Being overweight

Understanding Being Overweight

Having a good understanding about being over weight includes an understanding about adult obesity, and how to measure adult obesity. Child Obesity is discussed on the Special Conditions page. Knowing the health risks and complications of being overweight helps to understand obesity’s statistical relevance and economic cost to society.

Obesity & Weight Loss

Healthy Eating and Exercise

Healthy eating and consistent exercise are both important components of maintaining a healthy weight.  Our practice will educate you on the simple steps that you need to take with exercise and eating behaviors to be successful with the Lap-Band procedure.

Only after one is informed of all of the traditional methods for losing weight and weight management, should one consider the Lap-Band procedure.

Lap-Band® from a Personal Perspective

This is a letter we received from a former patient, giving her personal perspective on achieving weight loss success. She explains how Lap-Band has changed her life and brought her everyday victories.
Lap-Band Before and After San Diego Lap Band

* Results may vary.

My name is Duana, and I had Lap-Band® surgery on May 11, 2011. My story started when I went with my parents to the Lap-Band orientation with my insurance information. I eventually received the insurance approval, but it was a long road to get it done. I almost gave up, but Dr. Gertsch and Dr. Martinez (from the Premier Weight Loss Center) never did. I would not be where I am today without them.
Before I had my surgery, I was 349.5 pounds. I am now 194 pounds, a size 14, and getting smaller! The first seven days after my surgery, I lost 20 pounds, and the weight loss just kept going. I did the surgery for my health, because I was borderline diabetic. I had to take two water pills a day and wore clothing in sizes 26 to 28.*
When I would go to places like Sea World, I would have to stop every 10 to 15 minutes to rest because my back would be hurting. Now that I have lost 156 pounds, I walk a lot without needing to stop and rest along the way. My kids have to catch up with me because I am walking too fast.*
Before the surgery, when I would go to theme parks, I was too big for the rides. I was told I was too fat and could not go on them with my kids. Now I go on amusement park rides with no problems, and no one looks at me as if I am too fat for them.*
I am very happy with this procedure, and I love my doctor for all they have done for me. Everyone at the Premier Weight Loss Center cares for the patients and does not judge them. I would do the surgery all over again, and I brag about this medical center to all my friends. I even had two friends who also had the procedure done.*
*Results may vary.
Thanks to all who helped me!
To learn more about surgery for successful weight loss, contact our Premier Weight Loss Center of San Diego. You can attend one of our free seminars which are held daily or you can attend one of our monthly free support group meetings which are held on the second Monday of every month at 6:30 pm. The Premier Weight Loss Center can be reached at 800-GBC-7103 or 800-422-7103. *Results may vary from person to person.


A Healthy Pregnancy After Lap-Band

12 Jul 2013 LAP-BAND Procedure

If you’re an overweight woman who is planning to have a child in the future, the Lap-Band® procedure can be an important step in preparing for a safe, healthy pregnancy. Lap-Band surgery may lead to significant weight loss and the reduction of obesity complications. Here are some points to consider to have a healthy pregnancy after Lap-Band. *

  • You need 12-18 months of “me” time. We recommend waiting at least one year after the procedure before trying to get pregnant. Dedicate this time period to concentrating on your own weight loss, as the body adjusts to the Lap-Band. Preferably, before becoming pregnant, you will have reached a healthy weight. *
  • In some cases, weight loss can enhance fertility. Being significantly overweight may affect hormone levels and fertility. As the weight comes off, fertility could improve. It is important to remember that your smaller stomach may not absorb oral contraceptives as well, meaning you should consider alternative forms of contraception. *
  • A healthier weight may mean fewer complications. Pregnancy with obesity carries risks. Excessive weight is associated with specific health concerns as you carry a child. Achieving a healthy weight with Lap-Band can alleviate the worries over pregnancy complications related to obesity. *
  • Congratulations! Let us know you’re pregnant. Your obstetrician is vital to the health of your baby. You’ll also want to contact your Lap-Band San Diego physician when you receive the good news. During this time, you will need to gain some weight. Your band can be loosened, allowing you to follow your obstetrician’s recommendations concerning nutrition and food intake. Because the Lap-Band is adjustable, it does not prevent a baby from receiving nourishment from its mother. The band should also support more gradual weight increases. *
  • Think weight loss after baby. Once your bundle of joy arrives, talk to your medical providers about the best time to make adjustments for weight loss. These can usually be performed while breastfeeding, if you continue eating nutrient-rich foods for your little one *

A healthy pregnancy is the top priority. Contact Lap-Band San Diego if you need more information as you start or add to your family.
*Results may vary. All medical procedures have risks of complications.  Consult your doctor.

As Obesity Surgery Soars, Patients Weigh Which Method is Best

By MARILYNN MARCHIONE, AP Medical Writer. Associated Press. New York:
Jan 1, 2006. pg. 1
As more people abandon New Year’s resolutions to lose weight and turn to obesity surgery, doctors are debating which type is safest and best.
And researchers are uncovering some surprising trends.
The most common method in the United States – gastric bypass, or stomach-stapling surgery – may be riskier than once thought. Yet surgeons still favor it for people who need to lose weight fast because of heart damage or other serious problems.
A gentler approach favored in Europe and Australia – an adjustable stomach band – can give long-term results that are almost as good and with far fewer risks. It may be the best option for children or women contemplating pregnancy, and is reversible if problems develop.
A radical operation – cutting away part of the stomach and rerouting the intestines – is increasingly being recommended for severely obese people. It gives maximum weight loss but also is the riskiest solution.
A large U.S. government study just got under way to compare all three options.
But regardless of which method is used, studies show an inescapable reality: No surgery gives lasting results unless people also change eating and exercising habits.
“The body just has many ways of compensating, even after something as drastic as surgery,” said Dr. Louis Aronne, director of the weight loss program at Weill-Cornell Medical College.
He is president of the Obesity Society, the largest group of specialists in bariatrics, as this field is known. The group’s recent annual conference in Vancouver featured many studies on surgery’s long-term effects.
Obesity is a problem worldwide. About 31 percent of American adults – 61 million people – are considered obese, with a body-mass index of 30 or more. That’s based on height and weight. Someone 5- foot-4 is obese at 175 pounds; 222 does it for a 6-footer.
Federal guidelines say surgery shouldn’t be considered unless someone has tried conventional ways to shed pounds and is at least 100 pounds over ideal weight, or has a BMI over 40, or a BMI over 35 plus a weight-related medical problem like diabetes or high blood pressure.
More people are meeting those conditions. A decade ago, less than 10,000 such surgeries were done in the United States. That ballooned to 70,000 in 2002 and more than 170,000 in 2005, says the American Society for Bariatric Surgery.
Doctors disagree over which is better: the most popular method, Roux-en-Y gastric bypass, or the adjustable band, which is rapidly gaining fans. Either can be done through a big incision, or laparoscopically with tiny instruments passed through small cuts in the abdomen.
In gastric bypass, a small pouch is stapled off from the rest of the stomach and connected to the small intestine. People eat less because the pouch holds little food, and they absorb fewer calories because much of the intestine is bypassed. They must take protein and vitamin supplements to prevent deficiencies.
The adjustable band has been available in the U.S. only since 2001 but far longer in Europe and Australia where it is dominant. It accounted for 17 percent of U.S. obesity procedures in 2005.
A ring is placed over the top of the stomach and inflated with saline to tighten it and restrict how much food can enter and pass through the stomach.
Deaths from the procedure are only 0.1 percent compared to about 2 percent for gastric bypass. One recent study of Medicare patients found deaths a year after gastric bypass as high as 3 to 5 percent.
The band’s reversibility makes it a better choice for children, some doctors say.
“It’s becoming more well-known and more accepted. Patients like it because it’s less invasive. It’s an easier surgical procedure. It’s safer,” said Georgeann Mallory, executive director of the bariatric society.
“To me it is a very straightforward decision,” said Dr. Paul O’Brien, director of the Centre for Obesity Research and Education at Monash University in Melbourne, Australia. “I would strongly recommend that the consumer consider the safest effective procedure first,” which is the band, he said.
American doctors have preferred bypass operations because they produce faster, greater weight loss. But new research by O’Brien and others calls that into question.
Combining results on 23,638 patients in 43 published studies, they found that bypasses beat bands for the first three years but were comparable after seven years, with excess weight loss of 55 percent for bypass and 51 percent for bands.
That impressed Dr. Edward Livingston, chief of gastrointestinal surgery at the University of Texas Southwestern Medical Center and chief of bariatric surgery for the Department of Veteran’s Affairs national system.
“I really was not enthusiastic about bands until I came to Dallas from Los Angeles and saw the results from the group that I joined, which where quite good,” he confessed. “What you can accomplish in a year with a gastric bypass you can accomplish in five years with a laparoscopic band.”
Results would improve if Americans copied the Australians and included in the price of the band any future adjustments, Livingston said.
“A key to the success of banding procedures is the followup and working with a patient on their compliance,” he said. “When they come in and they’ve sort of fallen off the wagon, you adjust the band. It really has an amazing effect.”
Bands also appear safer for women attempting pregnancy. Several years ago in Massachusetts, a woman and her 8-month-old fetus died of complications 18 months after gastric bypass surgery. Other pregnancy-related deaths have been reported.
In contrast, another study O’Brien and colleagues presented at the obesity meeting found that pregnancy outcomes for women with stomach bands were comparable to normal-weight women, and better than for obese women without bands.
Dr. Mitchell Roslin, chief of obesity surgery at Lenox Hill Hospital in New York City, did a band operation in October for Long Islander Donna Dotzler, who weighed 279 pounds, but wants to do a more drastic surgery for her husband.
“I gave up on New Year’s resolutions maybe five years ago,” said Jim Dotzler, who weighs 479 pounds. “I’m a smart guy. If this were a matter of willpower, I’d have taken care of this a long time ago.”
The operation Roslin has advised for him is BPD, which stands for biliopancreatic diversion, with or without a second procedure called a duodenal switch. Studies show it can cause loss of up to 80 percent of excess body weight for at least as long as 10 years afterward.
Surgeons remove three-fourths of the stomach to leave a sleeve- or banana-shaped organ that is connected to the small intestine, bypassing more of it than a standard gastric bypass does. It can be done in two operations a year apart to reduce its severity and the chances of death, which can be as high as 5 percent.
The “switch” preserves a valve that controls release of food into the intestines from the stomach. These operations account for nearly 5 percent of U.S. obesity surgeries and are growing.
On the horizon are other approaches, like vagus nerve stimulation, to control impulses to eat, and new drugs like rimonabant, which blocks a pleasure center in the brain that makes people want to munch.
“I see the future as combined therapy,” with surgery, medication and other approaches used simultaneously, said Aronne, the obesity society president. “Time will tell what works out best.”
Copyright © Associated Press Jan 1, 2006. Reproduced with permission of the copyright owner. Further reproduction or distribution is prohibited without permission.

On a Scale of Life or Death

by Valerie Reitman, Times Staff Writer / Los Angeles Times
Jan 4, 2006
It started with a terrible dream: Cyrus Tehrani had died. At the funeral, his wife and six children wept over his outsized coffin.
That nightmare jolted Joe Guarderas awake. He knew that if his best friend Cyrus, 34, didn’t take drastic action, the dream would become reality.
Cyrus had grown gargantuan. His girth had destroyed his knees, spiked his blood pressure, sapped his breath and landed him in the hospital for several days with severe leg swelling.
Cyrus’ older sister, Sheila Tehrani, 37, was just as big, and just as imperiled. Only a pound separated the siblings: Cyrus weighed 578, Sheila 579.
Guarderas hatched a plan. “If you knew Cyrus was going to die,” Guarderas recalled asking the healthier Sheila, “would you give anything to get him back?”
“In a heartbeat,” Sheila replied.
“Would you give up the house?”
“Of course,” Sheila replied.
Well, said Guarderas, “that’s what you may have to do.”
That conversation late in 2004 launched the Tehranis’ last-ditch attempt to shed the weight that was slowly smothering them. Surgery to slash their food intake would cost at least $25,000 each. With no health insurer willing to pay, the only recourse was to refinance the house they had inherited from their father. Sheila still lives in a studio apartment behind the house.
Sheila researched options on the Internet and made an appointment with one of Los Angeles’ most experienced bariatric surgeons, Dr. Carson Liu.
Liu wondered if it was too late. Had the siblings become so huge that the surgery was too risky?
Vast numbers of Americans face a similar predicament. They have outgrown the weightiest medical description: morbid obesity. About 725,000 to a million people fit in this “super-obese” category.
But even that term is no longer expansive enough for the Tehranis and a fast-rising number of others. Between 140,000 and 400,000 Americans are believed to weigh more than 400 pounds. Liu dubs them the “super-duper” obese.
With a few hundred extra pounds severely straining every bodily organ, they appear to have one last hope: bariatric surgery.
But that surgery poses such grave risks for huge patients that many surgeons refuse to operate on them.
“They are at the end of their lives,” Liu said. “They are being operated on much too late. These are the patients that have bad congestive heart failure — their hearts can’t keep up with their bodies, which are falling apart.”
By the time the Tehranis consulted Liu in early April 2005, they could walk only a few yards before becoming winded. Their arms puffed out like basketballs. Their distended bellies draped to their knees like sandbags. Restaurants with booths, chairs with armrests, airline flights, even clothes from shops catering to big and tall people — all were out of the question. (Cyrus jokes that labels on his clothes couldn’t accommodate all the Xs: he wore 7X shirts over 78-inch-waist pants.)
Stares were as painful as stairs for Sheila.
A pudgy child, she had grown quite heavy by high school, despite the attempts of her father — an engineer who immigrated to the United States from Iran — to police what she ate.
When she was 11, her father sent her to the now-defunct Schick behavioral modification center in Pasadena, where she received tiny electrical shocks as she took bites of a Hostess apple pie. Like the diets before, it didn’t work.
By her late 20s, she no longer could fit behind the wheel of her Toyota pickup truck. She sold it and gave up driving.
She grew more sedentary, rarely leaving her studio apartment in the back of the family house. Instead, she earned money baby-sitting the children whom relatives would take to her home.
Grocery shopping required exercising only her index finger — to dial Vons for delivery.
Cyrus, who as a husky teenager had biked and lifted weights, wedged himself behind the wheel of his Ford Windstar minivan (“thank God for tilt steering,” he says) to commute to Santa Ana, where he still makes DVD masters used to mass-produce movies and music.
The Vietnamese immigrant owners and workers there affectionately rub his belly and call him their Buddha. He calls the men there — and everywhere else — Slim. Other potential employers snubbed him because of his size, he says.
Caring for six children — three of his own with Karen, his wife of seven years, and her three children from a previous marriage — kept him busy.
But his stamina had dwindled. By the time Joe Guarderas talked to Cyrus’ sister, he could barely get out of bed or bend over to tie his shoes. To ease his aches and lower his blood pressure, he downed prescription and over-the-counter pills by the handful.
When he was in the hospital last spring with his leg problems, a cardiologist told him he’d be lucky to live 10 years.
But until Sheila convinced him of the serious health risk after Guarderas’ dream, Cyrus preferred to look at the “funny” side of being fat. He reveled in his young son’s riposte to an unkind remark by his kindergarten friend: “Wow, Gavin, your dad is really fat.”
“My daddy’s not fat,” Gavin shot back. “My daddy’s full of love.”
The Tehranis certainly overate. They loved heaping portions of calorie-rich Persian foods — breads, rice, cheeses and kebabs. Cyrus often ate super-size fast-food combos for lunch and had a weakness for Ben & Jerry’s Chunky Monkey and Chubby Hubby ice cream, at about 600 calories per cup.
“If I knew I’d buy as much Ben & Jerry’s as I have, I’d have bought stock,” said Cyrus, who really packed on the pounds after quitting smoking in his 20s.
The siblings also ate to soothe bouts of depression after the deaths of their parents and a half-sister.
But the siblings and friends insist that they weren’t eating near the Costco-size quantities one would think necessary to be 400 pounds overweight. “It’s not like we were pulling up to a food trough,” Cyrus says.
Sheila said she did none of the things she heard others report at Overeaters Anonymous meetings. “I thought these people were sick, because they were eating out of the trash and were closet eaters,” she said.
All it takes to gain a pound a week is a 500-calorie surplus every day. That’s two Mrs. Fields cookies or a large order of McDonald’s fries.
A pound per week totes up 52 pounds annually. In five years, that’s 260 pounds.
The bigger the Tehranis got, the less they restrained themselves. At their size, what did one extra Krispy Kreme doughnut matter?
Surgeon Liu attributes two-thirds of super-obesity to genetics (many members of the Tehrani family are heavy, though not super-obese) and one-third to eating habits and lack of exercise.
Yo-yo dieting can make it worse.
“There is something that happens when fat cells starve,” Liu said. “It makes people extremely hungry, and they fall off their diets and gain the weight back so fast — and then maybe add an additional 20 pounds.”
Above 300 pounds, the weight seems to accrue even faster, Liu says, without “the patient — or anybody — realizing exactly why.”
Few doctors have a scale that goes beyond 350 pounds. So Cyrus was shocked in April when he stood on Liu’s and it registered 150 pounds more than his last weigh-in four years earlier.
“I knew I had gotten fatter, but I never thought I would break that 500-pound mark,” Cyrus said. “And when I saw 578, I got sick to my stomach.”
Standing 5 feet 11, Cyrus had a weight-to-height ratio, or body mass index, of 81, more than triple the maximum 25 considered healthy for most adults. At 5 feet 2, Sheila had a body mass index of 106.
Cyrus’ health insurer refused to cover weight-loss surgery. Insurance companies typically want documentation that patients have tried dieting. The insurers blanch at the procedure’s mortality rates, and also fear that too many of the 20 million obese patients nationwide will sign up for their plans if they offer the surgery too readily, Liu said.
Sheila has no insurance.
By the time they saw Liu, the Tehranis, inspired by the huge weight losses of NBC weather forecaster Al Roker and singer Carnie Wilson, were convinced they needed a gastric bypass procedure.
But Liu told the Tehranis gastric bypass was too risky for them. Super-obese patients are 10 times more likely to die from bariatric surgery than those who are morbidly obese. And he warned that a serious complication necessitating hospitalization for a month could easily cost $300,000, virtually all the equity in their childhood home.
The only procedure he would do for them was the LAP-BAND® System adjustable gastric banding system, in which a synthetic ring is attached to the upper end of the stomach. Liu has performed more than 1,700 gastric bypasses and 350 using LAP-BAND® Systems. He said he prefers the latter because it is far less drastic and, unlike the bypass, is adjustable and reversible, though weight loss is slower.
If they still wanted a bypass, Liu assured the Tehranis, he would do it — after they each lost 150 pounds with LAP-BAND® Systems.
He instructed the siblings to lose 28 pounds, about 5% of their weight, before the surgery to show their determination, shrink their fatty livers and make the surgery easier.
The Tehranis delayed the start of their diets for a week until after Sheila’s birthday party. After that, they stuck to two protein shakes and one healthful, low-carbohydrate meal a day. In six weeks, Sheila dropped 28 pounds and Cyrus lost 19.
But Liu said he was worried that swelling in Cyrus’ legs might indicate the right side of his heart was failing. He was concerned that Sheila’s fast pulse might mean her heart was starting to give out.
Liu said he needed to conduct tests for congestive heart failure. The overnight stay in the intensive-care unit at Olympia Medical Center, near Beverly Hills, cost the siblings $5,000 each.
On the last day of solid food before the operation, the Tehranis pigged out one last time. Cyrus downed a Tommy’s triple cheeseburger topped off by Chubby Hubby.
Sheila had higher standards. “I’m not investing my last meal on Tommy’s,” she recalled telling Cyrus. She opted for rice and kebabs from Shiraz restaurant in Glendale.
Liu dubbed such binges “last meal syndrome.”
Sheila barely slept the night before she and her bother entered the hospital. Cyrus’ children clung to him as he prepared to leave.
“When you come home, will you be skinny?” 5-year-old Jillian piped up.
He reassured them it wouldn’t be long before he could ride the rides at Disneyland with them — something he’s been too big to do since age 21.
At the hospital, Cyrus and Sheila nervously poked fun at each other. The only children of parents who divorced when they were 3 and 7, they have always been close and see (and tease) each other constantly.
“I told [wife] Karen I have atrophy of the jaw because I’m not chewing nearly as much,” Cyrus told Sheila.
“But you’re still talking,” Sheila shot back.
A nurse asked Cyrus if he had any valuables with him. He looked at Karen.
“Just her,” he said.
“Do you have an advance directive?” the nurse asked.
“She knows what I want,” Cyrus said.
As they were wheeled separately into their intensive care unit rooms, the Tehranis realized they wouldn’t see each other for a while.
“Bye, Fat,” Cyrus said to his sister.
When Liu looked askance, Cyrus explained that “fatso” was a name they fondly split.
“Bye, So,” she said.
Liu worried as he walked out of the hospital that night, not so much about Cyrus, whose health had improved with the weight loss, but about Sheila. Her liver hadn’t shrunk much. So much fat still swathed her overburdened lungs that he worried she might not wake from the anesthesia.
The morning of June 7, their hearts were beating at triple the normal rate. But test results revealed no permanent damage. Liu gave the go-ahead for both.
Sheila was first. As music from David Gray’s “White Ladder” album poured into the operating room, Liu inserted an instrument equipped with a tiny camera into her navel. An image of her insides flashed onto monitors above the operating table.
He inserted three more tong-like cutting and suturing devices into her abdomen.
The long hours that Liu, 40, spent playing video games while growing up chagrined his Chinese immigrant parents, but they paid off professionally. Eyes glued to the monitor, he maneuvered the tools.
It took more than an hour to work through the hardened fat, which looked like yellow gel on the screen. Finally, Liu saw the left lobe of Sheila’s liver, swollen to the size of a five-pound steak from what is normally the size of an orange. The surgeon assisting him pulled it aside to reveal the stomach.
Liu positioned the inflatable LAP-BAND® System so it cinched her stomach into an asymmetrical hourglass shape, with 98% of the stomach below the band.
At 11 a.m., Liu finished the 2 1/2 -hour procedure. It had taken five times longer than usual.
“I’m hungry,” the fit, 6-foot, 1-inch Liu declared. He repaired to the hospital’s cafeteria for a two-hour break.
Cyrus’ abdominal wall was softer and his liver much smaller. Liu finished his procedure in just 50 minutes. The Tehranis went home the next day.
The LAP-BAND® System, which narrowed the stomach opening from the size of a silver dollar to the size of a dime, made the siblings feel stuffed. At first, they could down just liquids, then soft foods, like tofu and yogurt.
For the first month, Sheila was depressed. “I don’t know what it was — whether it was that food was always my outlet and now it was taken away or if it was because, being healthy all my life, this was the most I’d ever seen a doctor,” she said.
But she dropped 22 pounds by the time they next saw Liu, two weeks after surgery.
At a family cookout soon after, Cyrus and Sheila could eat only about one-third of a chicken breast and some green beans each.
By mid-July, Cyrus began to pull ahead; he had dropped 48 pounds in five weeks, 83 pounds total. Sheila had dropped 28 pounds, for a total of 61.
Sheila mentioned to Liu that she had eaten pasta and bread, albeit in tiny portions.
He reacted with horror.
“You ate bread?”
He told her it was time to tighten the LAP-BAND® System.
“He’s punishing me for eating bread,” she joked as Liu filled a syringe and pumped saline into the barely visible port opening in her chest, which was attached to the LAP-BAND® System device.
Cyrus began walking more around the neighborhood with his children.
Two months after the surgery, both Tehranis had dropped below 500 pounds. Cyrus had lost 97 pounds and Sheila 85. The whole family rented an RV and went camping at Lake Perris, the siblings’ first camping trip since they were kids.
At their October appointment, Sheila told Liu she needed “a LAP-BAND® System for my mind,” something to choke off the emotional issues and the habits that drove her to eat.
Sheila considered it a victory that she got by with just one tiny box of Junior Mints for Halloween. Cyrus carried his children’s trick-or-treat bags but abstained.
On the eve of the family’s Thanksgiving potluck dinner, Sheila made chocolate chip and gingerbread cookies, without sampling any batter, and ate only a few the next day. Cyrus ate some turkey and splurged on a dollop of homemade cranberry sauce.
He has become downright militant about sweets and starches, much to Sheila’s chagrin. She believes that eating a little of something she loves will prevent her from feeling deprived, then binging.
Cyrus has become zealous about going to Bally’s gym in Pasadena several nights a week to lift weights and walk on the treadmill. His children are asleep when he returns home.
“Every day I wake up and look into the faces of my motivation,” Cyrus said of them.
It has been six months since the surgery. At their most recent appointment, early in December, Cyrus registered the loss of 19 more pounds, while Sheila showed a gain of 1 1/2 pounds. All told, Cyrus had lost 146 pounds and Sheila, 101.
Sheila was disappointed but refused to let Liu tighten the LAP-BAND® System. She already had trouble eating meat and told him it was painful to down more than half a cup of food at a time.
“There’s only so much you can eat, even if you do eat crap,” she said.
Liu told her she must start exercising. She vowed to get a treadmill. Cyrus suggested an elliptical trainer.
“Are you kidding?” she replied. “I’d start a fire with my calves” rubbing together.
Cyrus, meanwhile, complained to Liu that he was losing muscle as well as fat, despite his workouts and increased protein intake.
” ‘Boohoo, I’m losing weight,’ ” Sheila mocked.
She later said she felt “like we’re having two completely different experiences. He stands up at support group meetings — and he happens to be wearing a T-shirt that says ‘I had an IQ test and it came out negative’ — and he’s saying, ‘It’s all mental.’ He’s like, ‘Don’t eat it, don’t do it.’ I don’t know if it’s because he’s a man and I’m a woman, but I’m much more emotional.”
Though everyone praises her accomplishment, Sheila said she still imagines them thinking, “Oh, my God; you’re still so fat.”
The one thing the siblings — who were down to 432.6 and 477.6 pounds as of Dec. 7 — do agree on is how much the weight loss has changed their lives. “It’s amazing how much more energy I have now,” Cyrus said. “I’ve lost a whole person.”
Their faces look healthier. Sheila walked up a steep hill at Eagle Rock Hillside Park on Thanksgiving with the rest of the clan. She played in the inaugural Tehrani kickball game — though her 3-year-old niece served as pinch runner. For the first time in years, she went Christmas shopping, spending a few hours walking around the Glendale Galleria with her best friend.
Cyrus has lost 20 inches from his waist. He no longer needs medications and his blood pressure is nearly normal.
A few weeks after the operation, Karen called Guarderas to thank him for saving Cyrus’ life.
On New Year’s Eve, she reflected on how much better life is now that Cyrus can join the rest of the family in so many activities.
She choked up as she recalled the cardiologist’s grim 2004 warning that Cyrus wasn’t likely be around much longer and how she tried to protect the children from that prediction.
They sensed the looming threat, she believes: Jillian hated to leave Cyrus’ side, not wanting to go to kindergarten, sometimes even trying to sneak home. Now, she loves school.
And so the Tehranis don’t mind paying $730 more each month for the next 30 years to pay off the $100,000 home-equity loan they took out to pay for their transformation and the surgery they may need in the future to cut off the folds of skin. Said Sheila: “Oh, my God, we are so lucky we had the option…. How do you put a price on your life?”
The Times will follow the Tehranis’ progress with occasional articles in the paper and on The writer can be reached at
Copyright © 2006 Los Angeles Times. All right reserved. Republished with permission.

Study: Gastric Band Works Better than 500-Calorie Diet

by Nanci Hellmich / USA Today
May 2, 2006
Adjustable gastric banding is much more effective long-term than a very low-calorie diet for people who are about 50 pounds overweight, a study shows.
Medical guidelines support this surgical procedure — which puts a band around the top of stomach to create a feeling of fullness — in patients who are extremely obese, about 100 or more pounds over a healthy weight, or those who are almost as overweight and have serious medical conditions, such as type 2 diabetes.
Researchers at Monash University Medical School in Melbourne, Australia, recruited 80 patients who were on average 52 pounds over a healthy weight. Half had the laparoscopic adjustable gastric band surgery.
The other half followed a medical program that included a variety of strategies such as a very-low-calorie diet (500 calories a day) with liquid meal replacements, prescription weight-loss medication and behavioral therapies.
Findings in today’s Annals of Internal Medicine:
After six months, both the surgery patients and the low-calorie dieters lost an average of 14% of their starting weight.
After two years, the gastric band patients lost 22% of their starting weight. That was about 87% of their excess weight, or roughly 45 pounds. They also showed marked improvement in their health and quality of life.
At the end of two years, the dieters had regained much of their lost weight but were still 5.5% below their starting weight. They had lost 22% of their excess weight, or about 12 pounds.
Researchers are still analyzing the weight-loss data. “I’m very happy that the gastric band patients are continuing to maintain their weight loss,” says lead author Paul O’Brien, director of the university’s Centre for Obesity Research and Education. Since the study, he received grants from INAMED Health, maker of the LAP-BAND® System.
In this study, the surgery was as safe as the diet program, but O’Brien notes the procedure does carry risks, and some may need follow-up procedures, such as readjusting the band position. The surgery costs $14,000 to $18,000 in the USA, he says.
Insurance companies vary widely in coverage of gastric banding or gastric bypass, a more complex surgery that creates a much smaller stomach and rearranges the small intestine. Average cost: $26,000. Under certain conditions, Medicare covers both surgeries.
Many surgeons in the USA use gastric bypass because bypass patients lose more weight overall and lose it faster, says Neil Hutcher, president of the American Society for Bariatric Surgery and a surgeon in Richmond, Va.
Thomas Wadden, an obesity expert at the University of Pennsylvania School of Medicine in Philadelphia, says gastric banding “is a very effective procedure, but it’s not a rational, cost-effective solution to the epidemic of obesity.”
“Because we have limited health-care dollars, we have to decide how best to invest them. Are we going to provide bariatric surgery for a relatively small number of people or instead invest in the prevention of obesity so our children hopefully won’t need this surgery?”
Copyright © 2006 USA Today. All rights reserved. Republished with permission.
Results may vary from person to person.

Educational Materials

Please call us and we will send you a free BROCHURE and a DVD on the Lap-Band System Procedure.

Getting a grip on obesity

by Loretta Grantham / Palm Beach Post
November 12, 2006
Many patients pondering weight-loss surgery, such as Margaret Kendall, say the thought of slicing, stapling and rerouting their digestive system is more than they can stomach. Read more.

Study: Gastric band works better than 500-calorie diet

by Nanci Hellmich / USA Today
May 2, 2006
Adjustable gastric banding is much more effective long-term than a very low-calorie diet for people who are about 50 pounds overweight , a study shows. Medical guidelines support this surgical procedure — which puts a band around the top of stomach to create a feeling of fullness — in patients who are extremely obese , about 100 or more pounds over a healthy weight , or those who are almost as overweight and have serious medical conditions, such as type 2 diabetes. Read more.

On a Scale of Life or Death

by Valerie Reitman / Los Angeles Times
Jan 4, 2006
It started with a terrible dream: Cyrus Tehrani had died. At the funeral, his wife and six children wept over his outsized coffin. That nightmare jolted Joe Guarderas awake. He knew that if his best friend Cyrus, 34, didn’t take drastic action, the dream would become reality. Cyrus had grown gargantuan. Read more.

Diet: As obesity surgery soars, patients weigh which method is best

By Marilynn Marchione / Associated Press
Jan 1, 2006
As more people abandon New Year’s resolutions to lose weight and turn to obesity surgery, doctors are debating which type is safest and best. And researchers are uncovering some surprising trends. The most common method in the United States – gastric bypass, or stomach-stapling surgery – may be riskier than once thought. Read more.
LAP-BAND® System Bibliography, Articles & Abstracts

Getting a Grip on Obesity

By Loretta Grantham
Palm Beach Post Staff Writer
Sunday, November 12, 2006
Many patients pondering weight-loss surgery, such as Margaret Kendall, say the thought of slicing, stapling and rerouting their digestive system is more than they can stomach.
“I consider gastric bypass to be the last straw,” says Kendall, referring to the procedure that accounts for about 70 percent of U.S. bariatric surgeries (and the choice of Carnie Wilson and Al Roker, celebrities who went public with their decision).
But at 315 pounds, the Royal Palm Beach teacher was desperate. She’d tried so many diets, she says, that the letter she wrote to her insurance company outlining her weight-loss attempts was six pages long.
Kendall, 46, attended a JFK Medical Center seminar on the LAP-BAND® System, an adjustable silicone ring that’s placed around the upper portion of the stomach to limit food intake and boost fullness.
“As soon as I heard about the reversibility and the less invasive feature of the band, I was interested,” she says. “But my primary thing was that it didn’t have anything to do with the intestines. When they said that, I got a lot more comfortable.”
So comfortable, in fact, that she’s having a LAP-BAND® System implanted this month, joining an increasing number of people who’re willing to accept slower initial weight loss in exchange for a less drastic operation that doesn’t alter their anatomy.
“The LAP-BAND® System has gone from 0 to approximately 25 percent of bariatric operations in about five years,” says Dr. Philip Schauer, president of the American Society for Bariatric Surgery. “That’s pretty rapid. It definitely has found a niche.”
The Lap-Band® System, developed by Inamed (which was acquired by Allergan in April), received FDA approval in June 2001 and is the only gastric band used in the United States. Its name comes from “laparoscopic banding,” which means the device is designed to be implanted with instruments passed through small cuts in the abdomen rather than through a full incision.
Rocker wife and reality TV matriarch Sharon Osbourne was an early success story after getting a band in 1999 at Cedars-Sinai Medical Center in Los Angeles during FDA trials. She lost 125 pounds and has regained just 15.
Although the LAP-BAND® System is relatively new in the United States and still gaining acceptance by initially wary insurance companies, gastric banding (there are other versions beside the LAP-BAND® System) has been popular in Europe for more than a decade.
Studies vary, but in general, LAP-BAND® System patients drop about 45 percent of their excess weight the first year after surgery. Patients who have gastric bypass, which involves stapling off a small pouch from the rest of the stomach and attaching it to the small intestine (therefore “bypassing” some intestine and decreasing calorie absorption), lose as much as 70 percent the first year.
Schauer, director of bariatric surgery at the Cleveland Clinic in Ohio, likens the choice to picking stocks: The higher-yield procedure carries more risk.
Dr. Andrew Larson at JFK Medical Center in Atlantis, however, doesn’t think the risk is worth it. Research shows that after seven years, both surgeries achieve comparable results — 51 percent of excess weight for bands and 55 percent for bypass.
“The operation is quicker,” he says, referring to the LAP-BAND® System. “You don’t have to cut the stomach, you don’t have to cut the small intestine, you don’t have to cut anything. This eliminates complications caused by leakage at the connections. Remember there are two connections with the bypass, and both of them have to heal properly. Also when you reroute the bowel, you create potential blockages down the road, and that’s a lifelong concern.”
Larson, who’s been at JFK for two and a half years, is trained in gastric bypass but only does LAP-BAND® System.
“If somebody’s 100 pounds overweight, is a long-term difference of 5 pounds or so enough to justify a much higher surgical risk?” he says.
John Hoffmann, however, was more than 200 pounds overweight. The Boynton Beach construction project manager chose the bypass on the advice of a surgeon at the Cleveland Clinic in Weston.
“He recommended that I have it because with the bypass you don’t absorb as many calories,” says Hoffmann, 41, who had the operation in April and is down 170 pounds from his top weight of 432. “He thought it would be a better choice for me because I’m more of an emotional eater.”
LAP-BAND® System critics say patients can cheat the band — in other words, indulge in large quantities of high-calorie soft foods such as milkshakes — because it only restricts the opening to the stomach, which remains its original size.
“You have to be careful with patient screening,” says registered nurse Patricia Specian, bariatric surgery program coordinator at Wellington Regional Medical Center, which plans to start offering the LAP-BAND® System next summer. (JFK and West Boca Medical Center are the only hospitals currently using the band in Palm Beach County and the Treasure Coast.)
“If you’re someone who can’t say no, then the LAP-BAND® System isn’t going to work for you,” she says. “You could eat all day long. If you have gastric bypass, you experience dumping syndrome, and that holds you back.”
Specian is talking about the nausea, cramps, vomiting and heart palpitations that occur when some bypass patients eat foods that are high in sugar or fat. Most people who resort to weight-loss surgery hope they get the unpleasant syndrome, which is a strong deterrent to overeating. But there’s no guarantee.
Robert Grant, president of Allergan Medical, a division of the company that makes the LAP-BAND® System, says that despite the criticism, “there’s no evidence that the device is less effective for ‘sweet eaters’ and ‘bingers.’ ”
But it’s important, he adds, “that a patient is fully informed about post-surgery dietary requirements, lifestyle changes and band adjustments to achieve an optimal outcome.”
In short: You can’t gobble vats of chocolate pudding and drop pounds.
Bariatric psychologist Melodie Moorehead, who works with JFK patients, stresses that neither procedure is foolproof.
“It’s natural, when you’ve fought obesity your whole life, to come in and want magic,” says Moorehead, whose main office is in Fort Lauderdale. “But part of the help we give patients is the awareness that the band is just the beginning, and many changes have to take place.”
Schauer says the American Society for Bariatric Surgery doesn’t formally recommend either procedure, leaving the decision up to patients and their doctors.
“The LAP-BAND® System is definitely an effective and safe weight-loss procedure that’s less invasive with a lower rate of major complications,” he says. “It’s an important tool in a toolbox that includes changes in exercise and eating habits.”
Regina Ortega, 37, a Royal Palm Beach bookkeeper who lost 150 pounds after bypass surgery two years ago, echoes Schauer’s analogy. (She chose bypass, she explains, “because I was afraid I’d end up convincing the doctor to loosen the band so I could eat more.”)
“Gastric bypass is a tool, just like the band,” she says. “Whether you reroute your body with the bypass or you strap your stomach with a LAP-BAND® System, you still have to learn new coping skills because you can’t turn to food.”
Staff researcher Angelica Cortez contributed to this story.

What You’ll Eat Afterwards

Post Operative Period

The LAP-BAND® System should be considered to be a permanent medical device. Eating healthy food, exercise and behavior modifications are very important in the post-op period.


It is important that patients comply with specific dietary and other instructions after the LAP-BAND® System is in place. These instructions include the following:

  • Eat 3 smaller meals per day
  • Avoid snacking between meals
  • Eat slowly and chew food well
  • Stop eating as soon as you feel full
  • Do not drink liquids during meals or for one hour before and one hour after meals
  • Drink plenty of non-caloric liquids such as water in between meals. (at least 8 glasses per day to avoid constipation, to maintain normal kidney function and avoid kidney stones)
  • Avoid alcohol which is high in calories
  • Avoid high calorie foods (fats, sugars and carbohydrates) and eat primarily protein, i.e. fruits, vegetables and whole grains
  • Avoid aspirin and anti-inflammatory drugs (can cause stomach erosion)
  • Do not use a straw since it can put air into the stomach

Immediately after surgery, patients will start on a liquid diet and then progress to a soft diet. Patients should continue progress to a regular diet at approximately 6 weeks after surgery.*
* Results may vary. Complications are possible with any medical procedure.

Results may vary.
Dieting Following Lap-Band® System Surgery (5 minutes)

Exercise: We believe the Post-op LAP-BAND® System Patients who adhere to a consistent exercise program after surgery may lose the most weight and will also lose it faster.*
*Typical results. May vary from person to person.
Aerobic Exercise: Aerobic exercise burns calories and causes fat loss and also strengthens your heart.  In our opinion, this should be done 30 minutes every day. Examples of aerobic exercise are walking, swimming, bicycling, treadmill, stair climbing, tennis, etc. High impact aerobic exercise such as running, can cause injury to your joints.
*Typical results may vary from person to person.
Anaerobic Exercise: (weight training) Burns calories and causes fat loss and also builds muscles and bones. Anaerobic exercise should be done for 20 minutes every other day only. When performing anaerobic weight training exercise, patients should remember the following:

  • Each time you lift a weight is called a repetition (i.e. up and down) and the number of repetitions in a series is called a set.
  • Repetitions should be done slowly and smoothly
  • Pick the proper weight so that you can do 8 to 12 repititions before fatigue or muscle burn sets in. This will be your 1st set.
  • Rest a few minutes and then perform a 2nd set.
  • Rest again for a few minutes and then do a 3rd set.

Then move on to other weight exercises and do #3 sets for each exercise. It is ok to weight train both upper and lower body on the same day. Try to gradually increase the weight that is being lifted as your muscles become stronger. Some soreness after weight training is normal. Do not arch your back when lifting weights and do not hold your breath.
You can do both anaerobic and aerobic exercises the same day. If you are in your 40’s or older or have a medical condition such as heart or lung disease, check with your physician before starting any exercise program. It is important to warm up with gentle exercise and stretching before starting your exercise routine each day. Try to have a goal to exercise daily and if you don’t reach that goal, then 3 to 4 times per week should be adequate. The daily 20 -30 minutes of exercise does not have to be continuous. Research shows that the exercise can be done in multiple five to ten minute sessions with the same beneficial results. Try to vary your exercise program to avoid boredom. Also during exercise, remember to do it with enough vigor and effort to get your heart beating more rapidly.

Benefits of Exercise:

  • Adds muscle (More in men than in women. This results in an increase of your metabolic rate or the rate at which you burn calories. So you burn more calories and have better control of your weight)
  • Reduces cholesterol
  • Lowers blood pressure
  • Strengthens your joints
  • Reduces the risk of osteoporosis by building strong bones
  • Increases your energy.
  • Curbs your appetite.
  • Strengthens your heart and decreases heart rate and heart disease
  • Decreases your risk of cancer, diabetes and arthritis
  • Decreases anxiety, depression and stress.
  • Improves your self-esteem.
  • Improves your body tone and flexibility.
  • Improves sleep patterns.


You will require adjustments of the LAP-BAND® System after surgery so that the band is just tight enough to allow gradual and steady weight loss. * The adjustments are made in small increments and can usually be done as an office procedure and do not require additional surgery. If the LAP-BAND® System is correctly adjusted, you should be able to eat (3) smaller meals per day and feel full so you don’t feel the need to snack in between meals. The first adjustment is done at 6 weeks post-op. Subsequent adjustments are usually done at 4 – 6 week intervals. If patients are not losing adequate weight, the patient may need a fill (tightening of the band by injecting saline). If nausea and vomiting and reflux or heart burn symptoms occur then an adjustment will be necessary to decrease the saline fill amount.*
* Results may vary. Complications are possible with any medical procedure. Know your risks and talk to a medical professional.

Post-Op Appointments

Patients need to be seen at 6 week intervals during the 1st year and then every 3 months for the next 2 years. It will also be necessary for post-op patients to have follow-up appointments with a family doctor for medication adjustments and also follow-up appointments with a dietician and a support group.*
*Results may vary.

Cosmetic Surgery

Most patients need to have post-operative plastic surgery to remove excess skin and fat on various areas of the body after they have achieved their desired weight loss.* Our physicians and our practice is dedicated to providing our patients with any needed plastic surgery procedures, such as abdominalplasty (tummy tuck) and other various body lifts. Financing is also available for these cosmetic procedures. Please contact us if you have interest in financing your post-op cosmetic procedures.
*Results may vary.

Support Groups

Support groups are very important after the procedure is performed. These groups are available to assist patients in achieving the optimal weight loss result during the post-operative period. Please ask us for information regarding our support group or support groups in your area.

Miscellaneous Information

Postoperatively if you take any large pills that you have difficulty swallowing, you may cut or crush the pills.
If pregnancy or severe illness occurs after the LAP-BAND® System has been placed, the band may need to be deflated temporarily to assure adequate nutrition.*
It is very important to avoid vomiting during the post–op period because this can cause the stomach to slip upwards above the LAP-BAND® System and enlarge the new stomach pouch.*
* Results may vary from person to person.

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