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Weight Loss Surgery for Teenagers And Adolescents

Weight Loss Surgery for Teenagers And Adolescents

It is no secret that obesity is an epidemic in the United States. More than 93 million Americans—that’s nearly 40 percent—were overweight or obese in 2015 and 2016, according to the Centers for Disease Control and Prevention.

And, if you think children and teens are immune to obesity, think again. One in five teens between the ages of 12 and 19 are obese.

Obesity is the top cause of preventable death, resulting in more life-years lost than even smoking. It increases the risks of a host of diseases—some deadly—including:

  • Heart disease
  • Diabetes
  • Obstructive sleep apnea
  • Some cancers
  • Osteoarthritis
  • Fatty liver disease
  • Kidney disease

…and more.

If you are overweight or obese, it is never too late to start getting healthy…or too early.

Bariatric Surgery for Teens and Adolescents

There are multiple guidelines for bariatric surgery in teens and adolescents. Patient selection is one of the most important parts, and most teens must meet fairly rigorous criteria to be considered for bariatric surgery. Some of these include:

  • A high body mass index (BMI) of 40 or more
  • Fully grown or nearly so
  • Failed at least six months of conservative weight loss attempts
  • Pass a psychological screen
  • Have an obesity-related condition such as type 2 diabetes, hypertension or obstructive sleep apnea

The US Preventive Services Task Force recommends screening for obesity in children and adolescents.

In 2018 American Society for Metabolic and Bariatric Surgery published guidelines in pediatric weight loss surgery and concluded that metabolic and bariatric surgery is a proven, effective treatment for severe obesity disease in teenagers and adolescents and should be considered standard of care.

Pediatricians and primary care providers should recognize that children with severe obesity should be referred to a center with advanced treatments and support as soon as possible.

Healthy Weight for Teens

Bariatric surgery is the most effective method for long-term weight loss, but there are many other tactics people can use to lose weight if they do not want or do not qualify for weight loss surgery. Candidates for bariatric surgery must generally meet one of the following requirements:

  • A BMI of 40 or more
  • A BMI of 35 or more, plus an obesity-related health condition such as high cholesterol, high blood pressure, type 2 diabetes or obstructive sleep apnea

BMI is a ratio of height to weight. Use the BMI calculator on our home page to determine yours. Calculating BMI is different for children and teenagers, but teenagers with a BMI greater than 30 are likely obese.

Teens who want to lose weight or maintain a healthy weight should start in much the same way as adults: getting plenty of activity and moderating food intake. The CDC recommends a minimum of 150 minutes of moderate exercise per week. A food diary or app such as MyFitnessPal can help teens estimate and limit the number of calories they consume every day.

If you or a loved one wants to lose weight and may be a candidate for bariatric surgery, request an appointment at Advanced Laparoscopic Associates today.

Can Exercise Cut the Risk of Dementia?

Can Exercise Cut the Risk of Dementia?

Humans were made to move. Exercise is so good for the body that the Centers for Disease Control and Prevention (CDC) recommends everyone get 150 minutes per week of moderate exercise. Regular exercise reduces the risk of a long list of diseases and risk factors, including:

  • Diabetes
  • Obesity
  • High blood pressure
  • High cholesterol
  • Stroke
  • Certain cancers

…and even death from any cause. And, Alzheimer’s disease may soon be added to that list.

What Is Alzheimer’s Disease?

Alzheimer’s disease, the sixth-leading cause of death in the United States, is the most common and best-known form of dementia. Dementia is an umbrella term for a number of diseases that cause degeneration of mental processes that can result in wholesale memory loss, drastic personality changes and a breakdown in cognition.

Much remains unknown about how and why Alzheimer’s takes hold and progresses, but prevailing theories revolve around abnormal brain structures known as amyloid-beta plaques and tau tangles. Plaques are protein snippets that build up between brain cells (neurons), whereas tangles are misfolded proteins that form within the neurons themselves.

A healthy brain clears these structures on a regular basis. A brain with Alzheimer’s cannot do so, and plaques and tangles accumulate. It is thought that plaques and tangles contribute to the destruction of neurons over time.

Brains with Alzheimers have abnormal protein structures

Alzheimer’s is both progressive and incurable. Symptoms start subtly and progress slowly. Some memory loss is a natural part of aging. It crosses into the territory of mild cognitive impairment (MCI)—a precursor to dementia—when it begins to affect daily life. On average, people with Alzheimer’s disease live between 3 and 11 years after diagnosis.

Exercise and Alzheimer’s: How It May Help

Exercise is good not just for the lungs, heart and other muscles, but evidence is mounting that exercise may have both a protective effect against Alzheimer’s and may mitigate its effects.

A 2017 review in The Lancet examined a number of studies on the benefits of exercise for people with mild-to-moderate dementia. While it found few well-designed studies on exercise and Alzheimer’s, most of the studies included in the review showed improvements in cognition for those who exercised compared to control groups. According to one of the studies, higher intensity exercise (greater than 70 percent of the maximum heart rate) produced stronger results.

The authors stated that, “Exercise programmes [sic] for people with mild-to-moderate dementia are feasible and well-tolerated, and exercise offers positive small effects on function for people with dementia, but whether it helps cognition is unclear.”

More recently, a study published in JAMA Neurology in July 2019 looked at data from more than 180 people. The results suggest that higher levels of physical activity are associated with slower amyloid beta-related cognitive decline, as well as a slower rate of brain matter loss. Additionally, it suggests that healthier blood vessels—one of the benefits of regular exercise—was also associated with slower cognitive decline.

Finally, an ongoing clinical trial called the EXERT study is attempting to quantify the effects of exercise on the prevention of Alzheimer’s disease. Participants are adults aged 65 to 89 who are physically inactive and showing signs of MCI. The goal of the study is to see if exercise can slow the progression of cognitive decline.

Obesity has recently passed smoking as the top preventable cause of life-years lost. If you are committed to getting to a healthy body mass index, request an appointment with Advanced Laparoscopic Associates. We can determine if you qualify for weight loss surgery, as well as help you decide which procedure is right for you.

The Gastric Sleeve Diet: How to Eat Before and After Your Gastric Sleeve Surgery

The Gastric Sleeve Diet: How to Eat Before and After Your Gastric Sleeve Surgery

Bariatric surgery is the most proven way to lose weight and keep it off long-term, but it’s only the beginning. A surgery like the gastric sleeve—the most popular weight loss surgery in the United States—requires a fundamental lifestyle shift, including how you eat.

Getting weight loss surgery is a big change, but that doesn’t mean it has to be difficult. At Advanced Laparoscopic Associates, we specialize in setting our patients up for success. That’s why we’ve put together this gastric sleeve diet guide. By following a sensible diet before and after gastric sleeve surgery, you won’t have to let your weight or your health hold you back from the life you deserve.

The Importance of Nutrition for Gastric Sleeve Surgery

The gastric sleeve procedure (also known as vertical gastric sleeve and sleeve gastrectomy) is a restrictive weight loss procedure. It works by removing approximately 80 percent of the stomach, leaving it roughly the size and shape of a banana.

A smaller stomach can hold less food, but what makes the sleeve gastrectomy different from another procedure, such as a gastric bypass or gastric band, is what gets removed during a sleeve gastrectomy. The true benefit to a gastric sleeve is the removal of cells that produce a hormone called ghrelin.

One of the roles of ghrelin, sometimes known as the hunger hormone, is signaling to your brain that your stomach is empty. In addition to causing feelings of hunger, it also promotes fat storage.

Losing ghrelin can make sticking to a diet easier, but because you’ll very likely be eating less, eating the right foods become all the more important. A small 2011 study found that up to 48 percent in the study were at risk for certain vitamin imbalances. Deficiencies included:

  • Anemia
  • Folic acid
  • Vitamin B12
  • Vitamin D

Getting and staying healthy, both before and after gastric sleeve surgery, means eating right. We’ll show you how.

Gastric Sleeve Pre-op Diet

Your pre-surgery weight and body mass index (BMI) may influence your gastric sleeve’s success, according to a 2015 study published in Bariatric Surgical Practice and Patient Care. Researchers found that patients who had a BMI of less than 50 had kept more excess weight off at one year after a gastric sleeve procedure.

If you are obese, you should focus on losing as much as you can before you get to the operating room. Weight loss is a simple—though not easy—equation of calories in, calories out: If you burn more calories than you consume, you’ll lose weight. That usually means a combination of diet to reduce the number of calories you consume and exercise to increase the number of calories you burn. At Advanced Laparoscopic Associates, we have a team of nutritionists who can make sure your weight loss efforts are safe and effective.

Post-op Diet Phases

It can be helpful to think of a post-gastric sleeve diet in stages or phases based on the amount of time that has passed since the surgery. Although the number of stages differs from source to source, a good rule of thumb is four phases, lasting from immediately after the surgery until about a month later.

Phase One Diet

Phase one diet will begin in the hospital and last for approximately a week. It is a clear liquid diet plan that takes into account the possible effects of anesthesia and the discomfort that’s possible after abdominal surgery.

A clear liquid diet can include:

  • Broth
  • Decaf tea or coffee
  • Jello
  • Sugar-free popsicles

Alcohol, caffeine and excessive sugar should be avoided, as should any food that requires chewing.

Phase Two Diet

Most people are not hungry immediately after gastric sleeve surgery. When they do become hungry—about a week after surgery for most people—phase two begins. Phase two consists mostly of liquids with some very soft foods as well.

Protein is extremely important to the healing process. People in phase two should aim for between 60 and 80 grams of protein per day.

Foods to eat in phase two include:

  • Protein shakes
  • Thin soups
  • Soft noodles in soup
  • Diluted juice
  • Applesauce
  • Greek yogurt
  • Mashed potatoes
  • Pureed chicken or tuna
  • Baby food
  • Thin oatmeal
  • Fat-free, sugar-free ice cream or frozen yogurt

Phase Three Diet

Phase three begins the transition to solid foods. All foods from phases one and two are safe to eat. Protein continues to be important, so keep drinking your protein shakes.

New additions include:

  • Eggs
  • Soft vegetables
  • Heartier soups
  • Cheese
  • Soft fish
  • Deli meat

Phase Four Diet

Four to six weeks after surgery, most patients are ready to return to their (new) normal eating patterns. Solid food is safe by now, but to achieve the success you want from your gastric sleeve surgery, you should avoid:

  • White bread
  • Fried food
  • Soda
  • Sweets
  • Processed food
  • High-fat, -sugar and -calorie foods

Eat Right for Results

The four-phase gastric sleeve diet will have you well on your way to meeting your goals. It takes discipline and commitment, but you don’t have to do it alone.

Advanced Laparoscopic Associates surgeons are pioneers in the field of laparoscopic weight loss surgery. We will be by your side every step of the way, from initial consultation to recovery and beyond. Our team of clinicians and nutritionists are always available to answer questions and make sure your weight loss is effective, safe and sustainable. Request an appointment today.

Dr. Schmidt Shares Expertise at GERD Symposium

Dr. Schmidt Shares Expertise at GERD Symposium

Advanced Laparoscopic Associates congratulates our own Dr. Hans Schmidt for a job well done. Dr. Schmidt was an invited lecturer at the 2019 GERD Symposium, which took place on June 9 at Hackensack University Medical Center in Hackensack, NJ.

Dr. Schmidt is an acknowledged expert on the surgical management of gastroesophageal reflux disease (GERD). At the symposium, he spoke to a large group of medical professionals about current surgical treatment options for the condition.

The annual symposium focuses on diagnostic and treatment protocols for GERD. Of special emphasis was minimally invasive surgical management, which Dr. Schmidt and Advanced Laparoscopic Associates specialize in.

GERD affects millions of people each year, leading to a lower quality of life and raising the risk of esophageal cancer. Advanced Laparoscopic Associates is one of the only practices in New Jersey that performs the LINX procedure, a safe option for the management for GERD.

If you are experiencing GERD and have tried more conservative treatment measures without success, request an appointment at Advanced Laparoscopic Associates to see if surgical management is right for you.

Body Shape: Why it Matters

Body Shape: Why it Matters

A July 2019 study has put a spin on the finding that body shape matters—despite one’s overall body size. We know that a pear-shaped body is better than an apple-shaped body in terms of health risks. That’s because the fat in the abdominal area (the apple shape) is mostly visceral fat, the most dangerous kind. And while it’s customarily been the case that this is true of only overweight people, the study contends that it doesn’t matter if you’re overweight or normal weight: Carrying fat around the middle is a significant mortality risk.

The study, detailed in the July 24, 2019 issue of the JAMA Network Open, included 156,624 postmenopausal U.S. women who are enrolled in the famed Women’s Health Initiative study. The authors state that while current public health guidelines for obesity focus on body mass index (BMI, which is determined by weight-to-height ratio), those guidelines do not sufficiently stress what is termed as central obesity, which is measured by waist circumference and reflected in the apple-shaped body.

Central (waist) obesity was highlighted in a 2010 JAMA Internal Medicine study of almost 105,000 people, which found that both men and women with bigger waistlines (apple-shaped) were twice as likely to die as those with smaller waistlines (pear-shaped). Those with bigger waists also had a greater risk for type 2 diabetes, cholesterol problems and coronary heart disease.  The study pointed out that it is the body shape, i.e. where a person carries body fat, is what matters most when it comes to health.

The body size in the 2010 study included apple-shaped participants who had waistlines of more than 47 inches for men and 43 inches for women. Yet the new study findings show that even women of normal weight can carry the same health risks if they have central obesity. In fact, it found that those normal weight (as defined by BMI) post-menopausal women studied who had central obesity had a 30 percent increased risk of mortality over normal weight subjects without central obesity.

Types of Fat

Colors of fat

Although the term “body fat” is widely used, not all body fat is alike. There are several types, and each serves a physiological purpose. Fat is divided into various types and by its color shades. To simplify, there are three basic colors of body fat:

  • Brown: Brown fat is considered healthy, but is only present in small amounts in adults. It is mostly a feature of newborn babies. Brown fat helps keep us warm, so it is known as “fat-burning” fat.
  • White: White fat, on the other hand, comprises a majority of the body and increases with age. In excess amounts, white fat can be harmful for our bodies.
  • Beige: Beige fat is a combination: it is similar to brown fat in that it is energy-burning, but it has its own unique cell type and is embedded (mixed in) in white fat.

Essential fat

Essential fat is necessary for life and health. It is found in the heart, lungs, liver, brain, nerves, intestines, bone marrow, muscles and tissues of the central nervous system. It helps to regulate body temperature, hormones (fertility hormones in women) and cell structure. This is the type of fat you should not lose, as its loss compromises health.

Subcutaneous fat

Subcutaneous fat is fat stored under the skin and is a combination of brown, white and beige fat cells. This fat is partially energy-storing, it helps regulate body temperature, is padding to protect muscles and bones and is part of helping nerves and blood vessels to travel between skin and muscles.

However, too much subcutaneous fat can be accumulated due to genetics or lifestyle, such as overeating and being sedentary. Too much of this fat can lead to heart disease and stroke as well as high blood pressure, type 2 diabetes, kidney and liver disease and some cancers.

Visceral fat

Visceral fat, also known as “belly fat”, is sometimes also called “active fat” as it can actively increase the risk of various serious health conditions. Visceral fat is white fat, and it is located within the abdominal cavity and surrounds organs such as the heart, liver, pancreas and intestines.

Some belly fat is not necessarily visceral fat; it can be subcutaneous fat, the type of fat found in the arms and legs. But visceral fat increases the risk of heart disease and heart attacks, stroke, type 2 diabetes, and breast and colorectal cancer. It is also associated with an increased risk of Alzheimer’s disease. 


It is well-established that obesity is connected to a number of health risks. It is also well-established by significant research and the length of time it has been available that bariatric surgery is one of the safest and most effective ways to address obesity. This includes, in particular, the health risks related to obesity, which have been shown to dramatically decrease with the weight loss that occurs as a result of this surgery.

Explore bariatric surgery with one of our experts at Advanced Laparoscopic Associates by requesting an appointment today. We can determine if bariatric surgery is right for you and give you the options for the form of surgery most appropriate for you. We’ll care for you every step of the way, from consultation to postoperative follow-up and beyond.

ALA Surgeons Help Future Doctors Learn

ALA Surgeons Help Future Doctors Learn

At Advanced Laparoscopic Associates, we take our responsibilities for training the next generation of doctors seriously. Many of our clinicians hold prestigious teaching posts at area medical schools to ensure future colleagues are well-trained professionals. But just as important is fostering a love of medicine even earlier in prospective physicians’ academic careers. That’s why ALA surgeons Dr. Amit Trivedi and Dr. Sarah Wong hosted undergraduates in the Stewart Alexander internship program on July 24 and 25.

The Stewart Alexander internship program takes place at Pascack Valley Medical Center. Interns are undergraduate college students who shadow working doctors for six weeks in the summer. They are exposed to a variety of medical specialties, including:

  • Bariatric surgery
  • General surgery
  • Anesthesiology
  • Orthopedic surgery
  • Cardiology
  • Pediatrics

…and more.

On July 24, Dr. Trivedi and Dr. Wong exposed interns to one of the most fundamental skills in surgery: suturing. They set up a suturing lab at Pascack Valley Medical Center and oversaw interns practice suturing on pigs’ feet.

The next day, the interns got to see in action some of the most exciting medical technologies in current use with a full robot simulation lab. Pascack Valley Medical Center is one of only six hospitals in the United States to use the TransEnterix Senhance Surgical System. Students sat at the console and practiced controlling the robot to perform surgical skills.

Dr. Trivedi and Dr. Wong said it was a pleasure to work with the bright, enthusiastic young people in the Stewart Alexander internship program. ALA is proud to work with Pascack Valley Medical Center and the Stewart Alexander program.

If you are considering general or bariatric surgery, request an appointment at Advanced Laparoscopic Associates. With now five locations, we are the most comprehensive surgical practice in northern New Jersey and we can help you choose a path of treatment that is both effective and right for you and your life.

Is Honey Healthy? Health Benefits of Eating Honey

Is Honey Healthy? Health Benefits of Eating Honey

Sugar is sugar, right? Don’t be so sure. Packaging matters, and we’re not talking about 45-calorie packets from Starbucks. White sugar is so processed and refined that almost no nutritional value is left by the time it hits your tea or yogurt.

You have options, though. Forget the synthetic sugar substitutes. For the best nutritional bang for your buck, look to honey.

Watch Your Sugar

No one is saying an excess of sugar is good for you. In fact, overconsumption of sugar (especially added sugar, as opposed to sugar found naturally in foods) is one of the biggest public health risks of the 21st century. The average American consumes more than 150 pounds of sugar per year.

Too much sugar has been linked to:

  • Obesity
  • Type 2 diabetes
  • Heart disease

…and more.

It is important to cut sugar where you can. But, if you like things sweet, honey is one of the best choices available.

Types of Sugar

Gram for gram, all types of sugar have the same number of calories: 4 calories. That doesn’t mean all sugars are created equal, as we mentioned earlier. Honey’s main advantage here is its chemical structure.

Honey and white granulated sugar both contain glucose and fructose (two forms of sugar), but while white sugar has them both hooked together, in honey they are in separate molecular packets.

Glucose fuels cells. Insulin brings it into the cells where it is used for energy. When it is not immediately used, glucose is converted to glycogen and stored in the liver or muscles. Fructose, on the other hand, has to be converted into a useable form by the liver, and if it is not used immediately, it gets stored as cholesterol and triglycerides, both of which can be harmful to the heart in excess quantities.

Honey having both glucose and fructose present is a clear advantage over regular sugar.

Health Benefits of Honey

Honey is easier on the body than sugar, but the benefits don’t stop there. Because it is less processed, honey can often have more beneficial compounds taken from the plants from which it is made, which are called phytochemicals. Some types of honey can have more than 70 phytochemicals.

These phytochemicals, especially the ones known as antioxidants, may provide a range of benefits. Antioxidants such as polyphenols fight against free radicals, which cause a process called oxidation that destroys cells’ DNA.

Although definitive scientific evidence is hard to come by when discussing the medicinal effects of food, some studies have suggested that honey can cut the risk of certain dangerous diseases. A 2008 study in Scientific World Journal examined data from 55 obese or overweight people, some of whom took 70 grams of honey a day for 30 days.

The patients in the study who took honey saw a slight reduction in weight and body fat. They also had reductions of total cholesterol levels and LDL cholesterol levels (the “bad” kind of cholesterol), and an increase in HDL cholesterol (the “good” kind).

Another study, this one published in 2016 in Journal of Food Biochemistry, identifies a number of phytochemicals in honey that may protect against colon cancer, and concluded that honey may decrease colon cancer cells’ tendency to reproduce. A 2018 study in Food and Function suggests honey may induce cell death in colon cancer cells.

What Type of Honey Is Best?

You want your honey to be as minimally processed and as fresh as you can get it, and it doesn’t get any fresher than straight from the hive. Watch as our own Dr. Trivedi sets up his new beehive!

ALA Announces New Location in Wayne

ALA Announces New Location in Wayne

Advanced Laparoscopic Associates (ALA) is proud to announce that we are opening a new location in Wayne, NJ. We will begin seeing patients at the Wayne location in August 2019.

With offices in Paramus, Jersey City, Westwood, North Bergen and now Wayne, we now provide coverage for most of northern New Jersey.

Our new office’s address is:

246 Hamburg Turnpike

Suite 203

Wayne, NJ 07470

Adding a fifth location allows our patients to obtain the appointment they need at the time and location most convenient to them. Now patients all over New Jersey can schedule time with one of our surgical pioneers easier than ever.

ALA has been at the forefront of bariatric and general surgery since our founding. We offer procedures for weight loss and abdominal surgery that are both innovative and stand the test of time. If you are ready to take control of your health through weight loss surgery, or if you have a health condition that needs treatment, request an appointment at ALA today.

Advanced Laparoscopic Associates Sponsors Walk From Obesity Walkathon

Advanced Laparoscopic Associates Sponsors Walk From Obesity Walkathon

Advanced Laparoscopic Associates is proud to have sponsored the ASMBS Foundation’s Walk From Obesity event, held June 9 at Saddle River County Park in Saddle River, NJ. The event itself raised more than $9,000 for the ASMBS Foundation, and our ALA team was able to raise 205 percent of our goal, thanks to our generous donors and dedicated team members.

The ASMBS Foundation’s Walk From Obesity walkathon series is the only walkathon dedicated to raising awareness of the obesity epidemic currently affecting the United States. More than two-thirds of American adults are estimated to be overweight or obese, which can lead to dangerous health conditions such as:

  • Heart disease
  • Type 2 diabetes
  • Obstructive sleep apnea
  • Osteoarthritis

…and many more.

The ASMBS Foundation’s mission is to raise funds for obesity research and treatments, increase awareness of the dangers of obesity and improve access to care and treatment for obesity. ALA is dedicated to supporting this mission in any way we can, including participating in our local Walk From Obesity event.

The event took place in the beautiful 577-acre Saddle River County Park. Although the park’s path is an approximately 6-mile loop, the Walk From Obesity event was noncompetitive, meaning participants chose to walk as much or as little as they wanted.

ALA is proud of and grateful to all Walk From Obesity participants both for getting outside and getting healthy on a Sunday afternoon to provide awareness and raise funds for the ASMBS Foundation’s critical mission.

Dr. Trivedi Named 2019 Provider of the Year

Dr. Trivedi Named 2019 Provider of the Year

Please join Advanced Laparoscopic Associates in congratulating our own Dr. Amit Trivedi. Pascack Valley Medical Center named him 2019’s Provider of the Year during the facility’s National Hospital Week celebration on May 16.

Dr. Trivedi is chair of the Department of Surgery at Pascack Valley Medical Center. He has been instrumental in bringing the Senhance Robotic Surgical System to the medical center. Pascack Valley’s Senhance system—only the sixth in the United States—represents the future of laparoscopic and minimally invasive surgery.

This award, now in its third year, recognizes an outstanding physician who embodies all aspects of the hospital’s standards of performance and values. According to the medical center, Dr. Trivedi upholds its mission and vision every day and puts quality patient care as his top priority.

National Hospital Week is an opportunity for medical centers to recognize the outstanding staff—from physicians, nurses and other clinicians to administrators, operations staff and volunteers—who make a hospital run and change patients’ lives.

Advanced Laparoscopic Associates is proud to be represented by Dr. Trivedi and all of our dedicated clinical and administrative staff. Dr. Trivedi embodies our philosophies of patient-first care and relentless attention to the art and science of surgery.