Bariatric Surgery Bests Lifestyle Interventions For Diabetes Remission In Obesity

Anita P. Courcoulas M.D., M.P.H., F.A.C.S Professor of Surgery Director, Minimally Invasive Bariatric & General Surgery University of Pittsburgh Medical CenterMedicalResearch.com Interview with:
Anita P. Courcoulas M.D., M.P.H., F.A.C.S

Professor of Surgery
Director, Minimally Invasive Bariatric & General Surgery
University of Pittsburgh Medical Center

Medical Research: What is the background for this study?

Dr. Courcoulas: This study is a randomized clinical trial that was originally funded through the American Recovery and Reinvestment Act of 2009 (ARRA) as a high priority comparative effectiveness topic; the goal of which was to better understand the role of surgical versus non-surgical treatments for Type 2 diabetes mellitus (T2DM) in people with lower Body Mass Index (BMI) between 30 and 40 kg/m2. This report highlights longer-term outcomes at 3 years following random assignment to either an intensive lifestyle weight loss intervention for 1 year followed by a low-level lifestyle intervention for 2 years or surgical treatments (Roux-en-Y gastric bypass [RYGB] or laparoscopic adjustable gastric banding [LAGB]) followed by low-level lifestyle intervention in years 2 and 3.

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Bariatric Surgery Reduces Urinary Incontinence As Well As Obesity

MedicalResearch.com Interview with:
Leslee L. Subak, MD

University of California, San Francisco
Professor, Departments of Obstetrics, Gynecology & Reproductive Sciences, Urology and Epidemiology & Biostatistics
Chief of Gynecology, SF Veterans Affairs Medical Center
UCSF Women’s Health Clinical Research Center

MedicalResearch: What is the background for this study? What are the main findings?

Dr. Subak: Urinary incontinence is very common, affecting an estimated 30 million adults in the U.S., and may account for as much as $60 billion in annual medical costs. Incontinence can cause significant distress, limitations in daily functioning, and reduced quality of life. Obesity is an important risk factor, with each 5-unit increase in body mass index – a ratio of someone’s weight divided by the square of their height – above normal weight associated with far higher rates of incontinence.   The prevalence of incontinence has been reported to be as high as 70 percent among severely obese women, and 24 percent among severely obese men (BMI greater than 40, or more than about 100 pounds greater than ideal body weight).

Since obesity is a risk factor for incontinence, several studies have examined whether weight loss is a treatment for incontinence among obese people with the condition.  Clinical trials have shown the low calorie diets, behavioral weight reduction, and bariatric surgery are associated with improvement in incontinence in obese women and men through one year, but evidence on the durability of this effect is lacking.

We performed this study to examine changes in urinary incontinence and identify factors associated with improvement among women and men in the first 3 years following bariatric surgery.

This study included 1987women and men in the Longitudinal Assessment of Bariatric Surgery-2 (LABS-2) study performed at 10 hospitals at 6 clinical centers in the U.S. who underwent bariatric surgery between 2005 and 2009.  The study participants ranged in age from 18 to 78 years old – the median age was 47. The analysis controlled for factors such as age, race, smoking status and recent pregnancy.  Nearly 79 percent of the participants in the study were women with 49% reporting at least weekly incontinence, compared with 2% of men reporting incontinence.

Following surgery and large weight loss of 29% for women and 26% for men, substantial improvements in incontinence were observed, with a majority of women and men achieving remission at 3 years post-surgery. The more weight lost, the higher the chances of improvement. While the risk of relapse rose with each gain of about 10 pounds, overall there was substantial improvement for both women and men. People who were older, had severe walking limitations or were recently pregnant showed less improvement.

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History Of Bariatric Surgery Has Risks and Benefits For Pregnancy

Kari Johansson, Phd Department of Medicine Solna, Karolinska Institutet Clinical Epidemiology Karolinska University Hospital Stockholm, SwedenMedicalResearch.com Interview with:
Kari Johansson, PhD

Department of Medicine Solna, Karolinska Institutet
Clinical Epidemiology
Karolinska University Hospital
Stockholm, Sweden

 

MedicalResearch: What is the background for this study? What are the main findings?

Dr. Johannson: The number of women who are obese in early pregnancy has increased dramatically over the last decades. Consequently, there has been a dramatic rise in the number of women becoming pregnant after bariatric surgery. In Sweden the number of births of women with a history of bariatric surgery has increased from 150 (≈0.15%) to more than 500 (0.5%) per year between 2006 and 2011. The positive effects of bariatric surgery on health outcomes, such as diabetes and cardiovascular disease, are reasonably well-studied, but less is known about the effects on pregnancy and perinatal outcomes. We therefore conducted a population-based study, using data from nationwide Swedish registers.

The main findings are that women who had a history of bariatric surgery were much less likely to develop gestational diabetes (2% compared to 7%; P<0.001) and give birth to large-for-gestational age babies (9% vs 22%; P<0.001). On the other hand, the operated women were twice as likely to give birth to babies who were small for gestational age (16% vs 8%), and have pregnancies of shorter duration (273 vs 277.5; P<0.001). 
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Which Bariatric Procedure Is Best For Patients With Morbid Obesity?

MedicalResearch.com Interview with:
Torsten Olbers MD, PhD

Assistant Professor of Surgery
Sahlgrenska University Hospital
Gothenburg, Sweden

Medical Research: What is the background for this study? What are the main findings?

Dr. Olbers: Until now there has been no consensus regarding preferred bariatric procedure for patients with a body mass index (BMI) above 50 kg/m2. We report on the 5-year outcomes from a randomized clinical trial of gastric bypass and duodenal switch published online by JAMA Surgery on February 4th.

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Bariatric Surgery Linked To Lower Long Term Mortality

David Arterburn, MD, MPH, FACP Associate Investigator Group Health Research Institute Seattle, WA 9810MedicalResearch.com Interview with:
David Arterburn, MD, MPH, FACP
Associate Investigator
Group Health Research Institute
Seattle, WA 98101   and

David L. Maciejewski PhD Center for Health Services Research in Primary Care Durham VA Medical Center, Durham, North CarolinaDavid L. Maciejewski PhD
Center for Health Services Research in Primary Care
Durham VA Medical Center, Durham, North Carolina

MedicalResearch.com: Why was this study needed?

Response: There were several reasons to conduct this study.  First, although complications and death during and soon after bariatric surgery have progressively declined over the past several decades, there is simply very little long-term evidence on the survival benefits of bariatric surgery in Americans having surgical procedures that are being used today in routine practice.

Second, we felt that it was important to look at the impact of bariatric surgery among veterans because they represent an older male cohort often with multiple medical comorbidities, which is different from the typical bariatric patient in the United States, who is often younger and female.

MedicalResearch.com: How was your study conducted?

Response: We conducted a retrospective observational study using high-quality data from national Department of Veterans Affairs electronic databases and the VA Surgical Quality Improvement Program. We identified veterans who underwent bariatric surgery in VA medical centers from 2000 to 2011. Three quarters of them were men. We matched them to control patients using an algorithm that included age, sex, VA geographic region, body mass index (BMI), diabetes, and Diagnostic Cost Group. We then compared survival across bariatric patients and matched controls using Kaplan-Meier estimators and stratified, adjusted Cox proportional hazards analyses

MedicalResearch.com: What were the main findings of your study?

Response: This study had three important results:

1)      Our analysis showed no significant association between bariatric surgery and death from all causes in the first year of follow-up. In other words, having bariatric surgery was not significantly related to a veteran’s chance of dying in the first year compared to not having surgery.

2)      We had an average follow-up of 6.9 years in the surgical group and 6.6 years in the matched control group. After one to five years, adjusted analyses showed significantly lower mortality in the patients who had surgery: 55% lower, with a hazard ratio of 0.45. The finding was similar at 5 or more years, with a hazard ratio of 0.47. This means that bariatric surgery was associated with lower long-term mortality – that is, better long-term survival among veterans, which is consistent with limited non-VA research that has addressed this same question.

3)      Finally, we also found that the relationship between surgery and survival were similar comparing men and women, patients with and without diagnosed diabetes, and patients who had bariatric surgery before versus after year 2006.

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Vitamin Deficiency After Bariatric Surgery Can Lead To Eye Complications

MedicalResearch.com Interview with:
Rui Azevedo Guerreiro

Centro Hospitalar de Lisboa Central
Portugal

Medical Research: What is the background for this study? What are the main findings?

Response: This article aims to summarise the current state of understanding on the possible ophthalmic complications that can occur after a bariatric surgery. The main finding of this review article is that ophthalmic complications after bariatric surgeries are more frequent that we could thought initially, especially in patients not adherent to their vitamin supplements. In one study, the percentage of patients with vitamin A deficiency 4 years after the surgery reached up to 69%.

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Eating Behaviors Predict Long Term Weight Loss After Bariatric Surgery

MedicalResearch.com Interview with:
Hanna Konttinen, PhD, Docent

Post-doctoral researcher
Department of Social Research
University of Helsinki

Medical Research: What is the background for this study?

Dr. Konttinen: Bariatric surgery yields significant weight reduction for the majority
of severely obese individuals with accompanied improvements in health
status and health-related quality of life. Nonetheless, slow weight
regain over time is frequent and there is a need for a better
understanding on the factors that influence long-term post-surgical
weight outcomes. To our best knowledge, this was the first study to
examine whether psychological aspects of eating behavior predicted
weight changes 10 years after surgical and conventional treatment for
severe obesity.

The participants were from the Swedish Obese Subjects intervention
study: 2010 obese subjects who underwent bariatric surgery and 1916
contemporaneously matched obese controls who received conventional
treatment.
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Internalized Fat Bias Impacts Bariatric Surgery Success

Dr. Michelle Lent PhD Geisinger Health SystemMedicalResearch.com Interview with
Dr. Michelle Lent PhD
Geisinger Health System

Medical Research: What is the background for this study?

Dr. Lent: Previous study findings indicate that weight bias relates to a number of adverse outcomes in overweight and obese populations, including binge eating, psychological disorders and body image issues. In this study, we measured the degree to which people undergoing weight-loss surgery translate “anti-fat” attitudes into negative beliefs about themselves before surgery (known as “internalized weight bias”) and if this influences weight loss outcomes after surgery. Continue reading

Body Contouring Surgery Helps Bariatric Surgery Patients Keep Weight Off

MedicalResearch.com Interview with:
Donna Tepper, M.D.
Henry Ford Hospital

Medical Research: What are the main findings of the study?

Dr. Tepper: We looked at 94 patients who underwent bariatric surgery at Henry Ford from 2003 through 2013. Of those, 47 subsequently had body recontouring procedures, such as body lift, abdominoplasty (tummy tuck), arm lift, thigh lift, face lift.  We recorded the patients’ body mass index prior to bariatric surgery, and then again at 6 months, 1, 2.5, 4, and 5 years.  Of the patients who underwent contouring surgery, the average decrease in BMI was 18.24 at 2.5 years, compared to a statistically significant 12.45 at 2.5 years for those who did not have further surgery.  This is statistically significant.  This 3 point change in BMI is an 18-21 pound difference depending on patient height.  Furthermore, the BMI in the body contouring group continues to be lower at 4 and 5 years from bariatric surgery compared to the bariatric surgery alone group. Continue reading

Bariatric Surgery Effective For Both Weight Loss and Diabetes Remission

Anita P. Courcoulas M.D., M.P.H., F.A.C.S Professor of Surgery Director, Minimally Invasive Bariatric & General Surgery University of Pittsburgh Medical Center MedicalResearch.com Interview with: 
Anita P. Courcoulas M.D., M.P.H., F.A.C.S
Professor of Surgery
Director, Minimally Invasive Bariatric & General Surgery
University of Pittsburgh Medical Center

Medical Research: What are the main findings of the study?

Dr. Courcoulas: This paper was not a study but a summary of findings from a multidisciplinary workshop (and not a consensus panel) convened in May 2013 by the National Institute of Diabetes and Digestive and Kidney Diseases and the National Heart, Lung, and Blood Institute. The goal of the workshop was to summarize the current state of knowledge of bariatric surgery, review research findings on the long-term outcomes of bariatric surgery, and establish priorities for future research.
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Bariatric Surgery May Improve Brain Metabolism In Obese Patients

MedicalResearch.com Interview with:
Cintia Cercato, MD, PhD and
Emerson Leonildo Marques

University of São Paulo in Brazil

Medical Research: What are the main findings of the study?

Answer: The major findings are that the cerebral metabolism of the obese compared to normal weight people is increasing. The fact that it can be increased means a greater chance of Alzheimer‘s disease, but bariatric surgery can reduce cerebral metabolism of obese.
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Diabetes Treatment: Bariatric Surgery May Be More Efficient Than Conventional Care

Lars Sjöström, MD, PhD Professor Department of Body Composition and Metabolism Sahlgrenska University Hospital Göteborg, SwedenMedicalResearch Interview with:
Lars Sjöström, MD, PhD
Professor
Department of Body Composition and Metabolism
Sahlgrenska University Hospital
Göteborg, Sweden

 

MedicalResearch: What are the main findings of the study?

Prof. Sjöström: In obese diabetic subjects, the 2-year diabetes remission was 72% in bariatric surgery patients but only 16% in obese controls obtaining conventional obesity and diabetes treatment. After 15 years, 30% were in remission in the surgery group and 6.5% in the control group. In addition, the 20-year incidence of diabetes complication was 30 -55% lower in surgery than control patients. Continue reading

Bariatric Surgery May Reduce Risk of Uterine Cancer

Dr. Kristy Ward Department of Reproductive Medicine UCSD School of MedicineMedicalResearch.com Interview with:
Dr. Kristy Ward
Department of Reproductive Medicine
UCSD School of Medicine

 

MedicalResearch.com: What are the main findings of this study?

Dr. Ward: As the second leading cause of preventable death, obesity is one of the nation’s most serious public health problems.  Over two-thirds of the US population is currently overweight or obese and the prevalence continues to increase.  A number of studies have linked obesity with an overall elevated risk of cancer and with many individual cancer types. Among obesity related cancers in women, endometrial cancer is most strongly associated with increasing body mass, with 39% of cases in the US attributable to obesity.

In patients with clinically severe obesity (BMI ≥ 40 kg/m2), bariatric surgery results in rapid weight loss and has greater long-term success when compared to non-surgical weight loss methods. Surgical weight loss procedures have been found to reduce obesity-related comorbidites and improve outcomes in clinically severe obese populations. In addition to improved cardiovascular risk factors and mitigation of physical symptoms, there is increasing evidence that cancer risk is reduced after bariatric surgery.
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After Bariatric Surgery: Risk of Preterm Babies

MedicalResearch.com: Interview with:
Olof Stephansson MD, PhD
Associate professor, senior consultant in obstetrics and gynaecologyDepartment of Medicine, Clinical Epidemiology Unit, Karolinska InstitutetDepartment of Women’s and Children’s Health, Division of Obstetrics and Gynaecology
Karolinska Institutet, Stockholm, Sweden

MedicalResearch.com: What are the main findings of the study?

Answer: Women with a history of bariatric surgery have an increased risk of preterm delivery, a doubled risk for small-for-gestational-age births and a reduction in large-for-gestational-age births. Also when considering maternal weight, education, age, parity and year of birth. There was no increased for stillbirth or neonatal mortality.
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Bariatric Surgery: Adolescents and Perioperative Course

Thomas H. Inge, M.D., Ph.D. Professor of Surgery and Pediatrics Director of the Surgical Weight Loss Program for Teens Director for the Center for Bariatric Research and Innovation Cincinnati Children’s Hospital Medical CenterMedicalResearch.com Interview with:
Thomas H. Inge, MD, PhD, FACS, FAAP
Surgical Director, Surgical Weight Loss Program for Teens
Director, Center for Bariatric Research and Innovation
Attending Surgeon, Cincinnati Children’s Hospital Medical Center
Professor, UC Department of Surgery
Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio

MedicalResearch.com: What are the main findings of the study?

Dr. Inge: The mean age of the 242 participants of this observational study was 17.1±1.6 years and the median BMI was 50.5 kg/m2.  Fifty-one percent demonstrated four or more major co-morbid conditions.  Laparoscopic Roux-en-Y gastric bypass, vertical sleeve gastrectomy, and adjustable gastric banding were performed in 66%, 28%, and 6% of subjects, respectively.  There were no deaths during the initial hospitalization or within 30 days of surgery; major complications were seen in 19 subjects (8%). Minor complications were noted in 36 subjects (15%).  All re-operations and 85% of re-admissions were related to WLS. Continue reading

Type 2 Diabetes and Role of Bariatric Surgery

Manish Parikh MD Associate Professor of Surgery, NYU School of Medicine Director of Bariatric Surgery, Bellevue Hospital Center 550 First Ave NBV 15 South 7 New York, NY 10010MedicalResearch.com Interview with:
Manish Parikh MD
Associate Professor of Surgery, NYU School of Medicine
Director of Bariatric Surgery, Bellevue Hospital Center
550 First Ave NBV 15 South 7
New York, NY 10010

MedicalResearch.com: What are the main findings of the study?

Dr. Parikh: The main findings of this study is that surgery is safe and effective in patients with type 2 diabetes and BMI under 35.  The overall estimated rate of diabetes remission was 55% at 12 months, ranging from 33% for the adjustable gastric banding, 49% for the “mini” gastric bypass, 54% for the sleeve gastrectomy, 64% for the gastric bypass, 71% for the biliopancreatic diversion, and 81% for ileal transposition.
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Bariatric Surgery: Self-Reported Weight Loss Fairly Accurate

MedicalResearch.com Interview with:
Nicholas J. Christian, PhD
Graduate School of Public Health
University of Pittsburgh

MedicalResearch.com:  What are the main findings of the study?

Dr. Christian: We found that the differences between measured and self-reported weights following bariatric surgery were small and did not systematically differ by measured body mass index or degree of postoperative weight change. The average degree of underreporting by self-report was 0.7 kg for women and 1.0 kg for men.
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Comparison of Bariatric Surgery Procedurues and Glucose Tolerance

Dr. Mitchell S. Roslin, MD Lenox Hill Hospital Manhattan Minimally Invasive & Bariatric Surgery 186 E 76th Street, 1st Floor New York, NY 10021.MedicalResearch.com Interview with:

Dr. Mitchell S. Roslin, MD
Lenox Hill Hospital Manhattan Minimally Invasive & Bariatric Surgery
186 E 76th Street, 1st Floor New York, NY 10021.


MedicalResearch.com: What are the main findings of the study?

Dr. Roslin: The cornerstone of medical management for weight loss and to prevent weight gain is to regulate glucose and insulin and prevent wide fluctuation.  Yet, Gastric bypass, widely considered the gold standard operation, accentuates these fluctuations.  The purpose of our study was to compare glucose tolerance of gastric bypass, sleeve gastrectomy and a modified version of duodenal switch that  preserves adequate intestine. We found that all operations improve insulin resistance, but that duodenal switch normalizes the curve, whereas gastric bypass causes wide spikes in insulin and glucose.

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Opiod Use after Bariatric Surgery

 Marsha A. Raebel, PharmD, BCPS, FCCP Investigator in Pharmacotherapy Institute for Health Research 10065 E. Harvard Ave Suite 300 Denver, CO 80231.MedicalResearch.com Interview with:
Marsha A. Raebel, PharmD, BCPS, FCCP
Investigator in Pharmacotherapy
Institute for Health Research
10065 E. Harvard Ave Suite 300
Denver, CO 80231.


MedicalResearch.com: What are the main findings of the study?

Answer: We found that in a group of patients who took chronic opioids for non-cancer pain and who underwent bariatric surgery there was greater chronic use of opioids after surgery compared with before surgery, findings that suggest the need for proactive management of chronic pain in these patients after surgery.
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Bariatric Surgery: Centers of Excellence Programs and Minority Access

Dr. Lauren Hersch Nicholas Ph.D Research Affiliate, Population Studies Center. Faculty Research Fellow, Survey Research Center University of MichiganMedicalResearch.com Interview Invitation
Dr. Lauren Hersch Nicholas Ph.D
Research Affiliate, Population Studies Center.
Faculty Research Fellow, Survey Research Center
University of Michigan


MedicalResearch.com: What are the main findings of the study?

Dr. Nicholas: We found that a Medicare policy designed to improve the safety of bariatric surgery was associated with 17% decline in the share of Medicare patients from minority groups receiving bariatric surgery.
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