Friday, December 31, 2010

Bariatric Surgery, A Possible Treatment for Obese Heart Failure Patients

To be considered for bariatric or weight-loss surgery today, using the National Institutes of Health (NIH) guidelines, a person must have a BMI greater than 40 or a BMI greater than 35, with weight related comorbidities. The comorbidities include type II diabetes and sleep apnea and hypertension.

A Mayo Clinic study "found that morbidly obese heart failure patients who undergo bariatric surgery gain long lasting and meaningful improvements in diabetes symptoms and quality of life". The researchers also state that bariatric surgery could become part of the treatment for obese patients who experience heart failure if there are no contraindications for the surgery. The researchers point out, however, that most cardiologists don't "refer for obese patients with heart failure for bariatric surgery."

Of course, more study needs to be done to support enlarging the treatment options for obese heart failure patients. The study looked at only thirteen patients. But since weight loss has been proven to have positive effects on type II diabetes, hypertension and cholesterol, it is quite possible that weight loss and weight management would benefit heart failure patients who are obese. And indeed bariatric surgery would play a significant role here.

We should also point out that in addition to bariatric surgery, nonsurgical weight loss methods deserve some attention. If cardiologists partnered with physicians who are expert in nonsurgical weight-loss treatments, obese patients who have experienced heart failure, but don't qualify for bariatric surgery for some reason, could receive medical weight-loss treatment that could improve their
diabetes symptoms and quality of life.

Perhaps bariatric surgeons and physicians who specialize in nonsurgical medical weight loss (bariatricians) should contact cardiologists, and try to enter into a relationship with them. This relationship would benefit the patient and the cardiologist. This relationship could also benefit the bariatrician by increasing his patient base.

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Friday, December 17, 2010

The CDC Underestimated the Overweight Problem

In 2005, CBSNews reported on a study by the Centers for Disease Control (CDC) that showed "that people who are modestly overweight actually have a lower risk of death than those of normal weight." The CDC's conclusions created a lot of confusion, because they implied that being overweight was not the serious problem Americans had been led to believe. Well, a new study published in the New England Journal of Medicine concludes that both obesity and overweight are "associated with increased all-cause mortality."
The study is further summarized on WebMD. Although the study pooled data from research where the subject population consisted of white adults, we believe that the results apply to most population groups. So, contrary to the CDC's 2005 conclusions, being just a little overweight increases your risk of death compared to someone of normal weight.
Indeed, the WebMD summary shows that if your BMI is between 25.0 and 29.9, your risk of death increases by 30%; if your BMI is between 30 and 34.9, your risk of death increases by 44%; if your BMI is between 35.0 and 39.9, your risk of death increases by 88%; and if your BMI is between 40 and 49.9, your risk of death increases by 251%.
Although the significance of being overweight is becoming more and more apparent, weapons to combat the problem are not being created fast enough. In fact, the number of weapons is decreasing. Sibutramine (Meridia) was recently taken off the market for health reasons, and two promising new weight loss drugs, qnexa and lorcaserin, were rejected by the FDA this year. Still, there are two recent bright spots in the fight against overweight and obesity.
The FDA is considering a reduction in BMI guidelines normally used for lap band surgery. Currently, it is recommended that a person have a BMI greater than 40, or a BMI between 35 and 40, with weight related comorbidities, in order to to be considered for bariatric surgery.

However, the FDA is considering lowering these guidelines by five points. Under the new guidelines, an obese person with a BMI of 35 would be a candidate for the surgery, and someone with a BMI between 30 and 35 would be a candidate, if the person has certain weight related comorbidities.

Another bright spot in overweight and obesity weaponry is the possible addition of a new FDA approved weight loss drug. The drug, contrave, has received the recommendation of an FDA panel.

However, even in light of these bright spots, there is a dearth of tools available to fight the overweight and obesity problems. So we must learn to use the tools we now have more effectively. This reality puts pressure on bariatric surgeons and physicians specializing in nonsurgical medical weight loss. This reality also offers opportunities for these two groups of physicians to work together.

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Thursday, December 2, 2010

Suicide Appears to be Linked to Bariatric Surgery

Bariatric surgery has become the gold standard for treating morbidly obese patients (patients with a BMI greater than 40). And the number of patients obtaining the surgery increased at least tenfold between 1998 and 2008. Therefore, bariatric surgery has achieved prominence over the past decade. However, research done at the University of Pittsburgh, in Pennsylvania, suggests that suicide may be a significant complication of the weight loss surgery.

The research, which investigated a link between suicide and bariatric surgery, was highlighted in an October 2007 Medscape article. The title of the article was "Higher-Than-Expected Suicide Rate Following Bariatric Surgery." And a November 2010 Pub Med abstract entitled, "Risk of Suicide After Long-term Follow-up of Bariatric Surgery,” also documented work done at the University. The work was directed at examining the risk of suicide a year or more after bariatric surgery.

The 2007 investigation looked at data pertaining to obese residents in Pennsylvania who had undergone bariatric surgery between January 1, 1995 and December 31, 2004. During this period, there were 440 deaths among the bariatric patients. And at least 16 of these deaths were due to suicide.

"Based on statistics for the general US population," only two of the 440 deaths should have been attributable to suicide. Therefore, because of the increased number of suicides, some of the suicides are likely linked to the bariatric surgery.

The suicides occurred at least one year following the surgery. This leads to the conclusion that follow-up intervention, to bariatric surgery, may be crucial to long-term mental health, as well as physical health. In fact, counseling prospective bariatric surgical patients before the surgery is important, since some of the obese patients are probably suffering from depression.

Hence, primary care physicians and bariatricians could indeed play vital preoperative and postoperative roles in the overall obese patients' treatment. The physicians could work with the patients before the surgery, helping the patients prepare for the surgery. And the physicians could provide long-term counseling and other services after the surgery.

As some experts have said, non-surgical and surgical bariatric practitioners must work together to produce weight loss and long-term weight management among obese patients. This collaboration would be quite beneficial to the patients, since the non-surgical practitioner would be able to provide the patients with ongoing medical weight management support.

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