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FAAAAAHTS or Gastrointestinal colonization with methanogens increases difficulty of losing weight after bariatric surgery

Gastrointestinal colonization with methanogens increases difficulty of losing weight after bariatric surgery.

PAC MAN
This is totally my gut.
 
I feel like we knew this - have you lived with a gastric bypass or duodenal switch patient for a period of time?  I'm just saying, those of us with altered bariatric intestines  LIVE with "MARSH ASS."   Welcome to the world of pre-biotics, probiotics, fart-smell-better products and I kid you not, LINED UNDERWEAR.  

 
Hey, I never said I was a professional.  Read the studies.
 
What is a methanogen?  Wisegeek says --
"Methanogens are a type of microorganism that produces methane as a byproduct of metabolismin conditions of very low oxygen. They are often present in bogs, swamps, and other wetlands, where the methane they produce is known as "marsh gas." Methanogens also exist in the guts of some animals, including cows and humans, where they contribute to the methane content of flatulence. Though they were once classified as Archaebacteria, methanogens are now classified as Archaea, distinct from Bacteria.

Some types of methanogen, including those of the Methanopyrus genus, are extremophiles, organisms that thrive in conditions most living things could not survive in, such as hot springs, hydrothermal vents, hot desert soil, and deep subterranean environments. Others, such as those of the Methanocaldococcus genus, are mesophiles, meaning they thrive best in moderate temperatures.  Methanobrevibacter smithii is the prominent methanogen in the human gut, where it helps digest polysaccharides, or complex sugars."

Gut bacteria may decrease weight loss from bariatric surgery March 6, 2015
 

The benefits of weight loss surgery, along with a treatment plan that includes exercise and dietary changes, are well documented. In addition to a significant decrease in body mass, many patients find their risk factors for heart disease are drastically lowered and blood sugar regulation is improved for those with Type 2 diabetes.

Some patients, however, do not experience the optimal weight loss from bariatric surgery. The presence of a specific methane gas-producing organism in the gastrointestinal tract may account for a decrease in optimal weight loss, according to new research by Ruchi Mathur, MD, director of the Diabetes Outpatient Treatment and Education Center at Cedars-Sinai.

"We looked at 156 obese adults who either had Roux-en-Y bypass surgery or received a gastric sleeve. Four months after surgery we gave them a breath test, which provides a way of measuring gases produced by microbes in the gut," said Mathur. "We found that those whose breath test revealed higher concentrations of both methane and hydrogen were the ones who had the lowest percentage of weight loss and lowest reduction in BMI (body mass index) when compared to others in the study."

The methane-producing microorganism methanobrevibacter smithii is the biggest maker of methane in the gut, says Mathur, and may be the culprit thwarting significant weight loss in bariatric patient. Mathur and her colleagues are conducting further studies to explore the role this organism plays in human metabolism.

While that research continues, bariatric patients may still have options to improve weight loss after surgery.

"Identifying individuals with this pattern of intestinal gas production may allow for interventions through diet. In the future there may be therapeutic drugs that can improve a patient's post-surgical course and help them achieve optimal weight loss," said Mathur.

The study, "Intestinal Methane Production is Associated with Decreased Weight Loss Following Bariatric Surgery" was done in collaboration with the Mayo Clinic. The paper is being presented by Mathur Thursday, March 5, at the 97th annual meeting of the Endocrine Society in San Diego.

 


Patients With Psychiatric Illness Require Close Watch After Bariatric Surgery

A study conducted in Brazil and presented at a poster session at the 2014 annual meeting of the International Federation for the Surgery of Obesity and Metabolic Disorders looked at six cases in which patients committed suicide or attempted suicide after bariatric surgery. The study did not specify the form of weight loss surgery that each patient underwent.

Continue reading "Patients With Psychiatric Illness Require Close Watch After Bariatric Surgery" »


A dirty not-so-secret of the gastric bypass world has been studied! AND WE WERE RIGHT.

carbonation bubbles
Via Mira Shemeikka - Flickr

What does a gastric bypass patient do when they feel food stuck - trapped - balled up - in their gastric pouch or stomach, or even further down in the intestine?

Sometimes we walk it out, sometimes change positions rapidly hoping the food shifts, oftentimes we lay on a certain side and get all fetal-curled and try to work the food down... we do countless things to relieve the pressure of a stucked.

BE_Stage13_f01

However, many times it is just easier to break up a stuck, and many of us know this because we have been doing it for years intuitively because STUCKS!! HURT!!

Before you ask -- "What Does A Stuck Feel Like?"  You'll know it when it happens.  You will also know it if it has happened to you.

You may have another word to describe it -- too.  I often describe it as oncoming death.  I may or may not have sent myself to the ER once with a stuck because it felt like a heart attack, panic attack because the squeezing in my chest made me anxious -- bad combination.   Too much of the wrong, sticky, fibrous food, trapped in the gut PLUS anxiety over the malcontent = OMG I AM DYING.   I am dying right now.  Am I really?  OMG. 

I know better now.  I avoid it.  

DISCLAIMER -- THIS POST IS NOT INTENDED NOR CONSTRUED AS MEDICAL ADVICE.  I AM A 10.6 year post GASTRIC BYPASS PATIENT WITH ZERO PROFESSIONAL CREDS.  DO NOT LISTEN TO ME.  This is JUST my personal experience, mmmkay? YES I AM YELLING CAUSE Y'ALL DO NOT LISTEN.

Some of us whom grew up as baby bariatric patients not following our rules -- learned something early on.

Carbonated liquids fix stucks, because it forces the food through.  This relieves the pain, and clears the gut.  You might notice something about those of us willing to tell the truth about our (bad) habits.  We tend to drink a LOT of Diet Coke, Diet Pepsi, and have for years since our weight-loss surgeries, some of us more than we did before WLS.  

"Diet Coke and Coke Zero worked just as well as the sugared versions because they contain the same basic ingredients."

BECAUSE IT FEELS GOOD.

Bubbles fix the stucks.  

Stucks are technically called bezoars or phytobezoars which means FOOD BALL - a gastric concretion formed of vegetable fibers, with the seeds and skins of fruits, and sometimes starch granules and fat globules.  It's basically a GREASE TRAP of things that we might not have been able to digest due to our WLS arrangement - and the diet soda goes down and acts as Liquid Plumbr.

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Hey, it's not my study, but it is my pre-treatment -- and has been for at least ten years - 

Not exactly THIS way - but - y'know -

 

Apt12141-fig-0002

http://onlinelibrary.wiley.com/doi/10.1111/apt.12141/full

Medscape - 

Drinking Coca-Cola appears to be an effective treatment for gastric phytobezoar in 50% of cases, and combining the soda with additional endoscopic methods may lead to resolution of as many as 91.3% of phytobezoars, according to a newly published review.

Spiros D. Ladas, MD, from the Gastroenterology Division, First Department of Medicine–Propaedeutic, Medical School, Athens University, Laikon Hospital, Greece, and colleagues presented the results of their systematic literature review in an article published online December 17, 2012, and in the January 2013 issue ofAlimentary Pharmacology and Therapeutics.

The authors searched the literature for the combined keywords "phytobezoars treatment" and "Coca-Cola lysis" and reviewed 24 articles published during a 10-year period between 2002 and 2012. The articles included 46 patients. The authors note that the majority of the articles included in the review did not have patient follow-up, and therefore the review cannot speak to patient relapse.

Although most of the articles were case reports, one was a retrospective study of 17 patients. In their review, Dr. Ladas and colleagues found that only 4 patients (8.7%) who received Coca-Cola treatment went on to develop small bowel obstruction that required surgical treatment. Despite the need for surgery, 3 of the 4 patients still had partial dissolution of their phytobezoars from the Coca-Cola treatment.

The researchers also report that the soda was able to completely dissolve gastric phytobezoars in half of the patients. Although they were unable to state the mechanism of action with certainty, they posit that the soda's pH of 2.6 played an important role in fiber digestion.

Diospyrobezoars (persimmon bezoars) are one of the more difficult types of bezoars to dissolve. They are formed after persimmon ingestion and are characterized by a hard consistency. The authors found that diospyrobezoars were less likely to be completely dissolved by the soda than were phytobezoars (60.6% vs 23%; P = .022).

Physicians seek conservative treatment options, such as dissolution therapies and endoscopic fragmentation techniques, for bezoars, to avoid surgery. The reviewers suggest that Coca-Cola ingestion should be the treatment of choice for gastric phytobezoars because it allows for reduced patient stay in the hospital and may not require endoscopies or equipment. "Moreover," they conclude, "availability, low cost, rapid way of action, simplicity in administration and safety renders Coca-Cola a cost-effective therapy for gastric phytobezoars."

Low-cost effective therapy for stucks.  Um, yeah?  Considering the alternative, I'll avoid the pain --

Slide22


The Biggest Loser Meltdown Moment

Did you watch this last night?

"I don't want you to go through what your dad has gone through." -Dr.

So -- you KNOW I am thinking it -- I probably yelled AT THE TV.

angry lego head

I would like to know what happened to Rob's dad after all this crying and freaking out with the shaming of the wheel-chair.  I hate when information about weight loss surgery is thrown out there to the general public like "this" without any context.

Biggest Loser, please explain.  I understand that the producers like to create 'breakthrough' moments with the contestants to get them motivated and moving forward and to tear off all excuses, but why create a stigma around weight loss surgery? 


#itfits

It, fits?  OH COME ON.  

The NEW AND IMPROVED LAPBAND!  

You can do better!

New

Apollo Endosurgery, Inc., the leader in minimally invasive endoscopic surgical products for bariatric and gastrointestinal procedures, today announced the launch of the “It Fits” campaign, aimed at rejuvenating the LAP-BAND® System and educating a broad range of patients about the benefits of the minimally-invasive weight loss procedure.

“It Fits” supports the company’s decision to place greater emphasis on the unique advantage of the LAP-BAND® System – the only FDA approved device for weight reduction for people with at least one weight-related health problem, and having a BMI of 30 or greater.

Read more: http://www.digitaljournal.com/pr/1989812#ixzz34taKYjn9

The new ad spot - from Apollo - tugs right there at your heart, don't it?  I might be tearing up over all of the completely stereotypical situations right here in this here commercial!  OMG I CAN FIT IN THE AEROPLANE SEATBELT WITHOUT AN EXTENDER COULD YOU PLEASE PUT ME IN A COMMERCIAL ALTHOUGH I WAS NEVER SUPER MORBIDLY OBESE I AM JUST AN ACTOR!

Until this and my tears dry up!

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Because of course we will ignore the patient histories of thousands -- to have a procedure to lose how much weight?  

Just as a frame of reference, that makes me qualify in a few BMI points.  Confession:  when I reached my high weight about the same time the new BMI-qualifications for the Allergan-owned lap-band came around, I decided THAT WAS IT.  I could not possibly do it again, my butt was not revising band-over-bypass for that much weight, not after watching this weight loss community for 12 years.  Nope.

Jawdrop


Ain't nobody never told you. Hiccups after gastric bypass.

That shit like this happens after gastric bypass.   Ten years post op and I still hiccup like a drunken sailor if I take ONE BITE TOO MANY.  Yes, hiccups can be a sign of a complication early post operatively, but they're also a sign that you're eating too much in a long termer!

 

PS. Please to note my child was changing her entire outfit in the back of the car, as we were on the way to the gym, and my face is tripping on novocaine post dental work. LOL.


Dietary Supplements cause 20% of liver injury

The terrifying issue about diet supplements and liver failure -- is that those of us who have bariatric surgery are already at a slightly higher risk for liver concerns.   (Go ahead and look it up.)

Some bariatric patients have a history of fatty liver disease, had WLS to help it, and unknowingly make themselves sick again by taking in high levels of toxins!

It's not just diet pills -- you can kill your liver with too much alcohol -- acetaminophen -- but this is scary guys.

Save your liver.  Please.

Continue reading "Dietary Supplements cause 20% of liver injury" »


Report: Some money in Lap-Band settlement to pay for billboards on weight-loss surgery risks

AP -  Report: Some money in Lap-Band settlement to pay for billboards on weight-loss surgery risks

LOS ANGELES — A company that promoted Lap-Band weight-loss surgery has agreed to pay $1.3 million to settle a false-advertising lawsuit, with some of the money going to billboards warning the public about the risks of weight-loss surgery, a newspaper reported Thursday.

From 2009 to 2011, five patients died after Lap-Band surgeries at clinics affiliated with the 1-800-GET-THIN ad campaign, according to the Los Angeles Times (http://lat.ms/11knLBS ).

The proposed settlement still needs the approval of Los Angeles County Superior Court Judge Kenneth Freeman, who asked attorneys at a hearing Thursday to provide more information and resubmit their settlement motion before he gives the deal his OK.

Relatives of two of the dead patients, Ana Renteria and Laura Faitro, filed the lawsuit as a class action in 2011.

The lawsuit sought damages from several companies and two brothers, Michael and Julian Omidi, who court documents said owned and managed Top Surgeons, a weight-loss business.

John Hueston, an attorney for the Omidis, said the settlement was not an admission of wrongdoing.

“Under the agreement, our clients ... are dismissed without any admission of liability, and made no contribution whatsoever to the settlements,” Hueston said in a statement cited by the Times.

A lawyer for the surgery centers, Konrad Trope, said the action against the facilities was dismissed without admission of liability or financial penalty.

The proposed settlement will be paid only by Top Surgeons, one of the companies behind the GET-THIN operation, the newspaper said. The company did not immediately return a message from The Associated Press.

The lawsuits and other public documents showed that 1-800-GET-THIN was a marketing company that steered patients to a network of outpatient clinics, where thousands of weight-loss surgeries were performed.

The company used dozens of billboards — along with ads on television, radio and the Internet — to promote Lap-Band weight-loss surgery.

Some of the suits alleged that the clinics put profits above patient safety, employing physicians who were unqualified and allowing surgeries to be performed in unsanitary conditions, the Times said.

The proposed deal calls for $100,000 to be spent on billboard advertising throughout Southern California “intended to explain the risks of weight-loss surgery.” The agreement does not specify the language to be used in the ads but says it must be approved by the court.


Weight-Loss Surgery's Weird Alcoholism Risk (It's not weird.)

Weight-Loss Surgery's Weird Alcoholism Risk | The Fix.

Copied entire article from Weight-Loss Surgery's Weird Alcoholism Risk | The Fix. - because - BECAUSE -

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Gastric bypass surgery is something of a medical marvel. In Roux-en-Y surgery, a small pouch is made from part of your stomach, building a new, smaller one. The pouch is then connected to the middle portion of the small intestine (the jejunum), bypassing the upper part (the duodenum). Because your new stomach is about 90% smaller than your old one, you feel full with much smaller amounts of food and take in many fewer calories. Another popular smaller-stomach operation is adjustable gastric band surgery, in which an inflatable silicone device is placed around the top of the stomach.

In all, the American Society for Metabolic and Bariatric Surgery estimates that approximately 200,000 people have bariatric surgery every year. The Roux-en-Y operation generally costs between $15,000 and $30,000; the band is cheaper by about $10,000. Many private insurance policies offer no coverage for what they consider an elective procedure.

There have been previous reports of bariatric surgery patients having serious trouble with alcohol use after their surgeries. A 2012 Archives of Surgery study by the New York Obesity Nutrition Research Center looked at 100 people who had Roux-en-Y and 55 who had the adjustable band. The post-op patients were significantly more likely than the general population to use addictive substances, especially two years after the procedures. The Roux-en-Y cohort seemed particularly susceptible to alcohol use.

If food has always been your drug, and surgery abruptly denies you your fix, you turn to other drugs.

A much larger 2012 study in the Journal of the American Medical Association came to a similar conclusion. University of Pittsburgh researchers followed almost 2,000 people who had Roux-en-Y, adjustable band or another weight-loss surgery. Before their operations, 7.6% of the group abused alcohol; after the knife, 9.6% did so. And, the patients who had the Roux-en-Y surgery were twice as likely to abuse alcohol as those who had the gastric band.

Health experts have long known that obesity and depression often go hand-in-hand. Depression can lead to becoming obese, and the opposite is also true. Many obese people are depressed before they have surgery and are therefore at high risk of depression afterward. For one thing, recovery is a slow process, and health complications of the surgery are very common; 40% of patients suffer from infection and post-operative bleeding. Perhaps more important, bariatric surgery is no magic bullet, and some patients become disillusioned as they realize that in order to "solve" their serious weight problems, they have to maintain good eating and exercise habits—lifestyle changes that likely proved elusive in the past. 

Addiction experts see the problem as one of switching addictions. People become obese because they use eating as a drug. Excessive eating is a form of self-medication for painful feelings associated with depression, anxiety and deeper personality disorders. Like most drugs, food, especially carbs and sugars, trigger the brain's reward pathways, causing a feeling of pleasure. But sustained excessive eating causes the brain to lose its capacity to produce these feel-good chemicals. That's whenaddiction starts.

Weight-loss surgery fixes the outside of a person, but not the inside. While it can reduce the harm of obesity, it leaves the needs driving your addiction untouched. So if food has always been your drug, and stomach-minimizing surgery abruptly denies you your fix, you turn to other drugs. Alcohol, being legal, is the most available, but patients can take their pick among the panoply of addictive substances.

Hogwash, says John Morton, MD, a bariatric surgeon at the Stanford School of Medicine and member of the executive council of the American Society for Metabolic and Bariatric Surgery. Like many other surgeons who specialize in this procedure, he favors a physical rather than a psychological or switching-addiction explanation for the high risk of alcohol abuse. "[There is a] heightened sensitivity to alcohol [and it is] purely physiologic," Morton says. Along with the liver, the stomach produces alcohol dehydrogenase, an enzyme that breaks down alcohol into other, less toxic molecules. Because gastric bypass patients have much less stomach, and therefore less of that enzyme, more alcohol enters their bloodstream.

"As a result," Morton says, "you get drunker faster and stay drunker longer." The same phenomenon occurs with people who have their stomachs removed because of cancer. If alcohol abuse in bariatric patients were due to psychological issues, you wouldn't expect cancer patients to have greater alcohol sensitivity, Morton argues.

Mitch Roslin, MD, a specialist in bariatric medicine at New York's Lenox Hill Hospital, agrees. He calls the switching-addictions theory "BS.” Drinking alcohol in your post-Roux-en-Y life is "the epitome of drinking on an empty stomach"—after all, your stomach is almost nonexistent. "Essentially," Roslin says, "drinking alcohol after Roux-en-Y is like having an alcohol IV."

"Essentially, drinking alcohol after Roux-en-Y is like having an alcohol IV," Roslin says.

But why does alcohol sensitivity show up more in the second year after the surgery? Roslin suggests that the second year is when you realize that your surgery will not, by itself, keep you healthy, that you do indeed have to "fix the inside." At that point, you might feel depressed, use alcohol to escape and comply less with your post-op instructions. 

Morton’s and Roslin’s explanations may account for why people who have had gastric bypasses can get a buzz by drinking a small amount of alcohol, but they don't quite explain why some people who never abused booze before end up becoming post-op alcoholics. Nor do they account for another, even more serious, health risk for people who have had gastric bypasses: suicide.

Two recent studies—in Pennsylvania and Utah—reinforce the link between obesity and emotional distress by focusing on suicide rates. A study of 17,000 weight-loss surgeries performed in Pennsylvania from 1995 to 2004 showed a surprisingly high incidence of suicide. Of the 440 deaths that occurred, 16 resulted from suicide or drug overdose; by comparison, the rate for the general population is only three. And this August, a study published in The New England Journal of Medicineshowed that a group of almost 10,000 bariatric patients had a 58% higher than average risk of dying in an accident or suicide. When the bariatric patients' suicide rate was compared to that of obese people who had not had surgery, it was close to double, 11.1 per 10,000 compared to 6.4 per 10,000.

When the high risk of suicide is coupled with the high risk of alcohol abuse, a psychological, if not a switching-addiction, explanation is almost inescapable. Patients may be aware of these risks, but the need for the surgery overrides such concerns. While prospective patients often undergo psychological evaluations before the procedure, doctors often do not follow up with the patients and patients often do not participate in post-surgery counseling. The addiction to food is typically viewed as more or less having been "treated" by the gastric bypass. The danger of developing a new addiction remains low on the list of health priorities.

There is no denying the benefits of bariatric surgery. Without it, many people struggling with obesity would be doomed to lives burdened with diabetes, heart disease, mobility problems and high risk of stroke and early death. At the same time, it's clear that the surgery's benefits would be increased by improved screening of patients for mental health problems—and addiction—before surgery as well as deeper, longer counseling afterward. This may mean fewer people will be eligible for the surgery—a prospect that neither doctors nor patients would embrace. At the very least, reframing how patients understand the surgery is in order: It is not a magic bullet but one in a serious of interventions that are, like it or not, lifelong.


No long-term cost savings with weight loss surgery

Weight loss surgery does not lower health costs over the long run for people who are obese, according to a new study.   Shocking?  Meh.  No.

Pre-op patients don't want to know this sticky business, so maybe you should close your eyes or click away.  NOW.  I don't want to pop your bubbles.  I am not in the biz of selling weight loss surgery up in heah.

I don't think it would come as a surprise to many long-term post bariatric patients.  I know you understand.  We live it.

But that is just me, consider my stance as a nine year gastric bypass post op, married to a nine year gastric bypass post op, with a mother in law and sister in law who are both gastric bypass post ops.  Collectively we have about 30 years of missed "obesity" costs, but we have increased our health-care costs in other areas.  (*Looks at my current tally at the hospital.*)

Tumblr_lwj43hxcbD1ql141xo1_400The four of US (yes, this is totally biased because it is my immediate circle and what I know...this is understood, I am not arguing, I do not care to sell WLS nor unsell it!) are currently all maintaining a normal or slightly overweight body weight 6-9 years post bariatric surgery, however between us, we have created some seriously HUGE bills and other health conditions since having weight loss surgery.  (I have not shared much of it because I'm already TMI and HIPPA cries.)

Imagine now if any of us have a full and complete regain - which is a totally and absolutely typical pattern.  What then of our health?  What if we have the comorbids of obesity come back?  (Some of which don't always go away.... have you met my legs?)  Just saying.  I know we have made it this far, but it has NOT been cheap.

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Reuters -

Some researchers had suggested that the initial costs of surgery may pay off down the road, when people who've dropped the extra weight need fewer medications and less care in general.

The new report joins other recent studies challenging that theory (see Reuters Health story of Jul 16, 2012 here: reut.rs/NrQKPU).

"No way does this study say you shouldn't do bariatric surgery," said Jonathan Weiner from the Johns Hopkins Bloomberg School of Public Health in Baltimore, who led the new research.

But, he added, "We need to view this as the serious, expensive surgery that it is, that for some people can almost save their lives, but for others is a more complex decision."

According to the American Society for Metabolic and Bariatric Surgery, about 200,000 people have weight loss surgery every year.

Surgery is typically recommended for people with a body mass index (BMI) - a measure of weight in relation to height - of at least 40, or at least 35 if they also have co-occurring health problems such as diabetes or severe sleep apnea.

A five-foot, eight-inch person weighing 263 pounds has a BMI of 40, for example.

For their study, Weiner and his colleagues tracked health insurance claims for almost 30,000 people who underwent weight loss surgery between 2002 and 2008. They compared those with claims from an equal number of obese people who had a similar set of health problems but didn't get surgery.

As expected, the surgery group had a higher up-front cost of care, with the average procedure running about $29,500.

In each of the six years after that, health care costs were either the same among people who had or hadn't had surgery or slightly higher in the bariatric surgery group, according to findings published Wednesday in JAMA Surgery.

Average annual claims ranged between $8,700 and $9,900 per patient.

Weiner's team did see a drop in medication costs for surgery patients in the years following their procedures. But those people also received more inpatient care during that span - cancelling out any financial benefits tied to weight loss surgery.

One limitation of the study was that only a small proportion of the patients - less than seven percent - were tracked for a full six years. Others had their procedures more recently.

The study was partially funded by surgical product manufacturers and pharmaceutical companies, including Johnson & Johnson and Pfizer. Claims data came from BlueCross BlueShield.

It's clear that surgery can help people lose weight and sometimes even cures diabetes, Weiner told Reuters Health. But it might not be worthwhile, or cost-effective, for everyone who is obese.

That means policymakers and companies will have to decide who should get insurance coverage for the procedure and who shouldn't.

"It's showing that bariatric surgery is not reducing overall health care costs, in at least a three- to six-year time frame," said Matthew Maciejewski, who has studied that topic at the Center for Health Services Research in Primary Care at the Durham VA Medical Center in North Carolina, but wasn't involved in the new study.

"What is unknown is whether there's some subgroup of patients who seem to have cost reductions," he told Reuters Health.

In the meantime, whether or not to have weight loss surgery is still a personal decision for people who are very obese, Weiner said.

"Every patient needs to talk it through with their doctor," he said. "It obviously shouldn't be taken lightly, but shouldn't be avoided either."

SOURCE: bit.ly/K8qAyI JAMA Surgery, online February 20, 2013.

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Importance  Bariatric surgery is a well-documented treatment for obesity, but there are uncertainties about the degree to which such surgery is associated with health care cost reductions that are sustained over time.

Objective  To provide a comprehensive, multiyear analysis of health care costs by type of procedure within a large cohort of privately insured persons who underwent bariatric surgery compared with a matched nonsurgical cohort.

Design  Longitudinal analysis of 2002-2008 claims data comparing a bariatric surgery cohort with a matched nonsurgical cohort.

Setting  Seven BlueCross BlueShield health insurance plans with a total enrollment of more than 18 million persons.

Participants  A total of 29 820 plan members who underwent bariatric surgery between January 1, 2002, and December 31, 2008, and a 1:1 matched comparison group of persons not undergoing surgery but with diagnoses closely associated with obesity.

Main Outcome Measures  Standardized costs (overall and by type of care) and adjusted ratios of the surgical group's costs relative to those of the comparison group.

Results  Total costs were greater in the bariatric surgery group during the second and third years following surgery but were similar in the later years. However, the bariatric group's prescription and office visit costs were lower and their inpatient costs were higher. Those undergoing laparoscopic surgery had lower costs in the first few years after surgery, but these differences did not persist.

Conclusions and Relevance  Bariatric surgery does not reduce overall health care costs in the long term. Also, there is no evidence that any one type of surgery is more likely to reduce long-term health care costs. To assess the value of bariatric surgery, future studies should focus on the potential benefit of improved health and well-being of persons undergoing the procedure rather than on cost savings.

 


25% Drink 16% Calories Via Alcohol Daily.

About 25% of you drink alcohol every day -- given the normal non-weight loss surgical population according to a new CDC study.  And about 16% of your daily calories come from alcohol.  

PS.  Give this study to bariatric patients -- I would say from my very non-professional standpoint that results would be higher vs. calorie intake given our higher rates of addictions to All The Things.  

That is some scary daily nutrition math.

No-Light-Beers

Cheers.

CDC -

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The U.S. population consumes an average of 100 calories a day from alcoholic beverages. Men, 150 calories; women, 53.

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“If you are drinking an extra 150 calories more than you need a day, those extra calories could end up on your waist or your hips,” said Joan Salge Blake, a clinical associate professor in the nutrition program at Boston University and a spokeswoman for the Academy of Nutrition and Dietetics. “Those excess daily calories could cause you to put on a pound monthly and would add up to over 10 pounds in a year,” Blake said.

Specifically for a gastric bypass patient -- it can lead to all sorts of damage.  Play in the Google.  


Jesse Jackson, Jr. Resigns - Welcome to our world Mr J.

Visit NBCNews.com for breaking news, world news, and news about the economy

 

Huffington Post

"Jackson, 47, disappeared in June, and it was later revealed that he was being treated at the Mayo Clinic for bipolar disorder and gastrointestinal issues. He returned to his Washington home in September but went back to the clinic the next month, with his father, the Rev. Jesse Jackson, saying his son had not yet "regained his balance."

Shortly after taking office, he was deemed People magazine's sexiest politician in 1997 and became one of the most outspoken and quoted liberals in the House. There was a near-Hollywood buzz over his newly svelte figure in 2005 when he quietly dropped 50 pounds, disclosing months later that he had had weight-loss surgery.

Welcome to WLS + suspect malabsorption of medications.  We are a fun bunch!  :D

 

 

 


The Link between Acute Liver Failure and Bariatric Surgery

Tylenol, a no-no after gastric bypass?  Maybe.  Down the road, if confirmed in future large study -

Continue reading "The Link between Acute Liver Failure and Bariatric Surgery " »


Review - Before & After, Second Revised Edition: Living and Eating Well After Weight-Loss Surgery

Before & After, Second Revised Edition: Living and Eating Well After Weight-Loss Surgery

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Regurgitated Self-Importance Now With More Hate! 

A highlight from the OH Conference in Atlanta - Living Thin Within!

Recently the Obesity Help Conference I met this great woman, Jill.  Jill was to speak during the event, but I did not know that, nor did she introduce herself as anyone of importance.  

And we just TALKED AS PEERS.

Let me tell you something --

Continue reading "A highlight from the OH Conference in Atlanta - Living Thin Within!" »


Substance Use Following Bariatric Weight Loss Surgery - Alcohol Is a PROBLEM.

Reuters

More (albeit just a little...) evidence points to WHAT WE AS PATIENTS HAVE BEEN TRYING TO TELL YOU, over and over and over and over.

People who had weight loss surgery reported greater alcohol use two years after their procedures than in the weeks beforehand, in a new study.

"This is perhaps a risk. I don't think it should deter people from having surgery, but you should be cautious to monitor (alcohol use) after surgery," Alexis Conason, who worked on the study at the New York Obesity Nutrition Research Center at St. Luke's-Roosevelt Hospital Center, told Reuters Health.

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Woman Suffers from Lap Band Surgery Gone Wrong - Wernicke's Disease

Neurological diseases sometimes occur (if very rarely) triggered in part by a weight loss surgical procedure for various reasons -- some avoidable -- some not, please don't hate.  (Says she who developed a cognitive disorder and intractible epilepsy after weight loss surgery.  Be kind.)  The woman in the following story developed Wernicke's Disease after gastric banding surgery in 2009.

Wernicke's disease occurs at times with persistent vomiting after WLS, a study in Neurology (2007) states that in a review of cases a "majority of the patients (25 of the 32) had vomiting as a risk factor, and 21 had the classic Wernicke's triad of confusion, ataxia, and nystagmus. Other symptoms seen in these patients included optic neuropathy, papilledema, deafness, seizures, asterixis (bilateral) flapping tremor of the hands and wrist, weakness, and sensory and motor neuropathies."
  • A small number of cases, patients who undergo weight reduction surgery may develop Wernicke's encephalopathy, marked by confusion and problems with movement and eye control.
  • The cause is a thiamine (vitamin B1) deficiency and, if detected, can be easily corrected with dietary supplements. Untreated, it can be fatal and cause severe neurologic morbidity.

Shacka says she suffers from multiple health issues because of a lap band surgery she had in California back in 2009. It went horribly wrong.  And since then her independence is gone and her life has never been the same.

"At some point, I say I don't know what my life is supposed to be like now.  Like, where am I supposed to go?  Where do I fit in?," said Shacka.

But what is lap band surgery?

"They're a weight loss surgery where this band is placed around the top part of the stomach.  The bands have a balloon on the inside on the inner surface and through adjustments in clinic, the balloon can be tightened or loosened and help people feel full on a smaller amount of food," said M.D. Corrigan McBride of the Nebraska Medical Center.

Officials from the Nebraska Medical Center say health issues with weight are a common factor for patients battling weight gain and obesity.

"There's a certain percentage of patients that it's just not the right weight loss tool for them and they will elect to have the bands removed and converted to a different surgery," said McBride.

"I said I can't do this anymore, I need to go to the hospital.  This is not right, I'm still throwing up.  And finally I went in, and by then I had double vision and that's a sign of neurological disease," said Shacka.

Shacka also suffers from Wernicke disease—a form of brain damage.  She says this was a result of her surgery.  Through years of therapy, learning how to walk, speak and use her hands again, Shacka says her journey to better health isn't over.

"I beat the odds twice.  They told me I would be in a wheelchair for the rest of my life…and I'm walking.  They told me I would never do steps again, I went up four flights of steps with one physical therapist.  So I beat the odds and I need more additional help," said Shacka.

But through this traumatic experience, Shacka says she sees the bright side of it all.

"I met some wonderful, wonderful angels who've helped me to know what life is about.  I can't take that back and I would have never gotten it if I wouldn't have gotten sick," she said.

And her fight to spread awareness about the risks of lap band surgery keeps her motivated.

"You don't give up, and I'm not going to give up.  And I guess this is my way of not giving up and living life," she said.

Shacka plans to sue the doctors in California that did the surgery.  She's had some financial struggles raising enough money to hire a lawyer, but finally met that goal.  Now, she is trying to raise enough money to receive therapy and more medical treatment at Mayo Clinic. 

Clin Nutr. 2000 Oct;19(5):371-3.  Wernicke's syndrome after bariatric surgery.

 


Bone fracture risk increases after 3-5 years post weight loss surgery

Weight loss surgery doesn't increase the risk for bone fractures in the first two years after surgery, though the risk increases in the third year.  In other news, keep taking your calcium.

Medpage

Weight loss surgery did not predispose patients to an increased risk of fracture during the first 2 years after a bariatric procedure, data from a large retrospective cohort study showed.

The results showed an overall fracture risk of 8.8 per 1,000 person-years in the bariatric-surgery group and 8.2 per 1,000 person-years in the control group, which translated into an adjusted relative risk of 0.89, according to an article published online in BMJ.

In fact, the risk trended lower for patient who had weight-loss surgery, ranging from 10% to 33% lower, depending on the fracture outcome analyzed.

However, the fracture rate in bariatric patients started to increase when they were 3 to 5 years removed from surgery, leaving the long-term effects on bone health open to speculation.

"Bariatric surgery is becoming more common and has been associated with a reduction in bone density after the operation," study author Cyrus Cooper, MBBS, DM, of the University of Southampton in the U.K., said in a statement.

"This is the first time that we have been able to investigate risk of fracture following bariatric surgery by comparing patients with nonsurgical controls. The results suggest that, at least in the short term, such changes in bone density are unlikely to lead to increased fracture risk," he added.

-Medpage


Bariatric Surgery Most Common Elective Surgical Procedure - and safer!

Bariatric Surgery Most Common Elective Surgical Procedure-

Within the setting of academic medical centers, bariatric surgery is the most common elective general surgical operation and it has the highest use of laparoscopy.  In addition, the in-hospital mortality rate of laparoscopic bariatric surgery is now comparable to those of laparoscopic appendectomy and antireflux surgery, and is currently lower than that of laparoscopic cholecystectomy."

Nice.  Go bariatric surgery, way to get safer.  Check it out -

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Alcoholism and the family - are you affected by someone else?

How do you know if you are affected by someone else's problem drinking?  Are you?

Via Al-Anon -

Millions of people are affected by the excessive drinking of someone close. The following questions are designed to help you decide whether or not you need Al-Anon:

 1. Do you worry about how much someone drinks?

 2. Do you have money problems because of someone else’s drinking?

 3. Do you tell lies to cover up for someone else’s drinking?

 4. Do you feel that if the drinker cared about you, he or she would stop drinking to please you?

 5. Do you blame the drinker’s behavior on his or her companions?

 6. Are plans frequently upset or canceled or meals delayed because of the drinker?

 7. Do you make threats, such as, “If you don’t stop drinking, I’ll leave you”?

 8. Do you secretly try to smell the drinker’s breath?

 9. Are you afraid to upset someone for fear it will set off a drinking bout?

 10. Have you been hurt or embarrassed by a drinker’s behavior?

 11. Are holidays and gatherings spoiled because of drinking?

 12. Have you considered calling the police for help in fear of abuse?

 13. Do you search for hidden alcohol?

 14. Do you ever ride in a car with a driver who has been drinking?

 15. Have you refused social invitations out of fear or anxiety?

 16. Do you feel like a failure because you can’t control the drinking?

 17. Do you think that if the drinker stopped drinking, your other problems would be solved?

 18. Do you ever threaten to hurt yourself to scare the drinker?

 19. Do you feel angry, confused, or depressed most of the time?

 20. Do you feel there is no one who understands your problems?

If you have checked any of these questions, Al-Anon or Alateen may be able to help. Find a meeting now.