Monday, March 20, 2017            

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

Bariatric Surgery Impacts Joint Replacement Outcomes in Patients with Severe Obesity… Sleeve Gastrectomy Safe in Children with Severe Obesity… Obesity Tied to Esophageal Cancer Risk… Obesity Linked to Increased Arthritis Rates in Younger Adults… New Obesity Gene Identified for Some People of African Descent… Obesity In Early Pregnancy Tied to Cerebral Palsy… Moms with Obesity May Fail to Spot Obesity in Kids

Metabolic and Bariatric Surgery in the News…

Bariatric Surgery Impacts Joint Replacement Outcomes in Very Obese Patients
(Science Daily)

A new study finds that in patients with severe obesity, bariatric surgery performed prior to a total hip or knee replacement can reduce in-hospital and 90-day postoperative complications and improve patients’ health, but it does not reduce the risk of needing a revision surgery. Researchers used the New York Statewide Planning and Research Cooperative System (SPARCS) database to identified all patients with severe obesity who had a THA or TKA in New York State between 1997 and 2011. There were 2,636 patients who underwent a total knee replacement and 792 who underwent a total hip replacement after bariatric surgery. Statistical analyses showed that bariatric surgery lowered the comorbidity burden of patients prior to total joint replacement. Patients with severe obesity who had bariatric surgery had lower rates of in-hospital complications for total hip replacement (1.5% vs. 5.3%) and for total knee replacement (2.7% vs. 3.9%). The data reveals that patients with severe obesity who had bariatric surgery were 75% less likely to have in-hospital complications from a total hip replacement and 31% less likely to have in-hospital complications for a total knee replacement. The risk for 90-day postoperative complications was also lower in patients who received bariatric surgery, 14% lower in the THA group and 61% lower in the TKA group. Bariatric surgery did not lower the risk of having a revision surgery or the risk for a hip dislocation. The study was presented at the American Academy of Orthopedic Surgeons Annual Meeting.

Laparoscopic Sleeve Gastrectomy Safe in Children with Severe Obesity (Healio/Endocrinology Today)

Children and adolescents with severe obesity who had laparoscopic sleeve gastrectomy at a children’s hospital without NIH support experienced safety outcomes similar to those of NIH-funded bariatric surgery studies in children, according to a retrospective analysis published in Clinical Obesity. Researchers analyzed data from 105 children and adolescents who underwent laparoscopic sleeve gastrectomy between January 2010 and June 2015 and reviewed length of hospital stay, as well as morbidity and mortality data in the 30 days after surgery. Median length of hospital stay was 2 days; there were no deaths in the 30 days after surgery. Three patients (2.9%) experienced major complications during their initial hospital stay requiring reoperation; one patient experienced major complications in the 30 days after surgery (deep venous thrombosis). Four patients (3.8%) experienced minor complications, including one submucosal hematoma requiring 2 weeks of total parenteral nutrition, and three patients with decreased oral intake, requiring readmission for IV fluids and steroids. “Long-term efficacy data are still lacking, but all of the data to date suggest that adolescents do at least as well, if not better, than adult patients after bariatric surgery,” the study’s lead author commented. “We need more data to confirm these findings, and research on how to best optimize surgical outcomes in all ages.”

Obesity in the News…

Another Obesity Downside: Esophageal Cancer Risk (WebMD)

New research indicates people who are overweight in their 20s have a 60 to 80% increased risk of developing esophageal and stomach cancer, compared with those who maintained a normal weight throughout their life. And those who then gained more than 40 pounds by age 50 doubled their risk of esophageal cancer and moderately increased their risk for stomach cancer. But, it was those individuals who progressed from overweight at age 20 to having obesity at age 50 and older who had three times or more increased risk for esophageal and stomach cancer. The findings are based on data on more than 400,000 people that was published in the British Journal of Cancer.

Obesity Drives Increased Arthritis Rates in Younger Adults (Medscape)

A study published online in Arthritis Care & Research suggests obesity is driving the increase of arthritis among younger adults. Researchers analyzed longitudinal data for 8,817 subjects from the Canadian National Population Health Survey 1994-2011 and found the odds of reporting arthritis increased with increasing levels of BMI. Those who were categorized as having severe obesity were 2.5 times more likely to report arthritis than those of normal weight and arthritis age trajectories were shifted by obesity. Differences were greater for individuals with obesity than for normal-weight individuals, and their age trajectories were steeper, suggesting that people with obesity developed arthritis years earlier than normal-weight individuals.

New Obesity Gene Identified for Some People of African Descent (NBC News)

Researchers have found a genetic variation unique to some people of African descent that can add about six pounds of extra weight. About 1% of people of African heritage carry the genetic variation, researchers from the NIH reported in the journal Obesity. Moreover, those who have the gene are more likely to have obesity: more than 55% of people with the mutation were considered obesity, compared to 23% of those who don't have it. People of purely European descent don't have this variation. The team started with 1,500 people taking part in a diabetes study in Nigeria, Ghana, and Kenya. They did what's called a genome-wide association study, sequencing all their DNA. They found the mutation in a gene called SEMA4D. It's associated with inflammation and while most people in the world don't have mutations in the gene, 1% of the West Africans did. ”We are providing new insights into biological pathways for obesity that have not been previously explored," commented one of the study’s lead investigators.

Obesity In Early Pregnancy Tied to Cerebral Palsy (HealthDay)

Maternal obesity may be associated with risk of cerebral palsy in full-term infants, according to a study published in the Journal of the American Medical Association. Researchers collected data on more than 1.4 million children born in Sweden from 1997 through 2011. A total of 3,029 children were eventually diagnosed with cerebral palsy. For infants born at full term, who accounted for 71% of all cerebral palsy cases, the association between maternal obesity and cerebral palsy was statistically significant. The finding was not statistically significant for preterm babies, the researchers noted. About 45% of the association between maternal weight and cerebral palsy in full-term children was seen in infants who had breathing complications. "Although the effect of maternal obesity on cerebral palsy may seem small compared with other risk factors, the association is of public health relevance due to the large proportion of women who are overweight or obese worldwide," researchers said.

Obese Moms May Fail to Spot Obesity in Their Own Kids (HealthDay)

Mothers who are overweight or that have obesity may underestimate the weight of their obese children, a new study in Obesity Science & Practice finds. Among 230 mothers with preschool children who were overweight or had obesity only 20% correctly assessed their child's weight, while 40% underestimated it. "This is also concerning in the light of recent research showing children of obese mothers were less likely to recognize their own weight, as well as that of their mother, and therefore may be related to shifting attitudes toward weight status, where overweight is less recognized because of its prevalence," said the study’s lead author. Mothers who underestimated their children’s weight also tended to report less pressure to eat and less concern about a child being underweight.