At the Chicagoland Center for Cosmetic Surgery, we offer surgical and non-surgical treatment programs for the treatment of obesity:
Bariatric Surgery Options
Traditional weight loss surgery includes gastric banding and gastric bypass, usually followed by abdominoplasty and liposuction. However as Dr. Katsaros has demonstrated in published literature, in many cases (see picture below), abdominoplasty alone can achieve immediate and lasting weight loss with better quality of life than gastric bypass.
Before surgery the above patient was diabetic, had hypertention, had severe back pain requiring a cane and could not walk up more than a few stairs. After 4 hours of abdominoplasty surgery with large volume liposuction, the patient was 70 lbs lighter immediately after surgery and went from a size 30 to a size 6. Surely there is no quicker way to loose this amount of weight than large volume abdominoplasty.
After one month of physical therapy, the patient above did not require the cane and by 6 months she was jogging. The weight loss following abdominoplasty almost always results in permanent weight loss IF the volume of the stomach is reduced by tightening her fascia. If this is done, these patients eat 20-60% less food after abdominoplasty than before. In our experience, patients who have extensive abdominoplasty with very tight plications of their fascia have kept their abdominal weight off even 10 years after surgery.
Large volume abdominoplasty is not for everyone. For patients who have a lot of visceral (internal) fat, we prefer gastric bypass or gastric banding first, followed by abdominoplasty later. In the case shown here, this patient had gastric banding and lost about 150 lbs.
Weight loss and exercise alone will not burn off excess skin and will not tighten the loose fibrous tissues of the body, which lie under muscles. It does not matter how strong the abdominal muscles can be made, if the deep support layers (fascia) is loose, the abdomen will remain loose. Only surgery can remove extra skin and restore youthful "tightness". In the case shown here, gastric banding was done first, followed by abdominoplasty.
On the other hand, for patients who have most of their fat superficial to their fascia, as shown here, abdominoplasty and liposuction may be performed as the initial and only procedure. When abdominoplast is performed as the initial and only procedure, the weight loss is immediate and the patient may return to office work in two weeks. Furthermore as compared to gastric bypass, abdominoplasty has many fewer complications and no nutritional problems.
Medical Treatment of Obesity
At the Chicagoland Center for Cosmetic Surgery, we offer more than just weight loss surgery. Our center has a variety of medical, dietary and excercise treatment protocols for the medical treatment of obesity that can be tailored to your needs. A simple life-style changing program is described below. Specific recipes with this program are available.
Dr. Katsaros' Lifestyle Diet Program
Breakfast
*Eggs (boiled is best, scrambled OK but no cheese, use olive oil for shortening).
*Turkey sausages are OK.
*High fiber cereal with skim milk sprinkled with cinamon. Cereal should have at least 5gms of fiber per serving. Post Raisin Bran has 5 gms of fiber (because of the raisins). To any cereal add dried fruit, nutts, trail mix so as to increase the fiber.
*No coffee. Green tea with splenda or neutrasweet.
*No orange juice, no apple juice unless. May use Crystal light juice, V8 or diet tea.
*Unlimited fruits
Lunch or Dinner
*Always have a salad before a meal. Dressing will be olive oil and/or vinegar.
*Can have unlimited vegetables. Beans or tofu will supress appetite.
*Do not eat any mammals (No beef, no pork, no ham).
*If it flies or swims, eat it but don't fry it. Eat poultry or fish but not fried.
*Dessert: Pears, apples, unlimited fresh or dried fruit, trail mix, nuts.
*Drink: Water, skim milk, diet soda, green tea, diet drinks (Crystal light drinks). No juices, avoid non-diet drinks
*Avoid potatoes because most people only know how to eat potatoes with a lot of lard (fried or baked with butter or whipped cream). Potatoes can be baked with vegetables in olive oil or steamed. Mocrowaved potatoes can be mashed with onions or vegetables grilled with olive oil and seasoned with salt and pepper.
Spices
*Use potassium salt (salt substitute) if you have hypertention. Avoid regular table (sodium) salt.
*Use pepper and other dried spices, they are not fattening.
*Use Teriaki, Barbecue sauce, Cajun spices are all OK.
*Olive oil, oregano, garlic, vinegar combinations are excellent, they supress appetite.
*Avoid creamy dressings (Thousand Island, Ranch, Blue Cheese)
Snacks:
*No chips, no cookies, no chocolate, no deserts.
*Unlimited nuts, raisins, dried figs, trail mix with dried fruit (but no chocolate or M+Ms).
Excercise
*One hour of aerobic activity per day is minimal. Stationary bike and swimming are better than jogging because there is less joint trauma. Elliptical trainers are much less effective than swiming or biking.
*Weight lifting or strength training is not aerobic excercise. Weight lifting improves muscle tone, it does not burn a lot of calories.
*Aerobic training is not leisurly. It requires that your thighs are moving fast, you're sweating and that your heart rate is maintained at an aerobic level that is defined by your conditioning test.
The Rationalle for this program is as follows:
1. Eggs. Skip the bagel this morning. Eggs, which are full of protein, will help you feel fuller longer-a lot longer. A multicenter study of 30 overweight or obese women found that those who ate two scrambled eggs (with two slices of toast and a reduced-calorie fruit spread) consumed less for the next 36 hours than women who had a bagel breakfast of equal calories. Other research has shown that protein may also prevent spikes in blood sugar, which can lead to food cravings.
2. Beans. You've probably never heard of cholecystokinin, but it's one of your best weight-loss pals. This digestive hormone is a natural appetite suppressant. So how do you get more cholecystokinin? One way, report researchers at the University of California at Davis, is by eating beans: A study of eight men found that their levels of the hormone (which may work by keeping food in your stomach longer) were twice as high after a meal containing beans than after a low-fiber meal containing rice and dry milk. There's also some evidence that beans keep blood sugar on an even keel, so you can stave off hunger longer. Heart-health bonus: High-fiber beans can lower your cholesterol.
3. Salad. Do you tend to stuff yourself at meals? Control that calorie intake by starting with a large salad (but hold the creamy dressing). In a study of 42 women at Penn State University, those who ate a big, low-cal salad consumed 12 percent less pasta afterward-even though they were offered as much as they wanted. The secret, say researchers, is the sheer volume of a salad, which makes you feel too full to pig out. Health bonus: A study published in the Journal of the American Dietetic Association found that people who ate one salad a day with dressing had higher levels of vitamins C and E, folic acid, lycopene, and carotenoids-all disease fighters-than those who didn't add salad to their daily menu.
4. Green tea. The slimming ingredient isn't caffeine. Antioxidants called catechins are what help speed metabolism and fat burning. In a recent Japanese study, 35 men who drank a bottle of oolong tea mixed with green tea catechins lost weight, boosted their metabolism, and had a significant drop in their body mass index. Health bonus: The participants also lowered their (bad) LDL cholesterol.
5. Pears. They're now recognized as having more fiber, thanks to a corrected calculation by the U.S. Food and Drug Administration. At six grams (formerly four grams) per medium-size pear, they're great at filling you up. Apples come in second, with about three grams per medium-size fruit. Both contain pectin fiber, which decreases blood-sugar levels, helping you avoid between-meal snacking. This may explain why, in a Brazilian study that lasted 12 weeks, overweight women who ate three small pears or apples a day lost more weight than women on the same diet who ate three oat cookies daily instead of the fruit.
6. Soup. A cup of chicken soup is as appetite blunting as a piece of chicken: That was the finding of a Purdue University study with 18 women and 13 men. Why? Researchers speculate that even the simplest soup satisfies hunger because your brain perceives it as filling.
7. Lean beef. It's what's for dinner-or should be, if you're trying to shed pounds. The amino acid leucine, which is abundant in proteins like meat and fish as well as in dairy products, can help you pare down while maintaining calorie-burning muscle. That's what it did for 24 overweight middle-aged women in a study at the University of Illinois at Urbana-Champaign. Eating anywhere from nine to 10 ounces of beef a day on a roughly 1,700-calorie diet helped the women lose more weight, more fat, and less muscle mass than a control group consuming the same number of calories, but less protein. The beef eaters also had fewer hunger pangs.
8. Olive oil. Fight off middle-age pounds with extra virgin olive oil. A monounsaturated fat, it'll help you burn calories. In an Australian study, 12 postmenopausal women (ages 57 to 73) were given a breakfast cereal dressed either with a mixture of cream and skim milk or half an ounce of olive oil and skim milk. The women who ate the oil-laced muesli boosted their metabolism. Don't want to add olive oil to your oatmeal? That's OK-it works just as well in salad dressings, as a bread dip, or for sautéing.
9. Grapefruit. It's back! A 2006 study of 91 obese people conducted at the Nutrition and Metabolic Research Center at Scripps Clinic found that eating half a grapefruit before each meal or drinking a serving of the juice three times a day helped people drop more than three pounds over 12 weeks. The fruit's phytochemicals reduce insulin levels, a process that may force your body to convert calories into energy rather than flab.
10. Cinnamon. Sprinkle it on microwave oatmeal or whole-grain toast to help cure those mid-afternoon sugar slumps. Research from the U.S.
Department of Agriculture found that a little cinnamon can help control post-meal insulin spikes, which make you feel hungry. Health bonus: One USDA study showed that just a quarter teaspoon of cinnamon a day lowered the blood sugar, cholesterol, and triglyceride levels in people with type 2 diabetes.
11. Vinegar. It's a great filler-upper. In a Swedish study, researchers found that people who ate bread dipped in vinegar felt fuller than those who had their slices plain. The probable reason: Acetic acid in the vinegar may slow the passage of food from the stomach into the small intestine, so your tummy stays full longer. Vinegar can also short-circuit the swift blood-sugar rise that occurs after you eat refined carbs such as white bread, cookies, and crackers.
12. Tofu. It seems too light to be filling, but a study at Louisiana State University showed that tofu does the job. Researchers tested it against chicken as a pre-meal appetizer for 42 overweight women-and the participants who had tofu ate less food during the meal. The secret: Tofu is an appetite-quashing protein.
13. Nuts. Yes, they are fattening: A handful of peanuts is about 165 calories. But research shows that people who snack on nuts tend to be slimmer than those who don't. A study from Purdue University found that when a group of 15 normal-weight people added about 500 calories worth of peanuts to their regular diet, they consumed less at subsequent meals. The participants also revved up their resting metabolism by 11 percent, which means they burned more calories even when relaxing. Health bonus: Walnuts contain omega-3 fatty acids. And researchers at Loma Linda University recently found that eating 10 to 20 whole pecans daily can reduce heart disease risks.
14. High-fiber cereal. Studies show that you can curb your appetite by eating a bowl for breakfast. But how well does it really work? Researchers at the VA Medical Center and the University of Minnesota in Minneapolis tested the theory against the ultimate diet challenge: the buffet table. They gave 14 volunteers one of five cereals before sending them out to the smorgasbord. Those who'd had the highest-fiber cereal ate less than those who didn't have as much fiber in the morning. Try General Mills Fiber One (14 grams per serving) or Kellogg's All Bran With Extra Fiber (13 grams per serving).
15. Hot red pepper. Eating a bowl of spicy chili regularly can help you lose weight. In a Japanese study, 13 women who ate breakfast foods with red pepper (think southwestern omelet) ate less than they normally did at lunch. The magic ingredient may be capsaicin, which helps suppress appetite.
Medically Supervised Weight Loss Plans:
When conventional dietary and life-style changes are not achieving the desired results prescription medication, combined with medically supervised diet and exercise programs are initiated.
A) Prescription Medications: For short term use (2-3 months) prescription stength phentermine is inexpensive way to loose weight. We typically see a 2-5 pound weight loss per week with phentarmine alone.When combined with special diets (see below), faster weight loss will occur. After a period of a few weeks or months, patients may develop tolerance to phentermine, or any weight loss pill. In these cases, the weight loss pill is substituted with another formulation, so that weight loss can proceed. Meridia and xenical are FDA approved for long-term use, but are more expensive. In fact, abdominoplasty may be financed for about $5 per day, which is cheaper than Meridia and Xenical.
C) Special Diets Requiring Physician Supervision
Diets plans 1-6 donot require physician supervision per se, unless combined with diet pills. The combination of prescription diet pills AND calory restriction will result in rapid (5-10 pound) weight loss per week. In these cases, close physician supervision is mandatory. Physician supervision is also mandatory for diabetics, patients with hypertention, heart disease and other co-morbidities. Extreme weight loss may result in nutritional deficiencies, which may need to be monitored and corrected as indicated. Some of the diets we incorporate in our protocols are:
1) Mediterranean Diet (Modified)
2) Atkins Diet (Very Modified)
3) South Beach diet (Very Modified)
5) Orchin Diet (Modified)
6) Cabbage Soup Diet (Very Modified)
8) Our own Quick Loss Diet
9) Diabetics, patients with heart failure, kidney failure or liver failure require highly specialized diets.
7) Prescription Liquid Diets: ingenix, etc.
D) Excercice Program Tailored to the Patient
Patients are placed on a physician prescribed aerobic program. This program may be coordinated with your local gym or health club.
Before an exercise program can be safely prescribed, an on-site stress test and conditioning test is required. The stress test is designed to look for heart disease. The conditioning test, tests the level of endurance of the patient.
Once the conditioning test is completed, a precise exercise protocol may be tailored to the patient's exercise tolerance.
Putting it All Together
Gastric bypass surgery or gastric stapling is the treatment of choise for patients with visceral (internal) obesity. These patients are placed on a gastric diet protocol before surgery.
As demonstrated on network television, patients who have abdominal wall obesity are good candidates for large volume abdominoplasty and liposuction. This will result in immediate and dramatic weight loss within 4 hours with return to work in 2-3 weeks. When plication of the fascia is performed, these patients will have a smaller stomach volume and will be able to keep the weight off.
Patients who do not seek surgery, are placed on a medically supervised weight loss protocol. This protocol consists of prescription diet pills, medically prescribed diets and monitored exercise program.
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