The Bariatric Examiner

4th Quarter, 2011

In this issue...
(click the following links to jump down the page to each section, or use the scrollbar on the right to review all news and research updates)

1. Bariatric surgery procedure updates
   • Does weight loss surgery make sense for lower body mass index levels?
   • Dr. Oz Advocates Weight Loss Surgery
2. Pre- & Post-Surgery Treatment, Diet & Exercise
   • Weight loss before bariatric surgery – Is it really necessary?
3. Insurance & Financing
   • Medicare to Consider Adding Gastric Sleeve Surgery to Its Coverage
4. Obesity-related Health Problems
   • Should Obesity Be Considered a Disease?

Bariatric Surgery Procedure Updates

Does weight loss surgery make sense for lower body mass index levels?

According to the National Institutes of Health, patients must have a body mass index (BMI) of 40 or more or a BMI between 35 to 40 alongside at least one serious obesity-related health problem in order to be approved for weight loss surgery.

But folks with a BMI between 30 and 34.9 (“Obesity Class I”) also have a predisposition to serious medical problems including diabetes, hypertension and dyslipidemia. Should weight loss surgery be considered a viable option for these patients as well?

To contribute to ongoing efforts to answer this question, researchers from Cleveland Clinic Florida evaluated their 40 Obesity Class I patients from February 2000 through May of 2010. Of the 40 patients, 60% received gastric sleeve surgery, 25% had RNY gastric bypass surgery and 15% chose lap band surgery.

Following were their body mass index and conditions present along with the aggregate results of surgery:

Average body mass index went from 34.35 to 27.9 (mean weight loss of 44 pounds)

• 27 arterial hypertension: 85% improved (44% had full resolution, 41% had improvement)
  
• 26 dyslipidemia: 85% improved (31% had full resolution, 54% had improvement)
  
• 24 diabetics: 82% improved (30% had full resolution, 52% had improvement)
  
• 14 obstructive sleep apnea: 71% had full resolution
  
• 4 glucose intolerance: 100% improved (75% had full resolution, 25% had improvement)
  
• 4 osteoarthritis: 100% improved (25% had full resolution, 75% had improvement)

While the study did not address how weight loss surgery compares to other types of weight loss treatment, it provides solid evidence supporting bariatric surgery as a viable option for Obesity Class I patients.

What are your thoughts? Please click here to share them in the Comments box at the bottom of the page.

Related pages:

• Easier Surgery Approval? FDA Considers Lowering BMI Requirement
  
• Obesity health problems
  
• How to calculate BMI and interpret your score

Dr. Oz Advocates Weight Loss Surgery

Weight loss surgery continues to gain public acceptance as its benefits become more widely understood among the population at large.

Dr. Oz of The Dr. Oz Show recently furthered that recognition by endorsing gastric bypass surgery:

"I…think gastric bypass surgery will play a big role [in addressing obesity]. We probably do only 1% of the gastric bypass surgeries we should do."

“Listen, if you're one hundred pounds overweight at age fifty, you have the same mortality rate as if you have a solid cancer. Would you operate for cancer? Yeah. So if you cannot lose that weight, get one of these procedures. You have to do it with counseling and full awareness of what you're doing, of course. But if you get people to start losing 5% of their excess body weight, you're really taking a big whack out of the two-thirds of Americans [that are overweight]."

What are your thoughts? Please click here to share them in the Comments box at the bottom of the page.

Related Pages:

• Types of Weight Loss Surgery
  
• Obesity Health Problems

Pre- & Post-Surgery Treatment, Diet & Exercise

Weight loss before bariatric surgery – Is it really necessary?

Many surgeons recommend or even require that patients lose weight and begin an exercise program prior to moving forward with any bariatric surgery procedure, often citing two main benefits:

• The higher your body mass index at surgery time, the higher your risk of complications
  
• Lower body mass index before surgery reduces the risk of long-term complications and maximizes long-term weight loss

To assess the effectiveness of weight loss prior to surgery, a group of researchers at the University of Calgary analyzed 27 separate studies gathered from multiple databases. Here’s what they found:

• 17 studies consisting of 4,611 patients found weight loss prior to surgery to be beneficial
  
• 10 studies consisting of 2,075 patients found it to be of no benefit
  
• How weight loss before surgery affects weight loss after surgery:
  
  • 9 studies (39%) reported that post-surgery weight loss was greater
    
  • 15 studies (62.5%) reported no difference
    
• How weight loss before surgery affects complications:
  
  • 2 studies reported significant decrease in risk level
    
  • 9 studies reported no difference

In regards to exercise prior to surgery, the Longitudinal Assessment of Bariatric Surgery-2 (LABS-2), a 10-center longitudinal study of adults undergoing weight loss surgery, evaluated the pre- and post-surgery physical activity of 2,458 patients.

Not surprisingly, they found that patients engaging in more physical activity before surgery were more likely to engage in better levels of physical activity after surgery. More interestingly, they found three pre-surgery traits that made patients more likely to get the exercise they need after surgery:

1. No asthma
2. More physical activity
3. Less pain

Bottom line?

Prior to surgery, do your absolute best to lose as much weight as possible and to address pain, treat asthma and increase your physical activity. Nothing bad can come from it, and it will likely reduce your risks and improve your chances of long-term success in one form or another.

However, several studies included in the University of Calgary review suggested no benefit to weight loss prior to surgery, so if you are unable to lose much weight prior to surgery it still may make sense to move forward. If your surgeon refuses to perform the surgery due to your lack of weight loss, share this abstract and discuss whether the study’s results warrant reconsideration.

What are your thoughts? Please click here to share them in the Comments box at the bottom of the page.

Related Pages:

• Bariatric diet before surgery

Insurance & Financing

Medicare to Consider Adding Gastric Sleeve Surgery to Its Coverage

The Centers for Medicare and Medicaid Services (CMS) will reconsider adding gastric sleeve surgery to its list of approved procedures alongside gastric bypass surgery, lap band surgery and duodenal switch surgery.

Public comments are open until October 30, 2011 (click here for instructions).

What are your thoughts? Please click here to share them in the Comments box at the bottom of the page.

Related Pages:

• Medicare Coverage for Bariatric Surgery

Obesity-related Health Problems

Should Obesity Be Considered a Disease?

Yes, according to the American Association of Clinical Endocrinologists (AACE).

Dr. Alan Garber, Vice President of the AACE and the Chair of the AACE Task Force on Obesity had this to say:

"Whereas obesity was formerly viewed largely as the consequence of consistently poor lifestyle choices, sufficient evidence has accumulated to implicate a number of heterogeneous hormonal and regulatory disorders in the pathogenesis and progression of the obese state. Thus, multiple therapeutic interventions may be necessary lifelong to delay or reverse obesity in patients. Certainly, current efforts have not prevented the proliferation of obesity in the US population as well as elsewhere. Additional interventions and alternative approaches are clearly necessary."

Why is the designation of obesity as a disease state important?

Instead of attributing obesity to poor decisions or lack of willpower, classifying obesity as a disease state will lead to more targeted and aggressive treatment efforts that more effectively attack the problem. In addition to weight loss surgery, more targeted treatment will incorporate behavioral, nutritional and pharmacological considerations.

For AACE’s full press release, click here.

What are your thoughts? Please click here to share them in the Comments box at the bottom of the page.

Related Pages:

• Cause and Effect of Obesity

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