New procedure to reduce the size of the stomach, without incisions, in gastric-bypass-surgery patients who have started to regain weight

A few doctors around the United States are beginning to use an elegant new procedure to reduce the size of the stomach, without incisions, in gastric-bypass-surgery patients who have started to regain weight.

Because their stapled stomachs start to stretch out and enlarge, some 44 percent of gastric-bypass patients regain weight after a few years, and again become subject to the morbidities of obesity.

But with the new technique, called "ROSE" (Restorative Obesity Surgery, Endolumenal), doctors can reduce the patient's stomach pouch and the opening (stoma) to the small intestine to their original post-gastric-bypass size.

They do it by employing a small, flexible endoscope and a new EndoSurgical Operating System (EOS) created by USGI Medical Inc. The doctors guide these through the mouth and down into the stomach. With the EOS, the practitioners grasp tissue around the stoma and in the interior wall of the stomach and insert suture anchors, which are used to pull together the walls of the opening and the organ. This creates multiple tissue folds that reduce the size of both stoma and stomach.

And, voila!, the patient is once again on the road to weight loss.

"To date, revision options [for gastric-bypass weight regainers] have been expensive, difficult to perform and risky for the patient, effectively leaving them without any treatment options," said Dr. G. Derek Weiss, of Bluegrass Bariatric Surgical Associates in Lexington, Ky.

Weiss' colleague at Bluegrass Bariatric, Dr. John Oldham Jr., said, "By eliminating skin incisions, this new procedure may provide important advantages to patients, including reduced risk of infection and associated complications, less post-operative pain, faster recovery time and no abdominal scars."

Source: Empowered Doctor

Allina Hospitals & Clinics' Unity Hospital will present live weight loss surgery online at 3 p.m. on Thursday, Oct. 30.

Jeffrey Baker, MD, will perform a laparoscopic adjustable gastric band surgery, commonly known as Lap-Band® or Realize Band™ surgery, while Frederick Johnson, MD answers viewer questions, and talks about the benefits of adjustable banding procedures.

"This is a great opportunity for individuals contemplating weight loss surgery to learn more about a minimally invasive, proven option for surgical weight loss," said Frederick Johnson, MD, surgeon and co-medical director for the Unity Hospital Bariatric Center.

During the laparoscopic gastric banding procedure, surgeons make several small incisions and use long instruments, called laparoscopes, to place a silicone band around the top of the patient's stomach, creating a small stomach pouch. As a result, the patient feels fuller with smaller amounts of food, resulting in weight loss. The band can be further adjusted to limit or increase the amount of food the stomach can hold, or adapt to future lifestyle changes such as pregnancy.

Source: Unity Hospital

Cherries helps you to lose weight

New research ties eating tart cherries to lowering cholesterol, reducing inflammation and cutting one's body weight and fat - all major risk factors for heart disease.

This latest study, scheduled to be presented by University of Michigan researchers at the American Dietetic Association annual meeting, in Chicago, reached these conclusions after feeding whole tart cherry powder to obese rats.

After 12 weeks, the rats had 14% less body fat while maintaining lean muscle mass, compared to other rats who ate the same foods minus the cherry powder. The rats eating cherries also lost significant amounts of body weight - notably a loss of "belly" fat, a known risk for heart disease, according to the American Heart Association.

The rats eating a cherry-enriched diet also dropped their total cholesterol levels by about 11%. Levels of two known markers of inflammation linked to increased risk for heart disease also dropped by 31% to 40%.

Animal study is 'encouraging'
"Heart disease is the number one killer today, so it's important we continue researching ways people can improve their diet to help reduce key risk factors," study co-author Dr Steven F. Bolling, a cardiac surgeon at the University of Michigan Cardiovascular Centre, said in a news release from the study's sponsor, the Cherry Marketing Institute. "We know excess body fat increases the risk for heart disease. This research gives us one more support point suggesting that diet changes, such as including cherries, could potentially lower heart disease risk."

Researchers said the animal study is encouraging and will lead to further clinical studies in humans to explore the link between diet, weight, inflammation and lowering heart disease risk.

Tart cherries, often sold as dried, frozen or juice, contain powerful antioxidants known as anthocyanins. In addition to providing the fruit with its rich red colour, studies suggest these plant compounds may be responsible for the fruit's health benefits.

Source: HealthDay News

The benefits of rimonabant no longer outweigh its risks

The EMEA's Committee for Medicinal Products for Human Use (CHMP) has concluded that the benefits of rimonabant no longer outweigh its risks and the marketing authorisation should be suspended across the EU.

Following the assessment of the available information on the benefits and risks of rimonabant including data from studies completed since it was granted marketing authorisation, the CHMP confirmed at its October 20-23 meeting, that there is an approximate doubling of the risk of psychiatric disorders in obese or overweight patients taking rimonabant compared with those taking placebo.

The CHMP considered that the new data from post-marketing experience and ongoing clinical trials indicated that serious psychiatric disorders may be more common than in the clinical trials used in the initial assessment of the medicine. The CHMP was also of the opinion that these psychiatric side effects could not be adequately addressed by further risk minimisation measures.

In addition, the CHMP noted, that the effectiveness of rimonabant in clinical practice is more limited than was expected on the basis of the clinical trials, because available data indicate that patients generally take rimonabant only for a short period.

Prescribers should not issue any prescriptions for rimonabant and should review the treatment of patients currently taking the medicine. There is no need for patients to stop treatment with rimonabant immediately, but patients who wish to stop can do so at any time.

The CHMP opinion will now be sent to the European Commission for the adoption of a decision, applicable in all EU countries.

Source: Doc Guide

Obesity pill Tesofensine shows promise

Tesofensine works by interfering with three brain chemicals -- noradrenline, serotonin and dopamine -- involved in regulating hunger. People who take the pill are less hungry and feel full more quickly.
People taking NeuroSearch A/S's obesity pill tesofensine lost twice as much weight as men and women using approved weight loss drugs, Danish researchers said on Thursday.

The study suggest the experimental drug is safe because it had no effect on blood pressure and only raised heart rate slightly, said Arne Astrup of the University of Copenhagen, who led the study published in the journal Lancet.

"It is quite solid from this study that it seems to produce a weight loss that is twice ... what we see from existing compounds on the market," Astrup said in a telephone interview.

The company hopes to take tesofensine to Phase III clinical trials early next year -- the last stage of human testing before a company can seek regulatory approval for a drug.

Obesity, which raises the risk of diseases like type 2 diabetes and heart problems, is increasingly a problem as more people adopt a Western lifestyle.

The World Health Organization classifies around 400 million people around the world as obese, representing an increasingly lucrative market for drug makers.

Astrup and his team compared tesofensine against the Sanofi-Aventis SA obesity-fighting drug Acomplia and Abbott Laboratories' Reductil, known as Meridia in the United States.

The 203 obese volunteers at five Danish obesity centers were given different doses of tesofensine or placebo. The drug worked twice as well as previously published data on Acomplia and Reductil, known generically as sibutramine, the study showed.

SIDE EFFECTS

After the study ended, the men and women on tesofensine had lost 10 kilograms more than people on placebo, compared with studies which have shown weight loss of 3 kilograms for Reductil and about 5 kilograms for Acomplia over a similar six month period, Astrup said.

Side effects included dry mouth, constipation and insomnia, but importantly the volunteers did not exhibit the suicidal thoughts that have plagued Acomplia, known generically as rimonabant, Astrup said.

Acomplia took a hit last year when a U.S. expert panel recommended against its approval in the world's biggest market after it was linked to rare cases of suicide ideation -- a psychological problem not shown to raise the risk of suicide but one that worries doctors.

"So far there have been no warnings about problematic side effects," Astrup said. "It seems clean so far."

Other researchers not involved in the study cautioned that the results are from a single trial in a relatively small number of patients.

"We should therefore be a little circumspect about accepting these claims as to efficacy and await the results of the more relevant Phase III studies, which the author does say at the end of the paper," Ian Broom, a researcher at Robert Gordon University in Britain said in a statement.

in regulating hunger. People who take the pill are less hungry and feel full more quickly.

The next step are Phase III trials in which doctors will also try to regulate diet, something that Astrup said could lead to the kind of weight loss associated with gastric-bypass surgery.

"Most clinicians are always saying we need more effective drugs that can make surgery not necessary," Astrup said. "This is the first opening we have seen."

Source: Yahoo News

Gastric bypass reduced the risk for a future cardiovascular event anywhere from 8 percent to 79 percent

The take-home message is that "bariatric surgery can be considered as a means to reduce cardiovascular risk (in obese patients) after conservative treatment options have failed," Dr. John A. Batsis told Reuters Health. Batsis, at Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire and his colleagues identified six studies that looked at cardiovascular risk after bariatric surgery for obesity. The risk was estimated from standard tables that assigned a score for factors such as weight, blood pressure and cholesterol levels. Depending on how the patients' risk was assessed, the researchers found that gastric bypass reduced the risk for a future cardiovascular event anywhere from 8 percent to 79 percent, compared to not having the procedure, the team reports in the American Journal of Cardiology.

Looked at another way, the predicted chance of having a heart attack or needing heart surgery or dying of heart disease over 10 years fell from 7.0 percent to 3.5 percent after undergoing bariatric surgery. For people who did not have surgery, the probability fell from 7.1 percent to 6.5 percent.



These figures were estimates. As Batsis noted, "Further studies are required to better understand the long-term impact of bariatric surgery on predicted cardiovascular risk in obese patients by determining the actual number of cardiac events."

Source: Yahoo News

Starting your meal with a bowl of soup, apple or a salad will help you to lose weight

Eating soup, apple or a salad as a first course helped study participants lose weight because they consumed fewer total calories in the rest of the meal.

Dr. Barbara Rolls, a weight control researcher at Pennsylvania State University and author of "The Volumetrics Eating Plan," found that eating soup as a first course helped study participants lose weight because they consumed fewer total calories in the rest of the meal.

Rolls' theory is that the more water a food contains the more full we feel. And the lower the energy density of a food (the concentration of fat and calories) the more we can eat.

Source: detnews.com

Too much fructose can induce leptin resistance

Although previous studies have shown that being leptin resistant can lead to rapid weight gain on a high-fat, high-calorie diet, this is the first study to show that leptin resistance can develop as a result of high fructose consumption.

The study also showed for the first time that leptin resistance can develop silently, that is, with little indication that it is happening.

Source: Medical News Today

New research reveals the process by which unsaturated, or “good” fats, may actually aid in weight loss.

A recent University of California, Irvine, study shows when oleic acid, a component of healthy unsaturated fats like those found in olive oil, enters the small intestine, a hormone is released that ultimately creates a feeling of fullness. This feeling can fight off one important cause of overeating -- hunger pangs.

“People already recognize the health benefits of unsaturated fatty acids, and this is just an additional health benefit -- these nutrients produced delaying hunger,” study author Daniele Piomelli, Ph.D., Pharm.D., a professor of pharmacology at the University of California, Irvine, told Ivanhoe.

This discovery may help researchers develop drugs to boost levels or block breakdown of the hormone, called OEA, to manually fend off feelings of hunger. The discovery may also help experts determine the exact balance of fat and protein needed to best control hunger.

“One can design strategies to get a better bang for your buck, so if you eat the same amount of calories, you can design strategies whereby you will get greater control of the amount of food you eat in each individual meal as well as in delaying the hunger pangs after a meal,” Dr. Piomelli said.

Source: Ivanhoe Medical Breakthroughs

Severe obesed teenagers will be given drastic weight-loss surgery under a NSW Government strategy to fight the obesity epidemic

The Children's Hospital at Westmead is set to be the first in the State to offer taxpayer-funded gastric banding.
Doctors say the radical measure is needed to save teens with severe weight-related health conditions.

Dr Michael Kohn, of adolescent medicine at The Children's Hospital at Westmead, told The Sunday Telegraph lap-banding would be restricted to teens aged 14 and over because it was too controversial in younger children.

He said the surgery was reversible and could stall - or even resolve - severe health problems until teens could establish controlled eating patterns.

"Certainly with eating disorders, it's really about getting the young person through a critical period and developing eating patterns they can maintain,'' he said.

"I think the degree to which (our) population is overweight is not dissimilar to the US.''

Dr Kohn will formally apply to provide bariatric - or weight-loss - surgery in three weeks.

The State Government agreed it would provide funding for the surgery two months ago, with the first clinics expected to open by the end of 2008.

Publicly funded weight-loss surgery is expected to be available across the State by 2012.

Dr Kohn said some young people were developing severe lifestyle-related conditions such as pancreatitis and type 2 diabetes which needed urgent medical action.

Gastric banding costs at least $10,000 - an unaffordable amount for most parents of morbidly obese children, with statistics showing obesity levels are higher in poorer "battler'' areas of NSW.
Source: The Daily Telegraph

OEA might be useful in the treatment of obesity and other eating disorders

A fatty acid found in abundance in olive oil and other "healthy" unsaturated fats has yet another benefit: it helps keep the body satisfied to prolong the time between meals. A new study in the October Cell Metabolism, a publication of Cell Press, reveals that once this type of fat, known as oleic acid, reaches the intestine, it is converted into a lipid hormone (oleoylethanolamide, or OEA) that wards off the next round of hunger pangs.

The researchers said it may be the first description of an ingredient in food that directly provides the raw materials for a hormone's production.

The findings in rats may yield insight into the precise dietary makeup of fat and protein for optimal hunger control, the researchers said. (Protein plays in important role in limiting hunger as well, but by different means.) The newly discovered signaling pathway might also be tapped into with drugs designed to control appetite by supplementing OEA levels or blocking its breakdown. Similarly, in conditions where people don't eat enough, the researchers speculate that treatments targeting this system might improve the appetite.

Importantly, diets high in processed foods that are riddled with saturated fats might throw a wrench into this system of metabolic control, the researchers said.

" Eating is one of the most important things animals do," said Daniele Piomelli of the University of California, Irvine. "This is just one of many things that control it. That said, a system like this could be forced to inactivation by inappropriate feeding," he said, noting that saturated fats generally lack in oleic acid.

While such diets may lead people to overeat, Piomelli said it will also be of interest to see if this mechanism may be defective in some who tend to eat in excess.

Previous studies had shown that feeding stimulates cells in the intestinal lining to produce OEA, which, when administered as a drug, decreases meal frequency by engaging receptors called peroxisome proliferator-activated receptors a (PPARa).

Piomelli's team now reports that infusion of fat into the small intestine stimulates the release of OEA, whereas infusion of protein or carbohydrate does not. They also demonstrate that OEA production uses dietary oleic acid and is disrupted in mutant mice lacking the membrane fatty-acid transporter CD36. Treatments that disrupt CD36 or PPARa undermine the hunger control otherwise driven by fat.

Overall, the results suggest that activation of small-intestinal OEA release, enabled by CD36-mediated uptake of oleic acid from the diet, serves as a molecular sensor linking fat consumption to satiety. (Piomelli said satiety is perhaps best described as the opposite of hunger.)

" In conclusion," the researchers wrote, "our studies identify OEA as a key physiological signal that specifically links dietary fat ingestion to across-meal satiety. Nutritional and pharmacological strategies aimed at magnifying this lipid-sensing mechanism, such as inhibitors of OEA degradation, might be useful in the treatment of obesity and other eating disorders."

Source: Medical News Today

You can’t assume someone is unhealthy just because he’s fat

Some activists and academics, part of a growing social movement known as fat acceptance, suggest that we rethink this war — as well as our definition of health itself. Fat-acceptance activists insist you can’t assume someone is unhealthy just because he’s fat, any more than you can assume someone is healthy just because he’s slim. (They deliberately use the word “fat” as a way to reclaim it, much the way some gay rights activists use the word “queer.”) Rather, they say, we should focus on health measurements that are more meaningful than numbers on a scale. This viewpoint received a boost in August when The Archives of Internal Medicine reported that fully half of overweight adults and one-third of the obese had normal blood pressure, cholesterol, triglycerides and blood sugar — indicating a normal risk for heart disease and diabetes, conditions supposedly caused by being fat.

This is a core argument of fat acceptance: that it’s possible to be healthy no matter how fat you are and that weight loss as a goal is futile, unnecessary and counterproductive — and that fatness is nobody’s business but your own.

Many fat-acceptance activists prefer a new approach to dieting that focuses on nutrition, exercise and body image. A new book out this fall, “Health at Every Size,” by Linda Bacon, a nutritionist and physiologist at the University of California at Davis, outlines this approach, which is less about dieting than a lifestyle change that emphasizes “intuitive eating”: listening to hunger signals, eating when you’re hungry, choosing nutritious food over junk. It encourages exercise, but for its emotional and physical benefits, not as a way to lose weight. It advocates tossing out the bathroom scale and loving your body no matter what it weighs.

The philosophy is migrating slowly into mainstream programs, like a spa in Vermont that focuses on “acceptance of ourselves and our wonderful sizes.” But the spas and other programs have trouble with the bottom line of fat acceptance — rejection of weight loss as a goal. Weight Watchers, for instance, uses some of the same slogans, and while it promotes its program as “not a diet,” it still tracks weight loss down to the decimal point.

Several studies suggest that if the aim is getting healthier rather than slimmer, then in the long run the “Health at Every Size” approach works better than dieting. In 2005, Bacon led the only randomized control trial to date that tested this hypothesis physiologically. She randomly assigned half of the 78 subjects, all women, to a “Health at Every Size” group; while they lost no weight, their healthier behavior led to lower blood-pressure and cholesterol levels, which stayed low even two years later. In the weight-loss group, more than 40 percent dropped out before the six-month low-calorie diet ended, and at the two-year follow-up, the average dieter had regained all her lost weight, and the only measurement that dropped was one for self-esteem.

Scientists who study obesity at the cellular level say genetics determines people’s natural weight range, right down to the type and amount of food they crave, how much they move and where they accumulate fat. Asking how someone got to be so fat is as meaningless as asking how he got to be so tall. “The severely obese have some underlying genetic or metabolic difference we’re not smart enough to identify yet,” says Dr. Rudolph Leibel of Columbia University Medical Center. “It’s the same way that a 7-foot-tall basketball player is genetically different from me, at 5-foot-8.”

Fat has been blamed for cardiac trouble, diabetes and some forms of cancer. But fat-acceptance activists argue that the epidemiological studies that link fatness to disease often fail to adjust for non-weight-related risk factors found more often in fat populations. Poverty, minority-group status, too much fast food, a sedentary lifestyle, lack of access to health insurance or to nonjudgmental medical care, the stress of self-loathing and being part of a stigmatized group — all are more common among fat people, and all are linked to poorer health outcomes at any weight. This makes it harder to say to what extent an association between obesity and disease is due to the fatness itself or to the risk factors that tend to go along with being fat.

It remains an open question, one deserving of further scientific scrutiny, whether the health risks seen in fat populations are caused by the fat itself or by something else. Only then can we really know how to effectively wage the war on obesity — or if such a war even needs to be waged.

Source: NY Times

Inflammation may be a player in the development of obesity

Obesity is known to increase inflammation throughout the body. The new study -- published in tomorrow's edition of Cell -- shows that inflammation may be a player, and not an innocent bystander, in the development of obesity.

The researchers -- based at the University of Wisconsin-Madison and the University of California, San Diego -- focused on two things:

The hypothalamus, a brain region that regulates the body's energy balance.
A "master switch" of inflammation -- called IKK beta/NF kappa B -- that's usually turned off.
In lab tests on mice, that "master switch" of inflammation turned on in the hypothalamus of mice on a high-fat diet. "Chronic overnutrition" flipped on the inflammation switch, the researchers note.

With that master switch turned on in the hypothalamus, the mice gained weight and became resistant to insulin (a hormone that controls blood sugar) and leptin (a hormone involved in feeling full).

Next, the scientists used genetic engineering to flip that master switch off in the hypothalamus of other mice. Those mice were "significantly protected" from becoming obese, even on a high-fat diet, the researchers write.

Still, you wouldn't want to turn that master switch off forever, because inflammation is one of the body's tools for fighting infection.

Figuring out how to selectively control that switch in the hypothalamus might be a new strategy for curbing obesity and related diseases, the researchers conclude. In the meantime, the time-tested methods of a healthier diet and a more active lifestyle are still the cornerstones of managing weight. Easier said than done? Health care professionals can help with the process.

Source: WebMD