The Morbid Me

Discovery Channel World's Heaviest Man needs your Help!

A few days ago, I got a nice email from Katharine, and she asked me to publish the following. Please help her out as much as you can and also contact her directly, or leave your comments in the blog.

This is a good opportunity to cast your voice and experience, and who knows, you might be on TV ! :)

Hi All,

I work for the TV production company that produced The World’s Heaviest Man, the Discovery documentary about Manuel Uribe. We are now working on the follow up to that show with Manuel and would like to feature other people who are suffering from obesity who have been inspired by Manuel’s story. It would be great to hear from anyone who might like to be involved. Please email me! Let me know: how you heard about Manuel, what weight you are, your age, where you live and whether you have plans for surgery or other treatment. Also add any other information that you think is important.

Katharine.begg@eyeworks.tv

Thanks so much and I look forward to hearing from you soon!
Best wishes,
Katharine

New Research unveils the Dark Side to Weight Loss Surgery

Here is one of those studies I really don’t understand… But it is worth reading if you are planning to have, or had Gastric Bypass Surgery. The study by the University of Pittsburgh looked at nearly 17,000 Pennsylvania residents who underwent bariatric surgery, between 1995 and 2004 and was published in the October issue of the journal Archives of Surgery.

It reveals that coronary heart disease and suicide helped fuel the rise in the risk of death among patients after weight-loss surgery. Approximately 1 percent of patients died within one year of surgery and nearly 6 percent died within five years.

It is likely that this continued excess mortality after bariatric surgery could be reduced by better coordination of follow-up after the surgery, especially control of high risk factors such as hypertension, diabetes mellitus, hyperlipidemia [high cholesterol] and smoking, as well as efforts to prevent weight regain by diet and exercise and psychological support to prevent and treat depression and suicide. (Read more here)

Laparoscopic Banding in Adolescents Produces Major Weight Loss

Not only does laparoscopic gastric banding produce substantial weight loss in severely obese adolescents, but it also alleviates illnesses that go along with obesity, according to research presented at the 93rd Annual Clinical Congress of the American College of Surgeons (ACS).

Evan Nadler, MD, Assistant Professor of Surgery and Director of Minimally Invasive Paediatric Surgery, New York University School of Medicine, New York, New York, United States, and colleagues studied 25 morbidly obese youths, aged 14 to 17 years, who underwent laparoscopic adjustable gastric banding procedures.

Study subjects were evaluated for several measures of weight and body composition and also for comorbidities prior to surgery and again 1 year after the procedure, as part of a planned 5-year study.

Laparoscopic banding, in which an adjustable cuff is placed around the upper stomach through a small incision, has gained popularity as an alternative to conventional gastric bypass surgery due to apparently reduced mortality and morbidity.

In an oral presentation on October 8, Dr. Nadler said the 1-year follow-up results showed significant improvement in comorbid conditions as well as marked loss of body fat and overall weight.

Prior to surgery, 10 boys and 15 girls had a mean weight of 320 pounds, with mean fat mass of 136 pounds and mean body mass index (BMI) of 48. Android or central fat was 56% of total fat on average.

A total of 77 comorbidities were recorded preoperatively, or more than three per patient, Dr. Nadler said. Dyslipidaemia, diabetes, and musculoskeletal problems such as back pain and osteoarthritis were the most common.

At the 1-year evaluation, mean body weight had declined to 222 pounds, BMI to 35, and total fat mass to 100 pounds, of which android fat was 51%. Excess weight loss (weight greater than the ideal for a person's height and bone structure defined as excess) was 48%. All these declines were statistically significant (P <.01), Dr. Nadler said.

Perhaps as important was the fact that 40 of 60 comorbidities evaluable at follow-up had resolved entirely and 10 had improved, Dr. Nadler noted. The researchers could not evaluate changes in 11 cases of steatohepatitis and six cases of miscellaneous illnesses. Dyslipidemia, diabetes, hypertension and musculoskeletal conditions were most likely to improve, he said.

He noted that, on average, patients lost nearly as much lean mass as fat (28 pounds versus 36 pounds fat). He said it was most likely a physiologic response to the lost overall body weight. "We saw no negative impact" attributable to the lean mass loss, he added.

Among all children who may be considered overweight, surgical procedures should not take the place of dietary changes, exercise and other less invasive approaches to weight loss.

But in the morbidly obese population, from which the study sample was drawn, "these children are already too sick for those things to work," Dr. Nadler said. The long-term consequences of extreme overweight are so serious, and indeed life-threatening, that surgery, if effective, is entirely appropriate, he indicated.

New Diet Drug Tesofensine: Another As Seen on TV Pill?

Here we go again.. It’s all over the news, and since here in the US it’s all about Marketing, it will make us open our wallets once again. And as always, nothing conclusive to report from a scientific point of view. But well, let’s enjoy this anyways, so just read on:

Danish pharmaceutical company NeuroSearch reported on Sept. 17th that its drug tesofensine enabled overweight patients to lose an amazing average of more than 28 pounds in a 24-week Phase II clinical trial.

Neurosearch, which accidentally discovered that tesofensine promoted weight loss during studies of the drug for treatment of Alzheimer's Disease and Parkinson's Disease, said it now expects to start Phase III trials for tesofensine during the first part of next year.

Tesofensine is a triple monoamine re-uptake inhibitor which blocks the re-uptake of the neurotransmitters serotonin, dopamine and nor-adrenaline in the brain with no direct effect on the monoamine receptors.

Tesofensine’s impact on the three monoamine systems is believed to induce weight reduction through both a reduction in appetite and an effect in the metabolic center in the brain leading to an increased metabolic rate that helps the body burn fat.

Neurosearch said that in its trial, 204 patients who weighed on average between 220 and 230 were divided into four groups who either received a placebo, a .25 mg dose of tesofensine, a .5 mg dose or a 1 mg dose.

While those in the placebo group lost an average of just under 5 pounds, those taking a .25 mg dose of tesofensine lost an average of almost 15 pounds, those taking a .5 mg dose lost an average of almost 25 pounds, and those taking a 1 mg dose lost an average of more than 28 pounds.

"In the two highest dose groups (0.5 mg and 1.0 mg), treatment with tesofensine led to an average reduction in the patients’ BMI of 4," the company reported.

Neurosearch said one-fifth of the patients dropped out during the study, with the highest numbers discontinuing either in the placebo group or the group receiving the highest dose.

"The most frequently reported adverse events were mostly mild to moderate, and included dry mouth, sleep disturbances, nausea, constipation and diarrhea," the company reported. "No clinically relevant cardiovascular adverse events or changes in either blood pressure or pulse were seen, according to FDA criteria."

Dr. Arne Astrup of the University of Copenhagen, who led the study of tesofensine, said he was "thrilled" to see the tesofensine trial produce a weight-loss of approximately 22 pounds more than placebo without major safety concerns.

"If tesofensine will prove to live up to this weight loss effect in 12 months’ Phase III trials, thereby opening a whole new dimension in obesity management that can effectively compete with gastric surgery, this drug will definitely set a new standard in obesity treatment," Astrup said. (Source “Diet Drug Report”)

StomaphyX: Incisionless Surgery To Correct Weight Gain After Bypass

As the number of obesity cases continues to soar in the United States, the number of bariatric surgeries performed annually for weight loss increases steadily. But surgeons are now beginning to see another wave of patients whose success with the surgery has started to wane.

At Ohio State University Medical Center, surgeons have performed the first incisionless procedure in the United States for weight gain following gastric bypass – which makes it possible to escape the high rate of complications associated with traditional revisional surgery.

The incisionless technique has been approved by the Food and Drug Administration, using principles of revisional surgery to help shrink the size of the stomach. But the technique, “endoluminal tissue approximation,” is accomplished totally with a tube passed through the mouth – and no surgical incisions.

Key advantages of the new device, known as the StomaphyX, include: no incisions or scars; less pain; a lower rate of complications compared to the traditional revisional bariatric surgery; and a much quicker recovery, making it an outpatient procedure, according to Dr. Dean Mikami, a general surgeon at OSU Medical Center. Mikami helped to develop the new device and is the first surgeon in the U.S. to perform the procedure.

A flexible endoscope is passed through the mouth and advanced to the stomach, carrying a fiber-optic camera and a tubular surgical tool. Then tissue of the stomach is pulled by suction into the tubular device. Approximately 12 to 20 “H-shaped staple-like” fasteners are placed strategically in the stomach, to create pleats in the tissue and reduce the size of the stomach’s pouch.

“The incisionless surgery helps to re-create the patient’s smaller stomach, causing early satiety and further weight loss,” said Mikami. “This is currently the only endoscopic or nonsurgical way to reduce the size of the stomach after gastric bypass surgery.” The procedure also results in a smaller opening of the stomach’s pouch; a decrease in the stretch of the stomach, so that it can’t hold as much food; and a slower emptying of the stomach.

A total of 22 “endoluminal revisional bariatric operations” have been performed at Ohio State’s Medical Center since April 2007. All patients are doing well, according to Mikami. The average weight loss has been about 10 pounds at one month; 15 pounds at two months; and 20 pounds at three months.

The first patient in the United States to receive the new procedure was referred to Ohio State and received the incisionless operation on April 12, 2007. She had gained approximately 50 pounds since her gastric bypass. Since the StomaphyX procedure was performed, she has lost 26 pounds, or 38 percent, of her excess body weight.

“It is estimated that over 1 million people in the last 15 years have undergone gastric bypass surgery. About 10 to 15 percent of that group two to 10 years out may need a revisional procedure to reduce the size of their gastric pouch for further weight loss or to treat a post-operative bariatric surgery syndrome such as dumping. You’re looking at close to 200,000 patients who may need this type of follow-up procedure in the U.S. alone,” said Mikami, who has helped to train all of the surgeons in the United States – approximately 25 physicians so far – who have learned the procedure.

“As a bariatric surgeon, I treat a growing number of clinical severe obese patients,” said Mikami. “I know the joys of those patients who are cured of their diabetes and hypertension – and no longer require medication. It’s like they receive a second life. Now, the new device has actually given them a third chance at life – in a much safer way than could be offered in the past.”

The patient population for StomaphyX can range in age from 18 to 70. Mikami describes good candidates as those who have undergone gastric bypass for obesity, have re-gained some of the weight they had lost, are compliant with their diet, continue to exercise regularly, and do not have early satiety during meals. The StomaphyX procedure can give patients a tool to help them achieve their weight-loss goal and keep their obesity-related problems away.

“Incisionless surgery, or natural orifice surgery, is currently at the forefront of surgical procedures,” said Mikami. “This could perhaps also lead to the development of new ways to adjust the stomach, even before weight gain occurs. We are definitely on the leading edge of surgical technology.”  (Source)

Brookhaven Obesity Clinic Inspection Report

Thanks to our reader “Cheryl” for sharing the good find: “Brookhaven Obesity Clinic Inspection Report”. I just wanted to publish it here because so many people are debating and asking questions about this New York based Rehab & Health Care Center. This is an official New York State Department of Health report card, so, I guess you can’t go wrong. (Link here)

Gastric Bypass Lowers Risk of Death

Two new studies in the New England Journal of Medicine (NEJM) show another long-term benefit of Gastric Bypass Surgery and in my opinion the most important of all: a lower risk of death.

Researchers compiled data on 15,850 severely obese people, half of whom had undergone gastric bypass surgery between 1984 and 2002, and half who were from the general population and had had no surgical intervention for obesity. Overall, researchers found, the surgery patients were 40% less likely to die from any cause during a mean 7 years of follow-up, compared with the obese controls. What's more, the mortality rate attributable to obesity-related disease was 52% lower on the whole in the surgery group: after gastric bypass, patients were 92% less likely to die from diabetes, 59% less likely to die from coronary artery disease, and 60% less likely to be killed by cancer. (Read the full article here)

Bariatric Surgery Patients have fewer Complications at High-Volume Hospitals

Bariatric surgery patients had 64 percent fewer complications and a 26 percent shorter hospital stay if they went to a five-star rated hospital compared with a one-star rated hospital, according to a new study released today by HealthGrades. The study of bariatric surgery outcomes at hospitals in 19 states over the years 2003 to 2005 also found that five-star rated hospitals – those with better-than-average patient outcomes -- performed about twice the number of procedures compared with hospitals that rated poorly.

A clear trend away from traditional, more invasive gastric bypass to a less invasive laparoscopic procedure was also found in the study, according to the second annual HealthGrades Bariatric Surgery Trends in American Hospitals. Over 70 percent of the surgeries done in 2005 were laparoscopic, which are associated with fewer inhospital complications than traditional gastric bypass.

“Bariatric surgery has been demonstrated to be highly effective for those with morbid obesity, but the relatively new procedures are not yet regulated or a credentialed surgical subspecialty,” said Samantha Collier, MD., HealthGrades’ chief medical officer. “So it is important that patients considering surgery know how hospitals rate.”

The HealthGrades study analyzed 166,410 bariatric surgery procedures in the years 2003, 2004 and 2005 in the 19 states that collect and release all-payer outcomes data. Those states are: Arizona, California, Florida, Iowa, Maine, Maryland, Massachusetts, Nevada, New Jersey, New York, North Carolina, Oregon, Pennsylvania, Rhode Island, Texas, Utah, Virginia, Washington and Wisconsin.

HealthGrades’ quality ratings for bariatric surgery at individual hospitals in these 19 states were posted today. Each hospital receives a star rating based on their patient outcomes for bariatric surgery. Hospitals with above-average outcomes receive a five-star rating. Hospitals with average outcomes receive a three-star rating, and hospitals with outcomes that are below average receive a one-star rating.

The second annual HealthGrades Bariatric Surgery Trends in American Hospitals Study found that: Hospitals rated with five stars by HealthGrades performed, on average, almost twice the number of procedures during the three years studied compared with those rated with one star – 533 procedures compared with 293 for one-star hospitals.

Patients at one-star rated hospitals had, on average, a 16.07% chance of experiencing an in-hospital complication; patients at a five-star rated hospital had, on average, a 5.60% percent chance.

A typical patient at a five-star rated hospital had, a 64 percent lower chance of developing one or more major in-hospital complications compare to a one-star hospital, and a 41 percent lower chance compared to all hospitals studied.

The most common major complications include respiratory, bleeding, gastrointestinal and laceration complications.

The average length of stay was 26 percent shorter in five-star hospitals as compared to one-star rated hospitals.

Among the 19 states studies, almost half of all the procedures were performed in just four states – New York, Pennsylvania, Texas and Florida

Last year, a study published by the U.S. Department of Health and Human Services' Agency for Healthcare Research and Quality found that four of every ten patients undergoing bariatric surgery develop complications within six months.

Methodology

For this study, HealthGrades analyzed 166,410 bariatric procedures performed in the years 2003, 2004 and 2005. To make accurate and valid comparisons of clinical outcomes at different hospitals with different patient characteristics, HealthGrades risk adjusted the data using multivariate logistic regression-based ratings to account for age, gender and underlying medical conditions that could increase the patient’s risk of mortality or complication.

The full study and individual hospital ratings for bariatric surgery and other procedures can be found  here as an Adobe PDF document.

Alli the new Weight Loss Orlistat Marketing Drug

With the FDA banning last week the Rimonabant Obesity Drug, all eyes (and mouths) are now focused on the new drug Alli, that coincidentally was launched last week.

The main component of Alli, is Orlistat, a drug approved by the FDA in 1999 to treat obesity. Orlistat is marketed under the trade name Xenical by Roche. The only difference between Xenical and Alli is that the first comes in 120mg capsules and Alli in 60mg also, Alli does not require a prescription… here is where the fun begins!

So why all the hype about an 8 year old drug? Well, the answer is simple: Marketing! Yes, we are in America, and we will do whatever it takes to sell whatever we want to whoever is American enough to buy it.

Alli is all about marketing and hype, and soon you will see GlaxoSmithKline’s executives (the makers of this drug) showing off their new Bentleys all over the country. (Wait, a Bentley is a car for old fat rich people, since they sure are not fat, let’s change it for a slick Ferrari)

The over-the-counter dose of Alli is just half of the prescription one Xenical. Also, Orlistat as such, has a few side effects that Alli calls “Treatment Effects”. Wow, this is marketing! Have you ever heard a doctor tell you: “This medicine, has NO side effects, it has Treatment Effects!”

Well, who am I to write all of this? I am just a 35 year old former obese Gastric Bypass patient! Ohhh... wait a moment… Dr. Donald Hensrud MD a preventive medicine and nutrition specialist at Mayo Clinic, Rochester, Minn., answers some common questions about Alli here, and guess what, I might be considered a doctor myself after reading his post!

Thank God at least GlaxoSmithKline is fair with us and insists that if you decide to take Alli, you have to follow a strict diet and exercise plan… But, wait a minute! They just shoot themselves on their own foot! This solves the problem! There is no need for Alli! As per Dr. Hensrud “Alli could result in an average of 3 pounds lost in a year in addition to the approximately 8 pounds you could expect to lose from diet and exercise alone.” Great! So then, if a monthly supply of Alli will cost you about $60, you will have paid $720 for loosing 3 lbs in a year! This equals to $240 American Dollars a pound! Wow ! At that rate, I will start selling my excess fat to GlaxoSmithKline !!

FDA Rejects Rimonabant Obesity Drug

An FDA advisory panel has voted unanimously not to recommend sale in the U.S. of rimonabant, a widely anticipated antiobesity drug, the New  York Times reports.

The drug, available in 37 countries, was rejected "because of worries that it causes neurological and psychiatric problems and increases the  risk of suicide," according to the newspaper.

Rimonabant is a cannabinoid-receptor blocker. In clinical studies, it had shown favorable effects not only on weight loss but also on fasting glucose, HDL cholesterol, and triglycerides.