San Diego Tribune, 22 September, 2008

More and more children and teenagers are obese these days. After having tried dieting and not being satisfied with the results, they decide to go under the knife. A few years ago weight-loss surgery was only possible for adult patients. Now the situation has changed and also overweight teenagers can seek the solution within the operation.

Two the most popular surgeries amongst this age group are gastric bypass and stomach banding. They both make the stomach smaller, and gastric bypass also changes the digestive system and reduces the fat absorption.

Joey Fishell, who’s 13, had the surgery on July 2. He weighted 300 pounds and his mother said the operation was a life-saver for her son.

Weight-loss surgeons highlight the importance of the consequences of the surgery. Young patients must be aware of them. A strict diet must be followed for the rest of the life, otherwise all the weight will come back, which denies the sense of the procedure. Also, in order to avoid malnutrition, some patients have to take supplements.

Only in 2003, 771 teenagers had a weight-loss operation in U.S. Studies are being carried out to see if bands are safe for young people.

Shelby Gorman, 16, had an operation last October and has lost 88 pounds since then. Before the surgery, she tried numerous diets with no results. “In sixth grade, I did Atkins and lost maybe 10 pounds, but it just came back. Then in eighth grade, on Jenny Craig I lost 50 pounds, which was good. But then it came right back,â€� she said. “I just don’t have a lot of willpowerâ€�.

The other young patient is Hollie Johnson, 18. She lost 97 pounds and, as she said, her favourite thing now is wearing her younger sister clothes. “I used to hate the beach … where I would get to look at a bunch of girls who were everything I’m not,â€� said Hollie.
Joey Fishell has lost 59 pounds since the operation in July. He came a long way after years of bullying from the other children. Another issue was the fear of getting obesity-related diseases.

All three young patients had gastric bands inserted in their bodies. The plastic rings are about 4 inches and are put around the stomach. The digestive system is left intact but the quantity of food taken is decreased.

The silicone inside the gastric band can be filled with different levels of saline to regulate the amount of food that comes to the stomach.
Another way to lose weight is a gastric bypass. The top of the stomach is closed and a small pouch is created. The food is rerouted to the lower portion of the small intestine, then bypasses to the lower stomach. There, fat and some other nutrients are excluded so that they cannot be used by the body.

Shelby changed her lifestyle dramatically after the surgery. She doesn’t eat chocolates or Mexican food any more. Instead, she goes to the gym and does aerobic every day.

“I have more confidence, a lot more,â€� Shelby said. “I talk to people, new people. I don’t have to constantly think that they’re thinking about my size.â€�
Weight-loss surgeons agree that both teenagers as well as their parents should be well prepared for what their life will be after the operation.

Aug 29 2008 by Lisa Jones, South Wales Echo

‘I feel as if I’m stuck inside a horrible shell’

A YOUNG dad has told how he has become a recluse after being refused an operation to remove four stone of excess skin from his body.

Alistair Preston, 28, was morbidly obese and told he would be dead within a year if he did not shed weight from his 37-stone frame.

The father of one, from Pengam Green, Cardiff, lost 20 stone after he underwent a £10,000 gastric sleeve operation in 2006, paid for by his mother, who re-mortgaged her house. COSMETIC BLISS NOTE: A SLEEVE OPERATION WITH US WILL COST ONLY £4,990.00

He now needs another operation to remove the curtains of excess skin left behind. But Health Commission Wales, which pays for specialised health services, says he is still too overweight and must lose another three-and-a-half stone.

They say his body mass index, a way of determining if someone is a healthy weight for their height, is still too high. Alistair is 5ft 11in tall and now weighs under 17 stone.

Alistair, who has a three-year-old daughter, says he has sunk into a deep depression and admits he spends most of his time in his flat.

He said: “They promised to help me and now they’ve changed their minds. I feel like a slim person stuck in a horrible shell. I want a normal life. The skin is not just on my belly, it’s all down my legs and arms.

“The BMI index is out of date. They are setting me a target I can’t reach. It’s impossible for me to reach that weight because I would be ill.�

Alistair turned to food for comfort at 17 after nursing his father Alan until his death.

He added: “I had the operation so I could be around for my daughter. When my dad died, I didn’t know what to do.�

Health Commission Wales conducted an internal review panel but it decided to uphold the original decision to refuse surgery despite support from Alistair’s GP.

A spokesman for Health Commission Wales (HCW) said: “While we cannot comment on any individual case it should be noted that HCW always considers exceptional cases and will consider abdominoplasty/apronectomy for individuals suffering from severe functional problems that have a negative impact on their day-to-day life.�

Alistair’s mum, Anna Preston, of Bridgend, said: “He feels worse than he did before. If I could sell my house to pay for his operation I would but nobody is buying at the moment.�

His partner Samantha Collins, 24, said: “The longer this carries on, the more concerned I am about his mental well-being. It’s so frustrating to see how low he is. They are looking at numbers but they need to look at him as a person.�

Alistair said: “I was looking forward to leading a normal life and having the ability to go out and work but my life has come to a standstill.

“I’m getting more and more depressed and spend most of my time in my flat. It’s just me, myself and I.�

WKRC TV Cincinnati September 10, 2008

An investigational weight-loss operation has been carried out at Good Samaritian hospital.

Cindy McBride, after trying several unsuccessful diets, consulted a batriatic doctor. The surgery was very like a gastric bypass which helps patients loose weight, it was only performed in a unique way.

“We make the stomach a lot smaller, but we don’t do any of the intestinal re-routing, so there is no associated problems that we see with the gastric bypass of mal-absorption and malnutrition.” said Dr. George Kerlakian from the Samaritian hospital.

The procedure is called gastric sleeve. About 90% of the stomach is removed. The remaining part is being wrapped into a tube, then sewn into a round sleeve. “The sleeve is nothing but a long tube of stomach.”

Cindy needed only 20 weeks to lose 92 pounds. “I wasn’t hungry from the time I woke up from surgery.” She said.

The reason of this dramatic weight-loss is the reduction of the hunger hormones. After the surgery, Cindy had to follow a diet and do exercises.

Time September 16, 2008

Gastric bypass surgery is sometimes not only the last solution for obese and overweight patients, but it’s also a life saving procedure for patients with diabetes.

There are several reasons for that situation. Not only the operation reduces the risk of death because of obesity-related diseases, but also normalizes blood sugar with diabetes.

This is now the most common weight-loss surgery in the USA. About 140.000 operations are done each year.

The last studies show however that non diabetes patients who underwent the surgery lost much more weight than patients with diabetes.

310 patients were in the study. 92% of patients without diabetes lost about 40% of their weight which is considered to be successful. On the other hand, only 79% of the patients with diabetes were able to lose that weight a year later. The same surgery techniques were used in both cases meaning the patients’ stomachs were reduced so that they were forced to eat less.

The director of the Bariatric Surgery Program at the University of California, San Francisco, Dr Guilherme Campos, thinks although the same procedure is being used, there is not a standard size of the stomach sac. Doctors determine the individual size for each patient. As the stomach lining is elastic and flexible, if the diet is not followed, the stomach may return to its previous size. The other reason might be connected with the medicines that diabetes take to control blood sugar. “One of the known factors for why diabetics have trouble controlling their weight is the types of medications they take,” Campos said. “Diabetes is a consequence of being overweight, but [another complication] is having to take medications that add to weight gain. It’s a double-edged sword, and a vicious cycle.”

There is a solution, however. Dr Campos advices to take new anti-diabetes drugs, such as DPP-IV inhibitors. These can both, keep blood sugar and weight under control.

Another fact is that even though diabetes lost less weight after the surgery, 90% of them has lower blood sugar level after the operation. It means they can lower the amount of the medicines they used to take. Also, gastric bypass surgery has even greater results which are recently diagnosed with diabetes as it is very likely that they will get back to normal sugar metabolism after the surgery. The reasons are that some weight-related hormones are reduced.

Dr Campos reminds the patients that surgery is not a final answer as the weight-loss surgery needs to be maintained after leaving the hospital.

IrishTimes.com September 11, 2008

Hormones play a crucial role in weight issues. They are to be “blame� for being obese or overweight. Weight-loss surgery is a successful way of getting slim figure back as it changes hormone levels. There are three hormones involved: the hunger one, Ghrelin, which is reduced during the surgery, the satiety hormone, Peptide YY, (responsible for being full) is increased and the hormone that helps to regulate glucose, CGP-1, is altered.

Researches show that weight-loss surgery is a highly reliable way of losing weight for a long time.

The majority of the British population (two-third, as researches show) are overweight or obese. Both genes and environment are responsible for that situation.

To understand our metabolism we need to go back to the times when people suffered from starvation. That is when our metabolism evolved and learned to store the oodles as fat to survive when food was no longer available. Nowadays, however, when food is always within the reach it makes it difficult to diet.

Dr Batterham describes dieting as “fighting the biology we have developed to fight starvation�.

Batriatic surgery changes the amount of the hormones in the body which allows weight-loss. Dr Le Roux thinks batriatic surgery should be widely available for the society as obese people risk type II diabetes. Patients who had their weight-loss surgery tend to lose their diabetes. As Dr Le Roux highlights, the surgery is not cosmetic but it is about health.

The news Today September 5, 2008

Obesity is a huge problem nowadays. More than 33% Americans have weight problems. That is why weight loss surgeries became extremely popular over the last years. The procedure carried most often is gastric bypass surgery. The other popular solution is gastric banding. Some surgeons even say that it is safer, more effective and has fewer side effects than gastric bypass.

Batriatic surgery, simply speaking, is an operation on the stomach letting obese patients to lose and maintain normal weight, using healthy diet in the same time.

During the operation the stomach volume is reduced by 95%. It means only 5% of the food can be absorbed. Also a small part of the upper intestinal track is being bypassed. Thanks to that the patient does not need to eat that much as he/she feels full after having just a small amount of food. The procedure reduces the appetite and the amount of calories taken.

Gastric bypass is a very effective operation allowing patients to lose 65% to 75% of weight. Obviously a strict diet needs to be followed after the surgery as eating more will negate the effects.

The other very popular weight-loss surgery is gastric banding. This procedure consists of placing a silicone band inflated with saline on the top of the stomach. As in gastric bypass, this also restricts the amount of food that gets to the stomach. Gastric banding is a reversible surgery as the band can be removed if needed. Comparing to the gastric bypass, however, this option needs longer time to see the effects as the bypass component is not included. The weight patients after gastric bypass surgery lose in a year can only be lost in four-five years after gastric banding operation. On the other hand, however, it is said to be safer and more physiological way of weight-loss.

Another option to lose weight is Biliopancreatic diversion/duodenal switch. Compared with the above it is the least popular method of weight-loss. The reason is that it has the highest mortality (2.5% to 5%). The results. however, can reach 60% to 80% of weight-loss within one year only.

A very important thing to remember is that weight-loss surgery can result in side effects. The most common are: abdominal pain, gas, diarrhea, even nausea and vomiting. This may cause malnutrition and deficiency of vitamins. This again may cause osteoporosis and Wernicke’s Encephalopathy (thiamine deficiency). Other side effects may also be muscle weakness, abnormal eye movement, mental confusion or movement incoordination.

In many cases obesity can be worked against by using the right diet full of fruit, vegetable and protein, as well as being active.

By Kate Devlin Medical Correspondent Daily Telegraph 10/09/08

One of Britain’s top surgeons is considering taking legal action over the “rationing” of life saving obesity surgery on the NHS.Professor John Baxter said that the health service was putting patients lives at risk by not funding the surgery for many.

He accused Primary Care Trusts of limiting the number of operations they performed because of the cost, which can be up to £6,000.

He said that the operations, which include gastric band surgery, would pay for themselves within four years, because they would reduce the number of obesity-related conditions, such as diabetes.

The health service currently carries out fewer than 300 stomach shrinking operations a year.

Professor Baxter said that half of all PCTs in England were ignoring guidelines that morbidly obese patients should have the surgery, which can lead to rapid weight loss.

He told Sky News: “Yes, it is fair to say that I’m considering a legal challenge because that is true. You can’t go further than that as I have just discovered that there’s no legal compulsion to follow NICE guidelines”.

Professor Baxter, the president of the British Obesity Surgery Society, added: “The case for obesity surgery is overwhelming. It is clearly being rationed.

“I am surprised there have not been more law suits by patients around the country, trying to say ‘why are you not providing this’ and it’s just a matter of time I think.”

“You actually save money by investing in obesity surgery. Sure it costs a lot up front. But after three to four years you are saving money,” said Professor Baxter.

“You actually save lives,” he added.

Professor Baxter pointed to other patient groups which used legal action to advance their case for expensive treatments.

These include breast cancer patients who went to court in a battle over the drug Herceptin, which was eventually allowed for the early stages of the disease.

Obesity costs the NHS a estimated £1 billion a year, because of the expense of dealing with related conditions including heart disease and some even forms of cancer.

An estimated 1.2 million people in Britain are now so heavily overweight that they qualify for obesity surgery.

At the current rate at which the NHS performs the operations it would take the health service 54 years to clear the backlog.

Patients who receive the surgery can lose significant amounts of weight and increase their life expectancy, studies have shown.

Last month Alan Johnson, the Health Secretary, warned that today’s obese children faced dying 11 years younger than their slim classmates.

The National Institute for Health and Clinical Excellence (Nice) says that patients are eligible for the surgery if they have a BMI more than 40, and previous attempts at diet or prescriptions of weight-loss drugs have failed.

Anyone with a BMI between 35 and 40 can also be eligible, if they have an obesity-related condition such as diabetes.

But some PCTs require a BMI of more than 50 before they will consider the operation.

By Steve Connor, Science Editor INDEPENDENT (UK)
Tuesday, 9 September 2008
The number of Britons undergoing drastic stomach surgery to treat obesity will have to soar in the coming years because it will be the only way that many people are able to maintain the weight loss necessary for a healthy life, scientists have said.

Dieting and other lifestyle changes can lead to substantial weight loss. But many people, the scientists said, find it hard to maintain the loss because hormone levels change, making the body want to produce more fat.

“Once you start losing weight by decreasing calorie intake, your body interprets this as starvation and goes into emergency status, fighting to lay down fat deposits where possible,” explained Rachel Batterham of University College London. “Therefore you are fighting against your body when losing weight.”

Stomach surgery such as gastric bypass operations should not only be carried out on severely obese people, but offered to overweight men and women as a form of disease prevention, in much the same way statins are offered to prevent heart disease, they said.

At least 10 times as many people who currently have gastric bypass operations on the NHS already qualify for one under the Government’s own guidelines, according to the researchers, who believe that not enough is being done to inform obese patients about the benefits of surgery.

Dr Batterham added: “Surgery is currently the only effective treatment for obesity … It not only helps people lose weight by physically decreasing the amount they can eat, but also alters their hormone profile, meaning they feel less hungry and therefore find it much easier to maintain weight loss.”

An increasing number of men and women will fall in the eligible category for bariatric surgery, where the stomach is stapled or bypassed altogether by diverting food directly to the small intestine, said Carel Le Roux of Imperial College London.

Severely overweight people with a body mass index of 35 already qualify for gastric surgery and studies have shown that although the operation carries a small risk, the long-term benefits are better than for patients treated with drugs or lifestyle changes, Dr Le Roux told the British Association for the Advancement of Science’s Festival of Science at Liverpool University.

“The only proven way to lose weight and live longer is by having obesity surgery,” he said. “This type of surgery will, however, not make you thin, nor will it make you happy, it will only make you healthier.”

He added: “If we have low levels of mortality later on, we should ask ourselves the question, why is this not available to more patients and why in fact do we restrict this to patients with a body mass index over 35?

“Is it fair to restrict another medication like statins? Do we restrict statins to people who have already had heart attacks? No, we give them to people at risk of heart attacks.”

A gastric band operation costs the NHS about £5,500 and a gastric bypass costs about £9,000. At present about one in 100,000 people have the surgery but under the Government’s Nice guidelines, about 10 in 100,000 people actually qualify for the operations.

It was once widely believed that gastric bypass operations work by preventing food absorption in the gut but recent studies have shown that the surgery alters levels of the hormone which controls hunger pangs, said Dr Batterham.

“About one in four people in Britain is obese and this is projected to rise to 60 per cent of men and 50 per cent of women by 2050,” said Dr Batterham. “Future research will focus on developing drugs that work in the same way as gastric surgery in altering the hormone levels that control hunger and feeling full.”

WebMD September 2, 2008

Researches show that obese patients who had gastric bypass surgery have dramatic improvements in blood sugar control. What’s more, these changes come far quicker than actual weight loss. Gastric bypass is not only “just a conduit for food transitâ€� gastric bypass surgeon Francesco Rubino said. “We now know that it is also a very important organ for the regulation of glucose.”

Standard treatment for type 2 diabetes is not as effective as weight loss surgery. One of the theories while researching the causes of this situation was that surgery mends the expression of hormones responsible for appetite control, blood sugar and weight. But the studies did not prove this hypothesis. “We know from earlier work that the small intestine can produce glucose,” a diabetes researcher, Gilles Mithieux, said. “We showed that with gastric bypass surgery you essentially double the capacity of the intestine to do this.”

Gastric bypass produces a “double intestine�. The portion of the small intestine which is closest to the stomach does not receive nutrients. The lower small intestine becomes the main nutrient receiver by being attached to the stomach. “By surgically repositioning the lower small intestine, which usually does not produce much glucose, it ramps up intestinal glucose production and improves insulin sensitivity.� Mithieu said.
Even though the surgery does not completely resolve the problem, it is a very important part in the initial treatment against type 2 diabetes. Gastric bypass can help not only diabetic patients who are obese but also overweight patients who cannot have gastric bypass surgery as they do not weight enough.

Tenerife News September 2008

Even though a lot of celebrities have gastric band fitted, is not a fashionable accessory. It helps with the weight loss and for many people it’s a lifesaving operation.

The surgery is done under anaesthetic followed by microsurgery where several small incisions are made in the abdomen. Thanks to this the surgeon can operate the camera on the end of instruments to put the band around the stomach. If the client is more obese, a laperotomy takes place. This is a larger incision 15 to 20 cm in the abdomen.

The band is made of silicone, it is inflatable and is put around the upper part of the stomach. It makes the stomach smaller. In practice it means you do not to each much as you feel full quicker.

There are obvious benefits of the surgery but there are side effects of the surgery. Nausea or hair loss are some of them. Gastric banding also means healthy eating for life. The diet afterwards must be low-fat and high-protein. Only thee small meals a day should be eaten and no drinks should be taken during the meal.

Patients must also be aware that some foods (such as bread or pasta) can be tolerated more difficult. The other thing is also not eating the recommended amount of food – no weight will be lost if you still eat that much as you used to.

Not all obese patients qualify for gastric banding. Only those with BMI over 40, type 2 diabetes, with high blood pressure and heart disease are being recommended for such an operation. These conditions improve after the surgery, for example type 2 diabetes can disappear.

To help manage the diet it is possible to regularly meet nutritionists as well as support groups.

Who should be considered? Those who are clinically obese and whose weight is dangerous for health