Bariatric Surgery Improves Metabolic Syndrome for PCOS
3 January 2017
Happy New Year to you all! I hope you find the below article interesting. Polycystic Ovary Syndrome (PCOS) is a silent disease that affects young women significantly. The main things they notice are the masculinizing features such as body hair growth, menstrual irregularity with infertility and acne, but there are more significant medical consequences of PCOS that are not fully realised by those affected. PCOS accelerates the changes associated with metabolic syndrome ie hypertension, hypercholesterolemia with consequent Cardiovascular consequences. This does mean that treatment of PCOS becomes more of a priority and it seems that bariatric surgery does have significant positive effects on PCOS when there is very little other treatments on offer. An interesting read with indications for more in depth research into the area in the future.
Bariatric Surgery Improves Metabolic Syndrome for PCOS
Small cohort with obesity and PCOS saw improvement
ORLANDO -- Women who were overweight or obese and had polycystic ovarian syndrome (PCOS) saw significant improvements in all major metabolic syndrome components 8 months after undergoing bariatric surgery, researchers reported here.
The retrospective analysis of baseline factors and outcomes in 19 women, most of them black, showed significant improvements from pre-surgery values in body weight (P<0.0001), body mass index (P<0.0001), systolic blood pressure (P=0.0002), diastolic blood pressure (P=0.007), triglycerides (P=0.04), HbA1c (P=0.03), and HDL cholesterol (P=0.04).
Before surgery, about half (47%) of the women met the criteria for metabolic syndrome; only 21% after the surgery did, according to authors Mc Anto Antony, MBBS, and Shannon Sullivan, MD, PhD, at MedStar Washington Hospital in the District of Columbia.
Antony presented the findings at a poster session here at the annual meeting of the American Association of Clinical Endocrinologists.
"The reason we conducted this study is because PCOS is a very commonly seen disorder in reproductive-aged women, and most of these women are either overweight or obese, and obesity exacerbates the metabolic phenotype in these women; and, in the long run, because of the metabolic syndrome they are at risk for developing cardiovascular problems," said Antony in an interview with MedPage Today. "So we wanted to see if bariatric surgery could provide a solution in this population."
He added that for women who find it hard to achieve weight loss through diet and exercise, bariatric surgery could be a good option that might reduce cardiovascular risk.
All of the patients had visited MedStar at some point, and all were at least 18 years old. All values were taken at least 6 months after surgery (mean 7.9 ±3.4 months). Fifty-three percent of the women were black, 41% were white, and 6% were Asian. Prior to surgery, the mean number of metabolic syndrome factors per patient was 2.7 (±1.1) versus 1.9 (±1.2) after surgery (P<0.01).
Antony said that most of the time the first-line intervention among this populations is weight loss through diet and exercise. "But it's very hard for most of them to achieve that, and even if they achieve that, it's hard for them to sustain it," he said. "Hence we thought of bariatric surgery as an option."
Antony said that a significant limitation of the study was that there were not enough data to determine how the surgery affected the patients' PCOS. "We tried to look up whether the surgery had any effect on the PCOS itself, but there were not enough data in the patients' notes," he said.
But he added that other studies have showed an improvement after bariatric surgery for some PCOS symptoms, "like an improvement of menstrual irregularities and hormone markers." Participants in one study were more likely to conceive after surgery, he said.
He added that the topic needs more research, however. "It would be really interesting to follow a larger population to see if they are able to sustain the weight loss after surgery," he said.
Patients who attend follow-up have better outcomes
8 November 2016
This study proves what I have anecdotally noticed about my own patient group. The patients who are more reliable at attending follow up appointments, either to see me, my Nutritionist (Nicola Page) or my Bariatric Nurse Specialist (Kate Berridge) are more likely to stay on track with their weight loss in the long term. It is interesting to see that this also translates into improvements in their medical conditions associated with being overweight ie Hypertension, Hypercholesterolemia and Type 2 diabetes. It probably follows that if you are more conscientious about attending appointments you are probably going to be more strictly adhering to nutritional and eating habit guidelines that we suggest for post-bariatric surgery life. It is true that everything changes around eating and drinking immediately after having Bariatric surgery and these new habits should become a 'new normal' from then on to ensure the long term outcomes are good. The better patients are at practicing their new habits, the better the outcomes they will achieve. Anyway, plenty more to talk about when we meet in person. An appointment to see me for a chat is the first step to take and we can take it from there!
Bariatric patients who stick to a schedule of three-, six- and 12-month follow-up visits with their doctors see greater improvements or remission of their diabetes, high blood pressure and high cholesterol than patients who skip their visits, according to research presented at ObesityWeek 2016. The paper, “The effect of close postoperative follow-up on comorbidity improvement after bariatric surgery,” was presented by researchers from the Brody School of Medicine at East Carolina University in Greenville, NC.
The study assessed the relationship between complete follow-up and improvement or remission of comorbid conditions at 12-months after surgery. The investigators obtained data from the Bariatric Outcomes Longitudinal Database (BOLD) from 2007 to 2012 and reviewed the results of 38,613 patients who had the three follow-up visits (complete follow-up) and compared them to the results of 12,468 patients who only had one or two follow-ups (incomplete follow-up). Improvement and remission of comorbid conditions were compared between the two cohorts. Specifically, changes in diabetes (T2D), hypertension, and dyslipidemia were evaluated at 12-month postoperatively.
After one year, 62.3 percent of patients with complete follow-up saw their type 2 diabetes go into remission, while those who missed a visit or two had a remission rate of 57.5 percent. The rate of improvement in diabetes was also better for those who made all three visits (74.6% vs. 68.9%). The differences between the two groups also held for high blood pressure and lipid abnormalities including high cholesterol.
“This study shows there is great value in seeing patients at routine intervals after surgery in terms of health outcomes,” said Dr Andrea Schwoerer, study co-author, currently at Carolinas Medical Center. “Unfortunately, many patients, reportedly as many as 50 percent, are lost to follow-up and therefore may not benefit as much as they can from weight-loss surgery, no matter how well it was performed.”
Hypertension improved in 63.2 percent of the patients in the complete follow-up group and 58.1 percent in the incomplete follow-up group. The difference in resolution rates in the groups was less, but still statistically significant (46.1% vs. 42%). The trend also held for lipid abnormalities, with these improving for 55 percent of patients completing follow up versus 51.1 percent for those who did not. Remission rates were,42.8% vs. 41.1% respectively, a small, but still statistically significant difference. After adjusting for baseline characteristics, complete postoperative follow-up in the first year after surgery was independently associated with a higher rate of improvement or remission of comorbid conditions.
“We cannot stress enough the importance of follow-up visits and post-operative care,” said Dr Stacy Brethauer, President-elect, ASMBS and bariatric surgeon at the Cleveland Clinic in Ohio, who was not involved in the study. “It could mean the difference between a good and a great result. The most committed patients do best, and we need to find ways to keep all patients engaged for the long-term.”
Gestational Diabetes and the risk of developing subsequent Type 2 diabetes
16 August 2016
This study is a longitudinal look at not only what happens to women who have been diagnosed with Gestational Diabetes and whether they go on to develop Type 2 diabetes within 10 years of diagnosis, but also the effect of non-surgical interventions on the risk of going on to develop Type 2 diabetes. The positive news is that lifestyle changes alone can decrease this risk!! That is very encouraging. It also holds true for my patients who have chosen to have Bariatric surgery to improve their health and minimise medical issues associated with obesity. The message for my patients who undergo bariatric surgery is that the focus in the first post-operative year is to make lifestyle changes that can last a lifetime. This improves the chances of maintaining the weight loss that they have achieved with Bariatric Surgery (Bypass, Sleeve or Banding). And life long weight maintenance is what we all want!!
Women with a history of gestational diabetes (GD) face a heightened risk of developing yype 2 diabetes for years after giving birth, but intensive lifestyle intervention or a medication regimen can have a protective effect in this population, according to a study published in the Endocrine Society's Journal of Clinical Endocrinology & Metabolism.
"Our long-term follow-up study found the elevated risk of developing type 2 diabetes persisted for years in women who had been diagnosed with gestational diabetes, and this long-term risk can be reduced with either intensive lifestyle intervention or the medication metformin," said one of the study's authors, Dr Vanita Aroda of the MedStar Health Research Institute in Hyattsville, MD.
The Diabetes Prevention Program Outcomes Study (DPPOS) analysed long-term metabolic health in 288 women who had a previous diagnosis of GD and 1,226 mothers who did not have a history of the condition. The women all participated in the initial Diabetes Prevention Program study, a randomised clinical trial where they were assigned to intensive lifestyle intervention, the diabetes medication metformin or a placebo. The intensive lifestyle intervention was aimed at reducing body weight by 7 percent and participating in moderate cardio exercise for 150 minutes a week.
During the DPPOS, the women continued to have their blood glucose levels measured twice a year for six years. The study looked at long-term health outcomes in Diabetes Prevention Program participants for about a decade after the women first enrolled in the study.
Over 10 years, women with a history of GD assigned to placebo had a 48% higher risk of developing diabetes compared with women without a history of GD. In women with a history of GD, lifestyle intervention and metformin reduced progression to diabetes compared with placebo by 35% and 40%, respectively. Among women without a history of GD, lifestyle intervention reduced the progression to diabetes by 30%, and metformin did not reduce the progression to diabetes.
"Medical and lifestyle interventions were remarkably effective at slowing the progression of Type 2 diabetes in this at-risk population in both the short and long term," said Aroda.
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