STORIES OF THE WEEK

Monday, January 9, 2017            

The following is a summary/brief analysis of the obesity and surgery stories making news this week:

Durable Weight Loss Seen After Bariatric Surgery in Teens… Weight-Loss Surgery Linked to Gastro Issues… Kids Born to Parents with Obesity Show Developmental Delays… Plant-Based Eating Plans Ranked Highest in Annual Diets Report… Assessing Health Risks in “Overfat”… Lifestyle Medicine: Changing the Paradigm on Obesity

Metabolic and Bariatric Surgery in the News…

Weight Loss Surgery Offers Long-Term Benefits to Very Obese Teens
(Medpage Today, HealthDay)

Teenagers and young adults with morbid obesity who underwent gastric bypass surgery showed overall reductions in weight and improvement in cardiometabolic risk factors 5 years later, according to two small follow-up studies published in The Lancet Diabetes & Endocrinology. The first study found a mean change in BMI of almost 30% in children 5-12 years after surgery. The study also revealed, however, that nearly half the patients had mild anemia or vitamin D deficiencies. Study author Dr. Thomas Inge of Cincinnati Children's Hospital Medical Center and colleagues commented that the benefits of surgery "were achieved with some attendant risks of micronutrient deficiencies and requirements for additional gastrointestinal procedures related to surgery, providing important data to inform treatment decisions for families." The second study examined Swedish adolescents who had gastric bypass surgery, matched adolescent controls who were given "standard treatment" for their obesity, and matched adult controls. Overall, adolescents who underwent surgery had a 13-point reduction in BMI over 5 years of follow-up -- similar to the 12.3-point BMI reduction in adult controls. By contrast, adolescent controls had a 3.3-point increase in BMI during the same time period. The authors noted that "the numbers of failure would likely be worse" in the adolescent control group, but 25% of adolescents "crossed over" and had surgery during the study period. Cardiometabolic risk factors and comorbid conditions improved for adolescents in the surgery group, but not the adolescent control group. Vitamin D deficiencies were observed in most of the controls as well as in the surgical patients. There were no deaths in any group, although 25% of the adolescent treatment group reported additional abdominal surgical interventions, for acute intestinal obstruction and symptomatic gallstones.

After Gastric Bypass Surgery, Many Experience Eating Difficulties
(The Washington Post)

A study involving 544 adults with obesity, including 249 who had laparoscopic gastric bypass, showed two years after surgery gastrointestinal complaints — mainly indigestion, abdominal pain and dumping syndrome — were more common among those who had had weight-loss procedures than among those who had not. About 71% of the gastric bypass group, compared with 17% of the controls, could not tolerate certain items, including red meat and foods high in fat or sugar. Water was not tolerated by about 7% of those who had had gastric bypass compared to none of the others. The researchers found no link between the amount of weight people had lost and the digestive problems. Readers interested in more information about bariatric surgery are directed to asmbs.org.

Obesity in the News…

Parental Obesity May be Tied to Developmental Delays in Kids (Reuters)

Children with obese mothers are 67% more likely to have delayed fine motor skill development by age 3 compared to children with normal or underweight mothers, even after accounting for the father’s weight. With obese fathers, children are 71% more likely to have deficits in personal and social skills after taking their mothers' weight into account. When both parents were obese, kids are almost three times more likely to struggle with problem-solving. The finding are from a study that examined data from questionnaires parents completed for 3,759 singleton babies and 1,062 non-related twins, when the children were 4, 8, 12, 18, 24, 30 and 36 months old. Even though the study didn't examine how parents' obesity might influence child development, it's possible obese mothers might have babies more prone to inflammation, which can in turn impact neurological development in children, the authors note in the journal Pediatrics.

Plant-Based Diets Score Big for Healthy Weight Loss in 2017 (HealthDay)

U.S. News & World Report named the plant-based eating plan, DASH diet, as the best choice overall in its annual Best Diets report. Followed by the Mediterranean diet, the DASH stands for Dietary Approaches to Stop Hypertension, but its benefits go beyond preventing high blood pressure, the report found. The DASH and the Mediterranean diets, as well as most of the other recommended diets, focus on eating whole grains, fruits, vegetables, low- or no-fat dairy, lean meats, poultry and fish. They also recommend nuts, seeds and legumes (beans). But these diets limit or exclude most fats and sweets, and recommend modest portions. The MIND diet, which incorporates elements of the DASH and Mediterranean diets and is touted as a way to keep Alzheimer's disease at bay, was ranked third in effectiveness. There was a four-way tie for fourth place between the Flexitarian diet, a "casual vegetarian" diet that allows some poultry and fish; the Mayo Clinic Diet, an eating plan to keep you healthy and trim; the TLC diet, a plan that cuts cholesterol and fat by eliminating meats, dairy and fried food; and Weight Watchers, which helps you shed excess pounds. To come up with its list, U.S. News ranked 38 diet plans in nine categories. The rankings were done by an expert panel of nutritionists, dietary consultants and doctors specializing in diabetes, heart health and weight loss.

'Overfat' May be Better Than 'Overweight' in Assessing Health Risks,
Researchers Say
(UPI)

A study published in Frontiers in Public Health suggests an increased risk of chronic disease is not limited to just people with obesity or overweight people, but also affects normal-weight individuals who are considered are "overfat" – defined as having enough excess body fat to cause health problems – a condition known as normal-weight metabolic obesity. Researchers say 76% of the world's population is overfat. According to the study authors, the research suggests that waist circumference is a more practical measure of metabolic health than weight.

Lifestyle Medicine: Changing the Paradigm on Obesity (MedPage Today)

In December, the American Association of Clinical Endocrinologists and American College of Endocrinology published a position statement introducing "ABCD," for Adiposity-based Chronic Disease, as a new diagnostic term which supported previously published recommendations for a clinical diagnosis of obesity as a chronic disease. The new AACE/ACE statement recommends going beyond BMI to confirm excess adiposity to refine cardiometabolic risk of adiposity, advanced modalities, and emphasizes a complications-centric staging approach in order to treat patients based upon the pathophysiologic hostility of adiposity versus weight. Lifestyle changes and therapies were reviewed with evidence-based recommendations in the AACE/ACE clinical practice guideline and are a cornerstone for proposing the model of "ABCD." "Positioning lifestyle medicine in the promotion of overall health, not only as the first algorithmic step, but as the central, pervasive action" was listed as the number one key element in the document. The authors state that lifestyle medicine framed "positively as promoting 'health'" should be promoted throughout healthcare teams and applied to all patients with any disease which, as first line therapy, is supported by a variety of other clinical practice recommendations. However, it’s noted that lifestyle medical prescription “remains elusive” and "optimal application of lifestyle medicine in clinical practice requires scientific study and validation, much more effort in HCP education and training for standardized evidence-based protocols, and clinical implementation and monitoring with fair reimbursement strategies."