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Diabetes Remission Post Bariatric Surgery - or - Diabetes Comes Back For Some After WLS.

Diabetes Remission Post Bariatric Surgery

Medscape -  

Researchers in Pennsylvania have developed a tool comprising 4 preoperative clinical variables that surgeons and patients can use to predict the likelihood of type 2 diabetes remission after Roux-en-Y gastric bypass surgery.

Christopher D. Still, DO, director of Geisinger Obesity Institute, Danville, Pennsylvania, and colleagues developed their algorithm, known as the DiaRem score, on the basis of a retrospective cohort study of 690 patients who underwent gastric bypass surgery. They verified the results in 2 additional cohorts; their findings were published online September 13 in the Lancet Diabetes and Endocrinology.

DiaRem scores range from 0 to 22, with low scores consistently predicting higher remission rates and high scores predicting lower remission rates.

"Bariatric surgery is a very effective tool not so much for weight loss but curing or resolving comorbid medical problems," Dr. Still told Medscape Medical News in a telephone interview. "The surgery is the best we have for long-term success, but it's not without potential risks and costs."

Continue reading "Diabetes Remission Post Bariatric Surgery - or - Diabetes Comes Back For Some After WLS. " »


RNY patients after gastric bypass surgery have lower brain-hedonic responses to food than after gastric banding

RNY patients lose more than gastric band patients, and this study hypothesizes that RNY patients "think" differently about food.

As a ten-year RNY patient - I scream - AYE!  FOR THE LOVE OF DOG DO NOT FEED ME ICE CREAM!

It's called DUMPING SYNDROME, our brains learn to connect certain foods to the reactions they might or will cause, which is a learned behavior, and our brains react, which can be SEEN on an MRI machine.  Twitch.  Twitch.  (And, no, many people never ever learn.)

Amazing.

Study -

Objectives Roux-en-Y gastric bypass (RYGB) has greater efficacy for weight loss in obese patients than gastric banding (BAND) surgery. We hypothesise that this may result from different effects on food hedonics via physiological changes secondary to distinct gut anatomy manipulations.

Design We used functional MRI, eating behaviour and hormonal phenotyping to compare body mass index (BMI)-matched unoperated controls and patients after RYGB and BAND surgery for obesity.

Results Obese patients after RYGB had lower brain-hedonic responses to food than patients after BAND surgery. RYGB patients had lower activation than BAND patients in brain reward systems, particularly to high-calorie foods, including the orbitofrontal cortex, amygdala, caudate nucleus, nucleus accumbens and hippocampus. This was associated with lower palatability and appeal of high-calorie foods and healthier eating behaviour, including less fat intake, in RYGB compared with BAND patients and/or BMI-matched unoperated controls. These differences were not explicable by differences in hunger or psychological traits between the surgical groups, but anorexigenic plasma gut hormones (GLP-1 and PYY), plasma bile acids and symptoms of dumping syndrome were increased in RYGB patients.

Conclusions The identification of these differences in food hedonic responses as a result of altered gut anatomy/physiology provides a novel explanation for the more favourable long-term weight loss seen after RYGB than after BAND surgery, highlighting the importance of the gut–brain axis in the control of reward-based eating behaviour.


Bariatric Advantage Ultra Multi Formula with Iron

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From Bariatric Advantage a capsule supplement taken three times a day - with no chewing necessary.
Impressive Stats.
Powerful nutrition in 3 capsules! Our newest encapsulated multi formula is the highest potency member of our multi family of products.
Designed to meet the latest guidelines* just add one of our great selection of calcium products and you are ready to go for the day.
Contains a full 3000 IU vitamin D3, 400 mg Magnesium, 45 mg Iron, and a unique phytonutrient blend to support good health.
You also get at least 200 % DV for all the B vitamins, a full range of trace minerals, and all four fat-soluble vitamins (A, D, E, K) in water-miscible forms.
Our new Ultra Formula is a great choice for anyone who wants the benefits of great nutrition with nothing to chew.
  • Via - Bariatric Advantage 
  • Use my code if you'd like -  
  • Screen Shot 2013-08-21 at 2.57.19 PM

  • Price - $19.95 for 90, $49.95 for 270
  • Pros - No chewing, everything but calcium is in this dose
  • Cons - None that I can see
  • Rating - Pouchworthy, I am waiting to see if I can handle the size to swallow them - I am sure they are fine.

Hello maintenance or the no-stress apathetic no-diet plan for long term WLS patients.

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I suppose this is maintenance.
I'll take it.  I apparently maintain at this caloric intake at this activity level.
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It's magic. 

I have also been extraordinarily "lazy"  (in Beth terms) in the last 30 days -- with very little gym time. Calorie Control.org doesn't have a setting for extraordinarily lazy - but if they did - or a setting for extraordinarily lazy post bariatric patient who eats 1200-1400 calories per day, that would be me.
PS.  I'm not really that lazy, but, I am not about to own running half-marathons up in this bitch, because, no.
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I suspect that as soon as I get back into a routine at the gym (... school is out and it's hot and we are whiny)  that one or two things will happen:
I will see a bounce up because "YAY! MUSCLE!"  Or my trend down will start again - although as it has been - very slowly.  I still have body-fat to lose while I grow/gain muscle which I desperately need.   Either option is fine with me.  I have no goal, other than health with no stress in doing so.
Welcome to the apathetic non-diet plan for WLS'ers.  
It works.  

A dilemma-monade #fitbloggin #procrastination

It's 94 degrees in my bedroom right now where I should be packing my suitcase in anticipation for my flight out to fitbloggin' 2013 tomorrow morning.  However instead of packing I am playing the "until the very last minute" game because -

  • It is 94 degrees in my bedroom
  • And I am avoiding all things boob sweat.  (I am currently sweating, sitting still.)

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There is also this one thing --  I weighed in at 183 pounds last summer to fall.

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fitbloggin' 2012

I now weigh 144 pounds and that is a visible size difference.  
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2013

The thing is -- I've been wearing the same clothing regardless of its fit -- which means I probably look a mess quite often in a size 12-14 on a size 8 body.  I likely rock the plumbers crack.  #thumbsup

 

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I could use some clothes that fit, but I would rather not until I know I am settled into a size that I am staying in unless I find super-inexpensive deals.  I bought clothing prior to the last set of events I attended - and they're too big now.  

As someone who is pretty much stuck-at-home since I do not drive due to my seizures, I don't shop much at all, and rarely shop online either.  Also:  with five other people in the house, you don't just SHOP for clothes, you have to consider everyone, and we have a list seven miles long of "needs, wants and like-to-haves..." and my stuff sometimes gets bumped.  That's just the long way of saying I can't just run out and shop.  I do not have that luxury.  If I were an employed adult with a dependable weekly paycheck, who could drive myself to the mall?  I suppose I might consider it more often, but I know I'd likely end up spending on the kids first because that's what parents do.  School's out this week.  #brainimplodes  #sendababypool #sendairconditioning #help 

Do you like how I am avoiding?  

It is working.  

I am still sitting here.  

The suitcase is empty.  

I will also mention that it is empty because I did not get a sponsor for this event.  In the spirit of being honest:  I did not try very hard to gain a sponsor.  I did not ask much.  I was quite disheartened after the last event I attended and sort of gave up.   I promised myself that I would not attend another blog conference (...or otherwise) after paying out of pocket in full for the last one that went completely belly-up on me and my entire support group.  I swore I would never do it again, until this time.

I suppose I should attempt to put some poorly fitted clothes in a suitcase now that the sun has moved a bit.   (Still. trying. to. waste. time. here.)

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However, I've had two good experiences with fitbloggin'.    (A post from last year.)

I am off to Portland, Oregon in the wee hours tomorrow for fitbloggin' 2013 - which is my third trip to fitbloggin' - because they sort of rock.  I went in 2010, 2012 and now this year.  I will be live-blogging a session sponsored by #soyjoy about snacking!  *shrug*  

I like snacking.  

Many blog-friends will also be there!  Check out the list!  WLS bloggers in attendance:

 Watch the blogs - and

 

 


Ending TOMORROW - Nominations are open! #OAC #YWM2013

Via OAC -  Nominations END tomorrow!

We are proud to open the nomination process for the OAC’s 2013 Annual Awards that will be presented on Saturday evening, August 17, at the 2nd Annual Your Weight Matters National Convention in Phoenix, AZ.

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Last year, the OAC unveiled its Annual Awards Program as a way to honor outstanding OAC members and volunteers for their tireless efforts to advance the cause of obesity and help individuals affected through education, advocacy and support. Our members truly drive the successes of the OAC, and we are excited to celebrate the individuals that have made a direct impact in furthering the goals and mission of the OAC.

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During this year’s awards ceremony held in conjunction with the 2013 National Convention in Phoenix, we will present seven awards in key areas of focus for the OAC. A complete list of the awards to be presented may be found to the right. Of the seven awards, four are open to the membership to submit nominations. The remaining award recipients will be selected by the Annual Awards Program Review Committee.

If you know someone who is deserving of one or more of the OAC’s awards, we encourage you to submit a nomination using the below links. Self-nominations are also welcomed and accepted.

 

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Supporting the #WalkFromObesity for the OAC and ASMBS Foundation with the #BBGC

Deadline to Submit Your Nomination: Friday, July 19

 

Candidates for the below awards are nominated by the OAC membership and will be submitted for final review by the OAC Annual Awards Program Review Committee. Self-nominations are accepted. The description, qualifications and criteria for review are available once you click the link provided for the respective award. 

 

YWM2012
#YWM2012 Awards Night with Michelle Vicari

 

  • The deadline to submit a nomination is Friday, July 19. 

We hope you submit a nomination for the OAC’s Annual Awards and invite you to join us in Phoenix for the presentation. Here are the details of this year’s Awards Ceremony:

Saturday, August 17
7:00 pm – Arizona Grand Ballroom – Conference Center at Arizona Grand

Arizona Grand Resort & Spa
8000 South Arizona Grand
Phoenix, AZ 85044
Plated Sit-down Dinner

Tickets to the 2nd Annual OAC Awards Dinner are included in Full Convention Registration and can also be purchased separately. To learn more about registering for the Convention and this event, please visit the official Convention Web site at www.YWMConvention.com.

  • To view the recipients of the 2012 OAC Annual Awards, please CLICK HERE.



A Tongue Patch For Weight Loss

A tongue-patch to lose weight.  

No, really.

"Dr. Chugay has recently begun performing a revolutionary weight reduction procedure, which he has dubbed the Miracle Patch.  This patch, when surgically applied to the tongue, produces a means to lose weight never before offered by other surgeons.

During a reversible procedure that takes less than an hour, the patient is fitted with a custom patch for the tongue which makes chewing of solid foods very difficult and painful, limiting the patient to a liquid diet. Under the direct supervision of Dr. Chugay and his staff, the patient is put on an easy to follow liquid diet, fulfilling all of their nutritional needs while at the same time minimizing caloric intake and maximizing weight loss results.

Recovery is rapid; and patients are typically able to return to work the following day."

I am intrigued and disturbed at the same time.

As a woman who had her stomach and intestines altered to lose more than 170 pounds I will not judge much (?) the above procedure's level of "OMG YOU DID WHAT TO YOURSELF!?!" because I have heard it all.

But how is this accomplished?  

The doctor takes a piece of mesh - the material used to repair abdominal hernias - and attaches it to your tongue.  Heck, you may already have this stuff inside you.  (Half my family does.  We're all patched together.)

This is supposed to make eating now so. unpleasant. that. you. stop.

You have surgical hernia (repair?) of the tongue.  (I see other uses for this.  Today.   Yes.)

 

Now-with-more

I am not a psychologist, but I am a bariatric patient of nearly ten years and professional watcher of post op bariatric patients.  (That's my disclaimer, it's all you get.)  Rapid weight loss by behavior modification of "Eating!  Now Very Difficult And Painful!" can lead to some severe psychological eating issues later on.

Certainly if you're following the "rules of the tongue patch" it should work -- as as very low calorie liquid diet would.  But, add in the benefit of making food no longer a pleasant experience, you might as well add the cost of your therapists bill too.

 Sigh.


For Many, Affordable Care Act Won't Cover Bariatric Surgery

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For Many, Affordable Care Act Won't Cover Bariatric Surgery - via NPR

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Mr. MM newly post op


JACKSON, Miss. — Uninsured Americans who are hoping the new health insurance law will give them access to weight loss treatments are likely to be disappointed.

That's especially the case in the Deep South, where obesity rates are among the highest in the nation, and states will not require health plans sold on the new online insurance marketplaces to cover medical weight loss treatments like prescription drugs and bariatric surgery.

Dr. Erin Cummins directs the bariatric surgery department at Central Mississippi Medical Center in the state capital of Jackson. She grew up in the Delta, her husband is a cotton farmer, and although she's petite and fit, she understands well enough how Mississippians end up on her operating table.

"You have to realize in the South, everything revolves around food. Reunions, funerals, parties — everything revolves around food," Cummins says.

That long-standing food culture, as well as other factors like inactivity and poverty, have saddled Mississippi with the highest obesity rate in the nation.

Credit: Produced by Dave Anderson/Oxford American; Narrated by Debbie Elliott/NPR

Roughly 1 in 3 adult Americans is now obese. And ground zero for the nation's obesity battle is Mississippi — where 7 of 10 adults in the state are either overweight or obese. The problem is most pronounced in Holmes County — the poorest and heaviest in the state.

Doctors here are no longer surprised to see 20-somethings with diabetes, hypertension, sleep apnea, heart disease and severe joint pain. And the prevalence of severe and super-obesity is growing rapidly. For those patients, bariatric surgery is considered the most effective treatment to induce significant weight loss.

Cummins describes the procedure: "We're restricting the stomach size to where a patient isn't going to eat as much. Then we reroute the intestines a little bit and realign it to delay digestion, so to speak, to bypass it. So everything a patient eats in a gastric bypass is not going to be absorbed."

After surgery, many of the complications of obesity, like sleep apnea and high blood pressure, are reversed. Multiple studies have found that about 80 percent of diabetics can stop medication in the first year.

Medicare and about two-thirds of large employers cover bariatric surgery in the U.S. But the procedure is pricey — an average of $42,000 — and many small employers, including those in Mississippi, don't cover it.

When the Affordable Care Act became law in 2010, one goal was to erase those sorts of regional variations in access.

"Our hope was that there would be a single benefit for the entire country, and as part of that benefit there would be coverage for obesity treatment," says Dr. John Morton. He is director of bariatric surgery at Stanford University Morton, and has led national and state lobbying efforts to get insurance coverage for teh surgery.

But amid worries that a uniform set of benefits would be too expensive in some states, and sensitive to the optics of the federal government laying down one rule for all states, the U.S. Department of Health and Human Services changed course. It decided instead to match benefits to the most popular small group plan sold in each state, in essence reflecting local competitive forces.

That's led to an odd twist: In more than two dozen states, obesity treatments – including intensive weight loss counseling, drugs and surgery – won't be covered in plans sold on the exchanges.

Bariatric surgery won't be covered on the exchanges in Alabama, Louisiana, Arkansas, Texas and Mississippi. That's where, according to the Centers for Disease Control, obesity rates are among the highest.

Morton applauds the growing awareness around obesity prevention in the U.S., but, he says, some 15 million Americans who are already severely obese still need medical treatment.

"If they don't have insurance, they're not going to get the therapy," Morton says. "We see cancer therapy covered routinely. We see heart disease covered routinely. Why is it that we don't see obesity coverage routinely?"

Therese Hanna, Executive Director of the Center for Mississippi Health Policy, isn't surprised that obesity treatments are excluded on the insurance exchange in her state. She says it all has to do with keeping cost down for many people who will be buying insurance for the first time.

"With the discussions around what should be covered under the exchange within the state, a lot of it had to do with balancing cost versus the coverage," says Hanna.

Hannah says Mississippians who buy insurance on the exchange will likely be the cashiers, cooks, cleaners and construction workers that make up much of the state's uninsured. And even though many of them will qualify for federal subsidies, the price of monthly premiums must be kept low.

"If you try to include everything, the cost would be so high that people wouldn't be able to afford the coverage, so you defeat the purpose," Hanna says. The discussion in Mississippi, she says has focused on providing care for things like high blood pressure, diabetes and heart disease. "So we have a lot of needs to be covered other than obesity itself."


Report: Some money in Lap-Band settlement to pay for billboards on weight-loss surgery risks

AP -  Report: Some money in Lap-Band settlement to pay for billboards on weight-loss surgery risks

LOS ANGELES — A company that promoted Lap-Band weight-loss surgery has agreed to pay $1.3 million to settle a false-advertising lawsuit, with some of the money going to billboards warning the public about the risks of weight-loss surgery, a newspaper reported Thursday.

From 2009 to 2011, five patients died after Lap-Band surgeries at clinics affiliated with the 1-800-GET-THIN ad campaign, according to the Los Angeles Times (http://lat.ms/11knLBS ).

The proposed settlement still needs the approval of Los Angeles County Superior Court Judge Kenneth Freeman, who asked attorneys at a hearing Thursday to provide more information and resubmit their settlement motion before he gives the deal his OK.

Relatives of two of the dead patients, Ana Renteria and Laura Faitro, filed the lawsuit as a class action in 2011.

The lawsuit sought damages from several companies and two brothers, Michael and Julian Omidi, who court documents said owned and managed Top Surgeons, a weight-loss business.

John Hueston, an attorney for the Omidis, said the settlement was not an admission of wrongdoing.

“Under the agreement, our clients ... are dismissed without any admission of liability, and made no contribution whatsoever to the settlements,” Hueston said in a statement cited by the Times.

A lawyer for the surgery centers, Konrad Trope, said the action against the facilities was dismissed without admission of liability or financial penalty.

The proposed settlement will be paid only by Top Surgeons, one of the companies behind the GET-THIN operation, the newspaper said. The company did not immediately return a message from The Associated Press.

The lawsuits and other public documents showed that 1-800-GET-THIN was a marketing company that steered patients to a network of outpatient clinics, where thousands of weight-loss surgeries were performed.

The company used dozens of billboards — along with ads on television, radio and the Internet — to promote Lap-Band weight-loss surgery.

Some of the suits alleged that the clinics put profits above patient safety, employing physicians who were unqualified and allowing surgeries to be performed in unsanitary conditions, the Times said.

The proposed deal calls for $100,000 to be spent on billboard advertising throughout Southern California “intended to explain the risks of weight-loss surgery.” The agreement does not specify the language to be used in the ads but says it must be approved by the court.


Study - Expectations for weight loss and willingness to accept risk among patients seeking weight loss surgery.

Just a warning, this is NOT a pleasant Rainbow and Butterflies study for those in the early or research stages of weight loss surgery.
Study -

Expectations for weight loss and willingness to except risk - JAMA -

Importance  Weight loss surgery (WLS) has been shown to produce long-term weight loss but is not risk free or universally effective. The weight loss expectations and willingness to undergo perioperative risk among patients seeking WLS remain unknown.

Objectives  To examine the expectations and motivations of WLS patients and the mortality risks they are willing to undertake and to explore the demographic characteristics, clinical factors, and patient perceptions associated with high weight loss expectations and willingness to assume high surgical risk.

Design  We interviewed patients seeking WLS and conducted multivariable analyses to examine the characteristics associated with high weight loss expectations and the acceptance of mortality risks of 10% or higher.

Setting  Two WLS centers in Boston.

Participants  Six hundred fifty-four patients.

Main Outcome Measures  Disappointment with a sustained weight loss of 20% and willingness to accept a mortality risk of 10% or higher with WLS.

Results  On average, patients expected to lose as much as 38% of their weight after WLS and expressed disappointment if they did not lose at least 26%.

Most patients (84.8%) accepted some risk of dying to undergo WLS, but only 57.5% were willing to undergo a hypothetical treatment that produced a 20% weight loss.

The mean acceptable mortality risk to undergo WLS was 6.7%, but the median risk was only 0.1%; 19.5% of all patients were willing to accept a risk of at least 10%.

Women were more likely than men to be disappointed with a 20% weight loss but were less likely to accept high mortality risk.

After initial adjustment, white patients appeared more likely than African American patients to have high weight loss expectations and to be willing to accept high risk.

Patients with lower quality-of-life scores and those who perceived needing to lose more than 10% and 20% of weight to achieve “any” health benefits were more likely to have unrealistic weight loss expectations.

Low quality-of-life scores were also associated with willingness to accept high risk.

Conclusions and Relevance 

Most patients seeking WLS have high weight loss expectations and believe they need to lose substantial weight to derive any health benefits.

Educational efforts may be necessary to align expectations with clinical reality.

/end study

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NO SHIT, REALLY?!  Go back and READ IT AGAIN.

Now go read this: http://www.drsharma.ca/how-much-are-people-willing-to-risk-for-bariatric-surgery.html

WHAT HAVE WE BEEN TELLING YOU?!  Please.  START.  LISTENING.


Weight Loss Surgery Connected to Increased Risk Of Colon Cancer

GET. YOUR. COLONOSCOPIES.  IT COULD SAVE YOUR LIFE.  Don't be scared. It's no big thing. Really. The preparation is harder than the procedure.  (My spouse is at this very moment, searching for a GI to make that appointment he canceled more than five years ago.  He's a high-risk patient with family history.)

With that, I tell you - BOTTOMS UP!

(Reuters Health) - Obesity is already linked to a higher risk of colon or rectal cancer, but a new study suggests this risk is even greater for obese people who have undergone weight-loss surgery.

Based on a study of more than 77,000 obese patients, Swedish and English researchers found the risk for colorectal cancer among those who have had obesity surgery is double that of the general population.

Though colorectal cancer risk among obese patients who didn't have the surgery was just 26 percent higher than in the general population, researchers said the results should not discourage people from going under the knife.

"These findings should not be used to guide decisions made by patients or doctors at all until the results are confirmed by other studies," said Dr. Jesper Lagergren, the new study's senior author and a professor at both the Karolinska Institute in Stockholm and King's College London.

Each year more than 100,000 people in the U.S. have surgery to treat obesity.

Lagergren and his colleagues point out in their report, published in the Annals of Surgery, that obesity is tied to elevated risks for a number of cancers, including colorectal, breast and prostate (see Reuters Health story of November 3, 2011 here: reut.rs/t9sYxO).

Whether surgery to lose weight can affect those risks is uncertain.

Two earlier studies, one from the U.S. and the other from Sweden, found that the chances of obesity-related cancers decline after women have weight-loss surgery.

But an earlier study from Lagergren's group found the risks for breast and prostate cancers were unaffected by obesity surgery, and colorectal cancer risk increased.

To investigate that finding further, Lagergren's team collected 29 years' worth of medical records on more than 77,000 people in Sweden who were diagnosed as obese between 1980 and 2009. About 15,000 of them underwent weight loss surgery.

In the surgery group, 70 people developed colorectal cancer - a rate that was 60 percent greater than what would be expected for the larger Swedish population.

When the researchers looked only at people who had surgery more than 10 years before the end of the study period, the number of cancer cases was 200 percent greater than the expected risk for the general population.

In contrast, 373 people in the no-surgery group developed colorectal cancer, which was 26 percent more than would be expected in the population and that number remained stable over time.

A two-fold increased risk for colorectal cancer is not a "negligible risk increase, but it should not be of any major concern for the individual patient since the absolute risk is still low," Lagergren told Reuters Health in an email.

In the U.S., for instance, 40 out of every 100,000 women and roughly 53 out of every 100,000 men develop colorectal cancer each year.

Doubling that risk would make the annual figures 80 out of every 100,000 women and 106 out of every 100,000 men.

Lagergren said that more studies are needed to confirm his results before they should be included in clinical decision-making about whether patients should undergo weight-loss surgery.

The study results cannot prove that the surgery is the cause of the elevated cancer risk.

And, Lagergren says it's also not clear why the surgery might be tied to an elevated risk of colorectal cancer.

  • One possibility is that dietary changes after surgery, and increasing protein in particular, could raise cancer risk, he speculated.
  • Because the gut plays a significant role in the immune system, he added, "Another potential factor is that the bacteria that naturally reside in the intestines may change after surgery and alter future cancer risk."
  • Lagergren noted that he also couldn't rule out the possibility that residual excess weight and weight gain after surgery might be involved.

 

SOURCE: bit.ly/10TcCGy Annals of Surgery, online March 6, 2013

The study -

Annals of Surgery 

http://journals.lww.com/annalsofsurgery/Abstract/publishahead/Increased_Risk_of_Colorectal_Cancer_After_Obesity.98506.aspx

Abstract

  • Objective: The purpose was to determine whether obesity surgery is associated with a long-term increased risk of colorectal cancer.
  • Background: Long-term cancer risk after obesity surgery is not well characterized. Preliminary epidemiological observations and human tissue biomarker studies recently suggested an increased risk of colorectal cancer after obesity surgery.
  • Methods: A nationwide retrospective register-based cohort study in Sweden was conducted in 1980-2009. The long-term risk of colorectal cancer in patients who underwent obesity surgery, and in an obese no surgery cohort, was compared with that of the age-, sex- and calendar year-matched general background population between 1980 and 2009. Obese individuals were stratified into an obesity surgery cohort and an obese no surgery cohort. The standardized incidence ratio (SIR), with 95% confidence interval (CI), was calculated.
  • Results: Of 77,111 obese patients, 15,095 constituted the obesity surgery cohort and 62,016 constituted the obese no surgery cohort. In the obesity surgery cohort, we observed 70 patients with colorectal cancer, rendering an overall SIR of 1.60 (95% CI 1.25-2.02). The SIR for colorectal cancer increased with length of time after surgery, with a SIR of 2.00 (95% CI 1.48-2.64) after 10 years or more. In contrast, the overall SIR in the obese no surgery cohort (containing 373 colorectal cancers) was 1.26 (95% CI 1.14-1.40) and remained stable with increasing follow-up time.
  • Conclusions: Obesity surgery seems to be associated with an increased risk of colorectal cancer over time. These findings would prompt evaluation of colonoscopy surveillance for the increasingly large population who undergo obesity surgery. 


It's not about a number.

I'm not a shopper. Since I work from home, I rarely get new clothes.

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The other day I noticed that New York + Co had a 50% off everything sale and went in. The saleswoman said to me, "You look like you'd rather be anywhere but here." 

I told her that I am not fan of clothes shopping, and she called me "Cute," and "Small." 

Small. Snort.

I laughed, and realized soon why I have so much dismay for clothes shopping. THE FITTING ROOM. THE LIGHTS.

THE VARICOSE VEINS. I have the legs of an 80 year old woman.

It's not about SIZES or the number on my scale, because I am nearly to my lowest weight.  I reached my lowest weight just after one year post op, I hit 149 pounds for one day and regained immediately.  

I am 156 pounds today.  

I still don't like the melted candle puddle of skin that I have -- nine years later. Full honesty, I am FINE with it once I am wearing appropriate undergarments and everything is in it's place, but even in a size 8P (I also bought a pair of 6P) - sometimes you feel like a puddle of flesh.

It's not about a number.


After weight-loss surgery, new gut bacteria keep obesity away?

ENTHRALLING -

New York Times -

The research also suggests that a popular weight-loss operation, gastric bypass, which shrinks the stomach and rearranges the intestines, seems to work in part by shifting the balance of bacteria in the digestive tract. People who have the surgery generally lose 65 percent to 75 percent of their excess weight, but scientists have not fully understood why.

Now, the researchers are saying that bacterial changes may account for 20 percent of the weight loss.

The findings mean that eventually, treatments that adjust the microbe levels, or “microbiota,” in the gut may be developed to help people lose weight without surgery, said Dr. Lee M. Kaplan, director of the obesity, metabolism and nutrition institute at the Massachusetts General Hospital, and an author of a study published Wednesday in Science Translational Medicine.

Not everyone who hopes to lose weight wants or needs surgery to do it, he said. About 80 million people in the United States are obese, but only 200,000 a year have bariatric operations.

“There is a need for other therapies,” Dr. Kaplan said. “In no way is manipulating the microbiota going to mimic all the myriad effects of gastric bypass. But if this could produce 20 percent of the effects of surgery, it will still be valuable.”

In people, microbial cells outnumber human ones, and the new studies reflect a growing awareness of the crucial role played by the trillions of bacteria and other microorganisms that live in their own ecosystem in the gut. Perturbations there can have profound and sometimes devastating effects.

One example is infection with a bacterium called C. difficile, which sometimes takes hold in people receiving antibiotics for other illnesses. The drugs can wipe out other organisms that would normally keep C. difficile in check. Severe cases can be life-threatening, and the medical profession is gradually coming to accept the somewhat startling idea that sometimes the best therapy is a fecal transplant — from a healthy person to the one who is sick, to replenish the population of “good germs.”

Dr. Kaplan said his group’s experiments were the first to try to find out if microbial changes could account for some of the weight loss after gastric bypass. Earlier studies had shown that the microbiota of an obese person changed significantly after the surgery, becoming more like that of someone who was thin. But was the change from the surgery itself, or from the weight loss that followed the operation? And did the microbial change have any effects of its own?

Because it would be difficult and time-consuming to study these questions in people, the researchers used mice, which they had fattened up with a rich diet. One group had gastric bypass operations, and two other groups had “sham” operations in which the animals’ intestines were severed and sewn back together. The point was to find out whether just being cut open, without having the bypass, would have an effect on weight or gut bacteria. One sham group was kept on the rich food, while the other was put on a weight-loss diet.

In the bypass mice, the microbial populations quickly changed, and the mice lost weight. In the sham group, the microbiota did not change much — even in those on the weight-loss diet.

Next, the researchers transferred intestinal contents from each of the groups into other mice, which lacked their own intestinal bacteria. The animals that received material from the bypass mice rapidly lost weight; stool from mice that had the sham operations had no effect.

Exactly how the altered intestinal bacteria might cause weight loss is not yet known, the researchers said. But somehow the microbes seem to rev up metabolism so that the animals burn off more energy.

A next step, Dr. Kaplan said, may be to take stool from people who have had gastric bypass and implant it into mice to see if causes them to lose weight. Then the same thing could be tried from person to person.

“In addition, we’ve identified four subsets of bacteria that seem to be most specifically enhanced by the bypass,” Dr. Kaplan said. “Another approach would be to see if any or all of those individual bacteria could mediate the effects, rather than having to transfer stool.”

A second study by a different group found that overweight people may be more likely to harbor a certain type of intestinal microbe. The microbes may contribute to weight gain by helping other organisms to digest certain nutrients, making more calories available. That study was published Tuesday in the Journal of Clinical Endocrinology & Metabolism.

The study involved 792 people who had their breath analyzed to help diagnose digestive orders. They agreed to let researchers measure the levels of hydrogen and methane; elevated levels indicate the presence of a microbe called Methanobrevibacter smithii. The people with the highest readings on the breath test were more likely to be heavier and have more body fat, and the researchers suspect that the microbes may be at least partly responsible for their obesity.

This type of organism may have been useful thousands of years ago, when people ate moreroughage and needed all the help they could get to squeeze every last calorie out of their food. But modern diets are much richer, said an author of the study, Dr. Ruchi Mathur, director of the diabetes outpatient clinic at Cedars-Sinai Medical Center in Los Angeles.

“Our external environment is changing faster than our internal one,” Dr. Mathur said. Studies are under way, she said, to find out whether getting rid of this particular microbe will help people lose weight.


Leading Obesity Groups Call for Putting Health, Longevity and Quality of Life First When Considering the Economics of Bariatric Surgery

The OAC, The Obesity Society and the ASMBS have responded to the study published in the Journal of the American Medical Association that suggests that bariatric surgery doesn't pay off -

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Leading Obesity Groups Call for Putting Health, Longevity and Quality of Life First When Considering the Economics of Bariatric Surgery

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Bariatric Support Groups in Massachusetts - From ASMBS Directory - WLS Support Groups

"I can't find a support group in Massachusetts!"  

Here is a list of bariatric support groups in Massachusetts from the ASMBS website

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ReShape Duo™ Intragastric Balloon System Seeing Weight Loss Results in Study

The REDUCE Pivotal Trial is a pivotal clinical study designed to develop valid scientific evidence regarding the safety and effectiveness of the ReShape Duo® as an adjunct to diet and exercise in the treatment of obese subjects with one or more obesity-related comorbid conditions.

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