BMI » Exercise

PERSPECTIVE

ramana — Wed, 26 May 2010 04:34:09 +0000

“When you have a hammer, everything looks like a nail!”

We have all heard of this saying, and all of us agree. A skilled laparoscopic surgeon plots to take out huge tumors and cysts through the keyhole method, while the dinosaur surgeon tends to think of employing his hands to remove organs (like the appendix) that may have been better left alone.

Let me tell you a small story about myself. Not too long ago, at a Bariatric Surgery conference three or some years back, I had a chat with a renowned endocrinologist who was known for his work in obesity and diabetes. At that time, I was 86 kgs heavy, and most of it was fat. A hard-working surgeon, I was in the peak of physical un-fitness and a heart attack waiting to happen. My resting heart rate was always around 100 and my blood glucose was similarly poised over the century mark. I asked this gentleman how I could improve my markers and lose my fat. I also didn’t want to become a diabetic, I said.

He told me what anyone in his position would have: take a metformin pill, and do some walking. If your sugar levels go up, we will add another drug, he said.

I thought long and hard over what he said. I embarked on a new journey in life: a life of health and fitness. I trained hard and started IF (Intermittent Fasting). After an year of blundering along, I found my groove and results came in: resting heart rate down to 6o, blood glucose and lipid levels normal, and body fat well down (BW now 75 kgs).

To come back to the point, the doctor I asked hit my problem with the drug hammer he was holding by default. I did the smart thing by trying something different. I now firmly believe that everyone should try healthy eating and exercise in order to improve health and reduce body fat. As bariatric surgeons, we should not use the surgery hammer to hit every obese patient. When there is clear burden of disease (diabetes, hypertension, sleep apnea, gallstone disease, etc.) and the level of obesity is such that it is statistically unlikely to come off with lifestyle regulation, we recommend bariatric surgery. Not otherwise.

In other words, as specialists dealing with obesity and related diseases, we should have a broad perspective. We are always in danger of using a narrow knife-wielder’s perspective and eyeing every patient as a potential victim. We must be very careful. At BMI, we never stop telling each other this.

In clinical practice, the psyche of the patient is very important. But a more important factor (and an often unrecognized one) is the psyche of the doctor.

NO EXCUSES TRAINING

ramana — Tue, 22 Dec 2009 04:30:08 +0000

This morning, I was supposed to train with Ranadeep Moitra (the fitness coach of BMI) and a group of youths at his bootcamp (usually sprint intervals and stuff) at a local cricket ground. I was late, and reached the camp when it was on its way.
I had brought my kettlebells anticipating this, and started practicing my TGUs, presses and snatches with the 25 kg bell (as part of my variety, light day).

Halfway through my practice, a couple of trucks bearing sand and soil, came to the ground and started dumping them near me. I had to escape the dust and fumes, and abandoned the training.

(An Indian truck looks like this; pic source- from here)
But the disquiet of an incomplete session did not leave me as I proceeded home.

I live on the sixth floor of a building in Kolkata. As a routine, I never use the elevator, as part of my NEAT principle (check out the link).
Today, I decided to make a workout of my return home from the ground floor.
I walked to the floor above with one kettlebell (Kali- the 25 kg bell), ran down and brought back the other one (Sita- the 17 kg). Then I ran all the way down to the ground floor and back up. Now I had to carry one bell to the next floor, run down to two floors below, bring the other bell back, and then run down all the way to the ground floor and back. In other words, whenever both bells were on one floor, I had to run down to the ground floor and back up.
So, to put both bells up from, say the 3rd to the 4th floor, I carried one bell up straight from the 3rd to the 4th, ran back to the 2nd floor, sprinted up (two stairs at a time) to the bell at the 3rd floor, and carried it up to its partner in the the 4th floor. For the next round, I would start by going down to the ground floor and sprinting up all over again.
I calculated the floors and steps run in the few minutes of this workout:
1st- 2
2nd- 3
3rd- 6
4th- 7
5th- 8
6th- 9
TOTAL—35 floors
18 steps per floor—630 total steps up.
I am not calculating the steps run down.
At the end of it, my legs were saying, “PLEASE!!”
I was happy. No excuses training. That is what I want. So, the next time I take 3 kettlebells out, I know I would love the return of the kettlebells home.

PREPARING FOR YOUR BARIATRIC OPERATION

ramana — Mon, 14 Sep 2009 05:06:11 +0000

(pic credit goes to this site)

If you have decided to go for a bariatric operation, you need to do some preliminary preparation for it.

1. We tell our patients to go on a liquid diet for 15 days before the day of surgery. This does not mean you can drink ghee, condensed milk, juices and colas. You can drink soups, milk, dal, meat stocks, etc. You could also take ultra-low calorie liquid supplements like Optifast. The caloric deficit created by this would lead to around 15-20 lbs of fat loss or even more.

2. Significant fat loss immediately preceding bariatric surgery is good in terms of improving post-operative results and also in making the surgeon’s job easier. Much of the effects of the pre-operative low calorie diet is to shrink the size of the liver. This causes better visualisation during surgery.

3. A last binge before surgery is NOT a good idea! This is understandable from the patient’s point of view, but really does not do much good to him/her. Often, the last binge gives rise to one more, and then one final one, and so on. Rather than losing weight, the patient puts on some more!

4. Stop smoking and drinking alcohol! This is simply non-negotiable. Bariatric surgery is not a painless, cosmetic solution to some excess blubber your body may have. It is a serious undertaking on your (and our) part, in order to restore health to your body. There can be no healthy life if you drink and smoke. One is not referring to the occasional social drink or cigar, but you know what we are talking about! Smoking increases post-operative respiratory complications like pneumonia, as well as heart attacks and deep vein thrombosis. All these complications are terrible and potentially fatal, so be careful! Nothing is worth losing your life and health to, so quit NOW!

5. Continue to take your diabetes and hypertension medicines, unless told otherwise.

6. If you have respiratory problems like asthma, please see a respiratory physician or therapist who would treat your lungs with nebulisers, antibiotics (when indicated), and chest physiotherapy. In some patients, vaccines against respiratory pathogens (like Pneumococcus and Hemophilus influenzae) are also prescribed. Patients suffering from sleep apnea may need a CPAP machine that helps to oxygenate the lungs during sleep.

7. Walking every day or doing some mobility exercises is good for you– this is also important for you. We encourage patients to be ambulant immediately after surgery, and this helps.

8. Prepare a food journal– this should become a habit after your operation, so start anyways.

9. Ask other patients about how they have adapted to life after bariatric surgery. Remember that they may have a different procedure and their adaptations and restrictions may not apply to you!

10. Do you need further counselling? Are you nervous or unsure about anything? Don’t hesitate. Ask your bariatric surgeon!

“HOW MUCH WEIGHT CAN I LOSE, DOC?”

ramana — Tue, 01 Sep 2009 12:43:16 +0000

This is one of the commonest questions we face as providers of obesity care. The question may be posed by a matronly lady in her fifties, an out-of-shape PYT, or by a morbidly obese patient looking at bariatric surgery.

(pic source: here.)

The answer to that question, therefore, has to be contextual. In the more common non-surgical weight loss candidate, the question is not easily answered. How much of weight someone could lose is dependent on so many variables that it is foolhardy and unwise to venture a straight answer. This is in direct contrast to the typical slimming center approach of treating the entire complex subject of weight loss as a potatoes-by- the-kilo thing. You want to lose ten kilos? No problems, pay x amount.

The answer I give in the above context is, “How much do you want to lose, and what are you willing to do for that?” The focus, therefore, comes squarely back to the patient. It is not I who will melt your fat. It is you who will do so. I will merely set you on the right path for it. You would need to walk the path. If you are looking for a painless option, find yourself a slimming center, have a nice day!

The bottom-line being that in fat loss, you have to work hard– there is no escaping that. You will have to find a way to avoid the cravings. You will have to get up from bed for your workout. You will have to take your fish oil capsules. You will have to push yourself for that last rep when your body is screaming for you to rest at the end of your workout. I can only help you if you stand up to be counted.

If you have the requisite motivation, as I say in this article, we will surely guide you to success. But you can take all the credit for that. We only facilitate weight loss, demystify it, and bring a scientific perspective to it.

When a bariatric candidate asks, “How much fat can I lose?”, the answer is, “It depends“. Again, a contextual answer. In procedures like the gastric bypass, around 70-75% of excess body weight loss is typical. After this, the results depend on how well the patient controls his lifestyle. In the lap band procedure, weight loss is around 50%, much less. But then the mortality risks of this procedure are also less. On the other hand, more complex procedures like the duodenal switch have a greater (85%) weight loss, but also a higher risk of mortality.

In perspective, the more successful procedures (in terms of fat loss) come with a higher risk, and the lowest risk procedures give you the lowest fat loss rates.

Nature demands that we get something only if we take risks!

If you are the guy or girl intent on losing around 10 to 20 kgs of fat, the answer to your quest is that of course you can be successful but are you willing to be successful? Do you have what it takes to work your way to success?

GOOD HABITS HAVE GREAT MERITS!

ramana — Tue, 11 Aug 2009 12:59:59 +0000

From Journal Watch:

The more healthy lifestyle behaviors that adults follow, the lower their risk for a number of chronic conditions, reports Archives of Internal Medicine.

Researchers in Germany recruited some 23,000 adults aged 35 to 65 and followed them for roughly 8 years. At baseline, four healthy lifestyle behaviors were assessed: never smoking, having a BMI under 30, exercising regularly, and adhering to a healthy diet (high in fruits, vegetables, and whole grains, and low in red meat).

During follow-up, about 9% of the participants developed diabetes, coronary heart disease, stroke, or cancer. The risk for any of these conditions decreased as the number of healthy lifestyle behaviors at baseline increased. For example, adults with one healthy behavior saw a 50% reduction in risk — and those with all four behaviors saw nearly an 80% reduction — compared with those with no healthy behaviors.

The original article in the Archives of Internal Medicine is here.

EXERCISE AFTER BARIATRIC SURGERY

ramana — Mon, 10 Aug 2009 10:30:50 +0000

We have some patients who, a few months after bariatric surgery, want to maximise the weight loss following the procedure, and want to start off with exercise. This article will attempt to answer some of the most common questions we have faced.

When can I start working out after my gastric bypass?

The answer depends on who you are. If you have heart or lung problems, we would advice you to go easy. Morning and evening walks would be a great way of getting active, and the level of activity can be escalated slowly and steadily. Jogging is not a great activity, when you consider the impact on the joints which, in many bariatric patients, are damaged anyways. In the absence of major contraindications, we would encourage you to start exercising at any time your body tells you to. This could be one week after surgery or may be more, depending on the individual.

I have heard that I will get a hernia if I exercise. Is that true?

Hernias are known complications of any type of surgery, but are less common after laparoscopic surgery (compared to the open approach). However, if the 10/12 mm port sites (keyholes) are closed with sutures (internally, not on the skin) the incidence of hernias comes down significantly. BMI policy is to close all 10 or 12 mm trocar sites with vicryl sutures, in accordance with international standards. Once these are sutured shut, it should not matter if you start exercising in a week’s time. Go easy, though, if you are on the very heavy side.

Can I do crunches after surgery?

Sure, but why would you waste your time with them? Crunches don’t build your abs. Losing fat mass will itself help in revealing your abs. Some of the best ab exercises are planks, bird dogs and power wheel rollouts. Moreover, major compound exercises like squats, Turkish Get Ups, and Deadlifts work on the abs to a tremendous extent.

If you are really serious about getting abs, try hanging leg raises- this exercise, if done properly, can smash your abs to pulp!

Please note that these exercises should be done only if you do not have significant problems with your heart, lungs, back or knees. We offer you exercise advice according to your unique limitations.

Can I join swimming?

Absolutely, yes. Just wait for the port site areas to heal- you don’t want to get bad germs into the cuts. In other words, wait for a week or two before the plunge!

How can I lose more weight by exercising?

Realise that your body, after bariatric surgery, will behave more or less like any one else’s. In other words, if you exercise smartly, you can kickstart your metabolism, build muscle and burn calories in order to lose more fat and build some muscle.

In order to do that, train smart! That means you should get the maximum bang for your buck. If you do exercises of a certain nature and in a certain way, you will get the best and quickest results.

This means that weight training should be largely multi-joint oriented (deadlifts, squats, overhead presses), intense and short, and provide ecalating density of the load. This basically means you must work out of your comfort zone, train hard, use short rest periods and lift heavy. If you add cardio, try to do High Intensity Interval Training (HIIT), as you will find it more interesting than low/moderate cardio (which lasts longer). Don’t waste time training your arm muscles– they are for vanity only, and you won’t get leaner doing bicep curls!

HOW MUCH TIME DO YOU HAVE FOR FAT LOSS?

ramana — Mon, 10 Aug 2009 01:26:47 +0000

A well known person in Kolkata called me up for helping her to lose around 20 lbs of fat. “But I don’t have the time to exercise like you!”, she said.

(pic source: flickr.com/photos/ geekandpoke/2231731282/)

Now, she had no real way of knowing anything about my exercise regime or durations. I took it as a compliment that my physique looked to her as if I spent a lot of time in the gym (I don’t).

I had to answer her. I had to tell her that fat loss was not just a phone call away. One doesn’t get fat loss tips on the phone, and get lean. Fat loss comes when you commit to it. It is a full time commitment — not a half hour workout on a treadmill watching the news.

Another important thing she needed to hear was that the most important component of a fat loss program is not exercise, but diet (and the main component of a diet should be motivation, but we digress). It is what you eat that makes you fat. It is what you eat (and don’t eat) that will make you slimmer. Exercise is merely the icing on the cake (if you can excuse the bad pun). So, how much time do you need to eat right?

Does it take longer to eat meat, eggs, salad and fruits compared to hamburgers, pizzas, sodas and chips? Maybe, maybe not. But, for sure, you are going to spend eating more times in a day if you pig out on junk food. Eating clean is, in more ways than one, timeless.

As far as exercise is concerned, how much time is good? Fitness pros know that the testosterone and growth hormone peaks that come with exercise disappear after 45 minutes or so. So, if you have time enough to train for 45 minutes three times a week, it should be good. If you are super busy, you could train for less. Like 10 to 15 minutes. In a sense, less is more in the fitness world, but you should know that those 10 or 15 minutes should take more out of you than an hour of running.

(pic source: http://www.funnies.com/notimeforbreaks.jpg)

So, I told this lady, “How much time do you have for fat loss? Less time than you spend in the bathroom? Do you have time to go to the bathroom every day? Then you have time for fat loss! Do you have time to live? If you do, you have time for fat loss. For you, that is what life should be centered around- your health.”

Is it any wonder that friends call me an extremist?