In The News
Source: The New York Times
Type 2 diabetes is almost twice as common in African-Americans as it is in whites. Obesity, rather than racial factors, is to blame, a new study in JAMA reports.
Researchers began with 4,251 black and white men and women ages 18 to 30 who were not diabetic. They then followed up with periodic interviews and health examinations over an average of 25 years. Compared to whites, black men were 67 percent more likely, and black women almost three times as likely, to develop diabetes.
A study published Online First by Archives of Surgery compared the effectiveness of two common forms of treatment for excessive weight gain: Roux-en-Y gastric bypass (RYGBP) and gastric banding (GB). The researchers found that for more sustainable and rapid weight loss, RYGBP is the better form of treatment.
In relation to the treatment of other comorbidities – other existing illnesses among the patients – RYBGP was also found to be more successful. Cholesterol levels in those who received GB remained unchanged, but those who received RYBGP saw a notable decrease. The lipid profile for those after RYGBP was "significantly better" after five years than for those in the GB group, as well as a lower mean fasting glucose level.
Vertical sleeve gastrectomy surgery—more commonly known as the gastric sleeve procedure—restricts food consumption through the removal of 70-85% of the patient’s stomach. The remaining section of the stomach is stitched in the shape of a long tube or sleeve. Unlike gastric bypass surgery, the stomach is still connected directly to the lower intestine so the procedure does not induce malabsorption.
Gastric sleeve surgery often is performed prior to gastric bypass surgery or a duodenal switch procedure to help morbidly obese individuals with the first stage of their weight loss. Because the surgery is performed laparoscopically and does not involve rerouting the intestines, it is generally considered less risky than both the gastric bypass and duodenal switch procedure.
Researchers are learning, however, that the benefits of weight loss surgery (WLS) in obese patients biologically begin prior to dropping the pounds. Two new studies have been released this week explaining the reduction in risk factors for diabetes and cardiovascular disease.
"It’s clear that weight loss surgery, particularly gastric bypass, has a significant beneficial effect on glucose control," said Dr Carel le Roux, from the Department of Medicine, who led the study.
Two studies: Sleeve gastrectomy out performs RYGB long-term
Sleeve gastrectomy got a boost recently with the publication of two separate studies that concluded the procedure performs better long-term than other forms of weight loss surgery.
A study out of two universities in Australia published online in the journal Obesity Surgery1 concluded that food tolerance and gastrointestinal quality of life at 2 to 4 years post-surgery are ostensibly best after sleeve gastrectomy compared with adjustable gastric banding (AGB) and Roux-en-Y gastric bypass (RYGB).
The second study, out of the Albert Einstein College of Medicine in New York and published online in the journal Surgical Endoscopy, 2 found laparoscopic sleeve gastrectomy can be considered a definitive operation for morbid obesity, especially inner city patients, based on its low incidence of postoperative complications.
This prospective cross-sectional study evaluated 129 participants who completed a food tolerance questionnaire and 119 who completed a Gastrointestinal Quality of Life Index (GIQLI). After analysis, the control and sleeve gastrectomy groups showed the highest median scores for food tolerance. For GIQLI, the gastrectomy group had the highest median score (120.5), followed by the gastric banding (94.0) and control groups (96.0). The authors also reported that GIQLI scores correlated significantly with food tolerance scores.
Additionally, the median excess weight loss was similar in the sleeve gastrectomy and RYGB groups (76.3% and 76.5%, respectively) but significantly lower in the gastric banding group (38.2%).
New York Study
The authors cited the challenge of providing bariatric surgery to an inner-city population in structuring their retrospective review and analysis of 185 consecutive laparoscopic sleeve gastrectomy procedures that had completed at least 6 months follow-up. They excluded 11 conversions to laparoscopic RYGB, leaving 174 patients for outcome analysis. About 38% of patients had BMI greater than 50 kg/m2 was 37.94%.
Mean excess weight loss (EWL) was 44.76, 55.52, 59.22 and 58.92% at 6, 12, 24 and 36 months, respectively. Six patients (3.24%) lost less than 25% excess weight loss (EWL). Thirteen patients (7.02%) regained an average of 13 pounds after reaching a plateau.
Resolution/improvement of comorbidities was 84% for diabetes mellitus, 50% for hypertension, 90% for asthma, 90.74% for obstructive sleep apnea, and 45.92% for gastroesophageal reflux disease symptoms. Mortality rate was zero in this series. Perioperative complications occurred in 26 patients (14.05%). They included four staple-line leaks (2.16%), four bleeds (2.16%), four obstructions (2.16%), five vomiting/dehydration (2.70%), six new onset of GERD symptoms (3.24%), two with pneumonia (1.08%) and one with pulmonary embolism (0.54%).
"LSG results in stable and adequate weight loss with resolution/improvement in comorbidities in a high percentage of patients," the authors wrote.
- 1.Overs SE, Freeman RA, Zarshenas N, Walton KL, Jorgensen JO. Food tolerance and gastrointestinal quality of life following three bariatric procedures: Adjustable gastric banding, Roux-en-Y gastric bypass, and sleeve gastrectomy. Obes Surg. Epub 2011 Dec15
- 2.Chopra A, Chao E, Etkin Y, Merklinger L, Lieb J, Delany H. Laparoscopic sleeve gastrectomy for obesity: can it be considered a definitive procedure? Surg Endosc. E pub 2011 Dec 17