Published in June 2015 Issue             

BMI and Risk of Dementia in Two Million People Over Two Decades: A Retrospective Cohort Study (The Lancet Diabetes & Endocrinology)

A study of nearly 2 million people from the UK with a median age at baseline of 55 years (IQR 45–66) and a median follow-up of 9·1 years (IQR 6·3–12·6) finds being underweight in middle age and old age carries an increased risk of dementia over two decades, contradicting the hypothesis that obesity in middle age could increase the risk of dementia in old age. The incidence of dementia continued to fall for every increasing BMI category, with very obese people (BMI >40 kg/m2) having a 29% lower (95% CI 22–36) dementia risk than people of a healthy weight. The authors conclude the reasons for and public health consequences of these findings need further investigation.

Gender Disparities Among the Association Between Cumulative Family-Level Stress & Adolescent Weight Status (Preventive Medicine)

An analysis of data from more than 4,700 American teens born between 1975 and 1990 shows family stress may put teens at increased risk for being overweight or obese. Researchers from the University of Houston assessed the effects of three specific sources of family stress: financial problems, a mother's poor health, and family disruption. Only one family stress point, a mother's poor health, was associated with overweight or obesity in boys by the time they turned 18.

Bariatric and Metabolic Outcomes in the Superobese Elderly (SOARD)

The authors concluded that successful weight loss and metabolic improvement can be achieved safely in the high-risk population of superobese elderly. A retrospective analysis of primary bariatric cases performed on 30 patients 65 years or older with a BMI >= 50. Surgical approaches included: laparoscopic Roux-en-Y gastric bypass (n=16), laparoscopic sleeve gastrectomy (n=6) and laparoscopic adjustable gastric banding (n=8). There were no deaths, conversions or intraoperative complications. The early (< 30 day) major morbidity rate was 10.0%. At a median follow-up of 37 months, the cohort had a mean BMI of 42.3, which corresponded to a mean of 44.5% EWL, and mean percent total body weight loss of 24.4%. The most %EWL was achieved after LRYGB (54.1%) followed by LSG (48.3%) then LAGB (26.2%). Diabetic medication reduction in number and/or dosage was observed in 40% of patients and 33% of patients were completely off anti-diabetic agents.

Laparoscopic Roux-en-Y Gastric Bypass for Failed Gastric Banding: Outcomes in 642 Patients (SOARD)

A retrospective review analyzed short- and long-term results of reoperative LRYGB after failed LAGB. The study included 642 patients (566 women, 76 men) followed for an average of 10 years. There were no mortalities, and an overall complication rate of 9.7%, which included major complications (3.6%). The mean excess BMI loss was between 65% and 70% and the mean total body weight loss was between 28% and 30%. After reoperation, the mean BMI decreased to 31.6, 32.2 and 32.5 at 1, 5 and 10 years, respectively. The author concluded that reoperative LRYGB is safe and feasible after failed LAGB. Results up to 10 years after revision are comparable to those reported after primary LRYGB.

Effect of Roux-en-Y Gastric Bypass and Sleeve Gastrectomy on Non-alcoholic Fatty Liver Disease: A Comparative Study  (SOARD)

For the study, bariatric cases between 2005 and 2012 that had also undergone liver biopsies were identified, which included 14 RYGB and 9 SG patients. Comparatively, RYGB patients were older (56.2 vs. 46.3), and had lower initial BMI (51.0 vs. 72.7) and higher NAS (4.4 vs. 2.6), respectively. Prevalence of comorbidities was comparable between groups. After a mean follow-up of 1.5 years, body weight loss percentage was 32% and 25% following RYGB and SG, respectively. Percentage of excess weight loss (%EWL) was higher in RYGB patients (69.8% vs. 37.2%). NAS following RYGB significantly improved in all morphological characteristics whereas only steatosis and total NAS after SG. Fibrosis state improved in both groups, but to a greater degree after RYGB. No significant differences in NAS score decrease after RYGB and SG procedures though the baseline characteristics of the groups differed.

Can Weight-Loss Surgery Reduce Asthma Flare-Ups?  (Journal of Allergy and Clinical Immunology)

The study analyzed databases from California, Florida and Nebraska, which included almost 2,300 patients with obesity and asthma who had bariatric surgery between 2007 and 2009. Results show that one to two years before surgery, 22% of the group had at least one emergency department visit or hospitalization due to asthma. This was reduced to only 11% during the two years following surgery. However, it's not clear how much weight needs to be lost to make a difference in serious asthma symptoms, or if losing greater amounts of weight was linked to an even greater reduction in asthma flare-ups. The authors concluded that in patients with asthma, bariatric surgery is linked to a significant reduction in serious asthma flare-ups.

Better Joint Replacement Outcomes for Patients With Obesity Who Have Weight Loss Surgery (American Academy of Orthopaedic Surgeons)

Patients with obesity who have weight-loss surgery prior to having a knee or hip replacement may have better outcomes than those who do not. The data was presented during the American Academy of Orthopedics Surgeons Annual Meeting where the authors commented, "Ideally… a team approach would be used to treat morbidly obese patients with hip and knee arthritis in which various health care professionals are in place to help a patient lose weight, improve his or her health, and optimize nutrition before joint replacement to maximize its benefits." Additionally, it was noted that the findings may be “helpful” in re-evaluating if weight loss surgery should be a covered benefit for some health care systems that currently do not offer it as such.