Category Archives: WEIGHT LOSS

Bariatric surgery in children

Bariatric surgery in children- is it right?


There has been a huge explosion of bariatric surgery as a weight loss technique in the US. I have operated on many such patients as a board certified plastic surgeon. Cosmetic surgery for patients who have lost large amounts of weight include removal of excess skin from the abdomen (abdominoplasty), thigh (thigh lift)  and arms (arm lift). Weight loss patients also need to have breast lifts with or without breast enlargement with implants.

chubby kids

Here is a previous blog about this topic.

Whereas bariatric surgery for adults has proven safe and effective now there is a growing movement to perform weight loss surgery on children. In the US children as young as 14 are routinely patients for this type of surgery. In Saudi Arabia one bariatric surgeon has performed weight loss surgery on over 1500 children, the youngest being 3 years old!

Reasons for weight loss surgery

Being overweight causes significant medical problems for patients including,

  • Diabetes – over 50 %  of obese patients have Type 2 diabetes
  • Hypertension – and resulting heart disease
  • Sleep apnea – inability to sleep lying down causing breathing to stop
  • Joint pain – from carrying extra weight
  • inability to exercise
  • Cosmetic appearance suffering

These same medical problems occur for children in addition to social alienation specially due to lack of participation in sports and other activities.

Reasons not to have bariatric surgery

There are a number of possible complications to consider for patients who want to have weight loss surgery.

  • Infection- 2% rate
  • Leakage from intestines – 2% but with grave consequences
  • Bleeding – 10% rate
  • Malnutrition from mal-absorption of nutrients

amongst many other risks of surgery.

In children though the severe weight loss that occurs may cause problems with brain development and sexual maturation. Both these activities require sufficient energy and good nutrition.


The surgeons who perform weight loss surgery in children, argue that they must use all techniques available to improve the health of these children. it is true that many of these obese children are sick and will have remarkably shorter lives. Some may even gain notoriety in one of the many TV shows about the morbidly obese.

Plastic surgeons will also need to be on board with this idea. Sooner or later a parent of a child who has lost a large amount of weight and now has that weight hanging down will come forward and ask for a tummy tuck on a 10 year old or a thigh lift. Is that to be accepted medical practice?

Obesity in children occurs in 14% in developed countries and 9% in underdeveloped countries. Places like Saudi Arabia , Qatar and the gulf countries have rates of obesity much higher probably due to genetic factors also. The whole world is actually getting fat and our children are getting fat faster than is healthy for them.

Changes in nutrition, eating cultures, activity and parental ability to say NO to chubby youngsters will all be more important in years to come.



Psychology, Sports and Weight Gain

 Supporting a losing sports team makes you fat

I have written several posts in the past about our ever expanding knowledge of psychology,sports and weight gain. As a cosmetic plastic surgeon, weight loss is an important part of counseling my patients. Here are some of these posts to refresh your memory:

NFL teams photo



Weight loss, weight gain, obesity and misery—new research

A new study has shown that our intake of calories and saturated fat—and our weight gain—is linked to how well or how badly the sports teams we support are doing.

The study showed that if your team loses, the you will increase your intake of food calories and saturated (bad) fat the next day by at least 16 percent. If your sports team wins, you actually eat healthier foods and decrease your caloric and saturated fat intake by 9 percent.

If your team loses on Sunday, on Monday you are likely to go for a greasy burger and fries (weight gain); if your team wins, it looks like you will be eating salad (weight loss)!

Both male and female fans display same behavior.

The effect is greatest in cities where sports fans are known to be “sports crazy” like Philadelphia and Pittsburgh, with caloric intake increasing up to 25 percent over normal after a loss. That is almost the equivalent of eating another entire meal!

Past research has shown that there is an increase in heart attacks, car accidents and even domestic violence among supporters of losing teams.

These effects are amplified if you are one of those true and crazy supporters. If you refer to your team’s performance as “we lost” or “we won” rather than “they lost” or “they won,” the effects of your team’s playing on your eating habits will be greater.

Sports psychology affects eating habits

The explanation for these effects seem obvious now that we know about them. If your team loses, you feel miserable and make yourself feel better by partaking of comfort food. The researchers also point out that failure in life makes us look at the short-term results and take on a “to hell with it” attitude. The same thing happens if your lover leaves you—you might start binging on chocolate or alcohol!

On the other hand, a winning team or a success in life makes you look long-term at future possibilities.  Eating salad and staying healthy means you might be around to see even more victories and savor the exhilaration of your team winning the championship!


Fooling our brains

As you may have gathered from my previous weight loss posts, I am of the firm opinion that we have two distinct yet interdependent parts in our minds—the slow and the fast brain, or the ego and the id.

The ego is impulsive, like an impetuous child—fickle and unreasonable but imaginative and creative,  wanting satisfaction for all its needs (food, sex, material gain, etc.) now.

The id is compulsive, the deliberative, learned, docile, cautious and unimaginative part of your brain that will delay satisfaction of its needs for as long as necessary.

A healthy balance is best. Too much ego and you will flit away a sure-to-be short life in a fury of reckless sex, drugs, gluttony and unemployment.

Too much id and you are sure to become an insufferably boring, lonely, complicated and dull individual who will die before ever taking a vacation.


A sports team’s loss angers the ego, which demands satisfaction with at least a greasy meal. A win feeds the id in its “righteousness.”


All’s well as long as you know that you, as an individual, are being manipulated by your own brain . . .


Morad Tavallali, M.D., FACS

Gluttony—Why America is Fat

Americans may be guilty of gluttony

Even though this is a blog about cosmetic plastic surgery, I still feel that giving general health-related information is an important part of caring for my plastic surgery patients. Here are some posts about weight reduction:

We are all well aware of the problem of Americans and their increased weight. There is an epidemic of being overweight in this country, and though the rates for obesity have recently decreased in children after rising for many years, the rest of us remain… fat.

I was cleaning out my drawers the other day and came across some notes I had made from someplace regarding the sin of gluttony. Gluttony is one of the seven deadly sins in the Christian religion, but frankly the sins seem to cover most bad behavior by humans of any place and any religion and seem to have more to do with our morals as humans than with religion.

The seven “deadly sins” or “cardinal sins” were associated by Peter Binsfeld in 1589  with a particular “demon” who tempted the unsuspecting person to commit the vice.



Sin                            Demon

Gluttony                                      Beelzebub

Sloth                                             Belphegor

Greed                                            Mammon

Wrath                                            Gaap

Envy                                              Leviathan

Lust                                                Asmodeus

Pride                                              Lucifer



Thomas Aquinas, an early Christian philosopher, took the idea of gluttony a bit further than most of us conceive of it.  He actually divided gluttony into five different sections! thomasAquinas

  • Praepropere – eating too soon

Not giving yourself a schedule for eating. Giving way to eating as a psychological crutch to make yourself feel good. The midnight bowl of cereal I would eat in my forties falls into this sin category.

  • Laute – eating too expensively

Too much caviar, champagne and lobster I presume. But maybe also eating too “richly” as in too much fat or sugar. No cakes or creams should work against Laute.

  • Ardenter – eating too eagerly

I suppose this means vacuuming or wolfing the food down. Pacing yourself during a meal will allow your brain to catch up with your senses and you will actually eat less. It takes 20 minutes for the sensation of fullness to reach the brain from your stomach. Pace yourself.

  • Nimis – eating too much

Eating until you are bursting is obviously not a good idea, though we have all committed Nimi at some point in our lives. We should do less of it. Portion control is a key to healthy weight maintenance.

  • Studiose – eating too daintily or eating food that is too elaborately prepared

Frankly I see no harm in this sin as it sounds like good manners and fun. Aquinas may have been a bit of a ruffian. If it means being “picky” with your food, that is not good, as a healthy balanced diet does not leave too much room for being “dainty” in that sense. Also, if it means processed food (elaborately prepared), that is no good either!


Theologians elaborated that it is the eating of food for a sensation of pleasure that is the real vice and not so much the amount, type or preparation. Thus, you can commit a sin even just by eating bread and cheese if you enjoy it too much.

This is an important concept, since many diets are based on decreasing your psychological dependency and sense of pleasure in food, allowing you to eat less in that manner.


Following Thomas Aquinas’ diet tips may actually help Americans rid themselves of this vice, which leads to our national obesity problem.

Who could have known that the solution to a 21st-century condition was to be found among the sins and demons of the 13th century? Did you notice that if you look at the first letters of his five causes of gluttony they, spell out PLANS? That is what we all need at the table: PLANS for eating correctly.


Morad Tavallali, M.D., FACS

Cosmetic Surgery and Calories

How many calories are there in foods?


Those of you who follow this blog regularly may have noticed my interest in diets, weight loss and a crusade for nutrition literacy, i.e., knowing how many calories are in any food. Here are a few posts on weight loss and healthy eating.


Irrespective of your beliefs, or lack of them, regarding the importance of calories in dieting and weight loss, I have always maintained that most people know more about trigonometry than the caloric content of foods. Without the knowledge of how many calories there are in a handful of any particular food, we are doomed to getting fat through ignorance. Cosmetic surgery and calories have very close photo

Calories are a measure of the heat given off (energy) when food is burned.  If you are lying in bed in a room at a perfect temperature, the amount of calories you need to be kept alive and keep your organs working is about 1,000. This is called basic metabolic rate (BMR)The larger you are, the more calories you need and the higher your BMR and your daily caloric requirements.

Our bodies typically need about 2,000 calories a day to function at a normal level: working, a bit of exercise, walking around, etc. Manual workers or athletes will need closer to 3,000 calories, and diabetics (who must watch their weight) need about 1,800 calories.

Most diets try to limit your caloric intake to between 600 and 1,000 calories a day. For example, the new 5-2 Diet lets you have 600 calories per day for two days a week.

Why is this important to a cosmetic plastic surgeon? Well, apart from  a basic interest in my cosmetic patients’ health, it is important for them to be eating healthy diets before and after surgery.

A healthy diet before plastic surgery will ensure that the patient has adequate stores of protein, vitamins and the trace elements needed for the healing process and scar formation.  Vitamin C is essential to forming a scar—and to healing.

After surgery, the requirements for calories actually increase as our bodies heal and good sources of protein are essential to the process.

So how much is 200 calories?

The best thing I have seen to show you is this little video I am re-posting. Sometimes it is not necessary to re-invent the wheel, and these chaps have done a great job. So enjoy and learn so you can make healthy choices.

Caveat: the video also shows you many things you should not eat! Three Cinnabons a day will give you 2,000 calories but is not a good food choice! A varied diet rich in protein, vegetables and some fat but with less carbs (donuts and french fries) is best. See the posts at the beginning of this article for ideas.

Here is the video:


Morad Tavallali, M.D., FACS


Exercising Less May Be More Healthy

Less exercise may be better

We should all exercise!

Many cosmetic plastic surgery patients are looking for not only a new body shape but also a way to maintain that investment in their body. Healthy eating and some sort of exercise program are the basic steps that most cosmetic plastic surgeons will advise their patients to follow both before and after plastic surgery.

I have written about dieting and healthy eating in the past:


I have also written about exercise:

Recent research shows that how much exercise you do actually affects the amount of energy you use up (and the weight you lose), but in a counter-intuitive way! Here is the article from the New York Times on February 13, 2013:

Normally you would think that the more exercise you do, the more energy you burn. Yes… and no. It turns out that women who exercised six times a week actually burned fewer calories during the week than those who exercised four times a week or even two times a week! Exercising less is best!


Patients who exercise six times a week


Women who exercised heavily were so tired that they became lazy in their daily life. They took elevators instead of stairs, drove instead of walking small distances and generally were so exhausted that they just lay about at all other times, not using energy!

Patients who exercised four times a week lost an average of an extra 200 Kcal, and those who exercised twice a week even managed to lose 100 Kcal a week more than what they expended with exercising. The women exercising six times a week were actually spending 200 Kcal less energy than at the start of the experiment, even though they were working out like mad! At the end of the study, all groups were more fit than when they started.

It seems that exercise is just revving up the metabolism to allow the body to burn more calories on an ongoing basis, and too much exercise just slows down the whole process by sending the wrong signals to the body.

Exercising more may also increase your chances of injury—doing less may have that added benefit as well!

If you want to exercise six times a week, there is nothing wrong with that, as long as you continue to move around and do the activities of daily living and not get lazy!

But it’s obviously a lot more complicated than that. Though I do not doubt the study’s findings, I’ll keep to my mantra that exercise is an inefficient way to lose weight and moderation is best—not too much and not too little. Another recent exercise book suggests that the greatest benefit is in the first 20 minutes 4 times a week!

In fact, I’d like to see the weights and photos of the authors of the research and the New York Times article to see what they look like. This may all be a bit of a “chubby conspiracy,” don’t you think?

Morad Tavallali, M.D., FACS

How to Diet in 2016

Weight loss tips

It’s that time of the year again, when weight reduction resolutions and diets are in our minds. Here is a refresher on how to diet effectively to reduce weight. Here are some older posts on the topic:



Most active adults need about 2,000 calories a day derived from food and drink. That equates to roughly 20 handfuls of food, with each handful having about 100 calories worth of energy. Think of each handful as a serving of food.

The fewer calories you eat, the less fat you become, but you need a minimum of about 800 to 1200 calories a day to stay alive and prevent your protein (muscle) from breaking down!


Tips for losing weight

  1. Eat almost anything you want, but you must stay away from packaged food, sweets, chips, candy, cookies, etc.


Portion control

  1.  When you eat out, only finish half of your plate. Most restaurants in the US overfeed you with portions large enough for two people. At home, eat off of a salad plate instead of a regular-sized plate.
  2.  At each meal, only have one helping of each type of food (protein, carbs, fats).  DO NOT go back for second helpings!
  3.  Each serving of carbs or protein should be about the size of your fist. You can eat more servings (handfuls) of veggies if you must.


Types of food

  1.  Limit your intake of or stop eating altogether fried food. Anything fried adds 100 calories to the food’s caloric value. Do you want two hard boiled eggs or one fried egg? Same caloric value!
  2.  Limit alcoholic drinks, as they quickly add up calories. One hundred calories per alcoholic drink! But watch out! Have a gin and tonic and add another 100 calories for the tonic! That makes it a 200-calorie drink.
  3.  Do not eat between meals.  If you must, snack on fruits and vegetables only. No bread or sweets (no carbs).
  4.  Drink at least eight glasses of water each day. If you must, drink sugar-free sodas, and only in moderation. Sodas have 100 calories by themselves.



  1.  As I have often written, exercise is a poor way to lose weight but a very necessary way to prevent gaining it!
  2.  Start yourself on a daily walking program:
  •  Start walking for 20 minutes.
  • After you feel that 20 minutes is easy, add 5 minutes.
  • Continue to do this until you get up to 40 minutes of walking a day. At this point, you will begin to burn fat.
  • If you don’t enjoy walking, choose another activity that will help you stay motivated (swimming, biking, aerobics, etc.).

As your eating habits get better and your exercise program progresses, you will begin to see results.  GOOD LUCK!

Morad Tavallali, M.D., FACS

Weight Loss Statistics Show US is Fat and Obese

Big fat numbers

Here is a cruel and unnecessary joke an English friend of mine sent me the other day:

“Michelangelo’s David has been on loan to America for two years. This is how it looks now. “

chubby david





Americans will soon reach from sea to shining sea. Each one of us, that is.

Check this out for a totally musical interlude about the United States and the sea-to-sea thing:

Weight loss statistics show US is Fat and Obese. The fact that men are chubbier than women on the whole and that they do not diet as much as women interested me as a cosmetic plastic surgeon, so I did some research on these differences. The U.S. Preventive Services Task Force came out with a recommendation recently that all people should be examined for obesity by having their body mass index (BMI) calculated during regular doctor visits.  Liposuction and other cosmetic surgery procedures that a plastic surgeon can perform are really for people of normal height and weight—not the obese. Weight Loss Statistics Show US is Fat and Obese.

First let us define a few terms we keep on hearing:


Body mass index, or BMI, is a number calculated using one’s height and weight.  It is a number between 10 and 50 . The normal BMI for an athlete is 17-20.  For an adult it should be less than 25.


Body mass index higher than 30.



Body mass index between 25 and 30.


Here is a BMI calculator you can use to determine your own BMI:


The BMI, however, is not such a great predictor of health.  There are many false positives. For example, a muscular man who is 5’7″ and weighs 200lbs has a BMI of 31 and would be classified as obese rather than a god! So it’s not the best measure, but it is better than just looking at weight.

The scary thing is that by 2030, over 40% of we Americans may be obese. That would make us easy targets for whoever wants to get us. Think of the geopolitical ramifications!


Women and diets

Here are some interesting statistics about US women and their diets.  As I have mentioned in other posts, I cannot find similar information about men.

  • Two thirds of women are trying to lose weight at any given time.
  • Half of dieters at a healthy weight are still trying to lose weight.
  • One third of women say concerns about weight make them unhappy.
  • One third of women regularly skip meals to lose weight.

This website at the CDC has a great map showing the increase in obesity in the US over the past 20 years:

In 2011, 35.7% of Americans were obese.  More women (35%) were obese than men (32%).  Obesity rates have doubled over the past 40 years.

64% of women and 72% of men are overweight.  These rates have gone up slightly over the past 40 years, but not nearly as much as the rates for obesity.

For more statistics, check out this NIH government site:

So, where was I?

Men are are more likely to be overweight than women but less likely to diet.
Men are less likely to be obese than women.
Black men are more likely to be obese if they are rich.
Black women are more likely to be obese if they are poor.
All are less likely to be obese if they are college grads, etc.

Conclusion: to lose weight, look at this post: or this one:

Write your weight in front of you before you eat.
Have pictures of thin people around you while you eat.


If you see people carrying harpoons, run for your life or at least wiggle around…

For more info on bmi calculations look here

What is a Healthy Body Mass Index