Various epidemiological studies have shown that the prevalence of gastroesophageal reflux disease (GERD) is increasing worldwide, and the major contributing factor to this trend is the rising prevalence of obesity. The worldwide estimated prevalence of GERD ranges from 15% to 25%. Western countries, including the United State of America, haveaGERD prevalence higher than in Asia, ranging from 10% to 30% [1,2]. Other than obesity,several environmental and lifestyle factors also contribute to this increasing trend, such as being overweight, smoking, and consumption of alcohol, caffeine, fat, and chocolate (these factors indirectly lead to obesity and overweight) [3].In addition, estrogen also has an important role in the development of GERD; one study suggested that pre-menopausal and women on hormone replacement therapy are noticed to have a higher incidence of GERD symptoms [4].Lifestyle modifications, including weight loss, elevation of the head ofbed, smoking cessation, and avoiding late evening meals, lead to the resolution of GERD symptoms[5].One ofthe previous cohortstudies concluded that, in obese individuals, having a low-carbohydrate diet results in the improvement of reflux symptoms[6].

Most of the studies have found a positive correlation between obesity and GERD. Obesity has been defined as having BMI >30 kg/m2 in most of these studies. Four previous cross-sectional studies confirmed a positive association between overweight or obesity and GERD symptoms in the US, UK, Norwegian, and Spanish populations. Two studies have shown a dose-response relationship[7]. The primary mechanism by which obesity promotes GERD isunclear;recent data suggests that obesity increases the intragastric pressure causing relaxation of the lower esophagealsphincter (LES)and reflux of gastroduodenalcontents causing the symptoms of heartburn,acid regurgitation, and eventually causing erosive esophagitis[8].Erosive esophagitis eventually causes Barrett's esophagus, thus increasing the risk of esophageal adenocarcinoma.Treatment of GERD includesconservative and medical therapies. Recent studies suggested that the long-term use of and proton pump inhibitors (PPIs) can cause several adverse effects.

A retrospective cohort study conducted by Bang and Park in 2018 concluded a positive association between a higher BMI and the development of GERD and erosive esophagitis. Conversely, this study also suggested that a decrease in the BMI can lead to the resolution of erosive esophagitis, and weight loss is a potentially effective treatment of GERD [3].Furthermore, it is noticed that in obese individuals, asymptomatic GERD is more common than symptomatic reflux disease[9].

Although many studies have shown that GERD is associated with obesity, not all studies have shown a positive association. For example, two extensive population-based studies from Sweden and Denmark found no association. Researchers assumed that the disparity in results might be due to the non-adjustment of confounding variables[7]. In addition, weight loss had an independent effect on reflux symptoms in an obese individual. Still,wecouldn't find sufficient data to suggest the positive impact of weight loss achieved through different methods, either with lifestyle modification or with surgical procedures (Roux-en-Y gastric bypass or vertical band gastroplasty), on GERD symptoms[10].Thissystematicreview aims to assess non-pharmacological interventions for GERD treatment and the impact of weight loss on GERD in obese patients.

Study Design andSearch Strategy

This systematic review was designed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to improve reporting of this review [11]. We thoroughly searched through the following databases: PubMed, PubMed Central (PMC), Science Direct, and Google Scholar, using suitable keywords and Medical Subject Headings (MeSH) terms to extract all the relevant articles. Weused the Boolean scheme and MeSH strategy to form keywords. The MeSH strategy used was (Obesity/diet therapy"[Mesh] OR Obesity/drug therapy"[Mesh] OR Obesity/prevention and control"[Mesh]) AND (Gastroesophageal Reflux/diet therapy"[Majr] OR Gastroesophageal Reflux/drug therapy"[Majr] OR Gastroesophageal Reflux/prevention and control"[Majr] OR Gastroesophageal Reflux/therapy"[Majr]). For other databases, we used the following keywords: Obesity, Obesity AND GERD, Weight loss AND GERD, Obesity AND weight loss AND GERD. We removed duplicates by carefully scrutinizing the titles, and subsequently, we excluded irrelevant articles by screening the titles and abstract.

Inclusion and Exclusion Criteria

In this review, we included articles published in the English language, focusing on the adult population (18-65 years) and papers relevant to the research question. We excluded papers focusing on pediatric and geriatric populations and unpublished and grey literature.

Data Extraction

After we did the quality assessment, data extraction from the eligible papers included in the study was done. Two researchers did data selection and extraction (first and second authors). We reviewed the study design, relevance to our inclusion and exclusion criteria, intervention used, and outcomes measured in the selected paper.

Quality Assessment of the Studies

We used the Joanna Briggs Institute(JBI) critical appraisal checklist for cross-sectional studies and the Newcastle-Ottawa assessment tool for other observational studies (case-control, cohort). In addition, weused the assessment of multiple systematic reviews(AMSTAR) tool for the quality appraisal of the systematic reviews.

A total of 5922 papers were found after the database search. After removing 3379 duplicates,2543 articles remained. Then screening was done through titles, and we removed 2477 articles because of irrelevance, leaving 66 articles. Next, we checked the availability of full-text articles and pulled 43 out of 66 because of the unavailability of full-text articles, and a total of 23 articles remained. Then critical appraisal was done using different quality assessment tools, and a total of eight articles were found eligible to be included in our study after quality assessment.Out of eight papers, five were cross-sectional studies, three cohort studies, and one was a systematic review. The complete PRISMA flow diagram is well explained in Figure 1 [11].

We set the cut-off for bias at 20% or less to be included in this study (Table 1).

Out of five cross-sectional studies, four concluded that obese and overweight individuals have an increased risk of GERD. Obesity causes disintegration of LES and reflux of acidic gastric content in the esophagus, increasing the risk of erosive esophagitis. One cross-sectional study investigated the benefits of weight loss on GERD symptoms. All three cohort studies reported that weight loss could lead to the resolution of GERD and erosive esophagitis in obese patients. One systematic review investigated the impact of lifestyle intervention on GERD symptoms. That review also reported several adverse effects of the long-term use of proton pump inhibitors. The study concluded that because of some complications and the high costof PPIs, lifestyle interventions, especially weight loss, should be used as first-line management for GERD in obese individuals.

The reflux of gastroduodenal contents from the stomach into the esophagus due to any anatomical defect at the gastroesophageal junction (GEJ) is defined as gastroesophageal reflux disease[12]. Over the last few decades, the prevalence of GERD has been increasing worldwide. Most of studies have found that this increase is due to the increase in the prevalence of obesity worldwide [10]. Obesity is an independent risk factor for developing GERD symptoms, and several studies have been conducted to find a positive association between BMI and GERD.Jacobsonet al. conducted a case-control study in 2006 and found that BMI is directly associated with GERD irrespective of whether the individual is with normal weight or overweight[16].Obesity has been associated with various comorbidities including diabetes mellitus and cardiovascular diseases; however, gastrointestinal disorders including GERD, gall stones and non-alcoholic fatty liver disease (NAFLD) are more frequent in obese individuals [17,18]. Miliet al. conducted a study in 2014 and concluded that NAFLD is associated with obesityand the main treatment option for NAFLD would be weight reduction and life style modification[19].

Pathophysiology

The intra-abdominal pressure theory states that obesity in general and abdominal obesity increase intragastric pressure that causes mechanical stress on the gastroesophageal junction, causing transient lower esophageal sphincter relaxation (TLOSR) and predisposition of the hiatus hernia, which further facilitates reflux. The dietary habit theory suggests that some nutritional habits may be the main reason for increasing the risk of obesity and eventually increasing GERD risk. Both approaches are based on assumptions [13]. Hiatus hernia in obese individuals causes disturbances in the integrity of GEJ, thus aggravating reflux [20]. Obesity may cause humoral changes such as changes in leptin and insulin levels and hormonal changes such as changes in estrogen levels, which indirectly cause GERD [7]. Not enough evidence supports these mechanisms, so further studies are required to explore them.

A study conducted by Wuet al. in 2007 concluded that abnormal relaxation of the lower esophageal sphincter (LOS) might cause obesity-related GERD [14]. In this study, patients were divided into three groups: obese (BMI >30 kg/m2), overweight (BMI 25-30), and average weight (BMI <25), according to the World Health Organization (WHO). During the postprandial period, esophageal manometry and pH monitoring were done using the standard method. It was noted that TLOSRrates were higher in obese and overweight subjects. It was speculated that obese patients tend to overeat, causing an increase in intragastric pressure and gastric distention, disrupting the integrity of the LOS and causing acid reflux. Esophageal manometry was done in obese individuals before bariatric surgery and most of the people were noted to have motility disorder; this could be another reason for GERD in overweight individuals [21].

Non-pharmacological Interventions

Although obesity is a significant independent risk factor for GERD, several other factors are also noted to play an essential role in GERD development. In a recent retrospective cohort study conducted by Bang and Park, it was stated that GERD is associated with some dietary habits, for example, late-night meals, consumption of alcohol, caffeine, chocolate, fat, and smoking [3]. The intake of citrus fruit is also noted toaggravatethe GERD symptoms [22]. Non-pharmacological interventions, including smoking cessation, avoiding late-night meals, reducing the consumption of alcohol and caffeine, and behavioral changes such as weight loss, can lead to the resolution of GERD symptoms [3,5]. Another study suggested that elevating the head of the bed in the supine position and lying on the left side helps to improve reflux symptoms [23]. Furthermore, regular physical activity was noted to have a positive effect on GERD symptoms [24,25].

Smoking Cessation

Most studies have shown a positive association between smoking and GERD symptoms. In a recent systematic review conducted by Ness-Jensen et al., it was revealed that smoking reduces the LOS pressure facilitating reflux [5]. Also, it causes decreased secretion of salivary bicarbonate, eventually decreasing acid buffering. Another study concluded that smoking cessation was associated with decreased reflux symptoms in normal weight individuals. However, in obese individuals, obesity was the leading cause of GERD, so smoking cessation didn't help much in that group [5].

Lifestyle Modification

Some studies showed a positive association between some dietary habits, lifestyle factors, and the development of GERD symptoms, but previous data supporting these facts are scarce. For example, a randomized controlled trial (RCT) conducted with a small sample size (only 15 patients) showed that the elevation of the head of the bed decreased the time for which lower esophageal pH was <4 [5]. Another RCT demonstrated that an increased dietary fat intake causes more time without heartburn symptoms. A systematic review has shown that a high fiber intake and moderate physical activity can reduce GERD symptoms [5]. Arecent cohort study suggested that adjusting meal size and timing, i.e., avoiding late-night meals, is reported to be helpful for the management of GERD [3]. Although physical activity helps to improve the symptoms, but vigorous exercise after a meal can worsenthe condition. Post-dinner walking is recommended to relieve the reflux and heartburn, but eating before exercise should be avoided [26].

Weight Loss as a Management of GERD

Many observational and experimental studies confirmed the association between a high BMI and GERD. A retrospective cohort study was conducted in 2018 to investigate whether a decreased BMI can resolve erosive esophagitis (EE) [3]. All the participants underwent upper GI endoscopyand EE was classified according to Los Angeles (LA) classification; the baseline BMI wasnoted and all patients were instructed to lose weight. During five-year follow-up periods, the EE resolution rate was higher in subjects who had a decrease in BMI >2 kg/m2;the researchers concluded that a significant weight loss is required for EE resolution because some of the patients who had a reduction in BMI <1 kg/m2 did not show any positive effects [3]. Weight loss reduces intragastric pressure and pressure on the gastroesophageal junction, thus reducing the reflux episodes [10]. An RCT of 17 patients reported normalization of the esophageal pH with weight loss in a follow-up period of four months.

A cross-sectional study conducted in 2006 suggested that weight loss is an effective treatment for GERD. Still, two other studies showed contradictory results, stating that a reduction in the BMI does not cause improvement in healing rates after proton pump inhibitor use [15]. Other than heartburn and acid regurgitation, some extraesophageal manifestations of GERD include cough, hoarseness, asthma, sore throat, sinusitis, and globus sensation. There is a significant and nonlinear relationship between a higher BMI and GERD with extraesophageal manifestations reported in a previous study conducted by Aslam et al. The study concluded that an increased BMI is significantly associated with esophageal acid exposure and these findings suggest the benefit of weight loss in the treatment of GERD [13].Fraser-Moodie et al. conducted a prospective cohort study in 2014 to assess an independent effect of weight loss on the improvement of GERD symptoms [12]. This study found that weight loss is the first line of management in treating GERD in overweight patients. Weight loss either achieved through lifestyle interventions or through bariatric surgery was noticed to have improvement in symptoms of GERD [27].

Individuals can use different strategies to lose weight, including physical activity, dietary modifications, and behavioral changes. Physical activity can include walking or some other exercises. In a prospective cohort study, overweight patients were followed for six months for weight loss. Weight loss was achieved through different conservative measures, such as increasing physical activity, some dietary modifications that reduced the daily calorie intake to 1200-1500 cal/day, and some behavioral changes, including goal-setting, self-monitoring, feedback, reinforcement, and social support. Most patients lost weight, and with a structured weight loss program, GERD symptoms were entirely resolved. In addition, a dose-response relationship was reported between weight loss and the resolution of GERD symptoms [10]. But not all obese patients in this study had a reduction in GERD symptoms after losing weight [5].

Why Is Weight Loss More Effective Than PPIs for GERD SymptomResolution in Obese Patients?

Treatment options for gastroesophageal reflux disease include conservative measures and medical treatment. Conservative measures, as already mentioned, include weight loss, if the patient is obese and overweight, the elevation of the bed head, avoiding late-night meals, and reducing the consumption of alcohol, fat, caffeine, and chocolate intake [3,5]. Medical treatment is commonly achieved through antacids, H2 receptor antagonists (H2RAs), and proton pump inhibitorsfor heartburn and acid regurgitation [28]. PPIs work by inhibiting the acid secretion from parietal cells. Additionally, if symptoms are non-responsive to medical treatment or complications havedeveloped, then surgical treatment is also recommended especially in the presence of hiatal hernia [29].

Initially, PPIs were mainly used for treating GERD symptoms, but recently, some studies suggested that the long-term use of proton pump inhibitors can cause some adverse effects. Now that awareness about the side effects of PPIs has increased, lifestyle modification is preferred. For example, withdrawal of PPIs induces reflux symptoms. Other adverse effects include hypergastrinemia and rebound acid secretion. In addition, due to increased gastric pH, the risk of enteric infection and community-acquired pneumonia is increased. There is also an increased risk of hip fractures because of malabsorption of calcium [5].

Another study suggested that obese individuals require a long-term use of H2RAs and antacids for heartburn and reflux symptoms, concluding that obese individual are not as responsive to medications for GERD. Lifestyle interventions, including weight loss and smoking cessation, having a low economic cost and no harmful side effects, should be preferred for GERD treatment. Although proton pump inhibitors positively impact the resolution of GERD symptoms and extensive data supports these positive results, very few RCTs and observational studies are available investigating the positive effects of lifestyle interventions on GERD.

Weight loss should be used as the first-line treatment for GERD in obese and overweight patients because of its low-cost effects, preventing complications of GERD, and improving the quality of life. It was estimated in a recent study that around 10 billion US dollars a year are spent on medical treatment of GERD, and that is considered a burden on the healthcare system [10]. However, there are a few limitations of our study. Extensive data is available reporting the positive association between obesity and GERD development, but studies suggesting the impact of weight loss on GERD are scarce. We could not find sufficient RCTs and observational studies suggesting that weight loss is an effective treatment for GERD.

Further studies, including clinical trials for evaluating the effect of weight loss on symptoms of reflux, are required. Two extensive studies reporting the impact of weight loss on GERD produced contradictory conclusions [15]. Another limitation is that our research does not apply to the pediatric and geriatric population; it is only limited to the adult population (18-65 years).

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Role of Non-pharmacological Interventions and Weight Loss in the Management of Gastroesophageal Reflux Disease in Obese Individuals: A Systematic...

TOULOUSE, France Overweight patients tend to disagree with their doctors in a big way when it comes to health advice, according to a new study. Scientists report the more overweight the individual, the more likely they are to not see eye-to-eye with their healthcare provider on subjects including weight loss, exercise, and nutrition.

Its no secret that obesity is a major global health issue. The World Health Organization notes that obesity rates have nearly tripled between 1975 and 2016. Obviously, general practitioners and doctors play a big role in tackling this problem, but the relationship between practitioner and patient is a nuanced one.

Researchers say there needs to be a certain amount of mutual trust. The quality of information, mutual comprehension, and agreement between a doctor and their patient has a direct impact on that patients health outcomes, compliance, satisfaction, and overall confidence towards his or her doctor.

Notably, however, prior research reveals that doctors and patients often disagree when it comes to weight. Generally speaking, patients tend to blame factors outside of their control for excess weight gain, such as genetics or hormones. Doctors, on the other hand, emphasize the importance of making healthy lifestyle decisions (like proper nutrition and regular exercise).

At the end of the day, both genetic and behavioral factors influence a persons weight outcomes, but study authors explain this frequent difference of opinion between doctors and their patients can lead to a loss of trust and degrade doctor-patient interactions.

Study authors set out to analyze whether interactions between patients and their doctors varied in connection with patients BMI. The team measured these interactions based on the level of disagreement or agreement between the two parties regarding medical information and advice given during a consultation.

A total of 27 general practitioners and 585 patients from three regions in France took part in the project between September and October 2007. Each participant filled out surveys that collected data on general practitioners and patients perceptions pertaining to the advice given during a consultation.

Study authors then explored differences among the patients and doctors declarations in reference to actions, information, and advice given during the same visit, the patients health status, and the perceived quality of their relationship. Questions asked about weight loss included did your doctor advise you to lose weight during the consultation? (answered by patients) and did you advise this patient to lose weight during the consultation? (answered by doctors).

The team then used the fluctuations and differences in the answers to define any disagreements.

Overall, agreement between patients and their doctors turned out to be either fairly weak (20-40%) or moderate (40-60%) for most questions including those focusing on actions, information, advice, and patients health status. Agreement was even weaker (less than 20%) when it came to the perceived quality of the patient-doctor relationship.

Study authors noticed a clear trend: the more overweight a patient was, the more observed doctor-patient disagreement. These differences of opinion were especially apparent for doctors advice on weight and lifestyle issues. In comparison to other patients with normal BMI, overweight individuals were more likely to disagree with their doctor over advice on how to lose weight, eat healthier, and exercise more often.

An exploration of the patients representations and difficulties related to weight could be offered by the general practitioners as a basis for discussion and appropriate support, says lead study author Latitia Gimenez in a media release.

The study is published in the journal Family Practice.

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Obese patients more likely to argue with their doctors about losing weight - Study Finds

Poha has low calorie count and is also easy to digest along with being a great probiotic

Representational image of Poha dish. Wikipedia

What we eat truly has a great impact on our body weight. And, losing those extra kilos is definitely not an easy task.

However, breakfast is an important element of our entire weight loss journey. One reason is that it helps to start the day on a healthy note, motivating us to keep up the momentum.

Wondering if this is difficult?

Well, not for us as Indians as we all know India as a nation offers varied, and delicious cuisines. The fact that some of these can easily be termed as healthy breakfast options makes our weight loss journey a lot more easier. Low in calories and high in fiber is a combination that could be tried as you plan your diet.

In the world of healthy eating, fat is generally considered to be unhealthy. It is a general belief that consuming fat not only leads to weight gain but also leads to a number of diseases. So minimising fat consumption is a must if you really want to lose weight.

Here are some of the breakfast options that you should surely consider as you pledge to lose weight:

Poha: Poha has low calorie count and is also easy to digest along with being a great probiotic. Poha helps to achieve a healthy gut, which ensures that there is no unnecessary weight gain.

Yogurt: Creamy, delicious and satisfying, yogurt is an excellent addition to a weight loss diet. In particular, Greek yogurt consists of a high chunk of protein in every serving, making it a good option for losing weight.

Kiwis: High in vitamin C, vitamin K and potassium, the nutrient profile of Kiwis is very good. They are high in fibre too. Kiwis are believed to contain a particular type of fiber called pectin, which is believed to enhance the feelings of fullness and thus aids in weight loss.

Dalia: Dalia is an Indian superfood that is high in fibre. You may make it sweet and salty, according to your choice. But when consuming it to lose weight, its best to cook Dalia with vegetables.

Banana: High in fibre and low in calories, bananas are a great alternative to sugary meals that are high in calories. Having it in the morning can help you curb your cravings.

Read all the Latest News, Trending News,Cricket News, Bollywood News,India News and Entertainment News here. Follow us on Facebook, Twitter and Instagram.

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5 Healthy breakfast options to help you lose weight - Firstpost

Beyond this, these weight-loss challenges erroneously assume that dropping a few pounds automatically leads to better health and thus better wellness overall. But the research just isnt there. In fact, long-term weight loss is not clearly associated with improvements in lab values such as blood pressure, blood glucose, cholesterol, or triglycerides, nor is it reliably linked to reductions in premature death. What it is linked to? Increases in yo-yo dieting and weight cycling, which research has found does play a role in premature mortality.

There are many folks with larger bodies who check the boxes for things that are associated with being healthy, like eating nutrient-dense foods, getting in regular movement, managing stress, quitting smoking, and maintaining lab values within the normal range. We just cant assume that larger bodies are automatically unhealthy. Correlation does not equal causation, and illnesses and diseasesyes, even those typically associated with weight, like sleep apnea, diabetes, and heart diseaseoccur in people of all sizes.

We live in a society where its the norm to congratulate someone who has shed pounds without knowing what prompted the weight loss or what potentially unhealthy behaviorssay, restricting eating times for certain hours, cutting out foods or food groups, counting calories, or overexercisingmay have been in play there. Or if there were serious conditions, such as hyperthyroidism, diabetes, depression, or cancer, that precipitated the weight loss instead. We tend to look to weight loss, or how a body looks, to give us information on whats going on inside, which just isnt accurate.

Weight-loss challenges miss the mark for improving "wellness" and health because they dont take into account all of the combination of factors that affect someones health. If we truly wanted to discuss health, we would be talking about equal and equitable health care, access to food, mental health, social connections, access to green spaces, and much more. We would focus less on what a body looks like and more on behaviors that can help promote actual health.

The best workplace wellness programs tend to offer opportunities for collaboration, socialization, and team-building, which can be helpful for employee morale and mental wellbeing. But for these programs to become a positive thing, employers need to focus them on actual things employees could do throughout their day, rather than simply sending them to the scale and hoping for a certain number to appear.

Healthy behaviors actually have a much greater impact on someones overall health and wellness, Brenna OMalley, RD, a dietitian based in San Francisco, tells SELF. With that in mind, here are some behaviors companies might focus on to promote wellness in their employees.

1. Encourage breaks to ease stress.

Stress can seriously mess not only with our mental health, but our overall health tooit can affect our digestive systems, suppress our immune systems, and interfere with sleep.

Originally posted here:
Why Weight-Loss Challenges Have No Business in the Workplace - Self

30 August 2022, 14:13 | Updated: 31 August 2022, 14:39

Pierce Brosnan has once again proven what a great partner he is to his wife Keely Shaye Smith.

The James Bond actor, 69, was responding to a vicious social media user who had made a Facebook post comparing how different his wife looked now, compared to when she married Brosnan in 2001.

The commentator took photos from over 20 years ago and put them side-by-side with recent pictures of the couple to show much they'd changed.

The post went viral with endless fat-shaming and nasty comments aimed at Pierce's wife Keely, before the actor decided to take matters into his own hands and made a statement of his own.

The Irish actor who regularly posts loving snaps of him and his wife on social media spoke out strongly to protect his wife, saying 'he loves every curve' of her body and that he sees her as the most beautiful woman in the world.

Pierce reportedly wrote: "Friends offered her surgery to reduce her weight. But I strongly love every curve of her body.

"She is the most beautiful woman in my eyes. And also because she had our five children.

"In the past, I truly loved her for her person, not only for her beauty, and now Im loving her even more that she is my childrens mother.

"And I am very proud of her, and I always seek to be worthy of her love."

The pair have been together since they met in 1994, where the James Bond actor met journalist Keely at a party in Cabo San Lucas a year before he made his Bond debut in Golden Eye.

Speaking of their meeting, Pierce later told People he couldn't get enough of Keely from the moment he laid eyes on her.

"Wherever I went in the world I missed her, and Id send her tickets to come so we could be together. We just seemed to fit," adding: I found a great woman in Keely Shaye. Not if I searched a million times over would I find one as good.

The couple have two children together Dylan and Paris.

Pierce has three children from his marriage to his first wife, Cassandra Harris, who sadly died from Ovarian cancer in 1991, and adopted Cassandra's kids from her previous marriage, Charlotte Brosnan and Christopher Brosnan.

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Pierce Brosnan gives perfect retort to man who offered his wife weight loss surgery - Smooth Radio

Before and after of Ashleys progress. {Broward Health}

By Sharon Aron Baron

Ashley Pruden, 38, is no stranger to juggling multiple responsibilities. During the day, she is a full-time investigator for the state; after business hours, she works as a sitter for dogs and cats and regularly picks up work delivering packages for Amazon. Shes also a proud dog mom to three golden retrievers.

It may be surprising to some that such a busy person could be obese, as Pruden weighed 390 pounds at her heaviest. She struggled with her weight most of her life and said she was relentlessly bullied about her size in middle and high school.

I always felt like I was imprisoned in a body that didnt match my soul, because I love adventurous, outdoor activities, Pruden said. My weight held me back from so many things I loved, like scuba diving. It was hard finding diving gear that fit me. It was also difficult getting around the boat and even harder to climb back onboard after the dive was over.

After extensive research for the right hospital and bariatric surgeon for her, the Hollywood, FL resident made the life-changing decision in 2021 to undergo a bariatric procedure at Broward Health Imperial Point to improve her long-term health.

Pruden found Chi Zhang, M.D., a general and bariatric surgeon with Broward Health Physician Group and the medical director of the bariatric program at Broward Health Imperial Point.

Pruden lived with escalating hypertension, nocturnal asthma, high blood pressure, migraines, and arthritis, Dr. Zhang said. Following her robotic-assisted gastric bypass procedure on July 26, 2021, Pruden lost 150 pounds, and all her health conditions improved.

According to Dr. Zhang, a gastric bypass produces faster weight loss in the first year. The duration of the procedure is 90 minutes, followed by an overnight hospital stay, and recovery is relatively quick, he said.

In addition to the surgical services that Broward Health offers, Pruden successfully lost weight through nutritional changes, exercising, and attending monthly virtual support group meetings.

The integrated approach of the bariatric surgery program at Broward Health is what sets us apart, Dr. Zhang said.

Pruden appreciated being able to coordinate required pre-surgical approvals from a cardiologist and pulmonologist and receive a mental health screening and blood work under the same health system.

Broward Health provides psychiatric evaluation, full medical assessment, explanation of the surgery, and follow-up appointments, Dr. Zhang said. We provide all the tools for the success of our patients.

A year after surgery, Pruden said she has significantly more energy, better coordination and improved flexibility. She can more easily do things many people take for granted, such as crossing her legs, getting in and out of vehicles, and shopping for clothes. She is back to scuba diving and chooses the stairs even when there is an elevator just for the exercise.

Before Prudens procedure, she was self-conscious, going as far as to digitally edit and crop every photo of herself before sharing it with her family. That behavior is history now, she said, and shes proud of how she looks.

My goal is to continue working toward my ideal weight and staying healthy, Pruden said.

To learn more about Broward Healths bariatric services, visit BrowardHealth.org/Bariatric or call 954-759-7400.

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Bariatric Surgery Patient Turns Her Life Around After 150 pound Weight Loss Parkland Talk - Parkland Talk

If a picture paints a thousand words, then a picture of a fat guy probably paints several thousand.

That was me. A fat guy. And the pictures were taken several years ago at my brothers wedding when I was standing with my three, very thin nephews.

As I looked at the pictures, the Sesame Street song One of These Things is Not Like the Other kept running through my head. And I was the thing.

That was the day I started on, what has been a three-year odyssey to get thinner and in doing so, healthier.

For those of us that have struggled with their weight for years, losing it is easier said than done. There are so many places to start when commencing the journey. I realized my journey needed to start in my head. I needed to change the way I looked and thought about food. Again, easier said than done.

For me, the revelation came when I started to assess the quantity of food I was eating. Let me just say, I love food. I love everything about food. The way it tastes, the way it smells, the texture as it gently rolls across my tongue. Sorry, that was gross.

I started to cut back on what I ate. I found I didnt need more than one helping of anything to be full. I just wanted it. So, I started not to want it. I also cut out eating anything after dinner. This was hard because I used to love a bowl of cereal right before bed.

But cutting down on food alone was not going to get me to where I wanted to be. So, I contacted a friend that was a trainer and asked her for help. She put together a beginners work-out that gradually intensified to where I could feel the difference.

In the first year, I went from 340 pounds down to 285. But I was nowhere near being finished.

Year two, I changed up my diet again. I cut out bread, which was like losing a best friend, and other carb related products. I also reduced the amount of red meat I ate and focused more on chicken, fish and vegetables.

Success begat success so as I continued to see the weight dropping off, it inspired me to keep going on a steady course. By the end of year two, I had dropped from 285 down to 210. And that is where I frustratingly sat for months.

Then a friend sent me a link for an abdominal workout video, provided by a sassy little Aussie in the form of a 20-minute visit to hell. I tried, not always successfully, to do the workout every night, whether I was up for it or not. At the same time, I started running. Not far at first but gradually adding a bit more distance. Gosh I hate running. But I knew it was helping.

For those of you sitting on the edge of your seats to see how much I have lost in total, and yes, I realize no one is sitting on the edge of their seats, drum roll please; I am weighing in these days at 187. While Im not great at math, that puts my total weight loss at 153 pounds.

Is there one secret approach to take when losing weight? Yes, but Im not telling. Just kidding.

I would simply quote Yoda: No! Try not. Do. Or do not. There is no try

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Write Team: My 153-pound weight loss odyssey - The Times

Even in skilled nursing facilities (SNFs) without active Covid-19 outbreaks, the pandemic exacted a toll on residents in the form of increased weight loss and depressive symptoms.

These facts likely will not come as a surprise to SNF operators who have observed changes in their residents, but there is now data confirming these trends, thanks to findings from researchers with Harvard, Brigham and Womens Hospital, and Washington University in St. Louis.

Although a growing literature has documented the effect of Covid-19 on nursing homes, less evidence exists on health outcomes among LTC residents who did not contract Covid-19 but nevertheless endured stress and isolation during the pandemic, the authors wrote in a JAMA article published online on Monday. Understanding the effects of pandemic-related policy change is critical to define the trade-offs involved when facing future pandemic waves.

Policy changes related to Covid-19 included closing buildings to visitors, ending communal dining and other social gatherings, and disruptions in certain types of care, including outpatient, hospital and surgical care.

Noting widespread speculation that such changes led to adverse effects for SNF residents as the pandemic dragged on, the researchers examined Medicare and Minimum Data Set 3.0 data for more than 15,000 facilities. They compared pre-pandemic data from 2018 and 2019 with pandemic data from 2020.

Among the key findings:

So, weight loss and depressive symptoms significantly increased in SNFs during the first year of the pandemic, regardless of the presence of Covid-19 in a building in a given month, the researchers wrote.

Weight loss can worsen frailty and sarcopenia, which are risk factors for increased mortality among this resident population, they noted.

However, mortality rates only worsened in SNFs with Covid-19 outbreaks, while mortality rates slightly declined in SNFs without Covid-19 outbreaks.

Tighter infection control policies might have played a role in this decrease in mortality, along with residents moving around less frequently and therefore sustaining fewer falls, the researchers postulated.

But the decrease in mortality also occurred amid a substantial decline in hospitalizations and emergency department visits by SNF patients.

The observed changes during the pandemic suggest that some hospital use in SNFs has little mortality benefit, the authors wrote. This is relevant for initiatives to reduce excessive hospitalization in SNFs, which have been a major focus of nursing home quality-improvement efforts for years.

The studys limitations included the focus on Medicare fee-for-service data, which covers only a portion of long-stay residents. So, the authors cautioned that the findings might not be generalizable to all SNF residents.

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Resident Depression, Weight Loss Worsened Even in SNFs Spared from Covid-19 Outbreaks - Skilled Nursing News