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BHATIA GLOBAL HOSPITAL & ENDOSURGERY INSTITUTE NEWSLETTER VOL: 11

NO: 10

PRICE: Rs. 4/- PER COPY

OCTOBER, 2011

God’s greatest invention: Death ‘Death is very likely the single best invention of life’ - Steve Jobs “Three apples changed the world. The first one seduced Eve, the second fell on Newton and the third was offered to the world half-bitten by Steve Jobs.” So true and so in keeping Steve Jobs 1955-2011 with the profile of the man who single-handedly changed the way the world works, reads and listens to music. In Stanford Commencement Speech 2005, Steve said, “When I was 17, I read a quote that went something like: “If you live each day as if it was your last, someday you’ll most certainly be right.” It made an impression on me, and since then, for the past 33 years, I have looked in the mirror every morning and asked myself: “If today were the last day of my life, would I want to do what I am about to do today?” And whenever the answer has been “No” for too many days in a row, I know I need to change something. Remembering that I’ll be dead soon is the most important tool I’ve ever encountered to help me make the big choices in life. Because almost everything — all external expectations, all pride, all fear of embarrassment or failure - these things just fall away in the face of death, leaving only what is truly important. Remembering that you are going to die is the best way I know to avoid the trap of thinking you have

something to lose. You are already naked. There is no reason not to follow your heart. No one wants to die. Even people who want to go to heaven don’t want to die to get there. And yet death is the destination we all share. No one has ever escaped it. And that is as it should be, because Death is very likely the single best invention of Life. Your time is limited, so don’t waste it living someone else’s life. Don’t let the noise of others’ opinions drown out your own inner voice. And most important, have the courage to follow your heart and intuition. They somehow already know what you truly want to become.” Statement from President Obama


“Michelle and I are saddened to learn of the passing of Steve Jobs. Steve was among the greatest of American innovators - brave enough to think differently, bold enough to believe he could change the world, and talented enough to do it.

By building one of the planet’s most successful companies from his garage, he exemplified the spirit of American ingenuity.

By making computers personal and putting the Internet in our pockets, he made the information revolution not only accessible, but intuitive and fun. And by turning his talents to storytelling, he has brought joy to millions of children and grownups alike. Steve was fond of saying that he lived every day like it was his last. Because he did, he transformed our lives, redefined entire industries, and achieved one of the rarest feats in human history: he changed the

way each of us sees the world.

The world has lost a visionary. And there may be no greater tribute to Steve’s success than the fact that much of the world learned of his passing on a device he invented. Michelle and I send our thoughts and prayers to Steve’s wife Laurene, his family, and all those who loved him.” “Death is no more than passing from one room into another. But there’s a difference for me, you know. Because in that other room I shall be able to see.” – Helen Keller The Game Changer

Steve Jobs knew people. He knew how to learn about them, their dislikes and habits. He also knew how to identify things that people wanted (before they knew themselves). And most importantly, he knew how to teach people what they wanted and (eventually) needed. I’ve watched Steve’s Stanford Commencement Address many times, and each time I come away with something new that I only hope to instill in my two young children some day. As I look at their faces and think about what challenges they will face in their worlds, I find comfort in three ideals: the hunger to learn, the courage to explore and the risk in trying - much like Steve wished for those graduates that sunny day in 2005. May God bless Steve, his family and his friends at Apple. – Lourdes from Philadelphia Amit Mattoo, Shubham Bhatia

“Life is either a daring adventure or nothing. Security is mostly a superstition. It does not exist in nature.” – Helen Keller EDITORIAL BOARD Mr. R. S. Bhatia, Dr. Parveen Bhatia, Dr. Indu Bhatia, Dr. Sandeep Chopra, Sanchit Bhatia, Shubham Bhatia


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Three-Pronged Attack on Obesity

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Three-Pronged Attack on Obesity Dr. Parveen Bhatia

Dr. Sandeep Chopra

MS, FRCS (Eng.), FICS, FIAGES (Hon.), FMAS, FIMSA, FAIS Chairman, Institute of Minimal Access, Metabolic & Bariatric Surgery (iMAS), Sir Ganga Ram Hospital & Medical Director, Consultant Laparoscopic & Bariatric Surgeon, Bhatia Global Hospital & Endosurgery Institute, Ambica Vihar, New Delhi. +919810008507, bhatiaglobal@gmail.com

MD Senior Consultant Anaesthetist Bhatia Global Hospital & Endosurgery Institute, Ambica Vihar, New Delhi +919811078354, suraj_anuj@yahoo.co.in

October 7, 2011 (Orlando, Florida) — Physicians who specialize in treating obesity are conceding that education to promote prevention and lifestyle improvements will not be sufficient to reverse the obesity epidemic. So at Obesity 2011, three experts staged a debate on the future roles of behavior modification, drugs, and surgery in treating obesity.

“We wouldn't be having this conversation around oncology or cardiology”

behavior therapy alone to treat obesity in the majority of patients. “Right now, when you require diet and exercise interventions for at least six months prior to using drugs or surgery, you know the patient is going fail most of the time,” she said. “You’re just waiting for failure so you can then give them an intervention that is going to work.”

variety of reasons, many physiological and otherwise, it’s a lot harder to do than to say.... The environment that we live in really does encourage a lot of the wrong things from a weight-control standpoint.” However, Intensive behavior-modification therapy “We really need a Manhattan Project for O’Neil pointed out that lifestyle modification “improves weight loss, but it’s not practical medical treatment in the field of obesity- complements the more expensive and perhaps on a long-term basis,” she said. Apovian -we need prevention, we need behavioral risky measures such as bariatric surgery or cited a 1988 randomized study that showed that although patients who stayed involved modification, we need more drugs, and pharmaceuticals. in weight-maintenance therapy after six we need to look at better indications for “This is not an either-or recommendation. bariatric surgery,” surgeon Dr John Morton The [National Heart Lung and Blood months of weight-loss therapy did not gain (Stanford University, CA) said. Because of Institute] very explicitly recommends that back as much as patients who had only six the negative social stigma attached to obesity, there be a foundation of diet, physical activity, months of weight-loss therapy, the patients there is still a lot of reticence among patients, and behavioral activity, or lifestyle changes, in the maintenance-therapy group also physicians, and the general public to support even though the patient may in addition be started to gain weight again after about a year obesity treatments other than diet and considered for drugs or surgery,” because [1]. She also pointed out that the Institute exercise. That must change if the problem behavioral therapy enhances the impact of Medicine’s guidelines on maintenance is going to be solved, Morton argued. “We of surgery or drugs. O’Neil cited studies of weight loss recommend 90 minutes of need to mainstream the treatment of obesity. of several drugs, including sibutramine exercise a day, which is just not practical for That’s really the big thing here. We wouldn’t (Meridia, Abbott Laboratories), showing most severely obese patients, she said. be having this conversation around oncology that although the drug can produce weight We’ve created a society where it’s easy or cardiology. It would just happen. Those loss in obese patients by itself, patients taking to gain weight.... How are we going to patients would get treated.” the drug while also undergoing behavioral- change it? Tear down all of the fast-food Exercise More, Eat Less?

modification therapy lose even more weight.

In the staged debate, Dr Patrick O’Neil Morton, who debated in favor of surgical (Medical University of South Carolina, and device interventions for obesity, said that Charleston) was tasked with defending the even surgical patients must be receptive to importance of behavioral modification in lifestyle change first. “You need to say that preventing and treating obesity. “We all this is a big deal, to change how you live, how accept that in order to lose weight and keep you work, how you eat, and how you sleep. it off it’s going to require changes in caloric And you’ve got to have those patients on changes, changes in eating and drinking board. I wouldn’t offer surgery to somebody habits, and changes in physical activity, who is not ready.” including exercise and general lifestyle Thinner Living Through Chemistry? activity,” he said. Dr Caroline Apovian (Boston University, He conceded that “we all know that for a MA) is pessimistic about the ability of

restaurants?

It’s very easy to eat 3000 calories a day or more, so why are we torturing people? Some people really can’t make lifestyle changes in this environment, and if we really think that obesity is a disease, let’s treat it like one.” "We've created a society where it's easy to gain weight, and we can't change it right now," Apovian said. "How are we going to change it? Tear down all of the fast-food restaurants?

Whatever you can do or dream you can begin it. Boldness has genius, power and magic in it. Begin it now.


Three-Pronged Attack on Obesity

Drugs intended to treat obesity are having a difficult time reaching the US market lately. The FDA recently declined to approve Contrave (Orexigen Therapeutics), a combination of naltrexone and bupropion HCL, despite the favorable vote by the FDA’s advisory panel. Lorcaserin (Arena Pharmaceuticals) and phentermine/ controlled-release topiramate (proposed name: Qnexa, Vivus) were not favored by the advisory panel.

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of more intensive therapy, they agreed. “Too many people who need help don’t get it,” Morton said that, for example, a very small he said. “What we really need is better access percentage of people who could benefit from to care and to try to make some of those weight-loss surgery are currently undergoing changes earlier rather than later and find out the procedure. what works and doesn’t work.”

Despite the recent setbacks, Apovian, who is involved with research on several obesity drugs, argued that pharmaceuticals will play an important role in the treatment of obesity in the near future and could eventually even supplant the surgical options, which “just aren’t appealing to most patients,” she said. “The majority of obese Americans need something in between diet and exercise and gastric bypass or the Lap-Band [Allergan],” she said. Current surgery and device-based techniques are designed to alter patient’s perceptions of satiety and appetite. Eventually, better understanding of endogenous signaling of appetite-regulating hormones and neurotransmitters will allow drug therapy to accomplish the same goal safely, she predicts.

Dec. 08, 2010  Weight : 135.7 kg  BMI : 44.8

July 18, 2011  Weight : 97 kg 

Jan. 28, 2010  Weight : 168.15 kg  BMI : 53

Feb. 07, 2011  Weight : 123.27 kg  BMI : 38.9

“But in the interim, as we develop drug combinations and new drugs for obesity, we will have devices that are safer and less aggressive than surgery, like the Lap-Band and the EndoBarrier endoluminal barrier [GI Dynamics], to bridge the gap until we figure out which drug combinations simulate what we see with surgery,” she said. “Right now, surgery is the only option we have for severe obesity.” Apovian cautioned that although drugs and surgery can kick-start the weight-loss process, ultimately the patient must change his or her lifestyle. “There are combinations of drugs or surgery to help the patients suddenly be able to make lifestyle changes,” she said. O’Neil, Morton, and Apovian support a staged approach to treating obesity. It is hoped that people headed toward severe obesity can be identified early and treated with lifestyle changes alone, but for the foreseeable future, there will be severely obese people in need

I cried because, I had no shoes till the time I met a man who had not feet.


Three-Pronged Attack on Obesity

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RNI NO.: DELENG/2001/6114 REGD. NO.: DL(W) 10/2076/2009-11 LICENSED TO POST WITHOUT PRE-PAYMENT: U(W)-38/2009-11 Posted on 21st / 22nd of every month

Jan. 29, 2011  Weight : 167.62 kg  BMI : 64

May 03, 2011  Weight : 111.45 kg  BMI : 50

Oct. 10, 2011  Weight : 113 kg  BMI : 43.05

Oct. 05, 2011  Weight : 83 kg  BMI : 36.88

Jan. 13, 2010 Weight : 146.50 kg  BMI : 45

Oct. 18, 2011 Weight : 75 kg BMI : 23.80

Jan. 18, 2011 Weight : 124.50 kg  BMI : 43

Oct. 19, 2011 Weight : 88 kg BMI : 30.44

Printed, Published and owned by Dr. Parveen Bhatia and printed at Hindustan Offset Press: A-26, Naraina Industrial Area, Phase-II, New Delhi-110028. Phone: 25705629 and published at Bhatia Global Hospital and Endosurgery Institute, 307 & 308, Ambica Vihar, New Delhi-110087. Ph:+91-11-2527 0500, 2527 0701, 0702; Fax: +91-11-2527 3200; Email: bhatiaglobal@gmail.com; Website: www.bhatiaglobalhospital.com; Editor: R.S. Bhatia


Global eNewsletter, October, 2011.