Monday, April 16, 2018            

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

Bariatric Surgery Improves Risk Factor for Declining Kidney Function…Surgery Underutilized for Teens, Young Adults with Severe Obesity, Study Finds…Revisional Bariatric Surgery Improves, Resolves Residual Type 2 Diabetes…Significantly More Surgical Weight Loss in Patients Compliant with Follow-up Visits…Bariatric Surgery Not Found to Increase Non-Elective Readmission after Total Joint Arthroplasty…History of Obesity in Childhood Affects CV Risk Later in Life…Obesity and Overweight Linked to Cancer in Young Adults…Childhood Obesity Interventions Rarely Include Fathers…Obesity Increases Risk for Respiratory Tract Infection, Study Suggests

Metabolic and Bariatric Surgery in the News…

Another Bariatric Benefit: Improved Albuminuria (MedPage Today)

In the largest series of bariatric surgery in patients with diabetic nephropathy to date, Cleveland Clinic researchers found a high rate of patients had long-term improvement or resolution of their albuminuria, an independent risk factor for declining kidney function in patients with type 2 diabetes. The findings were presented at the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) 2018 Annual Meeting and 16th World Congress of Endoscopic Surgery. A cohort of 101 patients, 75 who had gastric bypass and 26 who had sleeve gastrectomy from 2005 to 2014, were followed for four to ten years. Patients' mean age was 53, mean BMI was 43, and median albumin:creatinine ratio (uACR) was 80 mg/g. Half of patients had their albuminuria resolve by the last follow-up visit, and 80 percent saw overall improvement in their uACR. By one-year, mean BMI had declined to 32. The average weight loss was 25 percent among those who had gastric bypass and
16 percent in the sleeve gastrectomy group.

Few Young Patients with Severe Obesity Undergo Weight Loss Surgery
(Sleep Review)

Among U.S. teens and young adults with severe obesity, new research presented at the Endocrine Society’s 100th annual meeting finds that only a small percentage undergo weight loss surgery. The study’s lead investigator said, “This finding is a wake-up call that we need to adequately use the appropriate treatment modality for the severity of the disease, which for many people with more severe obesity is weight loss surgery.” In the study, researchers examined the frequency of weight loss surgery in 14- to 25-year-olds treated at eight high-volume surgical centers across five states. The percentage of patients diagnosed with severe obesity who underwent weight loss surgery was 0.4 percent at Boston Children’s Hospital, 1.4 percent at Boston Medical Center, 2.3 percent at Beth Israel Deaconess Medical Center,
2.5 percent at Washington University and 21.5 percent at Partners Healthcare (which comprises Massachusetts General and Brigham and Women’s Hospital). Researchers suggest the lack of education and awareness of surgical treatment of obesity among healthcare providers and the public as a possible reason for the underutilization of bariatric surgery in young patients with severe obesity.

Revisional Bariatric Surgery Effective in Patients with Residual Diabetes
(Healio | Gastroenterology)

Revisional bariatric surgery leads to improvements and even remission of persistent or relapsed type 2 diabetes, according to a study presented at the SAGES 2018 Annual Meeting. “Diabetes is a chronic progressive disease,” lead study author Ali Aminian, MD, from Cleveland Clinic, told Healio Gastroenterology and Liver Disease. “If one surgery failed to improve diabetes, we can escalate the care and convert to another surgery or do a corrective procedure to improve diabetes. Unfortunately, many patients and physicians do not consider the option of reoperation to improve metabolic outcomes. Furthermore, many insurance providers do not cover reoperative bariatric surgery.” Revision of the gastric pouch and/or stoma in RYGB led to improvements in 69 percent of patients and remission in 25 percent. The data showed disease improvement of 70 percent for patients who previously had vertical band gastroplasty and later underwent conversion to RYGB, 28 percent for sleeve gastrectomy and 58 percent for adjustable gastric bandings procedures. Conversion to RYGB from vertical band gastroplasty also correlated with a remission rate of 6 percent, and the rate was 27 percent for both sleeve gastrectomy and adjustable gastric bandings.

Bariatric Surgery Patients Lose More Weight When Compliant with Follow-up Visits (Healio | Gastroenterology)

Patients who had RYGB achieved greater weight loss if they adhered to follow-up visits during the first two years after surgery, according to new research presented at the SAGES 2018 Annual Meeting. Researchers from the University of Alabama at Birmingham retrospectively reviewed data on 872 adults between 2005 and 2016. They identified 357 patients as having low compliance, having attended one to three of eight scheduled follow-up visits, and 515 as having high compliance, attending four to eight visits. While there was no difference in percentage of weight loss after one year of follow-up, patients who had high compliance with bariatric visits achieved a significantly greater percentage of weight loss after two years of follow-up. Further analysis of outpatient institutional visits also revealed significantly greater weight loss at both one and two years in those with high compliance. After factoring in all scheduled visits within two years, both bariatric and outpatient institutional, the researchers concluded patients with low compliance have significantly lower percentage of weight loss.

Preoperative Bariatric Surgery [Does] Not Increase Non-Elective Readmission Rates after TJA (Healio | Orthopedics Today)

Though patients who had bariatric surgery two years prior to total joint arthroplasty were not at risk for non-elective readmissions, bariatric surgery was a significant predictor of elective total joint arthroplasty (TJA) admissions up to one year following a procedure, according to findings published in Orthopedics. Researchers looked at 343,710 patients who had TJA between 2005 and 2014 and divided them into three groups, patients with obesity who underwent preoperative bariatric surgery within two years of TJA, patients with obesity that did not undergo preoperative bariatric surgery and patients without obesity. While there was no significant difference in non-elective readmission rates among the groups, bariatric surgery was an independent risk factor for all-cause readmission at all time points when elective TJA admissions were included.

Obesity in the News…

Childhood Obesity Can Affect Cardiovascular Risk Even if Resolved by Adulthood (TCTMD)

Having a childhood history of obesity affects cardiometabolic risk in adulthood, even if obesity is resolved by adulthood, according to new findings published in the European Heart Journal. Researchers looked at 2,631 participants from the Cardiovascular Risk in Young Finns Study who had their height and weight measured on at least three occasions between 1980 and 2011. The patients were designated into six different life-course BMI trajectories: 1. Stable (55.2%), 2. Progressively overweight (33.4%), in which BMIs increased over time, with individuals being overweight by their 30s, 3. Progressively obese (4.2%), in which BMI levels increased over time, with individuals having overweight in childhood and obesity by early adulthood, 4. Rapidly overweight/obese (4.3%), in which individuals were borderline overweight in early childhood, had obesity in mid-childhood, and obesity with stable BMIs by age 20, 5. persistent increasing overweight/obese (1.2%), in which BMIs persistently increased over time, with individuals being obesity throughout their life, and 6. Resolving (1.6%), in which individuals had overweight or obesity during childhood, had obesity by age 25, and progressively reversed their elevated BMI status between ages 30 and 50. Compared with the stable cohort, all individuals with increasing BMIs over their lives were at significantly higher risk for type 2 diabetes, hypertension, high-risk carotid intima-media thickness (cIMT), and high-risk lipid levels. Those in the resolving group were found to have a similar risk for dyslipidemia and hypertension as those who had never had obesity or been overweight but had more than a threefold higher risk for increased cIMT and a slightly higher risk for
type 2 diabetes.

Overweight, Obesity Contributing to Cancers in Young Adults
(Health Day via Endocrinology Advisor)

Overweight and obesity may be contributing to specific malignancies at younger ages, according to research published in Obesity. Researchers conducted a comprehensive narrative review of more than 100 publications to examine the correlation of the obesity pandemic with the appearance of 13 obesity-linked cancers in young adults under age 50. Based on multiple murine models, obesity was suggested to increase cancer incidence and accelerate its development.

Fathers Missing in Childhood Obesity Interventions, Study Finds (Medical Express)

A new study published in the journal Preventive Medicine finds fathers are rarely included in family-based interventions designed to prevent childhood obesity. Researchers from the University of Guelph in Ontario and the Harvard Chan School of Public Health analyzed 85 family-based interventions for childhood obesity prevention and found fathers represented only six percent of all parent participants. Of the studies examined, one-third of the interventions focused on mothers only, one-third included mothers and fathers, and one-third did not specify parent gender. Only one percent of all interventions were geared toward fathers only. Previous research has shown a child is ten times more likely to be overweight if a father is overweight than if only the mother is overweight.

Is Obesity a Risk Factor for a Respiratory Tract Infection? (Medical News Bulletinl)

People with obesity had consistently higher incidences of both upper and lower respiratory tract infections, researchers report in BMC Public Health. A total of 1,455 participants were included in the study, with ages ranging from 18 to 70 years. Researchers used participant-recorded diaries to track airway infections over an 18-month period during the course of three consecutive winter and or spring seasons. Women with obesity were observed to have a higher association with respiratory tract infections than males.