STORIES OF THE WEEK

Monday, February 20, 2017            

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

Bariatric Surgery Delivers Durable Diabetes Control, STAMPEDE 5-Year Results in NEJM… NYTimes: Research Shows Weight Loss Surgery Better at Reversing “Devastating Effects” of Obesity… Vagal Nerve-Blocking Therapy Safe, Effective for Patients with Obesity and Diabetes… 1,100 Pound Woman Travel 2,700 Miles for Lifesaving Saving Weight-Loss Surgery… People with Predisposition for Excess Visceral Fat More Likely to Have Diabetes, Heart Disease… Exercise During Pregnancy May Help Women with Obesity Avoid Complications… Obesity May Raise Heart Risk by Triggering Harmful Immune Response

Metabolic and Bariatric Surgery in the News…

Weight-Loss Surgery May Help Obese Patients Beat Diabetes
(HealthDay, Medscape)

The final 5-year results of the Surgical Treatment and Medications Potentially Eradicate Diabetes Efficiently (STAMPEDE) trial, which included 150 patients with obesity (BMI 27-43) and uncontrolled type 2 diabetes, showed that bariatric surgery plus intensive medical therapy was more effective than intensive medical therapy alone in decreasing or resolving hyperglycemia. Preliminary 5-year findings from STAMPEDE were presented at the American College of Cardiology 2016 Scientific Sessions in April. The newly published final results appeared in the February 15 issue of the New England Journal of Medicine. About one in four patients who had gastric bypass or sleeve gastrectomy but only one in 20 patients who had received only intensive medical therapy attained the primary end point of HbA1c < 6% at 5 years. Moreover, the "beneficial effects of bariatric surgery on glycemic control were durable, even among patients with mild obesity (body mass index [BMI] of 27–34), which led to a sustained reduction in the use of diabetes and cardiovascular medications," wrote Cleveland Clinic’s Dr. Philip Schauer and colleagues. “Surgery has come as close as any treatment that we know of that can lead to long-term remission of type 2 diabetes, which is about as close to a cure as you can get," Dr. Schauer commented in HealthDay. In an interview with HealthDay, ASMBS President-Elect Dr. Samer Mattar, who was not involved in the study, provided perspective on the effectiveness and durability of bariatric surgery, noting, "Bariatric surgery is the most effective and durable treatment we have for obese patients with type 2 diabetes. It goes way beyond weight loss and improves the health of many patients with chronic disease.”

Why Weight Loss Surgery Works When Diets Don’t (The New York Times)

NYTimes.com Well Blog columnist Jane Brody reported on a detailed analysis “of the best studies yet done showing weight-loss surgery’s ability to reverse the often devastating effects of being extremely overweight on health and quality of life.” The review, which was published in the journal Obesity, included studies that followed patients for 5 to 25 years after bariatric surgery and found major long-lasting health and quality-of-life benefits. Compared to patients who did not have surgery, those who did fared much better physically, emotionally and socially, rated themselves as healthier, and were less likely to report problems with mobility, pain, daily activities, social interactions and feelings of depression and anxiety, among other factors that can compromise well-being. Brody notes that, “equally important are the undeniable medical benefits of surgically induced weight loss,” which include normalizing blood pressure, blood lipid levels and blood sugar -- results demonstrated in a study from Cleveland Clinic’s Dr. Stacy Brethauer that showed even a “modest” weight loss of just 5 to 10 percent resulted in a reduction of cardiovascular risk factors and blood sugar abnormalities in patients with obesity and type 2 diabetes. The NYTimes.com article, which also appeared in the print newspaper on February 14th, notes that patients who undergo bariatric surgery "often spend many years trying — and failing — to lose weight and keep it off. And the reason is not a lack of willpower,” citing results from the ASMBS/NORC Obesity Poll. The online article also provided a link to a separate 2016 story by the NYTimes on results of that national survey. Brody reports that the safety and effectiveness of bariatric surgery is “well-documented” and people interested in bariatric surgery should seek out programs that have been jointly accredited by the American College of Surgeons and the ASMBS, “which have combined forces to promote quality control,” added Dr. Jon Gould, a surgeon at the Medical College of Wisconsin in Milwaukee.

Vagal Nerve-Blocking Therapy Safe, Effective in Type 2 Diabetes, Obesity (Healio.com)

Treatment with intermittent electrical vagal blocking was safe and effective for reducing weight, HbA1c and other glycemic parameters at 3 years in adults with type 2 diabetes and obesity, according to data published in the Journal of Diabetes and Obesity. Researchers from the University of Minnesota evaluated data from the VBLOC DM2 study, which includes 28 adults with type 2 diabetes and obesity who have received intermittent electrical vagal blocking delivered via the Maestro rechargeable system. The system delivered 5,000 Hz for at least 12 hours each day; therapy did not require a specific diet or exercise program. Weight loss at 3 years was comparable to that at 1 and 2 years for an estimated mean weight loss of 21% from baseline among participants. Among 18 participants who attended the 3-year visit, mean estimated percent weight loss was 24%. At 3 years, 71% of participants had HbA1c less than 7% compared with 25% of participants at baseline. The most frequently reported adverse events were mild to moderate heartburn, constipation and neuroregulatory site pain.

1,100 Pound Woman Leaves Home for First Time in 25 Years — to Fly to India for Weight-Loss Surgery (The Washington Post)

On February 12, a 36-year-old Egyptian woman who weighs about 1,100 pounds flew 2,700 miles to the Center for Obesity and Digestive Surgery in Mumbai “to undergo a risky bariatric surgery that, if successful, could give her a chance at a ‘normal, healthy life’,” the Washington Post reports. She is likely the heaviest woman alive by roughly 450 pounds and has a BMI of 252 as well as several obesity-related co-morbidities including hypertension, hyperthyroidism, gout, diabetes and sleep apnea. The woman’s bariatric surgeon lobbied India's minister of external affairs to grant her a travel visa, after she was initially denied one for not showing up in person at the Indian Embassy in Cairo due to being housebound for nearly 25 years. She is scheduled to have sleeve gastrectomy on Monday, February 20, and her doctor told The Post that the hospital’s obesity treatment team has developed a four-year treatment plan that includes surgery, medication and lifestyle interventions, however, her sugeon also noted that he estimates her treatment will later include “two or three rounds of surgery; the goal was to get her, eventually, under 220 pounds.”

Obesity in the News…

Here’s the Strongest Evidence Yet That Belly Fat Is Really Bad for You (Health.com)

Research from the Broad Institute of MIT and Harvard found people who carry combinations of genes that predisposed them to higher waist-to-hip ratios — a comparison used to measure excess visceral fat — are 77% more likely to have diabetes, and 46% more likely to have coronary heart disease, than those who weren’t predisposed. They were also more likely to have risk factors for these conditions, including high cholesterol, high blood pressure, and high blood glucose levels. The findings come from an analysis of genomic data and medical records from more than 400,000 people. The study highlights the importance of a healthy lifestyle, the researchers said. “The amount of fat that you store around your stomach is influenced by genetics, but it’s also strongly influenced by exercise and diet… The message here is that if you want to reduce your health risks, you should minimize the fat you store around your abdomen.”

Exercise During Pregnancy May Help Obese Women Avoid Dangerous Complications (Reuters)

Exercise may be an efficient way for obese pregnant women to lower their risk of diabetes, dangerously high blood pressure and other complications according to a new study from researchers at Oregon Health and Science University in Portland. The findings are from an analysis of previously published research on the effect of exercise on pregnant women with a BMI of at least 30. “The study suggests that a prenatal exercise-based intervention leads to both decreased costs and improved outcomes in obese women,” said the study’s lead researcher. In addition, based on a cost-effectiveness threshold of $100,000 per quality-adjusted life year, the researchers also found that an exercise intervention could save money as long as expenses are held to just under $3,000.

Obesity May Raise Heart Risk by Triggering Harmful Immune Response
(Medical News Technology)

New research from the U.K. suggests that obesity resulting from a high-fat diet can trigger the immune system to increase inflammation and raise the risk of cardiovascular diseases that lead to heart attacks and stroke. Researchers say finding from the study, which was published in the journal Cell Metabolism, could lead to new treatments that reduce heart disease risk by targeting the inflammation. The study reveals a new link between obesity and heart disease risk that occurs via the triggering of an immune response involving T cells, which help to protect the body from infections. However, they can also cause inflammation that hastens the buildup of fatty plaque in atherosclerosis. Blood samples from 1,172 normal weight, overweight and obese people showed those with obesity had higher levels of T cells. They also found that participants who carried more fat around their middle had higher levels of T cells than those who carried it on their thighs and buttocks. The study’s lead researcher commented that drugs that target the pathway are already being tested as a cancer treatment and thus, "it might be possible to repurpose these drugs for the treatment of
heart disease."