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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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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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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Patients With Diabetes May Need Fewer Medications After Bariatric Surgery

Chicago — Bariatric surgery appears to be associated with reduced use of medications and lower health care costs among patients with type 2 diabetes, according to a report in the August issue of Archives of Surgery, one of the JAMA/Archives journals.

“The rapidly growing epidemics of obesity and diabetes threaten to overburden the world’s health care systems,” the authors write as background information in the article. “From an epidemiological standpoint, once these diseases develop they are rarely reversed. Dietary, pharmaceutical and behavior treatments for obesity are associated with high failure rates, and medical management of diabetes is also often unsuccessful. Despite many efforts to improve the control of glucose levels in diabetes, including clinical guidelines and patient and provider education, less than half of all patients with type 2 diabetes mellitus achieve the American Diabetes Association recommendation of a hemoglobin A1C level of less than 7 percent.”

The use of bariatric surgery—that results in long-term weight loss, improved lifestyle and decreased risk of death—has tripled in the past five years, the authors note. Martin A. Makary, M.D., M.P.H., and colleagues at the Johns Hopkins Bloomberg School of Public Health and The Johns Hopkins University School of Medicine, Baltimore, studied 2,235 U.S. adults (average age 48.4) with type 2 diabetes who underwent bariatric surgery during a four-year period, from 2002 to 2005. They used claims data to measure the use of diabetes medications before and after surgery, along with health care costs per year.

Of the 2,235 patients, 1,918 (85.8 percent) were taking at least one diabetes medication before surgery, with an average of 4.4 medications per patient. Six months after surgery, 1,669 of 2,235 patients (74.7 percent) had eliminated their diabetes medications. Of the 1,847 patients with available data one year after surgery, 1,489 (80.6 percent) had eliminated medications; after two years, 906 of 1,072 (84.5 percent) had done so. This reduction was observed in all classes of diabetes medications.

Before and after bypass gastric surgery

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Bariatric Surgery in Diabetic Adults Improves Insulin Sensitivity Better than Diet

San Diego, CA — Gastric bypass surgery improves Type 2 diabetes by other mechanisms in addition to weight loss and does so better than a low-calorie diet despite achieving equal weight loss, a new study finds. The results will be presented Monday at The Endocrine Society’s 92nd Annual Meeting in San Diego.

“Our study shows that in the short term, weight loss by diet alone does not achieve the same improvements in diabetes as gastric bypass surgery,” said the presenting author, Judith Korner, MD, PhD, assistant professor of medicine at Columbia University College of Physicians and Surgeons, New York.

Korner and her colleagues found that gastric bypass surgery better improved insulin sensitivity, the body’s ability to successfully clear glucose sugar from the bloodstream into the cells. Insulin sensitivity is impaired in people with Type 2 diabetes, and obesity adds to this problem. The result is a buildup of sugar in the blood.

The study compared the effects on diabetic adults of a low-calorie diet versus Roux-en-Y gastric bypass, the most common gastric bypass procedure. Roux-en-Y gastric bypass decreases the size of the stomach and reroutes the digestive tract to bypass most of the stomach and part of the small intestine. After gastric bypass, many diabetic patients achieve normal blood glucose control or vastly improved control, and some may no longer require diabetes medications.

In the study, seven obese patients with Type 2 diabetes received a daily 800-calorie liquid diet and no surgery, while seven other obese diabetic adults underwent gastric bypass surgery. The study ended when both groups lost the same amount of weight: an average of 8 percent of body weight. However, the surgery-treated patients lost the weight faster: in about 3.5 weeks compared with 8 weeks for the dieters.

Surgical patients were able to discontinue all of their diabetes medications by the study’s end, but the dieters reduced their medication use by 55 percent, Korner reported.

The researchers found significant improvements in the surgery group in measures of insulin sensitivity and function of beta cells, the insulin-producing cells in the pancreas. Improvements in insulin sensitivity in the low-calorie diet group were not statistically significant and beta cell function improved to a lesser extent.

Korner speculated that hormonal changes may be responsible for the improvements resulting from Roux-en-Y surgery in individuals with Type 2 diabetes.

“It will be important to understand how surgery works to produce these results so that we can develop medical therapies of equivalent efficacy,” she said.

The National Institute of Diabetes and Digestive and Kidney Diseases funded this study.

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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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