Bariatric Times

AUG 2017

A peer-reviewed, evidence-based journal that promotes clinical development and metabolic insights in total bariatric patient care for the healthcare professional

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Editorial Message 3 Bariatric Times • August 2017 Dear Friends and Readers, Welcome to this new and exciting edition of BT. As the obesity pandemic continues to rapidly expand, scientists are maximizing efforts in an attempt to elucidate disease ethology and alternatively develop new treatment modalities that might help counteract this devastating health threat. The human species is not only being affected and threatened by "global warming," but also by "global obesity." As stated in his book, Homo Deus: A brief History of Tomorrow, author Noah Yuval Hariri reports that in 2012 about 56 million people died throughout the world; 620,000 of them died because of human violence (war killed 120,000 people, and crime killed another 500,000). In contrast, 800,000 committed suicide and 1.5 million died of diabetes. Sugar, he concludes, is now "more dangerous than gunpowder." 1 When looking at long-term outcomes of bariatric surgery, I like to tell my patients that we operate on their stomachs and not on their brains. Long-term success, I like to emphasize, depends on lifestyle changes. I encourage bariatric patients to exercise every day and stay on a high-protein, low-fat, and low-carb diet. What is the evidence to support my recommendation? What kind of food is available to our patients in order to accomplish this task and what type of exercise should they pursue to in order to be successful? In this month's issue, Stacy A. Brethauer, MD, FACS, FASMBS, current president of the American Society for Metabolic and Bariatric Surgery (ASMBS) conducts a wonderful interview with Allen Levine, PhD, president of The Obesity Society (TOS) and one of our country's leading nutrition scientists. The topic— the interaction between medicine and food industry—cannot be more timely and interesting. How can we work with the food industry to provide a healthy diet to our citizens? Dr. Levine gives us an excellent overview on how we can partner and interact with industry to conduct meaningful research without incurring into conflict of interest. How about exercise? Is it true that we need to exercise every day? What is the proper duration of physical activity? Can we expect patients to fit exercise in their daily routines along with the responsibilities of life, such as work and family? In "Medical Methods in Obesity Treatment," Anthony Auriemma, MD, JD, reviews available guidelines for physical activity in United States adults and discusses recent literature on high-intensity interval training (HIIT) in individuals with overweight and obesity. He also discusses what kind of exercise we might recommend our patients our patients incorporate into their physical activity regimen in order to fulfill their weight loss or weight maintenance goals. I like to tell my residents, "to work longer does not necessarily mean to work better." When it comes to exercise and fitness it seems a Dear Readers, There are two recurring themes in my messages that often apply to various topics surrounding our specialty—"one size does not fit all" and "set realistic expectations." From diet regimens to obesity intervention decisions, these mantras always seem to work their way into the conversation because, at their core, they promote the end goal of success. I apply these mantras again as we talk about physical activity in patients with obesity. In this month's issue, Anthony Auriemma, MD, JD, discusses high- intensity interval training (HIIT) versus traditional exercise in adults with overweight and obesity, an interesting and timely topic with the rise in popularity of HIIT-like programs, such as CrossFit and Orange Theory. HIIT is a form of physical activity where one performs a short burst of high-intensity (or max intensity) exercise, often called "on" intervals, followed by a brief low-intensity activity or "off" intervals. From my personal experience trying HIIT, I can say that it isn't the exercise routine for me (I prefer racquetball and the stationary bike), but it likely has a place among a certain group of individuals. While available research on HIIT in the patient population with obesity is limited, I agree with Dr. Auriemma when he says, "the best exercise we can prescribe for our patients is the one they are willing to do." Our end goal as clinicians is to see our patients reach their health and weight loss goals, so we strive to provide the tools and resources that might help them along the way. This often means getting to know them as individuals and using motivational interviewing strategies to tease out what they think is realistic and achievable. Are they interested in HIIT, and can they commit to performing it consistently throughout the week? If so, then perhaps HIIT is the right exercise for them. When considering an achievable exercise routine, time is always a consideration, which is not surprising given reports by the Centers for Disease Control and Prevention (CDC) 1 identifying the following about American's exercise routines: fewer than 21 percent of U.S. adults meet the general recommendation for exercise behaviors, approximately 51 percent of U.S. adults meet the recommendation for aerobic (endurance) training, and 29 percent meet the recommendation for strength (resistance) training each week. Research shows that through HIIT, individuals might achieve the benefits of traditional continuous exercise training (e.g., increased cardiorespiratory fitness and insulin sensitivity) in 50 to 60 percent of the training time. 2–4 I think that the interval aspect of HIIT addresses the concern of time commitments, which is appealing, especially to individuals who feel they cannot fit exercise into their daily routine. These "bursts" of activity that characterize HIIT can be applied in traditional exercise routines as well. If a patient finds it daunting or unrealistic to fit in one 30-minute workout session during their day, I suggest that they break it up into three 10- minute sessions, stressing that anything you can do to get your heart rate up, breathe harder, and break a brow sweat is beneficial to your health. The Human Species is not only Being Affected and Threatened by "Global Warming," but also by "Global Obesity": Long-term Success in Obesity Management Depends Largely on Lifestyle Changes Preference, Time Commitment Important in Helping Your Patients Choose and Stick to Their Exercise Routine A Message from Dr. Christopher Still Christopher Still, DO, FACN, FACP, Co-Clinical Editor, Bariatric Times; Medical Director for the Center for Nutrition and Weight Management, and Director for Geisinger Obesity R esearch Institute, Geisinger Medical Center, Danville, Pennsylvania. Continued on following page... Continued on following page... A Message from Dr. Raul J. Rosenthal Raul J. Rosenthal, MD, FACS, FASMBS, Clinical Editor, Bariatric Times; Professor of Surgery and Chairman, Department o f General Surgery; Director of Minimally Invasive Surgery and The Bariatric and Metabolic Institute; General Surgery Residency Program Director; and Director, Fellowship in MIS and Bariatric Surgery, Cleveland Clinic Florida, Weston, Florida

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