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Obesity Paradox Debunked by Researchers in UK

The Obesity Paradox is, to put it simply, a theory that obesity has more positive health effects on some populations. As the theory goes, body fat is thought to protect the body’s organs in the elderly and in people with certain diseases. This paradox has been largely criticized since its publication and has at last been debunked by researchers at the University of Glasgow.

Research Findings

The Scottish study that included almost 300,000 people revealed that the risk of stroke, heart attack and high blood pressure increased with body mass indexes higher than 23. It also determined that the risk was even higher for people who carried excess fat in their stomach. People with a BMI of 22–23 were at the lowest risk of heart disease.

Healthy Patients

The patients studied were all considered healthy, so it’s important to remember that this study did not research the effects of obesity in people with diseases. It is still believed that obesity protects people suffering from cancer, as the disease and treatment can cause significant weight loss.

Reverse Causation

The results of the Obesity Paradox test force us to question if whether its proponents have misdirected causation. In other words, people with lower BMIs may not have an increased risk of death, but rather, people who are sick or near death suffer from significant weight loss.

BMI and Weight Distribution

The study determined two important factors: that people who can maintain a BMI of 22–23 and keep excess weight away from their midsection have the lowest chance of heart attack, stroke, and high blood pressure.

If your body mass index is higher than 23, speak to your doctor or dietician who will help you develop a diet and weight-loss plan. Your doctor may also recommend weight loss surgery.

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Dr. Gagner’s Recent Interview with Bariatric News About LSG

Bariatric News recently interviewed Dr. Michel Gagner who will be participating in two bariatric surgery events this summer to discuss the current status of the Laparoscopic Sleeve Gastrectomy (LSG): The 6th Annual International Consensus on Sleeve Gastrectomy and the GORE Sleeve Symposium. Dr. Michel Gagner is the preeminent surgeon of gastric sleeve surgery, which has become an increasingly popular procedure for weight-loss.

A Laparoscopic Sleeve Gastrectomy Procedure

In an LSG, 60% to 85% of the stomach pouch is removed through a series of small incisions, and the remaining stomach pouch is left in a sleeve shape. In this bariatric procedure, the patient’s appetite and hunger-related hormone production are reduced, thus improving the patient’s chances of long-term weight management.

6th Annual International Consensus on Sleeve Gastrectomy

Day One: On the first day of the Consensus, approximately 20 live LSGs, revisions, conversions, and single anastomosis duodeno–ileal bypasses will be performed by surgeons from all over the globe.

Day Two: The second day will involve discussions on the mitigation and prevention of LSG complications involving weight regain, revisions, and leak management. The Consensus will end with a questionnaire whose results will appear in a peer-reviewed journal.

GORE Sleeve Symposium

Unlike the Consensus, the Symposium will be hosting an Expert Panel Discussion in which experts give a speech and answer questions from the audience. The panel will discuss various ways to avoid surgical complications from LSGs. During the Symposium, Dr. Michel Gagner will demonstrate how to avoid preventable mistakes, such as:

  • Staple Line Reinforcement, which shows strong evidence of eliminating leakage and bleeding.
  • Dr. Gagner also questions recent study findings published by the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP), which stated that Staple Line Reinforcement was more commonly associated with increased leakage. Based on the paper’s inability to properly support their claims, Dr. Michel Gagner is unwilling to accept the paper’s findings.

Clinique Michel Gagner performs various bariatric surgeries. If you’re wondering if a laparoscopic sleeve gastrectomy is the right weight loss procedure for you, please fill out this patient questionnaire.

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Ethicon Discontinues Adjustable Gastric Band Due to Declining Popularity

In 2016, Ethicon, a Johnson & Johnson company, announced that it would no longer be manufacturing and distributing its Endo-Surgery Curved Adjustable Gastric Band. The reason for this cessation in sales is the declining popularity in gastric banding surgery itself. While some patients have lost weight and have seen a significant improvement to their health, our clinic does not offer gastric bands, nor do we recommend them.

The Realities of Gastric Bands

First of all, what is a gastric band? Essentially, a gastric band procedure does not entail removing any parts of the stomach. Your surgeon simply ties the adjustable gastric band around the top part of your stomach to reduce the amount of solid food you need to eat before feeling full. It does not restrict liquid intake. While the fact that it’s not as invasive as other bariatric operations can be considered a plus, long term effectiveness is not a guarantee, and you might find your limited weight loss to be nothing short of heartbreaking.

Why Gastric Bands Are Not Recommended

Gastric Band procedures are in decline due to the continuously high rate of necessary removal, which explains Ethicon’s decision to discontinue the sale of their product. According to some statistics, only 11% of Gastric Band patients still have their original bands intact. Complications make arise, such as leaks, gastric erosions, slippage, stomach dying, obstructions, perforations, etc. At Clinique Michel Gagner, we know that bariatric surgery is an expensive choice toward a healthier lifestyle. Patients who spend thousands of dollars on a procedure, which has proven many times not to be as effective as other procedures, may never see the weight loss results they paid for. That’s why our clinic only specializes in weight loss surgeries with higher result rates.

Alternatives to Gastric Bands

If you are considering undergoing weight loss surgery, our clinic provides many alternatives that will ensure a better success rate than a gastric band and minimal recovery time. Click here to learn more about what bariatric surgeries we perform at Clinique Michel Gagner in Montreal. Here are a couple preferred bariatric procedures.

Laparoscopic Sleeve Gastrectomy: In 2000, in New York City, Dr. Michel Gagner pioneered this ground-breaking procedure, which involves removing up to 85% of your stomach volume. This procedure has shown to reduce body weight by up to 75% in a single year.

Laparoscopic Roux-en-Y Gastric Bypass: A surgery that Dr. Gagner has pioneered and perfected over decades (He first performed it in 1995 at the Cleveland Clinic), this procedure has been proven to cause a significant amount of weight loss—up to 85% in the first year.

Laparoscopic Duodenal Switch: A surgery that Dr. Gagner pioneered laparoscopically since his work at Manhattan’s Mount Sinai Hospital in 1999, it gives the best weight loss results of any procedures and resolves type-2 diabetes.

Contact Clinique Michel Gagner to discuss if weight loss surgery is right for you.


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Dr. Michel Gagner Mentioned in NY Times Article

Dr. Michel Gagner was recently quoted in a New York Times article entitled “What is Bariatric Surgery and How does it Work?”, an in-depth look into the function and uses of bariatric surgery. The article spans common questions associated with the procedure like its cost, statistics on the procedure, what the surgery entails, the history of this procedure and its after effects.


As many of our readers know, bariatric surgery is an option that almost always has positive health implications on obesity. It can help to reduce or even completely remove harmful conditions associated with obesity such as:


  • Diabetes (a long-term remission for type 2 diabetes)
  • Acid reflux problems
  • Obstructive sleep apnea
  • Depression
  • Risk of coronary heart disease, stroke and peripheral heart disease — as blood pressure and cholesterol levels can return to normal or near-normal levels
  • Joint pain
  • Fertility issues and pregnancy complications
  • Metabolic syndromes
  • Gallbladder disease


Dr. Gagner’s Role


Under the historical question on bariatric surgery, Dr. Gagner was featured because he discovered the laparoscopic sleeve gastrectomy (LSG), one of the two most important procedures in bariatric surgery. Back in 2000 when he was a surgeon at the Mount Sinai Hospital in New York, he was operating on an extremely obese woman. He was quickly made aware that she was not getting enough oxygen and that he would have to stop the surgery. Dr. Gagner had already removed most of the patient’s stomach and had to patch up the patient, thinking that he had left the surgery incomplete. However, time told that the procedure was a success and the woman managed to lose a lot of weight and have a fresh start.


More on LSG


The LSG procedure was refined not long after into a standard procedure. It involves reducing the stomach volume by permanently removing 60-85% of the stomach pouch leaving the remaining section in what looks like a sleeve. This helps to restrict the amount of food (by restricting the hunger-related hormone) helping a person to feel full after a sufficient amount of food. This allows a person to naturally eat less, lose weight and later maintain a healthy weight.

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Une nouvelle campagne de la CDC s’adresse aux 86 millions d’adultes pré-diabètes aux É-U

Selon la Center for Disease Control (CDC) aux États-Unis, le pré-diabète affecte  86 millions de personnes aux États-Unis et 5,7 millions au Canada. Le pré-diabète est une condition sérieuse qui peut conduire au diabète de type 2. Si vous êtes pré-diabétiques, vous avez des niveaux de pression artérielle et de glycémie plus élevés, mais non suffisamment élevés pour être diagnostiqué avec le diabète de type 2.

Presque tous les pré-diabétiques ignorent leur condition. Le pré-diabète peut causer des problèmes de santé sérieux comme le diabète de type 2, des accidents vasculaires cérébraux et des crises cardiaques. Si une personne pré-diabétique n’est pas traitée, un quart de tous les cas se développeront en diabète de type 2 dans une demi-décennie.

Quelles sont les causes ?

Il existe plusieurs façons de devenir pré-diabète – et avec l’absence de traitement, de développer le diabète de type 2 par la suite. Voici les principaux facteurs qui contribuent à cette condition.

  • Avoir des antécédents de diabète dans votre famille
  • Si vous avez plus de 40 ans – le risque de pré-diabète et de diabète augmente avec l’âge
  • Si vous êtes en surpoid ou obèse
  • Avoir des antécédents de diabète gestationnel (le diabète ou une glycémie élevée lors de la grossesse)
  • Avoir une pression artérielle élevée

Que faire ?

Le pré-diabète peut être inversé par la perte de poids, les changements dans le régime alimentaire et l’exercice physique. Prenez le temps de vérifier et voir si vous devriez être diagnostiqué pour le pré-diabète – la recherche moderne a démontré que les gens qui savent qu’ils sont pré-diabétiques sont plus susceptibles de faire les changements nécessaires dans leur mode de vie.

La CDC a mis en marche une série d’annonces dans le cadre de leur programme national de prévention du diabète qui encouragent les gens à se faire tester pour le pré-diabète et le diabète. Ces messages d’intérêt public sont assez directs (au point de la comédie), mais avec une nuance d’urgence qui encouragera certainement plus de gens à se faire tester.

Pour ceux qui ont de la difficulté avec la perte de poids ou qui doivent perdre une grande quantité de poids, la chirurgie bariatrique est une option qui peut aider la lutte contre le diabète. Contactez la Clinique Michel Gagner pour plus d’informations sur les traitements disponibles.

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Traditional Methods of Weight-Loss Near-Impossible For Obese Patients, Study Finds

Ideally, healthy weight loss should be on every obese person’s to-do-list, but a new study published by the American Journal of Public Health reveals that this is near impossible to achieve with traditional dieting and exercising alone. The study shows the odds of a clinically obese person achieving normal weight without surgical interventions are just 1 in 210 for men in a given month. Women fared a little better; 1 in 124 in a given year. For those who are morbidly obese, the odds are even worse.

On the other hand, the study shows an initial positive effort by the participants: people in the study were successful in dropping 5% of their body weight. However they were not able to sustain it, nor were they able to achieve their weight goals. At least half of those who lost 5 percent of their body weight regained it within two years, and more than 78 percent regained it within five years. This is a clear indication that there is something wrong with traditional weight-loss strategies.

The study was based on analysis of more than 278,000 people from the UK’s Clinical Practice Research database, tracked between 2004 and 2014. The purpose of the study was to highlight the difficulty obese people face in trying to achieve sustained weight loss through diet and exercise alone. Dieting and exercise can work; it is just near impossible for obese patients. Oftentimes, weight cycling (frequent fluctuation in gaining and losing weight) was much more common than sustained weight loss. This has been shown to be even more taxing on the body than stable obesity.

While the findings may be bleak, it also emphasizes the importance of preventative measures for obesity. Part of the problem is that few obese Americans who are eligible for weight-loss medications or surgery actually do get those therapies. A more concerted effort needs to be made to educate the public on surgical treatments for obesity.

Source: HealthDay

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Startling Statistics Reveal 95% of Parents Believe Their Obese Children To Be “Just Right”

Naturally, parents want to believe that they are raising their children right; that they are providing them with a healthy diet, and that an inclination for food amongst younger children is a sign of good health and vitality. This was confirmed by a team of researchers from NYU Langone Medical Center who looked at data on how parents perceive their overweight young children, revealing that 94.9 percent of parents believe their kids’ size to be “just right” Researchers studied two groups of young children: a group of 3,839 kids from 1988-1994, and another group of 3,151 kids from 2007-2012, and published the findings in the journal Childhood Obesity. Similar findings were reported last year in the journal Pediatrics.

Perhaps even more disturbing, researchers found that results worsened from the same survey taken 20 years earlier. Obese children today are roughly 30% less likely to be appropriately perceived by their parents than they were in the 1990s. Amongst those with the highest chances of inaccurate perceptions were low-income parents and African Americans.

In the study, parents were asked the pivotal question: “Do you consider [child’s name] to be overweight, underweight, just about the right weight, or don’t know?” Data showed that parental responses were pretty much the same within the two time periods studied, however there was one very noticeable difference: childhood obesity is much more widespread today than it was the first time the study was conducted, meaning more parents are viewing their obese children as “just right”.

Signs point to changing societal ideals and a redefinition of healthy body weight. As obesity keeps rising in North America, larger body types are becoming more and more commonplace. Even among kids aged 2 to 5, who were the subjects of this study, perceptions of weight ideals have drastically changed. If every other child is obese, parents are more likely to see their own child as “normal” because of its prevalence.

Lessons can be learned from this study, yet none of them may be pleasant. Firstly, childhood obesity isn’t going away anytime soon. Secondly, more work needs to be done by pediatricians on educating parents about healthy diets for their children in the face of rising obesity rates. Thirdly, most parents have obviously lost a clear idea of what a healthy child looks like.

The important thing is that we start taking action now, before these trends become irreversible.

Source: Washington Post

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Dr. Gagner Appears In Wall Street Journal – “Obesity Surgery Is Better At Treating Type 2 Diabetes In Obese Patients Than Diet And Exercise”

The Wallstreet Journal recently published an article on July 1st that reflected on the growing body of evidence that suggests that weight-loss may be an effective way to treat type-2 diabetes, in conjunction with Dr. Gagner’s editorial companion piece published in the JAMA Surgery Journal.

According to a small but rigorous randomized trial published by JAMA Surgery, evidence shows baratric surgery is superior to lifestyle changes in resolving type-2 diabetes. In the trial, obese patients were randomly assigned either a Roux-en-Y gastric bypass, a laproscopic adjustable gastric banding, or a lifestyle weight loss intervention plan. Results showed that patients who had had the Roux-en-Y gastric bypass procedure had the highest type-2 diabetes partial or complete remission rate with 40%; 29% with the laparoscopic banding; 0% with weight loss intervention patients. In other words, no one in the group who received intensive lifestyle intervention resolved their diabetes, which stands in stark contrast to those who received weight-loss surgery.

If the JAMA Surgery study didn’t convince you, Dr. Gagner points to another study –  the TODAY clinical trial on adolescents with recent-onset type-2 diabetes similarly indicates no benefits of intensive lifestyle intervention. For Obese patients with type-2 diabetes, surgery resulted in better glucose control than did medical therapy.

Dr. Gagner states – “We should consider the use of bariatric (metabolic) surgery in all severely obese patients with T2DM and start a mass treatment, similar to what was done with coronary artery bypass graft more than 50 years ago.”

Source: Wall Street Journal, JAMA Surgery

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IFSO EFC – Interview With The Expert – “Which Is The Most Important Trick To Avoid In Sleeve Gastrectomy Staple Line Leaks?”

Dr. Gagner gives his expert advice on how to avoid staple leaks in Sleeve Gastrectomy surgeries.


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A Score Of New Peer-Reviewed Articles From Dr. Gagner

Be up to date in the field of Bariatrics by reading the latest peer-reviewed articles from Dr. Gagner:

1. Gagner, M: Bariatric surgery saves lives. CMAJ. 2015 Jun 16;187(9):681. doi: 10.1503/cmaj.1150042. Link

2. Gagner M: Effect of sleeve gastrectomy on type 2 diabetes as an alternative to Roux-en-Y gastric bypass: a better long-term strategy. Surg Obes Relat Dis. 2015 Mar 24. pii: S1550-7289(15)00064-7. Link

3. Nedelcu M, Noel P, Iannelli A, Gagner M: Revised sleeve gastrectomy (re-sleeve). Surg Obes Relat Dis. 2015 Feb 14. pii: S1550-7289(15)00040-4. Link

4. Huang R, Gagner M: A Thickness Calibration Device Is Needed to Determine Staple Height and Avoid Leaks in Laparoscopic Sleeve
Gastrectomy. Obes Surg. 2015 May 30. Link

5. Manos T, Nedelcu M, Noel P, Gagner M: Pigtails Internal Drainage for 2-cm Gastric Leak After Sleeve Gastrectomy Prolongs Healing. Obes Surg. 2015 Jul;25(7):1261-2. Link

6. Gagner M: Bariatric surgery: To bypass or switch? That is the question in obesity surgery. Nat Rev Gastroenterol Hepatol. 2015 May;12(5):255-6. Link

7. Roslin MS, Gagner M, Goriparthi R, Mitzman B: The rationale for a duodenal switch as the primary surgical treatment of advanced type 2
diabetes mellitus and metabolic disease. Surg Obes Relat Dis. 2014 Nov 25. pii: S1550-7289(14)00463-8. doi: 10.1016/j.soard.2014.11.017. Link

8. Sato T, Yamaguchi S, Harada M, Koyama I, Gagner M.Impact of laparoscopic surgery on survival of patients with small bowel adenocarcinoma and peritoneal metastasis. Hepatogastroenterology. 2014 Nov-Dec;61(136):2253-5. Link

9. Sato T, Yamaguchi S, Harada M, Gagner M: Long-term outcome of laparoscopic resection for stage IV colorectal cancer. Hepatogastroenterology. 2014 Nov-Dec;61(136):2232-5. Link

10. Nedelcu M, Manos T, Cotirlet A, Noel P, Gagner M: Outcome of leaks after sleeve gastrectomy based on a new algorithm adressing leak size and gastric stenosis. Obes Surg. 2015 Mar;25(3):559-63. doi: 10.1007/s11695-014-1561-y. Link

11. Gagner M: Decreased incidence of leaks after sleeve gastrectomy and improved treatments. Surg Obes Relat Dis. 2014 Jul-Aug;10(4):611-2. Link


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