STORIES OF THE WEEK

Monday, October 23, 2017            

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

ASMBS Develops, Implements Evidence-Based National Care Pathway for Laparoscopic Sleeve Gastrectomy…Bariatric Surgery Has Positive Effect on Fertility...Endoscopy as First-Line Fix for Bariatric Surgery Complications…Cholecystectomy Before Gastric Bypass…Trump Administration Wants to Defund Efforts to Tackle Childhood Obesity, Says Leaked Memo…Dr. Oz Says Losing Weight is 'Patriotic'…Immunometabolic Ties Between Obesity and Depression…Obesity Bigger Afib Risk Factor in Men

Metabolic and Bariatric Surgery in the News…

Society Develops Care Pathway For Lap Sleeve Gastrectomy
(General Surgery News)

The ASMBS has developed and implemented an evidence-based national care pathway for laparoscopic sleeve gastrectomy to promote continuous improvements in patient safety and to reduce risk. A sub-task force in ASMBS’s Quality Improvement and Patient Safety (QIPS) Committee reviewed more than 150 manuscripts and expert consensus statements. The review identified considerable national variations in clinical pathways across practicing bariatric surgeons. The lead author of the review, Dana A. Telem, MD, associate professor of surgery in the Department of Surgery at the University of Michigan, said, “Pathways are important so that we provide the most streamlined care to our patients in an effort to optimize patient outcomes.” Although a uniform, evidence-based pathway was required for MBSAQIP accreditation, it was not available, noted the review article published in the journal SOARD. Addressing this key practice gap became a priority for the QIPS committee. The review article summarizes the pre-, intra- and postoperative recommendations for the sleeve gastrectomy care pathway. ASMBS President Stacy Brethauer, MD, associate professor of surgery specializing in advanced laparoscopy and bariatric surgery at the Cleveland Clinic, said, “This is important work by the ASMBS Quality and Patient Safety Committee. It provides evidence-based practices for bariatric surgery programs that perform sleeve gastrectomy and, equally important, it shows us where the gaps in evidence are so we can target our research efforts appropriately.” The care pathway for sleeve gastrectomy is the first care pathway the task force prepared among the various bariatric procedures,
Dr. Telem noted.

Rising Obesity Rates Impact Fertility Among Young Adults
(Healio Endocrine Today)

Although age is the greatest predictor of fertility among women, obesity has a substantial effect on the likelihood of pregnancy. Dramatic weight loss via bariatric surgery, however, appears to have a positive effect on the fertility of young adults with obesity. Women who lose a substantial amount of weight after bariatric surgery often achieve more regular menstrual cycles, according to ASMBS President Dr. Brethauer. “Once they lose that weight, women get back into a regular rhythm in terms of their fertility to the point where we tell most of our patients, for a variety of reasons, that they’re much more fertile after they have their bariatric operation,” Brethauer told Endocrine Today. Women are typically advised to wait at least 18 months after surgery before becoming pregnant, he said. “Even if they want to start a family, we ask that they get their weight off and get stable before they have children,” Brethauer said. The main concern, he added, is nutritional support for the fetus. Once pregnant, women who have lost weight after surgery have fewer pregnancy complications than women with obesity, he said. Despite active research on the link between weight and fertility, many questions remain, yet it is clear that the effects of obesity and weight loss pose unaddressed concerns for families beyond infertility.

Endoscopy Should Be First Fix for Bariatric Surgery Complications
(Healio Gastroenterology)

While endoscopic bariatric procedures for obesity treatment increase, one expert at the World Congress of Gastroenterology said there’s a need for endoscopy as first-line treatment for existing bariatric surgery complications. “There are a variety of adverse events associated with [bariatric] surgery and endoscopy is often the first-line treatment, but it often requires multiple modalities and multiple procedures,” said Reem Sharaiha, MD, Weill Cornell Medical College. “Most complications are amenable to endoscopic therapy so we must know the post-surgical anatomy and the team approach is key.” Sharaiha says complications leading to endoscopy can occur in up to 30% of patients who undergo bariatric surgery. Anastomotic ulcerations, hemorrhage, anastomotic strictures, band erosion, leaks and weight regain are common complications seen after bariatric surgery, with leaks being the most common. Sharaiha says, “endoscopy should be the first line of treatment
for complications.”

Timing of Gallbladder and Weight Loss Surgery May Help Prevent Complications (Medical Xpress)

An analysis in the British Journal of Surgery found there was a higher risk of complications when cholecystectomy (gallstone removal) was performed after gastric bypass surgery rather than before. The analysis was based on data from the Swedish Register for Cholecystectomy and Endoscopic Retrograde Cholangiopancreatography, which includes nearly 80,000 patients, and the 36,000-plus patients in the Scandinavian Obesity Surgery Registry. "For patients with obesity and symptomatic gallstone disease, the best strategy complication-wise is to perform cholecystectomy before gastric bypass," said lead author.

Obesity in the News…

White House Officials Think Childhood Obesity is not a Problem. Have They Seen the Data? (Vox)

The Trump administration wants to defund efforts to tackle the childhood obesity, according to a memo sent by members of the Domestic Policy Council to the Office of Management and Budget in an effort to communicate the administration’s wishes and priorities for inclusion in the budget Trump will propose to Congress in 2018. “Childhood obesity,” White House officials wrote, “this is a priority of the [Health Human Services] Secretary for inexplicable reasons. Whatever has been designated to it should probably be reversed. Not a priority of this administration.” In August, Trump’s recently deposed Health Human Services Secretary Tom Price called childhood obesity “one of our top three clinical priorities…” Now an array of Obama-era efforts to push the food industry in a healthier direction are under threat. The Trump White House has repeatedly signaled a desire to back off the issue, even relaxing school lunch regulations that were targeted at making the food in schools more nutritious. In the memo, the White House also said the CDC must shift funding away from programs for chronic diseases, such as obesity and diabetes — especially “playgrounds/nutritional nannying” — and focus instead of “data-driven programming” related to infectious diseases. Of the 20 largest countries in the world, the US had the worst rate of childhood obesity, 13 percent of children now have obesity. Obesity-related chronic diseases cost the US more than $150 billion each year. The writer calls it “inexplicable” for the White House to put childhood obesity on the backburner.

Dr. Oz Says Losing Weight is the Most 'Patriotic' Thing You Can Do
(Fox Business)

“Losing weight in America is probably the most patriotic thing that you can do to help nation right now,” TV’s Dr. Mehmet Oz told FOX Business. “We’re all fighting about health care in Washington and how much it is going to cost and who is going to pay for it. I can tell you with 40% of the people overweight in this country, you can’t balance the health care budget, it is just too expensive with all the complications as a result of obesity. It probably drives half the health care budget itself.” Oz says one of the biggest problems contributing to the increase in obesity levels is the government having “misplaced priorities” when it comes to food. “I think we have subsidized food that is not in our best interest—like sugar. A lot of food that is grown in this country could be subsidized so that we don’t subsidize like fruits and vegetables. Yet, other foods that are processed or easy to make junk food, we support financially.” Another alternative Oz proposed would be to start taxing foods that are not healthy, similar to soda taxes that cities like Philadelphia and Berkeley, Calif. have implemented, saying “…if you tax sugary beverages, people will drink less of them.”

Do Obesity and Depression Have Immunometabolic Ties?
(MedPage Today)

Obesity and major depressive disorder (MDD) may be linked by shared immunometabolic mechanisms in some patients, a genetic analysis found. A subgroup of patients with MDD whose appetite and weight increased during episodes of depression carried a higher number of genetic risk variants for increased BMI; higher levels of C-reactive protein (CRP), a marker of inflammation; and abnormal levels of leptin, a hormone involved in appetite and energy metabolism, said Amsterdam researchers. These patients comprised 15% of those with MDD, and this subgroup had an 18% higher polygenic risk for increased BMI, an 8% higher risk for increased CRP levels and a 9% increase in risk for abnormal leptin levels, the investigators reported online in JAMA Psychiatry. "Development of treatments effectively targeting immunometabolic dysregulations may benefit patients with depression and obesity, both syndromes with important disability.”

Obesity Bigger Afib Risk Factor in Men than Women (MedPage Today)

Men developed atrial fibrillation, on average, roughly a decade earlier than women, and having obesity was a bigger risk factor for developing Afib in men than women, according to an observational study of sex differences and similarities in the disease. The analysis, published online Oct. 16 in the American Heart Association journal Circulation, included close to 80,000 European adults without an Afib diagnosis at baseline (median age 49.6 years) followed for a median of 12 years (maximum follow-up was 28 years). During the follow-up period, 4.4% of the cohort's women and 6.4% of the men developed Afib. Perhaps the most surprising finding involved higher total cholesterol, which appeared to be associated with a lower risk for developing Afib in women (HR 0.86, 95% CI 0.81-0.91), and to a lesser extent, in men (HR 0.92, 95% CI 0.88-0.97). Higher body mass index was more strongly related to new-onset atrial fibrillation in than in women, with a relative risk ratio of 0.89. The researchers conclude that for both sexes, much of the burden of atrial fibrillation is attributable to classic cardiovascular disease risk factors, such as smoking, excess alcohol consumption, high blood pressure, and obesity.