Trial Backs Metabolic Surgery as Long-Term Diabetes Cure

I recently read the article, published in one of the reputable medical journals and would like to share GREAT news for those of you, who are struggling with DIABETES,- there may be a CURE for it in Metabolic Bariatric Surgery! Read more

Covid-19 and its Relationship with Obesity

I recently came across the article, which speaks (again) about Covid-19 and its relationship with obesity and increased risk for Morbidly Obese population, specifically African-Americans, although it applies to everyone.
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Study: Insufficient Vitamin D Increases Risk of Severe COVID-19

From the desk of Dr. Alexander Abkin, President, Advanced Laparoscopic Surgeons of Morris, LLC.

I recently read the article, correlating low levels of Vitamin D with increased risk of severe COVID-19.

It reaffirmed to me what we at out bariatric practice, have known for decades, – the importance of good aftercare for our patients!

I cannot emphasize enough that everyone in NJ is, pretty much, Vitamin D deficient, and therefore, at increased risk of COVID-19. In addition, Morbid Obesity, Diabetes, High Blood Pressure are very common in our patient population and, in my opinion, “sitting on the sidelines” is not an option for our patients.

So, PLEASE, read the article, call our office today at 973-410-9700 or visit us online at www.alsnj.com. We offer virtual and in-person visits, so we can keep you SAFE and healthy and lessen your risks in the future.

Alexander Abkin, MD, FACS, FASMBS.

Click here to read the full article

ASMBS Calls for Resumption of Bariatric Procedures

Recently, ASMBS, which I am a Fellow of, called for resumption of Bariatric Procedures. Read more

Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in NYC Area

I, among many Americans, especially medical professionals, read the article, published in JAMA (Journal of American Medical Association). It showed that 88 % of coronavirus patients in NYC from March to April of 2020, who were placed on the ventilators, didn’t make it. Data also indicated that average age was 63, 57% had HYPERTENSION, 41% were OBESE, 34% had DIABETES! The message here is very clear, at least my message to our current and prospective future patients: Please, don’t wait any longer to get the surgery done! You waited long enough, especially those of you who had to do insurance-required medically supervised weight loss program for 3-6 months, before being approved. Our society, as a whole, has a very high prevalence of these comorbid conditions, listed above, therefore we are ALL at risk of higher mortality, especially knowing that the virus is coming back next year, before the vaccination is available.

How can we at Advanced Laparoscopic Surgeons of Morris help you to be Safe and get your life back? Please know that bariatric surgery, such as vertical sleeve gastrectomy, gastric bypass, can cure or improve Hypertension in 60-70% of patients, bring BMI (Body Mass Index) down to Normal numbers in at least 50-80% of patients, and cure or improve Diabetes in 50-75% of patients. It is the best “diet tool” you can reward yourself with.

We are open for business during the Covid19 epidemic, running Virtual Telemedicine visits, support groups and looking forward to helping patients to get their lives back.

Please call us 973-410-9700, or email us at info@alsnj.com.

Alexander Abkin, MD, FACS, FASMBS.

To read the full article, click here to download.

Obesity and Surviving the COVID19 Pandemic: Weight loss Boosts Immunity

Lessons learned from the Spanish Flu pandemic of 1918 proved that malnutrition was just as bad as ‘over nutrition’ or obesity, both of which created a worse prognosis. With the Asian Flu of the 1950’s and 60’s, the Hong Kong Flu of 1968, and even with the recent H1N1 Influenza virus, obesity increased both morbidity and mortality.

Obesity creates a chronic inflammatory state. Fat cells (adipose tissue)increase inflammatory signals that are normally produced only when a foreign intruder such as a virus invades the body. When viruses attack, these signals are dampened. Immune cells such as ‘macrophages’ that eat viruses are reduced and not activated.

Other immune defenses such as antibody ‘B’ cells and virus killer ’T’ cells are also impaired with obesity. As a result, obesity has been shown to cause prolonged viral shedding. Decreased immunity with obesity also increases chances of creating a more virulent viral strain. The higher your body mass index (BMI), the higher concentration of infectious virus in exhaled breath! Obesity thus increases your risk of transmitting a more lethal mutated viral strain to others. In addition, as BMI increases, immune response to vaccination decreases. Thus, vaccines are less effective with obesity!

The good news is that weight loss can reduce inflammation significantly — back to healthy levels which strengthens immunity! C Reactive Protein (CRP) is a measure of systemic, or whole body inflammation. Studies have shown that lifestyle changes such as diet and exercise can only achieve 5% long term weight loss at best. Inflammation (or CRP)levels were only reduced with 15% or more sustained weight loss! Additionally, higher levels of inflammation from obesity in the body is associated with harder ability to lose weight.10 A combined approach of lifestyle change with bariatric surgery for clinically or morbidly obese patients is the best way to decrease inflammation (CRP levels) and increase immunity for the long term. Bariatric Surgery is the most effective long term obesity treatment. Patients following metabolic procedures such as gastric sleeve or gastric bypass significantly increase their immunity—the only defense against coronavirus. Vaccines will also be more effective once they are made available. We congratulate our patients on maintaining a healthy lifestyle and strengthening their immunity to overcome this pandemic.

Click here to download this article.

Why Are Still Less Than 1% of Eligible Patients Undergoing Bariatric Surgery Each Year?

The latest estimates from the American Society for Metabolic and Bariatric Surgery (ASMBS) show that in 2017, 228,000 Americans underwent bariatric surgery—a 44% increase in procedures since 2011. Sleeve gastrectomy leads the way as the most common procedure, and has overtaken Gastric bypass, as more patients embrace weight loss surgery. These statistics hold true in our practice, Advanced Laparoscopic Surgeons of Morris, LLC.

Although many outside the bariatric community may view this growth as explosive, we view it as sad and tragic, given the fact that in the big picture, less than 1% of people with severe obesity undergo bariatric surgery in any given year. According to a recent study in Annals of Surgery, utilization increased from 0.07% in 1993 to 0.62% in 2004, and to slightly lower than 0.5% in 2016.

The bariatric surgery utilization rate has barely budged despite a rise in severe obesity and an avalanche of data demonstrating it to be the most effective treatment with a complication rate comparable to laparoscopic gallbladder surgery and hysterectomy, and a mortality rate similar to total knee replacement.3 The question is, why? More importantly, what can be done about it?
Imagine if 99% of patients with diabetes, cancer, or heart disease did not seek or receive medical treatment because the barriers were too high. The outcry would be unimaginable. But somehow it is more acceptable to treat the devastating consequences of obesity rather than the disease of obesity itself.

Health professionals represent many different specialties, backgrounds, and perspectives, but they all treat the same disease. The good news is there is growing interest in working together to better help patients with obesity.
This has led to a more collaborative and systematic effort to tear down the barriers and create a more favorable environment for obesity care. But there are no easy or magic formulas to create the watershed moment that is needed to turn a 1% lifesaving procedure into standard practice.

Barriers to Care Fueled By Misunderstanding

The barriers to obesity treatment are interconnected: Misunderstanding, social stigma, and bias about obesity and bariatric surgery negatively affect insurance policies and benefit design, doctor–patient interactions, and public policy, and discourage patients from even exploring surgical treatment.

When people fail to recognize obesity as a chronic disease and health professionals fail to treat it as such, the stigma surrounding it endures and patients are left facing more obesity, diabetes, heart disease, stroke, sleep apnea, and cancer, as well as reduced quality of life and shorter life spans.

Public Stigma and Misperceptions Are Pervasive

According to a national survey commissioned by the ASMBS and NORC at the University of Chicago in 2016, while there is growing public concern about the dangers of obesity—81% said obesity is as serious as cancer—only 1 in 3 of those with obesity reported that they have ever spoken with a doctor about their weight. Additionally, only 12% with severe obesity said a doctor had ever suggested consideration of bariatric surgery.

While scientific research shows that diet and exercise alone are largely ineffective for treating obesity and severe obesity, the survey found that more than three-fourths of Americans (78%) believe individuals with the disease should have the willpower to lose weight on their own, noting that diet and exercise is the most effective method for long- term weight loss—more effective than bariatric surgery (60%) and prescription obesity drugs (25%). This belief contradicts the evidence. The annual probability of achieving even a 5% weight reduction without bariatric surgery was 1 in 8 for men and 1 in 7 for women with severe obesity.

Stigma Surrounds Obesity And Bariatric Surgery

One of the realities of living with obesity is that there’s not only stigma about having obesity, but there’s also stigma around needing help to treat it. A recent study in JAMA Surgery found almost half of the 948 respondents (49.4%) believed most people had bariatric surgery for cosmetic reasons, and nearly 40% thought that people who underwent bariatric surgery chose “the easy way out.”

It has been about 6 years since the American Medical Association officially recognized obesity as a disease, but its full impact is yet to be realized. In a survey of more than 3,000 adults with obesity, 65% recognized obesity as a disease; yet, 82% felt “completely” responsible for weight loss. What a disconnect! There is no other life- threatening disease of which patients feel completely responsible for their own treatment.

Insurance Coverage

Insurance coverage is the price of admission for surgery, and misunderstanding and stigma are literally written into the insurance policies of millions of Americans. Although most would agree that coverage has improved, real access remains challenging. Co-payments may be as high as 50% of the cost of the procedure. Small and medium-sized companies must select bariatric surgery as an option, and some carriers offer bariatric surgery as a “rider” available at substantially increased cost to the insured.

Real Progress Across All Barriers to Care

Education and advocacy backed by data are leading to good progress in all areas. According to the ASMBS, just this year, some insurers, including UnitedHealthCare, dropped its arbitrary 6-month preoperative dietary requirements, and others have reduced other hurdles or even expanded indications for bariatric surgery.

Plan of Action – Where Do We Go From Here?

Public and Professional Education And Awareness

We must continue our efforts to educate both public and health professionals about obesity and bariatric surgery. We know misconceptions and bias persist. The best weapons we have against that are data and you.

Do not wait for the referral. Make connections with local orthopedic surgeons, gynecologists, primary care providers, and other specialists. Familiarize them with national obesity guidelines and the key clinical evidence demonstrating the safety and effectiveness of bariatric surgery. Then tell them about your bariatric program, the experience of your multidisciplinary team, and share your specific patient outcomes.

Surgeons must improve educational efforts with other health care providers. They should encourage every medical practice to include the following question on intake forms for new patients: “Is it OK if we talk about your weight today?” If a patient answers yes, permission is granted to start a conversation that will help a patient get treatment. Most patients and doctors today avoid the subject.

Insurance Coverage and Access

We must continue our work with insurers and employers to have a uniform single benefit for the entire country. Work is being done to create a model benefit that could be adopted by insurers nationwide. This would enable payers and the country to reap the health and cost benefits of bariatric surgery no matter how long a patient remains with one insurance provider.

Advocacy and Public Policy

The ASMBS, medical societies, advocacy organizations, and industry leaders are working to shape federal, state, and local government policies; pro- mote the approval of safe and effective treatment options; improve funding for obesity research; expand patient access; and fight stigma wherever it exists.

It is important for all of us to challenge people and organizations around the barriers to care and help them understand whether their views or policies are based on bias or misinformation or actual evidence and good science. This has changed many a payer’s perceptions about obesity care.

We also must stop the spread of stigma in mass media and social media and counter inaccurate and hurtful portrayals of obesity and its treatment with greater humanity, sensitivity, and evidence-based messages. Each negative portrayal is an opportunity to educate.

A Call for a National Obesity Strategy and a Patient Bill of Rights

The moment is now for a national obesity strategy. We as a nation must change our thinking about obesity and begin to remove the policy, social, medical, discriminatory, economic, and perceptual barriers that deny people appropriate treatment and support. The state of America’s health and wealth is at stake. We cannot keep doing the same things fighting a losing war against the obesity epidemic and expect a different result.

Some new thinking is required including the creation of a patient bill of rights that would ensure access to care is not limited by a person’s size, weight, or economic status and a national obesity strategy that encompasses both prevention and treatment. This national initiative could be headed by a newly created obesity czar tasked by the federal government to bring the public and private sectors together on prevention and treatment strategies and policies that destigmatize the disease and do not unnecessarily deny, delay, or defer proven evidence-based treatments across the continuum of care.

In this environment, the most effective treatment for severe obesity will no longer be reserved for less than 1% of the patients who could benefit.

We at Advanced Laparoscopic Surgeons of Morris, LLC, are here to help, to get you started in reclaiming your life back, your health back! It is even more important now, during and after the COVID-19 epidemic, which showed that OBESITY is a MAJOR factory in mortality from the virus, in addition to age over 60, Diabetes, Coronary Artery Disease, Obstructive Sleep Apnea, Chronic Kidney Disease. Please call us (973) 410-9700, or email us at info@alsnj.com or visit us on the web at www.alsnj.com.

Alexander Abkin, MD, FACS, FASMBS.

COVID-19: American College of Surgeons releases new guidance for resuming elective surgery

I recently read the article, which we atAdvanced Laparoscopic Surgeons of Morris will be using to guide our patients, waiting to have Gastric Sleeve, Gastric Bypass, Revisional Weight loss surgery or General surgery, such as Gallbladder removal or Hernia repair. The documents speaks to the need to be careful, when it comes to re-starting the elective surgeries, and additional steps, which we may have to take, including COVID-19 testing for the patients and healthcare providers.

In the interim, we want you to stay safe, but please be in touch with US, – we are open for business, via Telemedicine, Virtual appointments, support groups, etc.

Together, we will get through this period in history and we will be better equipped in the future.

Click here to download the article.

Recidivism Is Not A Failure

I just read a very good, inspirational article about human history of obesity. it specifically speaks to recidivism of it, but also compares it to other common, deadly diseases, such as diabetes, cancer and cardiovascular and its recidivism.

Not surprising to me, nobody shames medical doctors or surgeons for failure to control diabetes or cancer or cardiovascular diseases, but when it comes to Obesity and surgery for it, we or the patient get blamed for recidivism? Totally wrong and unfair. I think the opposite is true.

When we, bariatric surgeons, perform gastric sleeve or gastric bypass, or even bariatric revision surgery, and our respective patients diabetes, or sleep apnea or hypertension goes away or its management is improved for many years to come, we contribute not just to the obesity treatment of human race, but to other conditions and should not be discriminated against, but instead rewarded or applaud for it.

We at Advanced Laparoscopic Surgeons of Morris have been doing it for 2 decades and proudly helped thousands of patients!

Click here to read the article.