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Sleeve Gastrectomy more effective than Gastric band in terms of excess weight loss and resolution of type 2 diabetes

19 July 2014

Sleeve Gastrectomy more effective than Gastric band in terms of excess weight loss and resolution of type 2 diabetes

This article from China combines 12 studies together to see what the overall results are comparing Sleeve Gastrectomy surgery with Lap Band surgery.  It does show that weight loss is less with the band and, in parallel with this, resolution of co-morbidities is lower for patients who have a Gastric Band as well.  This has been widely published before, but it does highlight the fact that different weight loss operations offer different things for patients and what suits one patient doesn't necessarily suit all patients.  The Gastric Band is still a worthwhile procedure in the right setting and for the right patient.  Anyway, if you are wanting to discuss the options for you with respect to Bariatric surgery then it would be worthwhile calling my Receptionist at BetterLife surgery to make an appointment and I will point you in the right direction!

Regards, Steph Ulmer

 

LSG more effective than banding in terms of excess weight loss and resolution of type 2 diabetes

Thursday, July 4, 2013 - 12:52

Owen Haskins - Editor in chief, Bariatric News

A meta-analysis has showed that laparoscopic sleeve gastrectomy (LSG) is a more effective procedure for morbid obesity than laparoscopic adjustable gastric banding (LAGB), with a greater effect on excess weight loss EWL and improvement of type 2 diabetes. The study authors from Nanjing Medical University, Nanjing, and Subei People’s Hospital of Jiangsu Province, Yangzhou, China, write that the meta-analysis confirms the need for larger, randomised, and long-term follow-up studies to compare the efficacy of LSG, LAGB, and laparoscopic Roux-en-Y gastric bypass.

The study included 1,004 patients from 11 studies published between 2000 to 2012.

Results

The results (Table 1) showed that Gastric Sleeve surgery had a greater effect than Gastric Banding on weight loss at six and 12 months. For LAGB (Gastric Banding), the mean percentage EWL (% Excess Weight Lost) was 33.9 % after six months from six studies and 37.8 % after 12 months from four studies. In comparison, EWL was 50.6 % after six months and 51.8 % after 12 months from the same studies for LSG (Sleeve Gastrectomy).

Author

Improve or resolve T2DM

EWL% (6ms)

EWL% (12ms)

 

LAGB

LSG

LAGB

LSG

LAGB

LSG

Simon   KH Wong et al

n/a

n/a

27±26

63      ±      33

31      ±      24

65      ±      32

B   Breznikar et al.

16/22

6/8

n/a

n/a

52.4 (−2.0–145.3)

57.9 (7.6–92.3)

Juan   J. Omana et al.

6/13

14/14

25.2±12

39.5±16

40.3±19

50.6±19

Joshua   B. Alley et al.

11/17

22/31

n/a

n/a

29.5±16.7

47.2±11.9

Kazunori   Kasama et al.

3/4

4/6

n/a

n/a

n/a

n/a

Paul   Brunault et al.

n/a

n/a

34.8±18.4

43.8±17.8

34.8±18.4

43.8±17.8

Susan   S. H. Gan

6/12

20/21

n/a

n/a

34.2

35.9

W.   K. Fenske et al.

n/a

n/a

n/a

n/a

45.0±2.4

47.8±4.5

S.   K. H. Wong

n/a

n/a

n/a

n/a

25.4±20.2

68.6±39.6

F.   B. Langer et al.

n/a

n/a

28.1±10.6

61.4±16.3

n/a

n/a

M.   A. Kueper et al.

n/a

n/a

39.1±19.1

33.0±10

n/a

n/a

H.   R. Hady et al.

4/8

18/39

48.98±6.58

62.71±21.17

n/a

n/a

Table 1: Main outcomes of the 12 studies included in the meta-analysis T2DM (Type 2 Diabetes Mellitus)

After six and 12 months, the mean percentage EWL was higher for LSG than for LAGB by 33.0 and 27.0 %, respectively, indicating that (at these time points) LSG had a greater effect on weight loss than LAGB.

Resolution of Type 2 Diabetes

LSG was also superior to LAGB in treating type 2 diabetes. In five studies, 42 of 68 (61.8 %) type 2 diabetes patients experienced improvement of their diabetes after LAGB, whereas 66 of 80 (82.5 %) type 2 diabetes patients improved after LSG, an increase of 20.7 %.

“Because LSG is a comparatively new procedure that has become popular in recent years, there is also concern about the long-term results; the follow-up periods in most reports are 6 or 12 months, and the studies analysed here provided relatively short-term findings,” the authors note. “Some studies that reported three-year results were not included in this meta-analysis because of insufficient data, but their numbers are low. There are few reports with a follow-up period of 5 years or more.”

Body Shape is a better predictor of risk than BMI

4 June 2014

Body Shape is a better predictor of risk than BMI

Using BMI (Body Mass Index) as a measure of obesity has always had its shortcomings, and it appears that there is strong evidence now that using ABSI(A Body Shape Index) is a better predictor of who is more likely to suffer complications of their obesity.  From a clinical context, this is what we, as Bariatric Surgeons worry about because then we can advocate surgery for those whose body shape index suggests that their chance of developing medical issues as a result of being overweight is increased.  We do know that Sleeve Gastrectomy or Bypass or Lap Banding are Bariatric Surgical procedures that do produce excellent and long term weight loss solutions for people who struggle with being overweight. 

The weight loss results from surgery has been shown in many trials to be better than best medical management for weight loss.  Paste the link below if you want to know how to measure your Waist Circumference accurately and then you will be able to measure your own Body Shape Index!  http://dev.musc.edu/cme/resources/obesity_resources/WCMG-Self-Measurement.pdf

Steph Ulmer

 

 

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A Body Shape Index (ABSI), is a more effective predictor of mortality than Body Mass Index (BMI), according to at study published by the online journal PLoS ONE.

In 2012, Dr Nir Krakauer, an assistant professor of civil engineering in City College of New York's Grove School of Engineering, and his father, Dr Jesse Krakauer, developed a new method to quantify the risk specifically associated with abdominal obesity.

The team analyzed data for 7,011 adults, 18+, who participated in the first Health and Lifestyle Survey (HALS1), conducted in Great Britain in the mid-1980s, and a follow-up survey seven years later (HALS2). The sample was broadly representative of the British population in terms of region, employment status, national origin, and age. They used National Health Service records through 2009 to identify deaths and cancer cases: 2,203 deaths were recorded among the sample population.

The analysis found ABSI to be a strong indicator of mortality hazard among the HALS population. Death rates increased by a factor of 1.13 (95% confidence interval, 1.09-1.16) for each standard deviation increase in ABSI. Persons with ABSI in the top 20% were found to have death rates 61% higher than those with ABSI in the bottom 20%.

The results tracked closely with the earlier study, which used data from the National Health and Nutrition Examination Survey (NHANES), conducted in the United States between 1999 and 2004. This provides stronger evidence that ABSI is a valid indicator of the risk of premature death across different populations. Further, they showed that ABSI outperformed commonly used measures of abdominal obesity, including waist circumference, waist - hip ratio and waist - height ratio.

Also, because the data came from two surveys seven years apart, the researchers were able to assess the effect of change in ABSI on mortality. The found an increase in ABSI correlated with increased risk of death, and that the more recent ABSI measurement was a more reliable predictor. Noting this, the researchers contend that further investigation is warranted into whether lifestyle or other interventions could reduce ABSI and help people live longer.

“ABSI appears to outperform other popular anthropometry-based measures of adiposity, such as WHtR and WHR. Mortality risk appears to track changes in ABSI over time, motivating further research into whether lifestyle or other interventions could trigger reduction in ABSI and incur the longevity benefits seen in this study for those with lower ABSI,” the researchers concluded.

FAST FOOD TO BLAME finds a University of Auckland study

28 May 2014

FAST FOOD TO BLAME finds a University of Auckland study

Sometimes the best studies are the simplest - and this study is a good example of that!  This was an online survey of 100 NZers looking at their fast food intake.  The most-loved options were then analysed for their nutrition and compared with the recommended daily requirements as set by the WHO.  It showed that a large proportion of the daily requirements were being provided by one burger-chips and drink combo.  When these are eaten on a regular basis, obesity is the likely result.  It does seem that the time is right for stricter guidelines on nutrient composition of readily available fast foods - for the health of our nation.  After all, obesity is the new smoking as far as being a major health issue in our community...Have a read. 

Steph Ulmer

Some of New Zealand's favourite burger-chips-and-drink combos are fuelling our overfed nation up with more than 40 per cent of the energy recommended for an average adult for a whole day.

Based on the World Health Organisation's suggestion that maximum sugar intakes could usefully be halved, the combos were found to pack a sugar hit of 94 to 185 per cent of recommended daily sugar consumption.

Based on these findings, Dr Helen Eyles and her University of Auckland colleagues who conducted the research concluded in the New Zealand Medical Journal that "there is plenty of room for improvement in the nutrient composition of fast-food items in NZ".

They did an online survey of 104 adults in January to identify the most-loved fast foods at KFC, McDonald's, Pizza Hut and Burger King. They analysed the composition of the 14 most popular menu items.

For a typical woman, the four Burger King combos that made the favourites list carried between 35 and 54 per cent of the recommended daily intake of energy and 137 to 185 per cent of the recommended daily limit for sugar.

The McDonald's favourites would give her 31 to 41 per cent of her recommended daily energy.

The WHO says New Zealand experienced the fourth-greatest growth in fast-food purchasing among 25 high-income nations from 1999 to 2008. All 25 also increased their weight for height - and NZ was well in front with an increase of more than one point on the body mass (BMI) scale on which a score of 25-29.9 is overweight and 30-plus is obese.

In New Zealand, 31 per cent of adults are obese and 34 per cent are overweight. Our spending on takeaways rose by a quarter in four years, to $1.5 billion in 2012, according to industry data.

Dr Eyles and her colleagues said: "The rise in fast-food availability and consumption is concerning because this food is generally high in fat, sugar, sodium [part of salt] and energy, and high intakes are associated with increased body mass index ... and obesity risk.

"As such, there have been calls for guidelines around the nutrient composition of fast food and availability of healthier options."

The researchers found salads were offered at Burger King, McDonald's and KFC and on most nutritional measures had the healthiest profiles of main menu items. But salads were not popular in their survey.

"... no one indicated they had consumed a salad from one of the four fast-food chains in the past month."

A McDonald's spokeswoman said the chain supported a multi-sector approach to obesity, which was a complex issue. She criticised the study's design, which was "focused on one purchase, and provided no context of the person's overall diet".

"On average New Zealanders eat at McDonald's once a month. For over 10 years, McDonald's has reformulated its menu to reduce sugar, sodium and saturated fat, without impacting taste and quality ... We have added new menu items to provide choice ... [such as] a popular new range of salads and wraps ..."

A Burger King spokeswoman, Rachel Morriss-Jarvis, said energy labels had been introduced on menu boards last year to help customers make informed choices. There had also been significant improvements to the range available, including salads, wraps and low-fat options.

"As the WHO guidelines have just been released, we will review in line with our ongoing menu improvement processes which aim to reduce salt, sugar and energy from our menu," she said.

No one at Restaurant Brands, which operates Pizza Hut and KFC, could be reached for comment.

Read more here

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