UC Davis, 24th March 2010

Studies about delaying diabetes by weight-loss surgery were carried out in rats. The research was done by a veterinary endocrinologist, Peter Havel.
These findings should help in treating diabetes in human. Diabetes is a chronic disease which makes the body unable to properly metabolize sugar and fat. Diabetes cause serious health problems such as heart disease, blindness and kidney failure.

National Institutes of Health says diabetes affects about 21 million of Americans. The annual cost is more than $150 billion.

Peter Havel said weight-loss surgery is the most effective long-term treatment not only for obesity but also for diabetes.

“It has been thought that reduction of blood sugar, which indicates a reversal of type 2 diabetes, in patients following bariatric surgery was due to post-surgery weight loss,� Havel said. “This study, however, supports the observations from a number of earlier clinical studies reporting that diabetes is often improved prior to substantial weight loss. It also suggests that endocrine changes in hormones produced by the gastrointestinal tract may contribute to the early effects of bariatric surgery, in addition to the later effects of weight loss.�

Other observations show that metabolism is quickly regulated after the surgery.

For severly obese patients, with 80 or more pounds overweight, excess weight is a life-threatening problem.

There are numerous weight-loss procedures available. Gastric bypass is one of the most common, and consists of making the stomach smaller and reroutes the digestive tract. That causes changes in intestinal function and hormones.

Havel and his colleagues set out a hypothesis that bariatric procedure can improve type 2 diabetes, as this increases the flux of unabsorbed nutrients to the far end of the small intestine. This triggers increased secretion of two hormones (glucagon-like peptide-1 and peptide-YY) that control food intake and improve insulin secretion and sensitivity. This helps to stabilize sugar levels.

The researches were carried out in rats that were predisposed to obesity and type 2 diabetes. These conditions in rats are very similar to the human ones.

A short portion of the small intestine was relocated forward in the intestinal tract. Then it was compared how long it took for the animals to develop diabetes compared with a group of rats that had surgery but without rearrangements of the intestines.

The results were that the rats having the ileal interposition surgery developed diabetes 120 days later than the rats in the control group. A year later, 78% of rats in the control group were diabetic while only 38% of the rats that had the ileal interposition procedure had developed diabetes.
Havel said that delaying diabetes in rats by one year will be similar to delaying diabetes in a person by 10 years. This will give enough time to decrease the amount of the complications and reduce health costs that come with treating the disease.

Other results were:

~~ lower fluctuations in blood sugar levels
~~ improved insulin production
~~ decreased levels of cholesterol and triglyceride in the bloodstream

Researchers agree that further studies need to be carried out to better understand what new methods will be able to prevent and treat type 2 diabetes.

Irish Times, 15th March 2010

David Ludwig is a director of the obesity programme at Children’s Hospital Boston. He says he was against the weight-loss surgery for the young patients. The reason for that was that he was ignoring the problem. He has, however, changed his mind.

From 1980 the number of obese children in the USA increased by three times. Obesity causes serious health problems such as sleep apnea, diabetes and heart disease.

To avoid these, Ludwig thinks regulations should let young patients undergo weight-loss procedures. These consist mainly on making a stomach smaller which limits the amount of food consumed by a patient.

Christine Ren-Fielding, a surgeon from New York University, also thinks that gastric banding should be allowed from the age of 14.

Both Ren-Fielding and Ludwig say the long-term aim is to change children’s life style – remove junk food from their diet, improve school lunches and physical education. Before it happens, though, both doctors think the surgery is going to be necessary.

Researches show that children who undergo weight-loss procedure lose 11 times more weight than those who only change diet and exercise.
More than 220,000 Americans underwent weight-loss procedures in 2009. When compared to year 1999, when 28,000 operations were carried out, the increase is huge.

The surgeons warn though, that weight-loss procedure is only a tool, not a cure. Patients do have to realize that the change of life-style after the surgery is a must. If they don’t follow the new healthy diet and physical activity, they’ll gain the pre-operational weight.

Joliet Herald News, 10th March 2010

Weight-loss surgery doesn’t start with the bariatric procedure. It starts long time before that. About two weeks before the operation, the patients have to start a special diet which stimulates weight loss and shrinks the liver. The diet doesn’t contain any carbohydrates, as they make the liver larger when they are being digested.

Only two portions of food are allowed daily. It is not normal food but protein powder shakes. Patients can’t eat fruit or vegetables at this stage. To replace the hydration, they drink more water.

This helps the doctors to perform the surgery.

Two days after the procedure patients drink sugar-free, non-caffeinated liquids and water. Sugar is not allowed as it causes dumping syndrome and caffeine irritates the stomach lining.

The next step is purred-protein food. This period lasts for 10 days. Patients can choose between meat, fish, eggs and cheese. Milk or yogurt is not allowed yet. The consistency of the food has to be similar to baby food.

The same diet has to be followed for the next two months. The only difference is that the food doesn’t need to be pureed any more. In month three patients can add a half cup of fruit. This, along with vitamin supplement, is the main diet until the target weight is achieved. This, depending on the individual, may take from 6 months to two years.

To maintain optimal weight, patients should add small amounts of whole-grain carbohydrates. Only small portions of food can be eaten as operation reduces the size of the stomach to the size of an egg. After the surgery the food bypasses part of the small intestine which makes it difficult to absorb B-12, folate and iron. That is why the supplement of vitamins has to be taken.

Weight-loss surgery is usually a very effective way of weight loss but the post-operative period might be quite difficult. That is why it is highly recommended to join a support group that not only educate but also encourage patients and answer their everyday questions.

OnMedica, 11th February 2010

The number of weight-loss procedures performed by NHS increased more than twice between years 2006 and 2009. The NHS performed 4,220 procedures in years 2008/09 whereas 1,950 operations were carried out in years 2006/07.

The new report on obesity for England for the year 2010 shows that the number of people admitted to the hospitals because of obesity increased by 60% from 2007/08 to 2008/09. Also the number of prescribed medicines to treat obesity is 10 times higher in 2008 than it was in 1999.

In 2008 about 24% of men and 25% of women were classified as obese with BMI of 30 or more. 42% of men and 32% of women were classified as overweight in 2008 (BMI of 25-30).

Also a big number of children were classified as obese: 17% of boys aged 2-15 and 15% of girls.

“This report highlights the impact of obesity not just on society, but on the NHS. The figures show a clear rise in hospital admissions, surgical procedures and drug therapies to help people tackle their obesity,� said Tim Straughan from The NHS Information Centre.

More study published in the Journal of the American medical Association show that weight-loss surgery is the most effective way of weight loss. The teenagers between 14 and 18 years old are very likely to lose about 50% of their excess weight, gain health benefits and a better quality of life.

“Bariatric surgery is now extensively used for adults and is being evaluated for adolescents,� the study conclude. “Laparoscopic adjustable gastric banding (gastric banding) has the potential to provide a safe and effective treatment.�