Rambodoc at large

Here is some more weird news about obesity. According to an article published in the New England Journal of Medicine, obesity tends to occur almost in synchrony within the same group of friends, even if they are in another country. Here is a news article on this.

If you are the snooty sort who likes to access the original research paper, here is how the authors say they did the study:
"We graphed the network with the use of the Kamada–Kawai algorithm in Pajek software. We generated videos of the network by means of the Social Network Image Animator (known as SoNIA). We examined whether our data conformed to theoretical network models such as the small-world,10 scale-free, and hierarchical types (see the Supplementary Appendix, available with the full text of this article at www.nejm.org)."
Understood, na? Easy! SoNIA, and yet, SoFa!

Want more? Here, take this:

"The use of a time-lagged dependent variable (lagged to the previous examination) eliminated serial correlation in the errors (evaluated with a Lagrange multiplier test) and also substantially controlled for the ego's genetic endowment and any intrinsic, stable predisposition to obesity. The use of a lagged independent variable for an alter's weight status controlled for homophily. The key variable of interest was an alter's obesity at time t+1. A significant coefficient for this variable would suggest either that an alter's weight affected an ego's weight or that an ego and an alter experienced contemporaneous events affecting both their weights. We estimated these models in varied ego–alter pair types."

Capital, my dear chaps! I couldn't have put it better, myself! Nothing does the old noodle as much good as a good, invigorating read of the NEJM's original scientific papers! Of course, for those surgeons who are too lazy to read such articles, there is always this blog, or the wires!

The Times of India, I was told in hushed whispers, has run a story on some deaths that have occured in Indian patients who had undergone bariatric surgery. As I said in my last post, WTF? I mean "Why The Fuss?"
Bariatric surgery is a science that causes massive weight loss in severely obese patients. There are a few types of these, which work by reducing the amount of food that the person can eat, and by preventing full digestion and absorption of ingested food. The commonest operations are the Gastric Bypass and the Lap Band.
Now, these operations, done by the popular keyhole (laparoscopic) method, are rather painless and allow rapid return to home and the workplace. Plus there IS weight loss: big time (70% of excess body weight)!
Now this boring medical, technical-kinda blogpost takes an interesting twist: bariatric surgery does cause fatality. There is a known complication rate. But why should it hit the papers? I have known of this happening in virtually every city in the world where bariatric surgeries are done, and there is always a big ruckus, and then things go back to normal again. Why?
Bariatric Surgery has been hyped up by the surgical industry. It's the truth, and there's no trying to escape that. The media is always fed stories on the positive aspects of the story, but since there is little point in dampening the enthusiasm of prospective patients, the complications are rarely dealt with. And WE, the surgeons, are guilty of this. I, too, have written about this, and not just once.There has been brand-selling in the name of awareness-building. And, of course, the surgical products industry is solidly behind the initiative. These are truths. You may argue over the ethics of it, but good work does get done because of the awareness building, patients do lose weight and get cured of their diabetes and high blood pressure, and surgeons do get their next big car or mistress, and their children do go to elite schools that wipe your bank accounts clean like Coke does to toilets. But, among the positives, there is a stain of the ugly, and the faint stench of death. Surgeons may underplay the issue of complications of bariatric surgery, resulting in a high level of expectations on the side of the patients. So, whenever a death occurs, there is a jolt, a jhatka. The ensuing agitation reaches the media, and there is hullah. After a while, things become normal when the positive spin starts the next cycle. After all, obesity is always a hot topic.
And, you know what, I do bariatric surgery. I make it a point to balance the hype of the positive endpoints (weight loss, improved outlook in life, etc.) with the possible complications and the mortality risks. Because I speak candidly ("Of course, one can die after this surgery, being in a special high risk group"), I don't get too many of these onto the operating table. But then, my fat is not on the fire, neither! That is, at least, one good thing to say about being a poor surgeon!

The Journal of the American Medical Association (JAMA) has published an article that deals with weight management programmes for obese kids.
I read this article eagerly, hoping for some new wisdom on the vexing issue of childhood and adolescent obesity, about which I am interested. Eleven authors for one study: very impressive, or... a bit suspicious? Too many authors looks like a few are free-tripping on the basis of position or something. You know, a Head of Department is also listed as an author, even though he may have done nothing more than signing his name. Anyways, I digress, as usual.



What does the article say? It says simply that where the weight reduction program was followed intensively, really hands-on, the results were better than the typical programs used before. Now it is a known fact that 95% of diet-and-exercise regimes fail to provide sustained weight loss. So how does the JAMA article make a difference? Look for yourself:
"The success of the Bright Bodies program undoubtedly relates, in part, to the frequent contacts between families and the professional staff." Which means that the team sat on the heads of the parents and their fat kids. Obviously, they can't do this forever, so once their attention is withdrawn, things are liable to turn back all over again.
"While the program was very successful in treating overweight children, the expense incurred in operating such a program is substantial." Meaning to say, in other words:"Don't even think you can afford this kind of treatment. This is only because we got big funding to enable us to publish this expensive scientific paper".

"Future work for our group includes cost-benefit analyses, as this would be helpful for pediatric clinicians or health management organizations that are considering offering similar services to overweight children and adolescents." Meaning "We are going to ask for more funds so that we can then publish another paper in JAMA that what we are doing is too expensive to be practical, and the State (or somebody) should allocate money for this project, which we will be happy to spearhead."
Another article that proves that the world is round, as are our bellies!

Stan Kegel sends us this one: this is so apt! Thanks, Stan!

And God populated the earth with broccoli and cauliflower and spinach, green and yellow vegetables of all kinds, so man would live a long and healthy life.

But Satan created McDonald's. And McDonald's brought forth the double cheeseburger.

And McDonald's said to man, "You want fries with that?"

And man said "Supersize them" and man gained pounds.

And God said, "Try my fresh salad."

But Satan created ice cream.

And man gained pounds.
And God said, "I have sent thee heart-healthy vegetables and olive oil with which to cook them."

But Satan created steak so big that it needs its own platter.

And man gained pounds and his bad cholesterol went through the roof.

And God brought forth running shoes and man resolved to lose those extra pounds.

But Satan created cable TV with remote control so man would not have to toil to change channels.

So man watched others exercise and man gained pounds.

And God brought forth the potato, a vegetable low in fat and brimming with nutrition.

But Satan created deep fried potatoes called potato chips (crisps) and dips in which to plunge them.

And man clutched his remote control and ate the potato chips swaddled in fat and cholesterol,

It tasted good, but man went into cardiac arrest.

And God sighed and created quadruple bypass surgery.

But Satan controlled the health care system.

20% of India's population is in the group called adolescents.
The vast majority of this group who live in villages suffer from stunted growth and malnutrition. However, an astonishing change in the health profile of these growing children is noticed in the cities. It has been estimated by the WHO that around 7% of our children are obese. In cities, it has been estimated that 30% of school children are overweight or obese.
One in fifteen kids are obese.
These children are at a high risk of suffering from a host of adult-type diseases like diabetes, hypertension, asthma, etc.
It is also known that 70-80% of fat adolescents become obese adults.
In order to ensure the future of the health of the nation, it is imperative to recognize that obesity is one of the most important diseases in India, as it is so recognized in the developed world. The incidence of childhood obesity is tripling, as per international statistics.
While the best way (as per the WHO) of addressing this issue is by preventive measures including addressing the issue of carbonated beverages, school nutrition, television time, and physical activities, it is also true that a large number of these boys and girls are already beyond prevention. These obese kids need help in order that they get back to the school playground and have the psychological competence and confidence to be with their peers on an equal footing.
For morbidly obese children and adolescents, bariatric surgery has an important role to play, as is being increasingly recognized by the medical profession.
Apollo Gleneagles Hospital, which inaugurated its Bariatric Surgery Department in June 2006, announced the first procedure for adolescent or childhood obesity in Eastern India: a laparoscopic Sleeve Gastrectomy. The two hour long procedure, done by a team of specialists led by Dr. B. Ramana, was followed by a painless and rapid recovery. The patient was a super-obese young boy of 20 years.
In this procedure, around 80% of the stomach is removed along its long axis, leading to a low-capacity stomach shaped like a hockey stick.
This operation was performed by using the most sophisticated technology available in the world, including staplers and the new staple-line buttress materials.

Morbid obesity means excess body weight that causes many diseases and reduces longevity.

It is objectively defined as a BMI of 40 or more. BMI is Body Mass Index.

It is measured as follows:

BMI = Weight (in kg)
Height(m)2
BMI effectively gives us an objective parameter to measure an individual’s state of obesity, relative to his height. If the BMI is more than 40 kg/m2, the condition is known as morbid obesity. In such a state the patient is prone to develop diabetes, hypertension, obstructive sleep apnea, arthritis, gallstones, reflux disease, hernias, cancers, etc. The average longevity of such a clinically severe obese person is cut short by 10-14 years. Indians have a higher proportion of body fat and less bone mass compared to Caucasian and African races. For this reason, the BMI parameters for defining obesity are a little less. For example, in India, a BMI of 37.5 would be the yardstick to call a person morbidly obese. In India, around 15 percent of the population is overweight or obese. Around 5 million people are morbidly obese.
Scientific studies have shown that in this group of patients, supervised weight loss programs using diet and exercise have a failure rate of 95% when it comes to assessing sustained weight loss. Drugs achieve a weight reduction of only 10% at most, and the benefits cease as soon as the drug is withdrawn. In addition, there are side effects of these. The only proven method of weight loss in morbidly obese individuals is Bariatric surgery. This surgery may be of two different types: restrictive (where the capacity of the stomach to store food is restricted), and malabsorptive (where the digestion of fats is hampered). The most common operations are Laparoscopic Gastric Bypass (LGB), Laparoscopic Adjustable Gastric Banding (LAGB), and Sleeve Gastrectomy.
Benefits of the surgery include 70% weight loss in two to six months that is sustained in life, cure of diabetes in 85% of patients, cure of hypertension in around 60%, and cure of snoring in around 90%.
In Kolkata, this kind of surgery is available at Wockhardt Hospitals.

No, I am not going to wear my bariatric surgeon cap and ask you to go under the knife to lose weight. Instead, why don’t you do what you are normally so good (or un-good) at? Use the Web to lose your weight! Ah, you must be thinking, just surf into some sites while slurping the chilled Coke (and making love to the chips, some cookies and a couple of laddoos to round it all off) and kick-start the magical melting machine! Er, I mean, to cut a long story short, no.
You can use your computer to help you in the process a lot better. How so?
Log on to a site like Fatsecret and explore. First do the free registration bit and then go! Fatsecret is not your typical site that promises you a one-week loss of a ton of lard and then tries to sell you diets. It just provides you a space where you can speak up and share your thoughts and experiences, at the same time becoming part of a community that believes in “United We Fall”, at least in terms of weight! I learn from a guy called Jiga, who has come into the nineties from a weight of a hundred kilos, that he gets his diet to work by eating every two hours to keep his metabolism going. In addition, he repeats some old pearls like “one bad meal does not deserve another”. You also get a variety of diet-friendly recipes for each meal. I read this laughably simple recipe for breakfast, called “low-fat yoghurt with banana”, where the directions are “chop banana and mix with yoghurt (dahi)”. But if you add, me-says, some chopped almonds and berries or papaya bits, you are in serious business! However, it is not merely the revision of various diets that matters, but a sharing of the psyche: one feels part of a community of people helping each other to lose weight. You could also imagine this site as a publisher interested in your personal weight loss (or gain) story and doing this for free!
Like exercise, dieting is good for some time before it gets boring and depressing. Don’t you feel that it would be so much better if you had a group with whom you could diet or exercise, so that when you feel down, there are others who pep you up? Fatsecret lets you do that. Find friends who will diet with you and share the experience. It may just work! There are lots of other sites that use innovative approaches that help you do better in your weight loss attempts. Traineo is another free site that works you out by setting up four motivators of your choice and sends weekly updates to them on your weight loss progress. This, surely, should be motivating!
If you like to go for the gimmicky stuff to spend money on to motivate you to use ‘em, try a Geek-a-Cycle that costs around $350 and exercise while you work at your desk.
There is actually some serious tech that helps you optimise those morning saunters in the park. Get a Nike with iPod. Check it out here and type ‘nike’ in the search bar. You will also gets loads of accessories that will certainly help you lose money, if not weight! The Nike with iPod is basically a wireless sensor that fits in your Nike shoe and sends the workout data (like how many kilometers you walked, your speed, calories burned, etc.) to your iPod nano, which you are using in the meanwhile to listen to your music. When you come home, sync your iPod to your computer (on the iTunes application) and get the records of your exercise. And, before you ask, it only works with the Nano, and not with your video iPods. On a daily basis, you can use this as a target-driven exercise program, and even compete with others online. Just sync your iPod at the Nike site and enrich yourself with the online community’s running and walking targets and experiences. You can also learn which rock ‘Powernumbers’ are celeb favorites that might just charge you up as you run. In case you didn’t get on to the hitch, it is that you have to buy the thing. The iPod sports kit (the sensor, stupid!) is cheap at Rs.1995 (around $29), but this goes only with the Nike + shoes. And them cushioned things cost only an arm and a leg! Want to buy it? As the company says, ‘Just Do It’! As for me, well, no thanks, I prefer to wait for it as a birthday gift, some day, some year!
I am indebted to Lifehacker for this article, and for lots more!