Clinical Practice Guidelines for the Perioperative Nutritional, Metabolic, and Nonsurgical Support of the Bariatric Surgery Patient—2013 Update

The Perioperative Nutritional, Metabolic, and Nonsurgical Support of the Bariatric Surgery Patient has been updated for the first time since 2008.   There are changes and updates and suggestions for your clinicians - the entire text is available online below -

Download here -

Clinical Practice Guidelines for the Perioperative Nutritional, Metabolic, and Nonsurgical Support of the Bariatric Surgery Patient - 2013 Update -

Abstract: The development of these updated guidelines was commissioned by the AACE, TOS, and ASMBS Board of Directors and adheres to the AACE 2010 protocol for standardized production of
clinical practice guidelines (CPG). Each recommendation was re-evaluated and updated based on the
evidence and subjective factors per protocol.

Examples of expanded topics in this update include: the roles of sleeve gastrectomy, bariatric surgery in patients with type-2 diabetes, bariatric surgery forpatients with mild obesity, copper deficiency, informed consent, and behavioral issues.

A lifetime history of substance abuse disorder is more likely in bariatric surgery candidates compared with the general population (211 [EL 3, SS]). In contrast, current alcohol and substance abuse in bariatric surgery candidates is low compared with the general population (211 [EL 3, SS]). The LABS study demonstrated that certain groups including those with regular preoperative alcohol consumption, alcohol use disorder, recreational drug use, smokers, and those undergoing RYGB had a higher risk of postoperative alcohol use disorder (212 [EL 2, PCS]). A web-based questionnaire study indicated that 83% of respondents continued to consume alcohol after RYGB, with 28.4% indicating a problem controlling alcohol (213 [EL 3, SS]). In a prospective study with 13- to 15-year follow-up after RYGB, there was an increase in alcohol abuse (2.6% presurgery to 5.1% postsurgery) but a decrease in alcohol dependence (10.3% presurgery versus 2.6% postsurgery) (214 [EL 2, PCS]).  In a survey 6-10 years after RYGB, 7.1% of patients had alcohol abuse or dependence before surgery, which was unchanged postoperatively, whereas 2.9% admitted to alcohol dependence after surgery but not before surgery (215 [EL 3, SS]). Finally, in a retrospective review of a large electronic database, 2%-6% of bariatric surgery admissions were positive for a substance abuse history (216 [EL 3, SS]). Interestingly, 2 studies have demonstrated better weight loss outcomes among patients with a past substance abuse history compared with those without past alcohol abuse.

Bariatric surgery remains a safe and effective intervention for select patients with obesity. A team approach to perioperative care is mandatory with special attention to nutritional and metabolic issues.

Obesity continues to be a major public health problem in the United States, with more than one third of adults considered obese in 2009- 2010, as defined by a body mass index (BMI)
30 kg/m2 (1 [EL 3,
SS]). Obesity has been associated with an increased hazard ratio for all-cause mortality (2 [EL 3, SS]), as well as significant medical and psychological co-morbidity. Indeed, obesity is not only a chronic
medical condition but should be regarded as a bona fide disease state (3 [EL 4, NE]). Nonsurgical management can effectively induce 5%-10% weight loss and improve health in severely obese
individuals (4 [EL 1, RCT]) resulting in cardiometabolic benefit. Bariatric surgery procedures are indicated for patients with clinically severe obesity. Currently, these procedures are the most successful and durable treatment for obesity. Furthermore, although overall obesity rates and bariatric surgery procedures have plateaued in the United States, rates of severe obesity are still increasing and now
there are approximately 15 million people in the United States with a BMI
40 kg/m2 (1 [EL 3, SS]; 5 [EL 3, SS]). Only 1% of the clinically eligible population receives surgical treatment for obesity
(6 [EL 3, SS]). Given the potentially increased need for bariatric surgery as a treatment for obesity, it is apparent that clinical practice guidelines (CPG) on the subject keep pace and are kept current.

Since the 2008 TOS/ASMBS/AACE CPG for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient (7 [EL 4; CPG]), significant data have emerged regarding a broader range of available surgeries for the treatment of obesity. A PubMed computerized literature search (performed on December 15, 2012) using the search term ‘‘bariatric surgery’’ reveals a total of 14,287 publications with approximately 6800 citations from 2008 to 2012. Updated CPG are therefore needed to guide clinicians in the care of the bariatric surgery patient.

What are the salient advances in bariatric surgery since 2008?

• The sleeve gastrectomy (SG; laparoscopic SG [LSG]) has demonstrated benefits comparable to other bariatric procedures and is no longer considered investigational (8 [EL 4, NE]).  
• A national risk-adjusted database positions SG between the laparoscopic adjustable gastric band (LAGB) and laparoscopic Roux-en-Y gastric bypass (RYGB) in terms of weight loss, co-morbidity resolution, and complications (9 [EL 2, PCS]). 
• The number of SG procedures has increased with greater third-party pay or coverage (9 [EL 2, PCS]). 
• Other unique procedures are gaining attention, such as gastric plication, electrical neuromodulation, and endoscopic sleeves, but these procedures lack sufficient outcome evidence and therefore remain investigational and outside the scope of this CPG update.
• There is also emerging data on bariatric surgery in specific patient populations, including those with mild to moderate obesity, type 2 diabetes (T2D) with class I obesity (BMI 30-34.9 kg/m2), and patients at the extremes of age. Clinical studies have demonstrated short-term efficacy of LAGB in mild to moderate obesity (10 [EL 1, RCT]; 11 [EL 2, PCS]; 12 [EL 2, PCSA]; 13 [EL 3, SS]), leading the Food and Drug Administration (FDA) to approve the use of LAGB for patients with a BMI of 30 to 35 kg/m2 with T2D or other obesity-related co-morbidities (14 [EL 4, NE]). Although controversial, this position was incorporated by the International Diabetes Federation, which proposed eligibility for bariatric procedures in a subset of patients with T2D and a BMI of 30 kg/m2 with suboptimal glycemic control despite optimal medical management (15 [EL 4, NE]). Thus, the term metabolic surgery has emerged to describe procedures intended to treat T2D as well as reduce cardiometabolic risk factors. In 1 study, metabolic surgery was shown to induce T2D remission in up to 72% of subjects at 2 years; however, this number was reduced to 36% at 10 years (16 [EL 2, PCS]). In a more recent study, patients who underwent RYGB sustained diabetes remission rates of 62% at 6 years (17 [EL 2, PCS]). The overall long-term effect of bariatric surgery on T2D remission rates is currently not well studied. Additionally, for patients who have T2D recurrence several years after surgery, the legacy effects of a remission period on their long-term cardiovascular risk is not known. The mechanism of T2D remission has not been completely elucidated but appears to include an incretin effect (SG and RYGB procedures) in addition to caloric restriction and weight loss. These findings potentially expand the eligible population for bariatric and metabolic surgery.

Download here - via -

Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient—2013 update: Cosponsored by american association of clinical endocrinologists, The obesity society, and american society for metabolic & bariatric surgery* (pages S1–S27)

Jeffrey I. Mechanick, Adrienne Youdim, Daniel B. Jones, W. Timothy Garvey, Daniel L. Hurley, M. Molly McMahon, Leslie J. Heinberg, Robert Kushner, Ted D. Adams, Scott Shikora, John B. Dixon and Stacy Brethauer

Article first published online: 26 MAR 2013 | DOI: 10.1002/oby.20461

 

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Just to keep you on your toes, a couple days ago I shared the study that stated that WLS doesn't save you money in the long run.

Now, we hear once AGAIN that roux en y gastric bypass bariatric surgery fixes diabetes damn near immediately. This is just another study on THAT topic.

We already knew this.

Thanks, pancreas!  *thumbs up for working so well!*

*Waves to all the post bariatric reactive non-diabetic hypoglycemics*

Visit NBCNews.com for breaking news, world news, and news about the economy

Cleveland Clinic study shows bariatric surgery restores pancreatic function by targeting belly fat

2-year study indicates how gastric bypass reverses diabetes. In a substudy of the STAMPEDE trial (Surgical Therapy And Medications Potentially Eradicate Diabetes Efficiently), Cleveland Clinic researchers have found that gastric bypass surgery reverses diabetes by uniquely restoring pancreatic function in moderately obese patients with uncontrolled type 2 diabetes.

No long-term cost savings with weight loss surgery

Weight loss surgery does not lower health costs over the long run for people who are obese, according to a new study.   Shocking?  Meh.  No.

Pre-op patients don't want to know this sticky business, so maybe you should close your eyes or click away.  NOW.  I don't want to pop your bubbles.  I am not in the biz of selling weight loss surgery up in heah.

I don't think it would come as a surprise to many long-term post bariatric patients.  I know you understand.  We live it.

But that is just me, consider my stance as a nine year gastric bypass post op, married to a nine year gastric bypass post op, with a mother in law and sister in law who are both gastric bypass post ops.  Collectively we have about 30 years of missed "obesity" costs, but we have increased our health-care costs in other areas.  (*Looks at my current tally at the hospital.*)

The four of US (yes, this is totally biased because it is my immediate circle and what I know...this is understood, I am not arguing, I do not care to sell WLS nor unsell it!) are currently all maintaining a normal or slightly overweight body weight 6-9 years post bariatric surgery, however between us, we have created some seriously HUGE bills and other health conditions since having weight loss surgery.  (I have not shared much of it because I'm already TMI and HIPPA cries.)

Imagine now if any of us have a full and complete regain - which is a totally and absolutely typical pattern.  What then of our health?  What if we have the comorbids of obesity come back?  (Some of which don't always go away.... have you met my legs?)  Just saying.  I know we have made it this far, but it has NOT been cheap.

Reuters -

Some researchers had suggested that the initial costs of surgery may pay off down the road, when people who've dropped the extra weight need fewer medications and less care in general.

The new report joins other recent studies challenging that theory (see Reuters Health story of Jul 16, 2012 here: reut.rs/NrQKPU).

"No way does this study say you shouldn't do bariatric surgery," said Jonathan Weiner from the Johns Hopkins Bloomberg School of Public Health in Baltimore, who led the new research.

But, he added, "We need to view this as the serious, expensive surgery that it is, that for some people can almost save their lives, but for others is a more complex decision."

According to the American Society for Metabolic and Bariatric Surgery, about 200,000 people have weight loss surgery every year.

Surgery is typically recommended for people with a body mass index (BMI) - a measure of weight in relation to height - of at least 40, or at least 35 if they also have co-occurring health problems such as diabetes or severe sleep apnea.

A five-foot, eight-inch person weighing 263 pounds has a BMI of 40, for example.

For their study, Weiner and his colleagues tracked health insurance claims for almost 30,000 people who underwent weight loss surgery between 2002 and 2008. They compared those with claims from an equal number of obese people who had a similar set of health problems but didn't get surgery.

As expected, the surgery group had a higher up-front cost of care, with the average procedure running about $29,500.

In each of the six years after that, health care costs were either the same among people who had or hadn't had surgery or slightly higher in the bariatric surgery group, according to findings published Wednesday in JAMA Surgery.

Average annual claims ranged between $8,700 and $9,900 per patient.

Weiner's team did see a drop in medication costs for surgery patients in the years following their procedures. But those people also received more inpatient care during that span - cancelling out any financial benefits tied to weight loss surgery.

One limitation of the study was that only a small proportion of the patients - less than seven percent - were tracked for a full six years. Others had their procedures more recently.

The study was partially funded by surgical product manufacturers and pharmaceutical companies, including Johnson & Johnson and Pfizer. Claims data came from BlueCross BlueShield.

It's clear that surgery can help people lose weight and sometimes even cures diabetes, Weiner told Reuters Health. But it might not be worthwhile, or cost-effective, for everyone who is obese.

That means policymakers and companies will have to decide who should get insurance coverage for the procedure and who shouldn't.

"It's showing that bariatric surgery is not reducing overall health care costs, in at least a three- to six-year time frame," said Matthew Maciejewski, who has studied that topic at the Center for Health Services Research in Primary Care at the Durham VA Medical Center in North Carolina, but wasn't involved in the new study.

"What is unknown is whether there's some subgroup of patients who seem to have cost reductions," he told Reuters Health.

In the meantime, whether or not to have weight loss surgery is still a personal decision for people who are very obese, Weiner said.

"Every patient needs to talk it through with their doctor," he said. "It obviously shouldn't be taken lightly, but shouldn't be avoided either."

SOURCE: bit.ly/K8qAyI JAMA Surgery, online February 20, 2013.

Importance  Bariatric surgery is a well-documented treatment for obesity, but there are uncertainties about the degree to which such surgery is associated with health care cost reductions that are sustained over time.

Objective  To provide a comprehensive, multiyear analysis of health care costs by type of procedure within a large cohort of privately insured persons who underwent bariatric surgery compared with a matched nonsurgical cohort.

Design  Longitudinal analysis of 2002-2008 claims data comparing a bariatric surgery cohort with a matched nonsurgical cohort.

Setting  Seven BlueCross BlueShield health insurance plans with a total enrollment of more than 18 million persons.

Participants  A total of 29 820 plan members who underwent bariatric surgery between January 1, 2002, and December 31, 2008, and a 1:1 matched comparison group of persons not undergoing surgery but with diagnoses closely associated with obesity.

Main Outcome Measures  Standardized costs (overall and by type of care) and adjusted ratios of the surgical group's costs relative to those of the comparison group.

Results  Total costs were greater in the bariatric surgery group during the second and third years following surgery but were similar in the later years. However, the bariatric group's prescription and office visit costs were lower and their inpatient costs were higher. Those undergoing laparoscopic surgery had lower costs in the first few years after surgery, but these differences did not persist.

Conclusions and Relevance  Bariatric surgery does not reduce overall health care costs in the long term. Also, there is no evidence that any one type of surgery is more likely to reduce long-term health care costs. To assess the value of bariatric surgery, future studies should focus on the potential benefit of improved health and well-being of persons undergoing the procedure rather than on cost savings.

 

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Brain study aims to stop overeating after weight-loss surgery

A clinical trial at Beth Israel Medical Center in Boston, MA is under way where a group of people who have had gastric banding surgery undergo non-invasive brain stimulation.  Video is at the link.

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USA Today -

A couple in Sarasota, Fla., lost 150 pounds between the two of them using hypnosis where they essentially were hypnotised into thinking they had had gastric bypass surgery.

Each of them has lost more than 70 pounds.  This is no joke.  They are adorable.

Would you consider hypnosis for weight loss?  Have you tried it?  Do you think it will keep the weight off in the long-term?

Good for these two, though, really.  

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Study - Physically Active Bariatric Surgery Patients Less Likely to be Depressed

If there was ever a motivation to get active, here it is -  

Just one hour of moderate-intensity physical activity a week — or eight minutes a day — was associated with 92 percent lower odds of treatment for depression or anxiety among adults with severe obesity.

That's TWO songs-worth of dances.

Let's go.

Here is 6:20 worth, dance!  Walk, bounce, march, whatever you can!

Adults undergoing bariatric surgery who are more physically active are less likely to be depressed, according to a new study, which found that being active for as little as eight minutes a day made a difference.

The study -

• Download Psychcentral.com- PhysicallyActiveBariatricSurgeryPatientsLessLikelyDepressed

Obese adults are nearly twice as likely to have a major depressive disorder (13.3 percent) or anxiety disorder (19.6 percent) compared to the general population (7.2 and 10.2 percent), according to Wendy C. King, Ph.D., an epidemiologist at the University of Pittsburgh Graduate School of Public Health.

“Typically, clinical professionals manage their patients’ depression and anxiety with counseling and/or antidepressant or anti-anxiety medication,” she said. “Recent research has focused on physical activity as an alternative or adjunct treatment.”

Just one hour of moderate-intensity physical activity a week — or eight minutes a day — was associated with 92 percent lower odds of treatment for depression or anxiety among adults with severe obesity.

Similarly, just 4,750 steps a day — less than half the 10,000 steps recommended for a healthy adult — reduced the odds of depression or anxiety treatment by 81 percent.

“It could be that, in this population, important mental health benefits can be gained by simply not being sedentary,” said King, who also was the lead author of the study.

The researcher notes it is important to treat depression and anxiety prior to bariatric surgery. Preoperative depression and anxiety increase the risk of these conditions occurring after surgery — and have been shown to have a negative impact on long-term surgically induced weight loss.

As part of the Longitudinal Assessment of Bariatric Surgery-2, an observational study designed to assess the risks and benefits of bariatric surgery, King and her colleagues assessed participants’ physical activity for a week prior to undergoing bariatric surgery using a small electronic device worn above the ankle. Participants also completed surveys to assess mental health, symptoms of depression, and treatment for psychiatric and emotional problems, including depression and anxiety.

The study included 850 adults who were seeking bariatric surgery between 2006 and 2009 from one of 10 different hospitals throughout the United States.

Approximately one-third of the participants reported symptoms of depression, while two in five reported taking medication or receiving counseling for depression or anxiety.

The researchers noted that the link between physical activity and less depression was strongest when only moderate intensity physical activity was considered. However, the number of steps a person walked each day, no matter the pace, also was related.

“Another goal of this study was to determine physical activity thresholds that best differentiated mental health status,” said King. “We were surprised that the thresholds were really low.”

Because this was an observational, cross-sectional study — meaning patients’ regular physical activity and symptoms of depression were measured at the same time — the study could not prove that a patient’s physical activity influenced mental health.

“Results of the study are provocative, but we would need further research to verify that physical activity was responsible for lower levels of depressive symptoms in this patient population,” said study co-author Melissa A. Kalarchian, Ph.D., associate professor at Western Psychiatric Institute and Clinic, part of University of Pittsburgh Medical Center (UPMC). “Nonetheless, physical activity is a key component of behavioral weight management, and it is encouraging to consider that it may have a favorable impact on mental health as well.”

The study is published in the Journal of Psychosomatic Research.

Let's move!

Move Your Ass - Workout - Treadmll

Created by Beth Sheldon-Badore.

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It's been quite a while since Beth wrote a vague blog. 

All the weight I didn’t lose

All the weight I didn’t lose - from Salon.com 

"I am the “after” side of surgery, having lost more than 250 pounds. No one gets this, at least not without an explanation, because I still weigh over 200 pounds, and the weight loss fable is supposed to end when you’re thin, not when you’re merely “an average fat American.”

Yes, some of us do "get it."  

This is a powerful article a friend of mine who happens to be a special kind of "after"  (which is not the kind of " air quotes" that indicate failure, but that she has SHIT TO DEAL WITH and y'all need to stop judging a person at first glance, you know?) posted in my BBGC support group.   Thank you, Sarah.  I GET IT.  Some of us DO.  Rawr.  

Please read it.  Please open your mind to all "afters," and stop the WLS shaming.  

Study - 47% Weight Stays Off Long Term After Gastric Band Bariatric Surgery - But...

Medpage -  Weight Stays Off Long Term After Bariatric Surgery - 

O'Brien PE, et al. "Long-term outcomes after bariatric surgery. Fifteen-year follow-up of adjustable gastric banding and a systematic review of the bariatric surgical literature" Ann Surg 2013;257:87-94.

Obese patients maintained about 50% excess weight loss for as long as 15 years after laparoscopic adjustable gastric banding, (LAGB), Australian investigators reported.

Experience at a single center showed an average of 47% excess weight loss in 714 patients followed for more than 10 years after LAGB, including 47% among patients followed for 15 years and 62% in a small group followed for 16 years, according to Paul O'Brien, MD, and colleagues, of Monash University in Melbourne, Australia.

A systematic review of published studies revealed a mean excess weight loss of 54% at 10 years and beyond for patients treated with LAGB or Roux-en-Y gastric bypass (RYGB), they reported in the January issue of Annals of Surgery.

The results also showed a marked reduction in late-occurring adverse events after LAGB, the authors added.

"Gastric banding is a safe and effective treatment option for obesity in the long term," they said. "The systematic review shows that all current procedures achieve substantial long-term weight loss. It supports the existing data that LAGB is safer than RYGB and finds that the long-term weight loss outcomes and needs for revisional surgery for these two procedures are not different."

Despite a history dating back more than 50 years, bariatric surgery has a paucity of long-term data to demonstrate durable weight loss. Most published studies have follow-up of less than 3 years. Systematic reviews have added relatively little in terms of long-term follow-up data, according to the authors.

O'Brien and colleagues introduced LAGB at their center in 1994, and have followed all patients by means of a dedicated bariatric surgery database. As of December 2011, O'Brien and co-author Wendy Brown, MBBS, PhD, also of Monash University, had treated 3,227 patients with LAGB.

The authors performed a prospective longitudinal cohort study of the patients. For comparison, they performed a systematic review of published literature on bariatric surgery. The focus was on long-term follow-up, 15 years for the cohort and 10 years for the systematic review.

The cohort had mean age of 47 and a mean presurgical body mass index of 43.8 kg/m². The authors identified 714 patients followed for at least 10 years, including 54 patients followed for 15 years and 14 followed for 16 years.

• The 10-year excess weight loss was 47%.
• The authors reported that 26% of patients required revisions for proximal enlargement,
• 21% for port and tubing problems, and 3.4% for erosion.
• Band removal was performed in 5.6% of patients.

During the first 10 years of clinical experience, the revision rate for proximal enlargement was 40%, declining to 6.4% during the last 5 years of the study period. Patients with and without revisions had similar excess weight loss.

The systematic review consisted of 19 published articles, 24 data sets, and approximately 14,000 patients. The data included six sets involving patients with LAGB, nine sets for RYGB, five sets for gastroplasty, three for biliopancreatic diversion or duodenal switch (BPD/DS), and one involving fixed open gastric banding.

According to the authors, every study had deficiencies related to data reporting. None of the studies was a randomized controlled trial. One investigation was a prospective, nonrandomized, matched interventional study, and the rest were observational studies.

With respect to safety, one perioperative death occurred in 6,177 LAGB procedures, compared with 21 in 2,684 RYGB procedures (P<0.001).

Excess weight loss at 10 years averaged 54% with LAGB and RYGB, 53% with gastroplasty, and 73.3% with BPD/DS. The mean revision rate was 26% with LAGB and 22% with RYGB. Revision rates from individual data sets ranged as high as 60% with LAGB and 38% with RYGB.

"The longitudinal cohort study of the LAGB patients shows that they have achieved and maintained a loss of nearly half of their excess weight to 15 years," the authors wrote. "The validity of the 15-year figure of 47% of excess weight loss is reinforced by the pooling of all long-term data (≥10 years) and finding the same weight loss of 47% excess weight loss for the much larger group."

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UK Lays out KICK ASS Advertising Codes for Weight + Diet Products

The UK just laid out some super-tough advertising guidelines for products and services aimed at the weight loss community - 

"This section applies to marketing communications for weight control and slimming foodstuffs, aids (including exercise products that make weight-loss or slimming claims), clinics and other establishments, diets, medicines, treatments and the like. If applicable, they must comply with Section 12: Medicines, Medical Devices, Health-related Products and Beauty Products and Section 15: Food, Food Supplements and Associated Health or Nutrition Claims)."

Check it out, it's a MOUTHFUL -  many most all we are unlikely to see in the US for years and years and years.  Some of the suggestions are amazing:   "Marketing communications for any weight-reduction regime or establishment must neither be directed at nor contain anything that is likely to appeal particularly to people who are under 18 or those for whom weight reduction would produce a potentially harmful body weight (BMI of less than 18.5 kg/m2). Those marketing communications must not suggest that being underweight is desirable or acceptable."

I love you, UK.  

Via Cap.uk -

1. 13.1  A weight-reduction regime in which the intake of energy is lower than its output is the most common self-treatment for achieving weight reduction. Any claim made for the effectiveness or action of a weight-reduction method or product must be backed, if applicable, by rigorous trials on people; testimonials that are not supported by trials do not constitute substantiation.

2. 13.2  Obesity in adults is defined by a Body Mass Index (BMI) of more than 30 kg/m2. Obesity is frequently associated with a medical condition and a treatment for it must not be advertised to the public unless it is to be used under suitably qualified supervision. Marketing communications for non-prescription medicines that are indicated for the treatment of obesity and that require the involvement of a pharmacist in the sale or supply of the medicine may nevertheless be advertised to the public.

3. 13.3  Marketing communications for any weight-reduction regime or establishment must neither be directed at nor contain anything that is likely to appeal particularly to people who are under 18 or those for whom weight reduction would produce a potentially harmful body weight (BMI of less than 18.5 kg/m2). Those marketing communications must not suggest that being underweight is desirable or acceptable.

4. 13.4  Before they make claims for a weight-reduction aid or regimen, marketers must show that weight-reduction is achieved by loss of body fat. Combining a diet with an unproven weight-reduction method does not justify making weight-reduction claims for that method.

5. 13.5  Marketers must be able to show that their diet plans are nutritionally well-balanced (except for producing a deficit of energy) and that must be assessed in relation to the category of person who would use them.

6. 13.6  Vitamins and minerals do not contribute to weight reduction but may be offered to slimmers as a safeguard against any shortfall in recommended intake when dieting. 

1. 13.7  Marketers promoting Very Low Calorie Diets or other diets that fall below 800 kilo-calories a day must do so only for short-term use and must encourage users to take medical advice before embarking on them. Marketers should have regard to the guidance on “Obesity: the prevention, identification, assessment and management of overweight and obesity in adults and children” (2006) published by the National Institute for Health and Clinical Excellence.

2. 13.8  Marketing communications for diet aids must make clear how they work. Prominence must be given to the role of the diet and marketing communications must not give the impression that dieters cannot fail or can eat as much as they like and still lose weight.

3. 13.9  Marketing communications must not contain claims that people can lose precise amounts of weight within a stated period or, except for marketing communications for surgical clinics, establishments and the like that comply with rule 12.3, that weight or fat can be lost from specific parts of the body.

13.9.1 Marketing communications for surgical clinics, establishments and the like that comply with rule 12.3 must not refer to the amount of weight that can be lost.

13.10 Claims that an individual has lost an exact amount of weight must be compatible with good medical and nutritional practice. Those claims must state the period involved and must not be based on unrepresentative experiences. For those who are normally overweight, a rate of weight loss greater than 2 lbs (just under 1 kg) a week is unlikely to be compatible with good medical and nutritional practice. For those who are obese, a rate of weight loss greater than 2 lbs a week in the early stages of dieting could be compatible with good medical and nutritional practice.

13.10.1 Health claims in marketing communications for food products that refer to a rate or amount of weight loss are not permitted.

1. 13.11  Resistance and aerobic exercise can improve muscular condition and tone and that can improve body shape and posture. Marketers must be able to substantiate any claim that such methods used alone or in conjunction with a diet plan can lead to weight or inch reduction. Marketing communications for intensive exercise programmes should encourage users to check with a doctor before starting.

2. 13.12  Short-term loss of girth may be achieved by wearing a tight-fitting garment. That loss must not be portrayed as permanent or confused with weight or fat reduction. 

We'll never see this in the US.  People are too in love with fake.

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Should A Christian Have Weight Loss Surgery?

This question just popped up in my Google Alerts and brought me to a health and weight loss site faith-based called "Take Back Your Temple," 

"Hello…I was wondering if I could have your opinion. Do you think surgery as a weight loss option is “against God”? I have struggled a long time…and am beginning to consider this option. Can it not be a blessing from God, having this technology and knowledge to even be able to have this done? I know God can move mountains…including my weight. Does my interest in this mean a lack of faith? I know it is a gray area since the Bible doesn’t specifically discuss this topic…but I’d love to hear feedback from another Christian woman about this. I appreciate your wisdom, and please pray for me that I feel God’s guidance. Also please pray for Him to free me from my obesity, and to know His will. "

The blogger replies:

Benefit of bariatric surgery may be temporary

This is not new news - however it just hit my Google alerts from my local news -

A major benefit of bariatric surgery, a cure for diabetes, may only be temporary.

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25% Drink 16% Calories Via Alcohol Daily.

About 25% of you drink alcohol every day -- given the normal non-weight loss surgical population according to a new CDC study.  And about 16% of your daily calories come from alcohol.  

PS.  Give this study to bariatric patients -- I would say from my very non-professional standpoint that results would be higher vs. calorie intake given our higher rates of addictions to All The Things.  

That is some scary daily nutrition math.

Cheers.

CDC -

The U.S. population consumes an average of 100 calories a day from alcoholic beverages. Men, 150 calories; women, 53.

“If you are drinking an extra 150 calories more than you need a day, those extra calories could end up on your waist or your hips,” said Joan Salge Blake, a clinical associate professor in the nutrition program at Boston University and a spokeswoman for the Academy of Nutrition and Dietetics. â€œThose excess daily calories could cause you to put on a pound monthly and would add up to over 10 pounds in a year,” Blake said.

Specifically for a gastric bypass patient -- it can lead to all sorts of damage.  Play in the Google.  

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Calories from alcoholic beverages add up

Alcoholic Drinks Add 100 Calories a Day to Average Adult's Diet

Freak the freak on.

Dear BTV -

These snarky-ass women  are the ones I met, and loved to begin with. Freak the eff on.  

"In this weeks episode of BariatricTV we kick things off in The Dumping Ground with an update on whats up with BTV. Then in Altered Reality we discuss the ofter heard saying “100 pounds gone forever!!!”

<3, MM

I blogged this before I watched the whole thing, ladies.  I love you in the non-stalkery way.  Thank you.  Finally.  

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Weight Loss Surgery Doesn't Cure Diabetes, forever - Sorry.

"I had weight loss surgery and beat diabetes, FOREVER!"  Not so much.

Don't buy that tee shirt just yet.

NYT -

Many people whose diabetes at first went away were likely to have it return. While weight regain is a common problem among those who undergo bariatric surgery, regaining lost weight did not appear to be the cause of diabetes relapse. Instead, the study found that people whose diabetes was most severe or in its later stages when they had surgery were more likely to have a relapse, regardless of whether they regained weight.

“Some people are under the impression that you have surgery and you’re cured,” said Dr. Vivian Fonseca, the president for medicine and science for the American Diabetes Association, who was not involved in the study. “There have been a lot of claims about how wonderful surgery is for diabetes, and I think this offers a more realistic picture.”

The findings suggest that weight loss surgery may be most effective for treating diabetes in those whose disease is not very advanced. “What we’re learning is that not all diabetic patients do as well as others,” said Dr. David E. Arterburn, the lead author of the study and an associate investigator at the Group Health Research Institute in Seattle. “Those who are early in diabetes seem to do the best, which makes a case for potentially earlier intervention.”

Study - http://www.ncbi.nlm.nih.gov/pubmed/23161525

Obes Surg. 2012 Nov 18. [Epub ahead of print]

A Multisite Study of Long-term Remission and Relapse of Type 2 Diabetes Mellitus Following Gastric Bypass.

Source

Group Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA, 98101, USA, [email protected].

Abstract

BACKGROUND:

Gastric bypass has profound effects on glycemic control in adults with type 2 diabetes mellitus. The goal of this study was to examine the long-term rates and clinical predictors of diabetes remission and relapse among patients undergoing gastric bypass.

METHODS:

We conducted a retrospective cohort study of adults with uncontrolled or medication-controlled type 2 diabetes who underwent gastric bypass from 1995 to 2008 in three integrated health care delivery systems in the USA. Remission and relapse events were defined by diabetes medication use and clinical laboratory measures of glycemic control. We identified 4,434 adults with uncontrolled or medication-controlled type 2 diabetes who had gastric bypass.

RESULTS:

Overall, 68.2 % (95 % confidence interval [CI], 66 and 70 %) experienced an initial complete diabetes remission within 5 years after surgery. Among these, 35.1 % (95 % CI, 32 and 38 %) redeveloped diabetes within 5 years. The median duration of remission was 8.3 years. Significant predictors of complete remission and relapse were poor preoperative glycemic control, insulin use, and longer diabetes duration. Weight trajectories after surgery were significantly different for never remitters, relapsers, and durable remitters (p = 0.03).

CONCLUSIONS:

Gastric bypass surgery is associated with durable remission of type 2 diabetes in many but not all severely obese diabetic adults, and about one third experience a relapse within 5 years of initial remission. More research is needed to understand the mechanisms of diabetes relapse, the optimal timing of surgery in effecting a durable remission, and the relationship between remission duration and incident microvascular and macrovascular events.

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Gastric bypass surgery: Follow up as directed to lose more - double!

Gastric bypass patients who follow through with their post op appointments in the first two years lose nearly twice as much weight as those who do not, suggests a study from the University of Pennsylvania School of Nursing.

Imagine what could happen with even more follow up.

Gastric bypass surgery: Follow up as directed to lose more

Living on borrowed time - Health Benefits of Gastric Bypass Surgery Persist for Six Years

Health Benefits of Gastric Bypass Surgery Persist for Six Years -  I guess I am living on borrowed time, seeing as I am working on year nine, as is Mr. MM, and Mr. MM's mom, and Mr. MM's sister.  We're all screwed.  - MM.

The health benefits of Roux-en-Y gastric bypass (RYGB) surgery in severely obese patients persist for six years, according to a prospective, controlled study (JAMA 2012;308:1122-1131). These benefits include weight loss and improvements in major cardiovascular and metabolic risk factors.

Weight Regain After Bariatric Surgery

Weight Regain After Bariatric Surgery - Dr. John Dixon of Monash University and the Baker Heart and Diabetes Institute of Melbourne, Australia gave a new presentation on Weight Regain After Bariatric Surgery.

Prof John Dixon, MBBS, PhD, FRACGP, FRCP Edin.

Email: [email protected]

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