Many of us may take multiple medications daily, and we depend on our prescriber’s ability to monitor those that are safe for us and exclude those that may be problematic. Anyone who wishes to be safer may do a bit of their research, and that’s fine. It does not mean you are suspicious; you only wish to ensure there’s no problem.

Hundreds of medications are listed, and it’s almost impossible for anyone to know if a medication could cause one of those rare effects for you. It is, therefore, in your best interest to be vigilant for these effects. In addition to being aware of the side effects, most patients would not know that the number of side effects may increase as the number of people taking the medication increases. Not every side effect manifests immediately, and it may require a significant increase in medication usage for it to show up.

How does a side effect enter the PDR? Usually, during clinical trials where drugs are being tested on patients, the principal investigator (PI) and those involved at the clinical sites will note any side effects that subjects report. Occasionally, an ultra-concerned clinical investigator may turn up a problem that isn’t one.

I recall a woman who developed a rash during clinical trials of a medication. Later, researchers determined that her caregiver had caused the rash by applying skin cream to her. The rash, however, continued to appear as a side effect of the drug. Although the rash wasn’t severe wasn’t related to the medication, it suggested that the researcher was very cautious about their protocol records.

Over the past several years, the discovery and prescribing of weight loss drugs (usually GLP-1) have been noted to have some mild side effects, and several studies have indicated what to expect in terms of side effects. Gut bacterial action causes bad breath (Ozempic breath), but it was easily manageable, provided the healthcare prescriber also examined any dental problems.

The Potential Risks

In another study, semaglutide was associated with a prevalence of nausea (44.10%), vomiting (24.58%), and gastroesophageal reflux disease (GERD) (6.28%) in obese individuals.

However, researchers are now expressing additional concerns about side effects that have emerged after tens of thousands of people have used these medications. How do these drugs work, and what are they noting?

By stimulating the body to create more insulin, these drugs decrease blood sugar levels. They also slow food’s passage through the stomach and lessen the sugar released into the bloodstream. When the digestive process is delayed, patients experience prolonged feelings of fullness, which can reduce their caloric intake and lead to weight loss. The action of the drugs would seem beneficial, especially for those who need to control their blood sugar levels and their weight.

But there was an increased risk, however, of gastrointestinal disorders, hypotension, syncope, arthritic disorders, nephrolithiasis, and interstitial nephritis associated with GLP-1RA use compared to usual care.

Researchers also followed more than 200,000 diabetics taking GLP-1 meds and over 1.7 million diabetics using other medications to decrease blood sugar for around 3.5 years. The study did find that using GLP-1 was not without its hazards. They found these medications were associated with an increased risk of pancreatitis of 146% and an increased risk of arthritis of 11%. But most of the study’s participants were white men in their 60s and 70s with US VA ties. Such a sample would not necessarily provide the most robust results, and future studies need to be much more diverse in the population studied.

The Vanity Factor

Aside from any physical effects, there is also something women especially might be concerned about: Ozempic face. A New York dermatologist came up with this term. It means that losing weight can make your face look older because of the tissue that is being lost. The fact that videos describing it have received millions of views indicates the extent of concern.

But when it comes to treating type 2 diabetes, the GLP-1 RA family provides positive benefits. In addition to a favorable impact on weight and a low risk of hypoglycemia, all medicines in the class have shown substantial reductions in A1C.

Despite some noted adverse side effects, the medications have proven beneficial to a significant number of users. However, as with everything, the benefits and risks must be weighed carefully, and Ozempic face should not be a negative when considering questions of health.

The post Skinnier, Sicker? Weight-Loss Meds Raise Concerns appeared first on Medika Life.

GLP-1 agonists have also shown promise in reducing the risk of major adverse cardiovascular events, such as stroke and heart attack. This adds to their potential benefits in managing obesity and its related health complications.

Clinical Trial of Semaglutide and Bimagrumab

One promising avenue of research involves combining existing GLP-1 receptor agonists with experimental drugs designed to preserve muscle mass. A clinical trial, known as the BELIEVE Phase 2b study, is currently underway to test the combination of semaglutide and bimagrumab. Bimagrumab is a first-in-class, fully humanized monoclonal antibody developed by Versanis Bio, a clinical-stage biopharmaceutical company recently acquired by Eli Lilly. It targets activin type II receptors, which play a role in regulating muscle growth and fat storage. This trial aims to assess the efficacy and safety of bimagrumab in preserving or increasing muscle mass while promoting weight loss with semaglutide in non-diabetic patients with overweight or obesity.

To be eligible for the BELIEVE study, participants must have a body mass index (BMI) greater than or equal to 30, or greater than or equal to 27 with one or more obesity-related comorbidities. Key exclusion criteria include a history of hypersensitivity to monoclonal antibody drugs, treatment with any medication for obesity within 30 days before screening, and a diagnosis of diabetes requiring current use of any antidiabetic drug.

Pre-clinical studies have shown that blocking activin type II receptors with bimagrumab leads to increased lean mass and decreased fat mass in mice. In a Phase 2 study, bimagrumab produced a 22% reduction in fat mass and a 4.5% increase in lean mass in patients with type 2 diabetes and obesity. Notably, no weight regain was observed after stopping bimagrumab treatment, unlike the rebound effect often seen with GLP-1 therapies. This suggests that bimagrumab may offer long-term benefits in maintaining weight loss even after treatment cessation.

The ongoing clinical trial will provide valuable insights into the potential of combining semaglutide and bimagrumab to achieve superior fat loss while preserving muscle mass. This combination therapy could offer a more comprehensive weight management approach, addressing fat loss and muscle preservation.

Semaglutide and Bimagrumab: Mechanisms of Action

Semaglutide and bimagrumab work through distinct mechanisms to achieve their therapeutic effects. Semaglutide, a GLP-1 receptor agonist, mimics the action of GLP-1, a natural gut hormone crucial in regulating blood sugar and appetite. GLP-1 agonists work by

• Triggering insulin release from the pancreas
• Blocking glucagon secretion
• Slowing stomach emptying
• Increasing feelings of fullness

Semaglutide helps lower blood sugar levels, reduce appetite, and promote weight loss by mimicking these effects.

Bimagrumab, on the other hand, is a human monoclonal antibody directed against type II activin receptors (ActRII). Upon administration, bimagrumab binds to ActRII, which prevents binding the natural ligands, myostatin and activin, to activin receptors and blocks ActRII-mediated signalling. This increases protein synthesis, decreases protein degradation, stimulates skeletal muscle cell growth, and increases muscle function and strength10. Overstimulation of the ActRII-mediated signalling pathway is associated with muscle loss and weakness.

Other Anti-Obesity Drugs in Development

The success of semaglutide and tirzepatide has fueled a surge in the development of new anti-obesity drugs. These drugs target various biological pathways and aim to improve upon the limitations of existing therapies. Targeting multiple pathways simultaneously could allow for lower doses that achieve the same weight loss with fewer side effects. Some of the key areas of development include:

GLP-1 and GIP Receptor Agonists

Tirzepatide is a dual GLP-1 and GIP receptor agonist that has shown superior weight loss results compared to semaglutide in a large head-to-head trial by Eli Lilly. Participants who took tirzepatide lost an average of 20% of their body weight, outpacing the 14% reduction achieved with semaglutide. Tirzepatide is already available under the brand names Mounjaro and Zepbound.

There are two main strategies for modulating GIP activity: activation and blocking. While both approaches can lead to weight loss, they have different potential benefits and drawbacks. As seen with tirzepatide, GIP activation can further enhance energy metabolism and promote weight loss. However, some concerns blocking GIP signalling could adversely affect bone health, as GIP also plays a role in bone metabolism.

Amylin Analogues

Amylin is a hormone co-secreted with insulin that regulates blood sugar and appetite. CagriSema, a combination therapy developed by Novo Nordisk that pairs a long-acting analogue of amylin (cagrilintide) with semaglutide, has shown promising results in clinical trials. Participants in a 68-week, phase 3 trial lost an average of nearly 23% of their body weight.

Glucagon and GLP-1 Receptor Co-agonists

Glucagon is a hormone that raises blood sugar levels, while GLP-1 lowers them. Combining these two hormones in a single drug could offer a balanced approach to weight loss by increasing energy expenditure while maintaining blood sugar control. Survodutide, a glucagon and GLP-1 receptor co-agonist developed by Boehringer Ingelheim, is currently in clinical trials.

Triple-Hormone Receptor Agonists

Retatrutide, a triple-hormone receptor agonist developed by Eli Lilly that targets GLP-1, GIP, and glucagon receptors, has shown impressive weight loss results in Phase 2 trials. This drug, dubbed “triple G,” delivered an average weight reduction of 24% after 48 weeks, setting a new benchmark for obesity treatments.

Alternative Delivery Methods for Anti-Obesity Drugs

Companies are also exploring alternative delivery methods to once-weekly injections, which can be challenging to incorporate into people’s routines and come with manufacturing challenges. Once-monthly injectables are in the works, but oral formulations of GLP-1 receptor agonists, such as orforglipron produced by Eli Lilly, could arrive first.

Another potential alternative is oral semaglutide. In a phase 3 study called OASIS 1, people taking oral semaglutide 50 mg once daily lost up to 15% of their initial body weight after about 15 months (68 weeks) of use. This is comparable to the weight loss benefits of Wegovy, the injectable version of semaglutide.

Potential Side Effects of Anti-Obesity Drugs

While anti-obesity drugs offer a promising approach to weight management, they can also cause side effects. Some of the common side effects of GLP-1 receptor agonists include nausea, vomiting, diarrhoea, and constipation. More serious side effects, such as pancreatitis and gallbladder problems, are rare but can occur.

Specific side effects associated with semaglutide include nausea, vomiting, diarrhoea, abdominal pain, constipation, heartburn, and burping. In rare cases, semaglutide can cause more serious side effects such as pancreatitis, kidney problems, and changes in vision.

Tirzepatide can cause similar side effects, including nausea, diarrhoea, decreased appetite, vomiting, constipation, and stomach pain. Serious side effects, such as pancreatitis, gallbladder problems, and low blood sugar, can also occur.

Another concern with GLP-1 and GIP drugs is the potential risk of pulmonary aspiration during anaesthesia. These drugs can cause delayed gastric emptying, which may increase the risk of residual gastric contents despite preoperative fasting. This can lead to aspiration, where food or liquid gets into the lungs during surgery.

The increased demand for GLP-1 receptor agonists and dual GIP/GLP-1 receptor agonists has led to temporary product shortages. This has resulted in the emergence of compounded formulations of these drugs, which produce entities that bypass regulatory measures. The American Diabetes Association recommends against using non-FDA-approved compounded GLP-1 and dual GIP/GLP-1 receptor agonist products due to concerns regarding their safety, quality, and effectiveness. The FDA has also issued an alert on dosing errors associated with compounded semaglutide injectable products, which have led to adverse events and hospitalisations in some cases.

It is important to note that the potential side effects of anti-obesity drugs vary depending on the specific medication and individual factors. Patients should discuss these medications’ possible risks and benefits with their healthcare provider to determine the most appropriate treatment option.

Alternative Treatments for Obesity: Bariatric Surgery

For some individuals, bariatric surgery may be an alternative treatment option for obesity. Bariatric surgery involves making changes to your digestive system to help you lose weight. It is typically considered for people with a BMI of 40 or higher or those with a BMI of 35 or higher who have obesity-related health problems.

There are several types of bariatric surgery, including

• Roux-en-Y gastric bypass: This procedure involves creating a small pouch at the top of the stomach and connecting it directly to the small intestine, bypassing most of the stomach and the first section of the small intestine
• Sleeve gastrectomy: This procedure involves removing about 80% of the stomach, leaving a long, tube-like pouch
• Biliopancreatic diversion with duodenal switch (BPD/DS): This is a two-part surgery that involves performing a sleeve gastrectomy and then connecting the end of the small intestine to the duodenum, bypassing most of the small intestine

Bariatric surgery can be very effective for long-term weight loss and can also improve or reverse obesity-related conditions such as diabetes, high cholesterol, and sleep apnoea. However, it is a major surgical procedure with potential risks and complications, such as bleeding, infection, and leaks in the gastrointestinal system. Patients should carefully consider the risks and benefits of bariatric surgery with their healthcare provider.

Emerging Applications of GLP-1 and GIP Drugs

While GLP-1 and GIP drugs are primarily known for their role in treating obesity and type 2 diabetes, research is exploring their potential applications in other disease areas. These include:

• Neurodegenerative diseases: Conditions such as Parkinson’s and Alzheimer’s disease involve protein misfolding and chronic inflammation. Studies have found that GLP-1 mimetics can cross the blood-brain barrier and have neuroprotective effects, including reducing oxidative stress and chronic inflammatory responses in the brain.
• Liver disease: GLP-1 and GIP receptor agonists have shown potential in improving liver health, particularly in individuals with nonalcoholic fatty liver disease (NAFLD).

These emerging applications highlight the versatility of GLP-1 and GIP drugs and their potential to address a wide range of health challenges beyond obesity and diabetes.

Conclusion

The field of anti-obesity drug development is rapidly evolving, with new therapies emerging that offer the potential for more effective and personalised weight management. While GLP-1 receptor agonists like semaglutide and tirzepatide have revolutionised the field, ongoing research is exploring new targets and combination therapies to address the limitations of existing medications. These advancements, such as the combination of semaglutide and bimagrumab, the development of triple-hormone receptor agonists like retratrutide, and the exploration of alternative delivery methods, hold promise for improving the lives of millions of people struggling with obesity and its related health complications.

However, it is crucial to acknowledge the potential side effects of these therapies, including gastrointestinal issues, pancreatitis, and the risk of pulmonary aspiration during anaesthesia. Patients should carefully consider the risks and benefits of these medications with their healthcare provider to determine the most appropriate treatment option.

Developing new anti-obesity drugs has significant implications for public health and the future of obesity management. These advancements offer hope for a more comprehensive and personalised approach to weight loss, potentially reducing the burden of obesity and its associated health problems.

The post The Evolving Landscape of Anti-Obesity Drugs appeared first on Medika Life.

Over a thousand epidemiologic papers were examined, including clinical trials of weight-loss or weight-control therapies. These investigations included observational studies on cancer risk and fat excess. Because of this, the assessments focused on the dangers of being overweight rather than the benefits of preventative measures.

Studies varied in their risk assessments; most focused on adults’ body mass index (BMI), while others looked at childhood or adolescent BMI or body shape, weight or BMI changes over time, or other measures of adiposity, such as waist circumference.

The analysis considered relative-risk estimates where sufficient analyses of observational data were accessible. The absence of extra body fat, it was concluded, reduces the risk of cancer at previously described organ sites. In addition, study results point to the fact that being lean reduces the incidence of eight more cancers: gastric, cardiac, liver, gallbladder, pancreatic, ovarian, thyroid, multiple myeloma, and meningioma. Once again, however, we must understand that correlation does not equal causation. But the indicators are of concern and great interest.

If the newly introduced GLP-1 medication can control obesity, which, in turn, may reduce the incidence of cancer, researchers are now questioning whether these drugs may serve other purposes in healthcare. There is a belief that GLP-1 medication use may extend beyond obesity and weight control. What areas are they currently considering for studies with these medications?

GLP-1 for Addiction?

The World Health Organization (WHO) found that 2.6 million people die each year because of alcohol intake (or 4.7% of all deaths), and 0.6 million people die because of the use of psychotropic drugs. Men accounted for 0.4 million drug-related fatalities and 2 million alcohol-related fatalities. But while alcoholism remains a serious health hazard, there are other addictions to street or prescription drugs that are also of concern to healthcare professionals and patients.

Cocaine use disorder affects an estimated 5 million people. Worldwide, the death toll from cocaine overdoses is rising at a faster rate than that from opiate overdoses.

But there is an intriguing relationship between obesity and addiction. Substantial evidence in the literature linking obesity to substance use disorders supports a link of sorts. Studies have shown that when people are exposed to meals that are very tasty, certain hormones in the brain are triggered, which makes consuming unhealthy choices more likely.

This is analogous to what occurs in the brains of those who suffer from substance abuse disorders. Behaviors comparable to addiction to foods high in fat and sugar have led to studies employing animal models of obesity, discovering typical neurobiological features of addiction in the brain systems. The reward system that is engaged, and that perpetuates a preference for specific types of foods, may also be involved in addiction disorders.

The conclusion, currently, is that there is a viable solution for addiction through the use of the GLP-1 medications. Researchers must further investigate these specific connections and detail their interrelationships.

Since the discovery of GLP-1 medications for obesity, several off-label uses have also been shown to be useful. Researchers are actively exploring the growing number of diseases that these medications might treat, which is extremely promising.

The potential utility of GLP-1 disorders of addiction and others include: food addiction (binge eating), alcoholism, Parkinson’s disease, depression, anxiety, heart disease, hypertension, fatty liver, polycystic ovarian syndrome, chronic kidney disease, inflammation, and opiate and narcotic addictions.

Addiction regulation, inflammation reduction, dopamine pathway modulation, and insulin sensitivity are just a few of the many physiological consequences of these receptor agonists. Because of these processes, they are promising candidates for the treatment of diseases outside of their original indications.

Medical and scientific communities are highly intrigued by the prospect of GLP-1 medicines potentially treating this wide array of illnesses, but research into these uses is still in its early phases.

The future, however, appears promising as new indications come to light, and as research reveals the areas where they may be brought into a treatment regime that is successful. At this juncture, however, it is not always apparent which biological pathways are being affected and that is a remaining question for future research efforts.

The post The Weight Loss Drugs That Refuse to Recognize Boundaries appeared first on Medika Life.

We begin with observations that, at first glance, seem obvious:

1. You cannot shed weight through dieting alone; you must exercise too.
2. Individuals who exercise burn more calories; burn more calories without consuming more calories, and you will lose weight.
3. A central reason for the obesity epidemic is that folks are less physically active today than they were a few decades ago.

What do you think?

“From his shoulder on down, the Rat felt the supple weight of her body. An odd sensation, that weight. This being that could love a man, bear children, grow old, and die; to think one whole existence was in this weight.”
― Haruki Murakami, Pinball, 1973

Exercise alone doesn’t usually control weight.

Physical activity is an essential component of a healthy lifestyle. It offers numerous health benefits, including improved cardiovascular health, increased muscle strength, and reduced risk of chronic diseases like type 2 diabetes, heart disease, and some cancers. However, physical activity alone may not be sufficient for weight control.

Weight gain or loss is primarily determined by the balance between the number of calories consumed and burned. You gain weight when you consume more calories than you burn; when you burn more calories than you consume, you lose weight. Therefore, weight control requires a balance between calorie intake and physical activity.

However, the amount of physical activity required to burn a significant number of calories can be quite high, and it is often difficult to achieve through exercise alone.

For example, an hour of moderate-intensity aerobic exercise, such as brisk walking, may burn only 300 to 400 calories for a person weighing 155 pounds. In contrast, a single large slice of pizza can contain over 500 calories, meaning it would take more than an hour of exercise to burn off the calories consumed in just one slice.

Additionally, physical activity can increase appetite and food intake, leading people to eat more calories than they burn, thereby offsetting the calorie-burning benefits of exercise. Also, some people may have a genetic predisposition to retain or lose weight more slowly, despite their physical activity levels.

Therefore, combining physical activity with a healthy, balanced diet (emphasizing nutrient-dense, whole foods and limiting calorie-dense, processed foods) is essential to control weight effectively. By creating a calorie deficit through diet and exercise, weight loss can be achieved and sustained over time.

The Hazda, a hunter-gatherer tribe in Africa

Duke University (USA) professor of evolutionary anthropology Herman Pontzer studied the Hazda. The Hazda is a group of traditional hunter-gatherers who live in Tanzania, while Americans refer to people living in the United States. The average Hazda likely burns more calories than Americans because they lead a more physically active lifestyle that involves a significant amount of hunting and gathering food.

Studies have shown that Hazda men walk an average of seven to 10 miles (11 to 16 kilometers) per day in search of food, while Hazda women walk an average of three to six miles (five to 10 kilometers) daily. I initially thought that this level of physical activity would be significantly higher than that of most Americans, who tend to have more sedentary jobs and lifestyles.

Additionally, the Hazda diet consists primarily of wild game, tubers, fruits, and honey, typically lower in calories and fiber, and protein than the typical American diet, which is often high in processed and sugary foods.

Yet, I was wrong: Pontzer discovered that the Hazda consume and burn the same number of calories to walk a mile as Westerners. And the number of calories burned per mile walked is comparable. This doesn’t seem to make sense.

This observation is not limited to the Hazda. An analysis of ninety-eight studies discovered the following:

People in third-world countries with physically demanding lives had similar energy expenditures to more sedentary people in the developed world.

But why?

Internal energy expenditure controller

We have an internal energy expenditure controller set to a particular level. The Hazda’s regulator recognizes their activity and adjusts for it to keep total energy the same (perhaps by diverting energy from the body’s normal housekeeping tasks).

Physical activity reduces our immune system’s inflammatory response and drops hormone levels. On the other hand, laboratory animals don’t increase their energy expenditure with exercise; rather, they ovulate less frequently and repair tissue damage more slowly.

Writing in Skeptical Inquirer, Harriet Hall reminds us of some myths:

1. You cannot drop weight by dieting alone; you must exercise too.
2. People who exercise burn more calories; if you burn more calories without taking in more calories, simple physics tells us that you will lose weight.
3. A central reason for the obesity epidemic cause is that people are less physically active now than they were a few decades ago.

Humans appear to have a metabolism that burns more calories than primates (to support the extra activity of our brains). While there is an energy cost to finding more food, we compensate by cooking to make more calories available and by the more efficient obtaining of food (for example, through farming). Our ability to store fat helps us survive famines but sets us up for obesity.

Back to the myths.

1. You can’t lose weight by dieting alone; you must exercise too. Hall reminds us of the tragic concentration camps, where individuals wasted away for want of food.
2. Exercise and burn calories. Simple physics dictates you will drop weight. True, but our metabolism adjusts to compensate for the calories expended. Your metabolism sabotages your diet. It would be best to curtail the calories, but the implementation is challenging for most.
3. A central reason for the obesity epidemic cause is that people are less physically active now than they were a few decades ago. Increased calorie consumption (not primarily decreased activity) caused the obesity epidemic, not decreased activity.

Physical activity is central to optimizing health for numerous reasons, including cancer and cardiovascular risk reduction. Move to stay healthy, but exercise alone to lose or control weight probably won’t get the job done.

The post Why Exercise Doesn’t Control Weight appeared first on Medika Life.

This increased risk is because the circadian rhythm can be thrown off, leading to fatigue and stress. And because they work at night, they don’t get to see their friends and families as often or spend time with them, which might amplify the sense of loneliness and despair they already feel.

Researchers discovered that night shift employees were more likely to experience depression than their daytime counterparts. This is in line with the findings of other studies, which indicated that night-shift employees have a higher chance of acquiring anxiety disorders.

Chronic insomnia, sleep disorders, gastrointestinal problems, and infertility are all linked to disruptions in the circadian cycle. In response to changes in light and dark, the hypothalamic suprachiasmatic nucleus (SCN) regulates the body’s natural 24-hour circadian rhythm.

The circadian rhythm controls not only the generation of hormones but also the maintenance of a steady core temperature and the rate at which nutrients are burned.

People who work night shifts have trouble falling asleep during the day because the regular light-dark cycle is disturbed. This makes the hormone melatonin, which helps you sleep, less effective.

Working the night shift is linked to a greater chance of gaining weight and developing type 2 diabetes. Another research study came to the conclusion that working the night shift makes you more likely to get colorectal cancer. Such an association might be a result of stress on our immune system.

This is because your body’s internal clock isn’t in sync with your social life. This is called “social jetlag,” and working night shifts makes it worse.

Night shift workers must frequently remain awake and productive when their bodies beg for rest and sleep. This can cause workers to feel run down, anxious, and unwell. According to research, night shift work has been linked to an increased risk of menstruation problems. Employers must consider the issues associated with working the night shift.

An employer with a productive workforce needs to know about the risks of night work and do everything they can to help employees who work night shifts, so that night work has less of an effect on their mental health.

Employers can provide training, education, and therapy to help their employees deal with the emotional and psychological effects of working the night shift. Regarding scheduling, employers can be more flexible if they let night-shift workers switch to day shifts often and ensure employees have enough time off between shifts.

Workers on the night shift should also be aware of the risks to their health and take their own steps to reduce them, such as keeping a regular sleep schedule, making sure they have a dark, quiet place to sleep, getting regular exercise, eating a healthy diet, limiting their intake of caffeine and alcohol, using light therapy, and taking frequent breaks.

Because of their irregular work schedules, those who work the night shift may find it difficult to keep in touch with their loved ones and form meaningful relationships. However, night-shift employees can keep up with friends and family in several ways. Suggestions for working these hours are readily available.

Social media, instant messaging, and video conferencing technology can help those who work the night shift maintain social relationships with others despite physical distance and time zone differences.

It’s vital to remember that keeping in touch with friends and family takes work and sometimes compromise, but the benefits to your health are well worth it. Workers on the night shift should be aware of the difficulties that come with their schedules and try to find new ways to get to know their coworkers.

Night shift workers who want to keep their minds healthy should also get some exercise. Running, cycling, and swimming are all examples of aerobic exercises that have been shown to improve sleep quality and lower stress and anxiety levels.

When thinking “exercise,” it’s not all outdoors or requiring expensive equipment or gym memberships because many exercises can be done at home with inexpensive equipment. Not all of these are possible, but some activity must be included to counter the effect of shiftwork.

Yoga is a practice that incorporates breathing exercises, bodily postures, and meditation. It can help you relax and calm down, leading to a more restful night’s sleep.

Building muscle and increasing one’s general well-being are two of the many benefits of strength training methods like weightlifting and resistance band exercises. Stretching is a quick and easy way to help you feel better and calm down.

HIIT, or high-intensity interval training, is a way to work out that involves short bursts of hard work followed by short breaks. Walking, hiking and swimming are all ways to exercise and enjoy the outdoors. And being outdoors (forest bathing) has its benefits even if you are walking.

Keep in mind that the optimum exercise plan for a night shift worker will vary from person to person based on factors including preferences, fitness level, and availability. Before beginning an exercise program, people who work the night shift should see a doctor. Workers on the night shift would do well to pay attention to their bodies and modify their workouts accordingly if they were feeling too exhausted.

Consequences for one’s mental health are real, and night work is a major contributor. Evidence suggests that night shift workers are likelier to have mental health issues like sadness and anxiety.

If a person who works the night shift is having trouble getting used to the new schedule or has mental or physical health problems, they should consider getting help from a professional.

The post Tackling Night Shift Worker Health Perils; Failure to Act Is Unhealthy appeared first on Medika Life.

The discovery that Ozempic (semaglutide) supports weight loss is not new, but the unexpected spotlight on weight loss as a side effect of a diabetes medication serves as a good reminder to healthcare providers (or a wake-up call, for some) that all medications’ potential effects on weight should be taken into account, because the opposite result — drug-induced weight gain — is more common than most practitioners realize.

A typical case

A 33-year-old woman, Jill, recently presented to my obesity medicine practice because she had suddenly started to gain weight — 32 pounds over the previous six months. Through my evaluation, I learned that she had received two Depo-Provera injections during that time. She had previously used oral contraceptive pills, but she often forgot to take her pills and wanted a lower-maintenance form of birth control. Although progestin injections work well for many women, weight gain is a known and fairly common side effect, and the timing of Jill’s weight gain suggested a causal link. As part of her weight-management plan, we discussed birth control alternatives, and she ultimately chose to switch to a nonhormonal IUD.

The OB-GYN who prescribed her Depo-Provera had not mentioned the possibility of weight gain. While it’s understandable that many practitioners don’t want to create unnecessary worry about a side effect that might never materialize, it can be extremely difficult to lose weight once it has been gained, particularly for those who already have overweight or obesity. Since many patients who don’t track their weight can gain significant amounts without realizing it, simply advising patients to monitor their weight and notify their provider if they notice an increase can prevent tremendous frustration.

Jill was on only one weight-gain-promoting medication, but I often identify two, three, or even four such culprits when taking a new patient’s history. In addition to injectable or implantable birth control, some of the most common weight-gain-promoting drugs include diabetes medications, blood pressure medications, and antidepressants. In many cases the effect is modest, but with long-term medication use for chronic conditions, even a small effect can lead to a significant increase in weight over time.

Prevention starts with awareness

What can healthcare practitioners do to help their patients avoid drug-induced weight gain? Essentially, four things:

1. Be aware. First, practitioners need to recognize how common the problem is and educate themselves about the weight profiles of various classes of drugs and different agents within classes. (The Endocrine Society’s practice guidelines for the pharmacological management of obesity include information on drugs that cause weight gain and recommended alternatives; see the original article in the Journal of Clinical Endocrinology and Metabolism, or a summary listing in Table 2 of our more recent best practices article.) As with most contributors to the multifactorial disease of obesity, the interactions are complex, and a medication’s impact on weight may vary based on a variety of physiological, genetic, and lifestyle factors. But despite some unpredictability, many medications do have a well-documented track record of promoting weight gain, and providers should be alert to this potential side effect.
2. Choose alternatives when possible. When prescribing any medication, providers should consider the drug’s weight profile in assessing the benefits and risks, and seek to avoid weight-promoting drugs when possible. Weight-neutral or weight-loss-promoting medications are available for many common conditions that are frequently associated with obesity, including type 2 diabetes, hypertension, and depression. These alternatives should be prioritized when appropriate as first- and second-line treatments — especially for patients with overweight, obesity, or metabolic risk factors. For example, for patients with type 2 diabetes, weight-loss-promoting medications such as metformin and glucagon-like peptide-1 (GLP-1) receptor agonists (semaglutide and liraglutide, for instance), or weight-neutral options such as DPP-4 inhibitors, are preferred over insulin and insulin secretagogues that promote weight gain. For patients with hypertension, weight-neutral angiotensin-converting enzyme inhibitors or angiotensin receptor blockers should be chosen over weight-gain-promoting alpha- or beta-adrenergic blockers if possible. Many antidepressants present a risk of weight gain, for example, but only one, bupropion, has been consistently shown to promote weight loss, though it’s not appropriate for all patients. When recommending changes to existing prescriptions, providers should either consult with the original prescribing physician or ensure that the patient does so. The topic of drug-induced weight gain needs to be discussed extremely carefully with patients, though, or they may feel alarmed and stop taking their medications before a plan for replacement is in place.
3. Use the minimum dose. Drugs in the same class often aren’t interchangeable, and if no appropriate alternative to a weight-gain-promoting medication is available, providers should aim to prescribe the lowest effective dose for the shortest possible duration needed to manage the patient’s symptoms. Too often, patients are started on a medication, and then the dose and duration of the drug regimen are never reevaluated.
4. Counteract the effects with anti-obesity medication. When weight-gain-promoting medications must be used, practitioners should consider adding an anti-obesity medication, in conjunction with appropriate lifestyle modifications, to counteract weight-promoting effects in their patients with obesity. Providers who don’t feel comfortable prescribing these medications can refer their patients to an obesity medicine specialist.

The challenge of reversing weight gain

Optimizing medication choices may seem like low-hanging fruit in the effort to help patients manage their weight, and in a certain sense it is: prescribing weight-loss-promoting instead of weight-gain-promoting drugs can be a relatively simple way to prevent unwanted weight gain. This is an important strategy because reversing drug-induced weight gain is not always simple.

Jill was disappointed to find out that weight gained due to medication is sometimes no easier to lose than weight gained due to any of the other myriad contributing factors. Although switching birth control stopped the increase, she didn’t immediately lose the pounds she had gained. This is such a crucial point: many patients aren’t alarmed when realize they’re gaining weight on a medication because they assume the weight will come off easily when the medication is discontinued — however, this is often not the case. Jill and I developed a comprehensive, personalized weight-management plan that is beginning to show results, but it will be a long-term effort.

There’s no silver bullet in the fight against excess weight; obesity is a chronic disease that requires lifelong management. While weight-loss-promoting medications are a valuable addition to our armamentarium, they are not a quick fix, and pharmacotherapy needs to be part of a multidisciplinary approach that also includes diet, physical activity, and behavioral modifications. So it won’t be a surprise if most of the people who recently flocked to Ozempic without proper medical supervision regain the weight as soon as they stop taking the medication.

The ratchet nature of weight gain (easy come, decidedly not easy go) makes it even more critical that healthcare providers be aware of the potential weight-related side effects of medications and adjust their prescription choices accordingly. Obesity has many complex and interrelated causes, and the more of these underlying factors we can eliminate — like weight gain secondary to medications — the more successful we will be in helping our patients move toward a healthier weight.

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Maybe I have oversold it as there is a catch: You have to be asleep. Historical studies inform us that if we put you in a sleep lab and limit your sleep to four or five hours nightly, you will consume more calories the following day.

But why do we eat more when we are sleep-deprived? Is it the fatigue that drives us, or is it something else? Will we decrease our caloric intake if we sleep more?

Thanks to a recently published study from the University of Chicago (USA), we have some answers.

Sleep and weight: Study details

Sleep expert Dr. Esra Tasali and colleagues randomized 80 overweight volunteers getting less than 6.5 hours of sleep per night to receive either personalized sleep recommendations (to extend sleep) versus nothing but routine study visits.

Here’s where we need to take a detour, as I want to share with you the very doable suggestions offered by the researchers:

• Create a bedtime routine
• Limit television and phone use in bed
• Decrease ambient light
• Decrease caffeine intake
• Increase exercise

One more thing — each study participant got a goal bedtime and wake-up time.

Sleep recommendations work

Did these sleep recommendations work? Yes. Following a two-week run-in, the intervention group slept 1.2 hours more (as shown by sleep monitors worn on their wrists).

Moreover, the sleep extension group had higher subjective scores in obtaining sufficient sleep, daytime energy and alertness, and better mood (compared with the control group).

Sleep, energy balance, and weight

The researchers scrutinized the energy balance of the subjects — calories in and calories out — using labeled water to measure. The findings are provocative:

The group randomized to sleep longer had decreased total energy intake (calories in), dropping by about 150 calories daily. They had no change in total energy expenditure (calories out).

This energy intake decrease translated to a one-pound loss over the two-week study period.

Sleep and weight — My take

This study is well-done. I love the randomized design and how the researchers measured energy intake and output objectively instead of depending on self-reporting of dietary intake.

In addition, the researchers used a validated tool to track sleep. The study authors excluded those with insomnia and sleep apnea.

Is the study perfect? We don’t know if the results apply to non-overweight individuals. Can the intervention group participants maintain their healthy sleep habits over a more extended period?

This well-done study reminds us of the importance of optimizing our sleep duration for obesity risk reduction. The strategies employed in the study are doable for many of us.

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Today is not about restricted diets for weight loss; instead, we look at a new study showing how a well-tolerated once weekly fasting approach may improve metabolism and potentially lower chronic disease risks such as diabetes and heart failure.

Intermittent fasting basics

People often use intermittent fasting strategies for weight loss. There are many approaches, including time-restricted feeding and alternate-day fasting. Some studies show intermittent fasting is an effective tool for weight loss. Other studies hint that alternate-day fasting is no better than regular dieting.

For example, a 12–week randomized trial of alternate-day fasting (with 25 percent of the energy consumed on fasting days and free eating on other days) showed a 5.2 kilogram (11.4 pounds) weight loss than a control group.

The University of Illinois at Chicago (USA) study authors offer that alternate-day fasting effectively reduces weight and cardiovascular risk.

On the other hand, a one-year experiment of 100 obese individuals showed that alternate-day fasting did not work better than daily calorie restriction. Participants consumed 25 percent of total energy on fasting days and 125 percent on “feast” days for this trial.

Compared with calorie restriction (75 percent of total energy needs consumed each day) and a no-intervention control group, average weight loss in the two diet groups appeared similar.

What about time-restricted feeding? This form of intermittent fasting has us stop eating by a specific time of day (for example, in the early afternoon). One creates a prolonged period of fasting that carries over into the next day.

Short-term experiments looking at time-restricting fasting suggest that aligning our feeding with circadian rhythms may facilitate weight loss and improve measures of metabolism.

Intermittent fasting, once weekly

Publishing in the European Heart Journal Open, researchers followed 67 subjects, ages 21 to 70 years, for six months. Each subject had at least one symptom of metabolic syndrome (for example, obesity) or type 2 diabetes.

All had elevated LDL (bad) cholesterol levels, but none took diabetes or statin medications.

The participants fasted twice weekly for 24 hours for the first four weeks. Then, they fasted once per week for the next 22 weeks. A control group ate whenever and whatever they wanted.

Study results

When compared with the control subjects, the intermittent fasting group had:

Improvements in markers for insulin resistance and metabolic syndrome. Cholesterol levels did not improve.

More specifically, the fasting participants had higher levels of galectin-3. This substance is an essential protein that plays a part in several cellular processes.

Galectin-3 is associated with inflammatory responses. According to the study principal investigator, Dr. Benjamin Horne, the improvement may lead to a lower risk of diabetes and heart failure.

Dr. Horne adds that “unlike some intermittent fasting plans that are quite restrictive and promise magic weight loss, this approach is not a severe fasting form. The best routine is one that patients can stick to over the long term, and this study shows that even occasionally fasting can have positive health effects.”

Reducing inflammation can improve the cardiovascular environment at a microscopic level.

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First, diets don’t work as tools for weight loss. Yes, I know that some of you lost weight on a restrictive diet, but the reality is that 95 percent of us who lose weight by dieting regain it within one to five years. Deprive yourself, and you may then overeat in a diet-binge cycle.

Our bodies are designed for times when there wasn’t always abundant food. Restrict your diet too much, and your metabolism will slow, making it even harder to lose weight. I think of the brain as similar to a thermostat. Set the thermostat, and even if you open your home’s windows, the thermostat will drive your furnace to maintain a set temperature.

Restrictive dieting: Perils

Second, fad diets have associated peril. Many lack essential nutrients. Furthermore, we don’t learn how to eat healthily. How many people end up yo-yo dieting, a pattern that can cause illness.

As demonstrated in well-designed clinical trials, several fad diets can facilitate rapid weight loss. For example, the Atkins diet is the most popular low-carbohydrate diet. Proponents claim the approach leads to rapid weight loss without hunger.

The Atkins diet is at least as effective (and frequently more effective) at driving weight loss than other diets. The A TO Z study examined 311 overweight women who followed the Atkins diet, the LEARN diet, the low-fat Ornish diet, or the Zone diet for one year.

The winner? The Atkins group lost more weight than any other group. Healthline.com has some good information about the Atkins high-protein, high-fat diet.

I began by offering that many “fad” diets are unbalanced and don’t live up to their hype. Several diets do help with weight loss. Unfortunately, just because a fad diet works for weight reduction in the short term does not mean that it is sustainable over the long haul.

Restrictive dieting: Taking joy out of eating food

Enough said.

Restrictive dieting and eating disorders

While dieting may not cause an individual’s eating disorder, it is often a precursor to the diagnosis. The National Eating Disorders Association reports these disturbing statistics:

Thirty-five percent of “normal dieters” progress to pathological dieting, and that 20 to 25 percent of those individuals develop eating disorders.

For those headed towards an eating disorder, elements of restrictive dieting can have appeal; for example, individuals may gain a sense of control by counting calories or fat grams, avoiding specific food types, and focusing on the weight scale.

So what is the approach that helps me dodge weight gain while not restricting diet? Let’s get to it.

Sleep, diet, and weight

Did you know that approximately 35 percent of Americans get less than the recommended minimum of seven hours of sleep each night? Or that upwards of 30 percent suffer from a sleep disorder such as insomnia or sleep apnea? Are you one of them?

Unfortunately, short sleep and other sleep disorders are associated with various illnesses, including type 2 diabetes and cardiovascular disease.

Diet may be something we need to be more mindful of when it comes to sleep. A suboptimal diet can contribute to how well we sleep.

I recently came across the fascinating work of Marie-Pierre St-Onge. She has shown that consuming less saturated fat and less sugar results in less disturbed sleep. A Mediterranean-style diet rich in olive oil, whole grains, nuts, legumes, and fruits and vegetables may be particularly beneficial:

Those who followed a Mediterranean diet appeared 1.4-times more likely to have a good night’s sleep.

Here’s why. Protein-rich foods contain tryptophan, an amino acid from which the brain makes the sleep-regulating hormone melatonin. Other foods such as tomatoes, apples, bananas, nuts, vegetable oils, and animal products contain melatonin. It is not clear if consuming melatonin-rich foods boost your melatonin levels.

Based on her research, Marie-Pierre St-Onge believes that diet may affect sleep at least as much as mindfulness practices or melatonin-containing pills. She notes that melatonin supplements reduce falling asleep by four minutes on average. This improvement compares to 12 minutes for eating a healthy diet. The overall sleep quality is better with the diet approach, too.

Sleep and diet are reciprocal.

Sleep and diet are intertwined, with each influencing the other. With inadequate sleep, we tend to make poorer diet choices (which then results in lower quality sleep). Try interrupting the cycle by eating well throughout the day. Your more restful sleep may then influence you to make better food choices.

Finally, the strategy appears more easily achieved by early risers. Night owls tend to consume less plant protein, fruits, and vegetables.

The anti-diet diet

If we want to permanently achieve long-term and healthy weight loss, we probably should ditch the restrictive diet mindset. Find a healthy approach to eating that you can achieve and enjoy for life. Instead of restrictive dieting, aim for healthy and pleasurable eating combined with regular physical activity. And get some sleep!

Thank you for joining me today in exploring how sleep and diet appear intimately related.

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What is the difference between open and laparoscopic surgery?

In open bariatric surgery, surgeons make a single, large cut in the abdomen. More often, surgeons now use laparoscopic surgery, in which they make several small cuts and insert thin surgical tools through the cuts. Surgeons also insert a small scope attached to a camera that projects images onto a video monitor. Laparoscopic surgery has fewer risks than open surgery and may cause less pain and scarring than open surgery. Laparoscopic surgery also may lead to a faster recovery.

Open surgery may be a better option for certain people. If you have a high level of obesity, have had stomach surgery before, or have other complex medical problems, you may need open surgery.

What are the surgical options?

In the United States, surgeons use three types of operations most often:

• laparoscopic adjustable gastric band
• gastric sleeve surgery, also called sleeve gastrectomy
• gastric bypass

Surgeons use a fourth operation, biliopancreatic diversion with duodenal switch, less often.

Laparoscopic Adjustable Gastric Band

In this type of surgery, the surgeon places a ring with an inner inflatable band around the top of your stomach to create a small pouch. This makes you feel full after eating a small amount of food. The band has a circular balloon inside that is filled with salt solution. The surgeon can adjust the size of the opening from the pouch to the rest of your stomach by injecting or removing the solution through a small device called a port placed under your skin.

After surgery, you will need several follow-up visits to adjust the size of the band opening. If the band causes problems or is not helping you lose enough weight, the surgeon may remove it.

The U.S. Food and Drug Administration (FDA) has approved use of the gastric band for people with a BMI of 30 or more who also have at least one health problem linked to obesity, such as heart disease or diabetes.

Gastric Sleeve

In gastric sleeve surgery, also called vertical sleeve gastrectomy, a surgeon removes most of your stomach, leaving only a banana-shaped section that is closed with staples. Like gastric band surgery, this surgery reduces the amount of food that can fit in your stomach, making you feel full sooner. Taking out part of your stomach may also affect gut hormones or other factors such as gut bacteria that may affect appetite and metabolism. This type of surgery cannot be reversed because some of the stomach is permanently removed.

Gastric Bypass

Gastric bypass surgery, also called Roux-en-Y gastric bypass, has two parts. First, the surgeon staples your stomach, creating a small pouch in the upper section. The staples make your stomach much smaller, so you eat less and feel full sooner.

Next, the surgeon cuts your small intestine and attaches the lower part of it directly to the small stomach pouch. Food then bypasses most of the stomach and the upper part of your small intestine so your body absorbs fewer calories. The surgeon connects the bypassed section farther down to the lower part of the small intestine. This bypassed section is still attached to the main part of your stomach, so digestive juices can move from your stomach and the first part of your small intestine into the lower part of your small intestine. The bypass also changes gut hormones, gut bacteria, and other factors that may affect appetite and metabolism. Gastric bypass is difficult to reverse, although a surgeon may do it if medically necessary.

Duodenal Switch

This surgery, also called biliopancreatic diversion with duodenal switch, is more complex than the others. The duodenal switch involves two separate surgeries. The first is similar to gastric sleeve surgery. The second surgery redirects food to bypass most of your small intestine. The surgeon also reattaches the bypassed section to the last part of the small intestine, allowing digestive juices to mix with food.

This type of surgery allows you to lose more weight than the other three. However, this surgery is also the most likely to cause surgery-related problems and a shortage of vitamins, minerals, and protein in your body. For these reasons, surgeons do not perform this surgery as often.

Most Common Weight-loss Surgeries

Gastric Band

What it is

Surgeon places an inflatable band around top part of stomach, creating a small pouch with an adjustable opening.

Pros

• Can be adjusted and reversed.
• Short hospital stay and low risk of surgery-related problems.
• No changes to intestines.
• Lowest chance of vitamin shortage.

Cons

• Less weight loss than other types of bariatric surgery.
• Frequent follow-up visits to adjust band; some people may not adapt to band.
• Possible future surgery to remove or replace a part or all of the band system.

Gastric Sleeve

What it is

Surgeon removes about 80 percent of stomach, creating a long, banana-shaped pouch.

Pros

• Greater weight loss than gastric band.
• No changes to intestines.
• No objects placed in body.
• Short hospital stay.

Cons

• Cannot be reversed.
• Chance of vitamin shortage.
• Higher chance of surgery-related problems than gastric band.
• Chance of acid reflux.

Gastric Bypass

What it is

Surgeon staples top part of stomach, creating a small pouch and attaching it to middle part of small intestine.

Pros

• Greater weight loss than gastric band.
• No objects placed in body.

Cons

• Difficult to reverse.
• Higher chance of vitamin shortage than gastric band or gastric sleeve.
• Higher chance of surgery-related problems than gastric band.
• May increase risk of alcohol use disorder.

What should I expect before surgery?

Before surgery, you will meet with several health care providers, such as a dietitian, a psychiatrist or psychologist, an internist, and a bariatric surgeon.

• The doctor will ask about your medical history, do a thorough physical exam, and order blood tests. If you are a smoker, he or she will likely ask you to stop smoking at least 6 weeks before your surgery.
• The surgeon will tell you more about the surgery, including how to prepare for it and what type of follow-up you will need.
• The dietitian will explain what and how much you will be able to eat and drink after surgery and help you to prepare for how your life will change after surgery.
• The psychiatrist or psychologist may do an assessment to see if bariatric surgery is an option for you.

These health care providers also will advise you to become more active and adopt a healthy eating plan before and after surgery. In some cases, losing weight and bringing your blood sugar levels closer to normal before surgery may lower your chances of having surgery-related problems.

Some bariatric surgery programs have groups you can attend before and after surgery that can help answer questions about the surgery and offer support.

What should I expect after surgery?

After surgery, you will need to rest and recover. Although the type of follow-up varies by type of surgery, you will need to take supplements that your doctor prescribes to make sure you are getting enough vitamins and minerals.

Walking and moving around the house may help you recover more quickly. Start slowly and follow your doctor’s advice about the type of physical activity you can do safely. As you feel more comfortable, add more physical activity.

After surgery, most people move from a liquid diet to a soft diet such as cottage cheese, yogurt, or soup, and then to solid foods over several weeks. Your doctor, nurse, or dietitian will tell you which foods and beverages you may have and which ones you should avoid. You will need to eat small meals and chew your food well.

How much weight can I expect to lose?

The amount of weight people lose after bariatric surgery depends on the individual and on the type of surgery he or she had. A study following people for 3 years after surgery found that those who had gastric band surgery lost an average of about 45 pounds. People who had gastric bypass lost an average of 90 pounds. Most people regained some weight over time, but weight regain was usually small compared to their initial weight loss.

Researchers know less about the long-term results of gastric sleeve surgery, but the amount of weight loss seems to be similar to or slightly less than gastric bypass.

Your weight loss could be different. Remember, reaching your goal depends not just on the surgery but also on sticking with healthy lifestyle habits throughout your life.

Weight-loss Devices

The FDA has approved several new weight-loss devices that do not permanently change your stomach or small intestine. These devices cause less weight loss than bariatric surgery, and some are only temporary. The devices may have risks, so talk with your doctor if you’re thinking about any of these options. Researchers haven’t studied any of them over a long period of time and don’t know the long-term risks and benefits.

• The electrical stimulation system uses a device implanted in your abdomen, by way of laparoscopic surgery, that blocks nerve activity between your stomach and brain. The device works on the vagus nerve, which helps signal the brain that the stomach feels full or empty.
• The gastric balloon system consists of one or two balloons placed in your stomach through a tube inserted through your mouth. Your doctor or nurse will give you a sedative before the procedure. Once the balloons are in your stomach, doctors inflate them with salt water so they take up space in your stomach and help you feel fuller. You will need to have the balloons removed after 6 months or a year.
• A new device uses a pump to drain part of the food in your stomach after a meal. The device includes a tube that goes from the inside of your stomach to a port on the outside of your abdomen. The port is a small valve that fits over the opening in your abdomen. About 20 to 30 minutes after eating, you attach tubing from the port to the pump and open the valve. The pump drains your stomach contents through a tube into the toilet, so that your body doesn’t absorb about 30 percent of calories you ate. You can have the device removed at any time.

What are the side effects of bariatric surgery?

Side effects may include

• bleeding
• infection
• leaking from the site where the sections of the stomach or small intestine, or both, are stapled or sewn together
• diarrhea
• blood clots in the legs that can move to the lungs and heart

Rarely, surgery-related problems can lead to death.

Other side effects may occur later. Your body may not absorb nutrients well, especially if you don’t take your prescribed vitamins and minerals. Not getting enough nutrients can cause health problems, such as anemia and osteoporosis. Gallstones can occur after rapid weight loss. Some doctors prescribe medicine for about 6 months after surgery to help prevent gallstones. Gastric bands can erode into the stomach wall and need to be removed.

Other problems that could occur later include strictures and hernias. Strictures—narrowing of the new stomach or connection between the stomach and small intestine—make it hard to eat solid food and can cause nausea, vomiting, and trouble swallowing. Doctors treat strictures with special instruments to expand the narrowing. Two kinds of hernias may occur after bariatric surgery—at the incision site or in the abdomen. Doctors repair hernias with surgery.

Some research suggests that bariatric surgery, especially gastric bypass, may change the way your body absorbs and breaks down alcohol, and may lead to more alcohol-related problems after surgery.

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