I read with great interest the article “Gastric Migration Crisis in Obesity Surgery” recently published in Obesity Surgery. The author, Dr. Runkel, is concerned about the increasing numbers of intra-thoracic migration of gastric sleeve leading to GERD and Barrett’s esophagus development. Continue reading “Gastric Sleeve Migration in Weight loss Surgery”
“Without data, you are just another person with an opinion”, concluded R. Cohen MD his attack and critique of the novel weight loss procedure, endoscopic sleeve gastroplasty also known as Endosleeve. Cohen et al conducted a systemic review regarding the efficacy and safety of endoscopic sleeve gastroplasty. The authors found no supporting scientific evidence to recommend the use of endoscopic sleeve gastroplasty for treatment of obesity in clinical practice. Continue reading “Endoscopic Sleeve Gastroplasty Under Fire”
A recent study by Courcoulas et al titled “Patient behavior and Characteristics Related to Weight Regain after Roux-en-Y gastric Bypass” highlights certain behaviors associated with weight regain years after bariatric surgery. Continue reading “Weight Regain after Bariatric Surgery”
Over the past 50 years a number of gastroplasties have been developed to treat obesity. From the first horizontal gastroplasty to the latest endoscopic sleeve gastrectomy, bariatric surgeons in Houston and all over the world attempted to reduce stomach volume in hopes of restricting food intake and promoting weight loss. Continue reading “Is Sleeve Gastrectomy the Best Gastroplasty for Weight Loss?”
Felsenreich et al. recently published in the journal of Obesity Surgery a very interesting study on gastric sleeve surgery long-term outcomes. The study is titled: “Update: 10 years of sleeve gastrectomy-the first 103 patients” and includes all patients who had gastric sleeve surgery prior to 2006 at participating bariatric centers in Austria. Continue reading “Does Gastric Sleeve Surgery Cause Barrett’s Esophagus?”
There is widespread belief that weight loss surgery is a last resort treatment for patients who are struggling to lose weight. Indeed, most primary care physicians, endocrinologists and cardiologists do not refer an obese patient for gastric sleeve or Roux-en-Y gastric bypass surgery until it is too late. Endocrinologists resort to escalating doses of long acting insulin in hopeless attempts to control blood sugar. Cardiologists spend countless hours chasing high cholesterol and blood pressure. Pulmonologists work tirelessly adjusting CPAP machines to improve breathing and control sleep apnea… The result is disease progression with more weight gain, shortened survival, and poor quality of life.
Weight loss surgery is currently the only effective, reliable and durable treatment for obesity and associated diseases like type 2 diabetes. Furthermore, weight loss surgery is safe with less than 1% mortality and morbidity rates. Accordingly, gastric sleeve and gastric bypass procedures must be considered early in the disease process. Young patients have many productive years ahead of them. The earlier we intervene in a chronic disease, the more effective the treatment can be and the longer it can last. Studies have clearly shown that the longer the duration of type 2 diabetes, the less likely is the resolution rate following laparoscopic sleeve gastrectomy. So why wait? Intervene now to relieve your body from the toll of obesity. Stop the Yo-Yo dieting for good and throw away all the supplements you are taking to lose weight. Reverse the damage obesity has incurred on your health and gain back your life.
If you suffer from excess weight and other obesity related diseases call the experts at Houston Weight Loss Surgery Center for a complimentary consultation.
Surg Obes Relat Dis. 2011 Nov-Dec;7(6):697-702.
Ten-year duration of type 2 diabetes as prognostic factor for remission after sleeve gastrectomy.
Casella G1, Abbatini F, Calì B, Capoccia D, Leonetti F, Basso N.
This month I read a very interesting study on long term weight loss outcome following bariatric surgery performed at Veterans Affairs, VA, medical centers. The first study is published online in JAMA Surgery by first author Matthew Maciejewski from Durham VA medical center. The retrospective study evaluated long-term weight loss in 1787 veterans who underwent gastric bypass surgery in VA facilities between 2000 and 2011. The majority of patients were white males with a mean BMI at 47.7. The control groups consisted of 5305 patients who did not undergo surgery and had a mean BMI of 47.1. The 10 year follow up rate was around 82% for the gastric bypass group and 67.4% for the control group. At 10 years, the majority of gastric bypass patients have lost more than 20% of their pre-operative weight compared to 11% of the control group. Only 3% of the gastric bypass patients have gained their weight back at 10 years. Continue reading “Bariatric Surgery Weight Loss Outcome at VA Medical Centers”
The study is titled: ”Excess weight loss and cardio-metabolic parameter reduction diminished among Hispanics undergoing bariatric surgery: Outcomes in more than 2000 consecutive Hispanic patients at a single institution”. It was published in the journal of The American College of Surgeons, JACS, in this month issue.
2002 Hispanic patients underwent bariatric surgery from 2008 till 2014 including 1235 gastric bypass, 600 gastric sleeve and 167 gastric band surgeries. This is the largest series published so far for Hispanic patients undergoing weight loss surgery. Hispanic adults are twice more likely to have diabetes and suffer more serious complications than non-Hispanic whites. Hispanics have a higher incidence of end stage renal disease when compared to Caucasians and have demonstrated a higher increase in the metabolic syndrome over the past 30 years when compared to non-Hispanic whites. It is obvious that the burden of obesity is significant in the Hispanic community and this study is quite relevant to our Houston patient population.
Bariatric surgery is the most effective and reliable treatment for morbid obesity and diabetes as well as other obesity related comorbidities. We now have 11 randomized controlled trials demonstrating the superiority of surgical over medical treatment for diabetes. However, the efficacy of bariatric surgery in minority groups in the United States has not been well defined. This report offers a comprehensive evaluation of bariatric surgery outcome in Hispanic patients. It demonstrates that gastric bypass and sleeve surgeries are effective weight loss modalities. There was a significant decrease in insulin, oral hypoglycemic, and hyperlipidemia medications after gastric bypass and gastric sleeve surgery. Interestingly, acid reflux medication reduction or elimination was higher for gastric sleeve patients (40%) compared to 34% for gastric bypass patients. However, these numbers are much lower than the reported rates of 74% in non-Hispanic cohorts. Similarly, excess weight loss was significantly lower in this study group when compared to non-Hispanic white and African American cohorts studied at other large volume bariatric centers.
The retrospective nature of this study has several limitations but does raise some interesting questions. Further prospective and randomized studies are needed to answer these questions. Why are patients of Hispanic origin less successful with gastric sleeve and bypass surgery than other ethnic groups? Is it related to certain genetic differences or lifestyle disparities? Why do patients of Hispanic origin continue with acid reflux medications especially after gastric bypass surgery? Are these medications prescribed to them or bought over the counter? Do they really have acid reflux disease or just treating dyspepsia related symptoms? We hope that additional studies will help answer these questions in the near future.
“Insurance-mandated medical weight management before bariatric surgery” by Manish Parikh, M.D. et al from the department of Surgery of New York University Langone Medical Center. This interesting study is published in the current issue of SOARD. It assesses the effect of insurance mandated medical weight loss programs on weight loss outcomes after bariatric surgery. A total of 1432 patients were analyzed retrospectively including a control group of 560 patients. There was no weight loss difference between both groups at one and 2 year follow up.
There is no doubt that patient education prior to bariatric surgery is crucial. Obesity is a lifestyle disease. Almost all patients I see in my practice presenting for gastric sleeve or bypass surgery consume junk and processed food on daily basis. They have no time to cook at home and very little time to exercise. They skip breakfast and eat heavy rich food at night. Many use food as a coping mechanism and are addicted to sugar in the form of soda, sweet tea or candies. Obviously, there is a role for education here. Some patients require one or two educational visits and others will never learn how to change their habits and lifestyle. Those who don’t learn or are not capable of changing their habits and daily living do not qualify for bariatric surgery even after they meet the insurance requirement for pre-operative medical weight loss.
This study proves that the insurance requirements are rigid, ineffective and not suitable for every patient. I would rather see the insurance companies create lifestyle programs that promote healthy eating and living. Through these programs patients are screened and referred to bariatric surgery if found appropriate. Bariatric surgery is currently the most effective treatment for obesity. It is a durable solution especially when patients adheres and adopts healthy eating and exercise habits. Gastric bypass and sleeve procedures save lives, resolve comorbidities and ultimately save money for both insurance companies and government. Insurance companies, public health officials and the federal government should work together to promote effective weight loss solutions and most importantly preventative measures to curb the obesity epidemic. Unfortunately, we are still dabbling with archaic rules and regulations that make no sense and are preventing qualified patients from getting the care they deserve.
Finally, I would like to emphasize the importance of post-operative follow up and supervised medical weight loss. Obesity is a chronic disease and weight loss is a lifetime battle. Bariatric surgery gives you the edge in this battle but you must keep fighting weight gain even after successful weight loss surgery.