Monday, June 19, 2017            

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

Research in SOARD Suggests Increase Risk of Alcohol Use Disorder After Gastric Bypass… Medicare Costs for Gastric Band Reoperations Rising… NEJM Study: 30% of People Worldwide Are Overweight or Have Obesity… Obesity, Inactivity Could Outpace Smoking in Cancer Death Risk… New FDA Nutrition Facts Panel Delayed by Dispute Over Added Fiber… Overweight Pregnancy Increases Risk of Birth Defects… Obesity Increases Risk of Complications After Shoulder Joint Replacement Surgery… Long-Term Type 2 Diabetes Risk Continues to Rise with Extreme Obesity

Metabolic and Bariatric Surgery in the News…

Why Drinking Problems Develop After Gastric Bypass Surgery (Healthline)

New research published online in Surgery for Obesity and Related Diseases (SOARD), journal of the American Society for Metabolic and Bariatric Surgery, by researchers from the University of Pittsburgh found gastric bypass surgery may increase the risk of alcohol use disorder. One in 5 people who’ve had the procedure met the study definition for the disorder at some point within five years of their surgery, even though they hadn’t had a problem in the year before their procedure. The study included nearly 1,500 people who’d had gastric bypass surgery and by the second year of follow-up the researchers found an increase in drinking frequency and problems. Additionally, there were people affected for the first time each year during the study’s duration. Their drinking also became more frequent over the years. About 16% of people said they were drinking at least twice a week by the last year of the research assessment, compared with around 6% pre-surgery. An ASMBS guideline on alcohol use before and after bariatric surgery concluded that more research is needed to conclude if gastric banding procedures speed up absorption. It was noted that the new research did not include sleeve gastrectomy, which now accounts for more than half of all weight loss surgeries, according to data from the ASMBS.

Gastric Band Reoperations Costly, Medicare Data Show (General Surgery News)

Since 2006, nearly half of the $470 million spent by Medicare for procedures related to the laparoscopic gastric band were for reoperations, reflecting complications related to gastric band placement or weight loss failure, surgeons reported at the 2017 annual meeting of the Society of American Gastrointestinal and Endoscopic Surgeons. The cost for reoperations grew tremendously over the eight years following 2006; the proportion of Medicare payments for reoperations increased from 16.4% to 77.3% of its annual spending on the gastric band device. “These findings indicate that the gastric band is associated with high reoperation rates and considerable costs to payors, which raises concerns about its safety, effectiveness and value,” said lead author Andrew M. Ibrahim, MD, clinical lecturer in surgery at the University of Michigan and a Robert Wood Johnson Clinical Scholar at the Institute for Healthcare Policy & Innovation. The study, which was published in the May edition of JAMA Surgery, examined device-related reoperation rates and costs nationally between 2006
and 2013.

Obesity in the News…

More Than 2 Billion People Are Overweight or Obese Worldwide, Says Study (CNBC)

A study published in the New England Journal of Medicine found about 2.2 billion people worldwide, approximately 30% of the population, are overweight or have obesity. Within the overweight population, 600 million adults and 150 million children have a body mass index above 30. The findings comes from researchers working on the Global Burden of Disease study, a large survey intended to quantify the impact of more than 300 major diseases and injuries around the world. About 2,300 researchers from 133 countries collaborated on the report, which also suggests the epidemic is leading to health problems and a rising number
of deaths.

Obesity, Inactivity Could Outpace Smoking in Cancer Death Risk (USA Today)

Dr. Richard Wender, chief cancer control officer at the American Cancer Society (ACS), released data suggesting obesity and inactivity could someday account for more cancer deaths than smoking if current trends continue. As the rate of smoking decreases, other unhealthy habits threaten to offset the progress in reducing cancer deaths. Calculating cancer's link to obesity is difficult in part because of an overlap in cancer risk factors, says Rebecca Siegel, strategic director of ACS' surveillance information services. While 20% of cancers are caused by poor diet, alcohol consumption, a lack of physical activity and/or excess weight, that can't be combined with the 30% of cancer deaths caused by smoking.

The New FDA Nutrition Facts Panel is Being Delayed by Dispute Over Added Fiber (CNBC)

The revamped Nutrition Facts panel, which was postponed this week, could change what ingredients products like Snack bars, cereals and brownies can count as dietary fiber. The Food and Drug Administration says added ingredients need to have a health benefit to be counted as fiber on the new panel. And many ingredients that are currently used to boost fiber counts, like sugarcane fiber and xanthan gum, haven't yet gotten approval to keep doing so. Bridget Christenson, a General Mills representative, said the FDA has received "more than ample scientific support" for the ingredients the company uses to boost fiber. So far, the FDA has cleared seven fiber ingredients to be counted as fiber. Clearance is pending for another 26 ingredients. Bonnie Liebman, director of nutrition at the Center for Science in the Public Interest, said the problem is that such added fibers may lead people to think foods like snack bars are healthier treats. "Our position is that none of these fibers should count," Liebman said of the 26 fibers under review and five of the seven that have been approved. Many are calling on the FDA to speed-up implementing the new Nutrition Facts panel, which makes it easier to see how many calories and how much added sugar are in products.

Overweight Pregnancy Increases Risk of Birth Defects, Study Says (CNN)

Risks of major birth defects increased in step with the severity of a mother's obesity or overweight, a study published in the journal BMJ found. Based on the results, women should be encouraged to adopt a healthy lifestyle and be at a normal body weight before conception, said researchers led by Martina Persson, a researcher in the clinical epidemiology unit at Karolinska Institutet in Stockholm, Sweden. Past studies have shown an increased risk of congenital malformations among obese mothers. Researchers analyzed data on more than 1.2 million live births, excluding twins and other multiples, in Sweden between 2001 and 2014. A total of 43,550 of the infants -- 3.5% -- had a major congenital malformation. Heart defects were the most common birth defect, followed by flaws in the genital organs, limbs, urinary system, digestive system and nervous system. Babies of normal-weight mothers had a 3.4% risk of a major congenital malformation. By comparison, the proportion of major birth defects among the children of overweight mothers was 3.5%. Among the babies of mothers in obesity class I, the rate was 3.8%; in obesity class II, 4.2%; and obesity class III, 4.7%.

Obesity Increases Risk of Complications After Shoulder Joint Replacement Surgery (ScienceDaily)

For patients undergoing shoulder joint replacement surgery, higher body mass index is linked to increased complications -- including the need for "revision" surgery, reports a study in the Journal of Bone & Joint Surgery. The study included data on 4,567 shoulder arthroplasties performed between 1970 and 2013. Forty-three percent of the shoulder arthroplasty patients had obesity. Overall, 302 patients needed revision surgery due to mechanical failure, loosening of the implant, or other causes. An additional 62 cases required a non-revision reoperation. Patients with obesity were at increased risk of both types of reoperation. Among patients with a BMI of 35 or higher, each additional one-unit increase in BMI was associated with a five percent increase in the risk of reoperation for any reason. Higher BMI was also specifically associated with revision surgery for mechanical failure. For every one-unit increase in BMI after 30, there was a five percent increased risk of revision for mechanical failure.

Long-Term Type 2 Diabetes Risk Continues to Rise with Extreme Obesity (Healio/Endocrine Today)

A longitudinal study presented at the American Diabetes Association annual meeting found among children with obesity the risk for developing type 2 diabetes in young adulthood increases incrementally with increasing BMI. The findings are based on data on diabetes and related conditions collected between 1965 and 2007 on 2,728 Southwest American Indian children aged between 5 and 10 years and 4,317 aged between 10 and 17 years without diabetes; follow-up continued for 20 years or until development of type 2 diabetes. Among the younger group, over a mean 10.8 years of follow-up, 98 participants developed type 2 diabetes by age 20 years and 543 by age 45 years (13.7 years’ follow-up); among the older group, over a mean 5.5 years of follow-up, 111 developed type 2 diabetes by age 20 years and 111 by age 45 years (mean 12.1 years’ follow-up)—for a total of 648 participants with type 2 diabetes over a median 11.7 years’ follow-up.