Benefits of laparoscopic sleeve gastrectomy diminish with time
Five years after weight loss surgery, patients can regain the weight that they had initially lost, according to a recent Israeli study. It has long been known that surgery remains an effective treatment for weight loss, however long-term follow-up data remains sparse. Whilst also seeing a gain in weight, a recurrence of diabetes was also noted. The study followed 443 who underwent sleeve gastrectomy. After the first year patients had lost 77% of their original weight, after 5 years the weight loss was only 56%. With regards to the diabetes, 51% saw it disappear in the first year, however by the fifth year only 20% of patients were diabetes-free.
The intention of a sleeve gastrectomy is to reduce the size of the stomach similar to that of a banana. Dr Andrei Keidar, one of the researchers, explains that several reasons could contribute to the fact that weight is regained. “The main reason is that the stomach dilates, meaning you can eat more. The appetite also comes back so patients want to eat more.” Furthermore, he described how the effectiveness of weight loss surgery has a behavioural aspect and “if you don’t change your behaviour, you are going to regain weight”. A large limitation of the study was that many patients dropped out at each stage but the follow-up rates in this study correlate with similar studies of its kind.
The benefits of this weight loss surgery are still relevant as meaningful health changes are seen with just 5% weight loss, so having lost 50% after five years is still going to vastly improve one’s health. More worrying however is the re-occurrence in diabetes.
Read MoreAmericans are finally eating less
After rising for decades, calorie consumption has declined in recent years as public attitudes have shifted. Calories consumed daily by the typical American adult, which peaked around 2003, are in the midst of their first sustained decline since federal statistics began to track the subject, more than 40 years ago. The number of calories that the average American child takes in daily has fallen by at least 9 percent. In the most striking shift, the amount of full-calorie soda drunk by the average American has dropped 25 percent since the late 1990s. As calorie consumption has declined, obesity rates appear to have stopped rising for adults and school-aged children and have come down for the youngest children, suggesting the calorie reductions are making a difference. The encouraging data does not mean an end to the obesity epidemic as more than a third of American adults are still considered obese, but the changes in eating habits suggest that what once seemed an inexorable decline in health may finally be changing course. The eating changes have been the most substantial in households with children, with the anti-obesity public health campaigns focussing on one subject more than any other: beverages. Beverage companies have reacted by marketing diet drinks and investing heavily in new products, including iced teas and flavoured water.
“This was like a freight train going downhill without brakes,” Kelly Brownell, dean of the Sanford School of Public Policy at Duke University, said. “Anything slowing it down is good.”
Read MoreFDA approves temporary balloon device to treat obesity – but is it needed in the UK?
The U.S. Food and Drug Administration approved a new balloon device to treat obesity without the need for invasive surgery. The ReShape Integrated Dual Balloon System is intended to facilitate weight loss in obese adult patients. The ReShape Dual Balloon device is delivered into the stomach via the mouth through a minimally invasive endoscopic procedure while a patient is under mild sedation. It should be removed six months after it is inserted. The ReShape Dual Balloon is indicated for weight reduction in obese adult patients with a body mass index (BMI) of 30 to 40 kg/m2.
But is it needed in the UK?
A very similar balloon was made available publicly in Europe and privately in the UK early last year. Obalon is a gastric balloon in pill form that can be swallowed to help overweight people achieve rapid weight loss without invasive surgery. It is intended to be used for a maximum period of three months. The balloon is designed to be used by people with a body mass index (BMI) of 27 or above. No sedation or anaesthetic is needed and you have to swallow the capsule with a very small tube attached. Once the capsule reaches the stomach, it opens up and releases the balloon. The main difference between the balloons is the amount and expense, Obalon uses three balloons placed in the stomach over a period of 12 weeks and costs £4500 whereas the ReShape dual balloon uses only one and costs £5500.
Read MoreExercise-mimic molecule may help treat diabetes and obesity
A new molecule that acts as an exercise mimicker could potentially treat type 2 diabetes and obesity, according to scientists from the University of Southampton.
The new molecule, compound 14, was developed by Professor Ali Tavassoli. The molecule blocks the function of the cellular enzyme ATIC, which holds an important role in metabolism. The blocking of ATIC leads to an accumulation of a molecule called ZMP (5-aminoimidazole-4-carboxamide ribonucleotide) in cells, activating the cells’ main energy sensor, an enzyme called AMP-activated protein kinase (AMPK) that monitors and responds to changes in the intracellular AMP/ATP ratio. Activation of AMPK causes the cells to believe that they are low in energy, which forces the cells to increase energy levels by boosting the metabolism and increasing the uptake of glucose from the blood stream.
The study, recently published in Chemistry and Biology, tested compound 14 on a mouse model of metabolic syndrome to show therapeutic viability.
“The issue is that established drugs do not successfully enable patients with type 2 diabetes to achieve glycaemic control and some can even result in weight gain, a leading factor driving the diabetes epidemic. In contrast, this new molecule seems to reduce glucose levels and at the same time decrease body weight, but only if the subject is obese,” says co-author Dr. Felino Cagampang.
This study still warrants further research to determine how compound 14 works on treating type 2 diabetes and obesity in mice, and if this can be applied to humans, particularly if there are fewer side effects.
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