IFSO-APC consensus statements 2011.

Associations of BMI with body composition and health outcomes may differ between Asian and European populations. Asian populations have also been shown to have an elevated risk of type 2 diabetes, hypertension, and hyperlipidemia at a relatively low level of BMI. New surgical indication for Asian patients should be discussed by the expert of this field. Forty-four bariatric experts in Asia-Pacific and other regions were chosen to have a voting privilege for IFSO-APC Consensus at the 2nd IFSO-APC Congress. A computerized audience-response voting system was used to analyze the agreement with the sentence of the consensus. Of all delegates, 95% agreed with the necessity of the establishment of IFSO-APC consensus statements, and 98% agreed with the necessity of a new indication for Asian patients. IFSO-APC Consensus statements 2011. Bariatric surgery should be considered for the treatment of obesity for acceptable Asian candidates with BMI ≥ 35 with or without co-morbidities. Bariatric/GI metabolic surgery should be considered for the treatment of T2DM or metabolic syndrome for patients who are inadequately controlled by lifestyle alternations and medical treatment for acceptable Asian candidates with BMI ≥ 30. The surgical approach may be considered as a non-primary alternative to treat inadequately controlled T2DM, or metabolic syndrome, for suitable Asian candidates with BMI ≥ 27.5. Other eight sentences are agreed with by majority of the voting delegates to form IFSO-APC consensus statements. This will help to make safe and wholesome the progress of bariatric and metabolic surgery in Asia.

The relationship of percent body fat by bioelectrical impedance analysis with blood pressure, and glucose and lipid parameters.

The objective of this study was to clarify the clinical significance and usefulness of measuring percent body fat (PBF) when compared with body mass index (BMI) in the Japanese population. A total of 2,483 Japanese individuals (1,380 men and 1,103 women) who underwent a medical checkup from 1999-2002 were employed. PBF was determined using bioelectrical impedance analysis (BIA). Relationships of age, BMI and PBF with several metabolic parameters, including blood pressure, lipids and plasma glucose levels were assessed in both genders separately. In men, PBF was a stronger determinant of total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-C) and triglycerides (TG) compared with age and BMI, whereas in women, age was the strongest determinant of TC and LDL-C. In both genders, BMI was the strongest determinant of serum HDL-C among age, PBF and BMI. Based on these data, we suggest that measuring PBF by BIA is superior to BMI for predicting TC, LDL-C and TG in Japanese men.

[Current status of obesity surgery as metabolic surgery].

Obesity Surgery is not only capable to reduce body weight of the morbid obesity patients but also capable to treat complications such as Diabetes, Hypertension, Hyperlipemia and etc. From this point view, obesity surgery is recently called Metabolic Surgery, intending to treat Metabolic Syndrome. Gastric Bypass, Adjustable Gastric Banding, Vertical Banded Gastroplasty, and Biliopancreatic Diversion are widely recommended in the world. We have operated 97 cases of morbid obesity patients with various types of gastric bypass and gastroplasty since 1982. Laparoscopic surgery is induced in the field of obesity surgery around 1995, and since then, it has been exploring rapidly over the world. Two thirds of total cases are recently operated laparoscopicaly in the world. We adopted laparoscopic obesity surgery in 2000, and now several institutions are operating with laparoscopy even in Japan. Considering the characteristic features of Japanese obese, we should have our own guideline for obesity surgery. Patients who have BMI > or =35 and severe complications which need to be treated promptly should be applied to surgical treatment in Japan.

Gastric bypass in a Japanese man with Prader-Willi syndrome and morbid obesity.

BACKGROUND: In Prader-Willi syndrome (PrWS), marked obesity is the most serious and common complication, contributing significantly to morbidity and mortality. Because of the associated psychosocial difficulties, bariatric surgery appears to be the only effective treatment. CASE REPORT: A 30-year-old man with PrWS weighing 108 kg (BMI 50 kg/m2), underwent Roux-en-Y gastric bypass (RYGBP). 3 months before the RYGBP, he weighed 146 kg (BMI 68.5), partly because of heart failure. 18 months after RYGBP, he weighed 92.4 kg (BMI 43.3), with no postoperative complications. Moreover, he showed considerable increase in serum HDL-cholesterol levels with reciprocal reduction in LDL-cholesterol after the surgery. CONCLUSION: RYGBP resulted in satisfactory weight loss and improvement in serum lipid profile in a Japanese morbidly obese patient with PrWS.