After weight-loss surgery, new gut bacteria keep obesity away?

ENTHRALLING –

New York Times

The research also suggests that a popular weight-loss operation, gastric bypass, which shrinks the stomach and rearranges the intestines, seems to work in part by shifting the balance of bacteria in the digestive tract. People who have the surgery generally lose 65 percent to 75 percent of their excess weight, but scientists have not fully understood why.

Now, the researchers are saying that bacterial changes may account for 20 percent of the weight loss.

The findings mean that eventually, treatments that adjust the microbe levels, or “microbiota,” in the gut may be developed to help people lose weight without surgery, said Dr. Lee M. Kaplan, director of the obesity, metabolism and nutrition institute at the Massachusetts General Hospital, and an author of a study published Wednesday in Science Translational Medicine.

Not everyone who hopes to lose weight wants or needs surgery to do it, he said. About 80 million people in the United States are obese, but only 200,000 a year have bariatric operations.

“There is a need for other therapies,” Dr. Kaplan said. “In no way is manipulating the microbiota going to mimic all the myriad effects of gastric bypass. But if this could produce 20 percent of the effects of surgery, it will still be valuable.”

In people, microbial cells outnumber human ones, and the new studies reflect a growing awareness of the crucial role played by the trillions of bacteria and other microorganisms that live in their own ecosystem in the gut. Perturbations there can have profound and sometimes devastating effects.

One example is infection with a bacterium called C. difficile, which sometimes takes hold in people receiving antibiotics for other illnesses. The drugs can wipe out other organisms that would normally keep C. difficile in check. Severe cases can be life-threatening, and the medical profession is gradually coming to accept the somewhat startling idea that sometimes the best therapy is a fecal transplant — from a healthy person to the one who is sick, to replenish the population of “good germs.”

Dr. Kaplan said his group’s experiments were the first to try to find out if microbial changes could account for some of the weight loss after gastric bypass. Earlier studies had shown that the microbiota of an obese person changed significantly after the surgery, becoming more like that of someone who was thin. But was the change from the surgery itself, or from the weight loss that followed the operation? And did the microbial change have any effects of its own?

Because it would be difficult and time-consuming to study these questions in people, the researchers used mice, which they had fattened up with a rich diet. One group had gastric bypass operations, and two other groups had “sham” operations in which the animals’ intestines were severed and sewn back together. The point was to find out whether just being cut open, without having the bypass, would have an effect on weight or gut bacteria. One sham group was kept on the rich food, while the other was put on a weight-loss diet.

In the bypass mice, the microbial populations quickly changed, and the mice lost weight. In the sham group, the microbiota did not change much — even in those on the weight-loss diet.

Next, the researchers transferred intestinal contents from each of the groups into other mice, which lacked their own intestinal bacteria. The animals that received material from the bypass mice rapidly lost weight; stool from mice that had the sham operations had no effect.

Exactly how the altered intestinal bacteria might cause weight loss is not yet known, the researchers said. But somehow the microbes seem to rev up metabolism so that the animals burn off more energy.

A next step, Dr. Kaplan said, may be to take stool from people who have had gastric bypass and implant it into mice to see if causes them to lose weight. Then the same thing could be tried from person to person.

“In addition, we’ve identified four subsets of bacteria that seem to be most specifically enhanced by the bypass,” Dr. Kaplan said. “Another approach would be to see if any or all of those individual bacteria could mediate the effects, rather than having to transfer stool.”

A second study by a different group found that overweight people may be more likely to harbor a certain type of intestinal microbe. The microbes may contribute to weight gain by helping other organisms to digest certain nutrients, making more calories available. That study was published Tuesday in the Journal of Clinical Endocrinology & Metabolism.

The study involved 792 people who had their breath analyzed to help diagnose digestive orders. They agreed to let researchers measure the levels of hydrogen and methane; elevated levels indicate the presence of a microbe called Methanobrevibacter smithii. The people with the highest readings on the breath test were more likely to be heavier and have more body fat, and the researchers suspect that the microbes may be at least partly responsible for their obesity.

This type of organism may have been useful thousands of years ago, when people ate moreroughage and needed all the help they could get to squeeze every last calorie out of their food. But modern diets are much richer, said an author of the study, Dr. Ruchi Mathur, director of the diabetes outpatient clinic at Cedars-Sinai Medical Center in Los Angeles.

“Our external environment is changing faster than our internal one,” Dr. Mathur said. Studies are under way, she said, to find out whether getting rid of this particular microbe will help people lose weight.

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Cleveland Clinic study shows RNY bariatric surgery restores pancreatic function by targeting belly fat

Just to keep you on your toes, a couple days ago I shared the study that stated that WLS doesn't save you money in the long run.

Now, we hear once AGAIN that roux en y gastric bypass bariatric surgery fixes diabetes damn near immediately. This is just another study on THAT topic.

We already knew this.

Thanks, pancreas!  *thumbs up for working so well!*

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*Waves to all the post bariatric reactive non-diabetic hypoglycemics*

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Cleveland Clinic study shows bariatric surgery restores pancreatic function by targeting belly fat

2-year study indicates how gastric bypass reverses diabetes. In a substudy of the STAMPEDE trial (Surgical Therapy And Medications Potentially Eradicate Diabetes Efficiently), Cleveland Clinic researchers have found that gastric bypass surgery reverses diabetes by uniquely restoring pancreatic function in moderately obese patients with uncontrolled type 2 diabetes.

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ReShape Duo™ Intragastric Balloon System Seeing Weight Loss Results in Study

The REDUCE Pivotal Trial is a pivotal clinical study designed to develop valid scientific evidence regarding the safety and effectiveness of the ReShape Duo® as an adjunct to diet and exercise in the treatment of obese subjects with one or more obesity-related comorbid conditions.

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Weight-Loss Surgery Ups Cardiac Function in Kids

Bariatric surgery resulted in cardiac improvements in obese teens that were sustained through two years.

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Medpage -

Bariatric surgery led to sustained improvements in left ventricular mass and diastolic function in morbidly obese teenagers, a researcher reported here.

The gains were seen as early as six months after the operations and they persisted through two years, Holly Ippisch, MD, of Cincinnati Children's Hospital, reported at the American Heart Association meeting.

But, she noted, "even though the measures are significantly better, they're still not normal," indicating that interventions might have to occur sooner.

"These data support a more aggressive preventive approach to adolescent weight issues," Ippisch said.

The prevalence of childhood obesity has risen from about 5% in the 1970s to about 17% today, according to Stephen Daniels, MD, PhD, MPH, of Children's Hospital in Denver, who moderated a press conference at which the results were presented.

The severity of obesity has increased as well, he said, making bariatric surgery a treatment consideration for some of these kids.

Consensus criteria generally reserve bariatric surgery for children with a body mass index over over 50 kg/m2 or for those with a BMI over 40 kg/m2 and serious comorbidities such as obstructive sleep apnea and type 2 diabetes.

Ippisch said leaner children might qualify for bariatric surgery depending on the burden of comorbidities.

Study – 47% Weight Stays Off Long Term After Gastric Band Bariatric Surgery – But…

Medpage –  Weight Stays Off Long Term After Bariatric Surgery

O'Brien PE, et al. "Long-term outcomes after bariatric surgery. Fifteen-year follow-up of adjustable gastric banding and a systematic review of the bariatric surgical literature" Ann Surg 2013;257:87-94.

Obese patients maintained about 50% excess weight loss for as long as 15 years after laparoscopic adjustable gastric banding, (LAGB), Australian investigators reported.

Experience at a single center showed an average of 47% excess weight loss in 714 patients followed for more than 10 years after LAGB, including 47% among patients followed for 15 years and 62% in a small group followed for 16 years, according to Paul O'Brien, MD, and colleagues, of Monash University in Melbourne, Australia.

A systematic review of published studies revealed a mean excess weight loss of 54% at 10 years and beyond for patients treated with LAGB or Roux-en-Y gastric bypass (RYGB), they reported in the January issue of Annals of Surgery.

The results also showed a marked reduction in late-occurring adverse events after LAGB, the authors added.

"Gastric banding is a safe and effective treatment option for obesity in the long term," they said. "The systematic review shows that all current procedures achieve substantial long-term weight loss. It supports the existing data that LAGB is safer than RYGB and finds that the long-term weight loss outcomes and needs for revisional surgery for these two procedures are not different."

Despite a history dating back more than 50 years, bariatric surgery has a paucity of long-term data to demonstrate durable weight loss. Most published studies have follow-up of less than 3 years. Systematic reviews have added relatively little in terms of long-term follow-up data, according to the authors.

O'Brien and colleagues introduced LAGB at their center in 1994, and have followed all patients by means of a dedicated bariatric surgery database. As of December 2011, O'Brien and co-author Wendy Brown, MBBS, PhD, also of Monash University, had treated 3,227 patients with LAGB.

The authors performed a prospective longitudinal cohort study of the patients. For comparison, they performed a systematic review of published literature on bariatric surgery. The focus was on long-term follow-up, 15 years for the cohort and 10 years for the systematic review.

The cohort had mean age of 47 and a mean presurgical body mass index of 43.8 kg/m2. The authors identified 714 patients followed for at least 10 years, including 54 patients followed for 15 years and 14 followed for 16 years.

  • The 10-year excess weight loss was 47%.
  • The authors reported that 26% of patients required revisions for proximal enlargement,
  • 21% for port and tubing problems, and 3.4% for erosion.
  • Band removal was performed in 5.6% of patients.

During the first 10 years of clinical experience, the revision rate for proximal enlargement was 40%, declining to 6.4% during the last 5 years of the study period. Patients with and without revisions had similar excess weight loss.

The systematic review consisted of 19 published articles, 24 data sets, and approximately 14,000 patients. The data included six sets involving patients with LAGB, nine sets for RYGB, five sets for gastroplasty, three for biliopancreatic diversion or duodenal switch (BPD/DS), and one involving fixed open gastric banding.

According to the authors, every study had deficiencies related to data reporting. None of the studies was a randomized controlled trial. One investigation was a prospective, nonrandomized, matched interventional study, and the rest were observational studies.

With respect to safety, one perioperative death occurred in 6,177 LAGB procedures, compared with 21 in 2,684 RYGB procedures (P<0.001).

Excess weight loss at 10 years averaged 54% with LAGB and RYGB, 53% with gastroplasty, and 73.3% with BPD/DS. The mean revision rate was 26% with LAGB and 22% with RYGB. Revision rates from individual data sets ranged as high as 60% with LAGB and 38% with RYGB.

"The longitudinal cohort study of the LAGB patients shows that they have achieved and maintained a loss of nearly half of their excess weight to 15 years," the authors wrote. "The validity of the 15-year figure of 47% of excess weight loss is reinforced by the pooling of all long-term data (≥10 years) and finding the same weight loss of 47% excess weight loss for the much larger group."

Pear

So maybe being pear-shaped is not such a good thing?

Pear

We have heard for years that being pear-shaped was preferable to other body-shapes, that carrying excess body-fat in the hips, thighs, legs and rear was 'healthier' than the belly.  That 'pears' were a preferable body-shape to have than 'apples.'  This is not necessarily so.
Chicago Tribune – via Journal of Clinical Endocrinology

If you're pear-shaped and smug, a new study's findings may take you down a peg: For those at slightly increased risk of developing diabetes, fat stored in the buttocks pumps out abnormal levels of two proteins associated with inflammation and insulin resistance. (And that's not good.)

The new research casts some doubt on an emerging conventional wisdom: that when it comes to cardiovascular and diabetes risk, those of us who carry some excess fat in our hips, thighs and bottoms ("pear-shaped" people) are in far better shape than those who carry most of their excess weight around the middle ("apples").

The new study was posted online this week in the Journal of Clinical Endocrinology and Metabolism, and it focuses on a number of proteins, with names such as chemerin, resistin, visfatin and omentin-1, that could one day be used to distinguish between obese people headed for medical trouble and those whose obesity is less immediately dangerous.

The subjects in the study were all people with "nascent" metabolic syndrome — meaning patients who already have at least three risk factors for developing diabetes (large waist circumference, high blood pressure, high triglcerides, low HDL, or "good" cholesterol, and high fasting blood sugar) but no cardiovascular disease or diabetes complications yet.

The researchers found these subjects' "gluteal adipose tissue" — fat in and around the buttocks — pumped out unusually high levels of chemerin, a protein that has been linked to high blood pressure, elevated levels of C-reactive protein, triglycerides and insulin resistance, and low levels of good cholesterol. The blood and subcutaneous fat drawn from gluteal tissue also contained unusually low levels of omentin-1, a protein that, when low, is linked to high triglycerides, high circulating glucose levels and low levels of good cholesterol.

"Fat in the abdomen has long been considered the most detrimental to health, and gluteal fat was thought to protect against diabetes, heart disease and metabolic syndrome," said Ishwarlal Jialal, a professor of pathology and laboratory medicine and of internal medicine at UC Davis and lead author of the study. "But our research helps to dispel the myth that gluteal fat is innocent," he added.

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Being slightly overweight may actually help you live longer.

My people will live forever.   -MM

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A new study says being slightly overweight may actually help you live longer.  Researchers looked at data on nearly three million adults around the world.  They compared the body mass index, a measurement of weight in relation to height, to the risk of death.  The study found people with a little extra weight had a six percent lower risk of dying compared to people considered "normal" weight.  However, it's not an excuse to pack on the pounds.

Obese people had more than triple the risk of dying, according to the study.

The research looked at only death, not chronic medical conditions.

The study is published in the latest issue of the Journal of the American Medical Association

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