It’s forever, sometimes.
“What we found was that the cardiac structure and function in these extremely obese adolescents scheduled for bariatric surgery was much more impaired than one might have thought,” said John Bauer, PhD with Nationwide Children’s Hospital.
The hearts and function of super-morbidly obese adolescents before undergoing bariatric surgery — were that of middle-aged persons.
After bariatric surgery — the teens' hearts underwent change — reverting to a healthier state.
RNY patients lose more than gastric band patients, and this study hypothesizes that RNY patients "think" differently about food.
As a ten-year RNY patient – I scream – AYE! FOR THE LOVE OF DOG DO NOT FEED ME ICE CREAM!
It's called DUMPING SYNDROME, our brains learn to connect certain foods to the reactions they might or will cause, which is a learned behavior, and our brains react, which can be SEEN on an MRI machine. Twitch. Twitch. (And, no, many people never ever learn.)
Objectives Roux-en-Y gastric bypass (RYGB) has greater efficacy for weight loss in obese patients than gastric banding (BAND) surgery. We hypothesise that this may result from different effects on food hedonics via physiological changes secondary to distinct gut anatomy manipulations.
Design We used functional MRI, eating behaviour and hormonal phenotyping to compare body mass index (BMI)-matched unoperated controls and patients after RYGB and BAND surgery for obesity.
Results Obese patients after RYGB had lower brain-hedonic responses to food than patients after BAND surgery. RYGB patients had lower activation than BAND patients in brain reward systems, particularly to high-calorie foods, including the orbitofrontal cortex, amygdala, caudate nucleus, nucleus accumbens and hippocampus. This was associated with lower palatability and appeal of high-calorie foods and healthier eating behaviour, including less fat intake, in RYGB compared with BAND patients and/or BMI-matched unoperated controls. These differences were not explicable by differences in hunger or psychological traits between the surgical groups, but anorexigenic plasma gut hormones (GLP-1 and PYY), plasma bile acids and symptoms of dumping syndrome were increased in RYGB patients.
Conclusions The identification of these differences in food hedonic responses as a result of altered gut anatomy/physiology provides a novel explanation for the more favourable long-term weight loss seen after RYGB than after BAND surgery, highlighting the importance of the gut–brain axis in the control of reward-based eating behaviour.
It's not uncommon for those of us who have lost massive amounts of weight with bariatric surgery to have major issues with body dysmorphic disorder or problems seeing ourselves the way we really look.
Importance Weight loss surgery (WLS) has been shown to produce long-term weight loss but is not risk free or universally effective. The weight loss expectations and willingness to undergo perioperative risk among patients seeking WLS remain unknown.
Objectives To examine the expectations and motivations of WLS patients and the mortality risks they are willing to undertake and to explore the demographic characteristics, clinical factors, and patient perceptions associated with high weight loss expectations and willingness to assume high surgical risk.
Design We interviewed patients seeking WLS and conducted multivariable analyses to examine the characteristics associated with high weight loss expectations and the acceptance of mortality risks of 10% or higher.
Setting Two WLS centers in Boston.
Participants Six hundred fifty-four patients.
Main Outcome Measures Disappointment with a sustained weight loss of 20% and willingness to accept a mortality risk of 10% or higher with WLS.
Results On average, patients expected to lose as much as 38% of their weight after WLS and expressed disappointment if they did not lose at least 26%.
Most patients (84.8%) accepted some risk of dying to undergo WLS, but only 57.5% were willing to undergo a hypothetical treatment that produced a 20% weight loss.
The mean acceptable mortality risk to undergo WLS was 6.7%, but the median risk was only 0.1%; 19.5% of all patients were willing to accept a risk of at least 10%.
Women were more likely than men to be disappointed with a 20% weight loss but were less likely to accept high mortality risk.
After initial adjustment, white patients appeared more likely than African American patients to have high weight loss expectations and to be willing to accept high risk.
Patients with lower quality-of-life scores and those who perceived needing to lose more than 10% and 20% of weight to achieve “any” health benefits were more likely to have unrealistic weight loss expectations.
Low quality-of-life scores were also associated with willingness to accept high risk.
Conclusions and Relevance
Most patients seeking WLS have high weight loss expectations and believe they need to lose substantial weight to derive any health benefits.
Educational efforts may be necessary to align expectations with clinical reality.
NO SHIT, REALLY?! Go back and READ IT AGAIN.
WHAT HAVE WE BEEN TELLING YOU?! Please. START. LISTENING.
GET. YOUR. COLONOSCOPIES. IT COULD SAVE YOUR LIFE. Don't be scared. It's no big thing. Really. The preparation is harder than the procedure. (My spouse is at this very moment, searching for a GI to make that appointment he canceled more than five years ago. He's a high-risk patient with family history.)
With that, I tell you – BOTTOMS UP!
(Reuters Health) – Obesity is already linked to a higher risk of colon or rectal cancer, but a new study suggests this risk is even greater for obese people who have undergone weight-loss surgery.
Based on a study of more than 77,000 obese patients, Swedish and English researchers found the risk for colorectal cancer among those who have had obesity surgery is double that of the general population.
Though colorectal cancer risk among obese patients who didn't have the surgery was just 26 percent higher than in the general population, researchers said the results should not discourage people from going under the knife.
"These findings should not be used to guide decisions made by patients or doctors at all until the results are confirmed by other studies," said Dr. Jesper Lagergren, the new study's senior author and a professor at both the Karolinska Institute in Stockholm and King's College London.
Each year more than 100,000 people in the U.S. have surgery to treat obesity.
Lagergren and his colleagues point out in their report, published in the Annals of Surgery, that obesity is tied to elevated risks for a number of cancers, including colorectal, breast and prostate (see Reuters Health story of November 3, 2011 here: reut.rs/t9sYxO).
Whether surgery to lose weight can affect those risks is uncertain.
Two earlier studies, one from the U.S. and the other from Sweden, found that the chances of obesity-related cancers decline after women have weight-loss surgery.
But an earlier study from Lagergren's group found the risks for breast and prostate cancers were unaffected by obesity surgery, and colorectal cancer risk increased.
To investigate that finding further, Lagergren's team collected 29 years' worth of medical records on more than 77,000 people in Sweden who were diagnosed as obese between 1980 and 2009. About 15,000 of them underwent weight loss surgery.
In the surgery group, 70 people developed colorectal cancer – a rate that was 60 percent greater than what would be expected for the larger Swedish population.
When the researchers looked only at people who had surgery more than 10 years before the end of the study period, the number of cancer cases was 200 percent greater than the expected risk for the general population.
In contrast, 373 people in the no-surgery group developed colorectal cancer, which was 26 percent more than would be expected in the population and that number remained stable over time.
A two-fold increased risk for colorectal cancer is not a "negligible risk increase, but it should not be of any major concern for the individual patient since the absolute risk is still low," Lagergren told Reuters Health in an email.
In the U.S., for instance, 40 out of every 100,000 women and roughly 53 out of every 100,000 men develop colorectal cancer each year.
Doubling that risk would make the annual figures 80 out of every 100,000 women and 106 out of every 100,000 men.
Lagergren said that more studies are needed to confirm his results before they should be included in clinical decision-making about whether patients should undergo weight-loss surgery.
The study results cannot prove that the surgery is the cause of the elevated cancer risk.
And, Lagergren says it's also not clear why the surgery might be tied to an elevated risk of colorectal cancer.
- One possibility is that dietary changes after surgery, and increasing protein in particular, could raise cancer risk, he speculated.
- Because the gut plays a significant role in the immune system, he added, "Another potential factor is that the bacteria that naturally reside in the intestines may change after surgery and alter future cancer risk."
- Lagergren noted that he also couldn't rule out the possibility that residual excess weight and weight gain after surgery might be involved.
SOURCE: bit.ly/10TcCGy Annals of Surgery, online March 6, 2013
The study –
Annals of Surgery
- Objective: The purpose was to determine whether obesity surgery is associated with a
long-term increased risk of colorectal cancer.
- Background: Long-term cancer risk after obesity surgery is not well characterized.
Preliminary epidemiological observations and human tissue biomarker studies recently
suggested an increased risk of colorectal cancer after obesity surgery.
- Methods: A nationwide retrospective register-based cohort study in Sweden was
conducted in 1980-2009. The long-term risk of colorectal cancer in patients who
underwent obesity surgery, and in an obese no surgery cohort, was compared with that of
the age-, sex- and calendar year-matched general background population between 1980
and 2009. Obese individuals were stratified into an obesity surgery cohort and an obese
no surgery cohort. The standardized incidence ratio (SIR), with 95% confidence interval
(CI), was calculated.
- Results: Of 77,111 obese patients, 15,095 constituted the obesity surgery cohort and 62,016
constituted the obese no surgery cohort. In the obesity surgery cohort, we observed 70
patients with colorectal cancer, rendering an overall SIR of 1.60 (95% CI 1.25-2.02). The
SIR for colorectal cancer increased with length of time after surgery, with a SIR of 2.00
(95% CI 1.48-2.64) after 10 years or more. In contrast, the overall SIR in the obese no
surgery cohort (containing 373 colorectal cancers) was 1.26 (95% CI 1.14-1.40) and
remained stable with increasing follow-up time.
- Conclusions: Obesity surgery seems to be associated with an increased risk of colorectal
cancer over time. These findings would prompt evaluation of colonoscopy surveillance for the increasingly large population who undergo obesity surgery.
After you read this study, let's discuss:
- Did your nutritionist give YOU guidance in regards to carbohydrate intake after your roux en y gastric bypass surgery?
- Background: Exact carbohydrate levels needed for the bariatric patient population have not yet been defined. The aim of this study was to correlate carbohydrate intake to percent excess weight loss for the bariatric patient population based on a cross-sectional study. The author also aimed to review the related literature.
- Materials and Methods: A cross-sectional study was conducted, along with a review of the literature, about patients who underwent Roux-en-Y gastric bypass at least 1 year previously. Patients had their percentage of excess weight loss calculated and energy intake was examined based on data collected with a four-day food recall. Patients were divided into two groups: 1) patients who consumed 130g/day or more of carbohydrates and 2) patients who consumed less than 130g/day of carbohydrates.
- Limitations: The literature review was limited to papers published since 1993.
- Results: Patients who consumed 130g/day or more of carbohydrates presented a lower percent excess weight loss than the other group (p= 0.038). In the review of the literature, the author found that six months after surgery patients can ingest about 850kcal/day of carbohydrates, 30 percent being ingested as lipids. A protein diet with at least 60g/day is needed. On this basis, patients should consume about 90g/day of carbohydrates. After the first postoperative year, energy intake is about 1,300kcal/day and protein consumption should be increased. We can, therefore, establish nearly 130g/day of carbohydrates (40% of their energy intake)
- Conclusions: Based on these studies, the author recommends that 90g/day is adequate for patients who are six months post Roux-en-Y gastric bypass and less than 130g/day is adequate for patients who are one year or more post surgery.
- The author concludes that maintaining carbohydrate consumption to moderate quantities and adequate protein intake seems to be fundamental to ensure the benefits from bariatric surgery.