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Chicago — Among obese individuals, having bariatric surgery was associated with a reduced long-term incidence of cardiovascular deaths and events such as heart attack and stroke, according to a study in the January 4 issue of JAMA.

Most epidemiological studies have shown that obesity is associated with increased cardiovascular events and death. “Weight loss might protect against cardiovascular events, but solid evidence is lacking,” according to background information in the article.

Lars Sjostrom, M.D., Ph.D., of the University of Gothenburg, Sweden, and colleagues conducted a study to test the hypothesis that bariatric surgery is associated with a reduced incidence of cardiovascular events and examined the relationship between weight change and cardiovascular events. The study (Swedish Obese Subjects [SOS]) is an ongoing, nonrandomized, prospective, controlled study conducted at 25 public surgical departments and 480 primary health care centers in Sweden, and includes 2,010 obese participants who underwent bariatric surgery and 2,037 matched obese controls who received usual care.

Patients were recruited between September 1987 and January 2001. Date of analysis was December 31, 2009, with median (midpoint) follow-up of 14.7 years. Inclusion criteria were age 37 to 60 years and a body mass index of at least 34 in men and at least 38 in women. Surgery patients underwent gastric bypass (13.2 percent), banding (18.7 percent), or vertical banded gastroplasty (68.1 percent), and controls received usual care in the Swedish primary health care system. Physical and biochemical examinations and database cross-checks were undertaken at preplanned intervals. The average changes in body weight after 2, 10,15, and 20 years were -23 percent, -17 percent, -16 percent, and -18 percent in the surgery group and 0 percent, 1 percent, -1 percent, and -1 percent in the control group, respectively.

- Before and after bariatric surgery in Argentina

During follow-up, there were 49 cardiovascular deaths among the patients in the control group and 28 cardiovascular deaths among the patients in the surgery group. In total (fatal and nonfatal), there were 234 cardiovascular events among patients in the control group and 199 cardiovascular events among patients in the surgery group. After adjustment for a number of variables, bariatric surgery was associated with a reduced number of fatal cardiovascular deaths and a lower incidence of total cardiovascular events.

Bariatric surgery was associated with reduced number of fatal heart attack deaths (22 in the surgery group vs. 37 in the control group), with analysis indicating that bariatric surgery was related both to reduced fatal heart attack incidence and total heart attack incidence. Also, bariatric surgery was associated both with reduced number of fatal stroke events and total stroke events.

However, the researchers found no significant relationship between weight change and cardiovascular events in the surgery or control group. The authors suggest that the lack of association between weight loss and reduction of cardiovascular events could be related to inadequate statistical power to detect this relationship. “Alternatively, following relatively modest weight loss induced by bariatric surgery, there is no further risk reduction attributable to greater, subsequent weight loss. Our negative findings also emphasize the need to explore weight loss independent of effects of bariatric surgery.”

“In conclusion, this is the first prospective, controlled intervention to our knowledge reporting that bariatric surgery is associated with reduced incidence of cardiovascular deaths and cardiovascular events. These results– together with our previously reported associations between bariatric surgery and favorable outcomes regarding long-term changes of body weight, cardiovascular risk factors, quality of life, diabetes, cancer, and mortality– demonstrate that there are many benefits to bariatric surgery and that some of these benefits are independent of the degree of the surgically induced weight loss.”

Undergoing Bariatric Surgery Associated With Obese Family Members Adopting Healthier Lifestyles

Having an obese family member undergo gastric bypass surgery for weight loss appears to be associated with additional benefits of weight loss and improved healthy behaviors of obese family members, according to a report of Archives of Surgery, one of the JAMA/Archives journals.

One of the biggest risks for becoming an obese child is having an obese parent, and data show that childhood obesity is strongly associated with obesity in adulthood, according to background information in the article. “The obesity rate in children of mothers who have had Roux-en-Y gastric bypass is 52 percent lower after surgery compared with the obesity rate in children born to the same mothers before surgery,” the authors write. “If one member of the family makes drastic lifestyle changes following surgery, it is possible that other family members will adopt similar healthy habits.”

- Before and after bariatric surgery in Argentina

Gavitt A. Woodard, M.D., and colleagues from Stanford University School of Medicine, Stanford, Calif., observed the weight and lifestyle changes of patients who underwent Roux-en-Y gastric bypass surgery and their family members. The study was conducted between January 2007 and December 2009, and included 85 participants; 35 bariatric surgery patients, 35 adult family members and 15 children under 18 years of age. Obese adult family members were define as having a BMI greater than 30 and obese children were defined as having a BMI at the 95th percentile or higher, using the BMI for sex and age growth charts of the Centers for Disease Control and Prevention (CDC).

The weight loss in patients observed by the authors one year following surgery was typical for patients undergoing gastric bypass surgery at the study institution. The mean (average) weight loss of all adult family members decreased from 220 pounds to 198 pounds but was not statistically significant. However, among obese family members, the weight decreased from 234 to 226 pounds, a difference that did reach statistical significance. The same results were observed for waist circumference, as the results among all adult family members did not change significantly (from 108 cm to 105 cm; 42.5 inches to 41.3 inches), but did significantly decrease among obese adult family members (from 119 to 111 cm; 46.9 inches to 43.7 inches).

In obese children only, the authors observed a lower BMI than was expected for their growth curve at the one-year follow-up, however this finding did not reach statistical significance.

One year following surgery, both patients and adult family members had significant changes in their eating habits, with patients significantly increasing cognitive control of eating while decreasing uncontrolled and emotional eating. Adult family members showed no significant changes in cognitive control of eating, but did significantly decrease uncontrolled eating and emotional eating. Additionally, children of bariatric patients were twice as likely to report being on a diet to lose weight one year post-surgery. Children also benefited from fewer daily hours of television watching and increased hours of physical activity after a parent underwent bariatric surgery.

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Gastric Bypass Surgery changes food preferences

Gastric bypass surgery alters people’s food preferences so that they eat less high fat food, according to a new study led by scientists at Imperial College London. The findings, published in the American Journal of Physiology—Regulatory, Integrative, and Comparative Physiology, suggest a new mechanism by which some types of bariatric surgery lead to long-term weight loss.

A growing number of obese patients are choosing to undergo bariatric surgery in order to lose weight, with over 7,000 such procedures being carried out on the NHS in 2009-10. The most common and the most effective procedure is the ‘Roux-en-Y’ gastric bypass, which involves stapling the stomach to create a small pouch at the top, which is then connected directly to the small intestine, bypassing most of the stomach and the duodenum (the first part of the small intestine). This means that patients feel full sooner.

The new study involved data from human trials as well as experiments using rats. The researchers used data from 16 participants in a study in which obese people were randomly assigned either gastric bypass surgery or another type of operation, vertical-banded gastroplasty, in which the stomach volume is reduced but no part of the intestine is bypassed. The participants who had had gastric bypass had a significantly smaller proportion of fat in their diet six years after surgery, based on questionnaire responses.

In the rat experiments, rats given gastric bypass surgery were compared with rats that were given a sham operation. Rats that had gastric bypass surgery ate less food in total, but they specifically ate less high fat food and more low fat food. When given a choice between two bottles with different concentrations of fat emulsions, the rats that had gastric bypass surgery showed a lower preference for high fat concentrations compared with rats that had a sham operation.

“It seems that people who’ve undergone gastric bypass surgery are eating the right food without even trying,” said Mr Torsten Olbers from Imperial College London, who performed the operations on patients in the study at Sahlgrenska University Hospital in Göteborg, Sweden.

Over 7,000 bariatric surgery procedures were carried out in England on the NHS in 2009-10.

Dr Carel le Roux, from the Imperial Weight Centre at Imperial College London, who led the research, said: “It appears that after bypass surgery, patients become hungry for good food and avoid junk food not because they have to, but because they just don’t like it any more. If we can find out why this happens, we might be able to help people to eat more healthily without much effort.”

The rat experiments suggested that the reduced preference for high fat food was partly due to the effects of digesting the food. There was no difference in preferences between gastric bypass rats and sham-operated rats when the rats were only given access to the bottles for a few seconds, suggesting that bypass rats did not dislike the taste of high fat emulsions when they were only allowed small volumes at a time.

Rats can learn to avoid foods that they associate with illness, so the researchers tested whether high fat foods would condition them to avoid certain tastes. They gave the rats saccharine-flavoured water while infusing corn oil into their stomachs. The gastric bypass rats learned to avoid saccharine, but the sham-operated rats did not, suggesting that the effect of digesting corn oil was unpleasant to the rats that had had gastric bypass surgery.

Levels of the satiety-promoting hormones GLP-1 and PYY were higher after feeding in the gastric bypass rats compared with sham-operated rats, suggesting a possible mechanism for the changes in food preferences. The team at Imperial plan to study the role of these hormones further to see if it might be possible to mimic the effects of gastric bypass without using surgery.

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Diabetes and Obesity Combo a Major Red Flag in Pregnancy

Type 2 diabetes and obesity in pregnancy is a daunting duo, according to new research published this month in The Journal of Maternal-Fetal and Neonatal Medicine. The study shows that both conditions independently contribute to higher risks, opening the door to a wide range of pregnancy, delivery and newborn complications.

Study authors say the findings are important because obesity and type 2 diabetes are skyrocketing in women of childbearing age. A study in The Journal of the American Medical Association reports that between 2007 and 2008 the prevalence of obesity among adult women in the United States was more than 35 percent. A report from the Centers for Disease Control and Prevention states that approximately 11 percent of women above the age of 20 had diabetes in 2010.

Loralei Thornburg, M.D., senior study author and a high-risk pregnancy expert at the University of Rochester Medical Center, emphasizes that the research is needed now more than ever. “We’ve never seen the degree of obesity and type 2 diabetes in women that we are seeing right now, because for a very long time diabetes was a disease of an older population, so we rarely dealt with it in prenatal care. We hope this new knowledge will help physicians better understand and care for this rapidly expanding group of high-risk women.”

While numerous studies have established that obesity, in the absence of diabetes, is associated with problems in pregnancy – preterm birth, birth trauma, blood loss and a prolonged hospital stay, to name a few – less is known about type 2 diabetes and what causes difficulties when the two conditions coexist. Researchers from Rochester wanted to determine if obesity alone accounts for the increased risks in this “dual-diagnosis” group, or if diabetes plays a role as well.

To determine the influence of obesity and type 2 diabetes when the conditions coexist in pregnancy, Thornburg and lead study author Kristin Knight, M.D., used clinical records and the hospital’s birth certificate database to identify 213 pairs of women who delivered babies at the Medical Center between 2000 and 2008. Each pair included a diabetic and a non-diabetic patient with approximately the same pre-pregnancy body mass index (BMI). The majority of women in the study were overweight, obese or morbidly obese.

“We matched the pairs pound for pound, because if obesity was the main problem, we’d see similar outcomes between women, whether they had diabetes or not. But if we saw different outcomes between pairs, we’d know the diabetes was impacting outcomes as well,” said Thornburg.

Using mathematical models and controlling for outside factors, such as age and tobacco use, researchers found that the patients with type 2 diabetes had overall worse pregnancy, delivery and newborn outcomes than their BMI-matched counterparts. Specifically, diabetic patients had higher rates of preeclampsia, cesarean delivery, shoulder dystocia, preterm delivery, large for gestational age infant, fetal anomaly and admission to the neonatal intensive care unit.

“Women and their physicians need to be aware that each condition on its own increases risk in pregnancy, so when they coexist the situation is even more worrisome,” said Knight, a maternal fetal medicine fellow at Rochester. “Pregnancy is a time of great change, and fortunately many women are very open to making modifications during this period in their life. Anything a woman can do to improve her condition, from controlling blood sugar and exercising, to eating nutritious foods and maintaining an optimal weight, will help her deliver a healthier baby.”

Knight originally focused her research on the effects of type 1 and type 2 diabetes on pregnancy. In a previous study, she found that women with type 2 diabetes, most of whom were also obese, had poorer outcomes. Consequently, her research turned to obese, type 2 diabetics and their experiences in pregnancy.

“If a woman enters pregnancy obese, but hasn’t developed type 2 diabetes, she is in a better place than if she had both,” concluded Thornburg.

In addition to Knight and Thornburg, Eva K. Pressman, M.D., and David N. Hackney, M.D., from the Medical Center, also participated in the research.

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New Study Finds That Gastric Banding Pays for Itself In Approximately Two Years for Patients With Diabetes and Four Years for Patients Without Diabetes

- Analysis Demonstrates Gastric Banding is a Safe and Cost-Effective Weight-Loss Surgery Procedure

- Note: Sublimis Argentina offers affordable bariatric surgery abroad. Feel free to contact us for more information

Irvine, CA – Allergan, Inc. announced a new study published in the peer-reviewed journal Surgery for Obesity and Related Diseases that found the cost of a gastric banding weight-loss surgery procedure, such as Allergan’s LAP-BAND® Adjustable Gastric Banding System, was offset by reductions in obesity-related medical costs within 2.25 years for surgery eligible patients with diabetes, and within four years of the procedure for all surgery eligible patients.

The study evaluated healthcare claims data from 7,310 patients who had undergone gastric banding compared to claims from a matched control group of 7,306 surgery eligible obese individuals who did not have weight-loss surgery, for the purpose of quantifying the potential savings of gastric banding. The study found that while post-surgery medical costs for the gastric banding group declined slightly, medical costs for the control group continued to rise, thus resulting in significant savings for the banding sample. These findings underscore the critical effect gastric banding has on containing healthcare costs among the target population.

“Although the gastric banding procedure is associated with upfront costs, our analysis shows that those costs are recovered in a relatively short period of time, particularly for obese patients with diabetes,” said study lead author Eric A. Finkelstein, Ph.D., of Duke University and Duke-NUS Graduate Medical School in Singapore. “Although the potential for cost-savings should not drive coverage decisions, some insurance providers are hesitant to cover the costs of bariatric procedures for fear they will break the bank. These results may allay some of those concerns,” Finkelstein said.

Currently, one in three American adults is obese. Due to increased medical expenditures, absenteeism, and presenteeism (reduced on the job productivity due to health reasons), obesity now costs U.S. businesses roughly $70 billion per year. The total medical bill for the nation as a result of obesity is now projected at $147 billion per year, or nearly 10 percent of all medical expenses in the United States. This figure is projected to reach 16-18 percent of all U.S. healthcare costs in the next 20 years. Given its known correlation to life-threatening co-morbid conditions, such as heart disease, stroke, Type 2 diabetes, high blood pressure, sleep apnea and even premature death, obesity is a disease that requires medical treatment. Furthermore, medical research has found that if left untreated those individuals who are currently obese will likely remain obese, highlighting the unmet clinical need among obese patients for the availability of and reimbursement for effective treatment options.

“This study is consistent with the vast findings from the published literature that support gastric banding is an effective and safe weight-loss surgery procedure that can produce sustained weight loss, ultimately resulting in reduction of obesity-related comorbid conditions and medical costs,” said Frederick Beddingfield, M.D., Allergan’s Vice President of Clinical Research and Development. “Research of this kind is integral in our efforts as a company to ensure appropriate access to and affordability for the LAP-BAND® System procedure for patients across the country.”
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Study Shows Gastric Bypass May Reverse Infertility

- New hope for women with morbid obesity trying to get pregnant

- Sublimis Argentina offers affordable bariatric surgery abroad and fertility treatments abroad

Orlando, FL – Obesity has been linked to infertility and now a new study shows bariatric surgery may treat its most common cause, polycystic ovarian syndrome (PCOS), a hormonal imbalance that affects up to 10 percent of women of child-bearing age — 33 to 50 percent of whom are overweight or obese. The findings were presented here at the 28th Annual Meeting of the American Society for Metabolic & Bariatric Surgery (ASMBS).

“Not many patients come to a bariatric surgeon to treat infertility problems,” said Mohammad Jamal, MD, FACS, study co-author and Clinical Assistant Professor of Surgery at the University of Iowa Hospitals and Clinics in Iowa City. “But this study suggests that women with morbid obesity, who are infertile secondary to PCOS, may have a new surgical option. Many other studies have shown bariatric surgery can improve or resolve a multitude of diseases and conditions. It appears that infertility now joins that list.”

In the study, researchers from the University of Iowa Hospitals and Clinics report that 100 percent of the morbidly obese women who were diagnosed with PCOS related infertility, and desired children, became pregnant within three years following gastric bypass surgery.

A review of medical records of 566 morbidly obese women who had gastric bypass surgery over a period of nine years revealed 31 patients between the ages of 22 and 42 who had PCOS before surgery. Six post-menopausal patients, and five patients lost to follow-up, were excluded. The remaining 20 patients, average age 32, were contacted by telephone. Fourteen of them were fertile prior to surgery or did not desire to become pregnant after surgery.

The remaining six women, who had been diagnosed with infertility before surgery, and still desired pregnancy, became pregnant within three years of gastric bypass surgery. Doctors advise women not to try to conceive until at least 18 months after bariatric surgery due to surgery-related changes that could affect fetal development.
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Adjustable Gastric Banding System is a Safe and Effective Weight-Loss Treatment

Note: Sublimis Argentina offer affordable bariatric surgery abroad

Irvine, CA – Two new studies published in the current issue of Surgery for Obesity and Related Diseases, a peer-reviewed journal, add to the large body of scientific evidence which supports that the LAP-BAND® Adjustable Gastric Banding System, made by Allergan, Inc. (NYSE: AGN), is a safe and effective weight-loss procedure. One study concluded that laparoscopic adjustable gastric banding (LAGB) procedure can be safely performed in a community medical practice, with patients experiencing meaningful excess weight loss. The second study examined patients who received LAGB following the failure of gastric bypass and found they achieved significant weight loss two years post-banding procedure.

While a wealth of data has been published in the literature worldwide, questions have recently been raised about the safety and effectiveness of the LAP-BAND® System, specifically with respect to average weight loss and complications. These two new studies support that the advanced product technology of the LAP-BAND® AP System, combined with surgical technique and patient aftercare result in positive clinical outcomes.  The LAP-BAND® System has an 18-year safety and effectiveness record, including almost 10-years in the United States, with more than 650,000 procedures performed worldwide, leading to more than two million patient years of exposure for the device.

- Before and after a Gastric Bypass

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Bariatric Operations Reduce Odds of Gestational Diabetes

Obese women who undergo bariatric procedures before pregnancy are three times less likely to have gestational diabetes

Chicago – Obese women who have bariatric surgical procedures before pregnancy were three times less likely to develop gestational diabetes (GDM) than women who have bariatric operations after delivery, according to new research findings published in the August issue of the Journal of the American College of Surgeons. The retrospective study also found that delivery after bariatric procedures was associated with reduced odds of cesarean section—an outcome associated with GDM.

Gestational diabetes affects at least seven percent of all pregnancies in the United States, with rates as high as 14 percent among certain populations. Its prevalence is increasing among reproductive-age women, parallel to increasing rates of obesity and type 2 diabetes. Currently, 33 percent of women over 19 years of age meet the criteria for obesity (body mass index [BMI] > 30 kg/m2) and seven percent for extreme obesity (BMI > 40 kg/m2). Bariatric surgical procedures are the only intervention shown to produce sustained weight reduction in the vast majority of subjects.

“The major finding of our study is that women who had bariatric surgery before they delivered reduced odds of gestational diabetes when compared with women had bariatric surgery after they delivered,” said Anne E. Burke, MD, MPH, assistant professor of obstetrics and gynecology at the Johns Hopkins University School of Medicine in Baltimore, Md.

- Before and After a bariatric surgical procedure

“Despite a growing body of evidence supporting the safety and efficacy of bariatric surgery in reversing obesity-related complications, few candidates for the procedure are referred to a surgeon to discuss their options,” stated Martin Makary, MD, MPH, associate professor of surgery at Johns Hopkins University School of Medicine and senior author of the study.
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