TOGA ProcedureTOGA Procedure (for "transoral gastroplasty"), incision free surgery for obesity

The first patient in the New York City area received incision free surgery for obesity as part of the ongoing multicenter TOGA Pivotal Trial at NewYork-Presbyterian Hospital/Columbia University Medical Center.

Drs. Marc Bessler and Daniel Davis performed the TOGA Procedure (for "transoral gastroplasty"), which, like other obesity procedures, is designed to alter the patient's stomach anatomy to give them a feeling of fullness after a small meal. The difference is that TOGA was performed under direct endoscopic visualization with specialized instruments passed into the stomach through the mouth without any incisions.

"This new surgery is an exciting option for severely overweight patients who do not respond to diet, exercise and drug therapy. We hope to show that, like other weight-loss operations, the TOGA procedure will help them to lose weight and improve their health," says Dr. Bessler, principal investigator and director of laparoscopic surgery and director of the Center for Obesity Surgery at NewYork-Presbyterian/Columbia. He is also an assistant professor of surgery at Columbia University College of Physicians and Surgeons.

In the new procedure, the surgeon introduces a set of flexible stapling devices through the mouth into the stomach, and uses them to create a restrictive pouch that is intended to catch food as it enters the stomach, giving patients a feeling of fullness after a small meal.

"The benefits of an endoscopic approach are less pain, quicker recovery, shortened hospital stay and decreased complications, as well as a lack of scarring," says study co-investigator Dr. Davis, a surgeon at NewYork-Presbyterian Hospital/Columbia University Medical Center and assistant professor of surgery at Columbia University College of Physicians and Surgeons. "Eventually, TOGA may also be an option for patients who are unable or unwilling to undergo more invasive surgery."

A 2006 - 2007 pilot study at medical centers in Mexico and Belgium found that patients receiving the TOGA procedure lost more than a third of their excess body weight. By 12 months, their excess weight loss averaged almost 40 percent.

In the current study, two out of three patients will receive the TOGA procedure, while one out of three will receive a control procedure, which is similar to the TOGA procedure except no pouch is created. After one year, patients will be told which procedure they received, and patients who received the control procedure will be offered the TOGA procedure if they continue to meet the treatment criteria.

Patients enrolled in the clinical trial will be followed for a minimum of 12 months. All study-related medical care will be provided at no charge to the patient, and patients will receive medically supervised nutritional counseling.

The purpose of the TOGA Pivotal Trial is to evaluate the safety and effectiveness of the TOGA procedure. Investigators will be evaluating weight loss and changes in obesity-related health problems such as Type 2 diabetes, cholesterol levels and hypertension. If successful, it's hoped that this study will result in FDA approval of the TOGA System, which will allow patients to be treated outside of clinical trials. Currently, the TOGA System is an "investigational device" and can only be used in clinical studies.

NewYork-Presbyterian/Columbia plans to enroll at least 15 patients out of a total 275 patients to be enrolled at centers nationwide. Volunteers must be 18 to 60 years old and 100 pounds or more overweight, and must have been unsuccessful with non-surgical weight-loss methods.

Obesity is a global disease affecting over 300 million people, according to the World Health Organization. Obesity causes or contributes to numerous serious medical conditions, including Type 2 diabetes, hypertension, cardiovascular disease, arthritis, sleep apnea and certain types of cancer.

Source: Medical News Today

Vigabatrin also led to rapid weight loss

US scientists testing the epilepsy drug vigabatrin (GVG) as a potential treatment for drug addiction, discovered that it also led to rapid weight loss and reduced food intake in genetically bred obese rats.

The discovery by scientists at the US Department of Energy's (DOE) Brookhaven National Laboratory, is published in the 20 August advance online issue of the journal Synapse.

Vigabatrin is currently being tested throughout the US in Food and Drug Administration (FDA) approved Phase II trials for the treatment of cocaine and methamphetamine addiction.

For this latest study, the scientists at the DOE's Brookhaven Laboratory found that rats that were genetically bred to be obese showed a 19 per cent loss of total body weight while rats that were not obese lost 12 to 20 per cent, after less than two months on vigabatrin.

Study leader Amy DeMarco, who works with co-author and senior scientist at the Laboratory, Stephen Dewey, said it appeared that the drug made the animals feel full:

"Our results appear to demonstrate that vigabatrin induced satiety in these animals."

Dewey's team was the first to discover vigabatrin as a potential treatment for addiction. They have been investigating the drug for more than 20 years.

Earlier research at Brookhaven discovered a strong link between obesity and addiction, characterized by similar changes in brain activity of the obese and addicts depedent on drugs like cocaine. This prompted Dewey and colleagues to try and find out if vigabatrin would quench food cravings as it does drug cravings. As Dewey explained:

"Given the growing obesity epidemic, we felt that examining vigabatrin's therapeutic efficacy for obesity was particularly relevant."

For the study, Dewey, DeMarco and colleagues assigned 50 adolescent and adult genetically bred "fat" and normal weight rats either to a control group or to groups that were given varios doses of vigabatrin and monitored them for up to 40 days.

The control group rats were given daily injections of saline, while the drug groups were injected with up to 300 mg of of vigabatrin a day. The injection phases lasted for two periods of 7 to 13 days, with breaks in between.

After 40 days, all the animals treated with vigabatrin weighed significantly less than those that received only the saline injections (the controls).

The biggest weight loss and reduction in food intake was in the group that had the biggest dose, the 300 mg dose of vigabatrin. The obese rats lost an average of 19 per cent of their body weight, and the non obese animals lost between 12 and 20 per cent.

Dewey said that the fact the results occurred in the genetically obese animals "offers hope that this drug could potentially treat severe obesity".

"This would appear to be true even if the obesity results from binge eating, as this disorder is characterized by eating patterns that are similar to drug- taking patterns in those with cocaine dependency," he added.

Source: Medical News Today

Poorer cognitive function in childhood may be linked to obesity and type 2 diabetes in adults.

The findings, based on 11,041 individuals in the ongoing National Child Development Study in Great Britain, showed that children who showed poor hand control, poor coordination, and clumsiness at age 7 in testing were more likely to be obese adults. Those with poorer functioning motor skills at age 11 also tended to be obese at age 33.

Adjusting for factors that may influence the results, such as childhood body mass and family social class, did not change the results. However, the study did not delve into specific biological processes that may explain poorer physical control and coordination in childhood with adult obesity.

"Some early life exposures (such as maternal smoking during pregnancy) or personal characteristics may impair the development of physical control and coordination, as well as increasing the risk of obesity in later life," the authors, from Imperial College London and Orebro University Hospital & Karolinska Institute in Stockholm, wrote.

"Rather than being explained by a single factor, an accumulation throughout life of many associated cultural, personal, and economic exposures is likely to underlie the risks for obesity and some elements of associated neurological function," they concluded.

Source: HealthDay

Some obese people are in good health

And are not predisposed to heart ailments, according to a surprise study published in the Archives of Internal Medicine. And yet another study showed that being slim doesn't automatically protect you from heart-related illnesses such as high blood pressure and cholestrol, and diabetes.

In the first study, conducted by Norbert Stefan and a team at the University of Tubingen in Germany, the researchers studied the fat around the internal organs and under the skin of 314 individuals with an average age of 45.

The obese individuals in the study were divided into two groups: those who were resistant to insulin and those who were not. Insulin resistance is a pre-diabetic condition, meaning some symptoms of diabetes are present and progression to full-blown diabetes is likely.

Those who were obese and resistant to insulin had more muscle fat, fat in their livers and thicker carotid-artery walls -- an early sign of artery narrowing, which is a heart-disease risk factor -- than obese individuals without insulin resistance, the study found.

In addition, obese individuals who were not insulin-resistant had no differences in artery-wall thickness from the normal-weight group. "We provide evidence that a metabolically benign obesity can be identified and that it may protect from insulin resistance and atherosclerosis," the researchers wrote.

The second study carried out by Rachel Wildman at the Albert Einstein College of Medicine in New York examined body weight and cardio-metabolic abnormalities -- including high blood pressure, elevated triglycerides and low levels of so-called good cholesterol -- in 5,440 individuals between 1999 and 2004.

The study found that some obese people are metabolically healthy.
"Obese individuals with no metabolic abnormalities were more likely to be younger, black, more physically active and have smaller waists than those with metabolic risk factors," the authors wrote. Those of normal weight with health risks were older, less active and had a larger waist than the average population.

Among the US population aged 20 and older, some 23 percent (16 million adults) of normal weight have metabolic abnormalities, while 51 percent (36 million) of overweight adults and 32 percent (19.5 million) of obese adults "were metabolically healthy," the authors wrote.

Source: Yahoo! News

Eating two eggs for breakfast helps overweight adults lose more weight

And feel more energetic than those who eat a bagel breakfast of equal calories. [1] This study supports previous research, published in the Journal of the American College of Nutrition, which showed that people who ate eggs for breakfast felt more satisfied and ate fewer calories at the following meal.

"People have a hard time adhering to diets and our research shows that choosing eggs for breakfast can dramatically improve the success of a weight loss plan," said Nikhil V. Dhurandhar, Ph.D., lead researcher and associate professor in the laboratory of infection and obesity at Pennington Biomedical Research Center, a campus of the Louisiana State University system. "Apparently, the increased satiety and energy due to eggs helps people better comply with a reduced-calorie diet."

Significant Weight Loss Related to Egg Breakfast

Compared to the subjects who ate a bagel breakfast, men and women who consumed two eggs for breakfast as part of a reduced-calorie diet:

- lost 65 percent more weight
- exhibited a 61 percent greater reduction in BMI
- reported higher energy levels than their dieting counterparts who consumed a bagel breakfast [1]

The egg and bagel breakfasts provided the same number of calories and had identical weights (energy density), which is an important control factor in satiety and weight loss studies.

The researchers also found that blood lipids were not impacted during the two month study. They found that blood levels of HDL and LDL cholesterol, as well as triglycerides, did not vary compared to baseline cholesterol blood levels in subjects who ate either the bagel or egg breakfasts. These findings add to more than 30 years of research that conclude that healthy adults can enjoy eggs without significantly impacting their risk of heart disease.

New Emphasis on the Importance of High-Quality Protein

This study adds to the growing body of research which supports the importance of high-quality protein in the diet. The American Journal of Clinical Nutrition (AJCN) published a special issue in May 2008, which contains nine articles that focus on the value of high-quality protein in the American diet. A major finding was that not getting enough high-quality protein may contribute to obesity, muscle wasting (loss) and increased risk of chronic disease.

Source: Medical News Today