Apollo Endosurgery, Inc., the leader in minimally invasive endoscopic surgical products for bariatric and gastrointestinal procedures, today announced the launch of the “It Fits” campaign, aimed at rejuvenating the LAP-BAND® System and educating a broad range of patients about the benefits of the minimally-invasive weight loss procedure.
“It Fits” supports the company’s decision to place greater emphasis on the unique advantage of the LAP-BAND® System – the only FDA approved device for weight reduction for people with at least one weight-related health problem, and having a BMI of 30 or greater.
The new ad spot - from Apollo - tugs right there at your heart, don't it? I might be tearing up over all of the completely stereotypical situations right here in this here commercial! OMG I CAN FIT IN THE AEROPLANE SEATBELT WITHOUT AN EXTENDER COULD YOU PLEASE PUT ME IN A COMMERCIAL ALTHOUGH I WAS NEVER SUPER MORBIDLY OBESE I AM JUST AN ACTOR!
Until this and my tears dry up!
Because of course we will ignore the patient histories of thousands -- to have a procedure to lose how much weight?
Just as a frame of reference, that makes me qualify in a few BMI points. Confession: when I reached my high weight about the same time the new BMI-qualifications for the Allergan-owned lap-band came around, I decided THAT WAS IT. I could not possibly do it again, my butt was not revising band-over-bypass for that much weight, not after watching this weight loss community for 12 years. Nope.
Importance The prevalence of obesity and outcomes of bariatric surgery are well established. However, analyses of the surgery impact have not been updated and comprehensively investigated since 2003.
Objective To examine the effectiveness and risks of bariatric surgery using up-to-date, comprehensive data and appropriate meta-analytic techniques.
Results A total of 164 studies were included (37 randomized clinical trials and 127 observational studies). Analyses included 161 756 patients with a mean age of 44.56 years and body mass index of 45.62. We conducted random-effects and fixed-effect meta-analyses and meta-regression.
In randomized clinical trials, the mortality rate within 30 days was 0.08% (95% CI, 0.01%-0.24%); the mortality rate after 30 days was 0.31% (95% CI, 0.01%-0.75%). Body mass index loss at 5 years postsurgery was 12 to 17. T
he complication rate was 17% (95% CI, 11%-23%), and the reoperation rate was 7% (95% CI, 3%-12%).
Gastric bypass was more effective in weight loss but associated with more complications.
Adjustable gastric banding had lower mortality and complication rates; yet, the reoperation rate was higher and weight loss was less substantial than gastric bypass.
Sleeve gastrectomy appeared to be more effective in weight loss than adjustable gastric banding and comparable with gastric bypass.
Conclusions and RelevanceBariatric surgery provides substantial and sustained effects on weight loss and ameliorates obesity-attributable comorbidities in the majority of bariatric patients, although risks of complication, reoperation, and death exist. Death rates were lower than those reported in previous meta-analyses.
Fifteen years after they have weight-loss surgery, almost a third of patients who had Type 2 diabetes at the time they were operated on remain free of the metabolic disorder, a new study says. And six years following such surgery, patients had shaved their probability of suffering a heart attack over the next 10 years by 40%, their stroke risk by 42%, and their likelihood of dying over the next five years by 18%, additional research has concluded.
The two studies, both presented Wednesday at the annual meeting of the American Society for Metabolic and Bariatric Surgery in Atlanta, offer the first indications of weight-loss surgery's longer-term health benefits for patients. While researchers have demonstrated dramatic improvements in many bariatric patients' metabolic function in the short term, the durability of those improvements has been unclear.
Research suggests that over several years, many bariatric patients regain some of the weight they lose in the first two years -- a fact that has raised doubts about the cost-effectiveness of the surgery, which can cost $20,000 to $25,000 for the initial procedure, plus a wide range of costs to treat complications after surgery.
The new studies' findings that patients' health prospects remain better for several more years may make weight-loss surgery a more appealing treatment for insurers to cover, and for obese patients with health concerns to seek out.
The study that followed 604 bariatric patients in Sweden for 15 years found that in the first two years after surgery, 72% achieved diabetes remission: They were able to cease taking medication for the metabolic condition. After 15 years, a little more than half of those had diabetes again. But 31% had remained in remission.
By contrast, only 16% of the comparison group -- similarly obese patients with diabetes who did not get surgery -- had seen their diabetes remit in the first two years. At 15 years out, diabetes remission was six times likelier in those who had surgery than in the those who did not.
In another study, researchers at the Cleveland Clinic in Ohio followed bariatric patients for an average of six years after surgery. They tallied those patients' likelihoods of developing a wide range of health outcomes at the time of surgery and six years later, and compared them. To do so, they used the Framingham risk calculator to estimate the before-and-after 10-year risks of heart disease, stroke, death, kidney disease and complications such as diabetic retinopathy and poor circulation.
(The Framingham risk calculator is derived from probabilities gleaned from following more than 10,000 subjects in Framingham, Mass., in the Framingham Heart Study, which started in 1948.)
In this study, the bariatric patients lost 60% of their excess weight and 61% saw their diabetes remit after surgery. Overall, their risk of having coronary heart disease, stroke or peripheral heart disease dropped by 27%.
Bariatric surgeon Dr. John Morton, a professor of medicine at Stanford University who was not involved in either study, suggested that the results of more modern bariatric surgical procedures may be superior. He added that reducing the stress of obesity on the body, even if some weight returns, may improve a patient's long-term health prospects.
"Carrying extra weight can carry forth year to year," said Morton, who is president-elect of the American Society for Metabolic and Bariatric Surgery. He likened long-term obesity to smoking cigarettes for years, suggesting that the number of years a person remains obese (or smokes) may interact with their degree of obesity (or how much they smoke) to influence his or her likelihood of developing health problems.
Your brain after obesity surgery responds to food differently than before surgery and differently than it does after a behavioral weight program. Likewise, brain function improves in children with excess weight and low fitness after treatment with an aerobic exercise program. These observations come from two new studies in Obesity that provide a glimpse of the growing understanding about how obesity and its treatment affect brain function.
Amanda Bruce and colleagues compared functional MRI scans of a sample of patients before and after gastric banding surgery to scans from a matched sample of patients losing similar amounts of weight in a behavioral treatment program.
The demographics of the two samples were also matched. The found changes in brain responses to food for both groups after weight loss. But the nature of the changes were different.
The response to food cues by the banding patients suggested that the cues were less relevant and rewarding to them. Food cues seemed to command more attention from participants in behavioral weight programs than they did from band patients.
- See more at: http://conscienhealth.org/2013/10/your-brain-after-obesity-surgery/#sthash.hBbCJfvF.dpuf
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."
In a single-center study, patients who underwent the procedure lost an average 57.4% of excessive body mass index (BMI) over 5 years, Ralph Peterli, MD, of Claraspital in Basel in Switzerland, and colleagues reported online in the journalSurgery for Obesity and Related Diseases.
Laparoscopic sleeve gastrectomy, first developed about a decade ago, "was initially intended to be a primary intervention in high-risk patients before laparoscopicRoux-en-Y gastric bypass or as the first step of biliopancreatic diversion duodenal switch," the authors noted in their introduction. But evidence has been mounting that sleeve gastrectomy itself is an effective surgery for weight loss.
But there is still a dearth of long-term evidence for its benefit -- one reason Peterli and colleagues conducted a retrospective analysis of a cohort from their facility that had a minimum of 5 years' follow-up.
A total of 68 patients had laparoscopic sleeve gastrectomy at their center as either a primary bariatric procedure or as a re-operation after failed laparoscopic gastric banding between August 2004 and December 2007.
At the time of sleeve gastrectomy, mean BMI was 43 and 78% of patients were female. They had a mean follow-up of 5.9 years.
Overall, Peterli and colleagues found that the average excessive BMI lost after 1 year was 61.5%, and then 61.1% after 2 years.
By 5 years, average excessive BMI lost was 57.4%, they reported.
Those losses correspond with a BMI reduction of 12.6 kg/m2, 12.4 kg/m2, and 11.2 kg/m2, respectively.
"The main weight loss occurred in the first postoperative year and appeared in the following years for the most part stable," they wrote.
However, 34.3% of patients who had sleeve gastrectomy as their primary procedure and 50% of those who'd had it after a failed gastric banding still had a BMI above 35 kg/m2 after 5 years.
"Patients with a prior [gastric banding] show worse results concerning weight loss," they wrote, noting, however, that international consensus considers Roux-en-Y gastric bypass [RYGB] surgery as the best option following failed banding, not sleeve gastrectomy.
The study also showed that comorbidities improved considerably, with remission of type 2 diabetes in most of the patients who had the disease before the procedure.
Among four insulin-dependent patients, only one still needed insulin therapy 5 years after laparoscopic sleeve gastrectomy. Two were able to switch to oral antidiabetic therapy, while one remained in full remission at 5 years, they reported.
In terms of complications, one patient had a leak, two had incisional hernias -- which were deemed unrelated to treatment -- and 11 patients had new onset gastroesophageal reflux disease, which typically resolved with proton pump inhibitor therapy.
Over 5 years of follow-up, 77.9% of patients developed vitamin D deficiency, 41.2% had iron deficiency, 39.7% had zinc deficiency, 39.7% had a vitamin B12 deficiency, 25% had a folic acid deficiency, and 10.3% developed anemia.
These deficiencies occurred "despite routine supplementation, in a higher rate than we had expected," the researchers wrote.
They also found that re-operation due to insufficient weight loss was needed in eight patients, or 11.8% of the study population.
But they concluded that sleeve gastrectomy is effective nearly 6 years after the initial operation, with nearly 60% of excessive BMI still gone and a "considerable improvement or even remission" of comorbidities.
"Although sleeve gastrectomy was initially only carried out as the first part of a two-step procedure," they wrote, "we could show that a rather small percentage needed a second-line procedure ... for treatment of insufficient weight loss."
Laparoscopic Sleeve Gastrectomy (LSG) is gaining popularity, yet long-term results are still rare.
We present the five-year outcome concerning weight loss, modification of co-morbidities and late complications.
University affiliated teaching hospital, Switzerland.
This is a retrospective analysis of a prospective cohort with a minimal follow-up of 5 years. A total of sixty-eight patients underwent LSG either as primary bariatric procedure (n=41) or as redo-operation after failed laparoscopic gastric banding (n=27) between August 2004 and December 2007. At the time of LSG the mean body mass index (BMI) was 43.0 ±8.0 kg/m2, the mean age 43.1 ±10.1 years, and 78% were female. The follow-up rate one year postoperatively was 100%, 97% after 2, and 91% after 5 years; the mean follow-up time was 5.9 ±0.8 years.
The average excessive BMI loss after 1 year was 61.5 ±23.4%, 61.1 ±23.4% after 2, and 57.4 ±24.7% after 5 years. Co-morbidities improved considerably; a remission of type 2 diabetes could be reached in 85%. The following complications were observed: one leak (1.5%), 2 incisional hernias (2.9%), and new onset gastroesophageal reflux in 11 patients (16.2%). Reoperation due to insufficient weight loss was necessary in 8 patients (11.8%).
LSG was effective 5.9 years postoperatively with an excessive BMI loss of almost 60% and a considerable improvement or even remission of co-morbidities.
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.
Left - Fitbloggin' 2012 Right - This Week - Lost the regain - Also, 3 pounds to my lowest weight.
Several years ago, a woman messaged on a weight loss surgery forum and told me that my weight chart resembled a roller-coaster and that she wanted to "help me get control." After a quick Google search -- I noted she was seeking a new client for her weight loss surgery coaching business and dumped her "friendship."
Friends do not pay friends to help them lose weight, maintain weight loss or to help them lose regained weight after weight loss surgery. If you are paying someone for your friendship, it might be time to redefine that friendship -- just saying. I suppose this changes if your friend happens to be a weight loss professional? But how often does that happen -- and how many weight loss professionals would potentially destroy a friendship with aligning with your weight loss journey?
Um. No. A professional would NOT.
Weight loss is personal.
It is something you choose for yourself when you are ready.
Weight loss is not something you can be talked into - nor shamed into.
Regain after weight loss surgery is also a very touchy subject. Countless bariatric patients go through it -- and less want to talk about it. But it seems like everyone wants to sell "us" something to fix it.
Let me repeat -
Weight loss is personal.
It is something you choose for yourself when you are ready.
Weight loss is not something you can be talked into - nor shamed into.
Yet it seems like the larger community wants "us" (the regainers) to feel shamed for regaining and wants to sell us another quick-fix.
Let us discuss: Regain is common. How much? Some is very typical. Sometimes even a lot of regain is normal. You do not have to be sold into another diet, quick-fix, or scam. You need to remind yourself why you had weight loss surgery to begin with --
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.
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.
ObesityHelp is excited to announce the 10th Annual ObesityHelp National Conference at the Crowne Plaza in Anaheim, California on October 4th and 5th, 2013. The ObesityHelp National Conference is a celebration of health and wellness for those navigating their weight loss surgery journey. You’ll walk away inspired, motivated and with a larger support system than you started with. You will be part of change, gain knowledge from experienced professionals, and witness (or have your own) non-scale victories right at the conference.
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 -
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.
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
alcoholism, Bariatric surgery; Obesity; Metabolic surgery; Diabetes surgery; Metabolic syndrome; Clinical practice
guidelines; Best practice guidelines; Weight loss surgery, gastric bypass, obese, obesity, RNY, roux en y, WLS
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.
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."
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.
"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.
(This would have been a super time to try out my brand-new Nikon, so as not to take a iPad shot of a mobile phone photo?)
My good friend Wendy heard that Al Roker had a live book signing near her hometown last night, so like a good Bariatric Bad Girl, she went!
I didn't see her Facebook message to ME until the moment she was Sitting In the Bookstore With My Name On A Sticky-Note For Mr. Roker To Sign when I realized what was going on. (This is partly because I am without cell-plan, and only see messages when I am near the computer now. So, sorry?!) When I saw this I was like like, "Why is Wendy at a party with resin lawn chairs in January -- with a book -- wai -- wha??"
And then I remembered the proximity of her stalkery locale to New York City (no comment from the peanut gallery) and this happened.
Wendy had a brief opportunity to talk to chat with Mr. Roker about the BBGC Bariatric Bad Girls Club and discussed fundraising we've done with the Obesity Action Coalition. Thank you, Wendy -- and thank you Al!
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. "
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.
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. “Those 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.
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.
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.