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.

Kerry Weems from CMS finds weight-loss operation is a life-saving option for the patients who have unsuccessfully tried to lose weight in other ways. “CMS wants to be sure that these patients have access to a solution to help them achieve a healthier weight and avoid some of the most serious complications of type 2 diabetes,” he adds.
The coverage of batriatic surgery was expanded in 2006 for Medicare patients who underwent the surgery from highly qualified surgeons. In order to get the coverage, patients’ BMI needs to be at least 35 and, next to severe obesity, have serious health issues such as coronary artery disease, osteoarthritis or hypertension.

CMS covers four types of weight-loss operations: gastric bypass, open and laparoscopic Roux-en-Y gastric bypass, laparoscopic adjustable gastric banding, and open and laparoscopic biliopancreatic diversion with duodenal switch.

A new suggestion is not to cover surgery for those patients whose BMI is lower than 35 even if they have got diabetes. CMS is convinced it is the right decision even if batriatic surgery is very helpful for these patients.

Comments from the public confirming efficiency of the weight-loss procedure with diabetes are being searched for.

“Limiting coverage of bariatric surgery in type 2 diabetic patients whose BMI is less than 35 is part of Medicare’s ongoing commitment to ensure access to the most effective treatment alternatives with good evidence of benefit, while limiting coverage where the current evidence suggests the risks outweigh the benefits,” said Barry Straube, the CMS MD.

The public are welcome to respond to the decision on: http://www.cms.hhs.gov/center/coverage.asp.

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.

“Literally, take 200-pound sacks of potatoes, put them on your shoulders. That`s what I was carrying.” Mike says.

Mike underwent gastric bypass surgery and got his life back. He can go out, garden, even ride a bike for the first time in 15 years. Now he’s determined not to gain unnecessary weight again. After the surgery, he started exercising and changed his diet.

Mike realizes that his stomach is much smaller after the surgery and he can’t eat that much as he used to. As he says, he used to eat constantly. “You can constantly what they call graze and that`s eat all day long,” he says. “You get done eating, eat some more, about an hour later, eat some more, so you can consume the two to three thousand calories a day or three to four without thinking about it, just by constantly eating.”

A weight-loss surgeon, Michael Schmit, warns about this eating pattern. “People really need to change essentially their whole lifestyle because if you don`t what will happen, what we`ve found over and over again is that you end up gaining the weight back,” he says.

Mike Klostreich considers his present life as a second chance. He attends a monthly support group for gastric bypass patients. It helps him and the other patients to understand why food becomes emotionally important, how to keep trim and how to adapt to a new lifestyle with exercising and healthy diet.

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.

But these are just the tip of the iceberg: there are also thousands of patients missing out on the surgery they need, thanks to the stealthy rationing of such treatment.And what makes this even more unacceptable is that Primary Care Trusts (PCTs) seem to be trying to cover it up.
My speciality is varicose veins — admittedly, these are not life-threatening, but they’re still a debilitating, chronic and often extremely painful condition.
And yet many GPs are being told not to refer patients for treatment. Even more worrying, PCTs are also telling me to ‘bounce’ back referral letters to the GP — in other words, I’m being told to refuse to see patients.
Of course I don’t bounce back these patients. But even if I do see them, only when a patient has signs of severe skin damage or a leg ulcer will a PCT sanction surgery.
The people most often affected by the condition have jobs that involve a lot of standing — policemen, schoolteachers, hairdressers and cleaners.
Their condition has a huge impact on their everyday working lives, causing them severe discomfort from the relentless aching and throbbing of their legs.
And yet I’m being told to send them home with nothing more than a packet of compression stockings —that’s because PCTs define surgery as any kind of treatment, from traditional, open surgery to lasers and injections.
No wonder I have witnessed a 70 per cent drop in patients having surgery in the past 18 months.
The fact is that compression stockings are an unsustainable short-term fix since they’re impossible for an active person to wear for any length of time.
The irony is that varicose veins are eminently treatable.Patients prepared to put up a fight for surgery can have their case considered by an exceptional treatment panel — but all 25 patient application forms I have submitted in the past 18 months have been rejected.
By arbitrarily taking operations off the menu, the NHS is simply taking another furtive step towards privatisation.
The only option for patients is to wait until their legs are bad enough to be considered for surgery (around a third will — by which time they will be in severe discomfort).
Alternatively, they can find the £2,500 or more to have the operation privately.
COSMETIC BLISS NOTE: WE CHARGE ONLY £1995 FOR THIS PROCEDURE FULLY INCLUSIVE OF FLIGHTS, HOTEL ETC

It’s not just surgery for varicose veins that’s being restricted — uncomplicated hernias are another.
What infuriates me is that the health economists responsible for this policy hide behind those at the coal face of clinical care; they expect us to break the bad news to the patient.
To ration treatment and tie a surgeon’s hands at a time when medical science can offer successful solutions is hard enough for a GP to swallow.
But forcing patients to put up with their condition is yet another hammer blow to a health service that once promised so much and now, thanks to NHS bureaucrats, can deliver so little.

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.

Last year, the Government-commissioned Foresight report warned that unless urgent action was taken half of all Britons could be obese by 2050.

Earlier this year Mr Johnson warned that heavily overweight schoolchildren faced dying eleven years younger than their slimmer classmates.

Announcing the new scheme he said: “Obesity is the biggest health challenge we face – every year 9,000 people die prematurely and a third of 11 and 12-year-olds are overweight.”

The aim of the new scheme was to create a “healthy England”, he added.

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.

“There is nothing worse than a risk factor that an individual cannot modify, but here are two risk factors – obesity and fitness – which they can do something about
Professor Tim Church
Pennington Biomedical Research Center
A team from the Pennington Biomedical Research Center carried out tests on 452 healthy men who were taking part in a long-term study of fitness.

Blood tests were taken, and analysed for their content of various types of white blood cell.

After taking account of age, the researchers found that all groups of white blood cell were lowest in the men who were most physically fit.

The greater proportion of body fat a man had, the higher his white blood cell count was.

Total white cell count was highest in men who had a combination of higher body fat and lower levels of physical fitness.

Levels were also high among men with lower body weight but lower levels of fitness.

However, a high degree of physical fitness negated the effect of extra body fat.

Full article:http://news.bbc.co.uk/1/hi/health/7669966.stm

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.

The figures also show that there are now 5 million people registered obese in the UK compared to almost 4.8 million last year.

Truly alarming figures
“These are truly alarming figures,” said Douglas Smallwood, Chief Executive of Diabetes UK.

“Part of why we have seen such a huge increase can be attributed to improved screening from healthcare services and greater awareness amongst those at high risk of Type 2 diabetes. However, there is no getting away from the fact that this large increase is linked to the obesity crisis.

“Diabetes is one of the biggest health challenges facing the UK today. It causes heart disease, stroke, amputations, kidney failure and blindness, and more deaths than breast and prostate cancer combined.

One million pounds an hour spent on diabetes
“The NHS already spends one million pounds an hour on diabetes. The soaring diabetes prevalence will continue to put a massive strain on an already struggling NHS and unless it can respond, people’s health could spiral downwards. We need to do all we can to raise awareness of the seriousness of diabetes and help people understand how a healthy lifestyle can help reduce their risk of developing Type 2 diabetes.�