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What do Angelina Jolie and Bariatric Surgery Patients Have in Common?

Angelina Jolie discovers she has a breast cancer gene, the same one that caused her mother to die an early death, and she decides on a proactive, and possibly radical, prevention – double mastectomy. By doing so, she lowers her risk of genetic breast cancer from 70% to 5%. No guarantees, but definitely improved odds of survival. Assuming she continues her lifestyle changes to support her good health.

So while everyone is debating the wisdom of either her decision or her open conversation, I find myself thinking about bariatric surgery patients.

Moderate to extreme obesity increases the odds of dying from all diseases exponentially. Just like having a gene for cancer increases the odds of dying from that cancer.

Before you start eye rolling and pulling an Abercrombie on me, let me state firmly that we have enough scientific evidence that obesity is NOT gluttony, but IS a chronic and difficult-to-control disease of altered physiology. Genetically things are not always working in your skinny favor. Physiologically your body wants to regain the weight you lost. Psychologically that struggle is exhausting.

Some people will make a decision that their weight is beyond their own control. They recognize the downhill course of associated illness, the march toward an early death, and choose a radical procedure to change that course. Bariatric surgeries are not without risk, and don’t always work, but the odds of survival improve dramatically when the surgery is successful. Assuming the patient can continue the lifestyle changes necessary to support their good health.

See the pattern?

It takes an extraordinary amount of courage to say I have a disease risk and I don’t want to succumb to it.

It takes an extraordinary amount of courage to have a radical surgery to prevent an early death.

It takes an extraordinary amount of courage to face your mortality, discard the wishful thinking, realistically assess the ability of modern medicine to save you, and move forward with a life-altering (and life-affirming) option.

It takes an extraordinary amount of courage to change your lifestyle and not look back.

Here’s the thing…

There isn’t a right decision here. The right decision is the one that works best for the individual patient, one they can adjust to and live with, one that fits into their lifestyle, one that moves them farther away from deadly illness.

I support Angelina Jolie and her surgery decision to save her life. No hindsight, only moving forward.

I support those of you who have bariatric surgery to save your lives. No hindsight, only moving forward.

There are no guarantees. Angelina may still need medical treatment for cancer, and bariatric surgery patients may still need medical treatment for obesity. To the scientists of the world, keep up the great research. To the doctors of the world, stay educated and open to possibility. To the patients of the world (and that is all of us), be proud of your courage, regardless of your decision, and stay vigilant.

That’s the only guarantee I have for you.

This post was originally published on kevinmd.com

#FitchtheHomeless and Why It’s NOT ENOUGH!

The CEO of Abercrombie & Fitch is a jackass, stuck somewhere in the 9th grade developmentally. He hates fat people and doesn’t want “uncool” people wearing his brand. He burns slightly defective clothes rather than distribute them to charity like most other clothiers. Plus… he’s butt ugly.

A genius filmmaker in LA, @gregkarber, a guy with an amazingly kind heart, the type that you want to meet his mother and congratulate her a thousand times over, made a video suggesting we give all of our A&F clothes to the homeless to REBRAND it. More than 6,000,000 people have watched this video thus far, with countless more opinion pieces written on the jackass CEO.

As a result of CEO stupidity, and social media, the A&F brand reputation has officially tanked.

Buzz: Abercrombie & Fitch, American Eagle, H&M

Buzz: Abercrombie & Fitch, American Eagle, H&M
Copyright © 2000 – 2013, YouGov plc is a company registered in England and Wales with company number 03607311. YouGov plc, 50 Featherstone Street, London, EC1Y8RT

So why is the frigging stock up? The guy’s a jerk, the product isn’t that great, the brand reputation is in the toilet… and the stock is up!

Abercrombie & Fitch Co.  NYSE: ANF – May 17 4:00pm ET

54.24 +0.92‎ (1.73%‎)

Open                    High                Low

53.14                    54.32              52.79

Google FinanceYahoo FinanceMSN Money

Here’s why… (disclaimer I am NOT a Finance expert, but I am a psychiatrist, and markets are made up of people).

People go where the attention is, they follow the hype,  they are impulsive, they buy what is a topic of conversation, they make their sell decisions later.

So what can you do?

Keep giving your Asscrombie and Fitch to the homeless. (Great idea Greg Karber!). But if you really want to hurt the guy… boycott and ignore. The goal is empty stores. Make them forgettable.

Viagra for Women: Why Your Doctor Might Prescribe 50 Shades of Grey

Could “mommy porn” have value in the doctor’s office? Unless you live in a cave (and we physicians sometimes do), you have heard of British author E.L. James’ modern erotic 50 Shades of Grey trilogy, 30-plus million copies sold, overwhelmingly to women. The trilogy is an erotic love story about a naïve college graduate who rescues an abused billionaire – a blend of the Story of O, Pretty Woman and a Danielle Steele novel. Not great literature, but clearly having some effect on the libido of millions of women. Do we finally have a safe and affordable clinical tool for women with blunted libidos and hypoactive sexual desire?

The prevalence of decreased female sexual desire and responsiveness has been estimated from 15 – 53%, higher in menopause and perimenopause. In one study, half of women with these symptoms spoke to their doctors about the problem, yet doctors have very few tools for women with hypoactive sexual desire. The phosphodiesterase inhibitors (nitric oxide agonists) such as Viagra increase genital circulation and can effectively treat erectile dysfunction in men, but have shown no benefit in women. Testosterone patches may increase sexual desire and satisfaction in both surgically and naturally menopausal women, but side effects can be uncomfortable, and long-term safety has not yet been established. The jury is still out on the effectiveness of adrenal hormone DHEA replacement, and herbal remedies such as gingko biloba.

So into the office walks a middle-aged female with a normal amount of stress, in a relationship that is comfortable but not passionate, and she wants her mojo back. Where does the doctor start and what is there to offer?

First, the differential diagnosis for diminished sexual desire and responsiveness in women: stress, relationship problems, depression, diabetes, endocrine (thyroid, prolactin, sex hormones), medication side effects (particularly antidepressants and blood pressure medication), vascular disease, nutritional deficiencies (and side effects of too much junk food), substance abuse, past history of trauma for starters. Eventually everything correctable has been corrected, you and your doctor have made a joint decision about the pros and cons of hormone replacement therapy … and still … no fire. Now what?

Think the missing hormone … oxytocin. That old induce-labor bag of pitocin IV hung on all those moms-to-be who weren’t progressing. Oxytocin, a major player in female sexual desire and responsiveness, released during any kind of cuddling – romantic, parental, puppies, and released during orgasm. And most importantly, released while reading romantic, erotic literature. But oxytocin blood tests are largely experimental and oxytocin replacement is not easily available at the pharmacy. How do you know if you have an oxytocin deficiency, and if it can be behaviorally corrected?

You take the oxytocin challenge test – read the entire Fifty Shades trilogy (all 3 books) in one week’s time, and see how you feel. (Don’t stop at the first book, it takes the next 2 books for the desired effect).

One middle-aged woman reported her animals sat next to her while she was reading, and she felt more connected and cuddly, but it didn’t save her relationship. She realized her lack of sexual desire was not physiological, but a result of relationship issues.

A younger woman reported more intense bonding with her young children and husband, and the “biggest orgasm” of her life.

A post-menopausal woman reported that she started to feel desire for her husband again, and had an increase in frequency of intercourse “like 20 years ago,” without hormone replacement, and with no change in their marriage. (He was delighted).

No meds, just books.

The key to the success of these books in women is not the abundant sex scenes, but the romance, and the massive release of oxytocin women experience as a result of immersing themselves in the “love” part of the book. Hearts and flowers increase desire in women; thus the success of the “chick flick” for dates.

Let’s face it. Pornography, written and visual, has existed forever, but remains a greater male stimulant than female. That difference is driven by physiology – women are not aroused by visual pornography to the degree that men are aroused. Male libido is stimulated more by visual and tactile erotic images and sensations – leading to a massive release of norepinephrine (energy/aggression) and dopamine (pleasure/reward). For men, increases in dopamine and norepinephrine appear to play a greater role in arousal than in women, whose arousal seems to be largely oxytocin driven.

What about men? Is there a diagnostic and treatment role for Fifty Shades and the like genre? As a sex manual, Fifty Shades has merit as a “touch here, kiss there, try this” benefit. As a male turn-on … maybe, but don’t count on it.  Cuddle? Pleasant, but not erection-inducing.

Is there anyone who should NOT read the Fifty Shades series? Yes – it may be too intense for younger women, even if sexually active, and it may be a trigger for women with sexual trauma or abuse histories, or it may simply be offensive. That said it’s certainly worth having a conversation with your doctor, and maybe getting a prescription for the bookstore or the library (if the waiting list isn’t too long!). You’ll love your doctor in the end.

This blog was originally posted on kevinmd.com

Dr. Sara Stein on the Medicinal Use for 50 Shades – Fox8 11-07-2012

WebMD’s Health Care Social Media Disaster – Read the Fine Print!

Occasionally, my vocation of treating obesity and my avocation of health care social media intersect.

This is one of those moments. This is the story of a health care social media betrayal in which obese children and e-patients are the victims. Nobody died, except medical ethics, good judgment, and trust in doctors. This is WebMD’s Health Care Social Media Disaster.

Big Cereal Comes to DC 5

Recently, WebMD published an “advertorial” from Kellogg’s: "Mums, kids & breakfast: The truth about sugar“ with a brief disclaimer, “This content is from our sponsor. The sponsor has sole editorial control.” The kind of disclaimer a casual visitor might easily overlook. Here are excerpts from the article, meant to convince you that sugary breakfast cereals are nutritious, and that sugar consumption is a healthy option for your children.

Myth #1 :Sugar is always responsible for tooth decay

The truth: Breakfast cereals eaten with milk, even pre-sweetened varieties, do not increase the risk of tooth decay.

Myth #2 : Sugar is bad for you

The truth: A panel of world health experts recently reviewed the scientific evidence and concluded that a high sugar intake is not related to the development of heart disease, diabetes, high blood pressure or cancer.

Myth #3: Some sugars are more nutritious than others

The truth: All sugars provide approximately 4 calories per gram. And despite popular belief, no type of sugar is more nutritious than any other.

Myth #4: Children should eat a lot less sugar than adults

The truth: Children do have different needs to adults, so they have different Guideline Daily Amounts (GDAs) for sugar. But not as different as you might think.

Because they are active and growing, children are not vastly different to the “average person” used on the front of the pack. In fact, for sugar, it is very similar indeed.

Guideline Daily Amounts (GDAs) for sugar: Average person – 90g; Children – 85g

Advertisers can claim pretty much anything as long as they can manipulate data. No surprise Big Food is fighting back on the attack on the nutrient value of processed food. The problem is not the advertisers. The problem is WebMD and the trust we want e-patients to have on the internet.

The main tenet of health care social media is to advise e-patients, also known as empowered patients, to seek out reliable and credible medical information, most often on major medical websites, including WebMD. We “soc med” docs are working hard to direct the 88% of patients getting healthcare information off the internet* to these sites. Our good faith and theirs. When a major medical site allows this level of misinformation in advertising, the average person is at serious risk.

Here are the tweets ….

@Appetite4Profit What happens when a medical site sells out to Big Food? Kellogg & WebMD report sugar’s good for you!

@AplusPaz Cigarettes are good for kids too, the nicotine kills bacteria within their stomach.

@MagWrites I guess that now really makes them cereal killers

@YoniFreedhoff Kellogg’s states 360 calories of sugar daily = good 4 kids. That’s 20-30% daily cals!

Obesity expert Dr. Yoni Freedhoff pondered the judgment of advertising authority in his blog, Weighty Matters, “I wonder who the WebMD genius was who decided giving sponsors sole editorial control over content was a good idea?”

I’m figuring it was the person who ate the sugared breakfast cereal, and was cognitively impaired for the rest of the day.


(This blog was originally published under the title “Sponsored content on health sites can mislead patients” on KevinMD.com 8-22-2011)

(Photo courtesy of Ted Eytan MD, http://tedeytan.com)


Stress is society’s greatest modern affliction. We have completely lost control of our workdays. A workday used to be dawn to dusk. It used to be from the time you arrived at your workplace until you went home. It used to be 5 days a week. Not anymore. We work constantly, 24 hours a day, 7 days a week. We work at our jobs, in our homes, at school, in traffic, at the grocery store. We work shopping on the Internet.

When we are resting, we are working: making lists, setting goals, reviewing today, and planning for tomorrow. We are not resting.

We continually increase our workload because work is addicting. We physically experience an increase in adrenalin, and energy and focus that expands our productivity. It’s a rewarding feeling to do a good job at something.

We add more work so we can feel even better. We start multi-tasking: the dishes, and the laundry, and the homework and the science project.

We add more forms of communication: television, radio, email, Internet, regular mail, newspapers, magazines, cell phones, voicemail, text messaging.More lives to keep track of, including people we don’t even know. Pretty soon, there is no time and we are multi-tasking every task, including some that should be enjoyable.

We read while we eat, we talk while we drive, we work on three things at once. Simple pleasures are eroded by a sense of urgency and the need for more adrenalin to keep us going. No time to say, “Hello”, “Goodbye”.

We work this hard because our society sets up overwork as a model of success. “Supermoms”, mandatory overtime, full-time students with full-time jobs.

One day I saw a 40-ish single mom who was working two jobs, going to school full-time and raising her children. She was exhausted, stressed, depressed, gaining weight and forgetting things.

“Why are you doing all of this”, I asked.

“For my kids, so I can get a better job.”

I looked at her without any humor, and replied, “If you live long enough”.

We are operating at a level of INTENSITY that causes DISEASE.

We have lost our ability to play, and live and love. We have lost our ability to experience emotion because we are so busy working. We have lost the ability to relax, and think and be alone with ourselves. We have lost the ability to feel content with our circumstances. We have forgotten how to look at the sky and wonder about the stars.

We have lost the ability to experience emotion when we are under severe chronic stress.

Hard at work and numbed out to everything and everybody.

When it’s time for me to relax and have fun, I often cannot. Unless I eat. Then I relax. The food pours out dopamine and GABA and serotonin and acetylcholine into my parched brain until I am positively serene. Am I relaxing because I’m healthy? Or am I relaxing because the food just drugged me into forgetting what I was doing.

For the five or ten minutes that you are stress-eating, your brain is transported to a lower-stress zone. You give your body, your brain, and everyone else in your life a break from the jagged energy you are projecting.

If you are eating all the time in response to stress, “all the time” is simply a reflection of HOW STRESSED YOU ARE!

Just in case you thought this was only about your own personal stress, there’s more. You can also absorb other people’s stress, particularly if they are close to you. Stressed people have a tendency to pour out their problems in rapid-fire succession, one after another, with great energy and emotion.

Relief from stress is about learning to say no: no to demands, no to internal goals, no to family expectations, no to overzealous work projects. Saying no does not mean quitting your job in a bad economy, nor does it mean walking away from a difficult supervisor and getting fired. Saying no means acknowledging your physical and emotional limits and respecting them.

Relief from stress is about recognizing your body’s signals. When you cannot sleep, and you cannot relax, and you cannot stop thinking about work, you are overworked.

The solution to stress and overwork lies in learning and practicing proper endings. To be able to say this is my workday and I am now off. This is my homework time and it is now over. The day’s work has ended and this is my sleep time. This is my stress, and this is yours and I cannot accept it. These are boundaries, yours, mine, and ours.

The solution for stress is to recognize that for your body, rest is as essential as exercise.

For your brain, quiet is as vital as thinking.

For your spirit, solitude is as healing as company.

The solution to stress is to accept your humanity and all its limitations.

excerpt from Obese From The Heart: A Fat Psychiatrist Discloses ©Sara L. Stein, M.D 2009 http://obesefromtheheart.com