Obesity and Thyroid Function

leonor-corsino-md-face-mhsBy: Leonor Corsino, MD, FACE, MHS, Endocrinologist, Duke Center for Metabolic and Weight Loss Surgery

January is Thyroid Awareness Month. The thyroid is an endocrine gland, located at the base of the neck, responsible for producing thyroid hormones. Thyroid hormones regulate the body’s energy use as well as the function of the brain, heart, muscles and other organs to make sure they are properly functioning.

Research has shown individuals suffering with obesity are potentially at an increased risk for developing autoimmune thyroid disease as well as thyroid cancer. On the other hand, thyroid malfunction is usually cited as a potential cause of obesity, but this remains very controversial.

A research study looked at weight loss surgery and its effect on thyroid function for individuals with morbid obesity. Results found that in a small group of patients treated with a thyroid hormone before surgery, 43.5% had improvement with hypothyroidism (underactive thyroid) after surgery. If you are obese and have a thyroid problem, talk to your doctor to see if weight loss surgery is right for you.

For more information about weight loss surgery at Duke, attend a free seminar. Register at www.DukeWLS.org.

Raftopoulos Y, et al. Improvement of hypothyroidism after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Obes Surg. 2004 Apr;14(4):509-13.

Padwal R. et al. A systematic review of drug absorption following bariatric surgery and its theoretical implications. Obes Rev. 2010 Jan;11(1):41-50


Weight Loss Surgery & Diabetes

Weight loss surgery is proven to be more effective than medical therapy alone when it comes to treating diabetes in morbidly obese individuals.

In a study of morbidly obese individuals with diabetes, researchers compared intensive medical therapy alone versus bariatric surgery to see which treatment had the greatest impact on diabetes. Over a three-year period, patients who received bariatric surgery enjoyed significantly better outcomes versus those who received intensive medical therapy. In fact, most patients who received medical therapy alone had worse hemoglobin A1c levels (a marker of long-term blood sugar control) and required higher doses of medications as the study progressed, while a number of surgery patients were able to stop taking diabetes medications within days of the operation.

To find out more about the most effective treatment for your diabetes, or to learn more about weight loss surgery, the Duke Center for Metabolic and Weight Loss Surgery invites you to attend a free seminar. Visit dukewls.org to register for an upcoming seminar.

(*Schauer, et al. Bariatric surgery versus intensive medical therapy for diabetes: 3-year outcomes. NEJM 2014)

A New Outlook on Life


Mechi Holt before weight loss surgery.

Mechi Holt of Creedmoor was overweight most of her life. “I was always a little heavier than the other kids,” said Holt of her childhood. She was a size 14 by age 16, and from there she says her weight escalated.

At age 20, Holt became pregnant. After giving birth, she was motivated to lose weight. “I worked really hard to get that weight off, and it would not budge.”

Holt tried losing weight many times through diet and exercise; however, nothing seemed to keep the weight off and she became frustrated. “I was depressed about my weight and about not being able to get it off,” she said. After several years of research, Holt decided to try weight loss surgery. She visited the Duke Center for Metabolic and Weight Loss Surgery and, under the care of Dr. Dana Portenier, Holt made the decision to have a Roux-en-Y Gastric Bypass.


Mechi Holt lost over 100 pounds after weight loss surgery.

Since the surgery at Duke Regional Hospital, she has lost more than 100 pounds. Holt also no longer deals with depression, hypertension or the fear of developing diabetes.

She credits the Duke Weight Loss Surgery staff with helping her have a successful surgery. Participating in the weight loss surgery support groups was helpful to Holt both before and after surgery. She enjoyed meeting others going through the same journey. “We are like a mini-family,” she says.

Nutrition counseling helped Holt understand meal planning and portion control. “You can’t have weight loss surgery and then continue the same eating habits,” she says. One of those changes includes baked chicken instead of fried.

Since having weight loss surgery, Holt’s life has changed. Together, Holt and her family enjoy hiking, camping, swimming and visiting theme parks. “I wasn’t able to join those activities when I was at my heaviest. We love theme parks, but I could never get on the rides. The safety bar wouldn’t come down over me. Now I can go on any ride and have fun.”

Holt enjoys offering advice and encouraging words to others going through this life-changing journey. “This is not a lose-weight-quick scheme, it is a total life change. If you do not get that in the very beginning, you will not have a successful surgery. I’m kicking myself for not doing the surgery sooner. It is the best thing I’ve ever done in my life.”

Is the Lap-Band System the right fit for you?

For some people, a healthy diet and rigorous exercise isn’t enough for dramatic weight loss. The Duke Center for Metabolic and Weight Loss Surgery specializes in weight-loss surgery options to fit people in all stages of obesity.

The Lap-Band System may be the right fit for you if:

  • You want to lose as little as 30 pounds.
  • You have a BMI of at least 30 with one or more co-morbidities, or you have a BMI of at least 40.
  • You have not had success with traditional weight-loss attempts through diet and exercise.
  • You are not currently suffering from another disease that may be related to your excess weight.
  • You are prepared to make a healthy lifestyle change.
  • You are at least 18 years old.
  • You do not drink alcohol in excess.

How does it work?
The Lap-Band System is placed around the stomach reducing the amount of food you take in. This allows you to feel full faster and for a longer period of time. This procedure is performed with minimally invasive surgical techniques, which lead to less pain, minimal scarring and a quicker recovery.

Weight loss is gradual, but patients experience significant reduction in obesity-related complications including heart disease, type 2 diabetes, sleep apnea and joint pain. Patients typically lose about 30-40 percent of excess weight one to five years following surgery. The exact amount of weight you lose will depend on your compliance with the dietary instructions and your tolerance to adjustments to the tightness of the band.

Learn more about the Lap-Band System at a free seminar. Click here to register.

Enjoy Fall Fruits and Veggies


Elizabeth Villalta, MS, RD, LDN

Registered dietician Elizabeth Villalta of the Duke Center for Metabolic and Weight Loss Surgery shares ways you can incorporate fall’s finest fruits and vegetables into your meals.

As we head into fall, there is no need to decrease our produce intake. We should (and can) continue to eat a variety of fresh fruits and vegetables. Fall is a great time for squash, cranberries, ginger, mushrooms, passion fruit, sweet potatoes, turnips and more. Below are a few ways you can enjoy fall produce.

Acorn Squash
Acorn squash can be added as a side dish or sauce, or steal the show as the main entrée! If you’re tired of the same old spaghetti dinner, try cooking thinly sliced acorn squash just like you would spaghetti. Acorn squash is fat free, cholesterol free, sodium free and a good source of vitamin C. One-half cup of acorn squash contains just seven grams of carbohydrates, where one-half cup of spaghetti contains 21 grams. Click here for more ways to enjoy acorn squash.

Cranberry is another fall classic that is low in fat and sodium and a good source of vitamin C and fiber. While this fruit is often thought of with a big turkey dinner, cranberries can be added to breakfast cereal, trail mix and even dessert. For more ideas on adding cranberry into your diet click here.

It isn’t just for carving! Pumpkin can be incorporated into everything from soup and salad to muffins and dessert. Are you looking to try a new smoothie recipe? Try adding pumpkin into your shake! Pumpkin seeds are also a fun seasonal treat and a good source of protein. Click here for 10 great ways to add pumpkin into your fall diet.

Duke Weight Loss Surgery Virtual Tour

For many people suffering from obesity, diet and exercise are not enough. Weight loss surgery, also known as bariatric surgery, has proved to be an effective option.

Duke offers an individually tailored approach to bariatric surgery. Nearly 99 percent of our bariatric surgeries are completed using minimally invasive surgical techniques, meaning they require only small incisions. Smaller incisions can translate to less pain, fewer complications, smaller scars, and a faster recovery time.

Duke’s in-house bariatric team is comprised of six fellowship-trained surgeons, a physician assistant, a clinical psychologist, registered dieticians, an endocrinologist, nurses, and other dedicated support staff.

Our program is designated a Center of Excellence and Center of Distinction by the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP), Blue Cross Blue Shield, Optum Health, and Cigna. Only centers that meet strict criteria including high quality care and positive patient outcomes receive this designation.

Take a virtual tour of our clinic:


Duke Minimally Invasive General Surgery and the Duke Center for Metabolic and Weight Loss Surgery is located at 407 Crutchfield Street in Durham. Our clinic provides free parking and is easily accessible.

Our waiting room features bariatric chairs and restrooms to accommodate our patients.

Our waiting room features bariatric chairs and restrooms to accommodate our patients.

Our exam rooms are bright and open. We take pride in ensuring our patients have a comfortable and inviting experience during their visit.

Our exam rooms are bright and open. We take pride in ensuring our patients have a comfortable and inviting experience during their visit.

Seminars are led by a surgeon. Feel free to ask questions during the seminar or at the end. To register for a seminar, click here or watch the online seminar.

Seminars are led by a surgeon. Feel free to ask questions during the seminar or at the end.

To register for a seminar, click here or watch the online seminar.

Meet the Weight Loss Surgery Fellows

Fellows are physicians who are completing additional training in a specific type of medicine that they intend to practice once the fellowship is completed. Duke Minimally Invasive and Bariatric Surgery fellows are very involved in the care of our weight loss surgery patients while they are in the hospital and during follow-up visits in the clinic.

2014-2105 WLS Fellows2

Pictured from left to right: Keri Seymour, Jegan Gopal and Caroline Reinke.

Meet the 2014-2015 fellows:

Jegan Gopal, MD
Medical school: Washington University School of Medicine
General Surgery residency: Penn State Milton S. Hershey Medical Center

Dr. Gopal was born in Sri Lanka and raised in California. “My grandfather first inspired me to get into medicine,” says Dr. Gopal. “Once getting into medical school and residency, my focus became minimally invasive surgery and bariatric surgery, mostly because of how much of a difference bariatric surgeons make in the lives of their patients. The change is very dramatic for patients.”

In his free time he enjoys playing basketball and tennis and watching movies.

Caroline Reinke, MD
Medical school: Duke University School of Medicine
General Surgery residency: Hospital of the University of Pennsylvania

Dr. Reinke was born in eastern North Carolina and raised in western North Carolina. “I’m excited to be back in North Carolina, and back in Duke University Health System, which I think is one of the best,” says Dr. Reinke. Dr. Reinke first became interested in surgery as a medical student on her surgery rotation. “I did not think I was going to like it, but I really liked working with my hands. I also really liked the ability to make a significant improvement in a short time-frame and see the results of my work.” As for her interest in bariatric surgery, she says, “I’ve had friends who have been helped by the procedure, and I think it is something you can do that can make a dramatic difference in a patient’s life.”

In her free time she enjoys playing with her son, gardening, and being outdoors.

Keri Seymour, DO
Medical school: Midwestern University
General Surgery residency: SUNY-Syracuse/Upstate Medical Center

Dr. Seymour is from upstate New York and is excited to learn more about the south. She decided to pursue a career in surgery because “Surgery is challenging and patients tend to get better after your care.” She also enjoys anatomy and working with her hands.

In her free time, she enjoys playing sports. She skied for a few years while living in Colorado and enjoyed running while in medical school and during her residency.