Published March 12, 2018             

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

When to Consider Bariatric Surgery…ASMBS Past President Dr. Kevin Higa Talks about the Rise of Medical Tourism in Fresno, CA…Article in AAFP News Sparks Discussion About Obesity Treatment, AAFP Responds…Improvement in Diabetes after Bariatric Surgery…Years after Bariatric Surgery Risk of IBD May Increase…Losing Weight Lowers Risk of Diabetes…Opinion: To Address Childhood Obesity, We Must First Address Childhood Poverty…Obesity Carries Increased Risk of
CVD Mortality

Metabolic and Bariatric Surgery in the News…

Is Bariatric Surgery for You? (HealthDay via U.S. News & World Report)

Reporter guides readers who have been struggling with weight loss to the prospect of bariatric surgery, providing a link to the ASMBS website’s FAQ section. To qualify, patients considering bariatric surgery need to be at least 100 pounds overweight with a BMI of 40, or 35 with serious health issues, the reporter writes. A patient will also need to show they haven't been able to lose weight with more conventional approaches. A person who has bariatric surgery stands to lose between 60 to 80 percent of your excess weight in the two years following the surgery. At first, a patient will not have much appetite, but later on will be satisfied with a lot less food than before, health professionals report. While bariatric surgery is helpful to many people with obesity, “it's not a magic wand,” and risks include infection, and vitamin, mineral and protein deficiencies. The patient must be committed to making permanent lifestyle and diet changes.

It’s Not Yosemite, It’s the Surgery: The Rise of Medical Tourism in Fresno
(The Fresno Bee)

Story highlights the rise of medical tourism in the Fresno, CA-area due to the work of Kevin Higa, M.D., FACS, FASMBS, Past ASMBS President, and director of the Minimally Invasive and Bariatric Surgery program at Fresno Heart & Surgical Hospital. Patients come to Fresno “because they developed surgical complications while trying to lose weight,” according to the report. “I think Fresno and Clovis should be known for the great community and medical care we deliver,” said Dr. Higa. Medical tourists spend five to 10 times more in the local economy than the typical vacationer, and in 2014, the Fresno hospital completed 821 bariatric surgeries, the most in California according to the Office of Statewide Health Planning and Development. Dr. Higa’s primary focus is caring for local residents, and he encourages people to seek care where they live because bariatric surgery requires lifelong care and support. Some patients do have high-risk problems, however, and those patients are sent his way from colleagues around the world. “We have a no-refusal policy,” said Dr. Higa. “We will take any bariatric patient who has an emergent problem, no matter who did the original operation, from anywhere, period.”

Draft Recommendation Sparks Discussion on Overweight, Obesity
(AAFP News - Editorial)

A Feb. 21 article on AAFP News summarizing the recent draft recommendations from the U.S. Preventive Services Task Force (USPSTF) calling on primary care clinicians to offer or refer their adult patients with BMIs of 30 or greater to "intensive, multicomponent behavioral programs" for weight management “sparked a lengthy conversation with different viewpoints,” writes Jennifer Frost, MD, Medical Director of the American Academy of Family Physicians, in a Guest Editorial responding to comments readers posted on the AAFP’s website. In the original article, a family care physician offered an opinion on the Task Force’s recommendations in a section titled “Family Physician Expert's Perspective,” saying that he “recommends his patients avoid bariatric surgery and weight control medications in most cases.” Specifically, regarding bariatric surgery, he says that he “generally recommends against it, except in patients who are morbidly obese with serious complications,” claiming "So many patients who have this surgery gain their weight back or have complications." The comment drew criticism from readers, and in her editorial, Dr. Frost clarifies that the physician “was speaking for himself, not on behalf of the AAFP.” Dr. Foster also notes that the AAFP endorsed the management guideline developed by the American College of Cardiology, the American Heart Association and the Obesity Society, which calls for adults with BMI 40 or greater or BMI of 35 or greater with an obesity-related co-morbidity who have not had a sufficient response to behavioral treatment with or without pharmacotherapy, “be informed about bariatric surgery and offered a referral to an experienced bariatric surgeon for consultation and evaluation.” She also urges individuals with opinions about the Task Force's recommendations to provide feedback directly to the USPSTF before the public comment window closes on March 18.

More Evidence Weight Loss Surgery Can Improve Diabetes Symptoms (Reuters)

The JAMA Surgery study that demonstrated people with obesity who have bariatric surgery are less likely to need diabetes medications, compared to those who don’t have surgery to lose weight continues to make news headlines. Among those taking diabetes drugs at the start of the study, gastric bypass had the biggest impact on diabetes remission. Those who had gastric bypass were 17 times more likely to discontinue diabetes medications by the end of the six-year study than those who didn’t have surgery. Patients who were not on diabetes medication were also less likely to start taking them if they had bariatric surgery. Twelve percent of the non-surgical control group had started diabetes medication by the end of the study, while only 1.4 percent of patients who had bariatric surgery did the same. The results add to evidence that surgical weight loss may help manage diabetes, said Dr. Michel Gagner, author of an accompanying editorial and a professor of surgery at the Herbert Wertheim School of Medicine at Florida International University in Miami.

Bariatric Surgery Linked to Increased Risk for IBD (Healio Gastroentergology)

Patients who had bariatric surgery are at an increased risk of developing new-onset inflammatory bowel disease (IBD), according to a study published in Alimentary Pharmacology & Therapeutics. Researchers at the Icahn School of Medicine at Mount Sinai found that patients who had recent bariatric surgery did not show an increased short-term risk for new-onset IBD. However, in their matched case-control study, the patients who had surgery more than four years prior exhibited nearly double the risk for developing IBD. The researchers emphasized that this potential risk does not outweigh the overall benefits of bariatric surgery but could provide new insight into the pathogenesis of IBD.

Obesity in the News…

Progression of Obesity Influences Risk of Diabetes Over Life Course (HealthDay via Medical Xpress)

A new study published in Diabetes Care found that people with obesity who lose weight have a lower risk of diabetes compared to those with stable obesity. Researchers from the Boston University School of Public Health analyzed patients' weight changes and the incidence of diabetes over 10 years of follow-up. During the 10-year period, the researchers estimated that 9.1 percent of observed diabetes cases could have been averted if the patients who had obesity lost enough weight to no longer have obesity. Over 60 percent of diabetes cases could have been averted if the population had maintained a normal BMI.

Counting Calories Won’t Cure Childhood Obesity (Newsday - Opinion)

There is no amount of positive nutritional advice or exercise encouragement that would slow the rise of childhood obesity without addressing the factors that contribute to childhood poverty, according to a syndicated columnist with The Washington Post. “The line between a healthy childhood and one marred by obesity is firmly drawn between whites and Asians on one side and blacks and Hispanics on the other,” she writes. A recent study in the journal Pediatrics found that childhood obesity rates are on the rise, and that specifically children who are white and Asian-American have significantly lower rates of obesity than those who are African-American, Hispanic or of other races. Columnist says schools in more affluent areas have more prospects for physical activity and access to athletic facilities, while low-income communities are not afforded the same opportunities. More affluent schools are also ahead of the curve in terms of food choices and rules prohibiting unhealthy foods, according to the columnist.

Cardiovascular Disease Mortality, Morbidity Linked to Obesity (HealthDay News via Cardiology Advisor)

Obesity is associated with increased morbidity and mortality linked to cardiovascular disease (CVD) and shorter longevity compared to those with a normal BMI, according to a study published in JAMA Cardiology. Northwestern University researchers calculated the lifetime risk estimates of incident CVD and subtypes of CVD in a population-based study, with 3.2 million person-years of follow-up. The researchers found that lifetime risks for incident CVD were higher in middle-aged adults in the groups with obesity and overweight compared with individuals with a normal BMI, with the risk increasing with higher BMIs. Among CVD subtypes, higher BMIs had the strongest association with incident heart failure.