Wednesday, May 25, 2016

Research into Hunger Related Hormones and Peptides Can Be Beneficial

As experts learn more about the pathophysiology of obesity, they are able to identify hormones and peptides that play major roles in weight loss and weight gain. There are certain hormones and peptides that are known to increase hunger, possibly leading to weight gain. And there are hormones and peptides that are known to decrease hunger, possibly leading to weight loss. But there is some question as to how these hormones and peptides function during weight maintenance.

Hormones or peptides that decrease hunger include leptin, peptide YY (PYY), gastric inhibitory polypeptide (GIP), and glucagon-like peptide-1 (GLP-1). Hormones or peptides that increase hunger include ghrelin and neuropeptide Y (NPY).  And it makes sense to assume that if there is an increase in hunger inducing hormones or peptides, that increase might boost the desire to eat, leading to weight gain. And if there is an increase in the hunger reducing hormones or peptides, that increase will lessen the desire to eat, thus causing weight loss.

So, research is being done to determine if increasing the number of hunger reducing hormones or peptides will lead to weight loss. For example, leptin, a hormone that is thought to be hunger reducing, was injected into obese subjects. But it was found that injecting leptin into obese patients did not lead to weight loss. However, injecting liraglutide, an analog of the hunger reducing peptide GLP-1, has led to weight loss. Indeed, the FDA recently approved liraglutide (trade name Saxenda) for obesity treatment.

While injecting the GLP-1 analog can lead to weight loss, how do GLP-1 and other peptides and hormones function during weight maintenance? A new study is shedding light on this question. The study shows how GLP-1 and PYY, both hunger reducing peptides, can work to help a person successfully maintain weight loss.

In the study, 20 obese patients in good health lost 13% of their weight by following a low calorie diet. After losing the weight, the patients were put on a 52 week maintenance program.  The patients maintained their weight loss. And the researchers concluded that "GLP-1 and PYY increased one year after weight maintenance" for successful weight loss maintainers.

So, we now have some idea of how some peptides function during weight maintenance. And we now know that research into hormones and peptides that influence weight loss and weight gain can produce valuable information. This information can be the forerunner of effective and safe therapies for weight loss and weight maintenance.

Tuesday, May 17, 2016

Questions about Bariatric Surgery

Bariatric surgery is, according to some, the best form of weight loss treatment for severely obese persons. But still, there are lingering questions about the safety and effectiveness of the surgery. For example, one question is this: Is bariatric surgery safe and effective for obese persons over the age of 60? And another question is this: What is the minimum number of surgeries a bariatric surgical center should have to perform before the center is deemed competent to perform high quality weight loss surgeries?

Concerning bariatric surgery for persons over the age of 60, a recent retrospective study looked at two weight loss groups to determine if bariatric surgery can safely and effectively be performed on persons over 60. One of the groups consisted of 40 patients, age 60 and above, who had RYGB (Roux-en-Y gastric bypass) or SG (sleeve gastrectomy) surgery. And the other group consisted of 40 patients, below the age of 60, who had had RYGB or SG.

Both groups of patients were looked at postoperatively up to one year. And there was no significant difference in readmission rates, weight loss, or complications between the 60-or-above group members and the below-60 group members. Therefore, the researchers concluded that good outcomes could result from RYGB or SG for persons age 60 and above.

And concerning the number of surgeries a center needs to have under its belt to be deemed proficient, one formerly accepted minimum number of 125 bariatric surgeries per year has been challenged. One of the first instances of the challenge was in 2013 when the American Society of Metabolic and Bariatric Surgery (ASMBS) issued a draft which supported the elimination of the 125 minimum. One of the reasons given for the elimination was the difficulty some hospitals had had meeting the 125-surgery yearly minimum.

One of the reasons for the 125 minimum was to insure that the weight loss surgeries were done under quality conditions. But a recent study has shown that, at least for laparoscopic sleeve gastrectomy (LSG), safe and effective surgeries can be performed at facilities that have done less than 125 LSG surgeries per year.

Thus, it appears that people 60 and older can feel comfortable getting SG and RYGB weight loss surgeries. Further, patients can feel comfortable getting LSG surgeries at facilities that have performed less than 125 surgeries annually. But remember, it is always a good idea to ask a lot of questions before undergoing any surgery. 

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