Category Archives: Bariatric surgery

EXTRA EDITION “BARIATRIC SURGERY REVISITED, A FURTHER IN DEPTH ANALYSIS”


A good friend and wise philosopher Walter E. Kurtz.
A good friend and wise philosopher Walter E. Kurtz.

Kurtz: [intercepted radio message] I watched a snail crawl along the edge of a straight razor. That’s my dream; that’s my nightmare. Crawling, slithering, along the edge of a straight razor… and surviving. (Apocalypse Now).

That is what obesity is like, “Crawling slithering along the edge of straight razor… and surviving.” The thinner we get the greater the likelihood of a longer survival. Obesity is in all its myriad forms an insidious disease not to be embraced, ignored, or accepted as the status quo!

According to an article published, in the pamphlet Bariatric and Metabolic Surgery, the “body works to defend it set point, dieting and exercising are rarely effective in helping people with obesity achieve and maintain a healthy weight long-term. When you go on a diet, your body thinks it’s being starved and its survival instincts kick in. As a result, your body stores energy rich body fat, and you can’t lose weight easily. A landmark Swedish study found that, on average, a 200-pound patient fighting obesity with diet and exercise alone would only be able to achieve a sustained weight loss of 4 pounds over 20 years.

7697a0b6872b4d965225c2de2d6e0919When weight is lost, lower body fat levels trigger hormones that encourage the body to get back to its previous weight set-point. The New England Journal of Medicine study showed that while dieters may initially lose weight, their bodies change levels of hormones that encourage weight gain in response to the weight-loss. These hormones increased appetite, decrease feelings of fullness, and slow down metabolism. This study also found that these hormones had not returned to create diet levels even 12 months after the initial weight loss, meaning their bodies were still encouraging  weight regain a year after they stopped dieting. This is a powerful defense mechanism and may explain why the majority of weight-loss attempts fail.

95% of obese people who lose weight with a rigorous weight loss program will regain the weight (or more) within 2 to 5 years. ” (1)

Therefore, all dear fellow travelers this leads us once again to revisit the option to have bariatric surgery. Most insurance and Medicare will cover approved mainstream surgeries if you have a BMI  ≥ to 35 with two comorbid factors e. g. elevated blood pressure, type 2 diabetes, high cholesterol etc. or a BMI  ≥  40 without comorbid factors.

Our Gazette namesake. He approves most heartily.
Our Gazette namesake. He approves most heartily.

As you already know, if you are an august reader of this splendid piece of yellow journalism, the Captain had a sleeve gastrectomy performed November 24, 2014. I am six months out and cannot recommend the surgery enough. Before surgery, I weighed 305 pounds at my heaviest. I lost 64 pounds before surgery but still decided to go ahead with it. Post-surgery I have lost another 52 pounds to date. I now weigh 189 pounds as of this writing and of course am still losing weight. Therefore, when you do the math weight-loss post-surgery in percentage is 17% and that is in just six months’ time! This surgery is most efficacious beating diet alone, diet pills, and all-sundry weight-loss programs.

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Endoscopic view of a sleeve gastrectomy in progress.

As the Captain has said so many times before, this surgery is painless. In the hands of a skilled U.S. or British surgeon with computer assist, you cannot miss. The surgery itself takes about 3 hours; recovery from anesthesia varies. With the gastric sleeve, you are up and walking the same day. I was roaming the halls of the hospital with absolutely no problem, no pain pills, and no pain. It is an overnight stay with this surgery.

I knew I needed a tool that would put the brakes on my bad behavior having lost the ability to binge and starve. That tool was a sleeve gastrectomy. My bad behavior started as a teenager but the weight only caught up with me when I hit my forties then the weight slowly crept up to 305 pounds at the age of 64. I have been on the thin side most of my life. It was quite a shock to see a fat, morbidly obese blob in the mirror.

Besides high cholesterol, high triglycerides, shortness of breath with exertion, and elevated blood pressure, I was an inveterate binge eater. Three weaknesses were sandwiches, pizza, and double portions for dinner. I could eat half-pound sandwiches or a large pizza without any problem, double portions I expected it. These problems do not magically disappear however, I still order pizza but can only consume two slices as to the sandwiches I have virtually given them up, they are too hard for me to consume and the double portions forget about it. Portion size is now totally controlled by the size of my sleeve. I can consume approximately 4 to 6 ounces of food at a sitting comfortably if I go over that I become terribly uncomfortable. Another problem I have is eating too fast and not allowing myself to feel full. This again is taken care by the sleeve size; it physically metes out the punishment for my indiscretion by making me feel full before I have even finished my 6 ounces of food. That said, my eating behaviors have dramatically improved and I am definitely on the road to recovery.

Again a good line bears repeating and repeating often, “95% of obese people who lose weight with a rigorous weight loss program will regain the weight (or more) within 2 to 5 years.” (1)

The Captain highly recommends the last section of this article on the misconceptions concerning gastric surgery. It will enlighten and disabuse any and all of the untruths that are bandied about by the unknowing to the unknowing.

We shall now move on to the three main types of bariatric surgery, taken from the American Society for Metabolic and Bariatric Surgery, ASMBS,  that are usually covered by Medical Insurance.

Gastric Bypass

The Roux-en-Y Gastric Bypass – often called gastric bypass – is considered the ‘gold standard’ of weight loss surgery and is the most commonly performed bariatric procedure worldwide.

The Procedure

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Roux-en-Y Gastric Bypass. Click to enlarge

There are two components to the procedure. First, a small stomach pouch, approximately one ounce or 30 milliliters in volume, is created by dividing the top of the stomach from the rest of the stomach. Next, the first portion of the small intestine is divided, and the bottom end of the divided small intestine is brought up and connected to the newly created small stomach pouch. The procedure is completed by connecting the top portion of the divided small intestine to the small intestine further down so that the stomach acids and digestive enzymes from the bypassed stomach and first portion of small intestine will eventually mix with the food.

The gastric bypass works by several mechanisms. First, similar to most bariatric procedures, the newly created stomach pouch is considerably smaller and facilitates significantly smaller meals, which translates into fewer calories consumed. Additionally, because there is less digestion of food by the smaller stomach pouch, and there is a segment of small intestine that would normally absorb calories as well as nutrients that no longer has food going through it, there is probably to some degree less absorption of calories and nutrients.

Most importantly, the rerouting of the food stream produces changes in gut hormones that promote satiety, suppress hunger, and reverse one of the primary mechanisms by which obesity induces type 2 diabetes.

Advantages

  1. Produces significant long-term weight loss (60 to 80 percent excess weight loss)
  2. Restricts the amount of food that can be consumed
  3. May lead to conditions that increase energy expenditure
  4. Produces favorable changes in gut hormones that reduce appetite and enhance satiety
  5. Typical maintenance of >50% excess weight loss

Disadvantages

  1. Is technically a more complex operation than the AGB or LSG and potentially could result in greater complication rates
  2. Can lead to long-term vitamin/mineral deficiencies particularly deficits in vitamin B12, iron, calcium, and folate
  3. Generally has a longer hospital stay than the AGB
  4. Requires adherence to dietary recommendations, life-long vitamin/mineral supplementation, and follow-up compliance

Sleeve Gastrectomy

The Laparoscopic Sleeve Gastrectomy – often called the sleeve – is performed by removing approximately 80 percent of the stomach. The remaining stomach is a tubular pouch that resembles a banana.

The Procedure

Laparoscopic Sleeve Gastrectomy. Click to enlarge
Laparoscopic Sleeve Gastrectomy. Click to enlarge

This procedure works by several mechanisms. First, the new stomach pouch holds a considerably smaller volume than the normal stomach and helps to reduce significantly the amount of food (and thus calories) that can be consumed. The greater impact, however, seems to be the effect the surgery has on gut hormones that impact a number of factors including hunger, satiety, and blood sugar control.

Short-term studies show that the sleeve is as effective as the roux-en-Y gastric bypass in terms of weight loss and improvement or remission of diabetes. There is also evidence that suggest the sleeve, similar to the gastric bypass, is effective in improving type 2 diabetes independent of the weight loss. The complication rates of the sleeve fall between those of the adjustable gastric band and the roux-en-y gastric bypass.

Advantages

  1. Restricts the amount of food the stomach can hold
  2. Induces rapid and significant weight loss that comparative studies find similar to that of the Roux-en-Y gastric bypass. Weight loss of >50% for 3-5+ year data, and weight loss comparable to that of the bypass with maintenance of >50%
  3. Requires no foreign objects (AGB), and no bypass or re-routing of the food stream (RYGB)
  4. Involves a relatively short hospital stay of approximately 2 days
  5. Causes favorable changes in gut hormones that suppress hunger, reduce appetite and improve satiety

Disadvantages

  1. Is a non-reversible procedure
  2. Has the potential for long-term vitamin deficiencies

Adjustable Gastric Band

The Adjustable Gastric Band – often called the band – involves an inflatable band that is placed around the upper portion of the stomach, creating a small stomach pouch above the band, and the rest of the stomach below the band.

The Procedure

 Adjustable Gastric Band. Click to enlarge
Adjustable Gastric Band.
Click to enlarge

The common explanation of how this device works is that with the smaller stomach pouch, eating just a small amount of food will satisfy hunger and promote the feeling of fullness. The feeling of fullness depends upon the size of the opening between the pouch and the remainder of the stomach created by the gastric band. The size of the stomach opening can be adjusted by filling the band with sterile saline, which is injected through a port placed under the skin.

Reducing the size of the opening is done gradually over time with repeated adjustments or “fills.” The notion that the band is a restrictive procedure (works by restricting how much food can be consumed per meal and by restricting the emptying of the food through the band) has been challenged. Studies show the food passes rather quickly through the band, and that absence of hunger or feeling of being satisfied was not related to food remaining in the pouch above the band. What is known is that there is no malabsorption; the food is digested and absorbed, as it would be normally.

The clinical impact of the band seems to be that it reduces hunger, which helps the patients to decrease the amount of calories that are consumed.

Advantages

  1. Reduces the amount of food the stomach can hold
  2. Induces excess weight loss of approximately 40 – 50 percent
  3. Involves no cutting of the stomach or rerouting of the intestines
  4. Requires a shorter hospital stay, usually less than 24 hours, with some centers discharging the patient the same day as surgery
  5. Is reversible and adjustable
  6. Has the lowest rate of early postoperative complications and mortality among the approved bariatric procedures
  7. Has the lowest risk for vitamin/mineral deficiencies

Disadvantages

  1. Slower and less early weight loss than other surgical procedures
  2. Greater percentage of patients failing to lose at least 50 percent of excess body weight compared to the other surgeries commonly performed
  3. Requires a foreign device to remain in the body
  4. Can result in possible band slippage or band erosion into the stomach in a small percentage of patients
  5. Can have mechanical problems with the band, tube or port in a small percentage of patients
  6. Can result in dilation of the esophagus if the patient overeats
  7. Requires strict adherence to the postoperative diet and to postoperative follow-up visits
  8. Highest rate of re-operation (2)

Bariatric Surgery Misconceptions

Misconception: Most people who have metabolic and bariatric surgery regain their weight.

Truth:

As many as 50 percent of patients may regain a small amount of weight (approximately 5 percent) two years or more following their surgery. However, longitudinal studies find that most bariatric surgery patients maintain successful weight-loss long-term. ‘Successful’ weight-loss is arbitrarily defined as weight-loss equal to or greater than 50 percent of excess body weight. Often, successful results are determined by the patient, by their perceived improvement in quality of life. In such cases, the total retained weight-loss may be more, or less, than this arbitrary definition. Such massive and sustained weight reduction with surgery is in sharp contrast to the experience most patients have previously had with non-surgical therapies.

Misconception: The chance of dying from metabolic and bariatric surgery is more than the chance of dying from obesity.

Truth:

As your body size increases, longevity decreases. Individuals with severe obesity have a number of life-threatening conditions that greatly increase their risk of dying, such as type 2 diabetes, hypertension and more. Data involving nearly 60,000 bariatric patients from ASMBS Bariatric Centers of Excellence database show that the risk of death within the 30 days following bariatric surgery averages 0.13 percent, or approximately one out of 1,000 patients. This rate is considerably less than most other operations, including gallbladder and hip replacement surgery. Therefore, in spite of the poor health status of bariatric patients prior to surgery, the chance of dying from the operation is exceptionally low. Large studies find that the risk of death from any cause is considerably less for bariatric patients throughout time than for individuals affected by severe obesity who have never had the surgery. In fact, the data show up to an 89 percent reduction in mortality, as well as highly significant decreases in mortality rates due to specific diseases. Cancer mortality, for instance, is reduced by 60 percent for bariatric patients. Death in association with diabetes is reduced by more than 90 percent and that from heart disease by more than 50 percent. Also, there are numerous studies that have found improvement or resolution of life-threatening obesity-related diseases following bariatric surgery. The benefits of bariatric surgery, with regard to mortality, far outweigh the risks. It is important to note that as with any serious surgical operation, the decision to have bariatric surgery should be discussed with your surgeon, family members and loved ones.

Misconception: Surgery is a ‘cop-out’. To lose and maintain weight, individuals affected by severe obesity just need to go on a diet and exercise program.

Truth:

Individuals affected by severe obesity are resistant to long-term weight-loss by diet and exercise. The National Institutes of Health Experts Panel recognize that ‘long-term’ weight-loss, or in other words, the ability to ‘maintain’ weight-loss, is nearly impossible for those affected by severe obesity by any means other than metabolic and bariatric surgery. Bariatric surgeries are effective in maintaining long-term weight-loss, in part, because these procedures offset certain conditions caused by dieting that are responsible for rapid and efficient weight regain following dieting. When a person loses weight, energy expenditure (the amount of calories the body burns) is reduced. With diet, energy expenditure at rest and with activity is reduced to a greater extent than can be explained by changes in body size or composition (amount of lean and fat tissue). At the same time, appetite regulation is altered following a diet increasing hunger and the desire to eat. Therefore, there are significant biological differences between someone who has lost weight by diet and someone of the same size and body composition to that of an individual who has never lost weight. For example, the body of the individual who reduces their weight from 200 to 170 pounds burns fewer calories than the body of someone weighing 170 pounds and has never been on a diet. This means that, in order to maintain weight-loss, the person who has been on a diet will have to eat fewer calories than someone who naturally weighs the same. In contrast to diet, weight-loss following bariatric surgery does not reduce energy expenditure or the amount of calories the body burns to levels greater than predicted by changes in body weight and composition. In fact, some studies even find that certain operations even may increase energy expenditure. In addition, some bariatric procedures, unlike diet, also causes biological changes that help reduce energy intake (food, beverage). A decrease in energy intake with surgery results, in part, from anatomical changes to the stomach or gut that restrict food intake or cause malabsorption of nutrients. In addition, bariatric surgery increases the production of certain gut hormones that interact with the brain to reduce hunger, decrease appetite, and enhance satiety (feelings of fullness). In these ways, bariatric and metabolic surgery, unlike dieting, produces long-term weight-loss.

Misconception: Many bariatric patients become alcoholics after their surgery.

Truth:

Actually, only a small percentage of bariatric patients claim to have problems with alcohol after surgery. Most (but not all) who abuse alcohol after surgery had problems with alcohol abuse at some period of time prior to surgery. Alcohol sensitivity, (particularly if alcohol is consumed during the rapid weight-loss period), is increased after bariatric surgery so that the effects of alcohol are felt with fewer drinks than before surgery. Studies also find with certain bariatric procedures (such as the gastric bypass or sleeve gastrectomy) that drinking an alcoholic beverage increases blood alcohol to levels that are considerably higher than before surgery or in comparison to the alcohol levels of individuals who have not had a bariatric procedure. For all of these reasons, bariatric patients are advised to take certain precautions regarding alcohol:

  • Avoid alcoholic beverages during the rapid weight-loss period
  • Be aware that even small amounts of alcohol can cause intoxication
  • Avoid driving or operating heavy equipment after drinking any alcohol
  • Seek help if drinking becomes a problem

If you feel the consumption of alcohol may be an issue for you after surgery, please contact your primary care physician or bariatric surgeon and discuss this further. They will be able to help you identify resources available to address any alcohol-related issues.

Misconception: Surgery increases the risk for suicide.

Truth:

Individuals affected by severe obesity who are seeking bariatric and metabolic surgery are more likely to suffer from depression or anxiety and to have lower self-esteem and overall quality of life than someone who is normal weight. Bariatric surgery results in highly significant improvement in psychosocial well-being for the majority of patients. However, there remain a few patients with undiagnosed preexisting psychological disorders and still others with overwhelming life stressors who commit suicide after bariatric surgery. Two large studies have found a small but significant increase in suicide occurrence following bariatric surgery. For this reason, comprehensive bariatric programs require psychological evaluations prior to surgery and many have behavioral therapists available for patient consultations after surgery.

Misconception: Bariatric patients have serious health problems caused by vitamin and mineral deficiencies.

Truth:

Bariatric operations can lead to deficiencies in vitamins and minerals by reducing nutrient intake or by causing reduced absorption from the intestine. Bariatric operations vary in the extent of malabsorption they may cause, and vary in which nutrients may be affected. The more malabsorptive bariatric procedures also increase the risk for protein deficiency. Deficiencies in micronutrients (vitamin and minerals) and protein can adversely affect health, causing fatigue, anemia, bone and muscle loss, impaired night vision, low immunity, loss of appropriate nerve function and even cognitive defects. Fortunately, nutrient deficiencies following surgery can be avoided with appropriate diet and the use of dietary supplements, i.e. vitamins, minerals, and, in some cases, protein supplements. Nutrient guidelines for different types of bariatric surgery procedures have been established by the ASMBS Nutritional Experts Committee and published in the journal, Surgery for Obesity and Other Related Disorders. Before and after surgery, patients are advised of their dietary and supplement needs and followed by a nutritionist with bariatric expertise. Most bariatric programs also require patients to have their vitamins and minerals checked on a regular basis following surgery. Nutrient deficiencies and any associated health issues are preventable with patient monitoring and patient compliance in following dietary and supplement (vitamin and mineral) recommendations. Health problems due to deficiencies usually occur in patients who do not regularly follow-up with their surgeon to establish healthy nutrient levels.

Misconception: Obesity is only an addiction, similar to alcoholism or drug dependency.

Truth:

Although there is a very small percentage of individuals affected by obesity who have eating disorders, such as binge eating disorder syndrome, that may result in the intake of excess food (calories), for the vast majority of individuals affected by obesity, obesity is a complex disease caused by many factors. When treating addiction, such as alcohol and drugs, one of the first steps is abstaining from the drugs or alcohol. This approach does not work with obesity as we need to eat to live. Additionally, there may be other issues affecting an individual’s weight, such as psychological issues. Weight gain generally occurs when there is an energy imbalance or, in other words, the amount of food (energy) consumed is greater than the number of calories burned (energy expended) by the body in the performance of biological functions, daily activities and exercise. Energy imbalance may be caused by overeating or by not getting enough physical activity and exercise. There are other conditions, however, that affect energy balance and/or fat metabolism that do not involve excessive eating or sedentary behavior including:

  • Chronic sleep loss
  • Consumption of foods that, independent of caloric content, cause metabolic/hormonal changes that may increase body fat (sugar, high fructose corn syrup, trans fat, processed meats and processed grains)
  • Low intake of fat-fighting foods (fruits, vegetables, legumes, nuts, seeds, quality protein)
  • Stress and psychological distress
  • Many types of medications
  • Pollutants

Obesity also ‘begets’ obesity, which is one of the reasons why the disease is considered ”progressive.” Weight gain causes a number of hormonal, metabolic and molecular changes in the body that increase the risk for even greater fat accumulation and obesity. Such obesity-associated changes reduce fat utilization, increase the conversion of sugar to fat, and enhance the body’s capacity to store fat by increasing fat cells size and numbers and by reducing fat breakdown. Such defects in fat metabolism mean that more of the calories consumed are stored as fat. To make matters worse, obesity affects certain regulators of appetite and hunger in a manner that can cause an increase in the amount of food eaten at any given meal and the desire to eat more often. There are many causes for obesity and that the disease of obesity is far more than just an ‘addiction’ toward food. The treatment of obesity solely as an addiction may be beneficial for a very small percentage of individuals whose only underlying cause for obesity is excessive and addictive eating, but would be unlikely to benefit the multitudes, particularly those individuals affected by severe obesity. (3)

Dear readers, if you have read this far, the Captain would be most heartened if you would rate this and future articles and/or leave a comment at the top of the blog posts whether positive or negative. In this way, “The Fat Bastard Gazette” may better serve you and our entire readership.


  1.  (Bariatric and Metabolic Surgery, 2012)
  2.  (ASMBS, 2015)
  3.  (ASMBS, 2015)

ASMBS. (2015). Bariatric Surgery Misconceptions. Retrieved May 29, 2015, from ASMBS American Society for Metabolic and Bariatric Surgery: http://asmbs.org/patients/bariatric-surgery-misconceptions

ASMBS. (2015). Bariatric Surgery Procedures. Retrieved May 29, 2015, from ASMBS American Society for Metabolic and Bariatric Surgery: http://asmbs.org/patients/bariatric-surgery-procedures

Bariatric and Metabolic Surgery. (2012). Bariatric and Metabolic Surgery. Ethicon.

 

Captain Hank Quinlan, Owner and Publisher, Chief Curmudgeon
Captain Hank Quinlan, Owner and Publisher, Chief Curmudgeon with Sam Borsalino, Assistant Publisher

Dear Hail-Fellows well met, “The Fat Bastard Gazette” is written and edited by your favorite curmudgeons Captain Hank Quinlan and

Flatfoot  Willie, Corespondent at Large with fellow Staff Writers
Flatfoot Willie, Correspondent at Large with fellow Staff Writers

Staff (monkeys in the back room). We offer an ongoing tirade to support or offend anyone of any large dimension, cultural background, religious affiliation, or color of skin. This gazette rails against an eclectic mix of circus ring ne’er do wells, big ring fatty and fatso whiners, congenital idiots, the usual motley assortment of the profoundly dumbfounded, and a favorite of intelligent men everywhere, the

May the Most Venerable H. L. Mencken bless our unworthy but earnest attempts at tongue in cheek jocularity .
May the Most Venerable H. L. Mencken bless our unworthy but earnest attempts at tongue in cheek jocularity .

“Great Booboisie.” Nor shall we ignore the wide assortment of shirkers, layabouts, and slugabeds.

Latest office staff confab at Fat Bastard HQ.
Latest office staff confab at Fat Bastard HQ.

All this and more always keeping our major focus on “Why so fat?”  Enough said? We at “The Fat Bastard Gazette” think so. If you like what you read, and you know whom you are, in this yellow blog, tell your friends. We would be elated with an ever-wider readership. We remain cordially yours, Captain Hank Quinlan and the Monkeys in the back room

“The Fat Bastard Gazette” does not purport to offer any definitive medical or pharmaceutical advice whatsoever in any explicit or implied manner. Always consult a qualified physician in all medical or pharmaceutical matters. “The Fat Bastard Gazette” is only the opinion of informed nonprofessionals for the general edification and entertainment of the greater public. 

No similarities to any existing names or characters are expressed or implied. We reserve the right to offend or support anybody, anything, or any sacred totem across the globe.

BARIATRIC SURGERY EDITION PART 3 “THE FAT BASTARD GAZETTE” VOL. 1 NO. 10


fat-man-with-hamburger-and-chips-on-dark-background-79384522Captain can only eat so much food at one time, having become a bariatric mutant. Q. needs all the protein he can get within reason. Rules of the road, after bariatric surgeries eat protein first, vegetables second, and lastly the starch; protein is needed to speed the healing process, “words of wisdom, Lloyd, words of wisdom” (The Shining). Q. has a nice long cut internally where his stomach used to be. Out of surgery only one month, Q. can only eat 4 ounces or less of solid food at a sitting; if he eats more than this, he gets a very bad sleeve ache with gastric reflux, this he experienced with one attempted lunch, very unpleasant indeed, the cost of doing business. Hence, the low-calorie counts. Q. is learning very quickly about the wages of sin in eating too many ounces, it really hurts, plenty of negative feedback in all this, which is actually a good thing. Nobody said this is going to be easy, but Q. is up for the challenge. Sit ludos incipe praemii aut poenae (So let the games of reward and punishment begin). A language so parochial is it not!

Edgar Small, Our Editor-in-Chief

Below is an informative and interesting article related to detoxing the liver while promoting weight loss. However, Q. and Staff are hard pressed to stop drinking coffee, soda (now flat soda after his surgery), and using Truvia™. Everybody needs a few vices to make the day more bearable.

Why are these soon to be hospitalized gigantesses smiling

How to Lose Belly Fat with Home Remedies

Last Updated: Aug 16, 2013 | By Linda Tarr Kent

There are many home remedies you can use to boost fat burn on your belly. Many of them will already be in your cupboard or refrigerator. The right foods can detox your liver and rev your metabolism, helping you to target belly fat. Belly fat is more than a cosmetic concern. It ups risk for a host of health conditions, including diabetes and heart disease. Consuming fat-burning foods and spices will put you well on your way to trading in that rubber tire in the middle for a sleek torso.

Step 1

Remove the things in your diet that stress your liver and lower your metabolism, and reduce your calorie intake. A stressed liver cannot properly metabolize fat, says nutritionist Ann Louise Gittleman, Ph.D., author of “The Fat Flush Plan.” Liver stressors include processed foods, too many carbohydrates in general, all forms of sugar, artificial sweeteners, caffeine, trans fats and soda. Cut 500 to 1,000 calories from your daily diet to lose 1 to 2 lbs. weekly, the safest and longest-lasting weight loss rate, according to the Mayo Clinic.

Step 2

Drink 100 percent cranberry juice or cran-water. Cranberries are high in organic acids that act as digestive enzymes. The enzymes work to gobble up little fatty deposits that get stuck in the lymphatics, Gittleman says. Mix a day’s supply of cran-water with 8 oz. unsweetened cranberry juice and 56 oz. of water.

Step 3

Consume your omega-3 fatty acids. These target tummy fat, Gittleman says. Fish oil is one great source. Take 6g, which is an overflowing tablespoon, or eat salmon or mackerel twice a week. Also chomp on chia. This ancient super seed is high in protein, is a good source of B vitamins, has calcium and is a high source of antioxidants.

Step 4

Get gamma linolenic acid (GLA) and conjugated linoleic acid (CLA) into your diet. GLA activates brown fat, often found in overweight people. Many people’s bodies don’t make GLA from its precursors-vegetable oils like safflower oil-so try a supplement. CLA aids the body in accessing and utilizing stored fat, particularly. This omega-6 fatty acid found in organic beef or can be taken as a supplement.

Step 5

Make monounsaturated fats another priority. MUFAs are omega-9 fatty acids that became important components of diet plans like the Flat Belly Diet following studies that show MUFAs rev body fat burn in the belly. MUFAs also are favored by the American Heart Association. The association recommends people replace trans and saturated fats with MUFAs. Cook with olive oil or try sunflower or safflower oil. Eat macadamia nuts, filberts, avocados and olives.

Step 6

Sip lemon or lime juice in hot water daily. These both invigorate the liver and help to liquefy fat, which aids in flushing it from your system more quickly. Getting enough water in general is important. Mild dehydration can cause your kidneys to call on your liver for help, reducing the liver’s ability to burn fat. This can lead to fat deposits, often in the belly.

Step 7

Detox gently by drinking dandelion tea. Add 200mg each of milk thistle and the Oregon grape root to further detox. These supplements are gentle enough to use every day, Gittleman says.

Step 8

Eat thermogenic spices to rev metabolism including cayenne and ginger. Consume cinnamon as well as cloves and cardamom to stabilize blood sugar.

LIVESTRONG.COM

If our Staff thinks this plan would be easy to follow so can you.

Cordially Yours,

Captain Quinlan and staff

Captain Hank Quinlan, Owner and Publisher, Chief Curmudgeon
Captain Hank Quinlan, Owner and Publisher, Chief Curmudgeon with Sam Borsalino, Assistant Publisher

Dear Hail-Fellows well met, “The Fat Bastard Gazette” is written and edited by your favorite curmudgeons Captain Hank Quinlan and

Flatfoot  Willie, Corespondent at Large with fellow Staff Writers
Flatfoot Willie, Correspondent at Large with fellow Staff Writers

Staff (monkeys in the back room). We offer an ongoing tirade to support or offend anyone of any large dimension, cultural background, religious affiliation, or color of skin. This gazette rails against an eclectic mix of circus ring ne’er do wells, big ring fatty and fatso whiners, congenital idiots, the usual motley assortment of the profoundly dumbfounded, and a favorite of intelligent men everywhere, the

May the Most Venerable H. L. Mencken bless our unworthy but earnest attempts at tongue in cheek jocularity .
May the Most Venerable H. L. Mencken bless our unworthy but earnest attempts at tongue in cheek jocularity .

“Great Booboisie.” Nor shall we ignore the wide assortment of shirkers, layabouts, and slugabeds.

Latest office staff confab at Fat Bastard HQ.
Latest office staff confab at Fat Bastard HQ.

All this and more always keeping our major focus on “Why so fat?”  Enough said? We at “The Fat Bastard Gazette” think so. If you like what you read, and you know whom you are, in this yellow blog, tell your friends. We would be elated with an ever-wider readership. We remain cordially yours, Captain Hank Quinlan and the Monkeys in the back room

“The Fat Bastard Gazette” does not purport to offer any definitive medical or pharmaceutical advice whatsoever in any explicit or implied manner. Always consult a qualified physician in all medical or pharmaceutical matters. “The Fat Bastard Gazette” is only the opinion of informed nonprofessionals for the general edification and entertainment of the greater public. 

 No similarities to any existing names or characters are expressed or implied. We reserve the right to offend or support anybody, anything, or any sacred totem across the globe.

BARIATRIC EDITION PART 2 “THE FAT BASTARD GAZETTE” VOL.1 NO. 9


rows of fruitcakesPoor benighted Tijuana fruitcakes, cheap surgeries, mediocre doctors and the Captain is being generous here, outré nurses, and who knows what filth and rodeo clowns were around the corner. All this to save a few dollars while taking an unacceptable chance with one’s life, lending credence to the old adage these Tijuana fruitcakes  must believe, ‘life is cheap’. Who are these people really, the Captain would like to know as well as his fellow travelers and have they ever heard of spell check and grammar check!

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“In the United States the lowest quote I got was $24,000.00 for the surgery and in Mexico,” [she] said. “I was getting quotes of $12,000.00 to $14,000.00 and I ended up paying $12,500.00.”

“But it was no bargain–since the April surgery she’s been to the emergency room three times. Larissa said she’s been told she needs surgery or she’ll slowly die.”

“I don’t have any more money, I don’t have insurance and [surgeons here] don’t want to take on somebody else’s mistakes.

The lesson that I want people to take away is this – you have to have money set aside for possible complications as well as the initial surgery. And if you have enough money for that – than why not get a competent US doctor (with US protections) in the first place? I feel like a complete fool. I gambled, and lost.”

She  cavalierly gambled with her life and is losing, doesn’t she know the house always wins. So now, the taxpayer has to pick up the tab for some Mexican butcher wielding a knife and fork at any gringo with no brains, a big belly,  and many American pesos.

The Captain shudders to think of all the flies in the operating room buzzing around her open wound in lovely Tijuana.

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“The morning at the airport meeting the driver was a clusterf*#k…. They allowed us to talk to Dr. Almanza about the surgery and we asked questions and he asked us if we had any prior abdominal surgeries. He used an interpreter but his English wasn’t bad…. All I remember about the surgery was seeing the anesthesiologist’s face and having my arms strapped down. I do not remember seeing Dr. Almanza after surgery either…. The room they tried to put me in had 4-5 beds all occupied from surgeries either the day before or whatever. There were also plastic surgery patients. They even had a bunk bed and I pity whoever tried to haul their butt up there after having surgery. There was a car alarm going off all day long and loud dogs barking. Rest was impossible. I will say that the staff was very friendly but not being able to have rest caused me to leave. I ended up staying at the Hotel Ticuan that night but please book a room in advance if you think you are going to stay there. It was almost completely booked solid! Although they say a reservation is not necessary, I think it certainly is if you don’t want to be left in the dark…. A couple of us who had surgery the same day left early. We got our drain tubes removed and left…. Some people it will be good for and some it will not. It is an individual choice…. The surgery itself seems positive though so keep your eyes wide open and wish you the best of luck!”

This from the Dr.’s web site:

About Dr. Mario Almanza

Dr. Almanza is the leading gastric sleeve surgeon in the world, and has performed more gastric sleeve procedures than any other surgeon in the world. Trust experience and get your weight loss surgery performed by Dr. Mario Almanza. Fill in the form on this page, and you will receive all the information to get started and book your surgery date with Dr. Almanza.

Well this duplicitous, south of the border chop shop chef certainly has a high opinion of himself.   According to the above clip all you have to do is fill in the forum,  put your money down and the renown back yard chef will go to work.  His dogs need to be feed too.

fruitcakeIs the above Tijuana fruitcake of a patient so oblivious to what he has written that he is so lucky to be alive and we presume well.  Where do these rock brained cretins crawl out from!

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“Almost echoes my experience to the tee from Dec 2010. You pay for what you get and this is certainly a cut rate surgery. My experience was just the same – tolerable but not the best.
Because of the armed robbery at the recovery house and some issues at the hospital from other patients I can no longer endorse this Dr or the “hospital”. There are alternatives that treat you better, however I have no direct experience with other sites to offer.”

The light bulb is on but only dimly lit.    Too late to be forewarned and  short a brick for a full load.

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“I think a lot of us have had different experiences with our surgeries in Mexico than what we would have had in the US. I went to Mexico for the usual reason, my insurance would not cover my surgery. I put my call light on a total of once while I was a patient after my surgery. I was having quite a bit of pain, and wanted to know if I could get some pain medication. The nurse came in, grabbed the call light out of my hand and yelled “WHAT?” at me! I am a nurse and know, absolutely beyond the shadow of a doubt, if I treated a patient like that, I might as well pack up my stuff and head for the front door. Hospitals in the United States do NOT tolerate attitude like that. But then I remember what I get paid working here in the states, and what nursing staff in Mexico get paid, and there is a SIGNIFICANT difference. The old saying “you get what you pay for” is true. My surgery was successful, but I paid a cut rate to have it done in Mexico, and I got cut rate service. I am happy, thrilled, and excited beyond words with the results I obtained from my VGS, but I know that the “niceties” that you receive here in the United States are not usually part of the hospital experience in Mexico….

If the facility where you are going to have your procedure done is JCAHO Internationally Certified, you can be assured that you are at least getting the minimum in safety standards.”

This Tijuana fruitcake RN is a disgrace to the profession. The Captain RN wouldn’t allow this cretin anywhere near his person.  Of all our contestants she wins the booby prize. Read between the lines dear fellow travelers and you discover this poor retch is clueless as to the life threatening imbecilic chances she took going south of the border!  Read what our fruitcake of the day has to say about her experience. She focuses on all the immediate incidentals highlighted above.  We would like to know if she has any thought as to her extended care now that she is alive

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_____**It has come to my attention that there is a man in Tijuana, Mexico that is posing as a physician, not a surgeon and no – he is not doing surgery he merely owns the clinic. This man is posing as a physician and he is not a physician. He has never been to medical school, he has no formal medical education. ANYONE that claims to be a physician or surgeon you should verify this through the Mexican Government. You need to obtain the license number of the physician and enter it to the following website. The true owner of the license will show up. There is absolutely no reason any licensed physician would deny you their license number, none!***

At least the lights are on and someone is home in this house, but sadly still bent on cut rate backyard surgery. The dogs must be fed!!

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Below  is a quick comparison between the cut rate, Third World Bariatric One Stop Chop Shop back yard care and safe, first rate, Tier 1 legitimate   Bariatric care .

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Below is a vetted WebMD article with legitimate sources! This is a must read: it is why  legitimate bariatric procedures cost so much more! 

Weight loss surgery is expensive. Typical costs can run from $20,000 to $25,000, according to the National Institute of Diabetes and Digestive and Kidney Diseases.

The price of your weight loss surgery will depend on several factors:

  • The type of surgery you’re having. Types of weight loss surgery include gastric bypass, adjustable gastric banding, vertical gastric banding (also called stomach stapling), sleeve gastrectomy, and biliopancreatic diversion. Each has a different fee.
  • Your surgeon’s fee. This will vary based on where you live, your surgeon’s expertise, and the procedure’s complexity.
  • The hospital you choose. Costs will vary and may include the operating and hospital rooms, among other fees.

Additional costs may include:

  • Anesthesiologist’s fee
  • Surgical assistant’s fee
  • Device fees
  • Consultant fees (if necessary)
  • Follow-up procedures (for the gastric band)

Will Health Insurance Pay?

If you have health insurance, read your policy carefully, and work closely with your insurer and your doctor to see what’s covered.

Most insurance companies recognize that people who are overweight and obese are more likely to get serious health conditions such as type 2 diabetes, high blood pressure, heart disease, high cholesterol, and sleep apnea. In fact, there’s plenty of evidence that bariatric surgery can improve or resolve up to 30 obesity-related conditions, according to the American Society for Metabolic and Bariatric Surgery.

If you don’t have health insurance, you’ll likely have to pay the entire bill yourself. Some weight loss surgery centers can help you get a loan that you can repay over a number of years.

Getting Your Insurance to Pay for Weight Loss Surgery

Most major insurance companies will require:

  • Proof that surgery is medically necessary. Your surgeon can help provide your medical history and documentation of your weight-related health problems.
  • Participation in a physician-supervised diet program. You may be required to successfully complete a 6-month weight-loss program before approval is granted. Medicare does not require this 6-month program, but you may be encouraged to participate anyway. This type of diet program involves monthly visits to your bariatric surgeon’s office for 6 months. The insurance companies aren’t trying to find out if you can lose weight through dieting. In fact, most insurance companies require that the patient’s weight be stable during this time — with no up-and-down fluctuations — or you may be denied coverage. They want you to demonstrate over the 6 months prior to surgery that you can commit to lifestyle changes you’ll need to make forever after your weight loss surgery.
  • A psychological evaluation. This is to make sure that you understand weight loss surgery and the impact it will have on your lifestyle. The psychological evaluation also checks for untreated binge eating or any other psychological issues.
  • A nutritional evaluation. You will work one-on-one with a nutritionist to outline specific dietary changes and habits that need to be changed.

What Happens Next?

When you have completed these steps, the surgeon will send a pre authorization letter to your insurance company. The letter will outline your medical history and health problems related to your weight, and provide documentation that you have completed all requirements for approval.

The insurance company will then review your case. If you have symptoms of weight-related conditions, the company may request specific diagnostic tests, such as cardiac, pulmonary, or sleep apnea evaluations.

During this period, keep accurate notes of all communications between the insurance company and your surgeon. Keep copies of completed insurance forms, letters sent, and letters received.

What if Your Insurance Company Declines Coverage?

If your request is turned down, or if the insurance company agrees to pay only a small percentage of the cost, the door is not closed.

What if Your Insurance Company Declines Coverage? continued…

You can write a letter of appeal to the insurance company representative (such as a claims supervisor) who signed the denial. Before you appeal, make sure you understand your policy completely, and that it does not specifically exclude the weight loss surgery you want.

Also, make sure restrictions were not in place when you first began your contract with the health plan.

Your appeal letter should include:

  • An explanation why you feel the procedure should be covered
  • A request for a full explanation of why coverage is being denied (or paid at a reduced level)
  • A request for a copy of the specific statement — taken from the policy or benefits booklet — that explains why your coverage is limited or denied
  • A copy of the denial notification
  • A copy of your doctor’s pre authorization letter

You may find it helpful to send a copy of your appeal letter to your state’s insurance commissioner or the department of corporations if you are covered by an HMO plan. You can explain that you’re having trouble, and ask for assistance. Your bariatric surgeon can help you with your appeal.

Other Ways to Pay for Weight Loss Surgery

If you do not have health insurance, or if your insurer will not cover weight loss surgery, talk to your doctor and your surgeon about financing plans. Check on the interest rate, and make sure you are OK with all of the terms.

SOURCES:

Anita Courcoulas, MD, MPH, chief of minimally invasive bariatric and general surgery, University of Pittsburgh School of Medicine.

American Society of Plastic Surgeons: “Insurance Coverage: A Patient’s Guide.”

American Society for Metabolic and Bariatric Surgery: “Metabolic & Bariatric Surgery.”

WebMD Medical Reference: “Preparing for Weight Loss Surgery,” “Your Options in Weight Loss Surgery: Making the Choice.”

Reviewed by Kimball Johnson, MD on August 13, 2012

© 2014 WebMD, LLC. All rights reserved.

Cordially Yours,

Captain Quinlan and staff

Captain Hank Quinlan, Owner and Publisher, Chief Curmudgeon
Captain Hank Quinlan, Owner and Publisher, Chief Curmudgeon with Sam Borsalino, Assistant Publisher

Dear Hail-Fellows well met, “The Fat Bastard Gazette” is written and edited by your favorite curmudgeons Captain Hank Quinlan and

Flatfoot  Willie, Corespondent at Large with fellow Staff Writers
Flatfoot Willie, Correspondent at Large with fellow Staff Writers

Staff (monkeys in the back room). We offer an ongoing tirade to support or offend anyone of any large dimension, cultural background, religious affiliation, or color of skin. This gazette rails against an eclectic mix of circus ring ne’er do wells, big ring fatty and fatso whiners, congenital idiots, the usual motley assortment of the profoundly dumbfounded, and a favorite of intelligent men everywhere, the

May the Most Venerable H. L. Mencken bless our unworthy but earnest attempts at tongue in cheek jocularity .
May the Most Venerable H. L. Mencken bless our unworthy but earnest attempts at tongue in cheek jocularity .

“Great Booboisie.” Nor shall we ignore the wide assortment of shirkers, layabouts, and slugabeds.

Latest office staff confab at Fat Bastard HQ.
Latest office staff confab at Fat Bastard HQ.

All this and more always keeping our major focus on “Why so fat?”  Enough said? We at “The Fat Bastard Gazette” think so. If you like what you read, and you know whom you are, in this yellow blog, tell your friends. We would be elated with an ever-wider readership. We remain cordially yours, Captain Hank Quinlan and the Monkeys in the back room

“The Fat Bastard Gazette” does not purport to offer any definitive medical or pharmaceutical advice whatsoever in any explicit or implied manner. Always consult a qualified physician in all medical or pharmaceutical matters. “The Fat Bastard Gazette” is only the opinion of informed nonprofessionals for the general edification and entertainment of the greater public. 

 No similarities to any existing names or characters are expressed or implied. We reserve the right to offend or support anybody, anything, or any sacred totem across the globe.

BARIATRIC EDITION PART 1 “THE FAT BASTARD” VOL. 1 NO. 8


And so it goes fellow Fat Bastards, mirabile dictu, Captain Q. had a vertical sleeve gastrectomy on the fateful day of November 25 of 2014. The gastrectomy was the culmination of approximately nine months of seeing registered dietitians, a psychologist, specialists in pulmonology, gastroenterology and the main man himself the surgeon. The nine months of prep work and surgery was done through Cadence Health Bariatric Treatment Center at Central DuPage Hospital in Winfield, Illinois. Dr. Woodard of Associated General Surgeons preformed a most excellent laparoscopic surgical intervention replete with DaVinci computer. Dr. Woodard’s comment to Q.’s spouse after surgery: “His stomach was huge.” Ha, Q. believes in getting value for money spent.

Get informed is an understatement!

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EPSON001   A must read!

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Read this!

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EPSON004The last statement says it all…

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EPSON001   Start surgical options

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Too radical a surgery even  for Captain.  Be very, very, circumspect when choosing this procedure.   Considered by many surgeons to be the Cadillac of weight loss procedures. Thank you very much, I’ll take the Jaguar if you please.

EPSON002     EPSON003

EPSON001Must read…while unlikely, one of these complications could happen to you.

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****Choice of Champions and Captain Q.****

This is it! the Jaguar of weight loss procedures.

EPSON004

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Q. is learning the meaning of portion control and eating more slowly in earnest for the first time, he will be the first to tell you! If you try to swallow too fast or swallow too much at once a sharp pain across the chest or in the sleeve will ensue  as well as gastric reflux.  There is nothing like draconian negative feedback in real time! This surgery is for the seriously minded weight reducers only: it is a lifelong commitment. Those who fail or try to cheat this radical approach to weight loss really do have bats in the belfry and deserve to simmer in their own rancid fat.

Gastric banding is falling out of favor with surgeons in the know, a complete waste and money, with poor efficacy. Like buying a beater Ford a name synonymous with ‘Fix or repair daily’.

EPSON007 Why bother?

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EPSON006   A bill of goods!

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EPSON001   Further reading!

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Future editions of “The Fat Bastard Gazette” will look into bariatric chop shops, cost of doing business legitimately / illegitimately, and the Good Captain’s continuing life-changing odyssey. In addition, do not forget the Captain’s ever erratic, maniacal fits of vitriol spewed upon fat clowns everywhere and anywhere in these august pages of record.

Cordially Yours,

Captain Quinlan and staff

Captain Hank Quinlan, Owner and Publisher, Chief Curmudgeon
Captain Hank Quinlan, Owner and Publisher, Chief Curmudgeon with Sam Borsalino, Assistant Publisher

Dear Hail-Fellows well met, “The Fat Bastard Gazette” is written and edited by your favorite curmudgeons Captain Hank Quinlan and

Flatfoot  Willie, Corespondent at Large with fellow Staff Writers
Flatfoot Willie, Correspondent at Large with fellow Staff Writers

Staff (monkeys in the back room). We offer an ongoing tirade to support or offend anyone of any large dimension, cultural background, religious affiliation, or color of skin. This gazette rails against an eclectic mix of circus ring ne’er do wells, big ring fatty and fatso whiners, congenital idiots, the usual motley assortment of the profoundly dumbfounded, and a favorite of intelligent men everywhere, the

May the Most Venerable H. L. Mencken bless our unworthy but earnest attempts at tongue in cheek jocularity .
May the Most Venerable H. L. Mencken bless our unworthy but earnest attempts at tongue in cheek jocularity .

“Great Booboisie.” Nor shall we ignore the wide assortment of shirkers, layabouts, and slugabeds.

Latest office staff confab at Fat Bastard HQ.
Latest office staff confab at Fat Bastard HQ.

All this and more always keeping our major focus on “Why so fat?”  Enough said? We at “The Fat Bastard Gazette” think so. If you like what you read, and you know whom you are, in this yellow blog, tell your friends. We would be elated with an ever-wider readership. We remain cordially yours, Captain Hank Quinlan and the Monkeys in the back room

“The Fat Bastard Gazette” does not purport to offer any definitive medical or pharmaceutical advice whatsoever in any explicit or implied manner. Always consult a qualified physician in all medical or pharmaceutical matters. “The Fat Bastard Gazette” is only the opinion of informed nonprofessionals for the general edification and entertainment of the greater public. 

 No similarities to any existing names or characters are expressed or implied. We reserve the right to offend or support anybody, anything, or any sacred totem across the globe.