Blog

Surgery induced weight loss improves brain function

7 November 2014

This is an unexpected finding!  I always tell people who come to me to find out more about Bariatric Surgery that obesity affects every organ system.  However, if you had asked me how it affected the brain I wouldn't have been able to give you a specific example.  But now here it is!  PET scans look at metabolic activity of the body or how rapidly cells are working in specific organs.  It is very sensitive and allows visual evidence that enables you to compare one part of the body with another.  They found that the metabolic activity in obese brains had areas of abnormally increased metabolism but it was very heartening to see that the brain can regain normal activity following surgery for weight loss (gastric bypass in this example) and improvements in cognitive functioning were measurable.  Another upside to significant and longterm weight loss with Bariatric surgery!

Enjoy, 

Steph Ulmer

Bariatric surgery can lead to changes in brain activity associated with obesity and improve cognitive function involved in planning, strategising and organising, according to a study published in the Journal of Clinical Endocrinology & Metabolism. 

"When we studied obese women prior to bariatric surgery, we found some areas of their brains metabolised sugars at a higher rate than normal weight women," said one of the study's authors, Dr Cintia Cercato from the University of São Paolo in São Paolo, Brazil. "In particular, obesity led to altered activity in a part of the brain linked to the development of Alzheimer's disease, the posterior cingulate gyrus. Since bariatric surgery reversed this activity, we suspect the procedure may contribute to a reduced risk of Alzheimer's disease and other forms of dementia." 

The longitudinal study examined the effect of bypass surgery on the brain function of 17 obese women and the researchers used positron emission tomography (PET) scans and neuropsychological tests to assess brain function and activity, in the participants prior to surgery and six months after the procedure. The same tests also were run once on a control group of 16 lean women. 

Before they underwent surgery, the obese women had higher rates of metabolism in certain areas of the brain, including the posterior cingulate gyrus.

Following surgery, there was no evidence of this exacerbated brain activity and their brain metabolism rates were comparable to the activity seen in normal weight women.  After surgery, the obese women also performed better on a test measuring executive function (the brain's ability to connect past experience and present action) than they did before the procedures

Five other neuropsychological tests measuring various aspects of memory and cognitive function showed no change following the surgery. 

"Our findings suggest the brain is another organ that benefits from weight loss induced by surgery," Cercato said. "The increased brain activity the obese women exhibited before undergoing surgery did not result in improved cognitive performance, which suggests obesity may force the brain to work harder to achieve the same level of cognition." 

“It seems that metabolic and inflammatory properties associated with obesity in young adults are accompanied by changes in the cerebral metabolism capable of being reversed with weight loss,” the authors conclude. “Further studies are required to improve the understanding of the pathogenesis of the cognitive dysfunction related to obesity and the effects of weight loss on the occurrence of dementia.”

How one Kiwi lost more than 150kgs

30 October 2014

I now own a pair of pants that three people can fit into. Why? Because I used to fit them myself. 

I don't say that to show off. I say that simply to paint a picture of the road I have travelled.

Shedding a ton of weight is just one side of the story. Regardless of how I got there and the tools I used to get to where I am now the journey has been more than about the numbers recorded on the scale. It has perhaps more so been about submission, forgiveness, healing and redemption.

I had to submit to the fact I had a problem. I had an addiction that was the same as a drug, alcohol, or smoking addiction. The only difference with mine was I could not remove food completely from my life, I could only adjust how I used it. Or the term I use now, change my relationship with food in order to change my life.

This admission was perhaps the hardest of all to make.

I had to admit that there were deep-seated emotional triggers I had to deal with to be effective in this change. Not all negative but they were there to be dealt with and I was introduced to some very inspirational people. Others stepped up to help me in other ways that made my road to travel a little less lonely.

150 kilograms is a lot of weight to lose. Did I do it without surgery? Of course not. 

In June of 2013 I had a gastric sleeve. Did it make it easier? No. It has brought about its own share of challenges. I can mess it up and revert back to the way I used to be. It is a tool, like gum to a smoker trying to quit, treadmill to a runner or a swimming pool to a swimmer. 

Bariatric surgery is NOT an easy option, nor is it a cure to the cravings, the desires and the habits of 20-plus years of living as a 7XL man. It helped me lose about 50 per cent of the total amount I have lost. The responsibility is now on me to keep it that way and that is not easy.

To that side I have had the help of counsellors, psychologists and dear close friends and family who have sat with me for hours and hours, talking through the challenges that have arisen in the months since surgery. 

I have had emotional moments in retail stores that for two decades I could never shop in for anything more than socks or ties, and even then would get sideways glances. In one store, the nice lady asked me what size I was used to wearing, and really didn't grasp what I was telling her that I used to wear 190cm pants and showed her the jeans I once wore without a belt. 

Visiting stores like that are now literally a part of my recovery and ongoing therapy.

The forgiveness I speak of has come from a loving and patient wife. No greater compliment comes from her lips than her saying how proud she is of me, but I cannot say how proud I am of her. She waited long and hard and when the time came, put her foot down which three years ago helped motivate my changes. 

Most people do not like negative motivation. People either walk away or take up the challenge. I took the challenge by walking, not away, but walking towards the hills and distances.

I walked around Lake Taupo in the 2012 and 2013 relays, walked the Rotorua Half Marathon, and doing other events like Tri-Maori and IronMaori in teams, and this year for the first time as a solo participant. It's the smiles and arms of my wife and daughter that keep me going when in the most difficult and trying moments I imagine them waiting at the finish line.

In my journey I went through the ups and downs people normally do with the numbers on the scale. 

I went from 257kg to 179kg on my own. Quite an achievement, but it didn't stick. 

Slowly but surely, in 2012 under the pressure of study and other matters it crept back up. By December 2012 I was back up over the 200kg mark. On the day of my surgery I was 193.8kg. 

I'm now sitting at 110kg and far more active than I have ever been in my life. I find myself trying to work with people who want to make changes in their lives. Literally, I've been given a second chance at a life I've never experienced before. 

Here is how new it is for me: I'm actually now 10kg lighter than I was in forth form (year 10). Yet I know, never before physically have I ever felt this good. 

I now in the words of Shakespeare am in "undiscovered country" for me and while there are moments of confusion and uncertainty, I am excited about the life that's up ahead, because of the one I've left behind.

Bariatric surgery causes remission of food addiction

16 October 2014

Food addiction is an interesting entity and this study looks at how Bariatric Surgery affects this condition.  The concern from Bariatric surgeons is that patients who have a food addiction will have a poor outcome from the operation.  However, the good news is that it seems to have a very beneficial effect on patients who feel that they are affected by food addiction.   The word addiction suggests that it is something that is out of the patients control, and the nice thing is that weight loss surgery gives patients back the ability to control their eating and drinking behaviours - something they may have felt was never going to possible for them. If you would like more information on this or any other topic around weight loss surgery - please don't hesitate to email me.

Regards,

Steph Ulmer

Bariatric surgery-induced weight loss induces remission of food addiction and improves several eating behaviours that are associated with the condition in extreme obesity, according to the study published in the journal Obesity.

Although, bariatric surgery is believed to be one most effective available weight loss therapy for obesity and impacts on patients desire to eat, it is not known whether it can affect food addiction in patients who meet diagnostic criteria for the condition before surgery.

Therefore, researchers from the Center for Human Nutrition and Atkins Center of Excellence in Obesity Medicine, Washington University School of Medicine, St Louis, MO, assessed whether weight loss induced gastric bypass, gastric banding and sleeve gastrectomy induced remission of food addiction, as well as normalising eating behaviours associated with the condition.

They recruited 44 obese patients (39 women, mean BMI48 ± 8) before and after bariatric surgery (after they lost ∼20% of their body weight). Twenty five patients had gastric bypass, 11 gastric banding and eight sleeve gastrectomy).

Food addiction was identified in 14 of 44 subjects (32%) before surgery, with no significant differences in factors that could affect the condition such as age, race, level of formal education, and income level.

They reported that remission of food addiction in 13 of the 14 subjects (93%) and no new cases were identified after surgery. The prevalence of food addiction in this study population decreased from 32% to 2% (p< 0.00001)

and reduced the median number of symptoms in all subjects (p< 0.0001).

Surgery was found to decrease food cravings in both groups, but the decrease was greater in patients addicted to food. Unsurprisingly, the addicted patients craved foods more frequently before, but not after surgery. Interestingly, surgery decreased cravings for all types of foods but cravings for starchy foods were still more frequent in in the food addicted group (p=0.009).

“Our findings demonstrate that weight loss can induce remission of food addiction, even though subjects are still obese,” the authors write. “These data suggest that obesity itself does not cause food addiction, but that food addiction is a contributing, but modifiable, risk factor for obesity. Additional studies are needed to determine the mechanism(s) responsible for food addiction remission, and to determine whether the presence of food addiction influences the weight loss efficacy of bariatric surgery.”