lifestyle and increased caloric intake. A sedentary lifestyle lowers your energy expenditure, thus promoting weight gain. Unhealthy habits such as sleep deprivation and frequent fast-food consumption are also associated with weight gain.

Effective measures to keep energy expenditure up are activity, low-calories meals and healthy habits.

Dr. Aditi Singh is an assistant professor of medicine at the University of Nevada School of Medicine in Las Vegas. She is board certified by the American Board of Internal Medicine.

Have a health question? University Health System doctors answer select questions from readers like you.

Dr. Evan Klass answers the question: “What is the relationship between obesity and diabetes?”

Obesity has become the nutritional disease of our age.

The causes of obesity are multiple and complex. Certainly our sedentary lifestyle contributes, but it is easy access to inexpensive, calorie dense foods which is primarily responsible.

In the setting of genetic predisposition to type 2 diabetes (formerly adult onset diabetes, for example, a family history of diabetes), increasing body weight increases the risk for developing diabetes.

We can’t change our parents so our genetic risk is permanent. If a woman had diabetes in pregnancy (gestational diabetes) her chance of developing diabetes in the future is significantly increased.

Likewise, women who have polycystic ovarian syndrome are at increased risk, as are patients with hypertension. Your doctor should be aware of these conditions and perform regular screening for diabetes in high-risk individuals.

We should all aim to increase our level of physical activity.

When patients ask how often they should exercise, I say “What’s the matter with every day?”

Exercise does not mean buying a gym membership. It means walking more, using the stairs, mowing the lawn on foot. Anything that gets you moving counts.

When we don’t watch our weight, it climbs.

We need to honestly evaluate where our calories come from and recognize that we all underestimate what we eat. Then we need to start reducing.

Many people benefit by meeting with a registered dietician. The best bet is sensibly reducing your calories and remembering that real weight loss is a slow process.

You can’t lose heart! The sooner you start the sooner you get to your goal.

Finally, it is very important to work with your physician to insure that, if you have diabetes, you are employing all of the appropriate current therapies and that all other cardiovascular risk factors, such as high blood pressure, high cholesterol and smoking, are aggressively managed.

Evan Klass, M.D. is an endocrinologist practicing in Reno, Nevada at University Health System. Dr. Klass completed his fellowship training in endocrinology at George Washington University Medical Center.

Have a health question? University Health System doctors answer select questions from readers like you.

Dr. Shawn Tsuda answers the question: “Laparoscopic gastric bypass versus the laparoscopic adjustable gastric band: Is one or the other better for long term weight loss results?”

The number of weight loss procedures performed over the past ten years has increased by more than a ten-fold in the U.S., exceeding 200,000 operations in 2006. The laparoscopic Roux-en-Y gastric bypass, which provides both restriction and malabsorption of food intake, is still considered the gold standard operation for long-term weight loss.

However, the laparoscopic adjustable gastric band, which uses one of two FDA approved devices for primary restriction of food into the gastrointestinal tract, is the second most commonly performed procedure and is quickly gaining in popularity. There is an abundance of data that supports both the gastric bypass and laparoscopic adjustable gastric band as safe (but not risk-free) procedures with sustainable weight loss and a positive impact on obesity-related diseases such as diabetes mellitus, hypertension and obstructive sleep apnea. (Learn more about weight loss surgery procedures from the U.S. National Library of Medicine).

The amount of weight loss that can be expected on average for the gastric bypass ranges between 60 and 80 percent of excess weight loss, or loss of weight beyond a calculated ideal body weight. The laparoscopic adjustable gastric band has a wider spectrum of success, ranging between 30 and 70 percent of excess weight loss.

Both operations are endorsed by most professional medical societies as acceptable treatments for the severely obese. The choice of operation depends on the patient’s preference, along with his or her surgeon’s counseling on any specific contraindications to either of the operations. An informed decision is essential to undergoing any weight loss procedure.

Shawn Tsuda, M.D. is vice chief for bariatric surgery at the University of Nevada School of Medicine, in Las Vegas, Nevada. Dr. Tsuda completed his fellowship training in minimally invasive and bariatric surgery at Harvard Medical School. He is board certified in general surgery.

Have a health question? University Health System doctors answer select questions from readers like you.

Dr. James Lau answers the question: “What’s the difference between being overweight and obesity?”

Obesity means having too much body fat. It is different from being overweight, which means weighing too much. Both terms mean that your weight is greater than what’s considered healthy.

Obesity most often occurs over time when you eat more calories than you burn or use. The balance between calories-in and calories-out differs for everyone. Genetics, overeating, eating high fat foods and being physically inactive are factors that can make you obese.

It’s important to note that obesity is not just a cosmetic concern. Obesity and carrying excess body fat places you at greater risk of developing high blood pressure, diabetes, stroke, arthritis, certain cancers, and other serious health problems. Losing even five to ten percent of your weight if you’re obese can help delay or prevent some of these diseases.

If your body hasn’t responded to diet and exercise, you may be a good candidate for weight loss surgery, or bariatric surgery, such as the gastric bypass or the lap band using laparoscopic techniques. It’s important to get the facts about your choices if you believe you’re a good candidate for weight loss surgery.

The University of Nevada School of Medicine and University Medical Center sponsors free seminars in Las Vegas on bariatric surgery that Dr. Shawn Tsuda and I personally conduct. These free seminars are usually held once or twice a month at the School of Medicine. For a complete schedule, and for more information, please contact Robin Morello at 702-671-5150.

James Lau, M.D. is an assistant professor and chief of the bariatric surgery division at the University of Nevada School of Medicine Department of Surgery. Dr. Lau is board certified in general surgery and completed fellowship training in bariatric and minimally invasive surgery at Stanford University. He specializes in weight loss surgery.

Have a question? University Health System doctors answer select questions from readers like you.

Dr. Shawn Tsuda answers the question: “I’ve heard a lot about minimally invasive surgery. What exactly is it?”

Minimally invasive surgery refers to operations performed with small scars. Typically this can be accomplished laparoscopically, or with the use of a tiny camera and long, narrow instruments. The advantages of minimally invasive surgery include less post-operative pain and quicker recovery. The cosmetic result is also more favorable.

The vast majority of weight loss procedures such as the Roux-en-Y gastric bypass and the adjustable gastric band are performed laparoscopically, along with common procedures like gallbladder removal and hernia repairs.

Recently researchers have been looking into performing “scarless” surgery, also known as natural orifice and transluminal endoscopic surgery (NOTES) or single-incision laparoscopic surgery, through a tiny hole in the belly button. Although these advanced techniques are still in development and not widely performed, it is likely we will continue to see more surgery performed with either reduced scars, one single scar in the belly button, or no scars at all.

Shawn Tsuda, M.D. is vice chief for bariatric surgery at the University of Nevada School of Medicine, in Las Vegas, Nevada. Dr. Tsuda completed his fellowship training in minimally invasive and bariatric surgery at Harvard Medical School. He is board certified in general surgery.

Have a health question? University Health System doctors answer select questions from readers like you.