Biomed Middle East, 24th February 2010

In the majority of cases patients with diabetes are obese or overweight. There are cases, though, when patients are not obese but suffer from the disease. On the other hand, there are also obese but diabetes-free patients.

This is one of the reasons why the BMI factor should be discussed as the only way to decide who is eligible for the weight-loss surgery.

Over 20 years ago BMI became a parameter of eligibility for weight-loss surgery. It makes sense to take BMI into consideration when selecting patients for the procedure aimed at weight loss but this factor becomes discriminatory when it comes to the patients with diabetes.

“As an alternative,� Says Dr. Francesco Rubino from the New York-Presbyterian Hospital, “patients should be triaged based on the severity of their disease, their metabolic profile, and other predictors of cardiovascular disease risk).

Type 2 diabetes is a disease that affects over 200 million people worldwide. Many of them have complications affecting kidneys, eyes, heart and extremities. In most cases treatments as diet, medications and insulin, are ineffective.

Dr. Rubino agrees that diet and exercise can prevent the disease and they are extremely important in the health care policy and planning. Unfortunately the life-style and diet have little impact on the advanced disease.

“Telling a patient with severe diabetes to eat low-fat diet and go to the gym Is comparable to telling the person with lung cancer to stop smoking,� says Dr. Rubino.

There are numerous advantages of the bariatric surgery: straight after the procedure the diabetes improve immediately, very often to the point of complete remission.

Researches have shown that removing portions of the jejunum or duodenum – the upper part of the small intestine below the stomach – leads to improvements or even diabetes cure. Also inserting a tube in that part of intestine which allows food to pass through without coming into contact with the area, has the same effect. When food passes from the stomach into the upper end of the small bowel, a mix of hormonal reactions causes diabetes. That is why it is so important to understand those reactions precisely.

More and more surgeons reckon that weight-loss surgery has a crucial role in curing diabetes. In the November 2009 publication in the Diabetes Care, 12 clinical experts published a consensus statement that defines remission and cure.

Dr. Rubino says: “The statement implicitly recognizes that remission is achievable only by surgery. It states that remission exists when normal glycemia is obtained in the absence of medical therapy; hence, by definition, medical treatment cannot achieve remission�.

Yorkshire Post, 17th February 2010

It’s not easy to cure obesity, especially with children. They often eat comfort food to hide from the world, when they’ve got a problem. Then they are bullied at school, so eat even more for comfort. It’s a vicious cycle. The bigger they are, the more risky it becomes for them to have serious health problems, such as heart disease, diabetes or others.

The results of the weight-loss surgery can be really impressive but experts try to find out how the young patients put some much weight on.
“It’s a horrendous indictment on society that we should ever allow these children to get this fat,” says Tam Fry, of the National Obesity Forum.
Whereas the number of adult patients undergoing weight-loss surgery goes up from year to year, such operations in young patients are still quite uncommon.

Children’s obesity is a growing problem nowadays. As experts highlight, this doesn’t happen overnight and they wonder how it is possible that nobody – parents, doctors, nurses – pays any attention to this.

At the moment, about one in five children starting the school are overweight or obese. By the time they leave for secondary school, it changes from one in three. In the majority of cases the children live in families where physical activities don’t exist and where junk food is the main diet.
Although the problem is serious, it’s not fair to say it’s only parents’ fault. Whereas younger children depend on their parents, teenagers are much more independent and they are influenced more by the environment than by the family.

Obesity means not only serious health problems but also shorter life by 20-30 years.

Introducing healthy life-style with plenty of fruit and vegetables, as well as physical exercise, is extremely important to beat the problem of obesity. Young children are usually very active and they love games and plays. Cutting the time they spend in front of TV and computer while eating junk food is also important. Getting children into good habits will bring results in the future.

If, however, the youngsters are already overweight or obese, waiting for a miracle won’t make them shed the weight. If changing the diet and physical exercise are not enough, let them consult a doctor and see the options for weight loss. The surgery, in some cases, is the only way. Young patients have to be aware, though, that it is absolutely necessary to change life-style after the procedure. Healthy diet and exercising have to be part of their life if they won’t to lose weight and maintain it.

NBC Bay Area, 10th February 2010

More and more young patients undergo weight –loss surgery. It might sound a bit extreme but, according to the studies of the Journal of the American Medical Association, these patients lose 76.2 pounds on average. Those who only use dieting and exercising, lose 6.6 pounds.

Lauren Richmond was 14 years old and weighed 210 pounds. She tried everything to lose weight, from Weight Watchers to exercising and dieting. Not only she didn’t lose any weight but also health problems appeared. She started to have thyroid problems, high blood pressure and diabetes.
That is why she decided to undergo weight-loss surgery.

Two years after the procedure, she weighs 130 pounds. Not only she feels and looks good but also she didn’t have any complications and says she would recommend this kind of surgery to all obese teenagers.

“Before I was depressed and alone,â€� she said. “Now I’m out of my shell and I’m confident and outgoing. I love doing all kinds of things. Once you see you are actually losing weight, you’re willing to exercise, and eat right in order to make it work.”

Dr. Richard Nguyen, a bariatric surgeon, says the lap band operation is safe and effective. As it is less invasive, patients recover faster.

“Some kids, no matter what they eat, they’re not able to lose weight or they’re gaining weight constantly no matter what they eat or do,â€� Dr. Nguyen said. “They have adult medical problems. They have heart disease. They have high blood pressure and diabetes that you only find in people typically much older than they are.”

Dr. Nguyen highlights that it is not a magic bullet. Healthy diet and exercising still play major role in weight loss. Those patients have to change their life-style completely, in order to lose weight and maintain it.

Tampabay.com, 31st January 2010

More and more people undergo weight-loss surgery each year. There are ongoing researches that aim to find out if those procedures are safe and if they really work.

Medical community is very optimistic about the future of the weight-loss operations. Modern surgeries show improved outcomes and lower complications.

These procedures are highly recommended by many medical bodies, including American Society for Nutrition and the Obesity Society. Bariatric surgery was even called “the most effective weight-loss therapy for obesity�. American Diabetes Association recommended bariatric surgery as a treatment option, for the first time last year.

The surgeons highlight, though, that weight-loss procedure is not a magic tool that will cure the obesity epidemic.

Patients have got a choice between a few procedures, depending on their individual needs. Most of them choose a gastric bypass or gastric banding. The first surgery consists on cutting and stapling the stomach, whereas the second one places an adjustable silicone ring around the top portion of the stomach. In both operations a smaller stomach is produced, in order to allow only small portions of food to be taken in.
Even though weight-loss surgery is quite common nowadays, it wasn’t always the case. The first operation took place in 1960 but even 30 years later it was still relatively uncommon.

One of the factors that helped was that the procedures became shorter, safer and less invasive. Then, studies showed how good the results were, that the surgery helped eliminate even chronic diseases associated with obesity.

The most recent studies showed also lower complication rates and shorter hospital stays.

Despite the call last week from the Royal College of Surgeons to stop the postcode lottery in PCT funding of Obesity Surgery, cash-strapped PCTs are making it even harder for patients to get the surgery they need.
Oxfordshire has raised the entry criteria for bariatric surgery to people with a BMI of more than 50.
The move to raise the criteria in the couty was agreed at a board meeting of NHS Gloucestershire. Shona Arora, director of public health, said: “This will help strike the right balance between early intervention and care for those who are morbidly obese and helping to meet demand. We are continuing to deliver a programme to support people in community settings to become more physically active and to eat more healthily.”
Dr Helen Miller, professional executive committee chairwoman, said: “Just because a BMI is 40 or even 50 it doesn’t mean you can’t lose weight.
Bariatric surgery is not a quick fix. It’s about saying to people it’s an absolute last resort. We know if people lose a stone or two they improve their risks of developing diabetes or heart disease.”

In Oxfordshire the county’s PCT has decided to fund surgery only for those with a BMI over 50 who also have a serious weight-related illness.
The trust said it could not afford to carry out more operations. Last year they received 64 requests for surgery but only approved 25 cases.

Nick Maynard, a surgeon at Oxford’s John Radcliffe Hospital, called for a rethink.
He said: “There is proof that this treatment works. Up to 10,000 Oxfordshire people could benefit.”

According to the NHS Constitution published in 2009, morbidly obese patients have a legal right to be properly assessed for weight-loss surgery under guidelines set out by NICE. However, although some PCTs adhere to the guidelines, others are only referring the most extremely ill patients for surgery.
The Royal College of Surgeons says there is no clinical evidence to support the practice of only operating on the most overweight patients. In fact, evidence suggests that not only do these patients have less to gain from surgery, they are far more likely to suffer serious complications.
Facts: 240,000 of the 1million people who meet NICE criteria want surgery
Only 4,300 weight-loss operations were done by the NHS in 2009
The only avenue open to patients hoping for surgery but unable to get their local health authority to fund it is to pay privately.
For detailed information on the different forms of weight loss surgery available and how to prepare to ensure surgery is both safe and successful see details: http://www.cosmeticbliss.co.uk/p/weight-loss-surgery