Published in March 2014 Issue             

Bariatric Surgery Improves the Metabolic Profile of Morbidly Obese Patients with Type 1 Diabetes

Bariatric surgery may lead to remarkable and sustained weight loss in individuals with severe obesity and type 1 diabetes, according to a study published in Diabetes Care (March). The case series review, which is the largest in this population to date, included 10 patients who had gastric bypass (n=7), gastric banding (n=2) or gastric sleeve (n=1). All patients, except one gastric banding case, achieved excess weight loss of >60% during the approximate 36-month follow-up. A mean reduction in BMI of 27.0 ± 9.6% was associated with a significant reduction in A1C (10.0 ± 1.6% vs. 8.9 ± 1.1%) and daily insulin requirement (0.74 ± 0.32 vs. 0.40 ± 0.15 units/kg/day). There were also favorable changes in LDL (-23.0 ± 19.3 mg/dL), HDL (10.8 ± 3.4 mg/dL), and triglyceride (-30.5 ± 17.1 mg/dL) following surgery. Hypertension resolved or improved in 5 of 7 (71%) hypertensive patients.

Mode of Delivery and Offspring Body Mass Index, Overweight and Obesity in Adult Life: A Systematic Review and Meta-Analysis

A systematic review and meta-analysis of 15 studies with a combined population of 163,753 patients found a strong association with mothers who delivered via Caesarean section (CS) and an increased BMI in children. Additionally, compared to women who gave birth vaginally, a strong association was also seen with CS and children being overweight or obesity in adulthood. Birth by CS increased the odds of overweight by 26% and obesity by 22%. Study author concluded that given the rising CS rate worldwide there is a need to determine whether this is causal, or reflective of confounding influences. The study was published in the February 26 edition of PLOS One.

Pregnancy Outcomes and Nutritional Indices Following Three Types of Bariatric Surgery Performed at A Single Institution

According to a study, women who had Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG) and biliopancreatic diversion (BPD) had good pregnancy outcomes provided they followed nutritional supplement guidelines. Researchers from the University Hospital in Greece reviewed the outcomes of 113 women who gave birth to 150 children following bariatric surgery between June 1994 and December 2011. Anemia was found in some patients (24.2% BPD vs. 15.6% RYGB). Low levels of Vitamin B12 were observed in all groups after surgery (15.6% RYGB, 13.3% SG and 11.7% BPD), with no additional decrease during pregnancy. In addition, folic acid levels increased and serum albumin levels decreased in all groups during pregnancy, however hypoproteinemia was seen only after BPD. Study authors noted that closer monitoring, particularly for protein nutrition, is required in pregnancies following malabsorptive procedures. The study was published online in SOARD on February 26.

Early Morbidity and Mortality of Laparoscopic Sleeve Gastrectomy and Gastric Bypass in the Elderly: A NSQIP Analysis

A study of 1,005 patients published in the online edition of SOARD (February 26) found the outcomes of elderly patients (mean BMI 44±7) undergoing laparoscopic sleeve gastrectomy (15.4% of patients studied) had similar low morbidity and mortality at 30 days when compared to gastric bypass. The 30-day mortality was the same for both procedures (0.6% SG vs. 0.6% GB). Serious morbidity was 5.2% vs. 5.6%, respectively and overall morbidity (9% vs. 9.1%) was similar. The study authors also noted diabetes was more common in patients who had gastric bypass (55.6% vs. 43.2%).

Use of Bariatric Outcomes Longitudinal Database (BOLD) to Study Variability in Patient Success After Bariatric Surgery

A large patient study published in Obesity Surgery (February 26) found the key predicators in bariatric surgery for absolute weight loss was determined by the procedure (44.8%) and baseline weight (18.5%) at 12 months, with the 34.2% variability unexplained. Researchers used the BOLD database to review the cases of patients who had adjustable gastric band (31,443), Roux-en-Y gastric bypass (40,352) and sleeve gastrectomy (2,194) between January 2007 and February 2010. Other predictors, including age, race, and diabetes, accounted for <1% of variability. Study authors concluded additional research focused on the sources of variability is needed to help explain the other remaining differences in post surgical outcomes.

The Reducing the Stigma of Bariatric Surgery: Benefits of Providing Information About Necessary Lifestyle Changes

According to a University of New South Wales Australia new study published online in Obesity, (March 6) people perceive others who have lost weight exclusively by bariatric surgery more negatively as compared to individuals who lost weight through the procedure and diet/exercise, followed by people who lost weight through diet/exercise alone. They deemed those who lost weight through diet and exercise most competent and most responsible. Participants provided their first impressions of a woman with obesity before finding out how she lost the weight through the methods noted previously. Later, they offered their opinions of the female after she lost weight. Study authors concluded the findings demonstrate the importance of perceived effort when judging individuals suffering from obesity and the results show some insights into the value of providing information about lifestyle changes and the impact it may have in dampening the negative evaluations of patients who had surgery.