Monday, June 11, 2018            

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

New Reports of Deaths Linked to Intragastric Balloons …Teens with Mental Health Issues and Obesity Still Benefit from Bariatric Surgery…Risk of Osteoporosis after Bariatric Surgery… Obesity Tied to Adverse Pregnancy Outcomes in Women with Mental Illness…Study Finds Exercise Can Help Combat Genetic Effects of Obesity in Older Age

Metabolic and Bariatric Surgery in the News…

Weight Loss Balloons Linked to 12 Deaths, FDA Says (WebMD, CNN, FDA Alert)

An additional five patients have died in association with intragastric balloon procedures performed worldwide since 2016, according to an alert issued by the U.S. Food and Drug Administration (FDA). Four of these deaths (three with the Orbera Intragastric Balloon System and one with the ReShape Integrated Dual Balloon System) occurred following gastric perforation one day to 3.5 weeks after balloon placement. The fifth death was reported for a patient who had the Orbera balloon, but there was no mention of a perforation event and the manufacturer is still investigating this death. Dr. Eric DeMaria, ASMBS president-elect commented to, "Clearly this is tragic, and we want to know more about the circumstances of these deaths, but overall we believe that the data on the procedure does suggest that it is safe and effective for the vast majority of patients." Dr. DeMaria described the procedure to WebMD noting it works best for people for BMI greater than 30, but less than 40. He said he’s concerned over the deaths, “but I certainly don't think at this point we would make any changes in our recommendation regarding safety and effectiveness." It was noted that last year the ASMBS added the intragastric balloon to its list of approved procedures and devices. In a television interview with CNN Headline News, Dr. John Morton, past president of ASMBS, expressed condolences to the patients’ families and said that it is important to put the FDA alert into context, and that the procedure remains safe, particularly if performed at an accredited center.

Obese Teens with Psychiatric Issues can still Benefit from Weight Loss Surgery (Reuters)

Teens with obesity who undergo bariatric surgery are likely to benefit from surgery regardless of whether they were previously diagnosed with psychiatric problems, according to a study published in Pediatrics. Doctors previously considered people with mood or cognitive disorders poor candidates because of concerns these patients would not follow strict dietary rules after surgery. Among 169 teens researchers found no meaningful difference in weight loss after one year between those with a mental health diagnosis and those without one. “For any adolescent with severe obesity, no matter where they come from or where they live, mental health is still important, but can be assessed and treated in conjunction with the surgery,” said lead study author Eleanor Mackey of Children’s National Health System in Washington, DC.

Clinical Challenges: Osteoporosis Risk After Bariatric Surgery
(MedPage Today)

Anatomical changes after bariatric surgery can put patients at risk for mineral deficiencies and osteoporosis. Mixed restrictive and malabsorptive procedures such as RYGB and BPD carry an increased risk of fracture at osteoporotic sites, while LAGB does not, at least in the short term, according to Anne Schafer, MD, of the University of California San Francisco and the San Francisco VA Healthcare System. Joint guidelines released by the ASMBS, AACE, and The Obesity Society state that DXA bone density scans are indicated both preoperatively and two years after bariatric surgery. In addition to screening bariatric surgery patients for bone changes, clinicians must also closely monitor calcium and vitamin D levels before and after surgery. Dr. Schafer recommends that providers refer to the ASMBS guidelines when considering calcium and vitamin D supplementation.

Obesity in the News…

Obesity Tied to Adverse Pregnancy Outcomes in Mentally Ill Women (Medscape)

Women with psychiatric illness who become pregnant are more likely to have adverse obstetric outcomes if they have obesity, according to research presented at American Society of Clinical Psychopharmacology 2018 annual meeting. Researchers collected data from pregnant women aged 18 to 45 years who were enrolled in the Massachusetts General Hospital National Pregnancy Registry for Psychiatric Medications. Of the 584 participants, 252 were of normal weight, 170 had overweight, and 162 had obesity. The unadjusted odds ratio of major malformations in infants born to mothers with obesity versus normal-weight mothers was 3.19. Women with obesity were also at a significantly higher risk for gestational diabetes (OR = 3.81). There was also a trend of higher rates of hypertension and cesarean deliver among the women with obesity. Other outcomes, including preeclampsia, stay in the neonatal intensive care unit, and preterm birth, did not differ significantly between
the groups.

Exercise Can Help Overcome Genetic Effects of Obesity in Older Age

A new study published in Menopause suggests, for the first time in women over age 70, that exercise can reduce the influence one's genes have on obesity. Researchers studied 8,206 women of European ancestry who participated in the Women's Health Initiative. They used a larger set of 95 genetic polymorphisms to construct BMI genetic risk scores to study the interaction between physical activity and obesity, and evaluated whether genetic associations were modified by exercise and age. Genetic associations on BMI were strongest in sedentary postmenopausal women and weakest in women who reported high levels of recreational physical activity. "Our sample, which included older women, is the first to show that in the 70- to 79-year-old age group, exercise can mitigate the genetic effects of obesity," said the study's lead author Heather Ochs-Balcom, associate professor of epidemiology and environmental health in the University at Buffalo's School of Public Health and Health Professions. "Our work suggests that in older age, we can overcome our destiny for obesity -- given to us by our parents -- through exercise."