Telegraph, 26th April

A new drug, Alli, has just hit the market with a promise of quick and effective weight-loss.

As the spring is blossoming and the summer with be here soon, everyone would like to look slim and trim. People don’t dress up in warm jumpers and baggy coats any more. Tops and T-shirts are not that forgiving for the figure. Even those who’ve got only a little bit of extensive fat, feel the pressure of losing it and get the flat tummy back.

That’s why Alli can become very popular. How effective and safe it is, though?

The first thing worth mentioning it that it’s not that easy to buy. Even though no prescription is needed, the pharmacist will ask for the BMI (the weighting scales are available for those who don’t know it). Only patients with BMI over 28 are eligible.

Another weight-loss medicine launched this week is Appesat. It is not a drug but an extract of seaweed. It works by expanding the stomach and works by suppressing the appetite. A tablet should be taken 30 minutes before the meal. It should work by sending a message to the brain that the stomach is full.

Is it possible at all losing weight without trying? And how safe it is?

The two week-dose of Alli costs £32.95. It prevents the absorption of fat in the stomach. The fat is excreted to the body causing unpleasant side effects: soft stools, flatulence, stomach ache, but also anxiety, headaches, tooth and gum disorders, chest infections and even rectal bleeding. The aim of the drug, apart from losing weight, is to encourage healthy eating habits.

“If you suffer from chronic malabsorption or are breastfeeding, then you mustn’t take it at all,” says Dr. Anna Hemming, a GP at private London clinic.

Appesat, on the other hand, is said to be a “natural� ewight-los aid that isn’t absorbed to the bloodstream. Dr Hemming says: “This is a bulk-forming agent and eating porridge would have the same effect. It won’t work for people who gain weight through snacking.�

There are some diet pills trials:

Fiona Macdonald-Smith had a BMI of 23.7. Her goal was to lose ¾ of a stone within six weeks. She tried Appesat.

She was taking the pills for three days an hour before the meal. The feeling of fullness was there for about an hour after taking the pill. Unfortunately some people, like Fiona, don’t need to feel hungry in order to eat. She was still eating because she was bored, had a deadline or was waiting for a kettle to boil.

Dr. Jason Halford says the key to the success is a healthy diet and exercise.

After a few days of taking Appesat, Mrs. Macdonald-Smith experienced the eructation.

Kara Gammel’s BMI is 28.5. She wanted to lose 10lbs. She was taking Alli for a few days. Unfortunately the side effects were very embarrassing: winds, sudden bowel movements, stomach pain and faecal incontinence.

MedPage Today, 20th April 2009

It is well known that obese patients who undergo weight-loss surgery benefit not only from losing weight, but their health issues improve significantly.

What’s interesting, even if some patients remain obese, their health problems get better. This argument was confirmed by a study carried on 625 obese patients. All those patients had a gastric bypass surgery and the researches carried out six years after the operation showed that most health problems improved significantly. They were: dyslipidemia, joint pain, sleep apnea, blood glucose, hypertension and gastroesophageal reflux. The study was published in the April “Archives of Surgery�.

Another interesting information is that even though some patients remain obese after the surgery, they still experience better quality of life and health improvements. That shows that weight-loss surgery is not only about weight-loss but has also important medical reasons.

In the study, all patients had the weight-loss surgery between 1999 and 2006. 492 patients had BMI between 34 to 49.9, 133 patients’ BMI was from 50 onwards and there were also 24 morbidly obese patients of BMI of 60.

The group of morbidly obese patients lost a maximum 15 BMI units. Six years after the procedure those patients managed to hold the loss of 13 BMI units.

The group of superobese patients managed to lose 21 BMI units compared to the 17 BMI units after six years after the surgery.

Reports say, most patients did very well in terms of weight-loss. The maximal weight-loss for all patients was obtained after 18 months after the operation. Superobese patients lost 60% of their excess weight whereas morbidly obese patients – 73%.

Six years after the surgery morbidly obese patients managed to maintain the loss of 60% of their excess weight-loss and the other group of patients – 55%.

About 20% of patients who were superobese before the surgery, still had their BMI of 40 six years after the procedure. What’s interesting, though, the majority of patients showed “durable improvement or complete resolution of comorbid conditions�.

At least 75% of patients in each category showed improvements. This lead to better control of existing health issues with the same or reduced medication, or even resolution of existing problems.

95% of patients showed improvements or resolution of sleep apnea.

Worsening of the health condition was unusual. 10% of patients had poorer blood pressure and further 5% showed worsening of joint pain and reflux disease.

Dr. Suter and other doctors who carried the researches said that patients showed “important improvements in comorbid conditions even though they remained clinically obese, even morbidly obese�.

“Weight loss or residual BMI is not all that matters, and all aspects of the results of bariatric surgery must be evaluated to draw meaningful conclusions about the effectiveness of a given bariatric operation,” they wrote.

Newswise, 15th April 2009

Not only severely obese patients should be allowed weight-loss surgery. Latest researches show that this kind of operation is helpful to moderately obese to lose more weight.

Until now many clinics accepted performing weight-loss operations on patients with body max index (BMI) with 40 or more. The studies show, though, that patients with BMI of 30 and 40, and diseases such as type 2 diabetes and hypertension will benefit from the weight-loss surgery as it will improve their health issues.

“We see a wide range of patients who consider surgery. The majority are people that attempted medical weight loss for years and decades without success, and they have an intimate understanding of what morbid obesity means to them in their life. They’re looking for a therapy that can give them some help,� said Peter Hallowell, an assistant professor of surgery at the University of Virginia.

The newest review was carried by Jill Colquitt, a senior research fellow at the University of Southampton. Colquitt examined 26 previously published studies that involved 5,766 patients. Six researches compared batriatic surgery outcomes to those who managed lose weight in conventional way. Twenty studies compared different batriatic surgery operations.

Patients with BMI between 30 and 40 who suffered health issues connected with obesity showed greater weight-loss than patients who tried to lose weight only by dieting and exercising. Also health problems improved significantly. Those results were shown two years after the procedure.

In comparison: moderately obese patients lost 87.2% of excess weight after the operation while those who used diet pills, exercising and low-calorie diet only managed to drop 21.8%.

The study says that also type of procedure affected the results. Gastric bypass, in which the stomach is made smaller and which shortens the small intestine, led to more weight-loss than gastric banding. The other procedure consists on using silicone bands that are adjust to make the stomach smaller. The results of gastric bypass and two other procedures called isolated sleeve gastrecomy and banded gastric bypass, were similar.

One of the aims of the research was to update the information about patients younger than 18 years. Unfortunately they were no researches about weight-loss surgery compared to dieting and exercising in this age group.

“The frontline question is, ‘Is surgery better for patients with lower levels of obesity?’ Those are areas of research that are just beginning to come to light,� said Hallowell. “Their findings are very important. In the small number of randomized controlled trials to look at, there’s clear evidence that surgery is better than not having surgery. There are risks to surgery — we don’t want to minimize that to any degree — but the health benefits noted in these studies certainly outweigh the risks for patients who undergo it.�

The review was published in The Cochrane Library, a publication of The Cochrane Collaboration.

Times Online, 5th April 2009

Public awareness and willingness to look good have made weight-loss surgery very popular over the last years. There were 72% more weight-loss procedures in the last months, than a year earlier. Also private clinics notice a boom proceeding twice as more operations. One of the private hospital chains carried 800 weight-loss procedures within five months.

Patients are more aware of the health risks connected with obesity: diabetes, high blood pressure, stroke, heart disease. The problem is even more serious after studies showing obesity being a growing epidemic in the UK.

Patients are concerned for both: their appearances and health. Doctors explain that such a growth in the weight-loss surgery is due to procedures being new and having more potential for rapid growth.

NHS had performed 2,724 weight-loss surgeries in 2008 which is 36% more that in 2007. Also hospital admissions for obesity-related problems were 30% more common. The UK’s biggest obesity-related issue is type 2 diabetes.

There were about 8,000 weight-loss surgeries in 2008, worth £30 million, which is five times more that five years ago. The NHS is the most popular weight-loss surgery provider that operates on patients in most need of weight-loss.

Great Falls Tribune, 27th March 2009

Obesity is a big world problem that makes people’s lives difficult. Some people try to lose weight unsuccessfully, using all possible methods.

Krista Freeny is one of them. She tried all possible weight-loss diets. All of them had one fault – the yo-yo effect.

At some point she started researching about batriatic surgery. Firstly, she made a list of pros and cons. She quickly realised that the risk of heart attack, diabetes and stroke is far too much for her. She wanted to enjoy life and see her kids growing which was probably not going to happen.

Krista’s surgery took place in September 2007. From then, she lost 130 pounds and sees the difference: her feet don’t hurt any more, she can easily play with her children, even her asthma improved.

In the past, obesity was her excuse not to do anything. It was taking time and energy. Now it all changed.

Weight-loss surgery is a very popular procedure. It gained its popularity especially in 1998 and 1999. Dr. Elizabeth Martin emphasizes it is not a cosmetic operation. It can help many diseases such as diabetes, high blood pressure, sleep apnea and many others. She also adds that looking good should not be the only reason of having it.

National Institutes of Health require that the BMI (body max index) of a patient eligible for the surgery should be at least 40. It means such a patient is about 100 pounds overweight. Also patients with BMI between 35 and 40 might be eligible if they have health issues connected with obesity.

Insurance companies might have other criteria such as trying low-calorie diet or follow physical exercises.

Gastric bypass and lap-band are two most popular surgeries. The lap-band procedure consists on placing an adjustable band around the upper part of the stomach. The result is quick feeling of fullness even after eating a small amount of food. The procedure helps to control how much food is taken.

The lap-band was invented in Australia in 1990s but then improved since.

Gastric bypass, on the other hand, is about creating a small pouch in the upper stomach. A portion of the small intestine is attached to the pouch which results in food bypassing a large portion of the stomach and small intestine.

This procedure allows quicker results as patients tend to lose 50-60% of excess weight in the first months after the operation. With the lap-band the same results can be seen in about 18 months afterwards.

But then, after 3-5 years, both surgeries have equal results.

The other difference in both procedures is that the lap-band is less invasive and can be reversible. The band is designed to stay in the patients’ bodies till the end of their lives even if they lost unwanted weight. Once removed, they would start gaining weight again. Placing the lap-band requires only overnight stay in the hospital, whereas gastric bypass patients stay for about two to three days.

Even though a normal BMI is rarely achieved by patients who underwent weight-loss surgery, it brings major health benefits. Weight-loss procedures reduce type 2 diabetes in 90% cases and improve sleep apnea in 75%.

Before a patient can undergo any procedure, a psychiatric evaluation and counselling about nutrition has to take place. Then, together with the doctor a decision is made on what type of surgery is needed, depending on patient’s conditions and preferences. Also information about what to expect from the surgery and how life afterwards will look like, is given.

Krista Freeny waited five years for the procedure as she wanted to be ready for it. “It’s a tool,” she says. “It’s not a cure.” She also adds life after the surgery requires lots of work so patients need to be really motivated. They have to change lifestyle, diet and start exercising, if they want to succeed.

After-surgery diet should be rich in proteins and patients should not eat anything between meals.

If those rules are not being followed, the stomach gets bigger and the operation will not be effective.

All patients who had the surgery say it is not easy but well worth it.