Injection controls hunger hormone

Fri. Sep 19, 2008

For more than a decade, researchers have investigated methods for safely and easily suppressing the appetite hormone grehlin to reduce hunger and help people control their weight.  Now, scientists from Johns Hopkins Medicine report success in reducing grehlin in pigs without major surgery using a relatively simple minimally invasive procedure.  

The new procedure uses chemical vaporization of the main blood vessel carrying blood to the upper part of the stomach known as the fundus.  This part of the stomach is responsible for producing almost 90 percent of the body's grehlin.  Without a good blood supply, the fundus can't make grehlin and the hormone levels drop significantly.

Using gastric artery chemical embolization (GACE), researchers monitored grehlin levels in pigs following a single injection of sodium morrhuate into the left gastric artery. They report the effect on appetite was similar to that achieved with bariatric surgery.

"Appetite is complicated because it involves both the mind and body," says Aravind Arepally, M.D.from the John Hopkins University School of Medicine, "Ghrelin fluctuates throughout the day, responding to all kinds of emotional and physiological scenarios. But even if the brain says "produce more ghrelin," GACE physically prevents the stomach from making the hunger hormone."  

What these findings mean in terms of additional treatment options for obese people is yet to be determined. Grehlin was found to be suppressed up to 60 percent of normal levels one month after the procedure. However, the long tem effects of the procedure have not been determined and additional study is required before it can be said that the procedure is a useful treatment choice for humans.

SOURCE: Radiology

Reality TV raises interest in surgical weight loss

Thu. Sep 04, 2008

A dramatic increase in Australians seeking cosmetic and weight reduction surgery may be the result of reality TV programs according to an editorial in the Medical Journal of Australia.

Commenting on reality shows like The Biggest Loser, Professor Keith Petrie, from the University of Auckland's Department of Psychological Medicine, says that the difficulty of these physical changes is usually distorted in TV programs which compress time making the process seem easier and less significant than it really is. He believes that the effect of reality TV on viewer's self esteem may be driving the increase in cosmetic and weight loss surgeries throughout the world and at the same time fostering unrealistic expectations of what these surgeries can achieve.

Professor Petrie points out that medical reality TV programs focus on people selected because they can achieve dramatic results.  This selection exaggerates the outcomes and minimizes the behind the scenes effort required to achieve these results. Most people do not have access to the level of resources available to participants in TV reality shows.  Open access to equipment, personal trainers, chefs and other support resources are available in the artificial environment of a TV show but this is not something that normal people can rely on while they are attempting weight loss. .  

Professor Petrie also voices concern about the effect of these shows on participants.  "Given the dissatisfaction that participants typically express about themselves and their lives at the programs' commencement, the extreme psychological pressure that is creating during filming, and the difficulty of maintaining rapid weight loss, it would be surprising if all participants and their families walked away unscathed," he said. He urges the adoption of ethical safeguards to protect participants who may be vulnerable to these potentially damaging situations and also suggests that more research is needed to explore the effects on both viewers and participants.

SOURCE: Medical Journal of Australia

Sleep apnea requires monitoring after bariatric surgery

Tue. Aug 19, 2008

Although weight loss resulting from bariatric surgery improves obstructive sleep apnea (OSA), the degree of improvement is more closely related to the severity of the condition before surgery than an individual's initial weight and subsequent weight loss.

OSA is common among obese individuals and its severity usually increases with the individual's weight.  However, losing weight does not automatically resolve OSA, especially in severe cases, say researchers at Walter Reed Army Medical Center.

In post surgical follow up studies of a small group of bariatric patients, many still had moderate to severe OSA one year after surgery.  Surprisingly, even though their condition remained severe, most people thought they had improved to the point that they could discontinue treatment.

According to Christopher J. Lettieri, MD, Chief of Sleep Medicine at Walter Reed Army Medical Center, people should not assume that their OSA will automatically resolve after weight loss. The baseline apnea-hypopnea index (AHI), a measure used to identify the presence of OSA and define its severity, is the most important determinant of whether or not an individual will be cured of the disease. Individuals with a lower AHI may experience complete resolution of their OSA.

While many individuals can expect to experience improvement in symptoms of OSA, assessment of the severity of OSA should continue after surgery so that adjustments in treatment match more precise medical measurement of the condition instead of subjective improvements in symptoms such as snoring or daytime sleepiness.

SOURCE: Journal of Clinical Sleep Medicine

New guidelines for endoscopy in bariatric patients

Mon. Jul 28, 2008

With the number of bariatric surgeries now exceeding 100,000 each year, the American Society for Gastrointestinal Endoscopy (ASGE) has issued guidelines on the role of endoscopy in the bariatric surgery patient.

"Obesity in this country is a major health problem that contributes to increased morbidity, mortality and a host of diseases. Bariatric surgery results in durable and significant weight loss," said Jason A. Dominitz, MD, MHS, chair of ASGE's Standards of Practice Committee. "Endoscopy plays an important role in the preoperative bariatric patient to detect and/or treat lesions in the gastrointestinal tract that might potentially affect the type of surgery performed. In addition, endoscopy is used to diagnose and treat many of the postoperative symptoms or conditions the patient may develop."

The new guidelines recommend:  

• An upper endoscopy should be performed in all patients with upper-GI-tract symptoms who are to undergo bariatric surgery.
• Upper endoscopy should be considered in all patients who are to undergo a Roux-en-Y gastrojejunal bypass (RYGB), regardless of the presence of symptoms.
• In patients without symptoms and who are not undergoing an endoscopy, noninvasive H pylori testing followed by treatment, if positive, is recommended.
• In patients without symptoms and who were undergoing gastric banding, a preoperative upper endoscopy should be considered to exclude large hernias that may change the surgical approach.
• An endoscopic evaluation is useful for diagnosis and management of postoperative bariatric surgical symptoms and complications.
• An endoscopic retrograde cholangiopancreatography (ERCP) is difficult in patients who had a RYGB, and a magnetic resonance cholangiopancreatography (MRCP) should be performed in cases where other noninvasive imaging studies are inconclusive. An ERCP in RYGB patients should be selectively performed.

SOURCE: Gastrointestinal Endoscopy

Gastric bypass surgery improves immune response

Tue. Jun 24, 2008

Weight loss following gastric bypass surgery increased the defensive activity of natural killer cells by almost 80 percent in a research study conducted at the University of Sao Paulo in Brazil. Natural killer cells play a critical role in controlling infections and cancer. 

Patients in the study lost an average of 78.5 pounds at 6 months after having Roux-en-Y gastric bypass surgery.  Researchers analyzed blood samples for natural killer cells and other immune response indicators. While the numbers of these cells did not increase in the surgery patients, the activity of the cells increased significantly indicating a greater capacity to kill infected cells or tumor cells

Study coauthor Alfredo Halpern, PhD comments," It [gastric bypass] may help protect against infections and cancer by improving the activity of certain immune cells." He also noted that the impaired natural killer cell function evident in extremely obese people may even explain their propensity to develop infections and cancer.

SOURCE: Endocrine Society

LAP-BAND improves health in obese teens

Mon. Jun 23, 2008

Health improvement is evident in obese teens at six months following laparoscopic gastric banding surgery. Weight loss of 20 pounds in six months shows significant improvement in abdominal fat, and blood fat and sugar levels. Liver function and immune response improvements are also noted.

According to Dr. Ilene Fennoy, a pediatric endocrinologist at Morgan Stanley Children's Hospital of NewYork, "Extremely obese teenagers have obesity-related health problems, particularly diabetes and increased cardiovascular risk. Laparoscopic gastric banding, which has been shown to be a safe and effective way to lose weight, now offers the possibility of reducing obesity's medical complications." Dr. Fennoy continues, "Until recently, these patients have had to rely primarily on non-surgical methods or higher-risk surgeries to lose weight, and few of these treatments have succeeded in achieving major weight loss or greatly improving their overall health."

LAP-BAND surgery is not approved for teenagers by the Food and Drug Administration (FDA). Three sites in the United States are currently investigating the LAP-BAND procedure to combat morbid obesity in teenagers.

SOURCE: Endocrine Society

Surgery more effective in controlling type 2 diabetes

Fri. Jun 20, 2008

Gastric bypass patients are significantly better able to get their blood sugar into a normal range than morbidly obese people treated with conventional medical interventions for type 2 diabetes such as insulin.   

Researchers from the Gundersen Lutheran Medical Center reported levels of hemoglobin A1c, a measure of glucose in the blood, dropped by 21 percent within a year of gastric bypass and was maintained for at least three years. People receiving conventional medical treatment saw an 11 percent increase over the same time period.

Prior to surgery 84.3 percent of the study participants were on oral medications and/or insulin. One year after surgery, only 22.4 percent still required medication. In contrast, the conventional treatment group had an increase in amount of oral medications and/or insulin taken. The study showed the number of patients on diabetes medication grew from 66.7 percent to 82 percent in one year.

"The data continues to support the effectiveness of bariatric surgery in treating Type 2 diabetes in morbidly obese patients," said Shanu N. Kothari, MD, FACS, the study's co-author and the director of Minimally Invasive Bariatric Surgery at the Gundersen Lutheran Medical Center in Wisconsin. "Clearly, conventional medical treatment has an important role to play, but surgery should also be presented as an option to appropriate patients."

SOURCE: American Society for Metabolic and Bariatric Surgery

Health benefits begin before excess weight is off for gastric band patients

Fri. Jun 20, 2008

Dramatic improvements in type 2 diabetes, hypertension, high cholesterol, and sleep apnea occur before half of expected weight loss has occurred in patients who have had gastric banding.

Researchers from the New York University School of Medicine followed patients after gastric band surgery and recorded decreases and discontinuation of medications prescribed for obesity related conditions.  They found that a 20 to 30 percent loss of excess weight  in the first year was enough to improve or resolve type 2 diabetes in 87.5 percent of patients. Losing about 50 percent of excess weight produced maximum improvement or resolution of obstructive sleep apnea in 87.5 percent of patients. Forty to 50 percent excess weight loss was enough for hypertension in 81.8 percent of patients and 30 to 40 percent was enough to produce maximum improvement or resolution of dyslipidemia or high cholesterol in 72.7 percent of patients.

SOURCE: American Society for Metabolic and Bariatric Surgery

Weight-loss surgery can cut cancer risk

Thu. Jun 19, 2008

Weight loss after Bariatric surgery may reduce the risk of developing beast cancer by up to 85 percent and colon and pancreatic cancers by 70 percent according to research from McGill University

"The relationship between obesity and many forms of cancer is well established," said the lead researcher Dr. Nicolas Christou. "This is one of the first studies to suggest that bariatric surgery might prevent the risk of cancer for a significant percentage of morbidly obese people."

Bariatric surgery can result in loss of up to 70 percent of an obese person's excess weight. The excess fat is believed to be responsible for increased hormone production which contributes to breast and colon cancer development.  It is thought that lowering hormone metabolism by losing weight may be responsible for the reduction in cancer risk.

SOURCE: American Society for Metabolic and Bariatric Surgery

Probiotics After Gastric Bypass Surgery Improve Weight Loss

Wed. May 21, 2008

Researchers seeking to improve gastrointestinal health in bariatric surgery patients say that probiotics enhance weight loss following gastric bypass surgery.

To prevent post surgical bacterial overgrowth in the gut, scientists from Stanford School of Medicine gave gastric bypass patients 2.4 billion colonies of Lactobacillus daily. At six months after surgery, patients receiving the probiotics showed lower levels of harmful gastrointestinal bacteria and increased weight loss.

"Finding that probiotics can actually enhance weight loss was an unexpected result," said John M. Morton, MD, MPH, associate professor at the Stanford School of Medicine. "There is no magic bullet for fighting obesity, but this simple dietary supplement may be one more weapon we can add to our arsenal."

Most probiotics are bacteria similar to those naturally found in people's guts, especially in those of breastfed infants.  Some conventional foods containing probiotics are yogurt, fermented and unfermented milk, miso, tempeh, and some juices and soy beverages. In those foods, and in probiotic supplements, the bacteria may have been present originally or added during preparation.

SOURCE: Stanford University School of Medicine