Wednesday, November 30, 2011

A Summer of Books

Here are some books I read during the past year or so that I found particularly absorbing, listed in no particular order.

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Obesity briefs - Brain Proteins, School Food and Metabolic Surgery

Here are some news briefs on the obesity front from the weekend covering everything from a study about brain proteins' effect on weight to using bariatric surgery to treat metabolic diseases.

KC-Area Benefits Company Argues in Support of Bariatric Surgery Benefits: Midwestern Benefits Company Lockton has released a report encouraging employers to offer weight loss surgery benefits in addition to wellness programs.

Obesity regulating gene found? London researchers have identified a gene they claim regulates obesity. The gene was previously known to be linked to cholesterol and type 2 diabetes. This study found that it also influenced other genes that regulate BMI (body mass index), cholesterol and glucose and insulin levels. The study, which was pubished in Nature Genetics offers hopes for new treatments for metabolic diseases.

Overweight? It's all in your head:A story from the Weizmann Institute of Science, published in the May issue of Cell Metabolism, followed mice that were engineered to lack the protein tyrosine phosphatase epsilon (PTPe) and found that without PTPe, mice were better able to regulate their weight. They found that PTPe dampens signals from the hormone leptin in the hypothalamus, leading to reduced appetite and increased physical activity. Researchers know that obese people tend to have an exess of leptin in their blood.

The results of the study suggest that another part of the obesity puzzle involves leptin insensitivity and if scientists could inhibit PTPe, it could improve leptin response to reduce appetite and increase physical activity. Think about that next time someone says that you simply need to eat less and exercise more.

Can video games contribute to obesity? Danish and Canadian researchers watched teenage boys who played video games and compared them to similar boys who were not playing video games. If they played for an hour, video gamers would burn an extra 21 calories compared to the others, but when offered a snack, they would eat 80 more calories than the kids who did not play video games. 

Parents in Oman Worried about Childhood Obesity, School Lunches: Parents of children in Oman are fighting problems familiar in America: the impact of school lunches on childhood obesity. Specifically, they are looking to remove low-quality meats, french fries and fizzy drinks from private schoole menus.

Bariatric Surgery recommended for Metabolic Diseases: with recent recommendations from the FDA and the American Heart Association, lowering the Body Mass Index specifications for people to get weight loss surgery if they suffer from diabetes, the mainstream media is starting to pay attention. 

From the Orlando Sentinel:

One review study of 3,188 obese, Type 2 diabetics who had bariatric surgery found that 78 percent of them no longer had diabetes afterward, according to a 2009 report published in the American Journal of Medicine. And the disease still had not returned by the two-year follow-up.

Another randomized study of obese Type 2 diabetics, published in 2008 in the Journal of the American Medical Association, found that 73 percent of those who had gastric-banding procedures achieved remission of their diabetes, compared with only 13 percent using lifestyle and medication to treat their diabetes.

It is, however, important to note that one can never be rid entirely of diabetes and that remission is always a possibility. It is also important to note that while the article speaks of various bariatric procedures, surgeons at Weight Loss Surgical Center perform only laparascopic adjustable gastric banding, which does not involve cutting, stapling or re-routing of your digestive tract.

Alcohol addiction risk with gastric bypass: A study of a Sweedish database of bariatric patients revealed that bypass patients were twice as likely to need treatment for alcohol addiction. The article explains that bypassing part of the digestive tract allows for faster alcohol absorption and increased risk of dependency.

If you're suffering from the dangerous combination of obesity and diabetes, weight loss surgery may be an option to help. Learn more about diabetes and LAP-BAND Surgery today.

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Tuesday, November 29, 2011

Our Very Own Dr. Kosinski Featured in the NY Times!

Our very own Dr. Kosinski was recently featured in a NY Times article about over-eating at Thanksgiving. Read more to find out what he has to say about that third helping.

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Jersey the loggerhead from Florida!

November 17th started out like any other day for John Kocinski and Ray Gabrish in Cudjoe Key. The sun was shining, and all was right in the world. Being avid fisherman, they decided it was a good day to check their personal lobster traps. They made it out to Sawyer Key, when they spotted something [...]

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Monday, November 28, 2011

Stanislaw Burzynski: Bad medicine, a bad movie, and bad P.R.

And the Lord spake, saying, “First shalt thou take out the Holy Pin. Then shalt thou count to three, no more, no less. Three shall be the number thou shalt count, and the number of the counting shall be three. Four shalt thou not count, neither count thou two, excepting that thou then proceed to [...]

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Tini? a.k.a. ?Shark Bait?

Tini came to us on�Oct 14�from St. Lucie Inlet State Park, in Martin County,�Florida.� Florida Fish and Wildlife Conservation Commission staff had to drive Tini to us.� The long drive couldn’t have been easy for this poor little green sea turtle who was attacked and mauled by a predator. With a recently bitten off front [...]

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Saturday, November 26, 2011

Insurance Commissioners Call For Another Look at Medical Loss Ratio

Underlying the resolution is a concern that medical loss ratio requirements are squeezing commissions paid to insurance agents and brokers.

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11 Weight Loss Tips for 2011, Part 8: Keep a Journal

This is the eighth in an 11-part series of weight loss tips for 2011. Yesterday, we talked about protein for weight loss. Today, we’re talking about keeping a journal.

Let’s start with an exercise. Think about everything you ate yesterday. Think about what you had for breakfast. Think about your lunch. Then think about your dinner. Did you have any snacks in between? Do you think you remember enough information about portion sizes and quantities that you could tell me how many calories you ate?

Probably not.                 

When you journal, you actually record what you ate, when you ate it and the details of what you ate so that you can look back on how well you stuck to your plan.

Remember your plan from Part 1 in this series? Journals work great with plans.

You could actually pre-journal based on your plan. You could plan out your meals for the day or week, and you could keep it easy on yourself by sticking to the plan and just putting checkmarks in your journal, or you could make it more difficult on yourself by having to edit your entries if you veer off course.

What would you put in a journal?

Anything you wanted. Anything you find helpful.

The basic reason is to make sure you are eating consciously. You might not realize how many calories or carbs a certain dish has. Journaling with those numbers requires you to look at the nutrition label or do some research to see how what you think you’re eating actually matches up to what you are eating.

You could keep track of only a couple simple numbers with each meal to give yourself broad insight into what you put into your body. Track your calories to see if you’re keeping  your daily total low. Track your carbs, especially if you are diabetic, as carbs affect your blood sugar.

You could also track physical activity, glucose numbers, weight. Track anything you want to track and are willing to do over time.

At Weight Loss Surgical Center, we help people lose weight with adjustable gastric band surgery and a special focus on long-term support after surgery. If you’re ready to lose some serious weight and get support from our weight loss professionals, schedule your initial consultation today.

Read more:
Next: Weight Loss Tip 9: Visit your Doctor
Prev: Weight Loss Tip 7: Eat Protein

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Friday, November 25, 2011

Random Flu Thoughts

I normally write the first draft of this blog the weekend before it is due, and this is no exception.� However, I am ill this weekend.� Headache, myalgias., painful cough, but only mildly ill.� The worst part is the interferon induced brain fog; my thoughts flow with all the speed of pudding and I was [...]

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Lap Band Support Groups are Key to Chuck's Success

In our final interview segment with Chuck from our Independence, Missouri Lap Band office, Chuck discusses how stories from the Independence Lap Band Clinic's Weight Loss Support Group helped him decide that the band was right for him.

After his initial decision, he has continued to be an active member of the group and has developed strong, supportive relationships. He believes that others in the group inspire him to be successful, and he hopes that his own experience encourages others.

Chuck also goes on to discuss how Weight Loss Surgical Center's Independence Lap Band clinic have been able to help him beyond his regular appointments and support groups.

He says that it's helpful to have an employee with his own lap band working in the clinic, because his first-hand experience has been beneficial to helping Chuck overcome his own obstacles.

If you have had or are considering lap band surgery for weight loss in the Independence, Missouri, area, join our Independence Lap Band Support Group to get the most out of your weight loss journey.

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Thursday, November 24, 2011

Why Children?s Hospital of Wisconsin is going purple for prematurity awareness

This year marks the fifth anniversary of the March of Dimes Neonatal Intensive Care Unit Family Support Program at Children?s Hospital of Wisconsin. This program has brought support and information to thousands of families impacted by prematurity and birth defects.
Over the last five years, the Neonatal Intensive Care Unit (NICU) has expanded, the scope of [...]

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An Enlarging Ulcer

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Wednesday, November 23, 2011

Two new CME courses on AJM website

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Steven Fowkes (Part 2 of 2): Nutrients for Better Mental Performance

Last week, in part 1, I covered Steven Fowkes? ?cures? for Alzheimer?s and herpes. In part 2, I will cover a video where he goes further afield. It is titled ?Nutrients for Better Mental Performance,? but he also discusses sleep, depression, hangovers, and a lot of other topics. Some of what he says are simple [...]

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Tuesday, November 22, 2011

Endoscopy Donation

One afternoon we received a surprise delivery that came in the shape of a big brown box. Once the box was opened we saw the treasures that were donated and a short note.�The note said�that one of the employee’s�from the Affiliated Veterinary Specialist-Surgery Center in Jacksonville�had visited our hospital and saw that we were only [...]

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Reporting back on my Grand Rounds experience at FSU

Last Thursday, I had the distinct privilege and honor to be invited to speak at Grand Rounds at the Florida State University College of Medicine in Tallahassee. Ray Bellamy, who is on the faculty there and is also the husband of our very own Jann Bellamy (who is herself is the founder of the Campaign [...]

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Monday, November 21, 2011

The extremely fast/retarded triage note

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Pediatrics & ?CAM? I: the wrong solution

Oh no!� Not again! The venerable medical journal Pediatrics devotes an entire supplement this month to Pediatric Use of Complementary and Alternative Medicine: Legal, Ethical, and Clinical Issues in Decision-Making. We sense from the very first sentence that we are in familiar territory: Rapid increases the use of complementary and alternative medicine (CAM) raise important [...]

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Sunday, November 20, 2011

English Departments and Healthcare

how professors of English might benefit from interaction with health care professionals

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A.M. Vitals: Teen Births, Food Fight, Hearing Loss

Teen Births Drop Again: The birth rate among Americans ages 15 to 19 years old fell 9% from the previous year, the Centers for Disease Control and Prevention said. The WSJ reported that more effective sex-education programs along with a rough economy may help explain the continued decline.

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Saturday, November 19, 2011

Cowboy

Around noon on October 13, we received a call from Captain Brian Stoner and Captain Rich Schaf of the Keys Cowboy Fishing Charter about a turtle missing a flipper. “He’s unable to dive and doesn’t look too good”, said Rich. We asked them to bring the turtle on board and meet us at the nearest [...]

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Karsten Released October 25!

Karsten was�released off of Sombrero Beach in Marathon, Florida Keys and quickly swam away.� Pictured below in blue shirts are Mike Puto and Turtle Hospital staff Jo Ellen Basile, Tom Luebke, and Richie Moretti,�along with several of a group of environmental journalists visiting the Keys and the Hospital�this week (photo by Larry Benvenuti). Karsten is [...]

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Why Children?s Hospital of Wisconsin is going purple for prematurity awareness

This year marks the fifth anniversary of the March of Dimes Neonatal Intensive Care Unit Family Support Program at Children?s Hospital of Wisconsin. This program has brought support and information to thousands of families impacted by prematurity and birth defects.
Over the last five years, the Neonatal Intensive Care Unit (NICU) has expanded, the scope of [...]

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Friday, November 18, 2011

Dr. One-Liner one liner of the night

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Weight Loss Surgical Center now accepting Missouri HealthNet

Missouri HealthNet has contracted with Weight Loss Surgical Center's hospital partner
Weight Loss Surgical Center is now accepting Missouri Medicaid patients in the Missouri HealthNet program, as is Blue Valley Hospital, where its surgeries are performed.

Missouri HealthNet participants should have a card similar to the one pictured to the left.

People with Missouri HealthNet who are interested in getting an adjustable gastric band, commonly known by the brand names LAP-BAND System or REALIZE Band Solution, should be aware of the state's requirements for gastric band surgery for weight loss.

To be qualified for weight loss surgery, patients must:
  • Have a Body Mass Index of 40 or higher
  • Have at least one weight-related health conditions, such as diabetes, high blood pressure, gastric reflux, sleep apnea, etc.
If you are ready to start losing weight so you can get more of life, request your initial consultation for LAP-BAND Surgery today.

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Report from the long-term acute care hospital

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Scholarly Journal Publishing in Canada - Report 2011

The Canadian Association of Learned Journals has released its Scholarly Journal Publishing in Canada Annual Industry Report 2010-2011. The report notes five major highlights of the journal publishing industry in Canada:

  • Autonomy: 85% of Canadian academic journals are published by scholarly, educational institutions and organizations
  • Few paid staff: only 15% have full-time journal managers; more than 40% of editors receive no compensation (course release, stipend, or other support)
  • Technological change: 53% of journals publish in print and online; 25% fully open access; 39% with a variety of access
  • Circulation: 35% of print journals have circulations of more than 500, compared to 55% with more than 500 registered readers
  • Subscription prices: 62% of journals charge less than $100 for institutional print subscriptions compared to 42% of journals charging less than $100 for institutional online subscriptions

The report is also available in French.

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Thursday, November 17, 2011

Telephone and Online Support for Weight Loss Works Fine, Study Shows

Actually showing up for group or individual support sessions doesn't seem to matter if the same help can be accessed remotely.

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9 Motivations for Weight Loss

At last night's Lap Band Support Group in Omaha, they covered the 9 Hidden Reasons to Stay Motivated.

Using the Sparkpeople.com article, 9 Hidden Reasons to Stay Motivated: Ways to Rediscover Your Drive, as the launching point for the conversation, the group discussed members' secret motivations for losing weight.

The article's nine reasons range from finding clothes that can fit after you've lost weight to being around long enough to watch your children grow up.

One of the more fun items on their list is the WOW effect. Stop and think about it. You're walking through the store, and someone from your past stops you to say "Wow, you look amazing."

Isn't that one of the greatest feelings in the world?

Check out sparkpeople.com for a lot of great information about weight loss, as well as some handy online tools for journaling and progress tracking.

Via sparkpeople.com: 9 Hidden Reasons to Stay Motivated

If you're ready to get the support and motivation patients get from Weight Loss Surgical Center, schedule your initial Lap Band appointment today.

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30 Articles in Press available on AJM website

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Dr. Hitchcock Joins Weight Loss Surgical Center

Dr. Thomas Hitchcock is now at Weight Loss Surgical CenterToday, we announced that Dr. Thomas Hitchcock has joined Weight Loss Surgical Center as our fourth surgeon on our team specializing in laparoscopic adjustable gastric band procedures to help patients lose weight and keep it off.

Dr. Thomas Hitchcock is now performing LAP-BAND® Surgeries and follow-up care only at Weight Loss Surgical Center.

“Weight Loss Surgical Center is the only surgery practice in the Kansas City area that is currently specializing exclusively in adjustable gastric band surgery for weight loss,” said Dr. Hitchcock. "I believe that adjustable gastric bands are still the safest, most effective and the healthiest option over the long term.”

Dr. Hitchcock was involved with a variety of surgical procedures developed for weight loss through the years. He spent 3 decades helping people suffering from morbid obesity and has worked specifically with adjustable gastric band patients since 2004.

He is a Board Certified General Surgeon, a member of the American Society of Metabolic and Bariatric Surgery and a fellow of the American College of Surgeons.

Dr. Hitchcock joins Dr. Lawrence Drahota, Dr. Scott Ellison and Dr. Stanley Augustin with privileges to perform weight loss surgery for us at Blue Valley Hospital.

We have clinics in Overland Park, Topeka and Wichita, Kan.; Springfield, St. Peters, Independence and Kansas City, Mo.; West Des Moines and Council Bluffs, Iowa; and Omaha, Neb., for initial consultations and long-term post-operative follow-up care.

You can find out if you qualify for the adjustable gastric band procedure and learn more it by taking the our free weight loss surgery seminar.

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Cowboy

Around noon on October 13, we received a call from Captain Brian Stoner and Captain Rich Schaf of the Keys Cowboy Fishing Charter about a turtle missing a flipper. “He’s unable to dive and doesn’t look too good”, said Rich. We asked them to bring the turtle on board and meet us at the nearest [...]

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Choosing a Physician

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Wednesday, November 16, 2011

Grey Literature in Public Health Web Conference Series 2011

AcademyHealth

AcademyHealth is pleased to announce that the archived recordings for all three Web conferences in the Grey Literature Web Conference Series are now available on the AcademyHealth website.�Presentation slides are also available.

To access the archived recordings, visit the Grey Literature Web Conference Series page.

Thank you again for your interest in AcademyHealth and the Grey Literature Web Conference�Series. We hope that you will find the seminars, as well as the other archived materials, useful in your work.

Questions?�Please send an e-mail to:�hsrmethods@academyhealth.org

AcademyHealth gratefully acknowledges the support of the�National Library of Medicine�for this Web conference series.�

AcademyHealth Home ������ | ������ Membership ������ | ������ Interest Groups ������ | ������ Publications

AcademyHealth | 1150 17th Street NW, Suite 600 | Washington, DC 20036
tel: 202.292.6700 | fax: 202.292.6800 | academyhealth.org

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Kroenke Sports and the Denver Nuggets

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Why Children?s Hospital of Wisconsin is going purple for prematurity awareness

This year marks the fifth anniversary of the March of Dimes Neonatal Intensive Care Unit Family Support Program at Children?s Hospital of Wisconsin. This program has brought support and information to thousands of families impacted by prematurity and birth defects.
Over the last five years, the Neonatal Intensive Care Unit (NICU) has expanded, the scope of [...]

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X-ray followage

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People Were Staring...

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The Importance of Being Elderly?Some Thoughts on the Care of Geriatric Patients

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Tuesday, November 15, 2011

Beneficial Effects of Wine

Even though alcohol addictions are a big problem of todays world, there is one representative of the alcoholic beverage group that can be beneficial for you and that is wine, of course if taken in reasonable amounts. If you can’t control yourself and you drink large quantities of wine, if you are not careful enough [...]


Related posts:
  1. Looking To Buy Resveratrol? Then Look No Further Are you currently thinking about the idea to buy Resveratrol?...
  2. The Natural Way Of Avoiding Wrinkles How can you prevent facial lines? Staying away from the...

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Alpha Brain ? What?s Wrong with the Supplement Industry

There is an endless stream of supplement products on the market that are of questionable value. They tend to follow a similar pattern: put an essentially random assortment of vitamins, minerals, perhaps herbs and nutritional elements into a pill and then make whatever pseudo-health claims you want. Usually the claim is implied in the name [...]

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Dr. No Bullshit's empathetic comment of the night

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Obesity Is Not Protective against Fracture in Postmenopausal Women: GLOW

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Pup

On September 3, Tim Hannah was out lobster hunting off Grassy Key and saw little Pup hanging out under a coral ledge. He thought it was odd that Pup didn’t swim away but thought he� just might�be taking a rest. Twenty minutes later, when Tim swam by again, he took a closer look and saw [...]

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Return of an old foe

In 2000, a panel of experts was brought together by the Centers for Disease Control and Prevention (CDC). They came to discuss whether measles was still endemic in the United States, that is whether it still existed in the general background of US infectious diseases. They concluded that measles had been eradicated in the US, [...]

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Monday, November 14, 2011

Report from the long-term acute care hospital

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Antimicrobial Use and Risk for Recurrent Clostridium difficile Infection

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Physical Fitness Associated With Healthier Brain Aging

The more physically fit the elderly person they studied, the fewer age-related brain changes the researchers could find.

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Severe medical illiteracy

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11 Weight Loss Tips for 2011 (Recap)

We started off January with 11 individual weight loss tips for 2011, and now here they are, re-presented in one handy list.

  1. Make a weight loss plan. Write it out, and stick to it.
  2. Drink water for better weight loss. Keep yourself hydrated and healthy.
  3. Control your portions to reduce caloric intake. Reduce portions before you begin eating, so you are not tempted.
  4. Get moving with light physical activity to burn excess calories. Even fidgeting burns calories, so get up off the couch and do something.
  5. Join a weight loss support group. If you can't find one you like then work on developing your own unique support system.
  6. Exercise to burn fat. Set a goal, start slow, and increase your effort over time.
  7. Eat plenty of protein. It makes you feel fuller longer and nourishes your body.
  8. Keep a journal of your weight loss efforts. You might be surprised what you actually eat in a single day.
  9. Visit with your doctor about your weight loss goals. Remember that weight loss is not only cosmetic; losing weight can help you improve your health.
  10. Treat illnesses without letting them become an obstacle. If a cold or flu knocks you down, treat it and then get back on the plan.
  11. Reward yourself for weight loss successes. Find non-food motivators and use them to push yourself forward.

Weight Loss Surgical Center offers long-term weight loss support for patients who have had laparoscopic adjustable gastric band surgery. Many of the weight loss lessons that are usable by the general public are still important to lap band patients.

If you are interested in weight loss surgery as a powerful tool to help you lose weight, download our free kit of weight loss surgery information today.

 

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Welcome New Members!

We would like to welcome our newest members that joined our family during the month of October: Ruthanne Bishop, Craigie Succop, Michael Bentle, Eral H. Dendle Jr., Erin & Paul McLarnon, Patricia Hanna, John Diversey, Lorraine Barba, Susan Dykema, Karen-lesley Price, Deborah Drafts, Edward Hopkins, Carl & Nancy Miller, Curt & Margie Smitch, and Diana [...]

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Sunday, November 13, 2011

Potential market for alternative medicine left untouched

A few days ago, I had the good fortune to share lunch and ideas with David Gorski and Kimball Atwood. �Kimball was on his way from a talk at Michigan State to one at Brigham and Women’s, one of the country’s best-known teaching hospitals. �David was planning a future talk for a group in Florida. [...]

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What Joe Paterno Could Have Learned About Disclosure from Health Care

Steven Lewis, President
Access Consulting Ltd., Saskatoon SK Canada
Steven.Lewis@sasktel.net

Happy Valley it ain't.�

Penn State University is aflame, its President, two senior officials, and sainted football coach Joe Paterno out the door after 46 years. A former assistant coach, Jerry Sandusky, is under indictment for multiple sexual assaults against young boys over a 15 year period. Each new piece of evidence confirms that any number of people could have stepped in years ago.�On being told an eyewitness account of the� sodomization of a ten year old boy in the showers of a Penn State facility - where Sandusky maintained an office long after retiring - Paterno notified his campus superiors (absent the gruesome details) and did nothing more. No going to the police; no search for corroborating evidence; no updates; no making Sandusky look him in the eye and deny.

He was told in 2002. Now, he tells us, he is devastated, and grieves for the victims. Two university officials are charged with perjury. There will be civil suits and millions paid out in damages. The Nittany Lions football program takes in $50 million a year. No wonder the damage control operation is at full throttle.

Irony doesn't begin to describe it. Paterno championed a culture that (so far as we know) tolerated none of the tawdry ethical violations that dog big-time NCAA football programs. It?s not like they were choir boys: between 2002 and 2008, 27 players garnered 45 criminal convictions. But on the playing field, Penn State won often and won clean. Other programs produce glamorous quarterbacks; Penn State is Linebacker U. It was a badge of honour ? a sacred trust ? to adhere to the NCAA rules: don't you dare give my players free concert tickets. Ex-coaches raping little boys? Not our territory - you deal with it.

Here we have a series of adverse events, to put it mildly. They are criminal acts, which makes them different from 99.999% of adverse events in health care. But the adverse events of interest here are not the crimes themselves, but the shared failure to respond. Not wanting to know, not wanting to tell, not wanting to call to account - that's the Penn State story. Too often it has been the story in health care. Are things different now?

What happened at Penn State sounds a lot like what happened to the children under the care of the Bristol Infirmary or the Winnipeg pediatric cardiology program. People knew that substandard health care was killing and maiming kids. There were lapses in judgment and in communication. Hierarchies resisted challenge and there was too much unearned deference to authority. Systems were ill-designed to detect early signs of trouble. Good people who could have acted earlier felt disempowered. Organizational peace trumped concern for the victims. The worst of all possible sins was a false-positive allegation.

Thanks to enlightened leaders, crusading patient advocates, and the insights of the quality improvement movement, there are a lot fewer Penn States in health care than there used to be. Health care has belatedly recognized that the way to earn public trust is to tell the truth, admit mistakes, apologize, and make things right. It's the same on the inside. If your employees and staff trust their leaders and each other, they will embrace a culture of disclosure, report near misses, and value errors as learning opportunities.� No name, no blame, no shame. Just improve. That's the deal.

But it's a hard deal to live up to. There is an irreducible tension between withholding the lash in service of quality improvement and the very human desire to call individuals to account. It sounds Orwellian to be told that your loved one died because of "system error" - even if it's true. The best-designed systems try to take human variability out of the picture almost entirely. That's why aviation is so safe and why OR teams that use a surgical checklist outperform the most conscientious teams that don't.

You shouldn't have to create protocols for decency, but there's nothing like the advice of lawyers to scramble the signals of an active conscience. Insurers instructed doctors not to apologize to patients they had harmed because apology implies guilt which creates liability. Patients and their families faced a wall of maddening obfuscation. It took decades to pass legislation - legislation! - that allowed people to say they were sorry. Only a few wise organizations had already understood that telling patients the truth reduced the likelihood of being sued.

I suspect something more elemental explains much of the tragic delay in coming to terms with hard realities. Our moral compass can spin wildly out of control in unfamiliar terrain. The usual defence mechanisms take over: denial of the unthinkable, the instinct to flee, the hope that others will fix it. The longer the silence, the harder it is to come forward because of the added guilt imposed by the rising number of avoidable victims. Finally, inevitably, the evidence overwhelms the protective psychological levee. The reckoning is long, hard, and costly for all involved.

There are moral failings to be sure in these cases, but humans fail morally all the time. More vexing is the failure of curiosity.�Why didn't Paterno want to get to the bottom of the allegations about someone he had trusted for decades? Why didn?t the graduate assistant who told Paterno what he?d seen ? now the receivers coach ? follow up on what had become of his revelation? And on purely self-interested grounds, how could senior Penn State officials calculate that a cover-up was a sound risk management strategy?

I?d like to think the CEOs of big-time health care organizations would do better than Paterno if faced with a similar situation. And I?d like to think Paterno would have done the right thing had he ventured outside the adulatory bubble to hear from people whose harm was compounded by powerful people who chose to do nothing.

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Brad Pitt Can Save Health Care

Brad Pitt has an approach to data and performance that could save health care. That's right: Brad Pitt. Yes, the same Brad Pitt that started his career on the daytime soap opera�Another World; played the cool thief in the Oceans series of films; then the goofy fitness trainer in Burn After Reading and topped it off by marrying Hollywood femme fatale, Angelina Jolie. Handsome, charming, master of self-deprecating humour, and now saviour of the health care system; Is there nothing he can?t do?

You see, Brad Pitt has the opportunity to teach us the tools needed to fix the Canadian health care system. Where did he get these magic tools to fix health care? Pitt is featured in the role of Billy Beane in the recently released Hollywood film Moneyball. Truthfully it is actually Billy Beane that has the tools to fix healthcare. Brad Pitt will just show us how to use them. However had I said, ?Billy Beane will show us how to fix health care,? you would have quit reading. Because unless you follow baseball you?ve most likely never heard of Billy Beane. Brad Pitt you?ve heard of. And while Billy Beane is quite the hunk himself, he?s not quite in Pitt?s league. In fact he?s in the American League.

Based on the book of the same name, Moneyball tells the story of Major League Baseball's Oakland Athletics in the early 2000s. �As Oakland?s general manager, Beane?s job was to create a winning team with a severely constrained payroll at the same time as the competition were doubling theirs. Essentially the new owners asked him to do ?a lot more with a lot less?.

Sound familiar?

I?m an emergency physician. In healthcare we are asked to do more with less almost daily.

?See more patients in the emergency department; but with fewer beds.?

?Do more surgeries; but with the same number of operating room hours.?

?Take care of sicker and more patients; but with the same number of staff.?

To be clear, baseball isn't the health care system. In health care we can close on the weekend. We can make people wait. We can put patients in beds in the hallway. Pressed to save money, we buy cheaper IV cannulas although the staff don?t like them. Maybe we don?t open all the beds on a ward to save on nursing costs. We used to be able to run a deficit, but increasingly those days are over.

Baseball is different. It plays by a different set of rules. They can?t tell ticket holders, ?Stadium?s full. You?ll have to wait in the hallway.? They can?t buy lower quality bats and gloves just to save money. They can?t say, ?We don?t have enough money to pay all the players for tonight?s game. Let?s leave right field open.? And they definitely can?t say, ?We?re not going to play on weekends. Or this summer for that matter?.

Forced to compete with the major league - literally and figuratively - payrolls of the New York Yankees and Boston Red Sox, Beane needs to figure out a new way to do business. What does he do with his team and its paltry budget? He takes The A?s, with their lowest or next to lowest payroll in the league, to winning the most games than any other team but one. They make the playoffs 3 years in a row. The A?s set the American League record for most consecutive wins in a season. And along the way they almost eliminate from the playoffs the richest team in baseball, the Yankees.

How does he do it?

He uses data: a lot of data. First he scans the data for any indicators of performance others in the league aren?t looking at. He determines which player attributes add value (runs for his side, prevented runs for opponents) to his team; and which do not. He looks at the traditional way of how the scouts identify excellence, and obsesses over how to turn the art of player selection and development into more of a science. He takes age-old problems and examines them from a different perspective. All of this analysis derives from the enormous amount of data available in baseball. Beane demonstrates that using the available data to arrive at new insights about the ideal players at the least cost creates a competitive advantage. In short, Beane takes his small budget team and turns it into a�big-ticket winner.

We can do the same in health care. And some high-performing organizations already have: Group Health Cooperative in Seattle and environs; Intermountain Health headquartered in Utah; the Geisinger Health System in Pennsylvania; Kaiser Permanente. Many factors account for their overall excellence, but a common feature is using data to drive improvement.

Health care in Canada has more than enough money. Throwing more money at our problems won?t fix them.�We need to move away from the old business model. We need to ask different questions of the data to discover why some health systems are performing at a higher level given the same set of circumstances. What is working? What isn?t? What changes do we have to make to maximize the human and financial resources to ensure better health for our population? What are we doing that doesn?t contribute to better health? If what we?re currently doing isn?t working, let?s try something different.

You don't have to like baseball to relate to Moneyball. You don?t even have to like sports. All you need is to work in a system that is asking for more with fewer resources. Or work in a system that you believe could be doing a better job than it currently is. Then you'll be hooked.

Go out and see Moneyball in the movie theatre. It?s a great film and an even greater story. Almost as good as the book on which it's based.

And if you don?t like it, and you don?t see a connection between sports and health care? At least you get to see Brad Pitt.

Topics: 

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Thank You October Donors

Thank you to all of you who donated during the month of October including: Kelly Coral, Erik Zimmerman, Bryn Flanigan, The Schwab Fund For Charitable Giving, Lawrence and Jane Gould, Platts Market Center Beta Test, Markus Roth, Robert Luce, Kimberly Messer, Marc Heydens, Particia Hanna, STMCS 5th Grade Class, Pamela Bowen Wessel, Arundel County Grovernment, [...]

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What Joe Paterno Could Have Learned About Disclosure from Health Care

Steven Lewis, President
Access Consulting Ltd., Saskatoon SK Canada
Steven.Lewis@sasktel.net

Happy Valley it ain't.�

Penn State University is aflame, its President, two senior officials, and sainted football coach Joe Paterno out the door after 46 years. A former assistant coach, Jerry Sandusky, is under indictment for multiple sexual assaults against young boys over a 15 year period. Each new piece of evidence confirms that any number of people could have stepped in years ago.�On being told an eyewitness account of the� sodomization of a ten year old boy in the showers of a Penn State facility - where Sandusky maintained an office long after retiring - Paterno notified his campus superiors (absent the gruesome details) and did nothing more. No going to the police; no search for corroborating evidence; no updates; no making Sandusky look him in the eye and deny.

He was told in 2002. Now, he tells us, he is devastated, and grieves for the victims. Two university officials are charged with perjury. There will be civil suits and millions paid out in damages. The Nittany Lions football program takes in $50 million a year. No wonder the damage control operation is at full throttle.

Irony doesn't begin to describe it. Paterno championed a culture that (so far as we know) tolerated none of the tawdry ethical violations that dog big-time NCAA football programs. It?s not like they were choir boys: between 2002 and 2008, 27 players garnered 45 criminal convictions. But on the playing field, Penn State won often and won clean. Other programs produce glamorous quarterbacks; Penn State is Linebacker U. It was a badge of honour ? a sacred trust ? to adhere to the NCAA rules: don't you dare give my players free concert tickets. Ex-coaches raping little boys? Not our territory - you deal with it.

Here we have a series of adverse events, to put it mildly. They are criminal acts, which makes them different from 99.999% of adverse events in health care. But the adverse events of interest here are not the crimes themselves, but the shared failure to respond. Not wanting to know, not wanting to tell, not wanting to call to account - that's the Penn State story. Too often it has been the story in health care. Are things different now?

What happened at Penn State sounds a lot like what happened to the children under the care of the Bristol Infirmary or the Winnipeg pediatric cardiology program. People knew that substandard health care was killing and maiming kids. There were lapses in judgment and in communication. Hierarchies resisted challenge and there was too much unearned deference to authority. Systems were ill-designed to detect early signs of trouble. Good people who could have acted earlier felt disempowered. Organizational peace trumped concern for the victims. The worst of all possible sins was a false-positive allegation.

Thanks to enlightened leaders, crusading patient advocates, and the insights of the quality improvement movement, there are a lot fewer Penn States in health care than there used to be. Health care has belatedly recognized that the way to earn public trust is to tell the truth, admit mistakes, apologize, and make things right. It's the same on the inside. If your employees and staff trust their leaders and each other, they will embrace a culture of disclosure, report near misses, and value errors as learning opportunities.� No name, no blame, no shame. Just improve. That's the deal.

But it's a hard deal to live up to. There is an irreducible tension between withholding the lash in service of quality improvement and the very human desire to call individuals to account. It sounds Orwellian to be told that your loved one died because of "system error" - even if it's true. The best-designed systems try to take human variability out of the picture almost entirely. That's why aviation is so safe and why OR teams that use a surgical checklist outperform the most conscientious teams that don't.

You shouldn't have to create protocols for decency, but there's nothing like the advice of lawyers to scramble the signals of an active conscience. Insurers instructed doctors not to apologize to patients they had harmed because apology implies guilt which creates liability. Patients and their families faced a wall of maddening obfuscation. It took decades to pass legislation - legislation! - that allowed people to say they were sorry. Only a few wise organizations had already understood that telling patients the truth reduced the likelihood of being sued.

I suspect something more elemental explains much of the tragic delay in coming to terms with hard realities. Our moral compass can spin wildly out of control in unfamiliar terrain. The usual defence mechanisms take over: denial of the unthinkable, the instinct to flee, the hope that others will fix it. The longer the silence, the harder it is to come forward because of the added guilt imposed by the rising number of avoidable victims. Finally, inevitably, the evidence overwhelms the protective psychological levee. The reckoning is long, hard, and costly for all involved.

There are moral failings to be sure in these cases, but humans fail morally all the time. More vexing is the failure of curiosity.�Why didn't Paterno want to get to the bottom of the allegations about someone he had trusted for decades? Why didn?t the graduate assistant who told Paterno what he?d seen ? now the receivers coach ? follow up on what had become of his revelation? And on purely self-interested grounds, how could senior Penn State officials calculate that a cover-up was a sound risk management strategy?

I?d like to think the CEOs of big-time health care organizations would do better than Paterno if faced with a similar situation. And I?d like to think Paterno would have done the right thing had he ventured outside the adulatory bubble to hear from people whose harm was compounded by powerful people who chose to do nothing.

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Attributable Risk Estimate of Severe Psoriasis on Major Cardiovascular Events

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Saturday, November 12, 2011

New "Now is for LAP-BAND�" Ads Hit Magazines

A new series of advertisements for the LAP-BAND® System is running now in national magazines, including Better Homes and Gardens, Every Day with Rachel Ray, Good Housekeeping and more.

Our LAP-BAND® Representative sent us a couple samples of from the ad series, below. 

What do you think of the new ads? Tell us in the comments!

 LAP-BAND Is For NOW Hula Hoop Advertisement

 

LAP-BAND Is For Now Pool Ad

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KA at U Minnesota and Michigan State

I’ll be giving a talk, “Homeopathy and Skepticism,” to skeptical students this Thursday, Oct 27, at the University of Minnesota (7:00 PM at MCB 3-120) and this Friday, Oct. 28, at Michigan State University (7:00 PM at Holmes Hall 106). Here is the abstract: Homeopathy is an extraordinary popular delusion that has persisted for more [...]

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Dr. Hitchcock Joins Weight Loss Surgical Center

Dr. Thomas Hitchcock is now at Weight Loss Surgical CenterToday, we announced that Dr. Thomas Hitchcock has joined Weight Loss Surgical Center as our fourth surgeon on our team specializing in laparoscopic adjustable gastric band procedures to help patients lose weight and keep it off.

Dr. Thomas Hitchcock is now performing LAP-BAND® Surgeries and follow-up care only at Weight Loss Surgical Center.

“Weight Loss Surgical Center is the only surgery practice in the Kansas City area that is currently specializing exclusively in adjustable gastric band surgery for weight loss,” said Dr. Hitchcock. "I believe that adjustable gastric bands are still the safest, most effective and the healthiest option over the long term.”

Dr. Hitchcock was involved with a variety of surgical procedures developed for weight loss through the years. He spent 3 decades helping people suffering from morbid obesity and has worked specifically with adjustable gastric band patients since 2004.

He is a Board Certified General Surgeon, a member of the American Society of Metabolic and Bariatric Surgery and a fellow of the American College of Surgeons.

Dr. Hitchcock joins Dr. Lawrence Drahota, Dr. Scott Ellison and Dr. Stanley Augustin with privileges to perform weight loss surgery for us at Blue Valley Hospital.

We have clinics in Overland Park, Topeka and Wichita, Kan.; Springfield, St. Peters, Independence and Kansas City, Mo.; West Des Moines and Council Bluffs, Iowa; and Omaha, Neb., for initial consultations and long-term post-operative follow-up care.

You can find out if you qualify for the adjustable gastric band procedure and learn more it by taking the our free weight loss surgery seminar.

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Tini? a.k.a. ?Shark Bait?

Tini came to us on�Oct 14�from St. Lucie Inlet State Park, in Martin County,�Florida.� Florida Fish and Wildlife Conservation Commission staff had to drive Tini to us.� The long drive couldn’t have been easy for this poor little green sea turtle who was attacked and mauled by a predator. With a recently bitten off front [...]

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Premature Claims for Neurotrophic Factors

Scientific medicine is not easy. By this point we have largely picked the low hanging fruit, and continued improvements are mostly incremental and hard won. In order to get the most out of our limited research dollars, and optimize medical practice with the safest and most effective treatments, we need to use all available scientific [...]

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Random Flu Thoughts

I normally write the first draft of this blog the weekend before it is due, and this is no exception.� However, I am ill this weekend.� Headache, myalgias., painful cough, but only mildly ill.� The worst part is the interferon induced brain fog; my thoughts flow with all the speed of pudding and I was [...]

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Friday, November 11, 2011

Travel to birth country can benefit adopted children

At the International Adoption Clinic, I often discuss racial and ethnic identity development with families (and children themselves). More and more, adoptive parents are exploring numerous ways to support positive racial/ethnic identities for their children. One way to do this is to visit the child?s birth country. Studies show that children who are adopted internationally [...]

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Protests

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Steven Fowkes (Part 1 of 2): How to Cure Alzheimer?s and Herpes

A correspondent asked me to review a video presentation by Steven Fowkes, ?Nutrients for Better Mental Performance,? one segment of a 9-part series on preventing and curing Alzheimer?s that was mentioned recently by an SBM commenter. Fowkes is an organic chemist without a PhD; he says this means: I am not institutionalized [This begs for [...]

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11 Weight Loss Tips for 2011, Part 6: Exercise

This is the sixth in an 11-part series of weight loss tips for 2011. Yesterday, we talked about support groups for weight loss. Today, we’re talking about exercise.

Today we’re going to step up our talk about physical activity and discuss how exercise can help you lose weight.

A crucial part to any weight loss program – even a surgical weight loss program – is exercise. If you’re trying to lose 100+ pounds, though, you may need to start slow with simple physical activities and work your way up.

I’ve found some interesting internet sources to help you get started. Try hundredpushups.com, even if you can’t make it through five pushups. They have a plan to get you moving from whatever your current ability allows to a regular 100 pushup routine.

Along a similar vein or ramping things up, you could try c25k.com, where they take you from the couch to a 5K run in 9 weeks.

100 pushups? 5 kilometers? Does it sound impossible?

It is if you don’t try. But these popular sites start with realistic goals and give you a structure to build and improve your exercise ability.

If you need a more personal approach, consider joining a gym AND meeting with a physical trainer. Commercial gymnasiums make a lot of money on those of us who pay our monthly dues but never show up. It may cost some extra money, but at least schedule an initial session with a personal trainer to teach you how to use the equipment. Once you’re comfortable with it you will be much more likely to come back again and again.

While sitting at the beginning of a weight loss journey, exercise can be intimidating, but there are plenty of resources available to help you start small and work your way to a healthier lifestyle.          

At Weight Loss Surgical Center, we help people lose weight with adjustable gastric band surgery and a special focus on long-term support after surgery. If you would like to learn more about what we do, download our free kit of adjustable gastric band surgery information.

Read more:
Next: Weight Loss Tip 7: Eat Protein
Prev: Weight Loss Tip 5: Get Support

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Emergent pediatric visit of the day

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AJM Editor-in-Chief previews the October 2011 issue (video)

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Movember Men?s Health Tips for Your 20s

Your 20s are still marked by a sense of invincibility, but you need to have regular check-ups. Talk to your doctor about the following important health issues.

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CAM practitioners react to Andrew Weil?s proposal for a board certification for integrative medicine. It isn?t (all) pretty.

About a month ago, I discussed a rather disturbing development, namely the initiative by Dr. Andrew Weil to set up something he was going to call the American Board of Integrative Medicine, all for the purpose of creating a system of board certification for physicians practicing “integrative medicine” (IM), or, as I prefer to call [...]

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Interdisciplinary Arts Project in a Family Medicine Residency Training Program

...through the courses I took in the Department of Education I discovered academic researchers were exploring different theories of knowledge and research (Barone and Eisner, Clandinin and Connelly, Cole and Knowles, and Patton)): i.e. Qualitative Inquiry, Interdisciplinary Artistic Inquiry, and Reflexive Inquiry

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FDA approves expanded use of LAP-BAND� System

Our friends at Allergan contacted us this morning to let us know that the FDA approved the expanded use of the LAP-BAND® Adjustable Gastric Banding System.   

LAP-BAND's new indication statement is as follows: 

The LAP-BAND® System is indicated for weight reduction for patients with obesity, with a Body Mass Index (BMI) of at least 40 kg/m2 or a BMI of at least 30 kg/m2 with one or more obesity related comorbid conditions. It is indicated for use in adult patients who have failed more conservative weight reduction alternatives, such as supervised diet, exercise and behavior modification programs. Patients who elect to have this surgery must make the commitment to accept significant changes in their eating habits for the rest of their lives.

The previous indications were for people who had Body Mass Indexes of 35 or above. Now people with BMIs as low as 30, with one or more obesity-related health condition, can have LAP-BAND Surgery.

To put that in perspective, previously, a person with diabetes or high blood pressure who was 5'10" would have to weigh about 245 lbs or more for FDA-approved use of the band. Now that same person could get band surgery if they weighed 210 pounds or more.

Unfortunately, this new range does not necessarily change any insurance company's criteria to cover the surgery, though we will keep in contact with them regularly to find out if they update their criteria. In the meantime, Weight Loss Surgical Center will continue to do surgeries for appropriate candidates who do not have insurance coverage at our reduced cash price.

Allergan figures that 26 million Americans who did not previously qualify for surgery now do, which doubles the potential patient population for the band.

If you're interested in losing weight, find out if your BMI qualifies for LAP-BAND Surgery or download our free catalogue of LAP-BAND information today.

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11 Weight Loss Tips for 2011, Part 11: Reward Yourself

This is the final entry in an 11-part series of weight loss tips for 2011. Yesterday, we talked about what to do when you are sick while trying to lose weight. Today, we’re talking about appropriate ways to reward your efforts.

If you have a 100-pound weight loss goal, you may feel like a failure after losing only 5 pounds in a month. That is why it is important to look for small victories in a variety of ways and reward yourself along your weight loss journey.

Even if you have a difficult time creating and maintaining a weight loss plan, at the very least you should give yourself small goals that will lead you to the larger goal. If at the end of the first month you’ve lost 5 pounds and acknowledge that you attained your 5-pound monthly goal, you will not be as likely to be disappointed in the distance left toward your 100-pound total goal.

Don’t forget, also, that it is not just about the scale. If you’re diabetic, give yourself some glucose monitoring goals. If you have hypertension, give yourself some blood pressure reading goals. Give yourself some goals related to fitting into a certain pair of pants or by measuring different parts of your body for comparison.

Once you have established those benchmarks, you should set rewards or celebrations to motivate yourself, but be careful to not celebrate with food.

Though it seems like a cultural obligation to celebrate, everything with food, it really is not appropriate to celebrate weight loss with food. Here are a few other rewards for yourself when you meet a milestone goal:

  • Go to a movie
  • Take the scenic drive home from work
  • Buy a piece of jewelry to mark the occasion
  • Get a massage
  • Buy some clothes that fit now

Use your own likes and interests (and budget) to create a list of non-food rewards that will keep you motivated throughout your journey. Reward yourself every step of the way, and before you know it, you’ll have rewarded yourself all the way to your final weight loss goal.              

At Weight Loss Surgical Center, we help people lose weight with Lap Band and Realize Band Surgeries. If you would like to learn more about these bands, download our free kit of information about Lap Band and Realize Band Surgery.

Read more:
Prev: Weight Loss Tip 10: Treat Illnesses Appropriately

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"On the Futility of Screening for Genes that Make You Fat"

J. Lennert Veerman (Univ. Queensland) has a nice commentary out in the latest PLoS Medicine entitled On the Futility of Screening for Genes that Make You Fat. Like all papers in this journal, it is available full-text and open-access. There...

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Thursday, November 10, 2011

Scholarly Journal Publishing in Canada - Report 2011

The Canadian Association of Learned Journals has released its Scholarly Journal Publishing in Canada Annual Industry Report 2010-2011. The report notes five major highlights of the journal publishing industry in Canada:

  • Autonomy: 85% of Canadian academic journals are published by scholarly, educational institutions and organizations
  • Few paid staff: only 15% have full-time journal managers; more than 40% of editors receive no compensation (course release, stipend, or other support)
  • Technological change: 53% of journals publish in print and online; 25% fully open access; 39% with a variety of access
  • Circulation: 35% of print journals have circulations of more than 500, compared to 55% with more than 500 registered readers
  • Subscription prices: 62% of journals charge less than $100 for institutional print subscriptions compared to 42% of journals charging less than $100 for institutional online subscriptions

The report is also available in French.

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