Access to surgery would improve health of thousands

7 January 2016

Access to surgery would improve health of thousands

Happy New Year to you all! As a Bariatric Surgeon this type of article is music to my ears! These are the types of studies that should start to ring bells with those in charge of health funding allocation. Not only in the public health sector but also for the private medical insurance providers. In the long run, the financial pros and cons would have to weigh in favour of bariatric surgery as money well spent. As the article describes, bariatric surgery including gastric sleeve, gastric bypass and gastric banding, is "unrivalled" as the most effective treatment for hypertension and type 2 diabetes (and a lot of other medical conditions that occur directly related to being over weight). This is not news to me - I see it everyday in my rooms at BetterLife Surgery. The happiest patients I come across are my Gastric Sleeve patients who are finally getting control over their eating and drinking and consequently their weight. It is something we see often but it never fails to give me goose bumps. It is not the easy way out but it certainly gives you a push in the right direction towards a healthier life! If you would like to hear more, make an appointment to see me.

Kind regards




Surgery could potentially prevent and/or resolve tens of thousands of cases of hypertension and type 2 diabetes in the UK

Bariatric surgery can reduce the risk of developing serious health conditions such as heart attacks and type 2 diabetes, as well improve existing conditions, according to a study published in PLOS Medicine. The paper, ‘Bariatric Surgery in the United Kingdom: A Cohort Study of Weight Loss and Clinical Outcomes in Routine Clinical Care’, is the result of the largest comprehensive study of longer-term outcomes post-surgery in the UK, and the paper suggests that widening the availability of bariatric surgery could boost the health prospects for thousands of people who are severely obese (BMI>40).

The research, led by the London School of Hygiene & Tropical Medicine in partnership with UCL and the UCLH Bariatric Centre for Weight Management and Metabolic Surgery, London, UK, states that bariatric surgery could potentially be used to prevent and/or resolve tens of thousands of cases of hypertension and type 2 diabetes, as well as prevent other obesity-related illnesses among the estimated 1.4 million morbidly obese people in the UK.

"Bariatric surgery is safe and produces unrivalled health benefits that are life-changing for patients and cost-saving for the NHS,” said study co-author, Professor Rachel Batterham, Head of the UCLH Bariatric Centre for Weight Management and Metabolic Surgery and the UCL Centre for Obesity Research. “Unfortunately, less than 1% of the patients who could benefit from this surgery currently receive surgery. This represents a major missed opportunity in terms of improving health and economic savings. Action is now needed to remedy this situation."

Using primary care records, the researchers compared weight, BMI and obesity-related illnesses between 3,882 bariatric surgery patients and similar control patients who did not have surgery, over an average period of three and a half years. They found that weight-loss surgery can significantly improve existing type 2 diabetes and reduce abnormally high blood pressure.

They also applied the findings to estimate that if the 1.4 million people believed to be morbidly obese in the UK had bariatric surgery, it could prevent;

  • 80,000 cases of hypertension
  • 40,000 cases of type 2 diabetes, and;
  • 5,000 heart attacks over a four year period

They also report that 110,000 people with type 2 diabetes and 13,000 people with hypertension could significantly improve their condition.

"Obesity is one of the biggest health problems of our generation. Rates of cardiovascular disease, although slowly declining, are still alarmingly high while type 2 diabetes is on the rise, affecting 3.5 million people in Britain. Finding effective ways to tackle the obesity crisis is therefore a key public health strategy,” said lead author, Dr Ian Douglas from the London School of Hygiene & Tropical Medicine. “Whilst effective prevention is clearly needed, our findings show that as well as helping patients substantially lose weight, bariatric surgery improves serious obesity-related illnesses as well as reducing the risk of developing them. People having weight-loss surgery were 70% less likely to have a heart attack, and those with type 2 diabetes were nine times more likely to see major improvements in their diabetes. We also found positive effects on angina and the debilitating condition obstructive sleep apnoea.”

They also found that gastric bypass and sleeve gastrectomy were associated with greater weight loss than gastric band, with estimated four year weight loss of 38kg for gastric bypass, 31kg for sleeve gastrectomy and 20kg for gastric banding.

“Although we acknowledge that not all patients are suitable for bariatric surgery, it appears that better access to bariatric surgery, where appropriate, could lead to a considerable reduction in the burden of disease and substantial cost savings for the health system,” the authors write. “…Resolution of T2DM and hypertension was more common in people receiving gastric bypass or sleeve gastrectomy than in those undergoing gastric band surgery. For other outcomes, there was little evidence of differential associations by surgery type.”

How bariatric surgery reduces sugar cravings

23 November 2015

How bariatric surgery reduces sugar cravings

This is great news for the true sweetooths amongst you!  Yes, bariatric surgery fixes some of the sugar cravings that tempt you to go for the Anzac biscuit over the carrot stick! This is a true phenomenon as demonstrated by our friends the mice, but one that we have very little idea how or why it happens.  Dopamine seems to be the transmitter in question but how and why the signals occur in the first place is a mystery.  It is nice to know that there are laboratory reasearchers keen to get to the bottom of it and help us all in our quest towards a healthier life.  Bariatric surgery including Gastric Bypass, Sleeve and Lapband surgery are still the best ways we have of dealing with weight problems over the longterm.

Kind regards, Steph


Bariatric surgery curbs the sweet tooth by acting on the brain's reward system, according to a study published in the journal Cell Metabolism. The researchers found that gastrointestinal bypass surgery, reduced sugar-seeking behaviour in mice by reducing the release of a reward chemical called dopamine in the brain. The findings suggest that positive outcomes are more likely if sugary foods seem less rewarding after surgery.

"The problem of how and why bariatric surgery works has been perplexing scientists for years," said senior study author, Dr Ivan de Araujo of Yale University School of Medicine. "By shedding light on how bariatric surgeries affect brain function, our study could pave the way for the development of novel, less-invasive interventions, such as drugs that reduce sugar cravings by preventing sugar absorption or metabolism upon arrival in the gastrointestinal tract."

Previous research has shown how patients have reported a change in the type of food they preferred after weight-loss surgery. Although the different bariatric operations are effective at reversing obesity and diabetes, it is not entirely clear how these surgeries work. It is likely that there are a number of different mechanisms at play. Bariatric surgery is more likely to succeed when patients substantially reduce their caloric intake, and reducing sugary foods is an important part of these behavioural changes.

Building on past studies that showed that the brain dopamine reward system regulates caloric intake as well as findings from his team that nutrient sensing in the gastrointestinal tract stimulates dopamine release in the dorsal striatum, de Araujo set out to test whether bariatric surgery relies on the same brain circuitry to curb sugary food preference. They performed surgery in mice to bypass the first part of the small intestine, directly connecting the stomach to a lower section of the gastrointestinal tract. The same procedure is performed in humans, and it mimics the bypass component of the commonly used Roux-en-Y intervention, but no gastric pouch was constructed to limit food intake.

The gastrointestinal rerouting procedure performed in mice suppressed their sweet tooth by reducing sugar-induced dopamine release in the dorsal striatum, essentially diminishing the rewarding effects of sugar. Due to the addictive properties of sweets, infusions of sugar into the stomach would typically cause mice to persistently lick a spout that released a sugary liquid, despite the sensation of fullness. However, bypass surgery inhibited the sweet-seeking impulse, almost as if it prevented the sugar addiction from taking hold.

This graphic depicts how the duodenal-jejunal bypass surgery curbs sugar cravings by eliminating sugar-induced dopamine release specifically in the dorsal striatum. Credit: Han et al./Cell Metabolism 2015

Moreover, using optogenetics, an advanced neuroscience technique, to directly activate the dopamine neural circuit in free-living animals, the researchers saw a striking increase in sugar consumption, overturning the effects of bypass surgery. Mice that underwent this procedure consumed virtually no sweetener following sugar infusions into the stomach, but optical stimulation of the dorsal striatum caused the mice to plant themselves in front of the sugar spout.

"Our findings provide the first evidence for a causal link between striatal dopamine signalling and the outcomes of bariatric interventions," said de Araujo. "However, we certainly do not want to give the impression that we have an answer for how and why bariatric surgery works. Much more research is needed in this field."

de Araujo plans to directly compare the impact on the brain's dopamine cells produced by different types of bariatric surgeries.

"We hope our work will provide new insights into how different bariatric interventions may lead to a diverse repertoire of behavioural modifications," he added. "However, ultimately we would like to help patients lose weight and reverse their diabetes without going under the knife."

Individuals with type 2 diabetes should exercise after dinner

10 October 2015

Individuals with type 2 diabetes should exercise after dinner

Hi All,

Well this is a quirky one! Who would have thought that your decision on when to exercise could have consequences on the effectiveness of the exercise on a physiological level.  Nice to know, and switching to post-dinner exercise would be a pretty easy change to a daily routine to get the maximum benefits out of your exercise.  We all know that Type 2 Diabetes is closely linked to Obesity, and that significant and long term weight loss can be considered the best chance of bringing about a 'cure' for the diabetes in some people.  Obviously optimising exercise will contribute positively to helping with that weight loss, however, the one thing that diabetics can do that gives them the best chance of weight loss and subsequent cure of their diabetes is to consider weight loss (Bariatric) surgery.  Gastric Banding, Gastric Sleeve and Gastric Bypass surgeries (among others) have been proven to be true in many studies from different parts of the world.  If you want to talk more about these options then a Consultation is the best first step.  Obligation free, but more knowledge can lead to better decisions.  I look forward to seeing you soon!

Steph Ulmer


Type 2 diabetics can lower their risks of cardiovascular diseases more effectively by exercising after a meal, according to researchers at the University of Missouri (UM). Although it is known that exercise can benefit these individuals, little research has explored whether these individuals receive more benefits from working out before or after a meal.

“This study shows that it is not just the intensity or duration of exercising that is important but also the timing of when it occurs," said Jill Kanaley, professor in the MU Department of Nutrition and Exercise Physiology. "Results from this study show that resistance exercise has its most powerful effect on reducing glucose and fat levels in one's blood when performed after dinner."

The study, ‘Post-dinner resistance exercise improves postprandial risk factors more effectively than pre-dinner resistance exercise in patients with type 2 diabetes,’ was published in the Journal of Applied Physiology.

Kanaley and her colleagues studied a group of obese type 2 diabetics and consumed a moderate carbohydrate dinner on the evenings of the study.

On one occasion, participants performed resistance exercises before eating dinner and on a subsequent visit they exercised 45 minutes after eating dinner. Participants performed resistance exercises such as leg curls, seated calf raises and abdominal crunches.

Compared to levels on a non-exercise day, the researchers found that the participants who exercised before dinner were able to only reduce the sugar levels in their blood; however, participants who exercised after dinner were able to reduce both sugar and fat levels.

"Knowing that the best time to exercise is after a meal could provide healthcare professionals with a better understanding of how to personalise exercise prescriptions to optimise health benefits," said Kanaley.

They also found that improvements in participants' blood sugar and fat levels were short-lived and did not extend to the next day. She suggests individuals practice daily resistance exercise after dinner to maintain improvements.

"Individuals who exercise in the morning have usually fasted for ten hours beforehand," Kanaley said. "Also, it is natural for individuals' hormone levels to be different at different times of day, which is another factor to consider when determining the best time to exercise."

In the future, Kanaley said she plans to research how exercising in the morning differs from exercising after dinner and how individuals' hormone levels also affect exercise results.


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