Gastric bypass surgery reverses metabolic syndrome

26 aug 2008--Metabolic syndrome, a cluster of conditions that increases the risk of heart disease, stroke and diabetes, in extremely obese patients can be cured by gastric bypass surgery, according to the findings from a new study.
"Reversibility of metabolic syndrome depends more on the percentage of excess weight lost than on other clinical or demographic characteristics," the research team reports in the journal, Mayo Clinic Proceedings.
To determine the effect of major weight loss on the metabolic syndrome, Dr. Francisco Lopez-Jimenez and colleagues evaluated patients being considered for bypass surgery at the Mayo Clinic in Rochester, Minnesota, between 1990 and 2003.
All patients met at least three of the five criteria for the metabolic syndrome - high levels of triglycerides (a "bad" fat), low levels of high-density lipoprotein "good" cholesterol, increased blood pressure, high blood sugar levels and obesity.
The study group included 180 patients who underwent gastric bypass and 157 patients who did not undergo the procedure, either because they declined surgery, were denied coverage by insurance providers, or did not maintain lifestyle interventions during their evaluation. All patients received medical and dietetic care and extensive counseling about the importance of physical activity.
The mean body mass index (BMI) was 49 in the surgical group and 44 in the nonsurgical group. A normal BMI is considered to be between 18.5 and 24.9.
During an average follow-up of 3.4 years, the prevalence of metabolic syndrome decreased from 87 percent to 29 percent in the surgical group, and from 85 percent to 75 percent in the control group. The authors estimate that the number of patients needed to treat with bypass surgery to cure one patient of metabolic syndrome was 2.1.
Weight loss averaged 44 lbs in the surgical group and 0.2 lbs in the nonsurgical group. Additional analysis showed that the percentage of excess weight lost was the primary factor that determined the resolution of the metabolic syndrome.
"Our study provides robust data to practicing clinicians about the benefits of counseling weight reduction in metabolic syndrome patients," Lopez-Jimenez and his associates conclude.
They recommend "gastric bypass surgery should be considered as a treatment option in patients with metabolic syndrome that has not responded to conservative measures" in those eligible for surgery.
SOURCE: Mayo Clinic Proceedings, August 2008.

Checkups key to success of obesity surgery

By Megan RauscherMon Jun 18, 2:21 PM ET
Seriously overweight people who undergo gastric bypass surgery to shed pounds should try to make as many scheduled post-op doctors appointments as possible, according to a new study. It shows that follow-up care is a key component of the long-term success of the weight-loss surgery.
With gastric bypass surgery -- the most common method of "bariatric" surgery -- surgeons reduce the size of the stomach, which substantially limits the amount of food a person can eat.
"Weight loss following gastric bypass varies from patient to patient," note Dr. Jon C. Gould and colleagues of the University of Wisconsin in Madison in a report to the annual meeting of the American Society for Bariatric Surgery. Continued and long-term follow-up care at a dedicated bariatric surgery clinic may impact the amount of weight that is lost, they add.
The investigators took a look back at 85 adults who had gastric bypass surgery at their center and found that the results were best in those who attended follow-up appointments for at least 3 years after they had the surgery.
Patients who attended every scheduled post-surgery follow-up appointment for 3 to 4 years lost 74 percent of their excess weight, whereas patients who kept every appointment for only 1 year lost 60 percent of their excess weight. Patients who missed appointments in the first year lost 56 percent of their excess weight.
"Our follow-up routine calls for visits at 2 weeks post-op, 6 weeks post-op, 6 months, and then annually after surgery indefinitely," Gould noted in a telephone interview with Reuters Health. "If we identify problems, we bring people in more often." The follow-up visits include meeting with a dietitian and medical health professional and often a health psychologist.
The most common reason given for missing scheduled appointments after gastric bypass surgery was lack of coverage by the patients' insurance company.
"This study shows that the more you put into bariatric surgery, the more you get out of it," Gould said in a written statement. "Patients must continue to attend their bariatric medical appointments and insurers should provide coverage for these visits."
In 2006 an estimated 177,600 severely obese people in the United States had bariatric surgery, according the American Society for Bariatric Surgery estimates. About 15 million or 1 in 50 adults in the US have morbid obesity, which is associated with a number of other diseases and conditions including type 2 diabetes, heart disease, sleep disturbances, asthma, cancer, and joint problems.

Nerve damage may occur after weight-loss surgery

Patients can develop potentially disabling neurological complications after gastric bypass surgery performed to treat morbid obesity, most likely due to deficiencies in certain nutrients, a new study shows.
While correcting these deficiencies can help patients, some are left with permanent damage, Dr. Katalin Juhasz-Pocsine and colleagues from the University of Arkansas for Medical Science in Little Rock report. Symptoms can strike many years after the surgery, they note, possibly because stores of certain nutrients may take this long to become depleted.
Some patients begin hallucinating and lose the ability to walk a couple of months after the surgery, Juhasz-Pocsine explained in an interview with Reuters Health. "After resolution of the acute symptoms they are quite weak, and it takes around a year to recover.
Some are permanently disabled," she said. Among patients who develop symptoms years down the road, the spinal cord typically is affected, resulting in falling, extreme coordination and gait problems, and severe spasticity, and some individuals need to use wheelchairs.
Juhasz-Pocsine and her team describe 26 cases of neurological problems that occurred in gastric bypass patients in the medical journal Neurology. Symptoms typically involved more than one portion of the neurological system.
While restoring nutritional deficiencies, which included lack of vitamin B12, thiamine, or copper, helped patients, many continued to have symptoms for months, while symptoms remained permanent in some patients, Juhasz-Pocsine and her team report. The patient who fared best was a woman who underwent surgery to reverse her gastric bypass after developing rapidly progressing symptoms that didn't respond to other treatment.
Gastric bypass patients and their doctors should be aware of the early signs and symptoms of neurological problems, and should know that these symptoms can strike many years after a person has had the surgery, Juhasz-Pocsine advises. Further research is needed, she added, on the risk of neurological problems in gastric bypass patients whose nutritional needs change dramatically, for example during pregnancy or breastfeeding or among individuals undergoing cancer treatment.
The researchers suggest that steps should be taken to help prevent gastric bypass patients from developing these problems in the first place by advising them to take vitamin and mineral supplements and to avoid "severe and rapid weight loss."
"Many of our patients were not instructed to take vitamin supplements, and postoperative follow-up visits with medical nutritionists were not emphasized," they note.
SOURCE: Neurology, May 22, 2007 online.