University Bariatrics Blog

Obesity—Willpower or Disease?

Obesity—Willpower or Disease?

“Trying 20 times and not succeeding—is that lack of willpower, or a problem that can’t be treated with willpower?” asked Dr. Louis Aronne, Director of the Comprehensive Weight Control Center at Weill Cornell Medicine and NewYork-Presbyterian.

Research shows that diet and exercise may be insufficient solutions for treating obesity. It may be in your genes.

1 in 3 people living with obesity say they have never discussed bariatric surgery with their doctor. That’s a dangerous fact which could be due in part to the common misconception that obesity stems from a lack of willpower.

Dr. Donna Ryan, Pennington Biomedical Research Center obesity researcher, said “It’s frustrating to see doctors and general public stigmatize patients with obesity… We would never treat patients with alcoholism or any chronic illness this way.”

A national survey of 1,509 adults by NORC at the University of Chicago, found that Americans believe that obesity and cancer are the biggest health threats challenging the nation today.

94% of participants shared that they had tried dieting and exercise in an effort to lose weight with no results. 15% attempted to lose weight more than 20 times.

Research points to genetics as a cause of obesity. However, we still only talk about it as a risk for other diseases, not as its own treatable, medical issue.

Why?

Dr. Scott Kahan, obesity medicine specialist and Director for the National Center for Weight and Wellness, states “Doctors learn nothing about obesity in medical school, which might be why only 12 percent of those… with severe obesity said a doctor had suggested surgery to them.”

Doctors are not learning how to treat patients struggling with obesity even though the NORC survey shows that one-third of Americans are affected by it.

At University Bariatrics, we have assembled a team of experts who are passionate about helping their patients succeed in losing weight long term! We have many resources that reach beyond the usual doctor-patient relation to aid patients in every aspect of their journey. Check out the resources we provide by visiting http://www.universitybariatrics.com/.

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Obesity Induced End Stage Liver Disease: An Increasing Indication For Bariatric Surgery

Obesity Induced End Stage Liver Disease: An Increasing Indication For Bariatric Surgery

In a recent newsletter published by the American College of Surgeons, researchers from Rutgers University presented their analysis of a large volume of data on the benefits of bariatric surgery. In addition to the well-established significant improvements in diabetes, lipid disorders, high blood pressure, and other complications of metabolic disorders, researchers found bariatric surgery to be very effective in treating fatty liver disease. With 90% improvement, bariatric surgery helped prevent the progression of fatty liver disease to nonalcoholic steatohepatitis and the inflammatory process that leads to fibrosis, cirrhosis, and liver decompensation.

This ultimately means a liver transplant is needed. In fact, fatty liver disease is expected to overtake hepatitis C virus as the number one cause of liver transplant within the next 5 years, drawing attention to bariatric surgery as a strategy to control liver disease. Ironically, the rate of liver transplant in people who are morbidly obese is lower in comparison to patients with normal weight. The survival of transplant organs is also negatively affected by continued obesity. The Rutgers group reported that bariatric surgery is already being used at their center to avoid a second liver transplant in obese patients who are unable to lose sufficient weight, preventing progressive fatty liver disease after a patient’s first transplant.

The Rutgers group also showed that the benefits of bariatric surgery include a nearly 40% reduction in liver inflammation, 20% reduction in liver fibrosis, 90% reduction in 10 year mortality, and large improvements in relevant measures of morbidity for more than 10 organ systems. This includes the improvement or resolution of dyslipidemia and hypertension in the circulatory system, asthma and other diseases affecting the respiratory system, gastroesophageal reflux disease, and other diseases that affect the gastrointestinal system.

Bottom line, there is no such thing as a healthy obesity. Fatty liver typically exists even when patients don’t suffer from the usual comorbidities such as diabetes, high blood pressure.

It’s important to have the best, most progressive treatments available to you. Our team at University Bariatrics is experienced and we will help you weigh all your options to determine which procedure will be most effective for you. Come in for a consultation and a personalized weight-loss plan! Call us at (805) 379-9796, visit our website, or register to attend one of our free bariatric surgery seminar, to start your health journey today!

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Bariatric Surgery Can Reduce Your Chances of Developing Certain Cancers and Diabetic Microvascular Disease

Bariatric Surgery Can Reduce Your Chances of Developing Certain Cancers and Diabetic Microvascular Disease

Two important new studies have recently been published in European medical journals about obesityrelated cancers and reductions in patients’ diabetic microvascular disease after bariatric surgery.

In a study by British Medical Journal, researchers analyzed 204 publications, exploring the connection between obesity, weight gain, waist circumference and 36 different cancers. They found that people who are obese have a greater risk of developing and dying from 11 types of cancer including malignancies of the breast, ovary, kidney, pancreas, colon, rectum and bone marrow. The associative evidence for the other 25 cancers exists but was not statistically significant.

To understand their findings, it’s helpful to know that a BMI between 18.5 and 24.9 is considered a healthy weight, a BMI between 25 to 29.9 is overweight, a BMI of 30 or above is obese, and a BMI of 40 or higher is considered morbidly obese.

This study found that for every 5 BMI units gained, the risk of cancer increased significantly; risk of rectal cancer rose 9% among men and the risk of tumors in the biliary tract system rose 56%.

For women, weight gain and extra belly fat—a measurement known as waisttohip circumference ratio—were also associated with an increased risk of certain cancers. Every 0.1-unit increase in waisttohip ratio was associated with a 21 percent jump in odds of developing endometrial cancer. After menopause, every 11 pounds gained during adulthood increased a womans risk of breast cancer by 11 percent; specifically, this was found in women who didnt take hormones to ease menopause symptoms—a treatment that is independently linked to an increased risk of breast cancer.

Researchers found strong evidence linking weight gain to colorectal cancer. They also found a strong connection between BMI increases and the development of cancers of the gallbladder, stomach and ovaries, as well as dying from bone marrow tumors. The authors of the study concluded that more research is needed to assess changes in body fat over time to better understand how obesity directly influences the risk of getting cancer or dying from the disease.

In the second study, Swedish researchers found that after undergoing bariatric surgery, patients with obesity and either prediabetes or type 2 diabetes saw a reduced longterm risk for microvascular complications compared with similar patients who did not have bariatric surgery. Diabetic microvascular complications affect the eyes, kidneys, and peripheral nerves among others body parts, which can lead to dreaded longterm complications of these organs, such as blindness, kidney failure, and limb loss.

They analyzed more than 15 years of data from 4,032 patients separated into surgical and nonsurgical arms, the timetofirst microvascular event, and noted that the incidence of microvascular disease was lower in the bariatric surgery group versus the control group. The most common observed microvascular complication was diabetic retinopathy, which was reduced after bariatric surgery across all glycemic subgroups. “We need new, effective nonsurgical treatments for prediabetes,” one of the authors said. “Our research shows that prediabetes is a serious condition that should be treated, and that this can be done by bariatric surgery. However, it is not possible to operate all obese patients with prediabetes.

The bottom-line: bariatric surgery significantly reduces the odds of developing certain cancers and, for those who are diabetic or prediabetic, it significantly delays or completely prevents the development of diabetic microvascular disease that would normally lead to blindness, kidney failure, and limb loss.

Bariatric surgery is proving to have so many benefits! The never-ending cycle of diets, shots, and pills can’t compare.

If you are suffering from obesity and tired of yoyo dieting, drugs, and fads, it’s of the utmost importance that you seek the most effective and progressive treatment options available to you. At University Bariatrics, we consider all your options during your consultation and create a personalized weightloss plan to help you along your journey to a healthier life.  Call us or visit us on the web to attend a free bariatric surgery seminar and set up your private consultation.

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Bariatric Surgery Can Improve Type II Diabetes

Bariatric Surgery Can Improve Type II Diabetes

“Patients with type two diabetes who underwent bariatric surgery had durable and significantly greater glycemic control than those managed with medical therapy alone,” wrote Peggy Peck, Editor-in-Chief of MedPage Today, in response to the results of a 3-year study by a medical research organization called STAMPEDE.

It sounds like something good came out of this study…but what does it all mean?

Let’s break it down.

Studies suggest that both genetics and being overweight or obese can lead to type two diabetes. Basically, diabetes is a condition in which there is too much sugar, also known as glucose, in the blood stream. There just isn’t enough insulin—the important stuff in your body that helps turn sugar into energy or saves it for later—to process it all. The body then has to get energy from its tissues, muscles, and organs.

As you can imagine, the primary goal for diabetics is to regulate the amount of glucose in the blood stream. This is what Peggy Peck means when she says “glycemic control.”

Bariatric surgery is weight-loss surgery available only to those who are very overweight or obese. There are many types of bariatric surgery, including sleeve gastrectomy, gastric bypass, laparoscopic adjustable band, duodenal switch, gastric balloon. By the way, our expert team of surgeons offers all of these options!

So, Peggy Peck is simply saying that the patients who couldn’t regulate the amount of sugar in their blood stream and underwent bariatric surgery were better able to control their sugar levels in comparison to the patients who didn’t have weight-loss surgery.

That’s a life-altering benefit to say the least.

Since 2011, the American Diabetes Association and the International Diabetes Federation have recommended that bariatric surgery should be considered for adults who have type 2 diabetes and whose BMI is greater than 35.

Other ways to help maintain a healthy glucose level:

  1. Sleep! Getting less than six hours of sleep per night has been scientifically shown to decrease your body’s ability to process sugar.
  2. Your feet were made for walking! 30 minutes of walking every day can strengthen your muscles, increasing your ability to process gluten.
  3. Relax. Take a couple of deep breathes, meditate for ten minutes, or go to a yoga class. Many studies show that this will effectively decrease your blood pressure.

Check out the procedures we offer today! We’d love to discuss all of your options with you.

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Strawberry and Lemon Infused Water

Strawberry and Lemon Infused Water

What if your water tasted like summer?

No, we’re not pulling your leg!

For all of you who miss warm weather and the smell of fresh cut lawns, guide your eyes to the soul-satisfying infused water recipe below.

Ingredients:

Water

Strawberries (five or the whole package–you’re choice.)

Half or a whole lemon (depending on how lemony you think summer tastes)

 

What to do:

1. Fill a pitcher with water.

2. Rinse strawberries and lemon under cool running water.

3. Grate strawberries into the water pitcher.

4. Thinly slice lemons and add to water pitcher.

5. Allow to sit for 3-12 hours in the refrigerator (the longer you let it chill, the stronger the taste).

6. Remove strawberries and lemon slices.

7. Sip and imagine sunny, longer days.

The infused water, if refrigerated, is good for 3 days after infused. So, you’ll be basking your faux-summer for days!

lemon and strawberry water

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New Year Weight-Loss Resolutions: Diets, Drugs, TV Weight Loss Shows… Bariatric Surgery Beats Them All

The start of 2017 means the beginning of a bunch of New Year’s resolutions, with weight loss topping the list for the overwhelming majority of people. TV, radio, newspaper and the internet are inundated with advertisements for pills, shots, detox regimen, commercial weight loss programs, gym specials, expensive exercise equipment, etc. So if they are successful, why is it that every year we go through the same cycle of resolutions and then break them after a few unsuccessful months?

The answer primarily lays in your genes, as well as improper dietary habits, and what we see in the food system nowadays vs. what was there just a few decades ago. But that is a long discussion of its own, plus you cannot change your genes. So what can you do?

You might have recently read about one of the Biggest Loser TV show’s contestants who successfully lost over 100 pounds, only to regain it all back a few years later. Whereas emotional trauma may have played an important role in the weight gain, that is not the only reason. Studies have shown that slower metabolic rates account for weight recidivism in all of the show’s contestants. The study, which was funded by the National Institutes of Health (NIH) and published in the journal Obesity, followed 14 (six men, eight women) of the 16 contestants who competed in the show’s eighth season.

tv-weight-lossAll but one regained much of the 100 pounds or more they lost through The Biggest Loser’s intensive dieting and exercise regimen, and five had returned to within 1% or above their original weight. Contestants also had slower metabolisms, which is expected after a diet ends, but is not expected to stay that way years later. This process is known as metabolic adaptation, wherein patients who lose massive amounts of weight experience a slowing of their resting metabolic rate, burning fewer calories while at rest. Those patients have to consume at least 500 fewer calories per day to maintain the weight loss. Interestingly, this phenomenon is not seen in bariatric surgery patients. Per the authors, a matched group of gastric bypass surgery patients who experienced significant metabolic adaptation six months after surgery had no detectable metabolic adaptation after one year, despite continued weight loss. The lack of long-term metabolic adaptation following bariatric surgery may reflect a permanent resetting of the body weight set-point.  

dietsHow about diets? How about not. According to research presented at an internal medicine meeting, weight loss programs do help people keep the pounds off, but long-term success is still rare. Of the 66,000 patients enrolled in weight loss programs over 5 years, less than half had lost more than 5% of their weight. More importantly, only 2% of them stuck with the program and did not drop out. Those who stayed lost only 8% of their weight in the long term. Compare that to bariatric surgery patients: those who have pursued gastric bypass or vertical sleeve gastrectomy lose 60-80% of their excess weight and in the longer term, keep more than half of it off. One question patients should ask themselves is why none of these commercial weight loss programs with ads all over TV ever publish longer-term data similar to what surgeons do.

So drugs may be the answer, right? Wrong. In a meta-analysis of 28 studies and 29,000 patients, researchers at UCSD looked at results of various medications and found very minimal weight loss results in the short term and no data in the longer term.drugs  The researchers found that a median 23% of placebo participants had at least 5 percent weight loss vs. 75% of participants taking phentermine-topiramate (Qysmia), 63 percent of participants taking liraglutide (Victoza), 55% taking naltrexone-bupropion (Contrave), 49% taking Lorcaserin (Belviq), and 44% taking orlistat (Alli/Xenical). All active agents were associated with significant excess weight loss compared with placebo at 1 year: Qysmia, 19.4 lbs.; Victoza, 11.7 lbs.; Contrave, 11 lbs.; Belviq, 7.1 lbs.; and Alli/Xenical, 5.7 lbs. Compared with placebo, Victoza and Contrave were associated with the highest odds of adverse event-related treatment discontinuation. So essentially, at one year, patients lost 5-20 pounds at one year plus a lot of possible dangerous side effects while they took the medications or when they stopped it. Now compare that with what patients typically achieve with gastric bypass or vertical sleeve gastrectomy: at least 50lbs or more. Plus you get to keep the weight off. With drugs, what will happen to your weight when you stop taking them especially if you follow FDA guidelines to limit their use to 90 days? Probably a major rebound.

Bottom line, going back decades, Roux en-Y Gastric bypass, Duodenal Switch and now the vertical sleeve gastrectomy remain the most effective and long-term treatments for morbid obesity and their associated comorbidities such as diabetes, high blood pressure, hyperlipidemia.

bariatric-surgery

If you are suffering from obesity and tired of yo-yo dieting and drugs and fads, it’s of the utmost importance that you seek the most effective and progressive treatment options available to you. At University Bariatrics we consider all the options during your consultation, and help create a customized weight loss plan to help you along your journey to a healthier life.  Call us or visit us on the web to attend a free bariatric surgery seminar and set up your personal private consultation.

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ASMBS/NORC Obesity Poll: How Do Americans Really Perceive Obesity?

ASMBS/NORC Obesity Poll: How Do Americans Really Perceive Obesity?

The New York Times recently featured a major story on obesity with the headline, “Americans Blame Obesity on Willpower, Despite Evidence It’s Genetic.” The story was based on a national consumer survey conducted by the ASMBS & University of Chicago on perceptions Americans have about obesity and its treatment. Major national news outlets including People Magazine, CNBC, and Cosmo covered the ASMBS/NORC Obesity Poll.

They wanted to use the survey as an educational and public awareness platform to inspire a national dialogue on the diagnosis and treatment of obesity and generate national media coverage on the issues that interfere with the treatment of the disease. That, by the way, includes your own doctors who don’t believe in metabolic surgery and still advise you to diet and exercise your way out of being morbidly obese.

“The barriers to treatment go beyond insurance,” said Raul J. Rosenthal, my mentor and past president of ASMBS. He added that the survey aimed to uncover other barriers including fear and denial about the disease and misperceptions about the safety and effectiveness of weight-loss surgery.

The New York Times also featured reactions to the survey from several non-surgeon obesity experts throughout the country. Their comments, as you see, reflect what most morbidly obese patients already know and go through every day:

 “It’s frustrating to see doctors and the general public stigmatize patients with obesity and blame these patients, ascribing attributes of laziness or lack of willpower. We would never treat patients with alcoholism or any chronic disease this way. It’s so revealing of a real lack of education and knowledge.”


“Trying 20 times and not succeeding — is that lack of willpower, or a problem that can’t be treated with willpower?”

“One problem, though, is that medical professionals can be as misinformed as the public. We are talking about people who are 100, 200 pounds overweight…”

“The failure by doctors to mention the only effective course of treatment (bariatric surgery). If that was the case for cardiovascular disease and bypass surgery, you would say doctors are negligent?”

obesity-survey-middle

Major findings from the ASMBS/NORC Obesity Poll include:

  • 81% of Americans consider obesity to be the most serious health problem facing the nation, tying cancer and ahead of diabetes (72%) and heart disease (72%)
  • 94% think obesity itself increases the risk for an early death, even when no other health problems are present
  • Most Americans think diet and exercise on one’s own is the most effective for long-term weight loss (78%), saying it’s even more effective than weight-loss surgery (60%) and prescription obesity drugs (25%)
  • 1 in 3 of those struggling with obesity, report that they have never spoken with a doctor or health professional about their weight
  • Only 12% of those with severe obesity, for whom weight-loss surgery may be an option, say a doctor has ever suggested they consider surgery
  • Only 22% of Americans with obesity rate their health positively, and half report being diagnosed with two or more chronic conditions
  • 88% say losing weight through diet and exercise, especially with the help of a doctor, is the safest way to do it, while prescription medications (15%) and dietary supplements (16%) are perceived to be the least safe
  • About one-third believe weight-loss surgery to be either safe (31 %), unsafe (37%), or neither safe nor unsafe (31%), though 68 % think that living with obesity is still riskier than having weight-loss surgery
  • 62% consider obesity simply a risk factor for other diseases and not a disease itself
  • 48% believe obesity is caused primarily by a person’s lifestyle choices and that the biggest barrier to weight loss is a lack of willpower (75%)

The misperceptions about the fundamental causes of morbid obesity and how to best treat it exist amongst both the patients and their doctors.

Don’t be one of the above statistics.

If you are suffering from obesity and tired of yo-yo dieting and drugs and fads, it’s of the utmost importance that you seek the most effective and progressive treatment options available to you.

At University Bariatrics we consider all the options during your consultation, and help create a customized weight loss plan to help you along your journey to a healthier life.  Call us today attend a free bariatric surgery seminar and set up your personal private consultation.

 

 

 

 

 

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With open enrollment around the corner, now is a good time to consider your insurance options if you are considering bariatric surgery in 2017

According to American Society of Metabolic & Bariatric Surgery, insurance denial and unattainable prerequisites were the two most common reasons why some patients do not undergo bariatric surgery. About 25 percent of patients considering it are denied coverage three times before getting approval.

Health insurance companies might not pay for weight-loss surgery, but do pay for years of treating the conditions associated with obesity such as diabetes, heart disease, sleep apnea, high blood pressure, hyperlipidemia, and many many others. Mounting evidence shows that surgery for morbid obesity can be more cost-effective than treating the conditions resulting from obesity. In fact, laparoscopic gastric bypass (and likely sleeve gastrectomy) pay for themselves within two years…And that comes straight from hospital and insurance company and managed care journals. But they still put up hurdles to discourage patients from seeking it.

It’s highly unlikely that you’ll find an individual health plan that won’t cover weight-loss surgery, including the Obamacare plans in California (aka California Exchange Plans). They usually do including Medicare and MediCal. Group health plans however may not cover bariatric surgery if an employer specifically selects it out as an option. Only six states mandate that treatment for morbid obesity be covered by group health plans: Georgia, Illinois, Indiana, Maryland, New Hampshire and Virginia. These mandates apply only to group plans but not necessarily those offered by self-funded companies. That’s where large employers take on their own financial risk of covering employee claims, and you probably won’t know if your employer is self-funded unless you ask.

So bottom-line, just because you have insurance does not mean that bariatric surgery is a covered benefit. That is why you have to take charge and start doing your homework now during open enrollment for 2017. Some strategies to consider include:

1. If your HMO plan doesn’t cover obesity surgery, change to a PPO plan at open enrollment if the PPO plan covers it.
2. Change to your spouse’s plan if it provides coverage.
3. Get a job with large employers that cover weight-loss surgery as a commitment to employee health (plus it saves them money in long term). According to ASMBS, examples include: Intel, Toyota, FedEx Freight, and Harrah’s and Caesar’s Palace.
4. Consider paying out-of-pocket for the surgery part. It is a lot cheaper than you think.

If you are suffering from obesity and tired of yo-yo dieting and drugs and fads, it’s of the utmost importance that you seek the most effective and progressive treatment options available to you. At University Bariatrics we consider all the options during your consultation, and help create a customized weight loss plan to help you along your journey to a healthier life. Call us or visit us on the web to attend a free bariatric surgery seminar and set up your personal private consultation.

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How are you cooking?

 

There are a lot of little pitfalls in cooking that can hinder your weight loss. Thankfully, there are also a lot of little ways to change your cooking to be healthier and with fewer calories.

Go easy on the nonstick spray.
While it may be a lower-calorie alternative to butter, that doesn’t mean anything if you use too much of it. A lot of people will spray for as much as six seconds! So, what’s the fix? A nonstick pan for cooking and parchment paper for baking can go a long way, and for some dishes like sautéed vegetables you can skip the spray entirely and use chicken broth instead.

Steam your vegetables in the microwave.
The longer vegetables cook the more nutrients they lose. Microwaving cooks them in less time and doesn’t require any extra fats or oils!

Speaking of veggies, cut them bigger!
If you are going to cook your vegetables in oil, you’re going to want them at least a half inch thick. The bigger they are, the less oil you’re eating per vegetable.

Don’t ditch the peel.
A lot of food’s fiber and nutrients, like in apples and potatoes, is found in the skin. Fiber helps you feel fuller, so without these you might not be as satisfied as you could be.

And make sure to wash the peel!
The more pollutants in the body, the slower your metabolism, says a study published by the International Journal of Obesity. Most fresh produce will have some residue of pesticides on it, so be sure to give a thorough (approximately 30 seconds) wash to produce before you cook or eat it.

You can also leave on the chicken skin.
While you still need to take the skin off before you eat your chicken, leaving the skin on while you cook can keep the meat moist and tender, eliminating the need for calorie-laden sauces or mayonnaise. This doesn’t apply, however, if you’re making a soup or casserole.

Also, use a rack when cooking meat.
You don’t want what you’re cooking to sit in its own liquid fat, put a cooking rack in the bottom of the pan to elevate it. You can keep the meat moist by adding some lower-fat liquids like lemon juice or broth.

Finally, lay off the hot sauce.
A single tablespoon of many hot sauce brands can be almost 10% of your daily sodium intake. The more sodium, the more your body makes insulin and the more your body turns sugar to fat. If you like the heat, an easy substitute is cayenne peppers or red pepper flakes.

Cooking is important, but so are the foods. Here at University Bariatrics we’re here to help you with registered dietitians as well as only the safest and most effective bariatric surgeries.

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Weight Loss Supplements Could Contain Illegal Substances

Dietary supplements, unlike prescription drugs, are not regulated by the Food and Drug
Administration (FDA). Supplements don’t have to run tests for safety, that what they contain
matches their label or that they work as intended. A recent study from the Regis University of
Denver revealed some of the dangers of dietary supplements by sampling products from at least one of every vitamin selling retail chain within 10 miles of their campus. They focused on
weight loss supplements, and found that 51 different products contained substances either regarded as dangerous or outright banned by the FDA. Two of the banned ingredients, ephedra and DMAA, have caused complications such as:

 
-Over 800 reports of serious toxicity
-Heart Damage
-Liver Damage
-Neurological damage
-Heart attack
-Stroke
-Death

Ephedra sales are banned at military bases due to the deaths of over two dozen soldiers taking
ephedra. The substance is also banned by the Olympic Committee, NFL and NCAA. Despite not
being banned by major league baseball, ephedra is a suspected cause of death for 23-year-old
pitcher Steve Bechler. Coroner in Steve Bechler’s death, Dr. Joshua Pepper, condemned the
drug, saying no athlete should take it.

At University Bariatrics we use only the safest, most effective weight loss methods. Come in
today for a no-risk consultation for the tools providing the best long term weight loss results.

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