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

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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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New Body Sculpting Technique uses High-Intensity Ultrasound

- Noninvasive Technique Reduces Waist Size in Nonobese Patients, Study Finds

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Arlington Heights, Ill. – A “body sculpting” technique using high-intensity focused ultrasound to eliminate unwanted abdominal fat effectively reduces waist circumference, with only minor pain and side effects, reports a study in the July issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

Body sculpting is defined as “the optimization of the smoothness, definition, or silhouette of the human physique, particularly the torso.” The most common medical procedure for body sculpting is liposuction, which can remove relatively large volumes of fat. High-intensity ultrasound provides a nonsurgical alternative to liposuction for removing unwanted fat in nonobese patients, according to the study led by ASPS Member Mark L. Jewell, MD of Oregon Health Science University, Eugene.

Body Sculpting Technique Eliminates Fat with Few Side Effects

The researchers evaluated the outcomes of high-intensity focused ultrasound for body sculpting of the abdomen and flanks in 180 patients. All patients sought treatment to eliminate excess abdominal fat; only patients who were not obese (body mass index less than 30) were eligible for the study. The average age was 42 years, and 85 percent of the patients were women.

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Study Shows Gastric Bypass May Reverse Infertility

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

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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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- VASER Lipo® uses ultrasonic energy — high-frequency sound waves — to produce superior results

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VASER Lipo uses a minimally invasive technique called LipoSelection® to selectively break apart and gently remove unwanted fat.

To begin the procedure, the targeted area is injected with a special saline solution known as “tumescent fluid.”

Tumescent fluid numbs the target area and shrinks local blood vessels. It also temporarily expands the volume of the targeted area, making fat cells easier to remove.

Small-diameter probes are then inserted into the body through small incisions. By resonating at a high ultrasonic frequency, the probes literally shake loose fat cells — while leaving blood vessels, nerves and connective tissues unharmed.

The loose fat cells mix with the tumescent fluid, which is then removed from the body using gentle suction.
After the surgery, patients are prescribed a recovery regimen to promote maximum skin retraction and smooth results. Your physician may recommend massage therapy to enhance results and speed recovery.

Breast Fat Transplantation: New Technique Doubles Breast Size

- Preoperative expansion is key to improving results of breast augmentation with fat transplantation

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Arlington Heights, Ill. – A plastic surgery procedure in which the patient’s own fat is transplanted to the breasts – used along with treatment to expand the breast tissue before surgery – can achieve up to a twofold increase in breast size, according to a study in the June issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

The procedure builds on previous fat transfer techniques to provide excellent outcomes of breast enhancement surgery. “Pre-expansion to the breast allows for mega-volume (over 300 cc) grafting with reproducible, long lasting results that can be achieved in less than two hours,” according to ASPS Members Daniel Alexander Del Vecchio, MD, Boston, and Louis Paul Bucky, MD, Philadelphia, authors of the new report.

“Pre-Expansion” Maximizes Results of Breast Fat Transfer

The technique is an adaptation of the increasingly popular autologous fat transplantation technique. In these procedures, fat obtained by liposuction from one part of the body – for example, the thighs – is transferred for use in breast enlargement and reshaping.

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Study finds association between the number of eggs and live birth in IVF treatment

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An analysis of over 400,000 IVF cycles in the UK has shown that doctors should aim to retrieve around 15 eggs from a woman’s ovaries in a single cycle in order to have the best chance of achieving a live birth after assisted reproduction technology.

The study, which is published online in Europe’s leading reproductive medicine journal Human Reproduction, found that there was a strong relationship between live birth rates and the number of eggs retrieved in one cycle. The live birth rate rose with an increasing number of eggs up to about 15; it levelled off between 15 and 20 eggs, and then steadily declined beyond 20 eggs.

One of the authors of the study, Dr Arri Coomarasamy, said: “This is the first study to look at the association between the number of eggs and live births. Some smaller studies have reported previously on the association between egg numbers and pregnancy rates, but not live births. This is also the first study to devise a graph that can be used by patients and clinicians to estimate the chances of a live birth for a given number of eggs.”

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