Weight loss after bariatric surgery in cancer survivors.

BACKGROUND: With improved methods of identification and treatment, the numbers of cancer survivors are increasing. Weight loss is encouraged to reduce recurrence. After cancer treatment, will survivors respond to weight change and receive the benefits of bariatric surgery? OBJECTIVE: To compare weight loss after bariatric surgery of patients treated for cancer with those never diagnosed with cancer. SETTING: The 10 surgical centers participating in the Longitudinal Assessment of Bariatric Surgery (LABS2). METHODS: A retrospective review of the LABS database of 2458 participants was completed to determine which patients had answered the question that they had been told they had cancer with a positive response. Cancer survivors were compared for body mass index (calculated as weight in kilograms divided by height in meters squared) at baseline and 1, 3, 5, and 7 years after bariatric surgery with those who responded negatively to this question. Descriptive statistics, Fisher's exact tests, 2-sample independent t tests, Wilcoxon rank sum tests, and multiple linear regression were used. RESULTS: Groups were significantly different in age (P < .0001) and surgery type (P = .02). Other demographic and clinical comparisons were nonsignificant at the .05 significance level. Cancer survivors demonstrated less weight loss at 1 year (P = .0001). Over 7 years, there was no significant difference between the 2 groups. Adjusting for age, sex, baseline body mass index, and surgery type, cancer history was not found to be significant predictor of body mass index change 1-year postbariatric surgery. CONCLUSIONS: Patients treated for cancer are not different than the general population in their capacity for long-term weight loss with surgical assistance.

Position of the American Dietetic Association: weight management.

It is the position of the American Dietetic Association that successful weight management to improve overall health for adults requires a lifelong commitment to healthful lifestyle behaviors emphasizing sustainable and enjoyable eating practices and daily physical activity. Given the increasing incidence of overweight and obesity along with the escalating health care costs associated with weight-related illnesses, health care providers must discover how to effectively treat this complex condition. Food and nutrition professionals should stay current and skilled in weight management to assist clients in preventing weight gain, optimizing individual weight loss interventions, and achieving long-term weight loss maintenance. Using the American Dietetic Association's Evidence Analysis Process and Evidence Analysis Library, this position paper presents the current data and recommendations for weight management. The evidence supporting the value of portion control, eating frequency, meal replacements, and very-low-energy diets are discussed as well as physical activity, behavior therapy, pharmacotherapy, and surgery. Public policy changes to create environments that can assist all populations to achieve and sustain healthful lifestyle behaviors are also reviewed.

Comparison of effects of gastric bypass and biliopancreatic diversion with duodenal switch on weight loss and body composition 1-2 years after surgery.

BACKGROUND: Gastric bypass (GB) is the most common surgical procedure for weight loss in the United States. Biliopancreatic diversion with duodenal switch (BPD/DS) is less routinely performed, perhaps because of its technical difficulty and metabolic concerns. The objective of this study was to determine whether these procedures had differential effects on weight loss and body composition. METHODS: Body composition was measured by bioimpedance (Tanita 310) at the initial consultation, and follow-up measurements were completed 1-2 years after surgery. RESULTS: Of the 72 patients in the study, 50, aged 46.2 +/- 8.5 years, had undergone GB and were measured 15.5 +/- 5.2 months after surgery and 22, aged 40.6 +/- 7.9 years, had undergone BPD/DS and were measured 19.5 +/- 7.5 months after surgery. Patient age and time after surgery were significantly different between the 2 groups. The body mass index (BMI) for the BPD/DS group was 53.6 +/- 11.9 kg/m(2), significantly greater than the BMI of the GB group (48.0 +/- 6.3 kg/m(2); P = .009). However, the percentage of body fat did not differ between the 2 groups (P = .515). Postoperatively, the BMIs for the GB group (31.5 +/- 5.0 kg/m(2)) and BPD/DS group (30.3 +/- 6.1 kg/m(2)) were not significantly different (P = .384). The percentage of body fat for the GB and BPD/DS groups had changed from 49.2% +/- 8.3% to 32.1% +/- 10.6% and 47.9% +/- 5.9% to 23.8% +/- 10.4%, respectively (P = .002). The BMI had decreased by 16.5 +/- 4.8 kg/m(2)after GB and 23.3 +/- 6.8 kg/m(2) after BPD/DS (P <.001). The decrease in fat was 17.1% +/- 8.2% after GB and 24.2% +/- 7.2% after BPD/DS (P <.001). CONCLUSION: The BPD/DS procedure is more effective in reducing the BMI and promoting fat loss than is GB. The assessment of the impact of these two operations on an individualized basis offers additional information to assist in the evaluation of these procedures.

Fat-free mass is not lower 24 months postbariatric surgery than nonoperated matched controls.

OBJECTIVE: Concerns about an excessive loss of fat-free mass (FFM) after bariatric surgery prompted this comparison of operated versus matched nonoperated controls regarding FFM. SETTING: University Hospital and University Research Unit in an urban medical center. METHODS: Body composition with bioelectric impedance (Tanita 310, Tanita Corp, Arlington Heights, IL) was measured approximately 2 years after bariatric surgery in weight stable patients and nonoperated weight stable controls matched for body mass index (BMI), gender, and age. t tests provided comparisons. Analysis of variance was used to compare FFM changes for 4 procedures. Levene's test evaluated variance. RESULTS: Patients (n = 252; 24.7±15 mo after surgery) and nonoperated controls (n = 252) were matched for gender (71.8% female), age (44.5±11.0 yr), and BMI (32.8±7.0 kg/m2). Patients had different surgical procedures: 107 gastric bypasses (RYGBs), 62 biliopancreatic diversions with duodenal switch (BPD/DSs), 40 adjustable gastric bands (AGBs), and 43 sleeve gastrectomies (LSGs). FFM percentage was significantly higher in the operated patients than controls, 66% versus 62%, P<.0001. For 3 procedures, the FFM was significantly higher; however, AGBs changed only 7.3 BMI units and FFM was not significantly different from their matched controls, 59.8% versus 58.2%. Across surgical groups, FFM percentage differed, P<.0001 (RYGB 66.5±9.2%, BPD/DS 74.0±9.3%, AGB 59.8±7.0%, LSG 59.6±9.3%). Variance was not different (P = .17). CONCLUSION: Weight-reduced bariatric surgery patients have greater FFM compared with nonoperated matched controls. These findings support surgically assisted weight loss as a physiologic process and in general patients do not suffer from excessive FFM depletion after bariatric procedures.

Nutrient Status 9 Years After Biliopancreatic Diversion with Duodenal Switch (BPD/DS): an Observational Study.

BACKGROUND: Since biliopancreatic diversion with duodenal switch (BPD/DS) produces hypoabsorption, evaluation of long-term nutrient changes is appropriate. METHODS: Measurements of micronutrients, trace elements, PTH, iron studies, and protein were completed for consented patients at baseline prior to surgery and at yearly intervals. The patients were advised and supplements were adjusted by blood studies with compliance checks. Independent t tests and ANOVAs compared changes between cross-sectional cohorts based on follow-up time from surgery. A p value of 0.05 was considered significant. RESULTS: Between 1999 and 2010, 284 patients had BPD/DS. At baseline, nutrient analysis was available for only 190 patients (70% women), age 42.7 ± 10.0 years, BMI 53.0 ± 11.9 kg/m2; at year 1, 189 were available; at year 3, 193; at year 5, 132; at year 7, 98; and at year 9, 68. Gender distribution was not significantly different between cohorts. Baseline vitamin D was low and PTH high. All of the patients took some supplements. Fat-soluble vitamins remained low. Protein deficiency appeared at year 3 and increased to 30% at year 9. Baseline zinc was normal, but at year 5, 45% were low. Over time, hematocrit was low for 40% and hemoglobin for 46%. Iron deficiency continued through year 9, more marked in males. Calcium deficiency increased from year 3 and remained steady. Half of the patients had abnormal PTH at baseline, and the percentage increased over time. Twenty percent had abnormal baseline magnesium values. Magnesium fluctuated during observation. CONCLUSIONS: Major deficits in nutrient status occurred and persisted after surgery although supplementation was prescribed. Interventions are mandated to avoid nutrient deficiency.

Changes in lipid profiles in morbidly obese patients after laparoscopic sleeve gastrectomy (LSG).

BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) has evolved as a primary weight loss surgery. This study provides changes in lipid profiles in obese patients 1 year after LSG. METHODS: A retrospective analysis of patients who underwent LSG from June 2004 to June 2008 provided data on demographics, body mass index (BMI) changes, co-morbidities, and medication changes. We compared lipid profiles, and the relationship between the lipid profiles and pre-operative weight, BMI, and weight loss. Proportion changes for all variables were also assessed. Lipid profiles for those taking lipid-lowering therapy and patients receiving no medication were evaluated. RESULTS: Data is presented on 45 patients (58% women) ages 18 to 73 years. Co-morbidities included hypertension (19), hyperlipidemia (22), and diabetes (13). One year after LSG, weight decreased from 161.4 ± 34.3 to 112.9 ± 25.6 kg (p < 0.01). BMI decreased from 57.5 ± 9.6 to 39.9 ± 7.1 kg/m(2) (p < 0.01). Patients with elevated triglycerides decreased from 17 to 8 (p < 0.01) while patients with elevated cholesterol increased from 13 to 15. High-density lipoprotein cholesterol (HDL) increased from 48.4 to 54.5 mg/dl (p < 0.01) and triglycerides (TG) decreased from 141.7 to 109.3 mg/dl (p < 0.01). TC/HDL and TG/HDL ratios also, decreased significantly (p < 0.01). There were no changes for total cholesterol (TC) and low-density lipoprotein cholesterol (LDL). TG/HDL changes correlated with pre-op weight (r = 0.363, p < 0.05). CONCLUSIONS: One year after LSG, significant weight loss and improvements in HDL and TG levels, TC/HDL and TG/HDL ratios were observed. TC and LDL levels were unchanged.

Health-related quality of life does not vary among patients seeking different surgical procedures to assist with weight loss.

BACKGROUND: Improvement in quality of life (QOL) is 1 of the goals of bariatric procedures. We hypothesized that greater impairment of QOL would encourage the choice of more invasive surgical procedures. Our study was performed at a university hospital weight loss surgical center in the United States. METHODS: Patients qualifying for weight loss surgery, who at their surgical consultation had chosen their surgical option and signed an informed consent form, were asked to complete 3 QOL forms--the Medical Outcomes Study Short Form 36-item Health Survey, the Beck Depression Inventory, and the Impact of Weight on Quality of Life-Lite. Analysis of variance was used to compare the surgery types with the demographics, QOL, and depression. RESULTS: A total of 367 patients, 114 men (31.1%) and 253 women (68.75), completed the QOL forms at their surgical consultation. Of these 367 patients, 68.9% elected gastric bypass (GB), 15% chose biliopancreatic diversion/duodenal switch (BPD/DS), and 16.1% chose adjustable gastric banding (AGB). The mean patient age was 42.5 ± 10.7 years (P = NS), with no differences in gender distribution. The body mass index was 51.9 kg/m(2) for the BPD/DS group, greater than that for the GB group (45.9 kg/m(2)) or AGB group (44.3 kg/m(2); P < .0001). No significant differences were found in the Beck Depression Inventory score among the 3 groups (GB 14.6 ± 9.6, AGB 10.8 ± 8.2, and BPD/DS 13.5 ± 7.3). For the Short Form 36-item Health Survey, only the physical component score was different for the AGB group compared with the BPD/DS group (GB 49.2 ± 25.1, BPD/DS 42.8 ± 26.4, and AGB 52.3 ± 31.7; P = .05). For the Impact of Weight on Quality of Life-Lite, all differences were nonsignificant. The total score was 44.1 ± 20.7, 44.4 ± 21.1, and 52.2 ± 19.6 for the GB, BPD/DS, and AGB groups, respectively. CONCLUSION: Patients requesting a weight loss procedure reported moderate to severe impairments in QOL and mood dysphoria compared with the community norms. However, the patients choosing from the 3 procedures studied scored similarly on the health-related QOL assessments.