Monday, September 11, 2017            

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

Higher Level of "Satiety Hormones" Released When Eating After Bariatric Surgery… Body Image Dissatisfaction Before Bariatric Surgery May Persist After… Study Examines Why LDL Cholesterol Decreases After Bariatric Surgery… Better Fatty Acid Handling by Lean Tissues in Bariatric Surgery Patients with Diabetes Remission… New Obesity Report: High Rates Costing U.S. Billions and Hurting Military… Obesity Cells “Crosstalk” with Tumor Cells… Genetic Risk for Obesity Influenced by Lifestyle Factors

Metabolic and Bariatric Surgery in the News…

Obesity: Lack of 'Satiety Hormones' Plays a Role (Medical News Today)

People who having obesity release significantly fewer "satiety hormones" after eating, compared with people of normal weight, according to a study published in the journal Scientific Reports. Samples of gastrointestinal tissue were collected from 27 adults with morbid obesity before and 3 months after having sleeve gastrectomy, as well as 24 adults of normal weight, for comparison. Tissue collected prior to surgery had significantly fewer enteroendocrine cells, which produce hormones that signal fullness to the brain, than the tissue samples of normal weight subjects. Prior to surgery, patients with obesity also demonstrated changes in the expression of transcription factors that regulate enteroendocrine cell formation. Tissue samples taken after surgery showed that the number of enteroendocrine cells and the expression of transcription factors in gastrointestinal tissue was almost the same as that of the comparison group. The findings indicate a molecular mechanism in people with obesity may prevent them from feeling full after a meal, which might cause them to eat more, said investigators.

Psychological Risk Factors Predict Body Image Dissatisfaction After Bariatric Surgery (Endocrine Today/Healio)

Adults with obesity who report symptoms of depression, anxiety, disordered eating and negative body image often continue to struggle with body image dissatisfaction in the months after having bariatric surgery, suggests data published in the journal Bariatric Surgical Practice and Patient Care. The study included 444 patients who completed a preoperative interview and postoperative psychology appointments 3 and 6 months after bariatric surgery. Preoperative body image dissatisfaction was associated with higher scores on MMPI-2-RF scales of emotional/internalizing dysfunction, demoralization, low positive emotions, dysfunctional negative emotions, self-doubt, inefficacy, anxiety and negative emotionality/neuroticism. This was also the case among patients who reported body image dissatisfaction at 3 months post-surgery, with the addition of higher scores in ideas of persecution. Moreover, researchers pointed to an important finding revealing, “men and women did not differ in their endorsement of [body image dissatisfaction] at any of the three time points [studied]… these results indicate that men are at risk for experiencing [body image dissatisfaction]… as well as suggest that men experience [body image dissatisfaction] at equal proportions to women both before and after bariatric surgery.”

Bariatric Surgery May Decrease PCSK9 Levels in Severe Obesity
(Endocrine Today/Healio)

Circulating levels of PCSK9, an enzyme that plays a role in plasma cholesterol metabolism, and LDL cholesterol may decline following biliopancreatic diversion with duodenal switch in adults with severe obesity, according to a study published in The Journal of Clinical Endocrinology & Metabolism. Among the 69 study participants, PCSK9 levels were negatively associated with body weight and fat mass and were positively associated with glucose levels and HbA1c. At 12-months following surgery, changes in PCSK9 were positively associated with changes in HDL cholesterol, adiponectin levels and HbA1c. From baseline to 1 day after surgery, LDL cholesterol levels decreased by 36.2% and were 30% lower than baseline at 12 months. This finding “could explain to a certain extent why LDL cholesterol decreases after bariatric surgery," said the study’s lead investigator.

Fatty Acid Remodeling Seen in T2DM Remission Post Bariatric SX (Medical Xpress)

Remission of type 2 diabetes following biliopancreatic diversion with duodenal switch is associated with increased disposal of triglycerides and acylcarnitine production during lipid overload, according to a study published online in Diabetes. Canadian researchers examined the longitudinal contribution of adipocyte size reduction and fatty acid metabolic handling to type 2 diabetes remission following bariatric surgery. During intravenous lipid overload, patients with severe obese and type 2 diabetes displayed hypertriglyceridemia and excessive systemic lipolysis. The whole-body glycerol turnover was normalized three days after surgery, and was associated with lower homeostatic model assessment of insulin resistance index. On average, one year following surgery patients achieved an excess weight loss of 84%. Triglycerides disposal and acylcarnitine production during lipid overload correlated with improvement in weight loss and muscle insulin sensitivity. Data also indicated that the increased storage capacity compensated the decrease in fat mass during weight loss. Type 2 diabetes remission after biliopancreatic diversion with duodenal switch is mainly associated with better fatty acid handling by lean tissues, the authors said.

Obesity in the News…

Obesity Report: One-third of U.S. Adults are Beyond Overweight
(CBS News, Forbes, Washington Examiner)

One-third of American adults and one in six children have obesity, according to the “State of Obesity: Better Policies for a Healthier America” report released by the Trust for America's Health and the Robert Wood Johnson Foundation. According to the annual report, 70% of the nation is overweight or has obesity. West Virginia had the highest obesity rate at 37.7%. Mississippi was second at 37.3% and Alabama and Arkansas were tied for third at 35.7%. Colorado had the lowest rate, at 22.3%. The adult obesity rate increased between 2015 and 2016 in Colorado, Minnesota, Washington and West Virginia, fell in Kansas, and was stable elsewhere. In fact, this is the first time in 14 years of conducting the annual report that any state's rate dropped, and rates of increases in other states have begun to slow. The study used BMI data and analyzed CDC figures, though, the rankings differ slightly from a recent CDC report, which had Louisiana in the No. 1 spot, followed by West Virginia, Mississippi and Alabama all tied for second. Additional health care for adults and children with obesity is $150 billion a year, according to the new report. Moreover, nearly one-quarter of military recruits are rejected because they have obesity and it costs the Pentagon $1 billion a year in added health care costs for troops and their families who have obesity. The two nonprofit groups recommend focusing on early childhood prevention efforts, including promoting exercise, expanding investments in community-based programs, increasing health-care coverage for obesity prevention and treatment, and improving school-based efforts to provide healthy meals and physical activities.

Science Weighs in On How Fat Raises Cancer Risk (HealthDay)

Researchers who reviewed 20 studies say research published over the past seven decades suggests identifying ways to interrupt cellular "crosstalk" -- changes in complex chemical signaling within cells -- between fat cells and malignant tumors could lead to new ways to help prevent cancer. In several of the studies reviewed, adipose stromal fat cells were able to invade cancer lesions and then help spur the growth of tumors. Data also shows that people with obesity and prostate or breast cancer appeared to have more of these cells than thinner people. Some types of fat cells are also more "metabolically active," releasing more substances that promote tumor growth. In addition, fat tissue is usually adjacent to colon and rectal cancers and it is part of the direct environment of breast tumors. Future studies might help doctors figure out if it's possible to disrupt the processes that promote the growth of tumors by affecting nearby fat, the researchers wrote in Cancer
Prevention Research

Genetic Risk for Obesity Influenced by Lifestyle, Study Says (UPI)

Genetic risk for developing obesity can be influenced by lifestyle factors, such as smoking, diet, physical activity, socioeconomic status and alcohol consumption, and is not necessarily predetermined, according a study published in PLOS Genetics. The study also revealed genetic risk for obesity was higher in participants with a lower socioeconomic status compared to those with a higher socioeconomic status, and genetic effects for obesity were lower for individuals who consumed alcohol more frequently. By changing his or her diet and exercise routine, a person with a strong predisposition for obesity could reduce their risk, researchers said.