Weight-Loss Surgery Increases Risk of Alcohol Addiction

iStockphoto/Thinkstock(PITTSBURGH) -- Having Roux-en-Y gastric bypass surgery, where the size of the stomach is reduced and the intestine is shortened, thus limiting how much a person can eat, can increase the risk of alcohol-use disorders, new research suggests.

The study, conducted by researchers at the University of Pittsburgh Medical Center, adds to mounting evidence of a link between having the popular gastric bypass surgery and the symptoms of alcohol-use disorders.

Before the surgery, the nearly 2,000 study participants completed a survey developed by the World Health Organization that is used to identify symptoms of alcohol abuse.

The patients then completed the survey one and two years after their weight-loss surgery.  The study found that 7 percent of patients who had gastric bypass reported symptoms of alcohol use disorders prior to surgery.  The second year after surgery, 10.7 percent of patients were reporting symptoms.

The findings were published Monday in the Journal of the American Medical Association.

"There have been previous studies that show there is a change in alcohol sensitivity in gastric bypass," said Wendy King, a research assistant professor in the department of epidemiology at the University of Pittsburgh Medical Center, and the study's lead author.

King's study is the first to show that with this increased sensitivity there is also an increased risk of alcohol use disorders (AUD), the term used to describe alcohol abuse and dependence.

Dr. Mitchell Roslin, a bariatric surgeon at Lenox Hill Hospital in New York City, said the link between gastric bypass surgery and increased alcohol use has been attributed before to the shifting addiction theory and that this is false. The shifting addiction theory is that if a person has an impulsive drive to eat and the ability to eat large amounts of food is taken away, then he will shift his addiction to another addictive substance, like drugs or alcohol.

"A gastric bypass patient has a small pouch [for a stomach] so alcohol goes straight into the intestine and is absorbed rapidly," said Roslin. "When it is absorbed rapidly, there is a high peak and rapid fall." The higher absorption rate makes alcohol more addictive, he added.

The study also found that the increase in alcohol-use disorders was not seen until the second post-operative year as opposed to the first year after surgery.

"This emphasizes that continuing education about alcohol use is needed until the second year after surgery.  With follow up [patients] need to hear about consumption and what is appropriate," said King.

Copyright 2012 ABC News Radio

Choking Death Linked to Gastric Bypass Surgery

Keith Brofsky/Thinkstock(LONDON) -- A U.K. woman died choking on food that wouldn't fit in her stomach after weight-loss surgery, according to an inquest into her death. But experts say gastric bypass patients are no more likely to choke than someone who didn't undergo the surgery.

The inquest into the December 2011 death of Dianne Bernadette Cooper-Clarke concluded the 64-year-old mother suffocated because of a backlog of food outside her stomach, which had been surgically shrunken to the size of a thumb, according to the Daily Mail.

"The tube that goes from the mouth to the stomach was swollen and food had built up all the way to the throat," Dr. Hugh Jones, the Royal Cornwall Hospital pathologist who performed the autopsy, told the inquest, according to the U.K.'s Daily Mail. "Your esophagus is the size of a little finger, but hers was as big as her stomach. ... I considered the food had blocked off her breathing, and that was the cause of death."

Calls by ABC News to Jones were not immediately returned.

Cooper-Clarke had gastric bypass surgery in March 2010, the Daily Mail reported. The procedure uses staples to shrink the stomach so patients eat less food and absorb fewer calories. Patients are warned that overeating can lead to complications.

"After surgery, correct behavior should be measuring food, eating small amounts several times a day and not eating to the point where you're too full or throwing up," said Dr. Mitchell Roslin, a bariatric surgeon at Lennox Hill Hospital in New York. "It takes a long time for the esophagus to dilate out like that, and you'd be symptomatic long before that happened."

Symptoms like bad breath, vomiting and regurgitating food can signal a digestive obstruction, a risk associated with bariatric surgery, according to Roslin, who has no firsthand knowledge of Cooper-Clarke's medical history. But choking would mean aspirating food into the windpipe and being unable to cough it out -- a rare event that could also happen to someone who didn't have bariatric surgery.

"People who can't protect their airways are usually in some sort of altered state," said Roslin, adding that aspiration is often a consequence of alcohol use. "Choking is not a realistic fear for bariatric surgery patients. This just demonstrates that crazy things can happen to anyone."

In the U.S., bariatric surgery is a last resort for people who have tried and failed to lose weight by other means. And while any surgical procedure carries risks, the benefits of bariatric surgery can be life changing, Roslin said.

"I've seen people on 20 medications come off them; people come out of wheelchairs able to live productive and active lives; people on transplant lists now working full time, just from the massive weight loss," he said. "It really can change lives. But the surgery is just a tool to help people be less hungry and make better choices. It's by no means a fool-proof solution."

The inquest concluded Cooper-Clarke's gastric bypass surgery was carried out properly, and that her behavior after the procedure is what led to her death.

"People do not stick to [eating less] and this is tragically what happens," said deputy coroner Andrew Cox, the Daily Mail reported. "This is not a natural cause of death. It is not an accident because she chose to eat. She died of a known complication of an elective surgical procedure of a gastric bypass."

Copyright 2012 ABC News Radio

Texas Teen Loses Over 150 Pounds with Controversial Gastric Bypass

Courtesy of Nick Preto(NEW YORK) -- A year ago, Nick Preto, a 16-year-old from Baytown, Texas, weighed an astounding 403 pounds.  He was about to enter his senior year in high school and was plagued with potentially life-threatening health problems.

ABC's Nightline asked Preto and his mother, Toni Preto, if they could follow him as he underwent a highly controversial surgery for teenagers: gastric bypass.

Over the course of the past year, Preto has gone on a remarkable weight-loss journey, losing 150 pounds and changing the way he lives his life.  But it has not been easy.

Last June, before the surgery, Preto took Nightline on a tour of the fast food joints he regularly visited.  He was routinely consuming 7,000 calories a day -- three times the recommended total for an adult man -- and knew he had to make changes.

"It's senior year, you know, you want to date the homecoming queen.  You want to have the cutest girl," he said at the time.  "I guess just because I've been bigger, nothing has really happened with ... the ladies."

But Preto's doctors told him if he didn't lose the weight, the ladies were going to be the least of his problems.  The teenager was careening towards an early death.  He was already a pre-diabetic and suffering from sleep apnea, liver damage and joint pains.  So he decided to get some radical help through gastric bypass surgery.

Preto's surgeon, Dr. Mary Brandt, was hesitant about doing such a major and irreversible operation on a teenager.

"I really didn't think it was a good idea," she said.  "I mean, metabolically changing someone who's a growing adolescent to me, made no sense.  But this is the first generation that's not going to outlive their parents.  That's the scariest thing to me."

The procedure, which completely rewired Preto's digestive system and reduced his stomach from the size of a small toaster oven to the size of an egg, took about two hours.  The first weeks after surgery were tough for Preto as he adjusted to eating tiny portions.

Seven weeks later, his weight was down from 403 pounds to 315 pounds.  But Preto told Nightline anchor Cynthia McFadden that changing his diet was difficult.  Not only was he frequently vomiting, the whole process had been an emotional roller coaster.

But despite the tough road, Preto was determined to keep going, and said he intended to lose 100 pounds in the next six months.

Nightline reconnected with Preto a few weeks ago after the six months was up for the big weigh-in.  When he stepped on the scale, he had dropped another 70 pounds, which was not quite the 100-pound goal he had set for himself, but still an impressive achievement, weighing a total of 247 pounds.  A year ago, his waist was 60 inches.  Today, it's 34.

But more important than the number on the scale was the joy in Preto's eyes as he stepped out to attend his senior prom with his new girlfriend, Jordan.  Not only was he healthier, he was happier too.

Copyright 2012 ABC News Radio

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

For Some, Weight-Loss Surgery Can Trigger Eating Disorders

Brand X Pictures/Thinkstock(NEW YORK) -- When multiple traditional diet methods fail, weight-loss procedures such as lap band surgery are seen as a last hope for getting obese patients to eat more healthfully and lose weight.

But for an under-recognized minority of patients, the surgery only triggers a different kind of disordered eating.  For some, it's bulimia, while for others, it's anorexia.

Sixty percent of individuals seeking treatment for obesity have some kind of eating disorder, usually binge eating, according to a 2007 Harvard study.  It is these individuals, who already have an unhealthy relationship with food and their bodies, who are at most risk of developing further eating disorders post-surgery, says Lisa Lilenfeld, a psychologist and president of the Eating Disorders Coalition at Argosy University in Washington, D.C.

Lap band or gastric bypass surgery is not likely to create an eating disorder where there wasn't one, she explains, but "the most likely thing is that people had untreated or unsuccessfully treated binge eating disorders before surgery will continue to have problems after surgery.  The problem is, it becomes physically challenging and potentially dangerous to binge like this because of the structural changes in the stomach," she says.

On the other end of the spectrum, patients who used to overeat now overshoot with their weight loss, severely limiting their caloric intake to the point of malnutrition and anorexia.

"I've had a number of patients go from very obese to very underweight, so much so that they need to be rehabilitated with intravenous nutrition," says Dr. Donald Kirby, a gastroenterologist at the Cleveland Clinic who treats patients undergoing bariatric weight-loss surgery.

Because there are still no statistics on how many of these patients experience eating disorders post-op, it's difficult to gauge the scope of this issue and there is much debate over its prevalence between the surgeons who perform the procedures and the therapists who treat eating disorders down the line.

Dr. Mitch Roslin, a bariatric surgeon at Lenox Hill Hospital in New York, has performed thousands of bariatric surgeries and he says he only sees one or two cases a year of eating disorders, but psychologist Lilenfeld believes it's much more common than that.

Copyright 2011 ABC News Radio

Gastric Bypass Surgery Can Reverse Diabetes

Jeffrey Hamilton/Thinkstock(BRUSSELS, Belgium) -- Surgery should be considered as a treatment for obese patients with diabetes, according to a statement released Monday by the International Diabetes Federation.

Doctors have made a significant discovery: When it comes to weight-loss surgery for diabetics, gastric bypass surgery reverses the disease before the patients lose the weight.

"It's not uncommon for a patient to be on 100 units of insulin a day, so they're injecting themselves three or four times a day, and before they leave the hospital, they will never use insulin again," said Phil Schauer, director of the Cleveland Clinic Bariatric and Metabolic Institute. "For that patient, it must be an absolute miracle."

Gastric bypass surgery works by reducing the size of the stomach so a person can't eat as much and shortening the length of the intestine so that the body doesn't absorb too many calories. But it might also have the side effect of normalizing blood sugar.

"The fast effectiveness is due to, we think, an elaboration of hormones made by the intestines," Schauer said. "These are called incretins and these are dramatically increased after surgery in hours or days."

"These hormones stimulate the pancreas to make more insulin. And that's thought to be the underlying problem with type 2 diabetes."

The International Diabetes Federation's recommendation might apply to more than 15 million people who have type 2 diabetes and are struggling with obesity.

But Ann Albright, director of the Division of Diabetes and Translation at the Centers for Disease Control and Prevention, cautions that surgery should not be the first option.

"You would not likely go to surgery initially, attempts should be made to manage type 2 diabetes with nutrition and physical activity first," she said.

"Then you would [take] medications as necessary, and if you still are not able to reach your treatment goals for those for which it is appropriate, surgery should be considered."

Copyright 2011 ABC News Radio

Study: Teens Lose Bone Mass After Gastric Bypass Surgery

Jupiterimages/Thinkstock(CINCINNATTI) -- Many adults who have gastric bypass surgery suffer bone loss in the years after their operation, and a new study shows the same thing happens to adolescents.

Researchers led by Dr. Anne-Marie Kaulfers, then a clinical fellow in endocrinology at Cincinnati Children's Hospital Medical Center, looked at 61 adolescents who had Roux-en-Y gastric bypasses.  A Roux-en-Y bypass involves making a small pouch from stomach tissue and attaching it directly to the small intestine, bypassing most of the stomach and the first part of the small intestine, called the duodenum.

They found teens suffered 5.2 percent bone loss a year after surgery, which increased to 7.4 percent after two years.  However, obese teens already have an above-average amount of mineral mass in their bones, so even though they lost more than seven percent of that mass, it decreased to the same amount that normal-weight teenagers have.

The study stopped two years post-surgery, so the researchers don't know whether the decline continues beyond that point.  "However, if bone loss continues, even at a slow rate, these patients may have an increased risk of fractures later in life," the authors wrote.

While some specialists say the findings aren't new because other studies showed similar results in adults, others say the study draws attention to one of the big risks of gastric bypass surgery.

"This study is very important because we all know that there are consequences to rapid weight loss, and bone loss has been a concern in adults and now we know that it happens in adolescents," said Dr. James Geiger, surgical director of the C.S. Mott Children's Hospital Comprehensive Weight Management Program in Ann Arbor, Michigan.

Experts say it's important to learn more about bone loss in younger people who have a gastric bypass in order to determine why it happens, what the long-term consequences are and how possibly to reverse bone loss.

Copyright 2011 ABC News Radio

Gastric Bypass Can Renew the Heart

Photo Courtesy - Getty Images(AUGUSTA, Ga.) - A surgery typically used to help the obese lose weight may also help bring a stressed heart back to a better condition, reports HealthDay News.

Researchers at the Medical College of Georgia have found that gastric bypass surgery can help improve an obese individual's heart, which is more susceptible to heart failure, abnormal heart rhythm and death.
 
The study, published in the Journal of the American College of Cardiology, found that the hearts of severely obese people who underwent the weight-loss surgery showed a reduction in the mass of the left and right ventricular areas.

"We know obese people get cardiovascular disease more often than non-obese people," said Dr. Sheldon Litwin, chief of cardiology at the Medical College of Georgia. "One of the questions out there is: Is it reversible if they lose weight? The answer is yes."

Reductions in the heart's mass means the heart is less stressed as it no longer has to work as hard to pump blood.

Copyright 2011 ABC News Radio

One Gastric Band, Two Sisters, Nearly Identical Weight Loss

Photo Courtesy - Getty Images(LONDON, England) - Paula Muir and her identical twin sister, Karren Fraser, have always been very close.

"We're competitive, but always encourage each other," said Muir. "We always show massive support for each other."

That support and competitiveness helped the sisters, who are 46 and live in England, achieve a remarkable goal: between them, they lost more than 300 pounds.

Muir lost about 140 pounds, but Fraser had an easier time losing weight, since she opted for gastric banding surgery, a procedure that involves placing an adjustable band around the top of the stomach. The result is that the person feels full more easily and eats smaller portions of food, leading to weight loss.

"I couldn't get a gastric band because I didn't have the money," said Muir. But she was determined not to let that get in the way of her weight loss goal. "I didn't want to be the fat twin," she said. "After all, we're twins, so we have to look alike."

Thanks to her competitive spirit and the support of her sister along the way, Muir disciplined herself to eat the same-size portions as her sister did. She knew she wouldn't lose quite as much weight as her sister, but was determined to keep it close.

Copyright 2011 ABC News Radio

Woman With Diabetes Gains Weight to be Eligible for Gastric Bypass

Photo Courtesy - Getty Images(LOS ANGELES) -- Rebecca Blair, a veterinarian from Rancho Cucamonga, Calif., got a dreaded diagnosis back in 2007: type 2 diabetes.

"I was on four different oral medications and injections, but my diabetes was very bad and nowhere near controlled," said Blair.

She ate healthy foods and did everything she could to lose weight, but wasn't successful at either dropping the pounds or bringing her blood sugar under control.

Blair said she watched a lot of health-related television programs and learned about overweight people who had a gastric bypass surgery that actually helped their diabetes in addition to helping them lose weight.

"That sparked my interest, and I did some more research," said Blair. After that, she was convinced she wanted to have a gastric bypass.

But the bariatric surgeon she saw, Dr. Theodore Khalili of Cedars-Sinai Medical Center in Los Angeles, dashed Blair's hopes.

"Her BMI [body mass index] was too low to do a gastric bypass, because we follow the guidelines set by the CDC [Centers for Disease Control and Prevention]," said Khalili. Those guidelines, he said, recommend against doing bariatric surgery on diabetics with a BMI less than 35. Blair's was only around 24.

Blair was undeterred.

"I did more research, then I tried to find a clinical trial, and then I decided to gain weight," she said.

Blair hoped to gain enough weight to qualify for a bypass -- and eventually she did. She gained about 85 pounds over a two-year period by eating a lot of fat.

"When she came back, she qualified for surgery," said Khalili, who by then had founded the Khalili Center for Bariatric Care in Beverly Hills. "She underwent the surgery, and is now down to one diabetes medication that she can probably discontinue soon."

But Khalili and other surgeons say that while gastric bypass seems to work wonders for diabetics by resolving their condition and helping them lose weight, they would never recommend that any patient deliberately gain weight in order to meet criteria for weight loss surgery.

Copyright 2011 ABC News Radio