SeniorJournal.com, 18th November 2008

Medicare Is not going to pay for the weight-loss surgery of patients with diabetes whose BMI is lower than 35.

Centers for Medicare & Medicaid Services (CMS) suggested the coverage policy for batriatic surgery for patients with type 2 diabetes was BMI 35. The other suggestion was not to cover the surgery if its purpose is to treat type 2 diabetes with a BMI below 35.

KFYR-TV, ND, 5th November 2008

People all over the world tend to get fatter. On the other hand however, there is a strong social need for a healthy lifestyle in order to look good.

More and more people turn to weight-loss surgery. Researches show that ten times more people go under the knife now than ten years ago.

Mike Klostreich works in a barber shop. Greeting clients and cutting hair are possible for Mike and do not hurt now. In the past, however, when he weighted 443 pounds, even very simple every day things caused many problems.

By Angela Epstein Daily Mail 10/11/08
Routine operations for complaints such as varicose veins are being cut back to save the NHS money, leaving patients having to put up with the agonising condition or pay for expensive private treatment. It’s just privatisation by stealth, says Eddie Chaloner, a consultant vascular surgeon at Lewisham Hospital — and once again, it’s the patient who suffers.

Every week we hear yet more stories about the rationing of life-saving drugs for diseases such as cancer and Alzheimer’s.

By Kate Devlin, Medical Correspondent Daily Telegraph - 10/11/08
Obesity kills more than 9,000 people a year, Alan Johnson warned as he launched a national campaign to fight the crisis. The Health Secretary announced plans for nine new “healthy towns” to share £30 million of investment designed to change attitudes and eating habits.

The announcement is the first stage of a new drive to encourage people to lose weight and become healthier, called Change4Life.

Experts predict that if trends continue the growing obesity problem could lead to rapid rises in the rates of life-threatening diseases like diabetes and cancer.

BBC News 17/10/08
Obesity and lack of fitness raise the risk of illness by impacting negatively on the body’s internal chemistry, research suggests.

A US team found levels of white blood cells were highest in men who were unfit and overweight.

White blood cells are key to fighting infection, but high levels can be a sign of inflammation, which is linked to coronary heart disease.

The study appears in the British Journal of Sports Medicine.

News Author: Jacquelyn K. Beals, PhD
CME Author: Désirée Lie, MD, MSEd
Medscape Today – Journal 15/10/08
Superobese patients who spend an average of 9 preoperative weeks on a very-low-calorie diet (VLCD) have reduced morbidity and mortality rates associated with bariatric surgery. The weight loss regimen appears to improve factors that influence technical aspects of surgery and reduces patient comorbidities.
George M. Eid, MD, FACS, from the Division of Minimally Invasive Surgery at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, presented the study here today at the American College of Surgeons 94th Annual Clinical Congress. The study reflected the literature on bariatric surgery that shows superobesity (body mass index [BMI] > 50 kg/m2) to be a major risk factor for adverse outcomes. Other risk factors are male sex, age, lower socioeconomic status, or smoking.
Dr. Eid noted in his presentation that the 30-day mortality rate reported for 575 bariatric surgery patients in the Veterans Administration system is 1.4%, with a 19.7% overall rate of complications. Superobese patients have a 2.3% mortality rate and a 29% morbidity rate.
The surgical risks associated with superobesity are both physiologic and technical. The physiology involves several comorbidities: diabetes mellitus, sleep apnea, congestive heart failure, hypertension, degenerative joint disease, and chronic obstructive pulmonary disease. Technical challenges include excess visceral fat, an enlarged liver (hepatomegaly), and a thickened abdominal wall.
The goal of the present study was to “evaluate changes in obesity-related comorbidities, liver size, and visceral and subcutaneous adipose tissue volumes following preoperative weight loss with a…VLCD program, and relate these changes with postoperative outcomes,” said Dr. Eid.
“The kind of medical weight loss we use in this study is called very-low-calorie diet. This is a mostly high-protein liquid diet with balanced electrolytes,” Dr. Eid told Medscape Surgery. “My understanding is it’s only FDA [US Food and Drug Administration] approved for a 3-month period.”
Even without the US Food and Drug Administration regulation, medical weight loss is rarely successful in the long-term.
“Medical weight loss has a high incidence of failure over the long period of time,” Dr. Eid told Medscape Surgery. “If you follow a patient at 6 and 12 months they regain their weight, and maybe gain more weight….Studies have been done showing over 1 to 2 periods of follow-up in a medical weight loss patient that you have a high percentage of weight regain and going back to square one.”
Data were collected prospectively from 30 consecutive patients (27 men and 3 women) with a BMI of more than 50 kg/m2 who were seen between August 2004 and April 2007 and were invited to take part in a supervised VLCD program. Participants received 5 servings of a high-protein liquid diet totaling 800 calories per day and were seen weekly for medical and behavioral follow-up. The targeted weight loss was 10% of body weight for patients with a BMI between 50 and 55 kg/m2. For patients with a BMI of more than 60 kg/m2, the goal was a BMI of less than 55 kg/m2.
Mean patient age was 53 years (age range, 34 - 65 years), mean baseline BMI was 56 kg/m2 (range, 51 - 69 kg/m2), and average period on the VLCD was 9 weeks (range, 4 - 13 weeks). To assess the physical changes that accompanied weight loss, computed tomographic scans of the abdomen were done at the beginning of the VLCD program and after its completion.
The scans determined liver volume in cubic centimeters, the depth of the abdominal wall in centimeters, and the subcutaneous adipose tissue and visceral adipose tissue in centimeters squared at locations 12 cm and 20 cm from the xiphoid process. The second scan showed significant improvements in BMI, liver volume, depth at 12 cm and 20 cm from the xiphoid process, total subcutaneous adipose tissue at 12 and 20 cm from the xiphoid process, and visceral adipose tissue (each P < .001).
Preoperative weight-loss with VLCD improved poorly controlled diabetes mellitus in 10 (62.5%) of 16 diabetic subjects. It also improved poorly controlled hypertension in 8 (40%) of 20 of affected patients, and improved degenerative joint disease with limited mobility in 12 (57%) of 21 of patients with this problem. “Some even stopped using their wheelchair and were able to do limited activity by walking,” observed Dr. Eid.
No deaths occurred in the patients who experienced weight loss with VLCD before their bariatric surgery, even with 1-year follow-up. There were 2 postoperative complications: a questionable pulmonary embolism that was examined and had a good outcome, and a minor bleeding episode. Historical data from the same institution report 0% mortality and 6.7% morbidity rates. National Veterans Administration data for superobese patients, as noted previously, show 2.3% mortality and 29% morbidity rates.
Dr. Eid and his colleagues conclude that “bariatric surgical outcomes in superobese patients are optimized through preoperative VLCD.” The significant reductions in liver volume, abdominal wall depth, and visceral adipose tissue and subcutaneous adipose tissue (technical factors) improve the surgical procedure. Improvements in diabetes, hypertension, and degenerative joint disease (physiologic factors) enhance the health of the patient.
“I had two factors. I had the technical factors and those had to do with decreasing the amount of fat and the size of the liver so we had better access to our organ and we can do a better job,” Dr. Eid told Medscape Surgery. “But also we had improvement in their medical condition with diabetes and everything, so it’s a two-pronged approach. On the one hand, you improve technical factors, but on the other hand you improve their comorbidities so you have less risk of complication and postoperative problems.”

20 October 2008 Diabetes UK
The number of people diagnosed with diabetes in the UK has risen by more than 167,000 since last year, bringing the total diabetes population to almost 2.5 million according to new data from GP practices. This rise is more than double the 2006 to 2007 increase of 83,000.

In England, a 6.4 per cent increase means the number of people diagnosed with diabetes has broken two million for the first time. In Northern Ireland and Wales, the increase was 6.8 per cent and 6 per cent respectively, with diabetes prevalence now standing at 60,822 and 138,988. Improved recording in Scotland contributed to the biggest rise (16.9 per cent) with the recorded diabetes population now standing at 200,669 compared to 171,513.

Reader’s Digest, 29 October 2008

Losing weight is not easy. Gaining seems to be so quick and effortless but losing requires lots of good will and… a good plan.

Especially people with diabetes have weight issues. By losing extra ponds your blood sugar will be easier controlled, also your blood pressure and cholesterol will be lower.

How to start?

The very first thing to do is to set achievable goals. Researches show that people consider themselves to be successful after losing 50 to 100 pounds. Be reasonable and set a goal of losing 10 pounds at the beginning. Moderate weight-loss is much more beneficial especially for diabetes.

WebWire, 15 October 2008

Weight-loss surgery gives relatively quick effects. The body adjusts to the new system and, as patients claim, they tend to lose weight with almost no effort. Unfortunately, not everything looks that good. After the initial period after the surgery, patients’ behaviour needs changing in order to achieve a long-lasting success.

As Dr. Ajay Goyal, FACS, Director of Bariatric Surgery at Overlook Hospital said: “Weight loss surgery is not the end of the weight loss process, it’s the beginning. “Gastric Bypass, Lap Band and REALIZE Band surgery is only a tool to jump start weight loss. For long term success and weight maintenance it’s important for patients to adopt a healthy lifestyle, full of exercise and nutritious choices for life.”

BBC News 07/10/08
Soaring obesity levels look set to drain local health and public service budgets, which will mean higher taxes for all, experts warn.

Obesity could cost NHS in England £6.3bn by 2015 if no effective action is taken says the Department of Health.

Local councils in England and Wales are already shelling out tens of thousands of pounds on “fat-friendly” services, like widening crematoria furnaces.

This comes as work shows obesity levels may have been grossly underestimated. The Local Government Association, which represents over 400 councils in England and Wales, says that Britain is fast becoming the “obesity capital of the world” and even more must be done to stop the nation’s waistline continuing to expand.