Q: I've been taking oral diabetes medications for five years. I've never gotten my A1c below 9 percent, and I can't lose and keep weight off. The doctor says I have a couple of alternatives: Start taking insulin and become more conscientious about testing and nutrition, or consider a kind of gastric surgery called sleeve gastrectomy. Is one better than the other? — Lauren B., Birmingham, Ala.
A: It's never too late to make a difference in your blood-sugar readings, your weight and your future. But you'll need to get more physical activity, eat healthful foods, reduce stress and sleep seven to eight hours a night, no matter if you're taking insulin or opting for gastric surgery.
That said, new info from the stampede study, supported in part by the Cleveland Clinic, shows that gastric surgery is an effective way to control weight and blood sugar. Both Roux-en-Y gastric bypass and sleeve gastrectomy (in combination with Advanced Medical Therapy — diet, exercise and medication), promote substantial weight loss and can bring A1c levels to 7 percent or lower. They also help people get off insulin and other meds better than Advanced Medical Therapy alone.
People who had gastric bypass lost 24 percent of total body weight after three years; sleeve gastrectomy, 21 percent weight loss; medical therapy around 4 percent to 5 percent. And, three years in, 90 percent of surgical participants stopped using insulin and took far fewer cholesterol and high blood pressure meds.
But gastric surgery can have complications (infection and blood clots) and sometimes needs revision. And you'll need to make sure you're getting the right amount of vitamins and odd omegas. One other point: This study was done on people with a BMI of 27 or higher; most insurance covers surgery only for those with a BMI of 35 (30 plus if you have diabetes). So you and your doctor need to carefully consider what will work best for you.
Q: We limit the amount of time our kids (son 9, daughter 13) can watch TV, play games on the computer, interact with social media and use their phones to no more than two hours a day after homework. But we picked up two e-book readers. Should reading on those count as screen time? — Frank G., Alpine, New Jersey
A: Parents everywhere are trying to figure out how to manage their kids' use of digital devices. Most make location the issue: No texting at the table; no TVs in the bedroom. You're trying to enforce time limits; that's harder to keep track of or enforce. If your kids cooperate, great, but a recent survey found that children 8 to 18 spend around 7 1/2 hours a day with their faces glued to a screen of one kind or another. No wonder the recent national report card on kids and physical activity gave U.S. children Ds or Fs in every measure! Every excess hour spent staring at a screen means kids are not doing what they need to do to develop physically, mentally and socially.
So, what about time spent using e-readers? Well, the facts aren't all in yet. What is known: Some kids read more when they have a tablet. Reading on an e-reader as opposed to other digital environments seems better for focused learning; reading on a computer or phone provides too many distractions. And the e-reader screens don't have the flicker of a computer screen, so they may not cause eye strain if type size and screen illumination are set correctly. We bet e-book reading is a good habit to let your kids develop – just take the time to supervise what they read, make sure they stay active and don't let the device keep them from getting the full night's sleep they need.