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Innovation needed to combat obesity pandemic

5 March 2015

Hi All, Everyone is on the same page with regards to the Obesity epidemic, and surprisingly it appears that Politicians are beginning to take on responsibility for looking at the problems that obesity causes for the population in general.  Whilst the article doesn't go into specific solutions it does touch on the fact that there are a whole lot of things that need to look at the problem and identify potential ways to combat its expansion over time.  It is heartening to be reminded people that small weight losses or even trying to lose weight can confer benefits on a physiological level to individuals.  So don't give up!  Keep your efforts going and your health will benefit! Regards, Steph

 

Policy and environmental changes are very important in preventing unhealthy weight gain but may not help people with severe obesity achieve substantial weight loss, according to a report published online in The Lancet. Instead, innovative new treatments, health delivery strategies and initiatives aimed at improving the care of people suffering from obesity must be deployed to fight what has now become a worldwide epidemic, says the lead author of the study.

 

"An estimated 600 million people worldwide now suffer from obesity, and that represents an enormous burden both for individuals and for society at large," says Dr William H Dietz, director of the Sumner M Redstone Global Center for Prevention and Wellness at Milken Institute School of Public Health at the George Washington University. "Our findings suggest that we must take steps now to transform the way obesity is treated, with more emphasis on partnerships, better training for health professionals, and initiatives aimed at erasing the stigma surrounding this serious health condition."

The is one of a series on obesity published online in The Lancet and presented at the Healthy Eating Research Conference held in Baltimore, MD.

 

Dietz and his colleagues conducted one of the most comprehensive reviews of the literature published between 2000 and December 2013 on obesity management. They concluded that the current clinical delivery systems are poorly suited for the prevention and management of obesity. In addition, they found that health professionals do not have the training and tools they need to treat this condition.

 

The report says that many health professionals express biased opinions toward people with obesity and that such attitudes can impair the quality of health care delivery.

"Many health professionals view people with obesity as lazy or lacking in willpower," said Dietz. "The disrespect shown by some providers may discourage future visits or delay essential care that could lead to weight loss or the detection of diseases associated with obesity."

 

The study suggests that training for health professionals should emphasize the complex biological factors that contribute to the development of obesity, factors that have nothing to do with willpower. The authors also urge health professionals to examine their own attitudes towards obesity and rely on new evidence-based tools that can help them care for people who suffer from obesity.

 

Health care providers must also stay informed on the latest therapeutic advances, including behavioural therapy to change diet and exercise; new drugs or devices that can dampen the appetite; and bariatric surgery, which can reduce the size of the stomach to help facilitate weight loss.

 

"Even a 5 to 10 percent weight loss can lead to a reduced risk of stroke, heart disease, and diabetes," Dietz points out. "Health professionals should stress the benefits of modest weight loss—and work with their patients to decide on the most appropriate therapy."

 

The researchers suggest that future efforts to improve care for obesity should integrate clinical and community initiatives. They point out that few examples on integrated systems exist, but that obesity will not be solved by clinical efforts alone. Complementary improvements in the nutrition and physical activity environments will be required to prevent obesity, and to augment and sustain weight loss.

Bariatric surgery associated with longer survival

10 February 2015

Bariatric surgery associated with longer survival

Hi Everyone.  This study is answering the 'holy grail' of Bariatric surgery outcomes - does it prevent early, obesity related death?  And now we can say the answer is yes.  The exciting thing is just how big the beneficial effect is - 53% lower risk of dying.  That is really significant.  I would also applaud the other questions mentioned at the end of the article which constitutes ongoing research.  The thing that the public hospital system wants answered is whether these improvements given to patients through weight loss surgery translate into cost savings for health care provision.  I suspect the answer to that will also be yes and hopefully translates into increased Bariatric surgery availability through the Public Health system.  Watch this space!  Happy times, Steph Ulmer

 

Obese people seem likely to live longer if they have bariatric surgery compared to those patients who do not have surgery, according to a paper published in the Journal of the American Medical Association. The study, which included 2,500 obese patients and nearly 7,500 matched controls, concluded that surgical patients had a 53 percent lower risk of dying from any cause at five to 14 years after the procedure.

"We expanded what we've been learning and showed that older men in this study do just as well after bariatric surgery as younger women in previous studies have done," said first author of the report, Dr David Arterburn a Group Health physician and a Group Health Research Institute associate investigator and affiliate associate professor of medicine at the University of Washington School of Medicine. "Previous studies of long-term survival after bariatric surgery involved younger, mostly female populations who tended to have few obesity-related diseases. In contrast, our study's population was older - with a mean age of 52 - and 74 percent male. Also 55 percent of our population had diabetes, and many had other diseases such as high blood pressure, arthritis, heart disease, and depression."

 

The study was designed to examine the long-term survival in a large multi-site cohort of patients who underwent bariatric surgery compared with matched control patients. In this retrospective cohort study, they identified 2,500 patients (74% men) who underwent bariatric surgery in Veterans Affairs (VA) bariatric centres from 2000-2011 and matched them to 7,462 control patients using sequential stratification and an algorithm that included age, sex, geographic region, body mass index, diabetes, and Diagnostic Cost Group. Survival was compared across patients who underwent bariatric surgery and matched controls using Kaplan-Meier estimators and stratified, adjusted Cox regression analyses.

Seventy four percent of patient had a gastric bypass, 15% sleeve gastrectomy, 10% adjustable gastric banding, and 1% other.

At the end of the 14-year study period, there were a total of 263 deaths in the surgical group (mean follow-up, 6.9 years) and 1,277 deaths in the matched control group (mean follow-up, 6.6 years). Kaplan-Meier estimated mortality rates were 2.4% at one year, 6.4% at five years, and 13.8% at ten years for surgical patients, compared to 1.7% at one year, 10.4% at five years and 23.9% at ten years, for the matched control patients.

Adjusted analysis showed no significant association between bariatric surgery and all-cause mortality in the first year of follow-up (adjusted hazard ratio [HR], 1.28 [95% CI, 0.98-1.68]), but significantly lower mortality after one  to five years (HR, 0.45 [95% CI, 0.36-0.56]) and five to 14 years (HR, 0.47 [95% CI, 0.39-0.58]).

The midterm (>1-5 years) and long-term (>5 years) relationships between surgery and survival were not significantly different across subgroups defined by diabetes diagnosis, sex, and period of surgery.

"We also found evidence that bariatric surgery has become safer," said Dr Matthew Maciejewski, a research career scientist in Health Services Research and Development at the Durham VA and a professor of general internal medicine at Duke University School of Medicine in Durham, NC. "We found that the risk of dying during and soon after bariatric surgery was lower in 2006-2011 than in 2000-2005."

"We have tracked a large group of patients for a long enough time that we can clearly see a strong link between bariatric surgery and long-term survival," added Arterburn. "As time passes, the risk of dying among the patients who've had surgery appears to be diverging from those of the matched controls who haven't had surgery."

With still-longer follow-up, Drs Arterburn and Maciejewski plan to explore various outstanding questions, such as:

  • Does bariatric surgery help certain subgroups of patients more or less?
  • How long does weight loss last after surgery, and at what level?
  • Is the course of associated diseases, such as diabetes, changed?
  • And do total costs of health care decrease in the long run?

"Our results may have broader implications for encouraging weight loss in general," Arterburn concluded. "Despite the studies showing that patients with lower BMIs live longer, not much evidence has linked intentional weight loss (from surgery, medication, or diet and exercise) with longer survival. But our results, combined with other studies of bariatric surgery, may help to make that case."

Access to obesity surgery in NZ hampered by lack of understanding

2 February 2015

Access to obesity surgery in NZ hampered by lack of understanding

Hi Everyone, This was from an Obesity Conference at the end of last year and you may agree or disagree with the comments.  I must say from my point of view the attitude of GPs towards Bariatric surgery has changed significantly and for the better since I have been operating regularly in NZ.  That goes for both the Public and Private sector.  Patients generally comment to me that they have discussed the concept of Weight Loss Surgery with their family doctor and the responses are usually positive from their GP.  This is extremely important for me as a Bariatric Surgeon, because my relationship with GPs is a collaborative one.  We definitely work together on the health of my patients from the minute I become involved with their care.  And that is essential, because your GP is the health professional you see most often.  I think this definitely helps patients to achieve the health goals that most come to see me with at their pre-surgery consultation as well!  Anyway, an interesting statement I thought... Steph

Media release from Obesity Surgery Society of Australia and New Zealand: One of the most effective long-term forms of treatment for obesity is being denied to thousands of New Zealanders because of a lack of understanding among family doctors about the procedures available, as well as public and private reluctance to fund bariatric surgery, according to the Obesity Surgery Society of Australia and New Zealand (OSSANZ)

Obesity Surgery Society of Australia and New ZealandMonday 17 November 2014, 2:22PM

Media release from Obesity Surgery Society of Australia and New Zealand

One of the most effective long-term forms of treatment for obesity is being denied to thousands of New Zealanders because of a lack of understanding among family doctors about the procedures available, as well as public and private reluctance to fund bariatric surgery, according to the Obesity Surgery Society of Australia and New Zealand (OSSANZ), which will be holding its annual scientific meeting in Wellington this week (November 20th -21st).

The uptake of bariatric surgery in New Zealand is one of the lowest in the world, with less than 900 procedures performed across the entire country last year, which means that around 0.03% of persons who are potentially eligible is having this treatment.

OSSANZ spokesman Dr Jon Morrow, a bariatric surgeon at Auckland’s Middlemore Hospital, says GPs’ lack of understanding about obesity surgery is as much to blame as poor funding for the poor access to bariatric surgery in New Zealand, in spite of the country ranking third in the world for obesity rates.

Dr Morrow explains: `GPs in New Zealand are generally against bariatric surgery even though the evidence is unequivocally in favour of its use. GPs generally tend to be quite traditional in their approach to weight loss, I reckon less than a quarter of GPs here will refer patients for surgery. Diet and exercise are important factors, but there is now a huge amount of data, which demonstrates that for up to 15 years after bariatric surgery people do lose weight and keep it off. Unfortunately in the face of this evidence GPs just continue to do what they have been doing. They see obese patients everyday and just don’t mention it to them because they find it impossible to broach the subject with them.’

Wendy Brown, OSSANZ President and Associate Professor in the Faculty of Medicine, Nursing and Health Sciences at Monash University, Melbourne, adds: `The theme of our annual meeting in Wellington is “working together for the good of our patients”. We know that when diet and exercise intervention has failed for obese patients, bariatric surgery is an effective treatment with a good evidence base. It is important that we educate GPs and the community on the role bariatric surgery may play in the treatment of obesity.

‘Surgery is currently one of the only options available that predictably provides substantial weight loss which is sustained when provided in an environment that supports lifestyle change. We hope that we can raise the awareness of this option for obese persons in New Zealand, and that the community can explore ways to improve access to this surgery.

‘However, bariatric surgery is not a magic bullet. It requires a commitment from the patient to change their lifestyle and to actively participate in long-term follow-up. Therefore, we need to involve GPs and other health professionals to support patients on this journey. It is important we have a team approach in the management of this disease so that we can get the best outcomes for our patients.’

Dr Morrow adds: `Most of the surgery performed in New Zealand is gastric sleeve. This procedure involves removing around 80% of the stomach, leaving behind a small tube of stomach. The part of the stomach that is removed is the area that produces hormones that increase hunger, and on top of this patients are physically not able to eat as much. It is safe surgery, causes less severe nutritional deficiencies in the longer term, has few longer term complications and requires 2-4 follow up visits per year, making it well suited to our population who are often reluctant, or find it difficult to, attend follow-up appointments. Typically, by four years people lose around 60% of the extra weight that they are carrying. With this we see diseases related to obesity such as diabetes, high blood pressure and sleep apnoea improve or completely resolve.

`Yet even though the New Zealand ministry of health knows that there are huge health and economic benefits from bariatric surgery, public and private funding is limited. Procedures cost between $18,000 and $20,000 privately, but the insurance companies will only pay a third of the cost up to a maximum of $8,000 even though it is in their economic interest to reduce the long-term economic effects of untreated obesity.’

According to the World Health Organization someone with a body mass index (BMI) of 30 or more is generally considered as obese. Obesity rates in New Zealand as a whole are just under 30% of the population, but among Maori the rates are over 48% and rise to 68% in Pacific islanders.

Now characterised as an epidemic, obesity in children and adults is associated with serious health risks that include hypertension, dyslipidemia, diabetes, fatty liver disease, obstructive sleep apnea, and psychosocial complications.

Professor Brown points out: `Obesity is a disease with far reaching consequences for health and well-being. Weight loss has the potential to be one of the most powerful health interventions in our community. Whilst prevention would be the ideal, preventative programmes just have not worked so far. Diet and exercise programmes are only successful in the long term for 3% of patients. It is not that obese people are just lazy and can’t be bothered; it is incredibly difficult to lose weight as your body defends your weight vigorously. We believe it is time for New Zealand to look at ways to improve access to bariatric surgery.‘

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