Friday, August 6, 2021

"After Weight-Loss Surgery, a Year of Joys and Disappointments"/ "An airport pianist received more than $60K in tips when an Instagram influencer recorded him playing"

Jan. 4, 2017 "After Weight-Loss Surgery, a Year of Joys and Disappointments": Today I found this article by Gina Kolata in the Globe and Mail.  It seems to be the condensed version.  I found the article to be very inspirational to be more healthy.  It was also educational by learning about weight- less surgery.


It was Oct. 11, 2015, and a middle-aged man and a young woman, both severely obese, were struggling with the same lump-in-the-throat feeling. The next day they were going to have an irreversible operation. Were they on the threshold of a new beginning or a terrible mistake?

They were strangers, scheduled for back-to-back bariatric surgery at the University of Michigan with the same doctor. He would cut away most of their stomachs and reroute their small intestines. They were almost certain to lose much of their excess weight. 

But despite the drastic surgery, their doctor told them it was unlikely that they would ever be thin.

Nearly 200,000 Americans have bariatric surgery each year. Yet far more — an estimated 24 million — are heavy enough to qualify for the operation, and many of them are struggling with whether to have such a radical treatment, the only one that leads to profound and lasting weight loss for virtually everyone who has it.

Most people believe that the operation simply forces people to eat less by making their stomachs smaller, but scientists have discovered that it actually causes profound changes in patients’ physiology, altering the activity of thousands of genes in the human body as well as the complex hormonal signaling from the gut to the brain.

It often leads to astonishing changes in the way things taste, making cravings for a rich slice of chocolate cake or a bag of White Castle hamburgers simply vanish. Those who have the surgery naturally settle at a lower weight.

Over the last year, I followed Keith Oleszkowicz and Jessica Shapiro — a computer programmer and a college student — from their surgeries through the transformations that followed. The operation, increasingly common as obesity threatens the health of millions of Americans, changes not just the bodies of those who have it, but also their lives: how they see themselves and how they relate to their romantic partners, co-workers and families.


As the pounds fell away in a society that harshly judges fat people, Keith and Jessica, two ordinary Americans, would go through an extraordinary experience, one that brought both joys and disappointments.

Jessica, 22, lived with her mother and grandmother in Ann Arbor, Mich., and worked at Panera Bread preparing food. At 5-foot-3 and 295 pounds, she had a difficult life. She needed a seatbelt extender on airplanes. She was unable to cross her legs. She had acid reflux and mild sleep apnea, which meant she woke up at night about seven times an hour.

A doctor told her something that shook her: “You are only 22, but your body is much older than you are.”

Even worse were the constant struggles of being fat in today’s society. She never had a date and no man ever seemed interested in her. Total strangers lectured her on how to eat. 

And she suffered unexpected humiliations, like when she went to an amusement park with friends and the ride attendant pulled her aside and asked her to try pulling the safety bar over her stomach. It didn’t fit, and he turned her away.

“Every day of my life, I’m just aware of how overweight I am,” she told me as she sipped a cup of water at a Starbucks near her home.

She tried programs like Weight Watchers, but her urge to eat, as powerful as the urge to breathe when holding your breath, defeated her. It is a drive, obesity researchers say, that people who have never felt it find hard to fathom.

“It’s like a physical need,” Jessica said. “It’s not just a longing or just a passing urge.” It is, she said, “like a kind of hunger that like kind of claws at you from the inside out.”

The surgery, she said, “is a last resort for me.”

Keith’s circumstances were a bit different. He was 40, married with a teenage son, and worked as a programmer at a big automaker. His wife, Christa, had had the operation two years before, after pondering it for nine years. She lost 143 pounds and felt that her life had been transformed.

Keith’s older brother had had the surgery, too, 16 years earlier, at a time when many doctors were splitting patients open instead of doing the surgery laparoscopically as they do today.

The complication rate was much higher at that time, and the death rate at one year after surgery was 4.6 percent, verging on unacceptable.

“We were not in a good place then,” Dr. Amir Ghaferi, a bariatric surgeon at the University of Michigan, told me. The one-year mortality rate today is 0.1 percent, safer than gallbladder surgery or a joint replacement.

Keith, at 5-foot-9 and 377 pounds, was not as fat as his brother had been, but he was having physical and medical problems. He somewhat hesitantly listed some of them: His joints hurt; moving around was an effort; he could not bend down to tie his shoes; he had sleep apnea and had to use a continuous positive airway pressure machine to push air into his lungs when he slept; he had high blood pressure.

He had lost 10, 20, 30, even 40 pounds at a time over the years with various diets, but he was plagued with insatiable urges to eat. The weight always came back.

“I’ve tried everything I can,” Keith said.

But, he stressed, it is not as hard for a guy to be fat as it is for a woman. And he’s right. Researchers have found that there is more prejudice against fat women than against fat men. Still, Keith suffered many indignities.

As a child, he was teased and became so ashamed of his body that he could not bring himself to undress for gym class. So he wore his shorts and T-shirt under his school clothes and spent the rest of the day with those sweaty clothes underneath. He even had his own amusement park moment, at the same place, Cedar Point in Ohio, where Jessica had been embarrassed.

Yet he had a hard time committing to the surgery. It was such a big step, and once it was done, there was no going back.

In the end, it was Keith’s son who tipped the balance. “I don’t want you to die, Dad,” he told him one day when the two were playing video games. He looked up at Keith, saying, “Dad, we need to do something.”

The Operation

By the day of their surgeries, Oct. 12, 2015, Jessica and Keith had spent months preparing.

They had had medical and psychological tests. They went to counseling and mandatory sessions explaining what was going to happen, and what to expect and how to eat afterward.

They learned that the gastric bypass operation both had chosen (it and a procedure called the gastric sleeve are the two main options) leaves patients unable to absorb some vitamins and minerals. 

They would need to take supplements daily for the rest of their lives. And because the rearranged digestive tracts can dump sugar into the bloodstream too quickly, they would have to be careful about sugar intake or risk “dumping syndrome,” which can cause vomiting, sweating and shakiness.

For two weeks before the surgery, Jessica and Keith followed a high-protein liquid diet to shrink their livers. People with obesity often have large, fatty livers that can get in the way during the operation.

The day before, Jessica stood at her kitchen counter preparing a mango protein shake with mango flavored Crystal Light and protein powder. It smelled foul. She forced herself to swallow it.

“I am excited,” she said.

At 6:30 the next morning, a nurse and a surgical resident wheeled Jessica into an operating room on a special wide gurney. They slid her onto an operating table that was set as low as it could go because bariatric patients’ abdomens rise high, as if they were domes.

The surgeon, Dr. Oliver Varban, started by inflating Jessica’s abdomen with carbon dioxide to give him more room to work. Then he made seven small holes in her skin and inserted his equipment, including a cylindrical tube containing a tiny light to illuminate her abdominal cavity, lenses, mirrors and a tiny camera to project the scene on a computer monitor above Jessica’s head. The screen showed gleaming golden bubbles of fat that were surprisingly beautiful.

Dr. Varban used what looked like a miniature table tennis paddle to push Jessica’s liver aside and give him a clear view of her stomach. Her intestines were obscured by fat, so he used a special surgical grasper to gently push the fat aside.

It might seem reasonable for Dr. Varban to simply remove some of the fat from Jessica’s abdomen, but doing that, he said, would result in a bloody, hemorrhaging mess. He explained that there is a mile of blood vessels in every pound of fat.

Dr. Varban cut off most of Jessica’s pink and healthy stomach, leaving a pouch the size of an egg. He stapled and sealed the pouch with a device that looked like a saw-toothed pair of shears, leaving a shiny metallic edge of staples. Then he grabbed the top of her small intestine and attached it to the stomach pouch.

A couple of hours later, he was done and it was Keith’s turn. The operation was the same, but Keith’s fat looked different, more yellow than golden, and lumpy. And there was much more of it — his organs were buried in it. Men tend to have thicker abdominal fat, Dr. Varban said, and it is slipperier, harder to grasp with the laparoscopic instruments.


Jessica and Keith spent two nights in the hospital and then were discharged, with instructions to follow a liquid diet for a couple of weeks and then gradually add solid foods.

Jessica was surprised by the pain. When she was home, recuperating, she started to have second thoughts about the surgery. One day, she sat down and cried.

“I had like this awful buyer’s remorse,” she said. “I was like, ‘What did I do to my body?’ This is not reversible, there is no going back.”

Improving the Technique

For years, surgeons thought weight-loss operations worked because they made the stomach so small that it hardly held any food. And with the bypass operation, they made it even harder for food to be digested. Of course patients lost weight.

But some things just did not add up.

A simple surgical treatment, the gastric band, which constricts the stomach, was widely used when it was first approved in 2011 but fell out of favor because its effects on weight were variable and almost always smaller than those of the other operations. It still is used (New Jersey’s governor, Chris Christie, had one), but it now accounts for just 5.7 percent of weight-loss surgeries.

At a recent meeting of Michigan bariatric surgeons, one doctor asked for a show of hands. Who in the room would refuse to do a gastric band procedure even if a patient asked for it? Just about every hand in the room went up.

“The most common operation with the band now is an operation to remove it,” Dr. Varban said.

Even leaving aside the gastric band issue, the idea that the bypass and sleeve surgeries were a mechanical fix, by limiting the amount of food a patient could eat, did not seem right.

Wiring people’s jaws shut would keep them from eating, noted Randy Seeley, who holds a doctorate in psychology and is a professor of surgery at the University of Michigan. But, he asked rhetorically, “If I wired your jaw shut, would you be more hungry or less hungry?”

In contrast, patients who had bypass and sleeve operations reported that they were not particularly hungry afterward, and that their incessant urges to eat vanished. Even more surprising, their taste for food often changed.

Dr. Lee Kaplan, an obesity researcher at Massachusetts General Hospital, recalled a patient who asked him: “Are you sure they didn’t operate on my brain? Food does not call out to me anymore.”

Another, who used to seek fatty and sugary foods, said, “I crave salads now.”

Dr. Justin Dimick, a bariatric surgeon at the University of Michigan, said a woman who lost 200 pounds told him that before the operation, a Reese’s peanut butter cup gave her such a rush that it was, she said, “like an orgasm of pleasure in my brain.” Now, she said: “It’s just peanut butter and chocolate. What’s the big deal?”

Experimental data support these reports. Both patients and rodents who had surgery are actually more sensitive to the taste of sweets: Receptors on their tongues detect smaller amounts of sucrose.

The data, the patients’ stories, made no sense if all surgery did was make it harder to eat, Dr. Kaplan said. Both the bypass and sleeve operations, he added, “drive the body to want to eat less.”

But why?
Some, including Dr. Seeley and Dr. Kaplan, looked for answers by studying the surgeries in fat rats and mice.

“What you find very quickly is that rats and mice lose weight just the way you see in humans,” Dr. Seeley said. “It’s remarkable.” Surgery changed the weight the animals’ bodies settled into. And, as with patients, their tastes in food changed.

For example, Dr. Seeley gave some rodents the exact bariatric surgery operation that humans get while he gave others, which served as controls, sham surgery: 

Researchers opened the animals’ abdomens and then sewed them shut. The bariatric surgery animals lost most of their excess weight and then stabilized at a lower weight.

Then the researchers put all the rodents on a diet. All lost weight.

Three weeks later, the animals were given as much food as they wanted. 

Those that had had the sham operation ate until they were back to their original weights. 

Those that had had the real bariatric surgery ate until they reached their post-surgery weight.

“Surgeons often talk about bariatric surgery as a tool. You have to follow all these instructions,” Dr. Seeley said. It only works, they tell patients, if they follow a diet and exercise program.

“My message is that the rats don’t appear to do it that way. They don’t know it’s a tool. They just naturally change lots of things in the way they relate to food.”

Three Months Later

After plummeting soon after the operation, Jessica’s weight began to fall more slowly. By January she had lost 65 pounds.

Jessica and Keith, too, had mixed reactions.

A year after his surgery, Keith weighed 284 pounds, down from his starting weight of 377, but not at his projected weight of 230. It is increasingly unlikely that he will get there.

But he looked and felt transformed.

“Some people I haven’t seen in years don’t recognize me,” Keith said.

“And I do have more energy,” he added. “It is a huge difference.”

Yet he is still fat, and still feels big. “I expected all my weight to be gone,” Keith confessed over lunch at a sushi restaurant near his work. “I wanted to be 230. I was hoping.”

And he misses his former lust for food. “I just liked eating before. I liked to eat.”

Jessica lost 112 pounds, just about exactly what was predicted.

“I expected myself to grieve a lot more for my loss of my old relationship with food, and I didn’t,” she said.

She began classes at Eastern Michigan University in the fall but dropped out in October, explaining that she did not like the courses and had a lot of anxiety. 

While she waits to apply to another college, she is working at coffee shop near her home. She still lives at home.

Before her operation, she could blame her stalled life on her obesity. Now, she says, “I don’t have an excuse anymore.”

“I’m smaller,” she said. “But it’s been gradual enough that I still feel like I’m the biggest person in the room wherever I go.”

On the other hand, her acid reflux is gone and she had the confidence to buy a bike.

She wants to lose another 40 pounds. Her plan is to start with that awful liquid diet she was on for two weeks before her surgery. In the meantime, she has not bought new clothes, holding off until she loses more weight. She says she will consider having plastic surgery to remove loose skin after she loses more pounds.

Yet, Jessica says, although she has mixed feelings about the results of the surgery and although she is disappointed that her life has not changed as much as she hoped, she does not regret having the operation.

And she had some triumphs.

She went back to the amusement park where she had been so humiliated when she was turned away from a ride, too big for the safety bar to go over her.

Now she fit.





Jul. 24, 2021  "An airport pianist received more than $60K in tips when an Instagram influencer recorded him playing": Today I found this article by Meryl Kornfield on Yahoo 
News:

It was a usual Wednesday for Tonee Valentine (Carter), a professional piano player at terminal A of Atlanta's Hartsfield-Jackson Atlanta International Airport.

Valentine's hands slid across the keys, his black brimmed hat bobbing. Amid the noisy and chaotic travel hub, the pianist provided rhythm.

Author and motivational speaker Carlos Whittaker, on an hour-long layover to Nashville, noticed. He saw the pianist "playing his heart out," opened Instagram and began recording. Whittaker, with a following of more than 170,000, panned to the meager contents of the blue tip bowl atop the piano and went up to give money. That's when the two struck up a conversation, Whittaker asking if the pianist would participate in his podcast "Human Hope."

"He asked me: Do I have hope in humanity?" Valentine told The Washington Post. "And I told him no. I didn't see it."

"Of course, that changed," Valentine added.

Within minutes, Whittaker's following and strangers began sending money through cash apps, contributing more than $10,000 in a half-hour and $61,000 in two days. Messages flooded in, people sending their appreciation of Valentine's talent and passion.

Since, the 66-year-old musician has gained more than 10,000 followers on Instagram and has become a destination for fans flying into the airport.

"This guy, Carlos Whittaker, blew into my life like a tsunami," Valentine said. "I was having a typical day at work, and now, I've been blessed by this man and his followers."

When Whittaker started talking to him, Valentine shared he received nightly dialysis treatment for kidney disease. Despite the hours-long time spent hooked to an IV, the man told the Instagram star that he had it much better than others.

This is not the first time Whittaker's followers, which he calls his "Instafamilia," have contributed to helping others: They've funded a pregnant woman living in an RV, a woman with epilepsy who wanted a seizure alert dog and lodging for inner-city Brooklyn children camping in Alaska's wilderness, Whittaker said.

Inspired by the generosity of Whittaker's online family, Valentine said he intends to pay the money forward instead - although he said he was considering getting his car's oil changed.

Eleven years and 87 countries later, Valentine had traveled the world as a pianist on cruise ships, he said, returning to playing at a local restaurant. That's when a man approached him with an offer: There was an opening at the airport. Valentine declined, but the man asked him to try it out for an hour.

"I tried it for an hour, but I stayed for three," he said. "I was having such a good time, 13 years later, I'm still there."

An airport pianist received more than $60K in tips when an Instagram influencer recorded him playing (yahoo.com)

My opinion: Aww.. what a happy and positive article.  There's a video clip and Valentine plays well.


Aug. 4, 2021 "American couple who retired in Nova Scotia leave $4.8M to local hospital": Today I found this article by Haley Ryan on CBC News:


An American couple who found peace in a small, seaside Nova Scotia town will continue serving the community for years to come.

Tim and Diane Ledvina posthumously donated $4.8 million to Liverpool's Queens General Hospital Foundation, the largest single private donation the foundation has ever received.

"They loved people," Tom, Tim's twin brother, said in a recent interview from his home in Easton, Md.

"They moved to a new country, to a small town, and they didn't just kind of lock themselves up in a house. They went out and met the community and made it their own."

Work in the auto industry as an engineer brought Tim to lots of international destinations, such as Germany and Japan, Tom said.

American couple who retired in Nova Scotia leave $4.8M to local hospital | CBC News


Jul. 27, 2021 "‘Arthur’ To End At PBS Kids After Season 25": I like this picture of Arthur smiling and giving the peace sign.  I posted this on Facebook.  


I used to read the picture books as a kid.  I saw the show and it was fun to watch: 


Arthur, the longest-running children’s animated series in the history of American television, is set to end with its 25th season.

The iconic children’s series will end on PBS Kids with its final season debuting in the winter of 2022.

‘Arthur’ To End At PBS Kids After Season 25 (yahoo.com)







Aug. 1, 2021 My birthday: I put this on my Facebook page:

Hi, my birthday is coming up on Aug. 11.
1. May you please get me some scrap printer paper from your work? You know the paper that was printed on one side and are put in the recycle bin. I would like to reuse them and reprint on them. Thanks.

2. Dry erase markers.


Aug. 3, 2021 Beyond Meat: I tried this vegetarian burger at A&W.  The patty looks like beef.  It doesn't taste good or bad.  It doesn't taste like anything.  I only ate the patty as it is without the bread or veggies, because I wanted to really taste the patty. I'm not ordering this again. 

Aug. 4, 2021 Century Palace restaurant: I went out to lunch/ dim sum with my parents and grandma today.  It was kind of busy there.  The food tasted good like the deep fried shrimp and chicken legs.

This is good to break out of the routine and go out for 2 hrs for fun.

I hardly ever go out for fun.  I do have fun by reading the news on the internet and watching TV, and those self- development videos.


Free astrology birth chart: You type in when (date and time) and where you're born, and this will tell you all about you.  I know my sun sign which is the zodiac sign you're born in.  There are ascendant sign and moon sign. 


There are all these planets in your sign and planets opposite other planets.  I read my chart and it was pretty accurate in my personality.  

You should check it out to see how accurate it is for you:



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"Do I look fat in this?"/ "Should obese teenagers get bariatric surgery?"

Nov. 18, 2016 "Do I look fat in this?": Today I found this article by Sharon Kirkey in the Edmonton Journal.  


This is a good article about mental health mainly amongst women who talk about how fat they are even though they aren't.  We should all stop talking about how fat and bad we feel about our bodies:

It’s something most women are guilty of. “I feel fat,” one will declare after a meal, no matter its size, to which her friend might reply, “God, if you think you’re fat, what about me?”

Fat talk, the everyday negative and body-disparaging comments and conversations between women about eating, weight and body shape (“I hate my thighs”, “She’s so thin!”) is fuelled by women who put more importance on physical appearance and attractiveness and who feel pressure to achieve the “perfect” body, suggests a new study exploring why women do it.

The findings shouldn’t be seen as any kind of judgment reaction, they and other researchers stress. It’s difficult, as a woman in this culture, to not be worried about how you look.

But fat talk has an extra element of perniciousness, because it feeds into the culture that creates it.

“Women who overhear others engage in fat talk are more likely to fat talk themselves and to experience heightened body dissatisfaction and guilt,” University of Ottawa researchers write in the most recent issue of the journal Body Image.

Fat talk occurs among women of all ages and all body types and women often engage in it to receive “validation or re-affirmation that their bodies are appealing,” they said.

“It’s done with the purpose of fishing, or trying to understand what people think of you, or perceive of you,” said co-author Luc Pelletier, a professor and social psychologist at the University of Ottawa.

In fact, “conversational shaming of the body” has become so pervasive, it’s “practically a ritual of womanhood (though men also engage in it),” Northwestern University psychologist Renee Engeln wrote last year in the New York Times. 

That occurred after Facebook ditched its pillow-cheeked “feeling fat” emoticon when thousands signed an online petition posted by Endangeredbodies.org, an initiative that exists to “challenge all those merchants of body hatred who turn girls and women against their own bodies.”

Many women who engage in fat talk have internalized an “ideal” (usually ultra-thin) body image perpetuated by the media, Pelletier said. “Some women become vulnerable to the images that are portrayed, while others are able to resist them,” he said.

For their study, the Ottawa researchers applied the “self-determination theory,” a basic theory of human motivation. The theory holds that people are motivated by either intrinsic (personal growth) or extrinsic (popularity, physical attractiveness, social status) goals.

Intrinsic goals are associated with better health and wellbeing, while extrinsic goals have been tied to lower self-esteem, higher depression, anxiety and stringent exercising and dieting.

Their sample included 453 female undergrads aged 17 to 50 who completed an online questionnaire. According to their BMI, or body mass index, 69 per cent were in the normal range, while 20 per cent were overweight or obese (11 per cent were underweight).

Most said they sometimes engaged in fat talk, but women who were more motivated by extrinsic goals — to “be beautiful” or “be admired by many people” — were more likely to do it.

“Looking thin and looking good respond to those goals, compared to others’ goals of being healthy,” Pelletier said.

The fat talkers were also more “non-self-determined,” which Pelletier described as women “who don’t regulate their behaviours themselves, who feel pressured or coerced to do something” in order to please others. 

They were also more likely to engage in unhealthy eating — focusing on calories to lose weight and be thin.

Self-determined women who are more likely to reject sociocultural pressures to pursue an idealist body image were less likely to engage in negative body talk, they found. 

“Some women prefer conversing with other women who speak more positively about their bodies, compared to women who tend to self-degrade about their bodies,” they write.

Despite the link between fat talk and body dissatisfaction, other studies have found that fat talk, in a rather twisted way, can make women feel better.

In a study reported by Engeln and her colleagues in 2011, “The most common response to fat talk was denial that the friend was fat, most typically leading to a back-and-forth conversation where each of two healthy weight peers denies the other is fat while claiming to be fat themselves.”

In an interview, Engeln said the Ottawa study is consistent with what was known about the “objectification” of women, “which tells us the more we worry about how we look, the more we can have all sorts of negative outcomes.”

“Like it or not, we still live in a culture where women are taught that how they look matters more than anything else about them,” she said. “Which, in this culture, means being thin”

Talking about it with other people would normally be seen as a good coping strategy, she said. But fat talk is different.

“We have evidence fat talk makes it worse, not just for you but for people who hear you doing it. Because the more you hear it, the more you think about your body.”




Mar. 3, 2017 "Should obese teenagers get bariatric surgery?": Today I found this article by Gina Kolata in the Globe and Mail:



If all goes well, Aliayha Carrasco-Garcia will have an operation next month that will change her life. She will shed many of the 240 pounds that now burden her 5-foot-2 frame. Like many who have bariatric surgery, she has tried diets and exercise to no avail. Surgery is her last best hope.

But there is a difference between Aliayha and almost everyone else who has had this operation: She is only 15.

While the number of adolescents who are overweight or obese has leveled off in recent years, the number who are severely obese — heavy enough to qualify for bariatric surgery — has nearly doubled from 1999 to 2014, according to national data, going from 5.2 to 10.2 percent of all adolescents aged 12 to 19. 

As a result, more and more doctors and parents are facing a difficult question: 

Should very heavy teenagers have bariatric surgery, a radical operation that is the only treatment proved to produce lasting weight loss in severely obese people?

The very idea fills many parents and doctors with trepidation, and with good reason, said Aaron Kelly, a physiologist and specialist in pediatric obesity at the University of Minnesota.

“We’re at a point in this field where surgery is the only thing that works for these kids but we don’t know the long term outcomes.”

The best data are from two recently published small studies that so far have outcomes for just five years. Scientists say there’s an urgent need for more ambitious research.
The question for teens and their parents is: 

Which is worse — accepting uncertainty about the long term health risks from surgery or the likelihood of serious health risks from remaining obese?

An estimated three to four million adolescents are heavy enough to meet the criteria for bariatric surgery, Dr. Kelly said. But only about 1,000 teenagers a year have the operation.

 Many medical centers will not perform it on teenagers and many pediatricians never mention it to their heavy patients.

“It obviously is a controversial area,” said Dr. Marc P. Michalsky, the surgical director at the Center for Healthy Weight & Nutrition at Nationwide Children’s Hospital in Columbus, Ohio..

Yet insurers routinely turn down teenagers on the first request, doctors say, leaving surgeons to appeal, sometimes multiple times, before they can operate on an adolescent. Dr. Kirk W. Reichard, the clinical director of pediatric surgery at the Nemours Alfred I. duPont Hospital for Children where Aliayha is planning to undergo her operation, said Delaware’s Medicaid program had denied coverage for all patients under the age of 18 with one exception.
“We still struggle with acceptance in the adult population,” said Dr. John M. Morton, the chief of bariatric and minimally invasive surgery at Stanford. “Acceptance in the pediatric community is even worse.”

Some researchers worry that five years may not be long enough to understand the effect of the surgery on people who undergo it as an adolescent.
The operations alter brain signals that control weight and appetite and change hundreds of nerve and hormonal signals to the brain. What, researchers ask, are the consequences for still-developing brains and bones and bodies? Could low levels of vitamin D cause osteoporosis?

The procedure for teenagers is the same as for adults — either a sleeve gastrectomy, in which much of the stomach is cut away to form a small pouch, or a gastric bypass in which the stomach is made smaller and part of the small intestine is rerouted. 

The operations are just as safe in teenagers as in adults, surgeons say: Mortality rates are around 0.1 percent, which makes them safer than gallbladder surgery or joint replacement.

Both operations require patients to follow detailed medical instructions, including taking supplements for the rest of their lives after surgery. Adolescents, though, are not always the most compliant patients. 

Dr. Inge said that when he first started offering the surgery in 2004, several of his patients developed beriberi, a serious condition that can affect the heart and nervous system. It is caused by a lack of thiamine.

Of course the best option would be to prevent kids from becoming obese in the first place, but that is not so easy. There seems to be a strong genetic component that is not easily overridden. 

Most of the teenagers who have the surgery have a parent who also is extremely obese, said Margaret H. Zeller, a professor of pediatrics and psychologist at Cincinnati Children’s Hospital whose research focuses on adolescents with severe obesity. Dr. Morton has operated on patients from three generations in some families.
But despite their qualms about possible medical problems with bones or other body systems in the future, many researchers and surgeons say those concerns are dwarfed by the consequences of being an obese teenager.

“I am less concerned about osteoporosis than that their lives will be completely destroyed if they don’t get some serious weight off,” said Dr. Lee M. Kaplan, the director of the weight center at Massachusetts General Hospital. By completely destroyed, he adds, he means “medically, socially and economically.”
In almost every aspect, life for very obese teenagers is “significantly impaired,” Dr. Zeller said.

 These difficulties, Dr. Zeller noted, are piled onto the normal angst of adolescence.

“It’s not just that people make them feel uncomfortable,” she said. The physical effort of carrying the weight around can make simple tasks arduous, like walking from one area of a high school to another or sitting at desks too small for them. Many have sleep apnea, making it difficult to stay awake in class. And, she said, “inside, they are feeling ashamed.”

Although not every obese teenager feels isolated and friendless, many, including Aliayha, do. She asked to be home-schooled, but her mother, Cristina Carrasco, refused.

Aliayha was not alone in wanting to leave school. Overwhelmed by their struggles, as many as 10 percent of obese students in grades eight to 12 leave the classroom and are home-schooled or take online classes instead, Dr. Zeller and her colleagues have found. That is nearly three times the rate of home schooling in the general population in those grades, according to the Department of Education.

But some teenagers expect too much from the surgery. They are told they will lose a significant amount of weight, feel better and be healthier but that they are unlikely to reach a normal weight. They are told the surgery will not solve all their problems. Some, though, hold out unrealistic expectations.
“They see shows about bariatric surgery or YouTube. They have this idea about the before and afters,” Dr. Zeller said. But, she added, “the average person having bariatric surgery isn’t doing a YouTube video.”

Dr. Morton worries about what he calls social re-entry. “When they lose the weight, they are not always prepared,” he said.

Tiffany Hunter can attest to that. She had the surgery when she was 15 and weighed 350 pounds. Now, 27 and 5-foot-11, she weighs 190.

She added, “You think everyone will immediately like you because of how you look on the outside.”

Dr. Daniels went from being shocked to hear at a meeting in 2003 that doctors were considering bariatric surgery for adolescents to wondering if a bar of a B.M.I. of 40 or 50 is too high. 

There was no real science behind those guidelines, he noted. He also worries about children who get fatter and fatter throughout childhood, reaching a level of obesity by adolescence that, even with surgery, will still leave them obese as they head into adulthood.

“We can only expect so much out of these operations,” Dr. Michalsky said. The longer the teenagers wait for the surgery and the fatter they get, the less likely they are to reach a normal weight.

But how young is too young? Should it be done on children?

Dr. Morton said the only place he knows where surgeons have done bariatric surgery on children is Saudi Arabia. He and others think it is best to wait until puberty to avoid interfering with physical, mental and emotional development.

“We get asked very often what is the lower age limit, but we really don’t know,” Dr. Michalsky said.

https://www.nytimes.com/2017/02/24/health/obese-teenagers-bariatric-surgery.html?_r=0

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"Adults are losing interest in losing weight, researchers find"/ "Fat bias appears to start early in life"

Mar. 10, 2017 "Adults are losing interest in losing weight, researchers find": Today I found this article by Lisa Rapaport in the Globe and Mail:


 (Reuters Health) - A growing share of overweight and obese Americans are not trying to shed excess pounds, and researchers think it's at least in part because more people see being fat as socially acceptable, if not healthy.
Over roughly the past three decades, the proportion of adults who are overweight and obese has surged from 53 percent to 66 percent, researchers report in JAMA. 

Over that same period, the proportion of heavy adults trying to lose weight dropped from 56 percent to 49 percent.

Losing weight is hard, and keeping it off is even harder. This may explain at least some of the waning national interest in weight loss, said senior study author Dr. Jian Zhang, a public health researcher at Georgia Southern University in Statesboro.

"It's hard to drop pounds," Zhang said by email. "It's a life-long commitment and painful, and many of us have tried and failed, tried and failed, and finally failed to try anymore."

A lot of heavier adults are probably also seeing so many other overweight and obese people that they feel comfortable at their current size and don't feel social pressure to slim down.

"This might be explained, at least partially, by increasing evidence that adults who are overweight may live as long as and sometimes even longer than normal weight adults," Zhang said.

The decline in weight-loss efforts occurred mostly among adults who were overweight but not yet obese, Zhang added.

For the study, researchers analyzed data from a nationally representative health survey for three time periods: 1988 to 1994, 1999 to 2004 and 2009 to 2014.

Among other things, the survey asked overweight and obese adults if they had tried to lose weight during the past 12 months.

Black women experienced the steepest decline in weight loss efforts from the first study period to the last. In the late 1980s and early 90s, 66 percent of overweight and obese black women said they were trying to lose weight, but by the final study period this dropped to 55 percent.

At the same time, the proportion of obese and overweight black women surged much more than for white women, the study also found. By the end of the final study period, 79 percent of black women were overweight or obese, compared with 59 percent of white women.

Limitations of the study include its reliance on survey participants to accurately recall and report their weight and height to allow researchers to calculate whether they might be overweight or obese, the authors note.

It's also possible to see the results in a positive light, said Susan Roberts, a nutrition researcher at Tufts University in Boston who wasn't involved in the study. That's because despite the challenges, millions of Americans are still trying to lose weight.

"People haven't given up," Roberts said by email.


For more of them to succeed, however, we may need to rethink what weight management means, Roberts added.

Things doctors have recommended to overweight patients for years like logging food in a diary, using willpower to resist overeating and getting 10,000 steps a day haven't worked.

"It doesn't address the basic neurobiology of how our brains think about food," Roberts added.

 "We can't use willpower to think ourselves out of hunger because willpower doesn't reach the unconscious brain."

The bathroom scale, however, is a simple tool that can work - especially for people who are overweight but not yet obese.

"I think a really important strategy is catching it quick," Roberts said. 

"Buying a bathroom scale if you don’t have one and weighing yourself regularly is so important because it's not that hard to lose five pounds with almost any diet method, and if you have a line in the sand that if you go over it you eat carefully for a couple of weeks you can make a big difference."

 http://www.reuters.com/article/us-health-obesity-weightloss-idUSKBN16E2QR



Aug. 28, 2017 "Fat bias appears to start early in life": Today I found this article by Jane E. Brody in the Globe and Mail:
A Duke University study suggests implicit weight bias in children ages 9 to 11 is as common as implicit racial bias among adults.

A very slender friend recently admitted to me that she “can’t stand to be around fat people.” Her reaction is almost visceral and it prompts her to avoid social and professional contact with people who are seriously overweight. 

Although she can’t pinpoint the source of her feelings, she said they go back as far as she can remember.

And she is hardly alone. Decades ago, researchers found that weight-based bias, which is often accompanied by overt discrimination and bullying, can date back to childhood, sometimes as early as the age of 3.

The prejudiced feelings may not be apparent to those who hold them, yet they can strongly influence someone’s behaviour. A study by researchers at Duke University, for example, found that “implicit weight bias” in children ages 9-11 was as common as “implicit racial bias” is among adults.

The study’s lead author, Asheley Skinner, a public-health researcher, said prejudices that people are unaware of may predict their biased behaviours even better than explicit prejudice.

She traced the origins of weight bias in young children and adolescents to the families they grow up in as well as society at large, which continues to project cultural ideals of ultra slimness and blames people for being fat.

“It’s pretty common for parents to comment on their own weight issues and tell their children they shouldn’t be eating certain foods or remark about how much weight they’re gaining,” Skinner said.

Explicit weight bias is well documented, as are its damaging effects on people who struggle with their weight. 

Yet, implicit bias can also result in discrimination and socially undesirable behaviour that negatively affect people who are seriously overweight.

Weight bias is widespread in society, occurring in employment, education, the media, health care and even in relationships with family members, parents and teachers, according to Dr. Scott Kahan, director of the National Center for Weight and Wellness in Washington.

“Obesity has been called the last socially acceptable form of prejudice, and persons with obesity are considered acceptable targets of stigma,” Kahan wrote in a 2015 blog post. 

He said that weight bias “occurs even in people who are otherwise fair-minded and non-judgmental – even in obesity specialists,” who may not realize that it “predisposes to unhealthier behaviors and more weight gain.”

Whether explicit or implicit, weight-based bias can be counterproductive, impairing the ability of overweight people to lose weight and keep it off. Studies by Rebecca Puhl and colleagues at the University of Connecticut Rudd Center for Food Policy and Obesity, among others, have found that overweight and obese people who experience weight based bias and who manage to lose weight are less able to maintain their weight loss.

Stigmatization is associated with more frequent binge eating and other “maladaptive eating patterns,” Puhl reported in a comprehensive review of the subject in the American Journal of Public Health. 

“In a study of more than 2,400 overweight and obese women who belonged to a weight loss support organization,” she wrote, “79 per cent reported coping with weight stigma on multiple occasions by eating more food, and 75 per cent reported coping by refusing to diet.”

Furthermore, experiencing weight stigma can result in a poor self-image, depression and stress that, in turn, increases the risk of poor eating habits and difficulty losing weight and keeping it off. 

People can internalize weight stigma, blaming themselves for their excess weight and the social discrimination they experience.

Even people who simply think they’re overweight – regardless of what they weigh – may be “at increased risk for weight gain and eating more in response to social threats,” Puhl wrote. 

Three long term studies involving more than 14,000 adults in the United States and Britain showed that adults who thought of themselves as overweight were more likely to gain weight over time, regardless of what they originally weighed and whether their self-perception of being overweight was accurate.

When weight stigma is internalized, it significantly diminishes a person’s chances of maintaining weight loss over the long term, Puhl and colleagues confirmed in an online survey of 2,702 American adults.

A study by Robert Carels and colleagues at Bowling Green State University of 46 overweight and obese adults enrolled in a behavioural weight-loss program found that both explicit and implicit weight stigmatization was linked to greater caloric intake, less exercise and energy expenditure, less weight loss and a greater likelihood of dropping out of the program.

“There are very visible people in society making comments about people’s physical appearance in very inappropriate ways,” Puhl said in an interview. “Where are the voices saying that this is not acceptable? That silence communicates this is socially acceptable.”

Three states – New York, Maine and New Hampshire – have passed laws prohibiting discrimination against people based on their weight, Puhl said. And Congress has amended the Americans with Disabilities Act to protect those with “severe obesity” against discrimination in employment (although many people who are discriminated against because of their weight are not covered by this law).

There has also been a growing movement to improve affordable access to healthy foods in communities considered “food deserts” where obesity is often rampant.

Still, being overweight is one of the most, if not the most, common reason children are bullied, a problem sorely in need of intervention and prevention both in schools and organizations to head off self-image problems and eating disorders that result in lifelong weight struggles, Puhl said.

While the ideal solution to weight bias ultimately depends on education of both lay people and health professionals, people currently struggling with weight problems can’t wait for a society wide reformation that may help to absolve them of personal responsibility for their weight.

“With extreme thinness being so prevalent in the media,” Puhl said, “it’s hard to change societal attitudes.”

To compete with “all the well funded messages from the diet and fashion industries,” she recommends making a concerted effort at self-acceptance and engaging in “positive self-talk” that challenges stereotypes to help people with weight issues recognize that what really matters to self-worth is “character, intelligence, ambition, effort and contributions to society.”

“We all need to move away from the current appearance-focused culture and recognize that other things matter more than what a person looks like,” she said.


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