bariatric surgery

Posted on Diabetes, Obesity

Sustained remission of diabetes and other obesity-related conditions found a decade after weight loss surgery

Study finds that type 2 diabetes patients treated with GLP-1RAs who lowered their BMI also reduced their cardiovascular risk

A study published in the New England Journal of Medicine found that ten years after undergoing bariatric surgery during their teenage years, more than half of the participants maintained significant weight loss. Additionally, many of these individuals showed improvements in obesity-related conditions, including type 2 diabetes, high blood pressure, and high cholesterol.

“Our study demonstrates remarkable results from the longest follow-up of weight loss surgery during adolescence, confirming that bariatric surgery is a safe and effective long-term strategy for managing obesity,” stated lead author Justin Ryder, PhD. He is the Vice Chair of Research in the Department of Surgery at Ann & Robert H. Lurie Children’s Hospital of Chicago and an Associate Professor of Surgery and Pediatrics at Northwestern University Feinberg School of Medicine.

Bariatric surgery is significantly under-utilized in the U.S., with only one out of every 2,500 teens with severe obesity undergoing the procedure. Based on existing recommendations, nearly five million adolescents qualify for effective weight loss interventions, such as bariatric surgery.

Hillary Fisher, now 31 years old, is glad she decided to undergo surgery at the age of 16. She was one of 260 adolescents who participated in the long-term Teen-LABS study.

“I felt overwhelmed by the daily struggles I faced due to my weight, health issues, and bullying in high school,” Ms. Fisher said. “After several unsuccessful attempts to lose weight, I weighed 260 pounds, and we decided that bariatric surgery was the solution. It changed my life; the improved health and self-esteem that came with losing 100 pounds were significant for me, and I would absolutely do it again.”

Notably, the study found that 55 per cent of the participants who had type 2 diabetes as teenagers and underwent surgery were still in remission of their diabetes at 10 years. 

“This is considerably better than the outcomes reported in people who underwent bariatric surgery as adults, a major reason why treating obesity seriously in adolescents is so important,” added Dr. Ryder. 

Indeed, a recent multi-centre randomized controlled trial found diabetes type 2 remission in adults to be 12-18 per cent at seven to 12 years after bariatric surgery.

Posted on Obesity, Weight Loss

Bariatric surgery may slow cognitive decline for people with obesity.

Cognition scores remained stable, while secondary executive function tests showed improvement
Cognition scores remained stable, while secondary executive function tests showed improvement

Within the next 10 years, it’s projected that up to 50% of United States adults will be affected by obesity, which is associated with cognitive impairment and dementia. 

Investigators at Michigan Medicine found that people with obesity who underwent bariatric surgery had stable cognition two years later. 

Researchers say it suggests that bariatric surgery may mitigate the natural history of cognitive decline expected in people with obesity.

The results are published in the Journal of Nutrition, Health & Aging.

“Since individuals with obesity experience more rapid cognitive decline than those without, stable cognition two years after bariatric surgery may be considered a success against historical trends, yet future controlled trials are needed to test this,” said first author Evan Reynolds, Ph.D., lead statistician for the NeuroNetwork for Emerging Therapies at Michigan Medicine.

Using a collection of memory and language tests developed by the National Institutes of Health, as well as the Rey Auditory Verbal Learning Test, the research team assessed over 85 bariatric surgery patients at two-year follow up.

They found that NIH Cognitive Battery test scores remained stable, with secondary executive function tests showing improvement. 

One of the memory assessments, however, declined following surgery.

While this current study is the largest to assess changes two years after bariatric surgery, researchers say, the results conflict with previous studies which found improved memory and executive functioning among similar patients.

“That study was primarily made up of patients who received gastric bypass, while our study was made up primarily of individuals that completed a sleeve gastrectomy,” Reynolds said. 

“To provide the best evidence on the effectiveness of bariatric surgery on cognition and potential differences between surgery types, we must conduct larger observational studies or randomized, controlled trials.”

After bariatric surgery, improvements in diabetes complications, such as peripheral neuropathy, chronic kidney disease and retinopathy, were not associated with improved cognition.

“Metabolic factors, including diabetes and obesity, are associated with cognitive decline, but we still need to better understand how best to treat these factors to improve patients’ cognitive outcomes,” said senior author Brian Callaghan, M.D.

Posted on Diabetes, Weight Loss

Pairing bariatric procedure with diabetes drug increases weight loss

Bariatric surgery
Bariatric surgery

 Combining minimally invasive endoscopic sleeve gastroplasty (ESG) with the diabetes drug semaglutide can provide additional significant weight loss for patients who are not candidates for invasive weight-loss surgery, according to research that was selected for presentation at Digestive Disease Week® (DDW) 2021.

“As the worldwide obesity rate continues to climb, so do the number of people seeking bariatric surgery to treat their condition,” said Anna Carolina Hoff, MD, lead researcher on the study and founder and clinical director of Angioskope Brazil, São José dos Campos. “Surgical procedures are some of the most successful ways to help patients lose weight, but they can eventually come with complications. Our study shows that patients may not have to undergo invasive surgery to get similar results.”

In a double-blind study, researchers randomized 61 patients undergoing ESG into two groups with one group of 29 patients receiving semaglutide — an injectable glucagon-like peptide-1 receptor that has been known to stimulate weight loss — beginning one month after the procedure. Another group of 29 patients received a placebo administered with look-alike injector pens. Three patients were lost to follow-up. Participants were monitored each month for body weight and body composition, and blood panels were taken every three months.

Patients who received semaglutide lost on average 26.7 percent of their total body weight compared to the control group, which on average lost 19.6 percent of total body weight. The semaglutide group lost 86.3 percent of their excess weight — the amount of weight the patients needed to lose to reach normal BMI — compared to 60.4 percent for the control group. The semaglutide group also lost 12.7 percent of their body fat by weight compared to 9 percent for the control group. Finally, glycated hemoglobin (Hb1Ac) levels fell 0.95 for the semaglutide group and 0.61 for the controls.

Surgical procedures, such as laparoscopic sleeve gastrectomy, come with increased costs and a higher risk for complications, such as gastroesophageal reflux disease, or GERD. These surgical procedures are typically limited to those with a BMI of at least 35 with comorbidities, or with a BMI above 40. ESG can be performed at an earlier stage of the disease and at a lower BMI, so more patients can get the treatment they need before their disease progresses. Treating patients with obesity earlier can help reduce death and comorbidities as well as reduce costs associated with treatments for these conditions.

“ESG has been available to patients for years, but it has not always been as successful as surgical options in helping patients lose weight,” said Dr. Hoff. “We now have a minimally invasive procedure that can be just as successful when combined with semaglutide and can be made available to even more people looking to lose a significant amount of weight.”

ESG is performed by guiding a device through the patient’s throat and into the stomach, where an endoscopist uses sutures to make the stomach smaller. This helps patients lose weight by limiting the amount they can eat. Patients are candidates for ESG if they have a BMI at or above 30, and diet and exercise have not helped them lose weight, or if they are not a candidate for surgery, or do not wish to pursue surgery.

The researchers caution that long term durability of the treatment still needs to be determined.

DDW Presentation Details

Dr. Hoff will present data from the study, “Semaglutide in association to endoscopic sleeve gastroplasty: Taking endoscopic bariatric procedures outcomes to the next level,” abstract Su548, on Sunday, May 23, at 12:15 p.m. EDT. For more information about featured studies, as well as a schedule of availability for featured researchers, please visit http://www.ddw.org/press.

Leave a comment Posted on Surgery, Weight Loss

Bariatric surgery – the pros and cons of weight loss surgery

Bariatric surgery

Bariatric surgery

Weight loss surgery, also called bariatric or metabolic surgery, is sometimes used as a treatment for people who are very obese.

It can lead to significant weight loss and help improve many obesity-related conditions, such as type 2 diabetes or high blood pressure.

But it’s a major operation and in most cases should only be considered after trying to lose weight through a healthy diet and exercise.

 

Weight loss surgery

Weight loss surgery is available on the NHS for people who meet certain criteria.

These include:

you have a body mass index (BMI) of 40 or more, or a BMI between 35 and 40 and an obesity-related condition that might improve if you lost weight (such as type 2 diabetes or high blood pressure)

you’ve tried all other weight loss methods, such as dieting and exercise, but have struggled to lose weight or keep it off

you agree to long-term follow-up after surgery – such as making healthy lifestyle changes and attending regular check-ups

Speak to your GP if you think weight loss surgery may be an option for you. If you qualify for NHS treatment, they can refer you for an assessment to check surgery is suitable.

You may can also pay for surgery privately, although this can be expensive.

Read more about NHS and private weight loss surgery.

Types of weight loss surgery

There are several types of weight loss surgery.

The most common types are:

gastric band – a band is placed around the stomach, so you don’t need to eat as much to feel full

gastric bypass – the top part of the stomach is joined to the small intestine, so you feel fuller sooner and don’t absorb as many calories from food

sleeve gastrectomy – some of the stomach is removed, so you can’t eat as much as you could before and you’ll feel full sooner

All these operations can lead to significant weight loss within a few years, but each has advantages and disadvantages.

If you’re considering weight loss surgery, speak to a surgeon about the different types available to help decide which is best for you.

Read more about the types of weight loss surgery.

Life after weight loss surgery

Weight loss surgery can achieve dramatic weight loss, but it’s not a cure for obesity on its own.

You’ll need to commit to making permanent lifestyle changes after surgery to avoid putting weight back on.

You’ll need to:

change your diet – you’ll be on a liquid or soft food diet in the weeks after surgery, but will gradually move onto a normal balanced diet that you need to stay on for life

exercise regularly – once you’ve recovered from surgery, you’ll be advised to start an exercise plan and continue it for life

attend regular follow-up appointments to check how things are going after surgery and get advice or support if you need it

Women who have weight loss surgery will also usually need to avoid becoming pregnant during the first 12 to 18 months after surgery.

Read more about life after weight loss surgery.

Risks of weight loss surgery

Weight loss surgery carries a small risk of complications.

These include:

being left with excess folds of skin – you may need further surgery to remove these

not getting enough vitamins and minerals from your diet – you’ll probably need to take supplements for the rest of your life after surgery

gallstones (small, hard stones that form in the gallbladder)

a blood clot in the leg (deep vein thrombosis) or lungs (pulmonary embolism)

the gastric band slipping out of place, food leaking from the join between the stomach and small intestine, or the gut becoming blocked or narrowed

Before having surgery, speak to your surgeon about the possible benefits and risks of the procedure.

Read more about the risks of weight loss surgery.

24 Comments Posted on Patient Talk

Gastric bands and obesity -Have you ever had a gastric band to help you lose weight?

Obesity

Obesity

Welcome to our new blog on the subject of gastric bands and obesity.  The aim of this blog is to encourage people who have had gastric bands to share their experiences with people who might be considering such bariatric surgery.

Over the last few years bariatric surgery (weight loss) has become far more common as a strategy to fight obesity.

So how does a gastric band work?  Actually the principle of the gastric band is very simple.  It involves the surgical implant of a band which reduces the size of the stomach.  This means that a person who has had a gastric band feels full more quickly than before and will eat less and this will lead to weight loss.


To help our readers understand what it is like to have a gastric band we would love it if you could share your experiences here on the blog.  Anything you have to say about weight loss surgery will be really useful but you might want to think about the following questions:-

  1. Have you had a gastric band?  If so what was the surgery like and how successful was the operation?
  2. If you have not had a gastric band would you ever considering having the implant?
  3. What other strategies have you used to lose weight?  How successful were they?
  4. Would you recommend the operation to other people?

Please feel free to use the comments box below to share you thoughts and experiences about weight loss surgery.  Please feel free to include any links which you think other readers may find of interest.

Many thanks in advance