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Entries in Bariatric Surgery (8)

Wednesday
Oct172012

Weight-Loss Surgery Tied to Substance Abuse

Tom Morello/Thinkstock(NEW YORK) -- Weight-loss surgery can help people who are obese ditch their unhealthy relationships with food.  But a new study suggests these patients sometimes enter a rebound relationship with something else -- alcohol, drugs or cigarettes.

The survey-based study of 155 bariatric surgery patients found a 50 percent rise in the frequency of substance abuse two years after the procedure.

“Many people who undergo bariatric surgery struggle with eating in response to different emotional cues,” said Alexis Conason of the New York Obesity Nutrition Research Center, lead author of the study published Monday in the Archives of Surgery.  “I [wondered] what happened afterward.  If they are no longer able to cope with their emotions through eating … do they turn to something like drugs or alcohol to serve the purpose that food did originally.”

Conason tested the theory of symptom substitution -- the swapping of one habit for another.  Patients who drank and smoked before surgery reported more drinking and smoking two years after.  And while one in 25 patients reported using recreational drugs before the procedure, one in eight said they used them two years later.  But Conason stressed that much more research is needed.

“The emerging body of literature [on this] is in its infancy,” she said, stressing that her study focused on frequency of substance use but not on the quantity of substances consumed or whether doing so caused problems for either the patients or their family members.  ”We have a small sample size, so it’s going to be important to see how this is replicated with larger samples.  We need to [better understand] the problematic nature of the substance use … the reasons why.”

Some experts think the uptick in substance use might be related to social behaviors.

“What this study may be showing is that morbidly obese people are socially isolated,” said Dr. Christine Ren-Fielding, chief of bariatric surgery division in the department of surgery at New York University Langone Medical Center.  “After surgery, they not only become physically healthy but mentally healthy and now become more social.  They go out on dates and go to parties which may involve a social alcoholic drink.”

The frequency of alcohol use among bariatric patients prior to surgery was very low, Ren-Fielding added.

“Perhaps after surgery, the frequency of alcohol use in bariatric patients normalizes to approach the frequency of alcohol consumption in the lean population,” she said.

The rise in substance abuse over two years followed an initial decline that Conason attributes to strict instructions for the recovery period after surgery.  She said patients should be followed closely to ensure they are maintaining a healthy weight and adjusting well to their new bodies, emotions and relationships.

Copyright 2012 ABC News Radio

Thursday
Aug232012

Weight Loss Surgery Cuts Diabetes Risk

iStockphoto/Thinkstock(NEW YORK) -- Weight loss surgery is twice as effective as lifestyle changes at preventing type 2 diabetes in people who are obese, a new study found.

The Swedish study followed more than 3,400 obese men and women, roughly half of whom had bariatric surgery, for up to 15 years. It found that bariatric surgery reduced the risk of type 2 diabetes by 78 percent – double the effect of diet and exercise alone.

"Bariatric surgery appears to be markedly more efficient than usual care in the prevention of type 2 diabetes in obese persons," Dr. Lena Carlsson from the University of Gothenburg, Sweden, wrote in the study, published Tuesday in the New England Journal of Medicine.

The surgery, which shrinks the stomach to hold less food and absorb fewer calories, has previously been shown to help treat diabetes. But this study, funded by the Swedish Research Council, the Swedish Foundation for Strategic Research to Sahlgrenska Center for Cardiovascular and Metabolic Research, the Swedish federal government, the VINNOVA-VINNMER program and the Wenner-Gren Foundations, is the first to suggest it can help prevent the disease.

"Instead of waiting for illness to begin and treat with medications, patients will now have a choice to prevent diabetes," said Dr. Carson Liu, a bariatric surgeon in Los Angeles. "This is a terrific data for decreasing the epidemic of diabetes."

Some experts say the study could broaden the spectrum when it comes to who qualifies for bariatric surgery, as most insurance companies currently cover the procedure only in adults who are obese or overweight with weight-related health problems.

"There are data to suggest that bariatric surgery can be safely employed in [non-obese diabetics]," said Dr. John Morton, associate professor of surgery at Stanford University, who has successfully treated diabetic patients with body mass indices -- or BMIs -- below 35.

"The threshold for metabolic surgery has been 35 for many years, like a brick wall," said Dr. Philip Schauer, director of the Bariatric and Metabolic Institute (BMI) at the Cleveland Clinic. "But that brick wall is like the Berlin Wall, it's coming down. Thirty is potentially the new wall."

Bariatric surgery is thought to cut the risk of diabetes by both reducing weight and changing hormone signaling pathways that control blood sugar levels. After the surgery, blood sugars typically normalize in just a few days -- long before the patient starts to lose weight.

But regardless of the mechanism, experts say the results speak for themselves.

"It is indisputable that bariatric surgery addresses weight-related problems better than medical treatments, regardless of the mechanism," said Dr. Ozanan Meireles, an instructor in surgery at Massachusetts General Hospital. "All patients would certainly benefit from it, either by achieving remission, by decreasing the amount of medications that they take on a daily basis, or by postponing the onset of diabetes in their lifetime."

Still, experts caution that the decision to go under the knife should not be taken lightly – keeping in mind that bariatric surgery can, in rare cases, cause infections, blood clots, malnutrition, ulcers, vomiting or diarrhea.

"Surgery still has risks," said Dr. Jaime Ponce, president of the Gainesville Fla.-based American Society for Metabolic & Bariatric Surgery. "There is more and more data supporting surgery, but you need to look at it on a case-by-case basis."

Copyright 2012 ABC News Radio

Wednesday
Jun202012

Bariatric Surgery for More Than Just Weight Loss?

Keith Brofsky/Thinkstock(NEW YORK) -- Gone may be the days of limiting bariatric surgery just to helping patients lose weight.  A slew of new research suggests weight loss surgeries can also be used to help reverse medical complications of obesity, not just eliminate obesity itself.

These procedures may reduce the risk of chronic disease, and even help patients better qualify for organ transplants, according to studies presented Wednesday at the American Society for Metabolic and Bariatric Surgery's annual meeting.

An estimated 72 million Americans are considered obese and nearly 200,000 Americans undergo bariatric surgery each year, according to the American Society for Metabolic and Bariatric Surgery.

Obesity can lead to chronic illnesses like heart disease and diabetes, which can cause organ damage.  But many who are morbidly obese and in need of a new organ do not qualify for transplants because of the increased risk of complications from medications and surgery.

"We tend to see obesity as a lifestyle problem, but it's really leading to worse medical problems," said Dr. Jaime Ponce, president-elect of the American Society of Metabolic and Bariatric Surgery.  "Eventually it becomes a vicious cycle of deteriorating health."

Some forms of weight loss surgery, which have grown to be less invasive and therefore less risky than procedures like transplant surgery, are not only regarded by surgeons as a way to shed dangerous pounds, but also reverse the complications of metabolic diseases.

"[Bariatric surgery] has been widely accepted in the medical field, but now we're trying to apply it to specific patient groups," said Dr. Matthew Lin, a bariatric surgeon at the University of California, San Francisco.

In one pilot study of 26 morbidly obese patients waiting for a kidney or liver transplant, researchers at UCSF found laproscopic sleeve gastrectomy, a procedure where a majority of the stomach is removed and reshaped into a small tube or sleeve, significantly improved the chances of having successful organ transplants.

"The reason why physicians are skittish about bariatric surgery for organ transplant is that these patients have more medical comorbities," said Lin, who is the lead author of the study.  "But our study shows that it is safe to proceed."

One of the patients in the study was even taken off the transplant list because his kidney function improved, according to the findings.

Not all cases of bariatric surgery will see a reverse in symptoms, or even reversal in damage of organs.  Patients who have endured the weight and the metabolic diseases for longer may have less chance to see any type of reversal, said Ponce.

However, there are many factors to the surgery that contribute to changes, he said.

"We're not just treating the weight; we're actually treating the metabolic damage by doing this surgery," said Ponce.  "It changes their hormones and how their organs work in their body."

In other studies, presented at the meeting on Wednesday, bariatric surgery was shown to reverse kidney disease, stave off heart attacks by nearly a decade, and help manage diabetes.

"We can treat increased blood sugars with medications, but we are reversing complications [with surgery]," said Dr. Robin Blackstone, current president of the American Society for Metabolic and Bariatric Surgery.  "We are moving away from treating people just because they are obese and now we have disease specific indications for surgery such as heart disease, cancer, and diabetes."

Copyright 2012 ABC News Radio

Wednesday
Jun132012

How Young is Too Young for Bariatric Surgery?

Keith Brofsky/Thinkstock(NEW YORK) -- A gastric sleeve operation helped Betsy Sanchez, of Coahuila, Mexico, lose nearly 70 pounds when she was 12, reports the Daily Mail.  Her case is becoming increasingly familiar as doctors perform bariatric surgery on younger adolescents and children.

Before her operation, Betsy weighed 210 pounds and had a body mass index of 41, the paper says.  Her mother, Ana Sanchez, said she tried to cut portion sizes for her daughter as she grew heavier, but Betsy would demand seconds and throw tantrums if she didn't get snacks.

Dr. Guillermo Alvarez, a bariatric surgeon in Piedras Negras, Mexico who was also Sanchez's second cousin, performed Betsy's surgery.

"It is very controversial to operate on children," Alvarez told the Daily Mail.  "But I see the benefits of helping children in cases where parents have tried everything but nothing else seems to control their eating problem."

Now 14, Betsy said she has taken up exercising and is no longer bullied for her size.

"It has changed Betsy's life," Alvarez said.

A 12-year-old may seem young for a grown-up surgical procedure, but such operations are happening more and more.  As bariatric surgeries become more common in teens and adolescents, doctors have been debating the earliest age at which they should be performed.  Some surgeons in other countries have started doing the procedure on even younger children. In April, doctors in Saudi Arabia reported performing surgery on children as young as 5.

Doctors in the U.S. are also performing gastric sleeve and other bariatric surgeries on children, in hopes of arresting obesity and a host of related diseases that plague 17 percent of children and teens in the U.S.  But many are divided on how young is too young for the procedure.

"I think 12 is too young," said Dr. Elizabeth Prout Parks, a pediatric gastroenterologist at the Children's Hospital of Philadelphia.  "The reason is that cognitively, you need to make sure they understand this is a life-changing event that they can't ever reverse."

Gastric sleeve surgery, called a sleeve gastrectomy, involves shrinking the stomach from the size of a football to the size of a banana.  But unlike other types of bariatric surgery, such as gastric bypasses, it doesn't keep the body from absorbing key nutrients.  That makes it a more attractive option for children and adolescents, who still have some growing to do.

"The sleeve doesn't have as many of the complications that you see with other types of bariatric surgery," such as vitamin and nutrient deficiencies, said Dr. Amir Mehran, director of the UCLA Metabolic and Bariatric Surgery Program.  "If you decide to do bariatric surgery in kids, that's the way to go."

But Mehran said he'd still hesitate to do the operation on any child younger than 15.

Copyright 2012 ABC News Radio

Saturday
May122012

Study: Weight Loss Surgery Can Regulate Menstrual Cycle, Improve Hair and Skin

Hemera/Thinkstock (NEW YORK) -- New research indicates that weight-loss surgery can help women regulate their menstrual cycles and reduce excessive hair growth and skin problems that go along with extra weight, Health Day reports.

During the study, conducted at St. Luke's-Roosevelt Hospital Center in New York, scientists monitored 126 women ages 18 to 49 who were planning to undergo bariatric surgery, which reduces stomach size to make it easier for patients to decrease their food intake. All of the women involved were not yet approaching menopause. Researchers looked at the women's body mass index, since a high BMI creates hormonal changes, such as production of more male hormones, that lead to disturbances in the menstrual cycle.

The average BMI of the women in the study was 46, much higher than the average range of 18 to 24. Before surgery, 52 percent of women had regular periods, 39 had irregular periods and 22 percent had no periods. After surgery, the average BMI of the women dropped to 33, and 99 percent of the women who previously had irregular periods began menstruating on a regular basis again. Nearly 82 percent of the women who had reported no periods also began getting regular periods as well, according to Health Day.

Additionally, many women experienced less excess hair growth, hair loss, acne and a skin condition known as acanthosis nigricans that causes darkening of the skin, after the surgery.

Copyright 2012 ABC News Radio

Tuesday
Apr172012

Weight-Loss Surgery Cuts Type 2 Diabetes 

iStockphoto/Thinkstock(ROME) -- Bariatric surgery may be the best treatment for obese people who suffer from Type 2 diabetes, according to a new study published in the Archives of Surgery that found that the procedure improved diabetes outcomes when compared to patients who received standard medication therapy for the disease.

Researchers from the University of Rome in Italy conducted a study that included 60 morbidly obese patients with Type 2 diabetes. Half the patients underwent sleeve gastrectomy, a surgical procedure in which the stomach is reduced to about 25 percent of its original size.  The other half of the study participants received conventional medical therapy for type 2 diabetes.

Eighty percent of patients who underwent the surgery were cured of diabetes 18 months after the surgery, and their BMI, which averaged 41.3 before the procedure among the participants, was reduced to 28.3 after the study period.  A BMI of 30 or above is considered obese. But patients who received medication for the disease did not show improvement, and remained diabetic during and after the study period.

Researchers also noted that patients who underwent surgery saw improvements in blood pressure, cholesterol levels and obstructive sleep apnea.

Medically treated patients required more medication for blood pressure and cholesterol control over time.

“Midterm and long-term results are needed to confirm the positive effect (remission and/or improvement) of [laparoscopic sleeve gastrectomy] on diabetes and, overall, on the chronic complications of the disease,” the authors wrote in the study. “Most importantly, the longer-term results will allow us to compare the costs and benefits of bariatric surgery vs conventional medical treatments.”

But the patients in the study who simply received medication for treatment were not newly diagnosed patients, and Dr. Vivian Fonseca, president of the division of Medicine and Science with the American Diabetes Association, said it would have been better to see how newly diagnosed patients responded to the medications versus the bariatric candidates.

“They selected people who were already obviously not doing well on medication therapy, so it’s unrealistic expectation that the medication therapy is going to be able to stop after a while,” Fonseca said. “It would have been better to see newly diagnosed patients who seemed to be doing well on medications.”

The Italian study comes on the heels of two studies published last month that found bariatric surgery lowers blood sugar levels almost immediately in patients with type 2 diabetes even before patients lost weight. One study found 42 percent of patients who underwent the gastric procedure showed no evidence of diabetes one year later, compared to 12 percent who received medication.

There are currently 25.8 million adults and children in the United States living with diabetes, according to the American Diabetes Association, and about 1.9 million new cases of diabetes were diagnosed in people 20 and older in 2010.

By 2020, the ADA estimates that the annual cost in caring for diabetic patients will near $192 billion. A typical bariatric surgery runs between $10,000 and $15,000 in the United States.

Only about 2 percent of these patients are currently treated with bariatric surgeries, but experts say the cost-effectiveness must be studied further to understand whether these surgeries are appropriate for the masses.

“There are a variety of treatments available in terms of altering the GI tract,” said Dr. Gerald Bernstein, director of the Diabetes Management Program at the Friedman Diabetes Institute at New York’s Beth Israel Medical Center.

Nevertheless, Bernstein said, given the tens of millions of people who have diabetes, it is economically impossible to offer the surgery to everyone. But it is important for primary care physicians, endocrinologists and surgeons to work together to decide which Type 2 diabetes patients would benefit most from these surgeries.

“Doctors need to be sure they find patients who will make this surgery worthwhile,” Bernstein said. “If you’re going to do something like this that significantly changes the body, you need to make sure they have the motivation to follow doctor’s recommendations.”

“Right now, this is another tool and option in the arsenal for diabetes treatment,” he said.

Copyright 2012 ABC News Radio

Monday
Mar262012

Bariatric Surgery Cuts Type 2 Diabetes, Studies Find

Jeffrey Hamilton/Lifesize/Thinkstock(NEW YORK) -- Type 2 diabetes, which affects nearly 26 million Americans, may have met its match.

The results of two separate trials published Monday in the New England Journal of Medicine showed for the first time that bariatric surgery can lower blood sugar levels immediately in patients with type 2 diabetes, even before the weight comes off.  The surgery limits the amount of food a person can eat, and the amount of calories they absorb.

"Bariatric surgery should not be considered just weight-loss surgery," said study author Dr. Francesco Rubino of Weill Medical College of Cornell University, "but a means to treat diabetes and metabolic disease."

Rubino and co-authors at the Catholic University in Rome enrolled obese patients to undergo either intense drug therapy for their diabetes or bariatric surgery.  Of patients who had Roux-En-Y surgery, the most common type of bariatric surgery in the United States, 75 percent showed no evidence of diabetes and were off their medications.  The improvement started 15 days after surgery.  No one in the drug treatment group was free of diabetes.

A similar study from the Cleveland Clinic found that 42 percent of patients who underwent gastric bypass surgery showed no evidence of diabetes one year later, compared with 12 percent of patients who received drug therapy.

"For about a century, we have been treating diabetes with pills and injections, and this is one of the first studies to show that surgical therapy may, at least in some patients, be much more effective than the polypharmacy approach to treating this disease," said study author Dr. Philip Schauer at the Cleveland Clinic Bariatric and Metabolic Institute.

The surgery also triggered a drop in triglyceride levels, and levels of good cholesterol went up.

"Currently less than 2 percent of patients are treated with bariatric or metabolic surgery," said Dr. Joel Zonszein, director of the Clinical Diabetes Center at the University Hospital of the Albert Einstein College of Medicine, who was not involved in the studies.  "Many more people can benefit."

As to whether bariatric surgery is the answer, more research into its cost-effectiveness is needed.

"Given that there are millions of obese people with diabetes, it is physically and economically impractical to provide this technology for all," said Dr. Gerald Bernstein, director of the Diabetes Management Program at the Friedman Diabetes Institute at New York's Beth Israel Medical Center.

Copyright 2012 ABC News Radio

Friday
Mar232012

Gastric Bypass Hypnosis: Weight Loss Training for Your Brain?

ABC News(NEW YORK) -- Imagine having the sensation that your stomach is surgically constricted to a fraction of its original size, making your appetite tiny, and your weight loss huge -- no surgery, no magic pills. According to hypnotherapists, you can achieve that for just a fraction of the cost of real bariatric surgery, by undergoing so called gastric bypass hypnosis.

The idea of losing weight through hypnosis has been around for decades, but now some hypnotherapists are offering "gastric bypass hypnosis," also called "lap band hypnosis." This "procedure" is done to "reprogram" the minds of patients to believe their stomachs are actually smaller, making them incapable of eating large meals without feeling uncomfortably full.

Every year, nearly 400,000 Americans undergo painful and expensive surgical procedures to have portions of their stomachs removed, repositioned or constricted. These procedures can cost up to $35,000 dollars, but gastric bypass hypnotherapists claim their hypnosis sessions can provide similar weight loss results for a lot less money: about $1200 dollars.

Certified hypnotherapist Rena Greenberg said she has worked with over 100,000 patients in the past 20 years and is adamant that hypnosis helps stop her clients from obsessing over food. Her "virtual" procedure includes three hypnosis sessions, her therapeutic CDs and a weight-loss juice she invented called "Slender Cider."

This promise of an inexpensive, re-programming of the brain to eliminate sugar cravings could appeal to many of the 60 million Americans who are classified as obese. To the skeptics of gastric bypass hypnosis, Greenberg said, "Many of us underestimate the real power of the mind -- what we're capable of."

Dr. David Treen, a leading bariatric surgeon in New Orleans, performs a radical stomach surgery known as sleeve gastrectomy, which removes 85 percent of the stomach and a hormone called Ghrelin, which stimulates appetite.

Treen said he thought long term success with hypnosis seems "unrealistic."

"The reality is that there are no studies which demonstrate that kind of weight loss with hypnosis alone," he said.

Copyright 2012 ABC News Radio







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