Monday, August 13, 2018

Bariatric Surgery in the News

Bariatric Surgery Halves Microvascular Risk in Type 2 Diabetes (Medscape) 

Patients with diabetes and severe obesity who had bariatric surgery were half as likely to develop certain complications of diabetes than those who did not have surgery, according to a large retrospective cohort study from Kaiser Permanente researchers published in the Annals of Internal Medicine. Among more than 4,000 patients who had bariatric surgery, the five-year incidence of microvascular disease — including neuropathy, nephropathy, and retinopathy — was nearly 60 percent lower than that of 11,000 matched nonsurgical control patients receiving usual diabetes care. The risk for each individual complication was significantly lower in those who had surgery, with hazard ratios of 0.37 for diabetic neuropathy, 0.41 for nephropathy, and 0.55 for retinopathy. “Such a remarkable decrease in microvascular complications has rarely been demonstrated by any form of diabetes therapy,” wrote Philip R. Schauer, MD, professor of surgery at Cleveland Clinic Lerner College of Medicine, Ohio, and a past president of ASMBS, in an accompanying editorial co-authored with Carel W. le Roux, MBChB, PhD, of the Diabetes Complications Research Centre at University College Dublin, Ireland. “The healthcare policy implication of these findings is that bariatric surgery should now be considered as an effective [type 2 diabetes] treatment not only to improve hyperglycemia but also to prevent the complications which account for the morbidity and mortality of the disease.”

Obesity in the News

Opinion: The Toll of America’s Obesity (The New York Times)

As the obesity epidemic continues to worsen, so too does economic inequality, writes two professors from Harvard University. Obesity rates have increased the fastest among low-income Americans and racial minorities, exacerbating both pre-existing health disparities and income inequality. The costs of a diabetes diagnosis can mean financial ruin for a low-wage worker and as disposable income declines, so too does the ability to afford a nutritious diet, creating a vicious cycle of poverty and diet-related disease. The obesity epidemic also imposes long-term fiscal pressure on the national budget deficit, as obesity substantially increases federal entitlement spending for medical costs, while the resulting lower worker productivity reduces tax revenues. Since body weight is strongly influenced by biology, and with seventy percent of American adults having overweight or obesity, the authors say we can’t blame individuals and expect personal responsibility to solve the epidemic. They propose two things. First, the government should establish a federal commission to coordinate obesity policy to “serve as a counterweight to the corrosive political influence and manipulative marketing practices of “Big Food” manufacturers.” Second, the government should adequately fund obesity research into innovative approaches for prevention and treatment, beyond the conventional focus on eating less and moving more.

Obesity, Diabetes in Pregnancy May Raise Kids’ Risk of Psychiatric Disorders (Reuters)

A new study published in Pediatrics suggests pregnant women who have severe obesity and diabetes may be more likely to have children with autism, ADHD and other psychiatric disorders than mothers who don’t have either condition during pregnancy. For the study researchers examined data on almost 650,000 live births in Finland between 2004 and 2014 and followed children from birth through the end of the study, up to age 11 years in some cases. Mothers who had obesity and preexisting diabetes were more than six times as likely as women of normal weight to have children with ADHD, conduct issues or autism and more than four times as likely to have children with emotional disorders. Mothers who had severe obesity but not diabetes were still 67 percent more likely to have children with mood and stress disorders than women who maintained a healthy weight during pregnancy. The researchers say the results underscore the potential for a range of neurodevelopmental disorders to have environmental origins that could potentially be predicted and prevented in some cases.

Can you be Obese and Healthy at the Same Time? (Today.com) 

Some medical experts fear the term “healthy obesity,” which emerged in the 1980’s as a way to describe individuals with obesity who have no metabolic risk factors, discourages doctors and patients from thinking about weight loss as a way to prevent disease. A 2017 study that looked at over 3.5 million individuals found that individuals with “metabolically healthy obesity” had a higher risk of heart disease, stroke and heart failure. A 2018 study of over 6,000 individuals confirmed these results when it showed in that half of the participants who had at least 30 pounds of excess weight developed metabolic syndrome within 10 years. The author advises people with metabolically healthy obesity not to ignore excess weight because risk factors simply aren’t showing up at a doctor’s appointment and to look at what lifestyle changes that can be made to reach a normal BMI.

Too Much Screen Time for Kids can Lead to Poor Health, American Heart Association Says (USA Today)

In a scientific statement published in Circulation, the American Heart Association (AHA) says screen time from smartphones, tablets and other devices can lead kids to a sedentary lifestyle and increase the odds they grow up to have overweight or obesity. “Although the mechanisms linking screen time to obesity are not entirely clear, there are real concerns that screens influence eating behaviors, possibly because children ‘tune out’ and don’t notice when they are full when eating in front of a screen,” said Tracie Barnett, a researcher at the INRS-Institut Armand Frappier and Sainte-Justine University Hospital Research Center in Montreal and one of the authors of the statement. The AHA recommends children get between one to two hours of screen time each day.