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Elective Surgery After Bariatric Surgery

sharma-obesity-surgery14While we are now well aware of all the positive effects of bariatric surgery on metabolic, mental and functional health, one of the lesser discussed aspects is that, as a direct of the substantial weight loss and improvement in health, many elective procedures that could not be carried out prior to weight loss are now possible.

Thus, the recent report on bariatric surgery in Canada, released by the Canadian Institute of Health Information points out that (in Ontario),

“For example, compared with the three years before bariatric surgery, the number of knee and hip replacements increased by 139% and 275%, respectively, in the three years after surgery. Similarly, therapeutic interventions on the muscles of the chest and abdomen (including hernia repair) grew by 298% in the three years following surgery.’

Other elective procedures, however, become necessary as a direct consequence of the weight loss,

“For example, 137 removals of excess skin were performed during that time, compared with 7 in the three years preceding surgery.”

These procedures are often a reason why health care costs following bariatric surgery actually go up rather than down.

I, however, don’t see these as costs, but rather as important benefits of undergoing bariatric surgery.

I am sure, some of my readers who have undergone bariatric surgery will relate to this – happy to hear your story.

@DrSharma
Edmonton, AB

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Obesity Surgery In Canada Infographic

This is an infographic about bariatric surgery in Canada released by the Canadian Institute of Health Information:

CANADA_BARIATRIC_INFOGRAPHIC-CIHI

@DrSharma
Edmonton Canada

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Bariatric Surgery in Canada 2015

sharma-obesity-cihi-logoLast week the Canadian Institute of Health Information released a new study on the recent developments in Bariatric Surgery across Canada.

The following are the main findings:

  1. In 2012–2013, about 6,000 bariatric surgeries were performed in Canadian hospitals. This represents an almost four-fold increase over six years, due largely to increased capacity for bariatric surgery in Ontario.
  2. The typical bariatric surgery patient is a woman in her 40s who has obesity and other conditions such as diabetes, hypertension or sleep disorders. These characteristics have remained relatively consistent since 2006–2007.
  3. Overall, 5% of bariatric surgery patients experienced complications during their hospitalization for the surgery, and 6% were readmitted to hospital within 30 days of discharge. This study shows that complication and readmission rates have declined over time and are comparable to rates reported in other countries. As well, the readmission rate is similar to that for surgical patients overall in Canada (6.5%).
  4. Short-term increases in use of hospital care often follow bariatric surgery. Some patients have a noticeable change in their pattern of health care utilization after bariatric surgery. In some cases, this represents readmissions or follow-up care directly related to their surgery. In others, it may represent deferred procedures, such as joint replacements or hernia repairs, which could not be provided to patients at their starting weights. While this study examined only pre- and post-surgery hospital care, other studies have found that the surgery can reduce health care use and costs in other areas, such as prescribed medication.

The full report is available here

@DrSharma
Edmonton, AB

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Will Dieting Make You Fatter? Only If You Are Skinny!

Professor Abdul Dulloo, University of Fribourg, Switzerland

Professor Abdul Dulloo, University of Fribourg, Switzerland

At the recent European Congress on Obesity, I had the occasion for a long chat with my friend and colleague Abdul Dulloo, from Friburg in Switzerland, who has worked extensively on the issue of weight regain.

I asked him how much evidence there is to support the common notion that losing weight makes you fatter – something many dieters claim to have experienced.

Indeed, both in animals and humans, weight loss, as a rule, is followed by a more rapid regain of body fat than lean body mass (i.e. preferential catch-up fat) than of lean body mass, as a result of which body composition post-weight regain results in a greater proportion of fat mass than before. But does this increased “fatness” persist over time?

This is where Dulloo made me aware of a recent paper he published in Obesity Reviews that examines this question.

What his analysis of prospective studies on this issue revealed is that paradoxically, people within a the normal weight range appear much more prone to weight gain over time with dieting than people who already have overweight or obesity.

Indeed as he points out,

“…it is dieting to lose weight in people who are in the healthy normal range of body weight, rather than in those who are overweight or obese, that most strongly and consistently predict future weight gain.”

The reasons for this rather unexpected finding are unclear and some have argued that repeated dieting to lose weight in normalweight people may represents unsuccessful attempts to counter genetic and familial predispositions to obesity – these people are genetically prone to weight gain, which is why they are dieting in the first place. Thus, rather than a causal relationship, the association between dieting and subsequent weight gain is just what would have happened to them anyway.

Others have argued that the metabolic effects resulting from the psychological “fear of fatness” (which prompts dieting) per se may increase the risk for weight gain hence a contributing factor to the obesity epidemic.

However, as Dulloo and colleagues discuss at length, based on their reanalysis of a wide range of human studies of weight loss and refeeding on body composition data on fat mass and fat-free mass (FFM) losses and regains, there is increasing support for the biological plausibility that dieting predisposes lean individuals (rather than those with overweight or obesity) to regaining more body fat than what had been lost (i.e. fat overshooting).

Overall the findings suggest that perhaps the reason why lean people regain fat faster is because their feedback signals in response to the depletion of both fat mass (i.e. adipostats) and fat-free mass (i.e. proteinstats), through the modulation of energy intake and adaptive thermogenesis, are more effective than in individuals with overweight or obesity, thus resulting in a faster rate of fat recovery relative to recovery of lean tissue (i.e. preferential catch-up fat).

In fact, it appears that lean people overshoot in terms of weight gain because the state of hyperphagia (in response to weight loss) appears to persist well beyond complete recovery of fat mass and interestingly until fat free mass is fully recovered (which may take months during which time fat gain continues).

Thus, it appears that in lean individuals “fat overshooting” following a diet is a prerequisite to allow complete recovery of fat-free mass (in obese individuals this may be less of an issue as recovery of fat-free mass is stimulated simply by the need to carry around a greater body weight).

Thus, it is easy to understand why repeated dieting and weight cycling would increase the risks for trajectories from leanness to fatness particularly in people who have a normal weight to begin with.

These findings have important public health implications and for promoting a “fear of fat”.

As Dulloo notes,

“Given the increasing prevalence of dieting in normal-weight female and male among young adults, adolescents and even children who perceive themselves as too fat (due to media, family and societal pressures), together with the high prevalence of dieting for optimizing performance among athletes in weight-sensitive sports, the notion that dieting and weight cycling may be predisposing a substantial proportion of the population to weight gain and obesity deserves greater scientific scrutiny.”

Indeed, I wonder how much of the obesity epidemic is directly attributable to normal weight people trying to lose weight for no good reason other than to look better.

@DrSharma
Edmonton, AB

ResearchBlogging.orgDulloo AG, Jacquet J, Montani JP, & Schutz Y (2015). How dieting makes the lean fatter: from a perspective of body composition autoregulation through adipostats and proteinstats awaiting discovery. Obesity reviews : an official journal of the International Association for the Study of Obesity, 16 Suppl 1, 25-35 PMID: 25614201

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Plan Your Personalized Program For The Canadian Obesity Summit Now

Summit15appIf you are planning to attend the 4th Canadian Obesity Summit in Toronto next week (and anyone else, who is interested), you can now download the program app on your mobile, tablet, laptop, desktop, eReader, or anywhere else – the app works on all major platforms and operating systems, even works offline.

You can access and download the app here.

(To watch a brief video on how to install this app on your device click here)

You can then create an individual profile (including photo) and a personalised day-by-day schedule.

Obviously, you can also search by speakers, topics, categories, and other criteria.

Hoping to see you at the Summit next week – have a great weekend!

@DrSharma
Gurgaon, Haryana

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