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The Submissions Are In

By Dr. Matthew Weiner, MD, FACS

Update July 25: We will be posting the essays of the four finalist to our Facebook fans. We will be posting them anonymously- meaning that we will not provide you the name of the person who wrote the essay.

We would like your input on each essay.
1 like = 1 vote
We would also like you to comment on how the essay makes you feel if you are moved to do so. Click Here for the Pound of Cure Facebook Page

FINALIST:
Please do not vote or comment. We don’t want to muddy the votes.

Thank you for helping with this very difficult decision.


July 21, 2013

All the submissions are in (over 70 in total) and deciding on the finalists has been agonizing. There were so many candidates, who truly need and deserve this surgery.   Stories of discrimination, the impact of their weight on personal relationships, the frustration with the lack of success on countless diet programs and the fear of a shortened life were present in nearly every application. We will be releasing some of these essays in the weeks to come in an effort to draw attention to the continued acceptance of discrimination against obese people, the unfairness of insurance policies that exclude coverage for bariatric surgery and to help disprove the public’s perception that obesity is not a disease, but rather a lifestyle choice.

I was amazed at the amount of thought and energy that were put into these applications. When I initially proposed this idea, many people told me that lots of people would just submit an application on a whim and that there would be very few applicants who had put much thought into bariatric surgery before they heard about our program. Nothing could be further from the truth. As the applications came in, it became clear that the majority were from people who had been struggling for years to get the surgery done, but didn’t have the insurance coverage for it.

One thing that I was surprised by was that the vast majority of the applicants (>75%) did have health insurance, it just didn’t cover bariatric surgery. Determining the actual number of people who are insured but don’t have coverage for bariatric surgery is difficult. I’ve always estimated it at around 10%, based on my experience in my practice. What I suspect is that the actual number is much higher and that my experience underestimates this number since many people discover that they do not have coverage before they even make an appointment to meet with a bariatric surgeon.

As health care reform moves forward, it is important that coverage for bariatric surgery and other treatments of obesity be included. Based on the number of applications and the stories behind them, the magnitude of this problem is staggering. If there were this many stories of pain and suffering from our relatively unpublicized announcement released in a small part of southeastern Michigan, imagine the number of people who are suffering across the country. Surgeons have often times found themselves on the front lines of public health crises. Trauma surgeons see the devastation of violent crime on a daily basis, thoracic surgeons have long addressed the consequences of smoking and now bariatric surgeons are drawing attention to perhaps our country’s greatest public health crisis to date, obesity.

We will be releasing more information about our finalists and will be following one deserving individual through the process leading up to surgery and their progress over the first year after surgery. I am hopeful that this program will tell a story that captures people’s attention and makes them rethink the way they view others who are overweight. If you feel strongly that it’s time to end the last acceptable form of discrimination in our country, please share this story and those to come with your friends. If you believe that obesity is not a lifestyle choice, but a disease with a strong genetic basis that is caused by our toxic food environment and that insurance coverage should not be optional, share this story with your local politicians. Finally, if you know someone who is suffering from obesity, share your compassion and kindnesss with them and be sure to reserve your judgment until you know their story.

Bariatric Surgery Sponsorship

WXYZ-Dr-Weiner-BAriatric-Surgery-Sponsorship

July 10, 2013

Dr. Matthew Weiner and DMC Huron Valley-Sinai Hospital are sponsoring a bariatric weight loss surgery for a patient who does not have insurance coverage for this life saving intervention.

It is with great excitement that I announce a partnership between DMC Huron Valley Sinai Hospital and the Michigan Weight Management Institute in holding a contest for a sponsored bariatric surgery.

Dr. Weiner has organized this program to draw attention to the inequities in insurance coverage for bariatric surgery. It would be completely unheard of for an insurance plan to refuse to cover the treatment of high blood pressure or colon cancer, but around 10% of insurance company policies in Michigan do not provide coverage for bariatric surgery.

Because the disease of obesity has long been considered the result of poor decisions and a lack of commitment and willpower, there has been little support for those who suffer from this debilitating disease. As the science of weight gain and weight loss advances, it is becoming clear that obesity is as much a disease as high blood pressure, heart disease, and even cancer.

First, it is clear that there is a subset of people who are uniquely susceptible to the weight gaining effects of our processed food environment. Second, we are beginning to understand the role of medications, stress, depression, injury, and environmental toxins in driving weight gain – all factors that have nothing to do with willpower or commitment.

Those who suffer from the disease of obesity understand that there is much more to weight gain than the sum of the calories that are ingested each day. Those who are lucky enough to be genetically resistant to weight gain are often quick to point out all the personal attributes that allow them to maintain their lean body; however, science offers another viewpoint on the role of their DNA in preventing unwanted weight gain.

Without question, the single best long-term treatment of obesity is bariatric surgery, yet more than 10% of all insured citizens of the state of Michigan do not have coverage. Many people question the wisdom of a surgical intervention for the treatment of obesity; however, surgeons have long found themselves on the front lines of public health crisis. Surgery was once the only effective treatment for tuberculosis infection and to this day, heart disease is primarily treated with procedures as opposed to lifestyle modification. The science is clear on the relative success of bariatric surgery compared to lifestyle modification for weight loss. What’s even more concerning is that for many who suffer from obesity, even lifestyle modification will not result in successful weight loss.

Dr. Weiner and Huron Valley Sinai Hospital hope to draw attention to this discrepancy in insurance coverage by offering a surgery that will allow people to follow a patient through their pre-operative evaluation and counseling, surgery and recovery, and most importantly long-term success. We will accept submissions from anyone who meets the criteria for bariatric surgery (having a BMI more than 40, or more than 35 and suffers from high blood pressure, sleep apnea, high cholesterol or diabetes). The submission process will include an essay allowing the participants to explain how this surgery will change their life. Some of the essays will be published. All those considered will meet with Dr. Weiner for a consultation and a finalist will be selected and offered a bariatric surgery with all expenses covered for one year.

It is our hope that this will demonstrate the severity of the disease, the impact on people’s lives, and the multidisciplinary support that is available at Huron Valley Sinai Hospital.

In good health-
Dr. Matthew Weiner

Top 5 Myths About Weight Loss Surgery

By Dr. Matthew Weiner, MD, FACS

May 21, 2013

1.) Weight Loss Surgery is the easy way out.
Many people believe that once they undergo weight loss surgery, their weight problems will be fixed. The truth is that dozens of factors control weight gain and weight loss – genetics, food choices, stress, medications, environment, hormones, and even financial stresses. Weight loss surgery is not a magic bullet cure for obesity. It’s just a tool – one of many tools in the toolbox – and lifelong, sustainable weight loss requires a multi-disciplinary approach.

After surgery, you will continue to struggle with your weight and nearly all of the same rules will apply. Weight loss surgery is definitely not easy – you will have to continue to do all of the things that you’ve done in the past to control your weight. The only difference is that it will work this time.

2.) After surgery, you lose weight because you can’t keep anything down.
In the first few months after surgery, you are significantly restricted to eating only a few bites of food at a time. Most patients will feel full and satisfied after only 1-2 bites. It is often common to overeat during this time period and vomit as a result. On average, most weight loss surgery patients vomit 2-3 time per month during the first three months after surgery.

After three months, there is a gradual relaxing of this restriction and you will eventually be able to eat more. After the three month mark, it is very uncommon for bariatric surgery patients to vomit. Over the next year, patients are able to gradually eat more until they are able to comfortably eat approximately half of what they were before surgery.

We now understand that bariatric surgery exerts the majority of its effect by re-adjusting your brain’s neurotransmitters and the levels of hormones that impact your appetite and your metabolism. This explains why you are able to maintain your weight loss despite a gradual relaxing of your gastric pouch.

3.) After surgery, you go to the bathroom multiple times per day because you’re not absorbing nutrients from your food.
Much like the vomiting myth, weight loss surgery patients don’t have to use the bathroom excessively. They absorb calories normally and go to the bathroom normally. If you know someone that had bathroom problems after surgery, chances are they had surgery a long time ago when the procedure bypassed a longer segment of intestine. Most patients complain more about constipation after surgery, rather than frequent bowel movements.

4.) Complications are very common after weight loss surgery.
Weight loss surgery is incredibly safe in 2013. Depending on your medical history and the amount of weight you have to lose, the serious complication rate is typically between one and four percent. This means that more than 95% of all patients do not have serious complications and get through the surgery without much difficulty at all. Almost all the surgeries are now performed through several small incisions using a technique called “laparoscopy.” This greatly reduces the amount of pain postoperatively and allows you to get up and walk around within a few hours after surgery.

The vast majority of patients are discharged on day two after surgery and approximately one-third do not need any prescription pain medicine after discharge from the hospital.

5.) You must be in great health – medically – to qualify for bariatric surgery.
I recently had a woman ask me if she would be turned down for weight loss surgery because she had stents in her heart. I’m not sure how this idea was fostered but I’ll tell you what I told her. I do bariatric surgery on patients who have stents in their hearts all the time. I would say probably 10% of the people I operate on have a history of having had a stent placed in their heart. Although the risks of surgery increase if your health is compromised, the benefits of the surgery are also increased. Only once patients become so sick that they have lost the ability to walk do we begin to become hesitant to proceed with surgery.

For more information on weight loss surgery or other weight loss options, call my office at 248-413-2670.

Dr. Weiner on DLight Talk Radio May 17

May 17 @ 12:30 p.m.

In this potentially life-changing episode D*LIGHT host, Krista-Lynn Landolfi, is joined by Dr Matthew Weiner, a bariatric surgeon who has made a ground breaking dietary discovery. In his book A Pound of Cure he shares his style of eating which mimics the changes that occur directly after undergoing bariatric surgery. Make this the summer you confidently ‘strut your stuff’ on the beach! Be sure to tune in to discover how you can create lasting weight loss and optimal health.

Join the conversation! Call to ask Dr. Weiner weight loss, nutrition and health questions: (619) 768-7217 Listen Here

A Pound of Cure outlines the steps necessary to lose anywhere from 5 to 100 pounds or more and keep it off which makes this book ideal for families and friends with different needs to embark on this new lifestyle together. If you are tired of the fad and commercial diet industry that peddles artificial, synthetic diet foods as healthy choices, the Pound of Cure plan will show you how to eat sensibly, control your hunger and lose the weight for the rest of your life.

Your Fat is Not Your Fault

By Dr. Matthew Weiner, MD, FACS

May 14, 2013

Our initial understanding on weight loss – the idea perpetuated by the media – has always been that you lose weight by making the decision to diet and exercise and then sticking to it. It requires a strong willpower and extreme motivation and your lack of both is why you’re fat. So they tell us. But, as we learn more about the neurotransmitter and hormones that drive our appetite and our metabolic rate, we are beginning to recognize that weight gain and weight loss is driven by forces much more complicated than our behaviors.

Starting a vigorous exercise program and going on a starvation diet has a long-term success rate of less than 5%. And, in fact, more than 25% of people who embark on such behavior changes will end up – in 5 years – weighing significantly more than they did when they started. Anybody who’s ever been on a diet knows that that’s the truth.

What’s worse is that most “diet” plans are constructed in a way that almost guarantees failure, all the while implying that your failure is your fault. That’s because diet plans are BIG business and generate billions upon billions of dollars for their creator. Once you fail, you’re pressured to buy more and work harder.

So, as a society, we have to recognize that the initial beliefs of why we lose and gain weight are completely flawed.

What we have now found out is that your nervous system controls your weight the same way it controls your blood pressure, your blood glucose, your cholesterol, and hundreds of other measurable parameters that determine the way your body functions. It works through very complicated neural and hormonal processes that are originated in your blood stream, in your organs, and most significantly in your brain. Your brain acts as the central command and is constantly trying to regulate your body to a healthy weight in order to respond to the signals it’s receiving from your digestive tract. I call this entire system your Metabolic Thermostat.

When you put your body – and ultimately your brain – through a period of starvation, your brain tells your body to slow down your metabolism and increase your desire for food. When your body is overfed, your brain tells your body to speed up your metabolism and decrease your desire for food.

metabolic-Thermostat
Figure 1 – Your Metabolic Thermostat

This is why so many people are strongly motivated to “go on a diet” for their New Year’s resolution. They are overfed from the holidays and their metabolism is ready to burn off the excess weight. However, as we all know, very few people actually successfully complete a New Year’s resolution. And, that’s because once you start to starve yourself, your brains says, “slow down – you’re not getting enough to eat.”

In my practice, the most common thing I hear people say to me is, “Dr. Weiner I hardly eat anything, I can’t understand why I am so overweight.” That’s the most common scenario. The misconception that people who are overweight are eating breakfast, lunch, and dinner at McDonald’s is just not true. That is not what’s happening out there. Most people are in the midst of some form of a starvation diet and their body is adjusting accordingly – by slowing their metabolism and increasing their desire for food.

The idea that people who are overweight become so because of a failure to control their eating habits is a fallacy and an unfair discrimination. While there are exceptions to this statement, they are relatively few, compared to the millions of Americans who are overweight. The truth is, our entire country eats way too much of the wrong foods, yet we only condemn those whose metabolism favors excessive fat storage from the American diet. Let he who is without fault cast the first stone…

The idea that you are in complete control of whether you gain or lose weight is a misconception. It’s simply not true. It’s also not true that eating fewer calories is the way to lose the weight and keep it off. The key to weight loss is eating an ENORMOUS amount of the right foods and very little of the wrong foods. This dietary change will prevent your metabolic thermostat from fighting your initial weight loss with neurotransmitters and hormones that slow down your metabolism and increase your hunger. The obesity epidemic is a grave problem and blaming the victims is not the answer. Once we recognize this, our country stands a chance at digging into the science and coming up with some useful solutions.

The Obesity Epidemic

What is the “Obesity Epidemic?”
According to the Surgeon General’s recent “call to action,” obesity has reached nationwide epidemic proportions. Obesity is defined as an excess of total body fat, a result of imbalance between caloric intake and energy expenditure. In 1999, an estimated 61 percent of U.S. adults were overweight, along with 13 percent of children and adolescents. Obesity among adults has doubled since 1980, while the number of overweight adolescents has tripled. Increases in obesity are associated with dramatic increases in conditions such as type 2 diabetes and asthma. In addition, a recent study reported that obesity causes more deleterious effects on health than either smoking or problem drinking. The increase in chronic health conditions caused by obesity is similar to that seen in 20 years of aging.

Obesity can be a degenerative and debilitating disease. The National Institutes of Health reports that obesity substantially increases the risk of morbidity and mortality from:

  • Heart disease
  • Diabetes (type 2)
  • Stroke
  • High blood pressure
  • Sleep apnea
  • Cancer
  • Breathing difficulties
  • Joint problems

Among individuals who are diagnosed with type 2 diabetes, 46 percent are obese. Among those with high blood pressure, 38 percent of men and 32 percent of women are obese. And of those diagnosed with high blood cholesterol, 20 percent of men and 25 percent of women are obese. According to the American Obesity Association, obese individuals have a 50 percent to 100 percent increased risk of death compared to individuals of normal weight, with obesity reportedly causing over 120,000 deaths each year. This substantial increase in health risks has made obesity the second leading cause of preventable death in the United States.

How many people in the US are considered obese?
During the past 20 years, obesity among adults has risen significantly in the United States. The National Center for Health Statistics demonstrates that 30 percent of the adult U.S. population (over 60 million people) is obese.
This epidemic is not limited to adults. The number of young people overweight has more than tripled since 1980. Among children and teens a 16 percent are considered obese.  Obesity is now one of the leading causes of early, preventable death among U.S. adults.

What is BMI and why is it important?
There are a number of ways to define and calculate obesity. Currently, the most universally accepted definition is defined by BMI (body mass index). An individual’s BMI is simply their weight in kilograms divided by their height in meters squared. Once calculated the BMI is a two digit number. This number is then compared to a per-established “normal” BMI, in the range of 20-25.  Insurance companies use BMI to determine the eligibility of a patient for bariatric surgery.

Why is obesity such a growing problem?
There certainly isn’t a clear answer to this problem, but our opinion is that the food service industry has done a tremendous job aggressive marketing a wider variety of high fat, high carbohydrate foods to Americans.  If you consider the grocery store of the 70′s and 80′s, your neighborhood A&P had between 5,000-10,000 different items to choose from.  Today’s Super Markets can have as may as 100,000 different items in every possible combination of size, packaging and taste to ensure that there’s something on that shelf that appeals to you.  The food service industry has borrowed some of the lessons from the tobacco industry and are targeting our children at a very young age (consider the number of fast food restaurants that have playgrounds) to ensure the long term success of their marketing strategy.

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