Sky News, 8th September 2010

A big part of the society nowadays is overweight or obese. A weight-loss surgery not only can help them to lose weight, cure their health problems and improve their life-style but can also help the economy.

The economic analysis show that the cost of the surgery pays for itself in just one year.

The royal College of Surgeons admitted that if obese patients underwent the weight-loss surgery, they could then get back to work instead of being on benefits. That could lower the cost of the surgery by £8.000.

Marcus Reddy from the St George’s Hospital said: “It has been a falsely held belief that bariatric surgery is expensive. It’s not. It’s very cheap. It’s something that will help all of us in the economy.”

Analysis shows that if only a quarter of obese patients had the size of their stomachs reduced, it would cost the NHS £546m.

On the other hand, though, over the next three years the NHS would save £104m as their health improved and the benefits bill would fall by up to £450m.

At the moment, there are so many obese patients that are housebound. If they had surgery, they could get back to work and help the economy to get a boost of £1.8bn.

Doctors admit that the weight-loss surgery might be seen as expensive in the first place. But we have to remember that after the surgery the diabetes is usually cured, which means they don’t need the medication and are no longer hospitalised.

Private Healthcare UK, 1.09.2010

Weight-loss surgery doctors raise the problem many patients that are eligible for the procedure, are missing it out.

The British Medical Journal (BMJ) stated that weight-loss operations rose from 238 in 2000 to 2,543 in 2007. 6,953 operations took place between April 2000 and March 2008. Doctors suggest that only 1 in 200 patients eligible for such procedure is actually offered one.

Doctors are also against the way the surgery is currently allocated. The main factor that makes a patient eligible for a weight-loss surgery is based on their BMI (Body Mass Index).

Dr David Ashton, medical director of Healthier Weight, said: “BMI was developed in the 19th century and is much too crude an instrument to be used as the basis for decisions regarding potentially life-saving surgery in the 21st century. BMI discriminates on the basis of age, gender and – especially ethnicity. The latter is of great importance because certain ethnic groups have a greater risk at lower BMI’s than Caucasian populationsâ€�

With the growing obesity problem in the society nowadays, the weight-loss surgery becomes more and more popular. Patients are aware they have got a choice and a powerful tool in their weight-loss battle. They need to be treated fair while deciding if they can undergo the procedure. In order to be able to do that, procedures of allocation of the weight-loss surgery need changing.

montrealgazette.com, 25th August 2010

Claudia Farner is the first Canadian who had part of the stomach removed. She underwent the laparoscopic sleeve gastrectomy in October 2008. Since then, Claudia has lost about 40% of her body weight.

Claudia has come a long way. She had to lose 40 pounds before the surgery. She lost other 156 pounds afterwards. She is now able to lead a normal life, to take a shower, to go to a restaurant, to visit family and friends.

She realises she still has got a long way to go but is very happy with what she achieved already. During the operation in 2008, doctors removed a part of Claudia’s stomach including the portion that creates ghrelin, a hormone that makes people feel hungry. Since then, she has stuck with the plan, eating no more than 1.5 cups of food at any meal.

She works really hard to achieve her goal. Swimming 6 days a week, hard-core cardio twice a week,
resistance and weight training, pulling and pushing sleds filled with weights to the 44-yard line.

Patients need to be really motivated if they want to be successful. Dr. Shahzeer Karmali who performed the operation said, Mrs. Farner is a model patient. She’s got her worse days when she’s not feeling that well, but then she looks in the mirror, sees her slimmer body and how much she’s done for herself already, and feels better again.

To July this year, another 80 people had the sleeve gastrectomy at the Royal Alexandra Hospital. One year after surgery, they had lost an average 88 pounds and decreased their body-mass index to 44 from 59. Dr. Karmali will be presenting the results at the 2010 Obesity Society conference in San Diego later this year.

Dr. Karmali highlights how difficult it is to start a different life-style. The surgery “Is kind of a kick-start,” he said, ” the society expects people like Farner to simply start eating less and exercising on their own. “She had so much (weight) on she was almost wheelchair-dependent. She couldn’t even get started. It’s very difficult.”

Just diet allows patients to lose between 5 to 10% of their excess body weight. When the person diets, they lose weight, but then put even more back on.

The weight-loss surgery brings more success. Studies show that the laparoscopic sleeve gastrectomy allows patients to lose 60% of their excess weight in two years. This is the sufficient motivation for them to lose the rest through exercise and diet. The traditional gastric bypass typically helps a patient lose 75 to 85% of their excess weight by having the stomach stapled, then hooked to the intestine to reduce the amount of food digested. Those patients who have their stomach banded, which makes them feel full more quickly, lose generally 40 to 60% of their excess body weight due to the surgery.

Obviously each type of surgery has got its strengths and weaknesses. Each patient should choose the best option depending on the individual needs.

HealthNews, 18th August 2010

The number of people suffering from diabetes increases dramatically. The CDC investigators say that it will double in the next 25 years from 23.7 million to about 44.1 million in 2034. The cost of treating diabetes is expected to triple from $113 billion $336 billion.

Dr. Elbert Huang says the situation becomes more and more dramatic and that we should change immediately the dietary and exercise habits in order to find more effective and less expensive ways of treating diabetes.

As Type 2 diabetes is an obesity-related disease, doctors recommend that losing weight will improve the situation or, in some cases, even heal it. Studies show that both exercising and weight-loss surgery are able to lower the diabetes.

Johns Hopkins from University School of Medicine found out in his latest study that about 75% of patients who had bariatric surgery for weight loss eliminated their diabetes medications within 6 months and almost 85% of patients remained off diabetes medications two years later.

This research showed that not only diabetes can be treated effectively, but also the health care cost can be dramatically reduced with weight-loss surgery. In America the average cost of treating a patient before surgery was $6,376 up to two years before surgery. That increased to $10,592 in the year leading up to surgery. In the year following weight loss surgery, the cost per patient was $6,992, fell to $4,197 in the second year, and fell even further to $1,878 three years after surgery.

The study that appeared in the American Journal of Managed Care in 2008, showed that the average monthly medical costs for the people who had laparoscopic bariatric surgery were approximately $900 lower than those people who did not, roughly a year after the procedure. Those participants in the study who had the surgery showed a decrease in medical conditions common to obese patients, such as hypertension, diabetes, and sleep apnea.

BusinessWeek, 11th August 2010

US doctors performed the first ever stomach reduction surgery via mouth.

Surgeons at the University of California, San Diego, performed a sleeve gastrectomy operation during which they removed 80% of the patient’s stomach.

The aim of such an operation is to make patients consume less food and allow a feeling of fullness quicker then previously. Patients lose generally two to four pounds a week after the surgery.

Surgeons all over the world try to find the least invasive methods of weight-loss surgery. Dr. Santiago Horgan, chief of minimally invasive surgery and director of the UCSD Center for the Treatment of Obesity said: “Our goal is to offer patients a customized long-term solution for losing weight with as few scars as possible, and if desired, no medical devices.”

The said operation required five small incisions in the abdomen to allow cameras and other instruments to enter the abdomen. Surgeons also removed a small portion of tissue through the abdomen and inserted staples to close the stomach.

Doctors say they are getting closer to the weight-loss surgery with no scars. There are, however, some questions that can’t be answered at this point as there aren’t any long-term follow-up data to confirm the effectiveness of sleeve gastreectomy as a stand-alone intervention at [or beyond] 5 years.

By Elizabeth Simpson
The Virginian-Pilot

Mary Writesel wrestled with obesity for a couple of decades, but it wasn’t until she was diagnosed with diabetes that she considered a drastic solution: Weight-reduction surgery.

Even before she left the hospital after the surgery last August, her blood sugar levels had fallen so much she no longer needed medication for diabetes, high blood pressure and high cholesterol.

A year later and 60 pounds lighter, “I’m considered diabetes free,” the 55-year-old Portsmouth resident said. “I can’t tell you what a relief it is.”

That by no means happens to all diabetics who go through weight-reduction surgery, but it happens enough that researchers are taking note.

Writesel agreed to donate a sample of fat removed during her surgery for a study being conducted by researchers at Norfolk’s Eastern Virginia Medical School. “I told them they could have as much of that as they wanted.”

The local medical school study is one of many exploring why diabetes sometimes goes away after weight-reduction surgery. At first, the phenomenon was chalked up to weight loss, but some patients were shedding the disease before losing a pound or even leaving the hospital.

Researchers at the EVMS Strelitz Diabetes Center decided to study different types of body fat to see whether certain aspects are more likely to result in problems such as diabetes and heart problems.

They’re particularly interested in visceral fat – what most people refer to as belly fat – that surrounds internal organs. People with a lot of that type of fat are generally apple-shaped and are at higher risk for Type 2 diabetes and heart disease.

People who are pear-shaped tend to have fat that is under the skin – subcutaneous fat – that shows up in the hips, thighs and buttocks area.

The researchers are focusing on an enzyme in fat called lipoxygenase, which can cause inflammation that damages blood vessels. If they can determine how the enzyme causes the inflammation, that could lead to medical treatments to correct it.

Dr. Jerry Nadler, director of the Strelitz center, said the study also wants to determine why patients who have gastric bypass surgery seem to be more likely to stop being diabetic than those who have “lap-band” surgery. Gastric bypass is a procedure that restricts the stomach so food bypasses part of the intestine; lap-band is less invasive, with a band placed on the upper part of the stomach to make it smaller.

Anca Dobrian, an assistant professor of physiological sciences at EVMS and lead author of the study, said fat samples from 34 people have been collected during the past year for the pilot study, which will eventually include 40. Half the patients will have had gastric bypass surgery, the other half the lap-band procedure. In each category, half are diabetic and half are not.

Samples of both belly fat and fat beneath the skin are being studied.

Dobrian said that so far the study is showing that the diabetics have certain enzymes that are different from non-diabetics, and that enzymes in the bloodstream change after gastric bypass surgery.

The initial results were presented at an American Diabetes Association conference in June, and they are intriguing enough that the researchers believe they can get more funding to expand the study.

Dr. Stephen Wohlgemuth, medical director at Sentara Norfolk General Hospital’s weight-loss center, is working in conjunction with the researchers by collecting samples from his patients.

He’s been doing weight-reduction surgery for a decade. He said many gastric bypass patients have gone home from the hospital without needing their diabetes medication, or stopped taking it within weeks of the surgery, even before they’ve lost much weight.

Across the globe, there have been other studies of weight-reduction surgery patients whose Type 2 diabetes disappeared after surgery. One study published in the Journal of the American Medical Association in 2004 found that 70 percent of 22,000 obese patients with diabetes had the disease go into remission after gastric bypass surgery. Some doctors are even recommending the surgery to diabetics who don’t meet the usual requirements for weight-reduction surgery.

There are critics, however, who contend that people can manage diabetes through diet, exercise and medication rather than risk complications of surgery and the expense of hospitalization. People can also regain weight after surgery and become diabetic again.

Insurance companies require patients to have a certain body mass index, and health complications such as diabetes or heart disease, to qualify for weight-reduction surgery coverage.

Nadler said there is a lot of discussion among health experts about the best treatments for diabetes and obesity, and for good reason. The medical costs of obesity are estimated to be as high as $147 billion a year; the American Diabetes Association pegs the costs of diabetes at about $116 billion a year.

Nadler is hopeful that the EVMS study will provide some answers. Blocking the enzymes that cause inflammation could help stem the damage of diabetes and heart disease.

Writesel, an executive secretary at Sentara Norfolk General, had been on high blood pressure medication since she was 19, shortly after her father died of a massive heart attack. When she was 50, her cholesterol was high, so she added more medication for that.

She was diagnosed with diabetes three years ago.

“I was devastated,” Writesel said. “I thought, ‘I can’t have one more thing go wrong with my body.’ ”

The diabetes medications brought her up to six to eight medications a day. By this time, she weighed 250 pounds.

Six months before her gastric bypass surgery she started classes to learn about nutrition and how to change her diet. By the time she had the surgery, she was down to 238 pounds, and her blood sugar levels were improving. Writesel was on a liquid diet for a week before the surgery and was taking her diabetes medication up until a few days before her surgery.

That was the last time she took it. As soon as she came home from the surgery, she felt more energetic. She’s lost 60 more pounds and wants to lose another 30. She walks two miles a day.

Instead of needing to see her primary care doctor every three months, she was advised to come back in a year.

“You don’t know how good that sounded,” Writesel said.

Audrey Floyd, 54, is another participant in the study. The Virginia Beach woman had lap-band surgery in May because the procedure did not require her to take as much time off work as gastric bypass. She’s lost 10 pounds so far. She still has diabetes, but she is hopeful it will fade away as she loses more weight.

She said her primary care doctor didn’t recommend the weight-reduction surgery but suggested instead that she “push away from the table.”

Floyd hopes the fat she donated to the study will help other people like her: “Diabetes runs in my family. We are all getting it as we get older.”

Elizabeth Simpson,(757) 446-2635, elizabeth.simpson@pilotonline.com

walesonline.co.uk

A FUNDING boost will see more people undergoing NHS weight-loss surgery to help tackle the nation’s obesity epidemic.

The budget for bariatric surgery operations, such as gastric banding or stomach stapling, is forecast to almost double to £500,000 this year. The extra cash could also help establish the nation’s first specialist morbid obesity service, operating out of hospitals in Bridgend and Swansea.

By comparison, £520,000 has been spent on weight loss surgery for Welsh patients over the past two years and most of the operations have been carried out in either Bristol or Salford.

A Freedom of Information request by the Western Mail showed fewer than 10% of those referred for weight loss surgery in Wales received NHS funding over the past two years.

Professor John Baxter, the nation’s leading bariatric surgeon, said: “I’ve had patients on my waiting list die when [the list] was long and you never got round to doing them. We’ve all had patients we know that are on a knife edge.�

Statistics released by the Welsh Health Specialised Services Committee (WHSSC) show 1,044 overweight patients were referred by their GP or clinician for surgery.

Of the referrals, the WHSSC approved 126 patients for assessment for publicly-funded surgery, including 94 in 2008/09 and just 32 in 2009/10.

But the body, which decides how funding for surgery is spent, said the figure is likely to be even lower as not all patients would have been considered “physically or psychologically suitable for surgery�.

Dr Cerilan Rogers, WHSSC’s director of specialised and tertiary services, said weight loss surgery had been assigned a “low priority� relative to ministerial priorities that required significant investment, such as renal dialysis or specialist cancer services.

She said funding available for morbid obesity had therefore been restricted to the most severe cases, where patients suffered from uncontrolled blood pressure, diabetes or sleeping disorders.

The rationing of weight loss surgery means that in Wales only patients with a Body Mass Index (BMI) of more than 50 were considered for operations, compared with a BMI of 40 in many parts of England.

Dr Nadim Haboubi, chairman of the National Obesity Forum Wales, said: “Why should the criteria for obese people to have surgery be different between Wales and England? What makes the obese Welshman different from the obese Englishman?

“Why should only people with BMI of 50 and above qualify for surgery, while in England it’s 40 and above? These people are desperate to have surgery and I see them every week.

“Bariatric surgery doesn’t exist properly in Wales. We have the highest morbidly obese people in the western world and their best chance to be healthy again is surgery. It’s all about finance and money, obesity is not considered a disease by the NHS.�

The WHSSC confirmed it was evaluating proposals for a South Wales morbid obesity service with Abertawe Bro Morgannwg University Health Board.

It is hoped the new service will see up to 80 patients have surgery at the Princess of Wales Hospital, Bridgend, in the next 12 months.

Prof Baxter said a second bariatric surgeon had been employed and there were plans for a new bariatric nurse, dietician and psychologist.

“We are trying to set up a solid South Wales service, albeit it heavily rationed. There have been a lot of negotiations and costing to repatriate it back from Bristol to Swansea/ Bridgend,� he said. “This has been an unmet need for a long time that has been poorly resourced, but now it’s finally being put right and we just need to get going.�

South West Wales AM Peter Black, the Liberal-Democrat spokesman for health, said any NHS money spent on weight loss surgery must be justified.

“Clearly there is a need, where there are good medical reasons, to carry out weight loss surgery, even if only to prolong life and encourage good health,� he said. “We also need to make sure that the people having the treatment are going to change their lifestyles. It’s much the same as smoking, if you provide help for them to give up smoking then you don’t expect them to go back and smoke again.

“It needs to be a part of holistic treatment, it isn’t just a question of carrying out surgery. There has to be support and counselling before and after surgery, because otherwise the money is being wasted.�

A WHSSC spokesman said any morbid obesity service must demonstrate cost efficiency, cost effectiveness and represent overall value for money.

TimesOfIndia

For Muzaffar Khan, gaining confidence and the ability to move far outweighs (no pun intended) losing 50 kg in three months. Frantically fighting morbid obesity for years, Khan, who is from Lonar in Buldhana, arrived in Pune and underwent bariatric surgery in May at a city hospital. Today, he boasts of fine health and speaks of how happy he is to finally fit inside an autorickshaw!

Khan, who suffered from childhood obesity, underwent the laparoscopic sleeve gastrectomy (surgery to achieve weight loss through reduction of the stomach) at the Jehangir Hospital on April 24, and was in the city recently for a routine follow up with his doctor. He said he found out about the surgery on the internet and consulted the doctors.

“I am so happy. I actually managed to travel by a luxury bus to Pune. After alighting from the bus, I hailed an auto rickshaw and, much to my surprise, I could actually fit inside it! Earlier, I would never even try to hire a rickshaw in Lonar, since I would never be able to get in,” said Muzaffar, who had traveled to Pune in an ambulance for the surgery.

It’s not just about fitting inside a rickshaw, for the 22 year old can now stand for more than 30 minutes at a stretch, something that he could only wish for a few months ago. Those were the days when he either remained sitting in one position or lying in bed for the better part of the day.

Khan is also ecstatic that he can get back to his studies now, which he had to leave since his weight got in the way. “I have lost 50 kg till now. I am going to appear for the Secondary School Certificate exams externally. I want to pursue aeronautical engineering and become a pilot,” he said.

His tendency to put on weight continued since his childhood and his lifestyle changed to such an extent that he could do only two activities eat and sleep. Khan never lived a normal life and always faced social stigma due to his weight.

“It was difficult to go to school. The students would taunt me because of my huge frame and massive weight,” said Khan. “People don’t tease me as much now, since I look more normal due to the weight loss,” said Khan. Sleeping was no less an ordeal for him back then, as he needed two to three pillows for support, because sleeping on his back without support would make him feel breathless.

Since diet is the only restriction following the surgery, he said, “I eat some noodles in the morning, a chapati for lunch and a small amount of rice for dinner. I get abdominal pain if I try to eat more.” Khan feels no weakness and is also on a regulated dose of multi-vitamins.

Among other things, Khan who lost 20 kg in the first month after the surgery, and 15 kg each over the next two months is very delighted that he can perform the Namaz (prayers) five times in a day. “Also, I have lost ten inches.”

“I don’t have to rely too much on my family members for small things. Now, with increased mobility, I’m doing routine things on my own,” he said.

Khan’s elder brother, who is a truck driver and the only earning member in the family, supported him to a great extent. Their father suffers from paralysis. “We had to sell half of the house to raise funds for the operation,” said Khan.

Bariatric surgeon Shrihari Dhore Patil, who performed the surgery on Khan, said, “Post-surgery, the patient will lose 50% of his current weight in a year and another 20 to 30% in the subsequent year. He will stabilise at around 100 to 125 kg. We have been carrying out this kind of a surgery since 1999 and over 800 such surgeries have been performed by us till date.”

He said, “In this surgery, we have shortened the length of his tummy so that his craving for food goes down and he eats less. With this, he will gradually start losing weight and will be able to lead a normal life. He will be monitored every two months for one year.”

According to senior marketing manager of the hospital, Sainath Pradhan, “Khan presented quite a challenge for the surgical and anaesthesia team. Shifting an unconscious patient weighing 265 kilos from operation theatre (OT) table to stretcher and then from stretcher to the bed in the ward was quite tough.”

MSN Health & Fitness, 28th July 2010

A new study about bartiatric surgery done in the state of Michigan shows that there is a relatively low risk of serious complications after the procedure.

The report published in the July 28 issue of the Journal of the American Medical Association showed the findings of Nancy Birkmeyer of the University of Michigan, Ann Arbor. 15,275 patients took part in the research. They all underwent one of three common bariatric procedures between 2006 and 2009. The operations were performed by 62 surgeons at 25 hospitals in Michigan.

The results showed that only 7.3% of patients experienced minor complications such as wound problems, for example. Serious complications were most common after gastric bypass (3.6 %), sleeve gastrectomy (2.2 %), and laparoscopic adjustable gastric band (0.9 %) procedures. Rates of serious complications at hospitals varied from 1.6% to 3.5%.

Infections were the most common among patients undergoing gastric bypass (4.4%) and sleeve gastrectomy (2.5%).

Another interesting result showed that fatal complications occurred in only two patients undergoing laparoscopic adjustable gastric band (0.04%), 13 patients undergoing gastric bypass (0.14%) and zero patients receiving sleeve gastrectomy.

The overall rates of serious complications were similar among patients who had bariatric surgery at centers of excellence (COE) hospitals (2.7%) and those who had surgery at non-COE hospitals (2%), the report said.

The researchers wrote that their results might not apply outside of the state of Michigan, but said they represented “useful safety performance benchmarks for hospitals performing bariatric surgery.”

Seattle Times, 19th July 2010

A new weight-loss surgery technique is being developed by surgeons in North Carolina. The new technique, called vertical sleeve gastrectomy, requires only one incision and is operated through the belly button.

A new Spider surgical tool is required for this type of surgery. Vertical sleeve gastrectomy cuts the stomach down to 20% of its normal capacity. The name suggests the shape of the stomach that remains after the surgery.

How is it possible for the surgeon to operate through the belly button? The Spider tool contain working arms that unfold inside the patient so that the surgeon can access the areas he needs.

Dr. Quebbemann who carried out the operation using the new tool said: “Instead of making several incisions to place my surgical instruments, I simply make one small incision, hidden in the patient’s belly button, and insert the Spider. I then expand the internal portion of the device, similar to expanding an umbrella. This allows me to clearly see the anatomy and accurately perform the operation.

At the end of the procedure, I simply close the system, and remove it through the small incision, leaving almost no visible scar.”

Vertical sleeve gastrectomy is one of the fastest growing types of bariatric surgery. It is said to be most effective while operating on severly obese patients but can also be used to treat patients with BMI of 30 to 35.

The new technique is an alternative to the gastric bypass and lap-band surgery.

The Spider tool is produced by TransEnterix Inc. of Durham, N.C. and was approved by the Food and Drug Administration last year.

Surgeons highlight that weight-loss surgery is not a quick solution. Patients have to realise that they need to change their life-style, exercise and start a healthy diet.

As vertical sleeve gastrectomy is a new technique, there isn’t much data about long-term
benefits and risks.