Published February 20, 2017             

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

PA to Cover Bariatric Surgery for Some State Employees…ASMBS Gives Balloon It’s Stamp of Approval…Bariatric Surgery Patients in JAMA Surgery Study No Longer in Need of Diabetes Meds…Bariatric Surgery Beats Intensive Medical Therapy…Bariatric Surgery Better than Abdominoplasty for Glycemic Control…Fitness May be More Important than Weight for Cardiovascular Health…Greater Survival from Melanoma in Men with Obesity…Art Program Shines Light on Obesity and Diabetes Epidemic in Poor Neighborhoods

Metabolic and Bariatric Surgery in the News…

Pennsylvania to Cover Bariatric Surgery for Some State Employees — 6 Insights (Becker's GI & Endoscopy)

The Pennsylvania Employees Benefit Trust Fund will cover bariatric surgery for some of its state employees. To be eligible, beneficiaries must have a BMI of 40 or above and type 2 diabetes. In addition, the beneficiaries must participate in a physician-supervised nutrition and exercise program for at least six months prior to the procedure. In a statement, ASMBS called the coverage, "a very important step in the right direction, and hopefully a signal to the handful of states that still deny bariatric surgery to reconsider their policy." However, ASMBS disagreed with Pennsylvania's plan on two fundamental levels: the six-month mandatory diet and exercise requirement and restricting the surgery to only those with a BMI at 40 or above or those with diabetes. ASMBS points out that the requirements are in contrast with those developed and recommended by the National Institutes of Health.

Society Adds Intragastric Balloon to Approved Devices (Healio Endocrine Today)

ASMBS has added the intragastric balloon to its list of approved devices and procedures, following an extensive review and safety analysis. “Intragastric balloon procedures may fill a treatment gap between medication and weight loss surgery and should be considered a standard intervention in the continuum of care for patients with obesity,” Samer Mattar, MD, ASMBS president said in a news release. “However, insurance coverage for this procedure is currently nonexistent. It is our hope that our approval, and the body of evidence that supports the appropriate use of the device, will change that, and more people will have access to a new treatment option for obesity.” A 2017 meta-analysis published in the American Journal of Gastroenterology, found that patients who received intragastric balloons experienced superior improvements in obesity-related metabolic risk factors compared with dietary interventions, and the balloons were associated with a low rate of adverse events. ASMBS estimates only 5,000 intragastric balloons have been implanted since the FDA first approved it in 2015 for the treatment, which represents less than 3% of the 216,000 bariatric surgeries performed in the United States in 2016.

Bariatric Surgery Enabled Stopping Diabetes Meds (MedPage Today)

A significant number of patients with obesity and diabetes discontinued their medications, and fewer patients without diabetes initiated treatment, following bariatric surgery, French researchers report in JAMA Surgery. The study included all patients undergoing primary bariatric surgery in France from 2008 through 2015 -- more than 15,000 in all. Nearly half of the surgical patients (48.5%) had adjustable gastric banding, 27.7 percent had gastric bypass, and 22 percent had sleeve gastrectomy. Six years after surgery, 49.9 percent of patients with diabetes who had surgery discontinued their medications, compared with just 9 percent of a matched non-surgical control group. For patients without diabetes at baseline, the 6-year antidiabetes medication initiation rate was 12 percent for the nonsurgical care control group, compare to just 1.4 percent for those who underwent surgery.

Bariatric Surgery Yields Greater Metabolic Benefits than Intensive Medical Therapy (Healio Endocrine Today)

Adults with type 2 diabetes and obesity assigned to gastric bypass were more likely to experience improvements in HbA1c and fasting plasma glucose, and greater weight loss compared to adults assigned to an intensive medical diabetes- and weight-management intervention, according to a study published in Diabetes Care. The non-surgical group’s multidisciplinary diabetes- and weight-management program incorporated diabetes medication adjustment to help with weight loss, a structured modified dietary intervention, individualized exercise program, cognitive behavioral intervention and group education. At three years, 42 percent of those who had gastric bypass achieved HbA1c less than 6.5 percent and fasting plasma glucose less than 126 mg/dL, whereas none of the medical intervention group achieved those goals. More participants in the surgery group achieved HbA1c less than 7 percent compared with the medical intervention group (58% vs. 11%), and greater weight loss at year three than the medical intervention group (change of –24.9 kg vs. –5.2 kg).

Bariatric Surgery Outperforms Abdominoplasty for Glycemic Control in Type 2 Diabetes (Healio Endocrine Today)

Adults with type 2 diabetes who underwent bariatric surgery experienced greater improvements in glycemic control and weight loss compared to those who underwent abdominoplasty to reduce subcutaneous adipose tissue, according to a study published in Bariatric Surgical Practice and Patient Care. In the abdominoplasty group, BMI decreased from 40.6 kg/m2 to 38.5 kg/m2 and HbA1c decreased from 7.4 percent at baseline to 6.8 percent at 12 months. In the bariatric surgery group, BMI decreased from 42.2 kg/m2 to 26.6 kg/m2, and HbA1c decreased from 7.9 percent at baseline to 5.5 percent at 12 months. The researchers say the “small improvement observed after abdominoplasty lends support to the idea that deep subcutaneous adipose tissue removal may reduce insulin resistance, although only having a small impact on glycemic control on patients with [type 2 diabetes].”

Obesity in the News…

Exercise Helps Counter the Ill Effects of Obesity — Even for the Severely Obese (Everyday Health)

A new study published in BMC Obesity suggest that cardiorespiratory fitness may be equally or even more important than body weight in determining cardiovascular health for people living with mild, moderate, or severe obesity. The study analyzed 853 patients who had overweight or obesity and assessed their maximal oxygen uptake, which is a standard measure of cardiorespiratory fitness. The data showed that 41 percent of the individuals who had mild obesity were fit, as were 25 percent of the individuals who had moderate obesity and 11 percent of those with severe obesity. The people who were highly fit had no difference in other markers of health (blood pressure, lipid levels, and blood glucose levels), regardless of whether they had overweight, moderate or severe obesity. “Normally, you see the largest exponential increase in health risk with severe obesity. So to see no difference in risk, as compared with those with mild obesity, was really surprising,” said the study’s lead author, Jennifer Kuk, PhD, an associate professor in the school of kinesiology and health science at York University in Toronto. “Even if you don’t lose weight, being physically active is likely going to be beneficial to your health and it is important to disconnect success from what you see on the scale,” Dr. Kuk says. John Morton, MD, MPH, the chief of bariatric and minimally invasive surgery at Stanford Health Care in California, and ASMBS past-president, agrees. “When it comes to physical activity, some is better than nothing.” Dr. Morton cautions, however, that the data shouldn’t be interpreted as meaning that people who have obesity are just as fit — and can have the same level of fitness for an extended period of time — as people who do not have obesity. “You see in this study that some discrete variables can come close, but overall I think there’s no denying that being at a higher weight is detrimental to your overall health.” If you look at epidemiological data, he says, as weight goes up, overall life expectancy goes down. According to Morton, the data from this study underscores the point that the heavier you are, the more difficult it is to be fit. Subjects were significantly more likely to be fit if they only had mild obesity than if they had moderate or severe obesity, he notes. “As your weight goes up, your ability to be fit appears to go down.” Morton says that he and his colleagues need more evidence to identify what stops people who have obesity from getting healthier, and what helps them. “Obesity is a very pervasive problem with a lot of impact on people’s lives. We need more tools to find out how we can
help people.”

Obesity Tied to Survival in Men with Melanoma
(The New York Times)

Men with obesity treated for metastatic melanoma may survive longer than their normal-weight peers, according to a Lancet Oncology retrospective analysis of 1,918 people (60% men) under treatment. Compared with men of normal weight, men with obesity had nearly double the progression-free survival time and nearly double the overall survival time. The more overweight the man was, the greater the effect. But there was no association of obesity with survival in women. The survival benefits were apparent in men undergoing immunotherapy and in those getting targeted therapy that aims to prevent reproduction of cancer cells without attacking healthy cells. Obesity provided no benefits in those taking chemotherapy. While the mechanism is unknown, lead author, Dr. Jennifer L. McQuade, an oncologist at the University of Texas M.D. Anderson Cancer Center, says that obesity causes chronic inflammation that might change the responses to therapy.

Using Art to Tackle Obesity and Diabetes in Youth (The New York Times)

Between 2000 and 2009, the rate of type 2 diabetes in children jumped more than 30 percent — and it is climbing especially fast among children from poor and minority families. Black and Hispanic children have eight times the risk of developing the disease compared with others. Public health experts and arts educators have teamed up to try a novel approach to preventing the disease in young people. The campaign, called The Bigger Picture, aims to get teenagers and young adults to view the diabetes crises in their communities not just as a medical problem related to poor diet and a lack of exercise but as a social justice problem tied to stress, poverty, violence and limited access to healthy and affordable foods. The program, created by the University of California, San Francisco School of Medicine and Youth Speaks, a nonprofit arts group, uses art to confront obesity and diabetes in youth. Poet mentors and doctors have been conducting workshops in poor communities, where they educate high-risk youth about the epidemic and provide a platform for them to create spoken-word poems to express how diabetes and obesity affect them. An article released in JAMA highlights some of the latest spoken-word poems.