Weight-loss threshold for improved cardiac health
23 August 2022
Another high powered study that gives additional insights into the effects of Bariatric surgery - this time on the heart and its function. It is high powered because of the number of patients who are included in the study. This allows us to see a small effect very clearly, and in this study it turns out to be a rather large difference between the two groups ie those who have lost weight because of weight loss surgery (including Gastric Bypass and Sleeve) and those who have lost weight through non-surgical means eg diet and exercise and anti-obesity medications. My guess is that weight loss due to bariatric surgery goes hand in hand with improving diabetes control and blood pressure control and cholesterol levels - all of which are having their own beneficial effects on the heart and its function. These benefits, however, may not be so dramatic for the patients who are losing weight in the non-surgical group. Fascinating and 'watch this space' as I'm sure further studies will be seeded from this one to answer the questions it throws up with more certainty.
Look forward to meeting some of you soon.
Five to 10 percent of surgically induced weight loss is associated with improved life expectancy and cardiovascular health compared with about 20 percent weight loss is necessary to observe similar benefits with a non-surgical treatment, according to researchers from Cleveland Clinic. In comparison. The findings also show that metabolic surgery may contribute health benefits that are independent of weight loss.
The paper, ‘How Much Weight Loss is Required for Cardiovascular Benefits? Insights From a Metabolic Surgery Matched-cohort Study’, published in the Annals of Surgery, sought to determine the minimum amount of weight loss required to see a reduction in major adverse cardiovascular events (MACE) as the minimum amount of weight loss to have a meaningful impact on cardiovascular health and survival is unknown.
The large, observational study examined 7,201 Cleveland Clinic patients: 1,223 patients with obesity and type 2 diabetes who underwent bariatric/metabolic surgery were matched to 5,978 patients who received usual medical care. About 80 percent of the patients had hypertension, 74 percent had dyslipidaemia and 31 percent were taking insulin to treat their diabetes.
Using different statistical models, the effects of weight loss were studied to identify the minimum weight loss needed to decrease the risk of death and of experiencing major adverse cardiovascular events, such as coronary artery events, cerebrovascular events, heart failure, kidney disease, and atrial fibrillation.
Following metabolic surgery, the risk of death and major heart complications appears to decrease after about 5 percent and 10 percent weight loss, respectively,” said Dr Ali Aminian, director of Cleveland Clinic's Bariatric & Metabolic Institute and lead author of the study. “Whereas, in the nonsurgical group, both the risk of death and major cardiovascular complications decreased after losing approximately 20 percent of body weight.”
Researchers continue to study the physiological changes in the surgically modified gastrointestinal tract, the impact on hormone secretion and the microbiome. Those beneficial changes may contribute to the cardiovascular and survival benefits of metabolic surgery, independent of weight loss. More research is needed to better understand the underlying mechanisms for the health benefits of metabolic surgery in patients who have obesity and type 2 diabetes.
"This study suggests greater heart disease benefits are achieved with less weight loss following metabolic surgery than medical weight loss using lifestyle interventions,” said Dr Steven Nissen, Chief Academic Officer of the Heart, Vascular & Thoracic Institute at Cleveland Clinic, and the study's senior author. “The study findings suggest that there are important benefits of metabolic surgery independent of the weight loss achieved.”
People struggled to manage their weight during COVID-19 lockdown
26 July 2022
Just in case you were wondering, you are not alone in having been negatively affected by lockdowns with respect to your eating habits and, as a result, your weight. It is no surprise to me that it is such a big proportion of people (65%) for whom lockdowns caused weight gain. Lockdowns were such a unique situation and it brought about changes in our lifestyle that we were definitely unprepared for. Interestingly, there was a proportion of people who were experiencing positive impacts, and these were people who were receiving support from a 'slimming club'. I take from that that building up a support network that will help with your weight loss journey would seem to be extremely important. This also applies to people who choose to go down the bariatric surgery pathway as well! Look forward to meeting you soon.
More than half of adults have found it difficult to manage their weight during the COVID-19 lockdown, according to the results of an online survey involving over 800 UK adults, presented at The European and International Congress on Obesity. Most of the respondents said their difficulties stemmed from increased snacking, not exercising as much as usual, increased anxiety or stress and not being able get hold of healthier food. However, those questioned who had received weight-management support from a slimming club continued to lose weight during this time, exercised more and reporting higher overall wellbeing compared to respondents from the general population.
The findings come at a time when the UK Government has unveiled a new obesity strategy with its 'Better Health' campaign to encourage millions of adults to kick start their health and reduce their risk of serious illness, including COVID-19. An estimated two-thirds (63%) of UK adults are above a healthy weight, with 36% having overweight and 28% having obesity.
The research was organised by Slimming World as part of their Health and Wellbeing Study, which is surveying new members regularly over the course of one year about aspects of their health and lifestyle. The survey at the six-month point coincided with lockdown, so questions were added to learn more about how lockdown measures had impacted the nation's health, wellbeing, and lifestyle behaviours.
Between April and May 2020, 222 Slimming World members (94% female, average age 52 years) and a representative sample of 637 adults in the general population completed an online survey asking their opinions about their general health, mood, diet, alcohol intake, physical activity and weight management.
Similar proportions of the general population (65%; 414/637) and Slimming World members (59%; 131/222) admitted to finding managing their weight since lockdown "very" or "somewhat difficult". The four key reasons given by both groups included difficulty getting to the shops and obtaining the usual healthy foods; boredom and being at home leading to increased snacking; higher levels of stress and anxiety leading to comfort eating; and more sedentary time and exercising less. However, some respondents in both groups reported some benefits of lockdown including more time to plan meals, cooking from scratch and sticking to a routine.
Two in five (42%) Slimming World members and one in three (34%) of the general population admitted eating more sugary foods during lockdown, while one in four (27%) members and one in five (18%) of the general population reported reaching for fatty foods. When looking at key parts of the diet, data indicated that members had a healthier overall diet than non-members (healthy eating score 13 vs 10; with a higher value indicating better overall diet quality).
This could help explain why Slimming World members reported continuing to lose weight during this time, with an average weight loss of 2kg (4.4 lbs) at the early stages of lockdown compared to three months earlier.
The research also highlighted differences in the impact of lockdown on overall health and wellbeing - fewer members said that their general health had been negatively affected compared to the general population (14% vs 22%). In addition, members said they had exercised more (25% vs 17%) and reported higher overall wellbeing (wellbeing score 28 vs 24; with a higher score indicating more positive wellbeing).
More than a quarter (28%) of members and 16% of the general population said they were drinking more alcohol during lockdown. Their reported alcohol intake was within government guidelines, with Slimming World members consuming around 13 units per week and respondents from the general population 14 units per week.
"Lockdown inevitably had an effect on our choices around food, drink and activity. Given that excess weight is associated with a higher risk of severe illness from COVID-19 and with lots of people coming out of lockdown feeling concerned about their weight and health, the findings of the study show behaviour change support is more important now than ever,” said study lead, Dr Sarah-Elizabeth Bennett, Slimming World's Senior Research Associate.
The authors of the study point to several limitations, including the reduced sample size of those who had completed all surveys to the point of lockdown and the inclusion of self-reported data which could be prone to reporting biases. The study included a representative sample of the general population at each timepoint, rather than following the same people, therefore it was difficult to make certain comparisons over time. The authors also noted that there could be variations in behaviour and wellbeing depending upon when respondents completed the survey, given the rapidly changing news and guidance during lockdown. Finally, they did not account for potentially confounding factors such as comorbidities, which may have influenced lifestyle behaviour changes.
T2DM patients should have bariatric surgery earlier
13 July 2021
The Scandinavian Obesity Surgery Registry has to be joined by every patient who has Bariatric Surgery in Scandinavian countries. Because of the wide inclusion of patients it makes it a very powerful tool for analysing outcomes. Any analysis relies on including as close to 100% of eligible patients as possible - and the SOSR achieves that. This analysis demonstrates the danger of type 2 diabetes - even for people considered pre-diabetic only. What follows is that the more successful a treatment is at preventing diabetes altogether, the more powerful it is. Weight loss surgery is the only treatment known that prevents people from becoming diabetic. And that is why it is becoming so popular for both patients, their medical specialists and their GPs.
Happy researching and I look forward to meeting you soon.
The latest findings from the annual Scandinavian Obesity Surgery Registry (SOReg) report could challenge existing recommendations and clinical practice for bariatric surgery and type 2 diabetes (T2DM) patients, according to the authors of a summary paper of the report, ‘Bariatric Surgery: There Is a Room for Improvement to Reduce Mortality in Patients with Type 2 Diabetes’, published in Obesity Surgery.
"SOReg provides a large high-quality database which gives the opportunity to better explore the associations between diabetes, weight loss after surgery, remission of diabetes and mortality," explained co-author of the paper, Professor Carel le Roux from the Diabetes Complications Research Center, University College Dublin, Dublin, Ireland. "Novel data which can only be obtained from these large datasets now challenge current guidelines and practice, because it appears as if we can improve significantly on our current best practice."
The 2020 SOReg report, published in May, examined 65,345 patients with up to ten-year follow-up after primary bariatric surgery and looked at the outcomes of patients with and without T2DM prior to surgery and those patients who achieved T2DM remission within one year after surgery. Crucially, the report found that the impact of T2DM duration on glycaemic remission suggest that patients with T2DM should have bariatric surgery earlier. Nevertheless, the SOReg report also shows that there was no change in the percentage of people with diabetes having bariatric surgery before 2012 (19.9%) or after 2012 (17.5%), “despite overwhelming evidence that bariatric surgery is superior to nonsurgical treatment”, the authors of the paper note.
Of the 65,345 patients included in the report, 11,990 (18.1%) patients had T2DM prior to bariatric surgery (gastric bypass or sleeve gastrectomy) and 19,281 (29.5%) had prediabetes. At 6.3 years after surgery, the report found that the mortality rate was 4.1% (487/11,990) in patients with T2DM prior to surgery, compared with 0.15% (798/53,355) in patients without T2DM prior to surgery (p<0.001).
“Thus, bariatric surgery reduces mortality compared with non-surgical medical care, but preoperative T2DM increases mortality 27-fold even after bariatric surgery. Therefore, more is needed to make bariatric surgery even better,” they write.
Moreover, in those patients with T2DM prior to surgery demonstrated improved survival if they achieved glycaemic remission one year after surgery. Some 2.9% (204/7,130) of patients died within 6.3 years despite achieving remission compared with 174 out of 3,379 patients (5.1%) who did not achieve glycaemic remission (p<0.001), meaning suboptimal glycaemic control one year after surgery was associated with a 1.7-fold increase in mortality.
They also noted that standard medications for T2DM with proven mortality benefits such as metformin, GLP-1 agonists etc are stopped after surgery - because the reduction in medication after surgery is a driver of the health economic benefit of bariatric surgery - without considering the impact on mortality. Therefore, the authors call for a “move away from the idea of surgery against medicine, but rather consider surgery with medicine.”
"We are getting better insight in what matters for the chance for remission and risk for relapse, but we could optimise this by improving collaboration between surgery and medicine," le Roux added. "Even if it seems possible to stop all drugs after surgery should we really do this? The question now is if we are keeping medications then which drug, which dose, and what metabolic targets should we aim for in the short and longer term? More work is needed, but we are on the right track."
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