Thu Dec 11, 2008 5:20am GMTLONDON (Reuters) – A third of all British adults — some 13 million people — will be obese by 2012 if current trends continue, jeopardising their health and straining healthcare budgets, researchers said on Thursday.

Over-eating and lack of exercise mean more and more Britons are seriously overweight, with 32.1 percent of men and 33.1 percent of women now expected to be clinically obese in four years’ time.

Almost half of them will be from low income and disadvantaged communities, widening the health gap between the haves and have-nots, according to Paola Zaninotto of University College London and colleagues.

Type 2 diabetes, heart disease and certain cancers are all directly linked to obesity, and the condition causes at least 9,000 premature deaths each year in England alone, the research team said.

It also costs the economy around 7.4 billion pounds a year, they reported in the Journal of Epidemiology and Community Health.

Their forecasts of future rates of obesity are based on data collected each year from 128,000 adults that provides a nationwide sample of Body Mass Index readings, which relate height to weight.

Previous research has shown a rapid rise in British obesity levels, with its prevalence almost doubling in men from 13.6 to 24 percent between 1993 and 2004 and rising nearly 50 percent among women, from 16.9 to 24.4 percent.

Obesity is a mounting concern for healthcare officials worldwide.

Drug companies have tried for years to develop a successful anti-obesity pill but the field is littered with failures, with Sanofi-Aventis’s Acomplia — withdrawn in October over links to mental disorders — the most recent casualty.

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.”

PR Web – United Kingdom, October 12, 2008 –(PR.com)–
Due to the financial pressures on the UK National Health Service, the vast majority of patients who are urgently in need of Obesity Surgery are forced to pay privately for their operations.
Searching for the right option for private surgery can be difficult, and sometimes confusing. Prices vary enormously, as does the extent of care and support offered before, during and after surgery. Making the right choice when dealing with something as important as major surgical procedures is vital. Cost, though important, is only one factor when deciding where to go for safe surgery.

Dr Michal Cierny PhD, the Chief Surgeon at the BMI Clinic in Brno, Czech Republic and a highly regarded Bariatric Surgeon specialising in Laparoscopic Vertical Sleeve Gastrectomy and Laparoscopic Gastric Banding, has announced that he will co-operate exclusively with Cosmetic Bliss for all English-Speaking patients, recognising their commitment to safety and patient care.

“It is most important to me that Bariatric patients are fully informed of the risks and benefits of surgery, that they have an understanding of the surgical procedures involved, and that, as far as possible, detailed checks as to their suitability for surgery have been completed before they arrive at the clinic for the in-depth pre-operative medical assessment.

“To have the best chance of successful long term weight loss, patients also need to have on-going support and contact, to help them through the process.

“I have worked closely with Cosmetic Bliss over the last 18 months, and know their approach to all aspects of patient care is excellent. Deborah from Cosmetic Bliss spends a great deal of time with the English patients here in my Clinic; fully informing them and reassuring them, enabling them to feel at ease when having surgery outside their home country. This is a valuable service to them, and to me.

“Pre-operatively Cosmetic Bliss does everything possible to ensure patients are fully prepared for surgery, and they provide me with detailed medical information on each patient to enable me to make an informed decision on suitability for surgery. Post-operatively they support and monitor patients, and enable me to keep the detailed records on Weight Loss and co-morbidities I require for purposes of evaluation.

“For these reasons I have decided to co-operate exclusively with Cosmetic Bliss in bringing English-Speaking patients to my Clinic. I am delighted to have them as partners, as they share my own aims of safe and successful Bariatric Surgery.�

Michael Dermody of Cosmetic Bliss said: “We feel honoured by the trust and recognition Dr Cierny and his clinic have shown us, and believe that we can continue to provide our patients with extremely safe, supportive and competitively priced Obesity Surgery at the BMI Clinic. We fully understand that travelling abroad for surgery can be daunting, and hope that the very personal service we give our patients allows them to feel secure and confident in their choice, and to be successful in their post-operative weight loss. We also welcome dialogue on co-operation from other companies promoting Weight Loss Surgery who wish to take advantage of the levels of patient care and service we and Dr Cierny provide.�

Following a BBC 10-o’clock news item on Thursday 9th October on the dangers of having Gastric Banding in Belgium, Cosmetic Bliss, who, of course, co-operate exclusively with Dr Michal Cierny PhD in Brno, Czech Republic for all bariatric surgery felt the need to respond.
Cosmetic Bliss hold no brief for Belgian Weight Loss Surgeons, and strongly support IFSO guidelines on appropriate BMI levels being used as a factor in risk assessment of patient suitability for surgery. All surgery performed under general anaesthesia carries a risk however, and the laparoscopic techniques used in Gastric Banding and Sleeve Gastrectomies, although proven to have several advantages over open surgery, are not risk-free. Nevertheless, under the care of an experienced specialist surgeon such as Dr Cierny, and with the support of a good surgical team the risks of surgery for a patient are much smaller than the risks involved in remaining obese. It is the duty of the surgeon and his team to make an assessment of a patient’s
suitability for surgery on the basis of this risk assessment.

Here is the text of Cosmetic Bliss’ response to the BBC item:

“Following the report on BBC News concerning Gastric Banding in Belgium, we wish to make the following points.

1. No RESPONSIBLE bariatric surgeon, abroad or in the Uk would offer surgery on a patient that did not meet the IFSO guidelines on BMI (same as NICE guidelines), and those surgeons who do perform surgery on patients who fail to meet the guidelines do so for one reason only – MONEY!!

2. The fact that a patient is refused surgery under the NHS does not necessarily mean that they are not suitable candidates for bariatric surgery. The chief reason surgery is denied by the NHS is because of cost. The figures speak for themselves. In 2006 almost 750,000 UK residents met the NICE (& IFSO) guidelines for surgery – only 7,000 operations were performed. The health service simply cannot afford to offer surgery to more than a fraction of those “qualified” to have it. More often than not local health authorities set much higher limits on BMI before considering a patient for NHS Surgery. That is why most patients seek a solution in the private sector, and why such companies as ours exist.

3. We agree that support post-operatively is essential to successful management of obesity, but that too is not always available to patients who have had surgery under the NHS, and I do not agree with the secretary of BOSS – Alberic Fiennes’ assertion that post-band patients should need to have access to “immediate” adjustment to the band. If the adjustments are performed by either an experienced bariatric surgeon OR qualified bariatric nurse, they should be safe and effective, and not require “emergency” correction. We have safely and responsibly arranged and accompanied more than 100 patients for successful surgery in the last 12 months alone, and do think it is entirely unfair to promote the idea that responsible surgery can only be assured in the UK, that “Johnny Foreigner” is more likely to breach guidelines for profit than a UK surgeon, and that competent aftercare is only available in the UK from the NHS. Many surgeons who perform Gastric banding for NHS patients, where the NHS “barâ€� is set MUCH higher than the NICE/IFSO guidelines also perform the same operations on private patients with lower BMI.Expertise and a commitment to care is not confined to the UK or the NHS, and there is a whiff of Xenophobia in this report which maybe has more to do with retaining a profitable private business for UK surgeons than a real concern over patient safety. It was very noticeable that although the straw poll conducted by BBC News cited UK Bariatric surgeons who had treated patients who had gone abroad for surgery, the question of how many patients were treated following surgery – either through the NHS or privately in the UK was never asked. We feel that the BBC has departed from standards of fair and balanced reporting in this instance, and find this very regrettable.”

Economic Times September 25, 2008

Recent studies show that weight-loss surgeries assisted by a robot make the operation safer for patients.

605 patients took part in the research. Doctors at the Texas University Medical School analysed several factors such as operation times, how long the patients stayed in the hospital and what complications they had. The patients underwent either a gastric bypass procedure with doctors or with robotic help.

The major difference was the gastrointestinal leak rate. Six patients who underwent the operation without the robot’s assistance had this complication within 90 days after the procedure. Eric B. Wilson, the study co-author, said that even though the robotic surgery takes more time and is more expensive, the results are better and “decreased leak rates may offset the cost to some extent”.

What’s more, during the surgeries carried out with robot’s help, there is clear, three-dimensional view of the operative field. That helps the doctors to see better tissue planes and place sutures more precisely.

The gastrointestinal leak can cause abdominal and chest pain, fever, nausea, vomiting, shortness of breath and death in rare cases.

Other results of both operations were similar. In comparison, the surgery assisted by a robot was 17 minutes longer. Patients from both groups had to stay in hospital for three days and had the complication rate of 14%.

San Diego Tribune, 22 September, 2008

More and more children and teenagers are obese these days. After having tried dieting and not being satisfied with the results, they decide to go under the knife. A few years ago weight-loss surgery was only possible for adult patients. Now the situation has changed and also overweight teenagers can seek the solution within the operation.

Two the most popular surgeries amongst this age group are gastric bypass and stomach banding. They both make the stomach smaller, and gastric bypass also changes the digestive system and reduces the fat absorption.

Joey Fishell, who’s 13, had the surgery on July 2. He weighted 300 pounds and his mother said the operation was a life-saver for her son.

Weight-loss surgeons highlight the importance of the consequences of the surgery. Young patients must be aware of them. A strict diet must be followed for the rest of the life, otherwise all the weight will come back, which denies the sense of the procedure. Also, in order to avoid malnutrition, some patients have to take supplements.

Only in 2003, 771 teenagers had a weight-loss operation in U.S. Studies are being carried out to see if bands are safe for young people.

Shelby Gorman, 16, had an operation last October and has lost 88 pounds since then. Before the surgery, she tried numerous diets with no results. “In sixth grade, I did Atkins and lost maybe 10 pounds, but it just came back. Then in eighth grade, on Jenny Craig I lost 50 pounds, which was good. But then it came right back,â€� she said. “I just don’t have a lot of willpowerâ€�.

The other young patient is Hollie Johnson, 18. She lost 97 pounds and, as she said, her favourite thing now is wearing her younger sister clothes. “I used to hate the beach … where I would get to look at a bunch of girls who were everything I’m not,â€� said Hollie.
Joey Fishell has lost 59 pounds since the operation in July. He came a long way after years of bullying from the other children. Another issue was the fear of getting obesity-related diseases.

All three young patients had gastric bands inserted in their bodies. The plastic rings are about 4 inches and are put around the stomach. The digestive system is left intact but the quantity of food taken is decreased.

The silicone inside the gastric band can be filled with different levels of saline to regulate the amount of food that comes to the stomach.
Another way to lose weight is a gastric bypass. The top of the stomach is closed and a small pouch is created. The food is rerouted to the lower portion of the small intestine, then bypasses to the lower stomach. There, fat and some other nutrients are excluded so that they cannot be used by the body.

Shelby changed her lifestyle dramatically after the surgery. She doesn’t eat chocolates or Mexican food any more. Instead, she goes to the gym and does aerobic every day.

“I have more confidence, a lot more,â€� Shelby said. “I talk to people, new people. I don’t have to constantly think that they’re thinking about my size.â€�
Weight-loss surgeons agree that both teenagers as well as their parents should be well prepared for what their life will be after the operation.

Aug 29 2008 by Lisa Jones, South Wales Echo

‘I feel as if I’m stuck inside a horrible shell’

A YOUNG dad has told how he has become a recluse after being refused an operation to remove four stone of excess skin from his body.

Alistair Preston, 28, was morbidly obese and told he would be dead within a year if he did not shed weight from his 37-stone frame.

The father of one, from Pengam Green, Cardiff, lost 20 stone after he underwent a £10,000 gastric sleeve operation in 2006, paid for by his mother, who re-mortgaged her house. COSMETIC BLISS NOTE: A SLEEVE OPERATION WITH US WILL COST ONLY £4,990.00

He now needs another operation to remove the curtains of excess skin left behind. But Health Commission Wales, which pays for specialised health services, says he is still too overweight and must lose another three-and-a-half stone.

They say his body mass index, a way of determining if someone is a healthy weight for their height, is still too high. Alistair is 5ft 11in tall and now weighs under 17 stone.

Alistair, who has a three-year-old daughter, says he has sunk into a deep depression and admits he spends most of his time in his flat.

He said: “They promised to help me and now they’ve changed their minds. I feel like a slim person stuck in a horrible shell. I want a normal life. The skin is not just on my belly, it’s all down my legs and arms.

“The BMI index is out of date. They are setting me a target I can’t reach. It’s impossible for me to reach that weight because I would be ill.�

Alistair turned to food for comfort at 17 after nursing his father Alan until his death.

He added: “I had the operation so I could be around for my daughter. When my dad died, I didn’t know what to do.�

Health Commission Wales conducted an internal review panel but it decided to uphold the original decision to refuse surgery despite support from Alistair’s GP.

A spokesman for Health Commission Wales (HCW) said: “While we cannot comment on any individual case it should be noted that HCW always considers exceptional cases and will consider abdominoplasty/apronectomy for individuals suffering from severe functional problems that have a negative impact on their day-to-day life.�

Alistair’s mum, Anna Preston, of Bridgend, said: “He feels worse than he did before. If I could sell my house to pay for his operation I would but nobody is buying at the moment.�

His partner Samantha Collins, 24, said: “The longer this carries on, the more concerned I am about his mental well-being. It’s so frustrating to see how low he is. They are looking at numbers but they need to look at him as a person.�

Alistair said: “I was looking forward to leading a normal life and having the ability to go out and work but my life has come to a standstill.

“I’m getting more and more depressed and spend most of my time in my flat. It’s just me, myself and I.�

WKRC TV Cincinnati September 10, 2008

An investigational weight-loss operation has been carried out at Good Samaritian hospital.

Cindy McBride, after trying several unsuccessful diets, consulted a batriatic doctor. The surgery was very like a gastric bypass which helps patients loose weight, it was only performed in a unique way.

“We make the stomach a lot smaller, but we don’t do any of the intestinal re-routing, so there is no associated problems that we see with the gastric bypass of mal-absorption and malnutrition.” said Dr. George Kerlakian from the Samaritian hospital.

The procedure is called gastric sleeve. About 90% of the stomach is removed. The remaining part is being wrapped into a tube, then sewn into a round sleeve. “The sleeve is nothing but a long tube of stomach.”

Cindy needed only 20 weeks to lose 92 pounds. “I wasn’t hungry from the time I woke up from surgery.” She said.

The reason of this dramatic weight-loss is the reduction of the hunger hormones. After the surgery, Cindy had to follow a diet and do exercises.

Time September 16, 2008

Gastric bypass surgery is sometimes not only the last solution for obese and overweight patients, but it’s also a life saving procedure for patients with diabetes.

There are several reasons for that situation. Not only the operation reduces the risk of death because of obesity-related diseases, but also normalizes blood sugar with diabetes.

This is now the most common weight-loss surgery in the USA. About 140.000 operations are done each year.

The last studies show however that non diabetes patients who underwent the surgery lost much more weight than patients with diabetes.

310 patients were in the study. 92% of patients without diabetes lost about 40% of their weight which is considered to be successful. On the other hand, only 79% of the patients with diabetes were able to lose that weight a year later. The same surgery techniques were used in both cases meaning the patients’ stomachs were reduced so that they were forced to eat less.

The director of the Bariatric Surgery Program at the University of California, San Francisco, Dr Guilherme Campos, thinks although the same procedure is being used, there is not a standard size of the stomach sac. Doctors determine the individual size for each patient. As the stomach lining is elastic and flexible, if the diet is not followed, the stomach may return to its previous size. The other reason might be connected with the medicines that diabetes take to control blood sugar. “One of the known factors for why diabetics have trouble controlling their weight is the types of medications they take,” Campos said. “Diabetes is a consequence of being overweight, but [another complication] is having to take medications that add to weight gain. It’s a double-edged sword, and a vicious cycle.”

There is a solution, however. Dr Campos advices to take new anti-diabetes drugs, such as DPP-IV inhibitors. These can both, keep blood sugar and weight under control.

Another fact is that even though diabetes lost less weight after the surgery, 90% of them has lower blood sugar level after the operation. It means they can lower the amount of the medicines they used to take. Also, gastric bypass surgery has even greater results which are recently diagnosed with diabetes as it is very likely that they will get back to normal sugar metabolism after the surgery. The reasons are that some weight-related hormones are reduced.

Dr Campos reminds the patients that surgery is not a final answer as the weight-loss surgery needs to be maintained after leaving the hospital.