New Study May Explain How Weight-loss Surgery Reverses Type 2 Diabetes

California – A team of researchers, led by a UC Davis veterinary endocrinologist, has shown for the first time that a surgical procedure in rats that is similar to bariatric surgery in humans can delay the onset of type 2 diabetes. The researchers also have identified biochemical changes caused by the surgeries that may be responsible for that delay.

Findings from the study, published online in the journal Gastroenterology, should help researchers identify strategies for preventing and treating type 2 diabetes, a chronic condition in which the body is unable to properly metabolize sugar and fat, leading to serious complications including heart disease, blindness and kidney failure.

Type 2 diabetes affects more than 21 million people in the United States, where it results in more than $150 billion in direct and indirect annual costs, according to the National Institutes of Health.

“Bariatric surgery currently is considered to be the most effective long-term treatment for human obesity and often leads to marked improvements in diabetes,” said the study’s lead author Peter Havel, a professor with joint appointments in the School of Veterinary Medicine and Department of Nutrition.

“It has been thought that reduction of blood sugar, which indicates a reversal of type 2 diabetes, in patients following bariatric surgery was due to post-surgery weight loss,” Havel said. “This study, however, supports the observations from a number of earlier clinical studies reporting that diabetes is often improved prior to substantial weight loss. It also suggests that endocrine changes in hormones produced by the gastrointestinal tract may contribute to the early effects of bariatric surgery, in addition to the later effects of weight loss.”

“This study confirms our clinical observations that metabolic regulation — specifically homeostasis of glucose — occurs quickly after gastric bypass surgery,” said Mohamed Ali, an associate professor of gastrointestinal surgery and a specialist in bariatric surgery at UC Davis Health System. “It’s clear from the outcome that something physiologic is at work with controlling diabetes that is not related to weight loss.

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Tratamientos contra la Obesidad

¿La obesidad es una enfermedad?
Los médicos entendemos a la obesidad como una enfermedad crónica progresiva y recurrente. Por lo tanto, la tendencia a aumentar de peso estará siempre presente, haciendo que el exceso de peso sea cada vez mayor. Esto explica porqué es difícil que los resultados sean duraderos si no se cambia para siempre el hábito de alimentarse.

¿Cómo evoluciona esta enfermedad?
A medida que el estado de salud se va deteriorando, la obesidad acarrea enfermedades tales como la hipertensión arterial, diabetes aumento del colesterol, dificultades respiratorias, artrosis, etc., que deterioran el estado de salud. Esto hace que cada día las personas se vean más limitadas para llevar una vida normal.

¿Por qué es importante bajar de peso?
Los beneficios de bajar de peso se relacionan con la desaparición de las enfermedades ya descriptas, que surgen como consecuencia de la obesidad. Esto significa que al bajar de peso, disminuyen los riesgos asociados a la obesidad, aumenta la expectativa de vida y las personas pueden reinsertarse a la sociedad.

¿Cuáles son los condicionantes de la obesidad?
El sobrepeso y la obesidad dependen del equilibrio entre factores del medio ambiente, la situación psicológica y características genéticas individuales.

La nutrición adecuada:
Los nutrientes son los factores más importantes del medio ambiente sobre los cuales podemos influir. Por esto, es necesario modificar nuestros hábitos hacia una alimentación sana. Para lograrlo es preciso evaluar el estado nutricional de cada persona y los factores de riesgo que presenta. Solo así es posible prescribir un plan alimentario personalizado acorde a requerimientos individuales que el paciente deberá aprender e incorporar para toda la vida.

Los factores psicológicos:
La existencia de múltiples factores tales como la ansiedad, depresión, inseguridad, stress, fobias, etc., contribuyen la aparición de la obesidad y condicionan su progresión en el tiempo. Por este motivo, los índices de descenso de peso son menores en los pacientes que no atienden estos condicionantes. Es posible mejorar estos aspectos a través de terapias individuales y grupos psicoeducativos o de reflexión con orientación y asesoramiento familiar.

Indice de Masa Corporal

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Model Estimates Risks and Benefits of Bariatric Surgery for Severely Obese

Chicago — A computerized model suggests that most morbidly obese individuals would likely live longer if they had gastric bypass surgery, according to a report in the January issue of Archives of Surgery, one of the JAMA/Archives journals. However, the best decision for individual patients varies based on factors such as age, increasing body mass index and the effectiveness of surgery.

An estimated 5.1 percent of the U.S. population is morbidly obese, often defined as having a body mass index (BMI) of 40 or higher, according to background information in the article. Available evidence suggests that dietary, behavioral and pharmacologic treatments frequently do not result in meaningful weight loss for individuals in this group. Bariatric surgery appears to be the only effective therapy for promoting clinically significant weight loss and improving obesity-related health conditions for the morbidly obese. However, the procedure is not without risk, including in-hospital death.

Daniel P. Schauer, M.D., M.Sc., of the University of Cincinnati Academic Health Center, and colleagues used two nationally representative surveys and a recent large observational trial to construct a model estimating the benefits and risks of gastric bypass surgery for individuals with morbid obesity. The model included data from almost 400,000 individuals nationwide to estimate the risk of death from obesity and its complications; data from 23,281 patients undergoing bariatric surgery to calculate in-hospital death rates following the procedures; and outcomes from participants in a seven-year study to determine the effects of surgery on survival and to calibrate and validate the model.

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Obesity Now Poses As Great a Threat to Quality of Life As Smoking

San Diego, CA – As the US population becomes increasingly obese while smoking rates continue to decline, obesity has become an equal, if not greater, contributor to the burden of disease and shortening of healthy life in comparison to smoking. In an article published in the February 2010 issue of the American Journal of Preventive Medicine, researchers from Columbia University and The City College of New York calculate that the Quality-Adjusted Life Years (QALYs) lost due to obesity is now equal to, if not greater than, those lost due to smoking, both modifiable risk factors.

QALYs use preference-based measurements of Health-Related Quality of Life (HRQOL) which allow a person to state a relative preference for a given health outcome. Since one person may value a particular outcome differently than another person, these measures capture how each respondent views his or her own quality of life.

The 1993–2008 Behavioral Risk Factor Surveillance System (BRFSS), the largest ongoing state-based health survey of US adults, has conducted interviews of more than 3,500,000 individuals; annual interviews started with 102,263 in 1993 and culminated with 406,749 in 2008. This survey includes a set of questions that measures HRQOL, asking about recent poor health days and tracking overall physical and mental health of the population. The authors analyzed these data and converted the measures to QALYs lost due to smoking and obesity.

From 1993 to 2008, when the proportion of smokers among US adults declined 18.5%, smoking-related QALYs lost were relatively stable at 0.0438 QALYs lost per population. During the same period, the proportion of obese people increased 85% and this resulted in 0.0464 QALYs lost. Smoking had a bigger impact on deaths while obesity had a bigger impact on illness.

Investigators Haomiao Jia, PhD and Erica I. Lubetkin, MD, MPH, state, “Although life expectancy and QALE have increased over time, the increase in the contribution of mortality to QALYs lost from obesity may result in a decline in future life expectancy. Such data are essential in setting targets for reducing modifiable health risks and eliminating health disparities.”

The article is “Trends in Quality-Adjusted Life-Years Lost Contributed by Smoking and Obesity” by Haomiao Jia, PhD, and Erica I. Lubetkin, MD, MPH. The article appears in the American Journal of Preventive Medicine, Volume 38, Issue 2 (February 2010) published by Elsevier.

For any inquiry about bariatric surgery procedures please do not hesitate to contact us.

Linking weight loss to less sleep apnea

Temple-led study, the largest of its kind, finds weight loss has significant impact on the disorder

More than 12 million people in the U.S. suffer from sleep apnea, most common among the overweight and obese. More than just loud snoring, it can lead to high blood pressure, stroke, cardiovascular disease and a poor quality of life. For years, doctors have told patients with sleep apnea that their best bet for alleviating it would be to lose weight, but there’s been very little research-based evidence to prove that.

“Existing research has been limited by a number of factors, so there are very few studies that show whether the recommended amount of weight loss – about 10 percent – is enough to sufficiently improve sleep apnea,” said Gary Foster, director of the Center for Obesity Research and Education.

Foster and colleagues from six other universities recently completed the largest randomized study on the effects of weight loss on sleep apnea in patients with type 2 diabetes. They found that among patients with severe sleep apnea, those who lost the recommended weight were three times more likely to nearly eliminate the number of sleep apnea episodes compared to those who did not lose weight. The results are published in the Sept. 28 issue of the Archives of Internal Medicine.

The new study, called Sleep AHEAD, looked at 264 obese patients with type 2 diabetes already enrolled in the Look AHEAD trial, an ongoing 16-site study investigating the long-term health impact of an intensive lifestyle intervention in 5,145 overweight or obese adults with type 2 diabetes. Participants were between 45 and 75 years old.

The 264 participants were broken into two randomized groups: the first received a group behavioral weight loss program developed especially for obese patients with type 2 diabetes, portion-controlled diets, and a prescribed exercise regimen of 175 minutes per week. The second attended three group informational sessions over a one-year period that focused on diabetes management through diet, physical activity and social support.

After one year, members of the first group lost an average of 24 pounds. More than three times as many participants in this group had complete remission of their sleep apnea (13.6 percent compared to 3.5 percent), and also had about half the instances of severe sleep apnea as the second group. Further, participants in the second group only lost about a pound, and saw significant worsening of their sleep apnea, which suggested to Foster and his team that without treatment, the disorder can progress rapidly.

“These results show that doctors as well as patients can expect a significant improvement in their sleep apnea with weight loss,” said Foster, the study’s lead author. “And a reduction in sleep apnea has a number of benefits for overall health and well-being.”

For more information about weight loss benefits don’t hesitate to contact us.

Weight-Loss Surgery Can Break a Family’s Cycle of Obesity

New study finds the intrauterine environment may determine whether a child is destined to become obese

Adolescent and young children of obese mothers who underwent weight-loss surgery prior to pregnancy have been found to have a lower prevalence of obesity and significantly improved cardio-metabolic markers when compared to siblings born before the same obese mothers had weight-loss surgery. This new study has been accepted for publication in The Endocrine Society’s Journal of Clinical Endocrinology & Metabolism (JCEM).

Obesity can lead to insulin resistance, cardiovascular disease and pregnancy complications and is a major contributor to causes of death in industrialized nations. Previous studies of obese pregnant women have shown that obesity and its co-morbidities can be transmitted to their children, which indicates that the intrauterine environment may determine whether a child at birth is already destined to become obese.

“Our study confirms previous research showing that the intrauterine environment may be more important than genes and the post-natal environment when it comes to the association between maternal obesity and childhood obesity,” said John Kral, MD, PhD, of SUNY Downstate Medical Center in Brooklyn, N.Y. and co-author of the study. “Any medical or surgical treatment to reduce obesity and existing metabolic disorders before pregnancy can be an investment in the life of future offspring.”

Weight-loss surgery limits the amount of food a person can consume. Some of these operations also restrict the amount of food that can be digested. This particular study focused on women who had undergone biliopancreatic diversion (BPD) prior to becoming pregnant. BPD changes the normal process of digestion by making the stomach smaller and directing food to bypass part of the small intestine resulting in fewer calorie absorption.

Specifically, researchers studied 49 mothers who had undergone BPD surgery and their 111 children (between the ages of 2.5 and 25 years). All mothers in this study had children born before and then after their weight-loss surgery. The research found that children who were born after their mother underwent weight-loss surgery had reduced birth weight and waist circumference and were three times less likely to become severely obese. Furthermore, children born after their mother’s weight-loss surgery had improved cardiovascular markers including reduced insulin resistance and lower cholesterol.

“To our knowledge, our paper is the first to demonstrate that dramatic maternal weight loss causes metabolic improvements in their children,” said Kral. “Our findings show that obese women should be encouraged to lose weight before becoming pregnant, and then, once pregnant, should limit their weight gain. For those women interested in both surgical treatment and having children, we believe surgery should come first. Preventing obesity and treating it effectively in young women could prevent further transmission to future generations.”

Other researchers working on the study include J. Smith, K. Cianflone, S. Simard and Picard Marceau of the Centre de Recherche Institut Universitaire de Cardiologie et Pneumologie de Quebec in Canada; S. Biron, S. Lebel, S. Marceau, O. Lescelleur and L. Biertho of Laval University in Quebec, Canada; and J.G. Kral of SUNY Downstate Medical Center in Brooklyn, N.Y.

The article, “Effects of maternal surgical weight loss on intergenerational transmission of obesity,” will appear in the November 2009 issue of JCEM.

For information about weight loss surgery in Argentina feel free to contact our surgeon Norman Jalil.

Source: The Endocrine Society

Cirugía Mínimamente Invasiva: Vesícula Biliar

¿Qué es la vesícula biliar?

La vesícula biliar tiene la función de acumular y concentrar la bilis producida por el hígado.  Habitualmente, este líquido es liberado hacia el tubo digestivo después de comer ayudando a la digestión. Dado que la vesícula concentra la bilis, en algunos pacientes la misma se cristaliza formando cálculos, pequeñas piedras compuestos principalmente de colesterol y sales biliares.  Estos cálculos pueden obstruir la salida de la bilis de la vesícula, causando su inflamación y dolor abdominal agudo, a veces acompañado de vómitos y ocasionalmente, fiebre.   Si el cálculo pasa hacia el colédoco, que es el conducto que lleva la bilis hacia el intestino, se puede producir ictericia (color amarillo en la piel) o incluso pancreatitis aguda.

¿Por qué es necesario operar la vesícula?

No existe un tratamiento médico efectivo para disolver los cálculos. Por este motivo, principalmente en los pacientes que ya han tenido síntomas lo más conveniente es extraer la vesícula, fuente de formación de los mismos.

La extracción quirúrgica de la vesícula biliar es el tratamiento más efectivo y seguro para resolver los problemas de este órgano, ya que no produce ningún daño en el proceso de la digestión.

¿Cómo se que tengo cálculos en la vesícula?

Una vez que el paciente tiene síntomas es necesario realizar análisis de sangre y una ecografía que permite al cirujano conocer el estado del hígado y de la vesícula biliar en vistas a una operación.

Tecnica Mini Invasiva

En el pasado era necesario realizar una incisión de 10 a 12 cm. para poder acceder al área de trabajo.  Esta forma de trabajar, denominada “convencional”  se acompañaba de mayor dolor postoperatorio, una internación más prolongada, y un retorno tardío a la actividad laboral.

El advenimiento de la laparoscopía, introdujo el concepto de visualizar el campo de trabajo a través de una cámara de video y trabajar a través de instrumentos delgados que se maniobran por fuera del paciente.  Así, es posible completar la  cirugía a través de cuatro incisiones de 7 a 12 mm.

¿Qué es la Cirugía Acuscópica?

Los avances en el desarrollo de la tecnología digital en imágenes y en la miniaturización de los instrumentos, permitieron desarrollar en los últimos años esta técnica innovadora que se acompaña de grandes ventajas. El nombre deriva del calibre de los instrumentos que se utilizan para operar ya que tienen un diámetro de 2 a 3 mm. y se asemejan a agujas.

Las diferencias con la laparoscopía tradicional radican en la excelente recuperación y el mínimo dolor en el postoperatorio.  El hecho de poder completar la operación con tres incisiones de 2 a 3 mm.,  hace que los pacientes puedan retornar a sus actividades habituales apenas unos días después de la operación.  La extracción de la vesícula se puede realizar utilizando una cicatriz de una cirugía previa para un mejor resultado estético.  Incluso pueden realizar actividades físicas habituales sin riesgos de complicaciones.

¿Cuáles son las condiciones para realizar esta técnica?

Las condiciones para realizar estos novedosos procedimientos se relacionan con la disponibilidad de tecnología de última generación en imágenes, instrumental apropiado, formación profesional y un centro equipado para realizar estas técnicas de manera segura.

Así es como hoy, gracias al nivel de detalle que ofrece la tecnología en imágenes, y a la disponibilidad de instrumental en miniatura, es posible realizar operaciones de vesícula biliar con alto grado de detalle, lo que otorga gran seguridad al procedimiento.

Ventajas de la Cirugía Acuscópica:

- Mínimo dolor postoperatorio
- Regreso a la actividad habitual en pocos días
- Interrupción mínima de la actividad física habitual
- Internación breve
- Excelente resultado estético

Por cualquier duda con respecto a la cirugía mini invasiva no dude en consultar a nuestro especialista el Doctor Norman Jalil.

Weight loss Before and After Photos: Gastric Bypass

In general defined, gastric bypass surgery describes any bariatric procedure that alters the digestive tract so that certain parts are “bypassed”. The food when passes through this altered tract, the body absorbs from it less calories than usual. The gastric bypass is the operation more commonly used to neutralize obesity.

Here are some photos before and after a gastric bypass surgery. For more information feel free to contact Doctor Norman Jalil.