Monday, February 13, 2017            

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

Cleveland Clinic Researchers Highlight Metabolic Consequences of Gastric Bypass Reversal in Diabetes Care… FDA Warns of Adverse Events with Two Intragastric Balloons… Gastric Bypass Report Reduced Cravings… Patients With Obesity Face Disparities in End-of-Life Care… Research Investigates Role of Protein in Obesity… Teachers May Discriminate Against Girls with Obesity… Air Pollution Linked to Diabetes in Overweight Latino Children

Metabolic and Bariatric Surgery in the News…

Gastric Bypass Reversal: Diabetes Can Return, Even if Weight Doesn't (

In a letter published in Diabetes Care, Cleveland Clinic researchers used two case studies to highlight how restorative surgery can impact the metabolic effects of gastric bypass, specifically in regards to type 2 diabetes. In the first case study, a patient’s gastric bypass procedure was reversed after she experienced abdominal pain and poor nutrition, and in the second case study the patient had developed a fistula resulting in the need for reversal surgery. This first patient had type 2 diabetes before her original surgery, while the second developed it after surgery. The first woman’s A1C steadily increased after the reversal procedure, even though she regained only 10 to 15 pounds. Her A1C reached 8.2% after a year, and she required more medication to manage her diabetes. The second woman did not need diabetes medications after 6 months, even though her weight fell to only 205 pounds from 240. The researchers wrote that this consequence “might be related to the exclusion of the distal part of the stomach and duodenum, and perhaps was not exclusively dependent on weight loss.” The published letter is the first to describe the metabolic consequences of having a gastric bypass procedure reversed. “Further research is needed to better delineate the role of weight-independent mechanisms on glycemic changes after reoperative bariatric surgery,” the authors add.

FDA on Adverse Events With ReShape, Orbera Intragastric Balloons (Medscape)

The FDA has issued a warning to healthcare providers, including emergency room doctors, regarding adverse events with two fluid-filled intragastric balloons used to treat obesity: the ReShape Integrated Dual Balloon System (ReShape Medical) and the Orbera Intragastric Balloon System (Apollo Endo-Surgery). "The first type of adverse event involves the fluid-filled intragastric balloon overinflating with air or with more fluid (spontaneous hyperinflation) in patients' stomachs, resulting in the need for premature device removal," notes the agency in its communication issued February 9. "The second type of adverse event is the development of acute pancreatitis, which has also resulted in the need for premature device removal." These adverse events may result in patients presenting with severe abdominal and/or back pain, abdominal swelling and discomfort, difficulty breathing, and vomiting, but neither is currently mentioned as a potential adverse event in the product labeling for these intragastric balloons and "the root cause and incidence of these complications is not known." According to the agency, it has recently received "several dozen” adverse-event reports, with most involving overinflation of the Orbera Balloon System, although events have also been reported with the ReShape Balloon System. It recommends that healthcare providers closely monitor patients with these devices and report any events that arise to help in the understanding of complications from use of the obesity
treatment devices.

Gastric Surgery Can Alter the Way your Brain Works as well as Forcing You
to Eat Less
(Mirror UK)

The Mirror UK reports on research from Massachusetts General Hospital in which patients reported reduced cravings for unhealthy foods after gastric bypass. Surgeons polled about 100 patients follow surgery and most reported that their “obsessive urge to eat had vanished,” and that their taste in food had changed as they no longer craved fatty and sugary foods. According to the Mirror, this occurred because surgery “alters the activity of thousands of genes [responsible for the] complex relationship between the gut and
the brain.”

Obesity in the News…

Obese Patients Receive Suboptimal End-of-Life Care (Medscape)

Research published online in Annals of Internal Medicine by University of Pittsburgh School of Medicine researchers found obesity is associated with diminished use of hospice services, leaving patients vulnerable to suboptimal end-of-life care. Investigators say the data shows, "the disparities in hospice use and Medicare expenditures by patient BMI provide an excellent opportunity for improvement. All people — regardless of body size — and their families should have equal opportunities to experience the benefits of high-quality end-of-life healthcare.” The study is the first to explore the association between BMI and end-of-life care. Results showed that increased BMI was independently linked with decreased enrollment in hospice care, which requires a doctor's referral, the researchers note. Patients with a BMI of at least 40 had a predicted probability of hospice enrollment of 23.1% vs 38.3% in those with a BMI of 20. Participants with a BMI of at least 40 also spent 4.3 fewer days in hospice care than those with a BMI of 20 and had significantly fewer in-home deaths. BMI was also associated with increased Medicare expenditures in the last 6 months of life. Suggesting possible reasons for the observed differences in hospice care among patients with different BMIs, the authors point out that cachexia, often experienced at end of life, might have a role to play. Physicians and family members often relate cachexia to the dying process, and patients who do not experience this (e.g. obese patients) are less likely to be referred for hospice care.

Study Finds Link Between Protein, Obesity Rates in Latin Women (UPI)

A study published in the American Journal of Human Biology investigated the causes of increasing obesity rates among Latin American women of low socioeconomic status and found that limited access to dietary protein makes them consume a lower proportion of protein, leading to higher calorie intake and obesity. The study used the protein leverage hypothesis, which predicts that protein intake is more regulated by the body than intake of other macronutrients, in a test sample of 135 Costa Rican women from three socioeconomic categories. The study showed that obesity rates were higher and the proportion of protein in the diet was lower among women of low socioeconomic status compared to women of higher socioeconomic status. The research also showed a link between the proportion of protein in the diet and total calorie intake. The relationship between the proportion of protein in the diet and calorie intake was strongest in middle- and high-socioeconomic groups and the study found no relationship among women of low socioeconomic status. "One possible explanation for this unexpected finding is that women of low socioeconomic status cannot afford to continue eating until they reach the body's protein intake target," researchers said.

Teachers May be Cause of 'Obesity Penalty' on Girls' Grades (Science Daily)

Research from the University of Illinois at Chicago suggests that discrimination by body weight may be an important factor for obese white female students' lower success in school. The study, published in the journal Sociology of Education, indicates that the relationship between obesity and academic performance may result largely from educators interacting differently with girls of various sizes, rather than from obesity's effects on girls' physical health. Even when they scored the same on ability tests, white girls with obesity received worse high school grades than their normal-weight peers. Teachers rated them as less academically able as early as elementary school, according to the study, which analyzed elementary school students around age 9 and high school students approximately 18 years old. Obesity was associated with a penalty on teacher evaluations of academic performance among white girls in English, but not in math. There was no penalty observed for white girls who were overweight but not obese.

Study: Air Pollution Is Linked to Diabetes in Overweight Latino Children
(NBC News)

A study from the University of Southern California found that Latino children living in areas with higher levels of air pollution may also suffer damage to the pancreas — the organ that produces insulin. That, in turn, could raise their risk of developing Type 2 diabetes. "Exposure to heightened air pollution during childhood increases the risk for Hispanic children to become obese and, independent of that, to also develop Type 2 diabetes," said the study’s lead author. The children who participated in the study lived in areas that, according to the U.S. Environmental Protection Agency, had excess nitrogen dioxide and tiny air pollution particles that are generated by vehicles and power plants. By the time the children turned 18, their insulin-creating pancreatic cells were 13% less efficient than normal, making them more vulnerable to developing Type 2 diabetes. They also had nearly 27% higher blood insulin after having fasted for 12 hours. The study, funded by the National Institutes of Health and published in the journal Diabetes, is the first to connect air pollution and diabetes risk
in children.