STORIES OF THE WEEK

Monday, August 7, 2017            

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

Mortality Rate Lower in Gastric Bypass Patients with Diabetes vs. Without… Liver Transplant Outcomes Unaffected by Prior Bariatric Surgery… Study Suggests Education for Medical Students Is Key to Reducing Obesity Bias… Overweight Asian-Americans Are Seen as More ‘American,’ Study Finds… Research Suggests Doctors Who 'Fat-Shame' Patients Can Cause Real Harm… Overweight, Obesity Increases Costs in Health Care Settings… Exposure to Violence and Obesity Linked in Teens… Obesity: 'Switch' in Brain Controls Weight Gain

Metabolic and Bariatric Surgery in the News…

Mortality Rate Lower in RYGB Patients with Diabetes vs. Without
(Endocrine Today)

Among adults with obesity, the risks for death from cardiovascular diseases, diabetes and respiratory conditions were lower among those with diabetes who underwent gastric bypass compared with those without diabetes who had the procedure and compared with those with diabetes who had not undergone bariatric surgery, according to a study published in Diabetes Care. Researchers from the Obesity Institute at Geisinger Clinic evaluated data on 625 gastric bypass patients with diabetes and 1,803 without diabetes between. Controls who did not undergo surgery were matched to participants with and without diabetes. Postoperative median follow-up was 5.8 years for participants with diabetes and 6.7 years for participants without diabetes. More deaths occurred in controls (n = 138) than the gastric bypass groups (n = 91) through follow-up. The risk for all-cause mortality was significantly reduced in the gastric bypass groups compared with controls. Gastric bypass patients with diabetes experienced reduced mortality, and the risks for death from cancer and respiratory conditions were also lower. The risk for death from external causes was higher among gastric bypass participants without diabetes compared with controls without diabetes. “Though patients without diabetes did not experience changes in all-cause mortality risk after surgery, patients can still benefit from the other well-documented benefits of RYGB, including better quality of life,” the researchers wrote. “

Liver Transplant Outcomes Unaffected by Prior Bariatric Surgery (Healio.com)

Patients who underwent liver transplantation after prior bariatric surgery compared favorably to other transplant recipients in rates of graft survival, patient survival and posttransplant complications, according to a new study published in the journal Liver Transplantation. The study included 11 patients who underwent liver transplantation 11.6 years on average, after bariatric surgery. Most patients underwent liver transplant for nonalcoholic steatohepatitis (90.9%). Patient and graft survival rates were both 81.8% at 1 year and 72.7% at 2 years, which was not significantly different compared with the observed overall survival rates. The researchers also noted, “despite a tendency towards weight gain in this population of patients with a history of NASH and often metabolic syndrome, their pre- and posttransplant weights were fairly stable at 1 year.”

Obesity in the News…

Education for Medical Students Is Key to Reducing Obesity Bias
(Medscape)

Authors of a study published in the Journal of the American Osteopathic Association say a comprehensive educational curriculum that gives medical students a solid working knowledge of the complex issues underlying obesity is effective in creating more positive attitudes toward patients who have obesity. The study, which followed 718 first- through fourth-year students through medical school, showed there was a significant increase in knowledge among students taking the first year of the obesity-specific curriculum compared with the precurriculum cohort. There was also a significant reduction in negative bias toward obesity among first-year medical students and that this was sustained through all 4 years of school. "The current study demonstrated that improving a medical student's basic knowledge of obesity can improve any obesity-related bias," the investigators write. "To our knowledge, this is the first study to demonstrate a sustained 4-year decrease in obesity bias." They add that more evaluation of the curriculum is needed to see whether the results can be reproduced at other medical schools. Negative attitudes toward those who have obesity are "ubiquitous in our society," said the study’s lead investigator. "Clinicians are not excluded from this bias. We hope that this reduction in bias will enable students to be better prepared to address the concerns of their obese patients and ultimately translate into better
clinical outcomes."

Overweight Asian-Americans Are Seen as More ‘American,’ Study Finds
(New York Times)

Authors of a new study published in Psychological Science found that heavier Asian-Americans are more likely to be perceived as “American” than those of a normal weight. The researchers also found that overweight Asian-American men were less likely than those of a normal weight to be viewed as being in the country illegally. “We found that there was a paradoxical social benefit for Asian-Americans, where extra weight allows them to be seen as more American and less likely to face prejudice directed at those assumed to be foreign,” said one of the study’s authors. However, the researchers say they did not find the same effect for whites, blacks or Latinos. Instead, they suggest, assumptions about where Asian-Americans come from seem to play a role. The findings are based on observations from more than 1,200 participants who were presented with photos of people who appeared white, black, Latino or Asian, defined as those of “prototypically East and Southeast Asian descent.” The photos, from online databases, were doctored to make the individuals appear both of a normal weight and overweight. The research raises questions about how cultural stereotypes affect perceptions of identity, the investigators suggest.

Doctors Who 'Fat-Shame' Patients Can Cause Real Harm (HealthDay)

A symposium during the American Psychological Association annual meeting focused on compounding research that suggests doctors’ bias against people who are overweight or obese can affect how they treat patients and reveals the negative effects “fat-shaming” by doctors can have on patients’ health outcomes. In addition to studies showing frequent underdosing of overweight patients receiving antibiotics and chemotherapy, research reveals that doctors sometimes fail to take overweight or obese patients' health complaints seriously or assume that their weight is causing their symptoms. "Recommending different treatments for patients with the same condition based on their weight is unethical and a form of malpractice," a professor of psychology at Connecticut College who participated in the symposium. Symposium participants also noted studies that have shown fat-shaming is not an effective way to reduce obesity or improve health, and even “poses serious risks” to patients who may, as a result, delay health care-seeking or avoid interacting with providers and may contribute to poor physical and psychological health outcomes.

Overweight, Obesity Increases Costs in Health Care Settings
(Endocrinology Advisor)

Excess weight is associated with increased costs across health care settings, with the highest percentage increases seen in costs for medications, according to research published online in Obesity Reviews. Researchers from the University of Oxford in the UK reviewed studies using individual patient data to examine the correlations between BMI and health care costs. They also compared how annual health care costs for overweight and obese individuals compared with those for healthy-weight individuals. Data were included from 34 studies. The researchers found that the median increases in mean total annual health care costs were 12% and 36% for overweight and obese individuals, respectively, compared with individuals at healthy weight. The highest percentage increases in costs were for medications (18% and 68%), inpatient care (12% and 34%), and ambulatory care (4% and 26%). Compared with men, women had higher percentage increases in costs associated with obesity.

Exposure to Violence and Obesity Linked in Teens (Science Daily)

A new study by Duke researchers showed teens consumed more unhealthy foods and beverages on days they were exposed to violence, and suffered from fatigue due to poor sleep the next day. Those behaviors are important predictors of weight gain, according to the investigators. Researchers collected data via cellphone multiple times per day for 30 days from an at-risk group of teens in California -- the miLife study. They compared it to data from a similar study of North Carolina public school students who were more representative of the population as a whole -- the RISE study. More than 500 teens reported on their exposure to violence each day, their consumption of fast food, sodas and caffeinated drinks, their lack of consumption of fruits and vegetables and their physical activity. They also logged their hours of sleep, sleep quality and tiredness. The study, published online in the journal Social Science & Medicine, is among the first to examine potential links between daily violence and obesity.

Obesity: 'Switch' in Brain Controls Weight Gain (Medical News Today)

New research has identified the mechanism through which the brain controls if and how much fat is burned after a meal. Faulty signals can promote obesity, according to findings published in the journal Cell Metabolism. Researchers say they found a link between food intake and the process whereby white fat turns into brown fat. According to the investigators, the brain normally "instructs" white fat cells to turn into brown ones after eating, however, brown fat cells are turned back into white energy-storing fat cells after a period of abstinence, during which no food is consumed. When this mechanism functions normally, it allows the body to stabilize its weight, preventing excessive gain - or loss - of fat. This mechanism, said the researchers, is akin to a switch, "reading" the insulin signals and flipping on and off as appropriate. The researchers said that in the case of people predisposed to excess weight gain, this switch malfunctions, becoming stuck in the
"on" position.