Gastric bypass surgery restores sexual function in morbidly obese men

Losing weight may help resolve erectile dysfunction in obese men, according to research presented today at the 103rd Annual Scientific Meeting of the American Urological Association (AUA). Morbid obesity can cause sexual dysfunction independent of other common confounders, including diabetes, hypertension and smoking. In this study from researchers in Boston and Philadelphia, sexual function was normalized in some men who underwent gastric bypass surgery for weight loss.

“This study shows that weight loss and other risk factors which are alleviated by weight loss may be keys to restoring sexual function,” said Anthony Y. Smith, M.D. “These results give men another reason to improve their health by losing weight.”



In this study, 95 patients undergoing gastric bypass surgery for weight loss completed the Brief Sexual Inventory (BSI) pre- and post-operatively. On average, BSI scores improved in all categories, including sexual drive, erectile function, ejaculatory function, problem assessment and sexual satisfaction. The amount of weight lost predicted the degree of improvement in all areas of the survey. Results were then compared to data from the Olmstead County Study of Urinary Health Status Survey, a community-based prospective study often used as a baseline for study comparison. After an average of 67 percent weight loss post-bypass, BSI scores were comparable to patients in the Olmstead Study.

Gastric bypass surgery, a procedure that reduces the body’s caloric intake, can be used to induce significant weight loss in the obese. Calorie reduction is accomplished by making the stomach smaller and bypassing part of the stomach and small intestines so that fewer calories are absorbed. The patient feels full faster and learns to reduce the amount of food that he/she eats.

Source: EurekAlert

Gastric bypass surgery may help protect against infections and cancer by improving the activity of certain immune cells

Another health benefit of bariatric weight-loss surgery may be a heightened immune defense against cancer and infections, a new study suggests. The results will be presented at The Endocrine Society's 90th Annual Meeting in San Francisco.
"Obesity is related to a higher rate of infections and some types of cancer," said a study coauthor, Alfredo Halpern, PhD, of the University of São Paulo, Brazil.


"Nevertheless, there are only a few published studies evaluating the immune function in severely obese patients and the effect of surgery-induced weight loss on these parameters."

Halpern and his co-workers therefore studied the effect of weight loss on immune function in 28 morbidly obese patients who had traditional "stomach-stapling" (Roux-en-Y) gastric bypass surgery. The 20 women and eight men lost an average of 78.5 pounds 6 months after gastric bypass. This operation permanently reduces the size of the stomach and bypasses part of the intestines, thus restricting food intake and food absorption.

Before and 6 months after the surgery, the researchers evaluated patients' blood samples for natural killer (NK) cells, which play a critical role in controlling infections and cancer. Specifically, they measured the number of NK cells and the cells' capacity to kill infected cells or tumor cells. They also looked at the production of certain cytokines, proteins that are essential to the immune response.

Although the number of NK cells did not increase with surgically induced weight loss, their activity changed, Halpern said. Before surgery, NK cells mounted a weak immune defense, but after surgery their activity increased by nearly 79 percent, representing an improvement in the effective immune response and, possibly, in the ability to fight cancer and infections.

The response of cytokines involved in NK cell activity also changed after weight loss, possibly affording higher protection against infection and cancer, the researchers found. Cytokines analyzed were interferon-gamma and interleukins 2, 12 and 18.

Prior studies have shown that bariatric surgery has many health benefits, including resolution of type 2 diabetes, improved blood pressure and lower risk of premature death. This study shows another possible benefit of the weight loss stemming from bariatric surgery. He said the impaired NK cell function evident in extremely obese people may even explain their propensity to develop infections and cancer.

Source: EurekAlert

TOGA Transoral gastroplasty, less invasive way to treat obesity

Drs. Roger de la Torre and J. Stephen Scott, on staff at the SSM Weight Loss Institute at SSM DePaul, and Dr. Thomas J. Fogarty, developed the first endoscopic gastric bypass procedure. The procedure, called transoral gastroplasty (TOGA), involves the use of flexible instruments inserted into the stomach through the mouth.

With the aid of an endoscope, doctors position a sleeve and staple a section of the stomach into a small pouch that slows down digestion and makes patients feel full after eating a small amount of food.

Obesity is a national epidemic and this procedure has the potential to open the door for more patients to receive a potentially life-saving cure,” Dr. Scott said.

Unlike other bariatric procedures, the TOGA does not require any incisions. That translates into quicker recover times, shortened hospital stays, and a decreased risk of complications. TOGA also can be used on patients who are heavier or lighter than those who qualify as candidates for more traditional gastric bypass surgery. The procedure has been tested in other countries since 2006. However, the first U.S. study began in July 2008, when a woman from Granite City, Ill., had the procedure done in St. Louis. U.S. Food and Drug Administration approval is pending upon the completion of the study.

Source: SSM Health Care

Hunger hormone ghrelin could be as effective as bariatric surgery

US researchers working with pigs discovered a way of lowering appetite as effectively as bariatric surgery except they used minimally invasive surgery that suppresses the hunger hormone ghrelin by vaporizing the main blood vessel that carries blood to the top section of the stomach (the fundus). The study was the work of researchers at Johns Hopkins Medical Institutions in Baltimore, Maryland, and the School of Veterinary Medicine, University of Pennsylvania, Philadelphia, and is published in the October 1st issue of Radiology.

The researchers wrote that about 90 per cent of the body's ghrelin comes from the fundus, and it needs a good blood supply to make it.

First author Dr Aravind Arepally said:

"With gastric artery chemical embolization, called GACE, there's no major surgery."

"In our study in pigs, this procedure produced an effect similar to bariatric surgery by suppressing ghrelin levels and subsequently lowering appetite," added Arepally, who is clinical director of the Center for Bioengineering Innovation and Design and associate professor of radiology and surgery at the John Hopkins University School of Medicine.

Arepally and colleagues wrote that the last ten years have seen several unsuccessful attempts to suppress grehlin safely and easily.

Bariatric surgery is where part of the stomach or bowel is either removed, reconstructed or bypassed. It suppresses appetite and results in significant weight loss. However, there are significant risks because it is an invasive and complex procedure.

Arepally explained that:

"Obesity is the biggest biomedical problem in the country, and a minimally invasive alternative would make an enormous difference in choices and outcomes for obese people."

For the study, Arepally and colleagues worked with 10 healthy and growing pigs for 4 weeks. Pigs were chosen because they their bodies have similar anatomy and physiology to humans. Baseline readings for ghrelin and other measures were obtained by fasting the pigs overnight, weighing them and taking blood samples.

The pigs were then put into two groups, one for the treatment and the other was the control group. Both groups underwent a procedure that used X rays to guide the surgery where researchers inserted a thin tube in the large blood vessel near the groin and then into the left gastric arteries supplying blood to the stomach.

In the treatment group (GACE group) they injected the site once with sodium morrhuate, a chemical that destroys blood vessels, and in the control group they injected the site once with saline.

The researchers monitored the blood levels of ghrelin for 4 weeks.

The results showed that:
Changes in ghrelin levels over time were significantly different between control and GACE treated pigs (P < .004). In the GACE treated pigs, the levels of ghrelin were suppressed by as much as 60 per cent compared to baseline levels. The percentage change in ghrelin levels in GACE treated pigs went down from baseline to -34, -38.6, -42.5, and -12.9 per cent during weeks 1 to 4, respectively. In the control pigs, the percentage change in ghrelin was -1.7, -9.7, +2.6, and +18.2 per cent during weeks 1 to 4, respectively. At the end of 4 weeks, the control pigs continued to gain weight, putting on 15.1 per cent their original weight in that time, while the GACE pigs' weight plateaued at an increase of 7.8 per cent from their original weight.

The authors concluded that: "Catheter-directed GACE can suppress the appetite hormone ghrelin and affect weight gain." Arepally said appetite is not an easy process to understand or control because it involves both the body and the mind. Ghrelin levels go up and down throughout the day, and they respond to emotional as well as physiological circumstances. "But", Arepally pointed out, "even if the brain says 'produce more ghrelin', GACE physically prevents the stomach from making the hunger hormone".

Source: Medical News Today

Using sibutramine or phentermine in tandem with pramlintide can enhance weight loss

Amy Halseth, MD, Amylin Pharmaceuticals, San Diego, California, and colleagues randomised 244 overweight or obese patients after a 1-week placebo run-in period to 24 weeks of subcutaneous injections of placebo or pramlintide 120 mcg TID alone or in combination with sibutramine 10 mg QAM or phentermine 37.5 mg QAM. Participants also received dietary counselling.

Pramlintide combined with sibutramine produced an 11.3 +- 1.2 kg mean weight loss, while pramlintide coupled with phentermine produced an 11.3 +- 0.9 kg mean weight loss. Subjects treated with pramlintide alone lost a mean of 3.6 +- 0.7 kg, and placebo-treated patients lost a mean of 2.1 +- 0.9 kg (P < .0001 combination arms vs pramlintide or placebo).

More patients achieved 5% or greater weight loss and 10% or greater weight loss in the pramlintide-sibutramine (78% and 49%, respectively) and pramlintide plus phentermine (82% and 56%, respectively) groups than pramlintide (36% and 11%) or placebo treatment groups (28% and 3%, respectively).

Three serious events occurred -- 2 with placebo, 1 with pramlintide plus phentermine. None of these events was judged to be related to the study medication. The most frequently observed adverse events were similar to those that have been previously reported with these agents when used individually, and no novel safety or tolerability issues arose with either medication, according to the researchers.

The robust weight loss (about 11% from baseline) with pramlintide plus sibutramine and pramlintide plus phentermine seen in this study confirms the potential for the development of combination treatment for obesity, Dr. Halseth said in a presentation on September 9.

She also noted that the findings corroborate earlier experimental data suggesting that targeting multiple pathways using the combination of pramlintide and other centrally-acting agents may produce robust weight loss.

Finally, she noted that future studies should assess more fully the potential risks of combination therapies in future studies.

Source: Doctor's Guide

Gastric bypass surgery is more likely to result in successful weight loss, than is gastric banding

According to one of the first head-to-head comparisons of the two most commonly used surgeries in obese patients.

Patients who underwent the bypass procedure also lost more weight and showed more consistent weight loss, Dr. Nancy Puzziferri of The University of Texas Southwestern Medical Center in Dallas and colleagues report.

Although evidence supports a faster weight loss with gastric bypass, 3 years after surgery the results of bypass and banding were the same, Puzziferri and her colleagues note.

However, the pros and cons of each procedure need to be weighed for each patient, they add. Bypass is a riskier and more complicated surgery, and banding requires more intensive follow-up.

"Risk-benefit ratios and the patient's ability to return to clinic are critical factors in choosing which procedure better suits a particular patient," they write in the Annals of Surgery.

To better understand how outcomes compare for the two procedures, Puzziferri's team evaluated 1,102 patients who had undergone gastric bypasses and 631 who had gastric banding at their center between 1997 and 2006. A total of 1,518 patients were available for evaluation.

Bypass patients lost more weight, lost it faster, and were less likely to have transient weight gain than patients who had the band procedure. The results of the bypass procedure were also more consistent from patient to patient.

While 18.1 percent of the band patients had lost less than 25 percent of their body weight 2 years later (the goal was 40 percent or more), just 2.6 percent of bypass patients did.

While 53.2 percent of the bypass patients lost at least 75 percent of their excess body weight by the study's end, 9.8 percent of the patients who underwent banding did.

The bypass patients were more than 18-times as likely as the banding patients to have achieved successful weight loss within 6 months of having the procedure, and 2 years out their odds of success were 9-times greater.

Weight loss with gastric banding is similar to the gradual loss seen with low-calorie diets, the researchers note. "Behavioral practices may be more critical to weight loss success in gastric band than in gastric bypass," they suggest.

"Despite its higher operative risk, gastric bypass may be a better choice for selected patients," the researchers add. They suggest that a larger study with at least 5 years of follow-up is needed to clarify how the risks, benefits and costs of the two procedures compare.

Source: Yahoo News

Drinking enhanced green tea helps you to lose weight

With all the hype about diet tea and weight loss going around lately, the consumerunderground.com team did some investigating.

Claims from the companies who make tea range anywhere from increased energy, weight loss, cancer prevention, anti-aging, stopping certain neurodegenerative diseases such as Alzheimer's and Parkinson's, fat burning properties and more.

Joy Bauer, a New York City nutritionist, says (the catechins in green tea) increase levels of the metabolism speeding brain chemical norepinephrine (noradrenaline).

Conducting a little experiment, with three women, ranging in height and weight, each drink a different weight loss tea for 30 days. They each drank 2 cups of tea a day and continued with their normal eating and exercise habits. They were weighed in before starting the tea and after 30 days of drinking the tea.

While none of these women reported any miracle disease cures one reported that she felt increased brain activity at work, which she assumed was from drinking the tea. Additionally each one reported some weight loss, which is very positive. Overall, it's safe to conclude that drinking enhanced green tea products to assist your weight loss is a worthy pursuit in your well rounded fitness program.

Source: Medical News Today

The most cost-effective treatment for obesity is bariatric surgery

Health insurers can offset the cost of laparoscopic or traditional bariatric surgery as a weight-loss treatment for obese patients within two to four years as a result of savings on other medical costs, according to a study published this month in the American Journal of Managed Care, the Wall Street Journal reports.

For the study, Pierre-Yves Crémieux, a health economist and principal at Analysis Group, and colleagues analyzed health insurance claims data for 2003 through 2005 for 3,651 severely obese patients who underwent either laparoscopic or traditional bariatric surgery. The patients in large part were female, with an average age of 44; more than one-third of the patients had high blood pressure, and many of them had high cholesterol, diabetes and other health problems.

Researchers matched each patient based on age, gender, geography, health status and baseline costs with a patient who did not undergo either of the surgeries. Researchers tracked claims data for the patients who underwent either of the surgeries for six months of pre-surgical examination and care, the procedures themselves, and about 18 months of post-surgical care; tracked claims data for post-surgical care for some patients for as long as five years; and tracked claims data for the matched patients over the same period.

According to the study, health insurers that covered patients who underwent laparoscopic surgery, which has an average cost of $17,000, offset the cost in about 25 months. Health insurers that covered patients who underwent traditional bariatric surgery, which has an average cost of $26,000, offset the cost in about 49 months. Crémieux said, "The most cost-effective treatment for obesity is bariatric surgery," adding, "If you do that, within two to four years, you will get your money back." In addition, he said, "We have identified the break-even point for insurers."
Implications
The study could "increase pressure" on health insurers to cover laparoscopic or traditional bariatric surgery, the Journal reports. Many health insurers do not cover the surgeries, although evidence indicates that the procedures are effective as weight-loss treatments, as well as treatments for diabetes, high blood pressure and sleep apnea. Susan Pisano, a spokesperson for America's Health Insurance Plans, said that health insurers continue to have concerns about the safety and effectiveness of the surgeries. She added, "I don't know if these results would be replicated in other populations."

According to the Journal, some lawmakers and health insurance industry observers likely will question the study because Ethicon Endo-Surgery, the weight-loss surgery device and instruments manufacturing division of Johnson & Johnson, funded the research. However, Crémieux said that Ethicon "has been totally hands off" the study. In addition, Michael Chernew, co-editor in chief of the Journal of Managed Care, said that the study underwent a comprehensive examination by independent reviewers who requested a series of revisions. He added, "I won't deny that I would rather this be funded by some other organization, but there is no bias in the methodology."

Eric Finkelstein -- a health economist who earlier conducted a study that found a 10-year return on investment for bariatric surgery -- questioned the study. In the event that the matched patents had "one really bad outcome, such as a heart transplant," it could have significantly changed the results of the study, he said. Finkelstein added that the "return-on-investment" analysis of weight-loss surgery is "misguided," as such analysis is not used to determine the cost-effectiveness of cancer or heart disease treatments.

Source: Medical News Today