STORIES OF THE WEEK

Monday, May 15, 2017            

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

Bariatric Surgery Diabetes Remission Score Validated… Bariatric Surgery Increases Risk for Acute Liver Injury… Emerging Treatment Offers Weight Loss Alternative... New 'Balloon-in-a-Pill' Spurs Weight Loss, Health Benefits… Heaviest Woman in the World Facing Health Issues After Weight-Loss Surgery… Brain Wiring May Be Why Some People Overeat… World Obesity Federation Recognizes Obesity as Chronic, Relapsing Disease… Study Suggests Connection Between Working Parents and Childhood Obesity

Metabolic and Bariatric Surgery in the News…

Bariatric Surgery Diabetes Remission Score Validated (Medscape)

Findings in support of the DiaRem score were presented at the American Association of Clinical Endocrinologists (AACE) 2017 Annual Scientific & Clinical Congress. The DiaRem score, developed by Dr. Christopher Still, director of Geisinger Obesity Institute, and colleagues, uses just four preoperative clinical variables — insulin use, age, HbA1c, and diabetes medication type — to generate a score of 0 to 22, where the lower the score means the greater the chance of remission 1 year after gastric-bypass. The study was a retrospective review of electronic health records of adults with preoperative type 2 diabetes who underwent bariatric surgery from 2006 to 2015. Of the 95 patients for whom 1-year data were available, 72 (76%) had undergone gastric bypass, while 23 (24%) had gastric band or sleeve gastrectomy. At baseline, their BMIs ranged from 36 to 50, and they had an average HbA1c of 7.48%. The patients with higher DiaRem scores were less likely to achieve diabetes remission. When divided into five groups based on score (0–2, 3–7, 8–12, 13–17, and 18–22), remission rates were 100%, 83%, 64.2%, 59.2%, and 16.6%, respectively. The score was significantly predictive of both partial and complete remission.

Bariatric Surgery Increases Risk for Acute Liver Injury (Healio/Gastroenterology)

Bariatric surgery increases the risk of subsequent acute liver injury, according to results of a study presented at Digestive Disease Week. Researchers identified 437,390 patients who presented with acute liver injury (ALI) between 2010 and 2013, which were divided into a non-surgery group and a surgery group of 3,799 patients who had undergone bariatric surgery. Compared with the non-surgery group, patients who presented with ALI and had a history of bariatric surgery were more likely to be in a lower age bracket of 25 to 49 years, female, white, residing in more affluent regions, had private medical insurance and had a lower Charlson comorbidity index. Acute liver injury rate was 0.85% in the surgery group compared with a rate of 0.72% in the non-surgery group. Patients in the surgery group had 11.3% higher mortality risk compared with patients with no acute liver injury, while patients in the non-surgery group had a 6.17% higher mortality risk in the same comparison. Age, African-American ethnicity, chronic heart failure and coagulopathy were also associated with increased mortality risk in this cohort.

Emerging Treatment Offers Weight Loss Alternative (WebMD)

A study presented at the Digestive Disease Week conference looked at how endoscopic sleeve gastroplasty compared with two types of weight loss surgery. Researchers followed 278 patients with obesity; 91 had endoscopic sleeve gastroplasty; 120 had a laparoscopic sleeve gastrectomy; 67 had a laparoscopic banding. Patients who had endoscopic sleeve gastroplasty had the lowest BMI (39) of the three groups, compared with an average BMI of 46 and 47 for the sleeve gastrectomy and lap band surgery groups. At one year, the weight loss was 29% for laparoscopic sleeve gastrectomy; 18% for the endoscopic sleeve gastroplasty; and 14% for laparoscopic band surgery. Although the treatment didn’t bring the most weight loss, the investigators said it has a much lower complication rate and cost than standard bariatric procedures for weight loss.

'Balloon-in-a-Pill' Spurs Weight Loss, Health Benefits: Study (HealthDay)

A study of 10 patients who were overweight or had obesity tested a new type of nonsurgical gastric balloon pill that has a "magnetic valve" that can be opened at any time to deflate the balloon. After six months, the patients had lost almost 13% of their body weight, on average. Beyond that their insulin levels dipped by 20%, and their levels of "bad" LDL cholesterol dropped by an average of 20 mg/dL of blood. The researchers said the findings suggest the balloon therapy can not only spur weight loss, but might also help control type 2 diabetes and high cholesterol. The results were presented at Digestive Disease Week.

Heaviest Woman in the World Facing Health Issues After Weight-Loss Surgery (New York Post)

In February, a 36-year-old Egyptian woman who weighed 1,100 pounds flew 2,700 miles to Mumbai, India to undergo sleeve gastrectomy, which the BBC reports is “a last resort to treat people who are dangerously obese.” Since her procedure on February 20, the woman has lost almost half her weight in two months. Her doctors hope that she will be able to lose another 200kg over the next 6 months before undergoing a second surgery to reach her goal weight of under 220 pounds. “She is currently facing several health conditions, including a cardiac issue, which is still under intensive investigation; severe urosepsis [a bacterial infection complicating a urinary tract infection]; and third degree infected bed sores,” a statement from the hospital said. The statement said doctors are focused on improving her condition and hope to have her sitting up with minimal to no assistance.

Obesity in the News…

Do You Overeat? Your Brain Wiring May Be Why (HealthDay)

A new brain scan study suggests that people whose brains are wired to produce a more muted response to food may ultimately compensate by eating more, thereby raising their risk for obesity. The study also unearthed possible evidence of a gender divide in the way men and women process the experience of eating. Women's brains may favor a more emotional response to the eating experience. In contrast, a man's brain seems more inclined to link eating to the region that handles things like smell, temperature or taste. And men with obesity tended to have a relatively amped up response to food in brain regions involved in sensory regulation. That dynamic was not seen among women with obesity.

World Obesity Federation Recognizes Obesity as Chronic, Relapsing Disease (News-Medical)

In a statement published today in the journal Obesity Reviews, the World Obesity Federation confirmed its support for defining obesity as a chronic, relapsing disease. The statement was prepared by a scientific committee of the Federation which concluded that obesity fits the epidemiological model of a disease process except that the toxic or pathological agent is diet-related rather than a microbe. In the publication, the committee draws parallels to chronic diseases, noting that the magnitude of obesity and its adverse effects in individuals may relate to the virulence or toxicity of the environment and its interaction with the host. In an accompanying letter to the editor, the Federation's policy experts suggest that declaring obesity to be a disease could benefit those people who are suffering with obesity and wish to have access to medical advice and support, “whilst also strengthening the call for dealing with the social determinants, obesogenic environments and systemic causes of individual weight gain.”

More Evidence of a Connection Between Working Parents and Childhood Obesity (MarketWatch)

New research suggests that when both parents are working and away from their children, their offspring may suffer from childhood obesity, according to researchers at the Institute of Labor Economics. The researchers looked at families’ youngest children going to school and the effect parental work had on the older children’s weight, using data from the 1979 cohort of the Bureau of Labor Statistics’ National Longitudinal Survey of Youth, which tracked nearly 10,000 Americans from 1986 to 2014. Estimates that 10% of the rise in childhood obesity is due to the rise in working mothers may even be too conservative. The study focused on the rise in recent years of maternal labor, but noted that there was “no evidence” that the effects of maternal and paternal work are significantly different.