In the News
Community Lecture Series Improving Metabolism in 60 Minutes – Marc Zare, MD
Dr. Marc Zaré – Laparoscopic & Bariatric Surgeon, San Jose
Weight-loss Surgery Puts Diabetes Into Remission
Pro’s Perspective on Ruling in Kaiser Plastic Surgery Lawsuit
In recent news, a California judge ruled that Kaiser Foundation cannot routinely deny coverage for skin excess procedures by classifying them as cosmetic in nature. The class action lawsuit, started by Wendy Gallimore of Alameda County in 2012, argued that Kaiser violated California law by refusing to cover procedures designed to remove excessive skin after surgical weight loss. The lawsuit and updates are in the Kaiser Plastic Surgery Class Action Lawsuit (Updated) article.
Meta‐analysis comparing early versus delayed laparoscopic cholecystectomy for acute cholecystitis
Previous studies comparing early laparoscopic cholecystectomy (ELC) with delayed laparoscopic cholecystectomy (DLC) for acute cholecystitis were incomplete. A meta‐analysis was undertaken to compare the cost‐ effectiveness, quality of life, safety and effectiveness of ELC versus DLC.
Biologically Inactive Leptin and Early-Onset Extreme Obesity
Source: The New England Journal of Medicine
Wabitsch et al. (Jan. 1 issue) 1 highlight how biologically inactive leptin from a mutation in the leptin gene (p.D100Y) led to early-onset extreme obesity in a 2-year-old boy, a finding that paralleled a murine model encoding mutated leptin (p.V145E). The authors cite studies that characterize leptin as an adipocyte-derived hormone reflecting body energy status and functioning as a satiety signal in the hypothalamus. Hence, the mechanism of obesity is ascribed purely to that resulting from hyperphagia and consequently high energy intake.
Association between Bariatric Surgery and Long-term Survival
Source: The Journal of American Medical Association
Importance Accumulating evidence suggests that bariatric surgery improves survival among patients with severe obesity, but research among veterans has shown no evidence of benefit.
Objective To examine long-term survival in a large multisite cohort of patients who underwent bariatric surgery compared with matched control patients.
“I’ve struggled with weight my whole life,” says Morgan Hill resident Matt Reichstein, 45, who had weight loss surgery at with Dr. Zare.
“I used to tell myself my size didn’t matter. I feel good and I have lots of friends, a job and a nice place to live. But, my self-confidence wasn’t good. I’d take a look at myself in the mirror and think, ‘you’re never going to have the life you really want.’
“Now, since the surgery, to be in restaurants, airplanes and even amusement parks with no problem . . . to buy clothes in regular department stores . . . to go on dates or be out in public and have people notice me with an appreciative glance . . . it’s an amazing feeling.”
|Before surgery||18 months later|
|Weight||434 lbs.||265 lbs.|
|Body mass index (BMI)||55.7||33.1|
At 6’3″, Matt has always been a big, active guy. He grew up in the Santa Cruz Mountains, where kids often teased him about being fat. Throughout his time at Los Gatos High School, he was a three sport athlete.
“Looking at old photos, I always thought of myself at heavy, but not obese,” he remembers. “But, I’m much like my dad. It’s our lot in life to be friendly and the life of the party, but also to love food and gain weight.”
It was during his college years that Matt really started putting on the weight. By the time he was in his 20s, he was in the 400-lb. range.
“That’s when I started working out in the gym and going to Weight Watchers. I was able to drop a lot of weight and, at one point, got down to 250 lbs. The trouble was, I never hung out with my friends or went for a beer or a glass of wine. I was in the gym all the time and, basically, didn’t have any kind of a life.”
Food has always been important to Matt. In his mid-30s he started putting the weight back on.
“It was as though food consumed me, and it felt like I never had enough. Plus, as I got older, it was harder to take off the weight in the gym,” he recalls.
At times, he would ‘give up’ his life again, redoubling his exercise efforts and trying to keep his diet in check—only to put it all back on and more. By the time he was in his early 40s, Matt was tipping the scales at 460 or 470 lbs.
Life changed the day he was approached by an old acquaintance during a night out with friends.
“I recognized her eyes, but not the rest of her. She looked great,” said Matt.
Turns out they had known each other for a long time and had a few things in common. She, too, was a good athlete and an active person but had always battled her weight. When Matt asked her what she had done to look so good, she told him about having weight loss surgery and urged him to consider it.
Over the next few months, he learned as much as he could about the surgery and his options. He met with a weight loss surgery nurse, attended support group meetings, and was referred to Dr. Zare, a surgeon on the medical staff at Good Samaritan Hospital. It was time for a change.
Matt and his surgeon selected a procedure called the laparoscopic vertical sleeve gastrectomy. With this minimally invasive surgery, a narrow sleeve of stomach is created and the excess stomach is removed. The procedure limits the amount of food a person can eat and helps suppress appetite. Patients can lose more than 75 percent of their excess weight over a period of eight to eighteen months.
After going through the weight loss surgery programwith Dr. Zare, and completing the necessary tests and preparations, Matt had his procedure. His parents and brother were with him. Friends and family were very supportive throughout his brief time in the hospital and for a two-week stay at his parents’ house after his discharge.
“The hospital experience was great. I had a private room, flat screen TV with all the stations, and everyone was very nice,” said Matt. “I’m not going to say it was totally easy and painless, but I got through it with some excellent care and a lot of walking the floors on my part. I guess all my working out had put me in good shape. I bounced back pretty quickly, and Dr. Zare sent me home earlier than expected.”
Matt continued his walks and returned to the gym for light workouts a week after surgery. He was able to go back to work in just two weeks. For him, the hardest thing was the all-liquid diet he had to follow for two months.
Within 4-6 weeks, he began doing heavier workouts at a new gym called Fitness Never Sleeps. According to Matt, the weight began ‘pouring off,’ with 50 lbs. vanishing in the first three months.
“That gym and the people there have become my support group. Working out has taken the place of much of the eating that used to be such a big part of my life,” he reports.
Matt won’t lie. Going through the changes in his body and adjusting to a much smaller diet have not been easy.
“But, I will say weight loss surgery is a wonderful tool that is making it easier for me to get to a healthier, more attractive weight and enjoy life on my own terms.”
Surgical Skill and Complication Rates after Bariatric Surgery
Source: N Engl J Med 2013; 369:1434-1442
Clinical outcomes after many complex surgical procedures vary widely across hospitals and surgeons. Although it has been assumed that the proficiency of the operating surgeon is an important factor underlying such variation, empirical data are lacking on the relationships between technical skill and postoperative outcomes.
We conducted a study involving 20 bariatric surgeons in Michigan who participated in a statewide collaborative improvement program. Each surgeon submitted a single representative videotape of himself or herself performing a laparoscopic gastric bypass. Each videotape was rated in various domains of technical skill on a scale of 1 to 5 (with higher scores indicating more advanced skill) by at least 10 peer surgeons who were unaware of the identity of the operating surgeon. We then assessed relationships between these skill ratings and risk-adjusted complication rates, using data from a prospective, externally audited, clinical-outcomes registry involving 10,343 patients.
Mean summary ratings of technical skill ranged from 2.6 to 4.8 across the 20 surgeons. The bottom quartile of surgical skill, as compared with the top quartile, was associated with higher complication rates (14.5% vs. 5.2%, P < 0.001) and higher mortality (0.26% vs. 0.05%, P=0.01). The lowest quartile of skill was also associated with longer operations (137 minutes vs. 98 minutes, P < 0.001) and higher rates of reoperation (3.4% vs. 1.6%, P=0.01) and readmission (6.3% vs. 2.7%) (P < 0.001).
The technical skill of practicing bariatric surgeons varied widely, and greater skill was associated with fewer postoperative complications and lower rates of reoperation, readmission, and visits to the emergency department. Although these findings are preliminary, they suggest that peer rating of operative skill may be an effective strategy for assessing a surgeon’s proficiency.
Bariatric Surgery Patients Exhibit Improved Memory Function 12 Months Postoperatively
Learning to eat again: Man drops 130 pounds after surgery
Debbie Benzine lost her first husband to heart disease when he was 44. His death left her to raise a young child alone. For 16 years, she stayed single because, “going through it once was enough for me.”
Weight Loss Surgery May Affect Fat-Related Genes
Weight-loss surgery changes the levels of genes involved in burning and storing fat, a new study says.
The findings may help lead to the development of new drugs that mimic this weight-loss-associated control of gene regulation, said the authors of the study published online April 11 in the journal Cell Reports.
The Obesity-Inactivity-Cancer chain
Source: Daily Rx
The link between obesity and cancer is nothing new. Lack of regular exercise and cancer are also teammates. A new study has added some links to this chain of knowledge.
Researchers found that higher body mass index (BMI) was associated with a specific type of colorectal cancer. Physical activity decreased the risk of this cancer, which has a specific molecular signature.
Surprising misperceptions about weight status and obesity health risks
Although the majority of the American public views obesity as a serious public health issue, a surprising number tend to misperceive their own weight status and do not fully understand all the health consequences of being obese, according to results from The Associated Press-NORC Center for Public Affairs Research survey.
The results showed that nearly half of the overweight, but not obese, respondents misperceived their own weight status and thought their weight was about right. And while many of the respondents were aware of the link between obesity with heart disease and diabetes, most were less likely to mention other serious health impacts associated with being overweight or obese.
Disabled by weight: obese with arthritis
Source: Daily Rx
Being obese is just plain unhealthy. All that excess fat can make outcomes worse for patients with any of a number of diseases, including rheumatoid arthritis.
A recent study showed that morbidly obese patients with inflammatory polyarthritis – which includes diseases like rheumatoid arthritis – had higher levels of disability than arthritis patients who were not obese. Morbidly obese patients had about twice the odds of disability compared to those who were not obese.
Seven dangerous myths about weight loss — or are they little white lies?
The cover copy of a thousand magazines was attacked this morning in the august pages of the New England Journal of Medicine by Krista Casazza, David B. Allison, both from the University of Alabama, Birmingham, and a long list of co-authors. Much of what you’ve been told about weight loss is wrong and, in the current style of journalists everywhere, they break these misconceptions down into a list of widely-held myths, which they then attack with dry academic savagry.
Eat lunch early and lose weight!
Source: Medical Breakthrough
Trying to lose weight can be awful; you do all the right things but the pounds stay put. Now researchers think they have discovered a significant factor in not only how much weight people lose, but how fast the weight is lost as well. The study says that early eaters lose weight more effectively than individuals who take their meals later on in the day.
Extra weight and slipped discs
Source: Daily Rx
Carrying excess weight can aggravate your lower back and cause other musculoskeletal problems. But when it comes to slipped discs in the spine, not much is known about the effect of that excess weight.
Time for dinner! Time for healthy kids
Source: Daily Rx
There’s more to a meal than eating. The time spent with family at the dinner table can be good both for the heart and to help keep off the extra pounds.
A recently published study found that families who sit down together for 20 minutes or more during meal times can improve kids’ health and better maintain a healthy weight compared to families who do not spend as much time together.
Bedroom TVs associated with childhood obesity
Source: Medical news today
Kids who have a TV in their bedroom are at a significantly higher risk of obesity and a larger waist circumference.
This finding came from a study in American Journal of Preventive Medicine which showed that a child’s waist size may greatly increase with prolonged TV viewing. The research is similar to a prior report which indicated that children’s muscular fitness decreases the more hours they spend watching TV, while their waistline gets bigger.
Kids between the ages of 8 and 18 in the United States watch an estimated 4.5 hours of television each day, and a TV is found in the bedroom of 70% of these children.
Obesity affects one-third of adolescents aged 6 to 19. Previous research demonstrated that childhood obesity can be prevented by sitting down to a family dinner more frequently and reducing the amount of TV viewed.
Studies have also shown that the amount of television viewed as a child remains the same in adulthood, therefore, the person becomes overweight and ends up with high total cholesterol.
A team of researchers, from the Pennington Biomedical Research Center in Baton Rouge, LA, demonstrated the association between having and viewing television in the bedroom and obesity in children, particularly elevated waist circumference.
Peter T. Katzmarzyk, PhD, leading researcher, said:
“The established association between TV and obesity is predominantly based on BMI. The association between TV and fat mass, adiposity stored in specific depots (including abdominal subcutaneous and visceral adipose tissue), and cardiometabolic risk, is less well understood. It is hypothesized that higher levels of TV viewing and the presence of a TV in the bedroom are associated with depot-specific adiposity and cardiometabolic risk.”
There were 369 kids and teens aged 5 to 18 from Baton Rouge, Louisiana who were involved in the study between 2010 and 2011. There was a balance between BMI status, gender, age, and ethnicity among the subjects, who were assessed for:
- fat mass
- stomach fat
- waist circumference
- fasting triglycerides
- resting blood pressure
- high-density lipoprotein cholesterol
Analysis showed that when kids had a TV in the bedroom, they had a higher probability of viewing more television.
In contrast to the children who did not have a TV in their room, those with a bedroom TV had a higher waist circumference, more fat and more subcutaneous adipose tissue mass.
The subjects who had a bedroom TV and who also viewed over 2 hours of TV a day, were shown to have 2.5 times the odds of the highest levels of fat mass.
Watching television for over five hours doubled the likelihood of being in the top quartile for visceral adipose tissue mass.
A TV in the bedroom was linked to three times the odds of:
- high waist circumference
- high cardiometabolic risk
- elevated triglycerides
Amanda Staiano, PhD, co-author, concluded:
“There was a stronger association between having a TV in the bedroom versus TV viewing time, with the adiposity and health outcomes. A bedroom TV may create additional disruptions to healthy habits, above and beyond regular TV viewing. For instance, having a bedroom TV is related to lower amounts of sleep and lower prevalence of regular family meals, independent of total TV viewing time. Both short sleep duration and lack of regular family meals have been related to weight gain and obesity.”
When Robotic Surgery Leaves Just a Scratch
SURGEONS once made incisions large enough to get to a gallbladder or other organs by using conventional tools they held in their own hands. Today, many sit at a computer console instead, guiding robotic arms that enter the patient’s body through small openings not much larger than keyholes.
Bariatric surgery cuts heart attack risk for years
Researchers looked at numerous heart (cardiac) risk factors before and after gastric bypass surgery and found all improved.
Improvements in heart risk factors included:
- Total cholesterol declined from 184 before surgery to 174 after. (Below 200 is recommended.)
- HDL or “good” cholesterol rose 40%.
- LDL or “bad” cholesterol improved.
- Triglycerides (blood fats) declined by about 55%.
Kidney cancers: Major rise ‘linked to obesity’
Obesity is fuelling a major increase in the number of cases of kidney cancers diagnosed in Britain, experts say.
Obesity increases kidney cancer risk by about 70%, compared with smoking which increases it by about 50%.
The experts say that being overweight increases the risk of this cancer, as well as others including breast, bowel and womb cancer, because it causes the higher levels of certain hormones to be produced, compared with those seen in healthy people.
Weight loss procedures help improve overall health
Source – WRAL
For the 90 million Americans impacted by obesity, bariatric surgery is becoming an increasingly popular option to jump start weight loss.
The procedures are life-saving in many instances, but not just because of the drastic weight loss. Doctors are quickly discovering that weight-loss surgeries can help improve symptoms associated with hypertension, diabetes and cardiovascular disease.
Genes found to increase childhood obesity risk
Researchers have identified two genetic variations that appear to increase the risk of childhood obesity.
The study authors took data from North American, Australian and European meta-analysis of 14 studies consisting of 5,530 obese children and 8,318 non-obese kids. The team compared the genetic data.
Surgery for Diabetes May Be Better Than Standard Treatment
Source: The New York Times
Two studies have found that weight-loss operations worked much better than the standard therapies for Type 2 diabetes in obese and overweight people whose blood sugar was out of control. Those who had surgery, which stapled the stomach and rerouted the small intestine, were much more likely to have a complete remission of diabetes, or to need less medicine, than people who were given the typical regimen of drugs, diet and exercise.
The surgery also helped many to lower their blood pressure and cholesterol.
Manitoba man’s life changed by weight-loss surgery
A Manitoba man says his life has been transformed since he underwent a weight-loss surgical procedure that he paid for himself, as he did not qualify for a provincial pilot program.
Keith Doerksen of Morden, Man., says he has lost about 150 pounds since he underwent vertical sleeve gastrectomy in January 2011.
Obesity and pain linked, study of one million Americans shows
Source: Science Daily
A clear association between obesity and pain — with higher rates of pain identified in the heaviest individuals — was found in a study of more than one million Americans published January 19 in the online edition of Obesity. In “Obesity and Pain Are Associated in the United States,” Stony Brook University researchers Arthur A. Stone, PhD., and Joan E. Broderick, Ph.D. report this finding based on their analysis of 1,010,762 respondents surveyed via telephone interview by the Gallop Organization between 2008 and 2010
.”We wanted to explore this relationship further by checking to see if it was due to painful diseases that cause reduced activity, which in turn causes increased weight,” says Joan E. Broderick, Ph.D., Associate Professor in the Department of Psychiatry and Behavioral Science and School of Public Health at Stony Brook University, and lead investigator of a National Institutes of Health-funded study on how arthritis patients manage their own pain.
Is Economy Class Air Travel Linked To Blood Clot Risk?
Source — Medical News Today
“Economy Class Syndrome” is a myth, your risk of developing a blood clot during a long-distance economy trip by plane is not higher than in first class, researchers report in an article published in Chest. The American College of Chest Physicians (ACCP) has issued new evidence-based guidelines which address some of the risk factors linked to DVT (deep vein thrombosis) – it says that there is no compelling evidence linking economy class air travel to the development of DVT.
CDC: Bread beats out chips as biggest salt source
Source — USA Today
Bread and rolls are the No. 1 source of salt in the American diet, accounting for more than twice as much sodium as salty junk food like potato chips.
That surprising finding comes in a government report released Tuesday that includes a list of the top 10 sources of sodium. Salty snacks actually came in at the bottom of the list compiled by the Centers for Disease Control and Prevention.
A Gut Check for Many Ailments
Source — The Wall Streeet Journal
What you think is going on in your head may be caused in part by what’s happening in your gut.
A growing body of research shows the gut affects bodily functions far beyond digestion. Studies have shown intriguing links from the gut’s health to bone formation, learning and memory and even conditions including Parkinson’s disease. Recent research found disruptions to the stomach or intestinal bacteria can prompt depression and anxiety—at least in lab rats.
Weight Loss: Is Bypass Better Than Banding?
Source — WebMD
Gastric banding doesn’t work as well as bypass surgery, according to a new study in the journal Archives of Surgery. More than 200000 weight loss surgeries are performed annually in the US and more people are choosing banding procedures …
Weight loss surgery doubles in past decade
Source — KMOV.com
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ASMBS updates position statement on sleeve gastrectomy
Source — Wlshelp Weight Loss Surgery News
The American Society For Metabolic And Bariatric Surgery (ASMBS) recently issued an Updated Position Statement on Laparoscopic Sleeve Gastrectomy as a Bariatric Procedure.
The ASMBS statement highlights the “substantial comparative and long-term data now published in the peer-reviewed literature demonstrating durable weight loss, improved medical comorbidities, long-term patient satisfaction, and improved quality of life after SG (Sleeve Gastrectomy).”
Bariatric Surgery Safety and Outcomes in Extremely Obese Patients
Source — Wlshelp Weight Loss Surgery News
A recently published study highlights the safety and feasibility of laparoscopic bariatric surgery on extremely obese patients as well as the outcomes of different surgical approaches.
Although it would seem that the most likely candidates for bariatric surgery are those with the most weight to lose, they often do not qualify for bariatric surgery. Surgery of any type, including bariatric surgery, is generally associated with greater surgical risks in patients with a very high body mass index (BMI), due to technical difficulties and severe weight related comorbidities.