Obesity

Sexual function after bariatric surgery

Sexual function after bariatric surgery

This meta-analysis shows that bariatric surgery significantly improves sexual function in men but that a more limited degree of improvement is achieved in women.

In obese male patients who underwent bariatric surgery, the levels of the sex hormones TT, FT, LH, FSH, and SHBG significantly increased, and the level of E2 decreased. In obese female patients, the levels of the sex hormones TT, FT, and E2 decreased, but the levels of LH, FSH, and SHBG increased.

Future studies should be performed to elucidate the mechanism of the improved sexual function in obese patients after bariatric surgery. 

JES

A possible new drug for diabetes and obesity (PTP1b inhibitor)

A possible new drug for diabetes and obesity (PTP1b inhibitor)

Protein tyrosine phosphatase 1B (PTP1b) was first discovered in 1988. It is a counter-regulator to insulin and leptin signaling pathways. Given current endemic of insulin resistance via obesity and type 2 diabetes, it is natural to search for drugs that improve insulin and leptin sensitivities. PTP1b suppression is one of those options.

Here is a phase 2 clinical trial on an antisense inhibition of PTP1b (IONIS-PTP-1BRx). Results are promising but not profound: A1c and body weight dropped by 0.7% and 6 lbs in 27 to 36 weeks. No major adverse events were seen. A clearer picture of the drug will emerge in the future trials. At the same time the search for the other perfect PTP1b continues.

GT

Leptin improves brain insulin resistance

Leptin improves brain insulin resistance

Leptin deficiency leads to weight gain, obesity, and insulin resistance. Leptin replacement in the form of metreleptin has been approved by the FDA for congenital or acquired generalized lipodystrophy. The current analysis reveals that metreleptin also improves central insulin sensitivity primarily via hypothalamus and to a lesser extent prefrontal cortex.

GT

BMI vs. CVD contradiction

BMI vs. CVD contradiction

The study observes that higher BMI is associated with higher cardiovascular mortality and morbidity. On the contrary, it is intriguing to see that CVD longevity is prolonged in adults with elevated BMI (>25) compare to those with normal BMI (19-25). A speculative explanation could be that once cardiovascular illness has been established, the high BMI-induced damage is irreversible and subsequently somewhat protective. Future research will clarify the molecular mechanisms of these observations.

GT

Diabetes and obesity increase the risk of 12 malignancies

Diabetes and obesity increase the risk of 12 malignancies

The article provides more evidence that diabetes and obesity increase the risk of malignancy, particularly of colorectal, gallbladder, pancreas, kidney, liver, endometrial, postmenopausal breast, ovarian, gastric cardia, thyroid cancer, esophageal adenocarcinoma and multiple myeloma. It is estimated that 430 million adults have diabetes worldwide, while 2.0 billions are overweight or obese. How could this global health problem be meaningfully approached?

GT

Bariatric surgery improves mortality outcomes

Bariatric surgery improves mortality outcomes

Bariatric surgery using laparoscopic banding, gastric bypass, or laparoscopic sleeve gastrectomy, compared with usual care nonsurgical obesity management, was associated with lower all-cause mortality over a 4.5 years follow-up.

JAMA

Obesity and kidney disease

Obesity and kidney disease

This is a nice review showing how obesity contributes to kidney disease, particularly in the setting of metabolic syndrome, diabetes and hypertension.

The process starts with glomerular hyperfiltration, and made worse by high sodium and animal protein intake. I suspect that inflammation from visceral adiposity plays a major role too.

It appears that the risk for kidney disease accumulates over time, as prognosis is worse in childhood-onset vs. adult-onset obesity.

GT

Obesity, from childhood to adulthood

Obesity, from childhood to adulthood

The study predicts dim outcomes. Around 57% of today's children are expected to be obese by age 35. High BMI and particularly high waist circumference are well known contributors to inflammation, insulin resistance, diabetes, high blood pressure, metabolic syndrome and malignancy.

Can it be delayed, reversed, stopped? If so, how? Education?

GT

Joint statement on metabolic surgery for diabetes

Joint statement on metabolic surgery for diabetes

Below are listed recommendations on when to consider metabolic surgery for type 2 diabetes. Decisions making would depend on BMI severity and glycemic control.

The joint statement advises surgery for patients with class III obesity, and in those with class II but have high A1c. Consideration should be given to adults with controlled class II or uncontrolled class I obesity. 

Standards are listed below with a slightly modified wording for easier and succinct reading:

GT

2017 ADA guidelines: metabolic surgery for type 2 diabetes

2017 ADA guidelines: metabolic surgery for type 2 diabetes

Obesity is a pro-inflammatory state contributing to insulin resistance and type 2 diabetes. Starting with jejuno-ileal bypass in 1954 by Kremer and intestinal bypass in 1967 by Mason, various techniques of the malabsorption surgery have been developed, researched and applied over the decades. They have shown good results in reducing hyperglycemia, the number of diabetic medications and excessive body weight.

Guidance on the importance and indications of metabolic surgery for type 2 diabetes were published in Diabetes Care, January 2017. Recommendations are listed below with a slightly modified wording for easier and succinct reading:

GT

Healthy obesity, still at risk for ischemic heart disease

Healthy obesity, still at risk for ischemic heart disease

About 6,000 individuals were followed for 10 years. Metabolically healthy obesity was defined by high BMI, but in the absence of HDL, triglyceride, blood pressure and glucose anomalies. Yet authors found that "healthy" obese adults, particularly men, were more likely to develop ischemic heart disease (IHD) then those with normal body weight. The IHD risk was highly elevated, by 3-fold in 10 years.  These findings give us still another reason to avoid high BMI.

GT

Global obesity study: dismal projections

Global obesity study: dismal projections

A global observational study on obesity and its related complications: about 70 million persons from 195 countries were analyzed. Study time span 1980-2015. Obesity and disease burden are on the rise, particularly among children. Cardiovascular disease is the number one killer among those with high BMI. Obesity can cause diabetes, NASH, CVD, kidney disease, musculoskeletal anomalies and various types of malignancies, primarily of GI and GU nature.

How to fix it??

GT

Medications that Promote Weight Loss in Type 2 Diabetes

Medications that Promote Weight Loss in Type 2 Diabetes

Type 2 diabetes is prevalent and a common cause of other conditions such as kidney failure (nephropathy), nerve damage (neuropathy), eye disease (retinopathy), bone infection (osteomyelitis) and heart illness (coronary artery disease). It is primarily due to excessive body weight. So it is natural to look for medications that can help not only with glucose control but also targeting the root problem, obesity.

In the diabetes world, there are two such drug classes, ‘GLP-1 agonists’ and ‘SGLT-2 inhibitors’. Both can assist patients in losing significant body weight. These medications could be expensive, but if covered by health insurance, would be viable options for type 2 diabetes. Of course, side effects and contraindications need to be discussed with the physician.

GT

Exercise effect in older sedentary adults

Exercise effect in older sedentary adults

Combined aerobic and resistance activity increased physical performance more than aerobic or resistance training alone. A group of 160 sedentary individuals with average age 70 and BMI 35 were followed and evaluated at 6 months.

Results could be confounded by the fact that participants in the combined training group spent overall more time exercising than those who utilized only aerobic or resistance activities.

GT

2017 Guidelines: Pediatric Obesity

2017 Guidelines: Pediatric Obesity

"Pediatric obesity remains an ongoing serious international health concern affecting ∼17% of US children and adolescents, threatening their adult health and longevity. Pediatric obesity has its basis in genetic susceptibilities influenced by a permissive environment starting in utero and extending through childhood and adolescence.

Endocrine etiologies for obesity are rare and usually are accompanied by attenuated growth patterns. Pediatric comorbidities are common and long-term health complications often result; screening for comorbidities of obesity should be applied in a hierarchal, logical manner for early identification before more serious complications result.

Genetic screening for rare syndromes is indicated only in the presence of specific historical or physical features. The psychological toll of pediatric obesity on the individual and family necessitates screening for mental health issues and counseling as indicated."

J C E M

Bariatric Surgery in patients with type 2 diabetes

Bariatric Surgery in patients with type 2 diabetes

A major study published in New England Journal of Medicine in February 2017 shows that bariatric surgery, either RY bypass or sleeve gastrectomy, is superior to medications alone in lowering A1c, body weight, triglycerides, HDL, insulin use and improving quality of life in adults with type 2 diabetes.

A group of 150 patients with baseline A1c 9.2% were randomized to receive surgery plus medications or medications alone. Participants were followed for 5 years. No major surgical adverse events were seen.

GT

NASH can raise risk of colorectal cancer

NASH can raise risk of colorectal cancer

Non-alcoholic fatty liver disease, NAFLD or NASH is a manifestation of advanced obesity. It can lead to liver inflammation, cirrhosis and even malignancy. This association study suggests it can also increase the risk of colorectal cancer. The bigger the severity of liver disease, the higher the chance of colorectal carcinoma. A group of 26,000 asymptomatic patients were analyzed.

GT

Obesity 2017

Obesity 2017

A great review article on the current state of obesity. Increased adiposity or high BMI is a cause or great contributor to multiple of conditions; such as metabolic syndrome, insulin resistance, diabetes, hypertension, high cholesterol, osteoarthritis, impaired renal function, kidney stones, gout and even cancer.

Aspiration therapy for obesity - a possible Intervention?

Aspiration therapy for obesity - a possible Intervention?

Aspiration therapy was implemented in 25 adults with average body mass index 40. BMI decreased to 32 in one year and 31 in two years. No electrolyte anomalies or major side effects were noted. Stomach was drained 20 min after each meal, 3 times a day. Adherence to procedure was 80% in 12 months and 60% in 24 months.

Could this be a future viable therapy for obesity?

GT