Gastric Band Service

Patients are to be given a choice of hospitals across England for operations as a key NHS reform is expanded.
Ministers are to announce that 32 foundation trusts will be added to the list of local hospitals that patients currently choose from.
From the start of this year, people have been able to choose between four hospitals for elective surgery.
But patient groups said people tended to want to stay local so the extra choice would not mean a great deal.
Patient choice has been one of the government's key reforms to make the NHS more patient-friendly ...........

Experts Debate Safety of Various Weight-Loss Surgeries While Lawmaker Urges Strict Oversight of Obesity Surgery Programs
Jan 3, 2006 NewsInferno.com
Overweight Americans now have several surgical options to help them lose weight, including gastric bypass surgery, adjustable stomach bands, and an operation which removes part of the stomach and reroutes the intestines. Doctors, however, are divided on what is the safest and most effective procedure.Gastric bypass, in which the stomach is stapled to reduce its size, is currently the most frequently performed weight loss surgery in America. It is effective in facilitating the rapid loss of a large amount of weight and is used to treat people with heart problems and diabetes caused by obesity.In Europe and Australia, adjustable stomach bands are preferred over gastric bypass. In this type of surgery, a ring is placed over the top of the stomach and inflated with saline to tighten it and restrict how much food can enter and pass through the stomach.This reversible procedure is safer, with a 0.1% death rate compared to about 2% for gastric bypass. Long-term it is nearly as effective at helping patients lose weight. It is also the recommended procedure for children or women who may want to get pregnant after surgery.According to the research of Dr. Paul O'Brien, director of the Centre for Obesity Research and Education at Monash University in Melbourne, Australia, the bands are just as successful as gastric bypass for achieving weight loss over an extended period.O?Brien considered results on 23,638 patients in 43 published studies to determine that although bypasses induced a greater weight loss in the first three years, bands were comparable after seven years, with 55% (bypass) and 51% (bands) of excess weight lost. The third, and by far the most risky, option is a surgical procedure that removes three-quarters of the stomach to create a banana-shaped organ that is connected to the small intestine. This surgery bypasses more of the small intestine than a regular gastric bypass does. Although the mortality rate can be as high as 5%, the procedure is becoming more common and now represents 5% of U.S. obesity surgeries .....................

Early U.S. outcomes of laparoscopic gastric bypass versus laparoscopic adjustable silicone gastric banding for morbid obesity
T. H. Kim1, A. Daud1, A. O. Ude1, M. DiGiorgi1, L. Olivero-Rivera1, B. Schrope1, D. Davis1, W. B. Inabnet1 and M. Bessler1
(1)
Center for Obesity Surgery, New York Presbyterian Hospital, Columbia University, 161 Fort Washington Avenue, Suite 620, New York, NY 10032, USA
Received: 14 April 2005 Accepted: 7 September 2005 Published online: 6 December 2005
Abstract. Laparoscopic gastric bypass (LGBP) is the gold standard operation for long-term weight control in the United States. Laparoscopic adjustable silicone gastric banding (LASGB) is the preferred operative method for morbid obesity worldwide. Limited data are available comparing the two procedure in the United States. This study compares weight loss, complications, and early outcome of comorbidity resolution in patients who underwent LGBP versus LASGB. A review of prospectively collected data was performed on 392 patients undergoing primary LGBP (n = 232) and LASGB (n = 160) procedures between February 2001 and July 2004. Differences in percentage excess weight lost (%EWL) at 3, 6, 12, 18, and 24 months postop, improvement or resolution of comorbidities, and complications across procedure types were evaluated. Mean initial body mass index between groups was not significantly different (LGBP 47.2 vs LASGB 47.1, p < 0.53). There were significant differences in age, gender, and self-reported sweet-eating behavior between operative groups. There was a significantly greater %EWL in patients who underwent LGBP compared to patients of the LASGB groups 3, 6, 12, and 18 months after surgery. There were no significant differences in resolution or improvement of comorbidities between the groups. Although LGBP patients experienced more complications compared to LASGB patients (5.6 vs 4.3%, respectively; p < 0.56), this did not reach statistical significance. Early after surgery, LGBP patients lose more weight than LASGB patients but have similar improvements in comorbidities. Further follow-up is needed to determine the relative long-term efficacy of these procedures.
Keywords Laparoscopic gastric bypass - Laparoscopic gastric banding - Morbid obesity - Percentage excess weight loss Surgical Endoscopy

Obesity consultation: full guidance

Obesity consultation: full guidance, section 1: Executive summary, introduction and methods
16 March 2006

Obesity consultation: full guidance, section 2: Identification and classification
16 March 2006

Obesity consultation: full guidance, section 3: Prevention
16 March 2006

Obesity consultation: full guidance, section 4: Management of obesity 1
16 March 2006

Obesity consultation: full guidance, section 5a: Management of obesity 2
16 March 2006

Obesity consultation: full guidance, section 5b: Management of obesity 2
16 March 2006

Obesity consultation: full guidance, section 6: Health economics
16 March 2006

Obesity consultation: full guidance, section 7: Research recommendations
16 March 2006

Obesity consultation: full guidance, appendices 1-3
16 March 2006

Obesity consultation: full guidance, appendices 4 & 5
16 March 2006

Obesity consultation: full guidance, appendices 6-8
16 March 2006

Obesity consultation: full guidance, appendix 9
16 March 2006

Obesity consultation: full guidance, appendices 10 & 11
16 March 2006

Obesity consultation: full guidance, appendix 12
16 March 2006

Obesity consultation: full guidance, appendices 13 & 14
16 March 2006

Obesity consultation: full guidance, appendix 15
16 March 2006

Obesity consultation: full guidance, appendices 16-

Obesity consultation
Clinical guidance on obesity is being developed for use in the NHS in England and Wales. Registered stakeholders for the obesity guidance are invited to comment on the provisional recommendations via this website.
Although individuals and organisations not registered as stakeholders are able to comment, we recommend that you contact the registered stakeholder organisation that most closely represents your interests and pass your comments to them. We work closely with stakeholder organisations and take their views very seriously.

Beverage consumption patterns have changed dramatically over the past three decades. Among all age groups in the U.S., sweetened beverage consumption has increased and milk consumption has decreased. Between 1977 and 2001 energy intake from sweetened beverages increased 135% and was reduced by 38% from milk, with a resultant 278 total kilocalorie increase. At the same time, Americans consumed larger portions and more servings per day of sweetened beverages. These changes have meaningful impacts on diet quality and have been implicated as a causal factor in the obesity epidemic. Excessive sweetened drink consumption (>12 oz/day) is associated with lower protein, calcium, magnesium, phosphorus and vitamin A intakes as well as higher energy intakes. Obese children and adults consume a greater proportion of their total energy intakes from soft drinks in comparison with their lean counterparts. Consumption of sweetened beverages is related to weight gain in children as well as young and middle-aged women. A school-based nutrition program aimed at reducing consumption of soft drinks prevented excessive weight gain among English school children. Suggested solutions aimed at reducing soft drink intakes include reduced portion cans, expanded nutrition labels that reflect the total kilocalorie content of a single-serve portion, low sugar beverages, restricting sales in schools as well as a tax on the sale of soft drinks.

Rachel K Johnson, PhD, MPH, RD, Dean and Professor of Nutrition, College of Agriculture and Life Sciences, The University of Vermont, Burlington, Vermont, USA.

Full reference list available from linked site.

Low leptin levels linked to failed diets
Source: Daily Mail
Date: 02/12/2005
Researchers at Columbia University Medical Centre in New York have found that people with low levels of the hormone leptin find it hard to maintain weight loss after dieting. Columbia's Dr Michael Rosenbaum explains that "Leptin fools your body into being happy with a lower weight". Leptin also plays a part in helping brain cells communicate, an essential part of learning and retaining information. Leptin is produced during sleep, which suggests that shift workers and others with abnormal sleeping patterns may face a higher risk of obesity.

******

'Fat' patients facing ops ban Source: Daily Express Date: 23/11/2005 The Daily Express and The Times both feature the news that Ipswich Primary Care Trust has declared that patients with a body mass index of over 30 - the level recognised by the World Health Organisation as obese - may not be eligible for hip and knee operations until they lose some weight, in a bid to save the trust money. Dr Brian Keeble, public health director, defended the plan, saying that clinically obese patients are unlikely to recover as fast as those who are slimmer. The news has angered many patients who say that their inability to move freely often causes them to be overweight in the first place. One patient with a bmi of almost 40, said 'It's extremely difficult to lose weight - you can't exercise because of the pain'

Sleep disorder 'danger' of HGVsOne in six HGV drivers has a form of sleep disorder that could prove fatal without treatment, a study says.

Sweet foods increase breast cancer risk
Abergavenny Roger Dobson
Regularly eating sweet foods, including biscuits, ice cream, honey, and chocolate, may increase the risk of breast cancer. Results from a large case control study of more than 5000 Italian women have shown that the effects may be significant: ?If real, the excess risk for frequent sweet consumption may account for 12% of breast cancer cases in this Italian population and, therefore, is far from negligible on a public health level,? say researchers in a report in Annals of Oncology (published online on 25 October; http://annonc.oxfordjournals.org, doi: 10.1093/annonc/mdj051) ...............................

Trained interviewers used a questionnaire to gather data on medical history; physical activity; sociodemographic factors; and smoking, alcohol, and other lifestyle habits. Information on diet over the previous two years came from a 78 question food questionnaire.
Compared with women who consume less than the lowest tertile, women with the highest intake of desserts (including biscuits, brioches, cakes, puffs, and ice cream) had a multivariate odds ratio of 1.19 (95% confidence interval 1.02 to 1.39) and women with the highest intake of sugars (including sugar, honey, jam, marmalade, chocolate) had a multivariate odds ratio of 1.19 (1.02 to 1.38).
?In this study, sweet consumption was directly associated [with] breast cancer risk. The risk was consistently elevated in strata of age, [body mass index], total calorie intake, alcohol, physical activity and family history of breast cancer,? say the authors from the Istituto di Ricerche Farmacologiche, Milan; the International Agency for Research on Cancer; and a number of other centres in Milan, Genoa, and Naples.
?We also found that women above the highest decile of consumption of cakes and desserts and refined sugars had a greater risk of breast cancer, suggesting that sweet foods are among the features of a high risk dietary pattern.?
The authors point out that the sweet foods were rich in several nutrients potentially involved in causing breast cancer, including refined carbohydrates and saturated fats. ?A frequent consumption of sugars or foods with a high glycemic index may lead to insulin resistance, and a direct association between glycemic index or glycemic load and breast cancer risk has been suggested,? they say.
?This may cause an increase of insulin related growth factors which are promoters of breast carcinogenesis. Insulin also stimulates ovarian steroid secretion, including oestrogens and androgens, which have been related to excess breast cancer risk.?

Gory burger posters target young

Images of burgers filled with bone and gristle are to appear across the UK in a campaign to improve children's diets.

Obesity increases risk of several cancers in men and women, study finds
Abergavenny Roger Dobson
Being overweight or obese increases the risk of several cancers in men and women, a new study has found.
The research, which followed more than 145 000 people in Austria for 10 years, shows that high body weight was associated with a greater risk of colon, rectal, and pancreatic cancer in men and of endometrial and non-Hodgkin?s lymphomas in women (British Journal of Cancer 2005;93:1062-7).
A high body mass index (BMI) also seemed to increase the risk of breast cancer among women aged 65 or more.
"Our study provides additional support . . . for associations between BMI and the incidence of colon, rectal and pancreatic cancer, and to a lesser extent of kidney and liver cancer in men, and with endometrial cancer, postmenopausal breast cancer and non-Hodgkin?s lymphomas in women," write the authors, who come from five institutions: the University of Ulm, Germany, the University of North Carolina, the Medical University of Innsbruck, Austria?s Agency for Preventive and Social Medicine, and the Cancer Registry of Tyrol.
The study followed 67 447 men and 78 484 women. Their mean age at the start of the study was around 42, and the average time of follow up was nearly 10 years. By the end of the observation period 6241 cancers, other than non-melanoma skin cancers, had been diagnosed.
Other data available from the cohort included smoking status, occupation, and BMI, which was classed as normal (18.5 to 24.99), overweight (25 to 29.99), obese class I (30 to 34.99), or obese class II and III (³35). ...............

By Sam Lister
Growing numbers are swapping failed weight-loss regimes for a selection of extreme procedures
THE NUMBER of patients undergoing major stomach surgery on the NHS has more than doubled in the past three years.
Radical surgical procedures to reduce the size of the stomach, such as gastric bypasses, gastric banding and duodenal switches, have become increasingly popular for patients who fail traditional weight-loss regimes.
NI_MPU('middle');
Data from NHS hospitals, released by the Department of Health, show that more than 600 gastric banding procedures and related operations were carried out in 2003-04, up from 300 in 2000-01. It is estimated that 4,300 people will have obesity surgery this year, compared with 2,287 in 2004, mostly at private clinics. ...................................

The Times October 13th 2005
By Nigel Hawkes
OPERATIONS to staple, strap, bypass or even remove parts of the stomach really do work for the morbidly obese, according to a comprehensive review of the subject.
Patients typically lose 100lb (45.5kg) after these operations, and in the majority, symptoms of type 2 diabetes completely disappear. So while such operations may appear to be a last resort, they are effective.
Some can be done by keyhole procedures and have a low death rate, and while others are more major operations with death rates of about 1 per cent, this compares favourably with the death rate from diabetes.
In Journal of the American Medical Association, a team led by Dr Henry Buchwald, of the University of Minnesota, reviewed 136 studies into the results of bariatric surgery, the panoply of techniques that surgeons have developed for treating the 5 per cent of the US population that is morbidly obese.
The most common of the operations are gastric banding or gastric bypass. In banding, a hollow elastic band is inserted by keyhole surgery around the stomach and tightened, dividing the stomach into a small pouch above the band and a larger one below.
The size of the passage between the divisions can be controlled by injecting saline solution into the band. The small upper pouch can take less food, leading to a sense of fullness after eating less.
A gastric bypass takes the process a step further, by attaching the small intestine directly to the upper pouch, allowing food to bypass the lower stomach and the first two parts of the small intestine, thereby reducing food absorption.
The study shows that patients given gastric banding typically lose just under 50 per cent of their excess weight; with a gastric bypass this increases to 62 per cent; and with more invasive procedures still, such as removing parts of the stomach, 68 per cent.
Diabetes was completely resolved in 77 per cent of patients, and resolved or improved in 86 per cent. High blood fat levels were lowered in 70 per cent, and high blood pressure resolved in 62 per cent. Such surgery is available from some surgeons in the NHS and in the private sector. The review suggests that its benefits are real.

In a story covered mainly in The Guardian and The Independent, it is reported that research by the Confidential Enquiry into Maternal and Child Health (CEMACH) has revealed that pregnant women with type 2 diabetes are five times more likely to give birth to still-born babies. Babies born to diabetic mothers are also three times more likely to die within the first four weeks of life. In the past it was thought that only type 1 diabetes, which means a lifetime on insulin, was a problem in pregnancy, but the biggest study to date has found that the risks are just as high in type 2, which is often triggered by obesity. Of the 2,356 babies born between March 2002 and February 2003 to women with type 1 and type 2 diabetes, there were 63 still-births and a further 22 babies who died before they were four weeks old. The findings are seen as a disappointment after the 1989 St Vincent declaration, which set a five year target to achieve similar pregnancy outcomes for women with diabetes and those without the condition.

Nic Fleming in the Daily Telegraph reports that Dr Ian Campbell, president of the National Obesity Forum, has advised that overweight people who reduce their waistlines by four inches could reduce their chances of developing Type 2 diabetes. A woman with a waist of more than 35in and a man with a waistline of more than 40 in are at greatest risk of metabolic disease like type 2 diabetes and cardiovascular diseases. Delegates at the NOF annual conference in London were told that a survey by the World Heart Federation had shown that 77% of GPs were not aware that abdominal obesity was a risk for both diabetes and heart disease. It is estimated that obesity-related illnesses, such as type 2 diabetes, heart disease and hypertension, cost the NHS £368 million a year.

DNA test for diabetes and obesity
Scientists say they have discovered a gene linked to diabetes and obesity, offering hope for a diagnostic test.
......
The Imperial College London team told Nature Genetics that spotting the problem early and intervening could save lives.
......
Experts have already predicted that the UK is facing an obesity and diabetes time bomb, with rates soaring among children and adults alike.
The number of people in the UK with diabetes is predicted to reach three million by 2010.
Diabetes and obesity increase the likelihood of potentially fatal diseases such as heart attacks.
While inactivity and poor diets are much to blame for obesity and the metabolic problems that can lead to full-blown diabetes, the authors of the latest study say some people are genetically prone as well.
Genetically prone
In these individuals - up to 20% of Caucasians and 50% of black communities - leading a healthier lifestyle from the outset is imperative if they are to avoid problems in later life, say Dr Philippe Froguel and his team.
However, Dr Froguel said those with a family history of diabetes and obesity should be particularly vigilant with regards to lifestyle.
Dr Angela Wilson of Diabetes UK said: "This research is an important step in helping us unravel the genetics of Type 2 diabetes. We will be following its progress with interest."

... Surgical treatments break down into restrictive, malabsorptive, combined restrictive and malabsorptive or motility-reducing procedures.

Laparascopic implantation of an adjustable gastric band is an efficient restrictive measure for treating the majority of patients with this condition. The adjustable gastric band enables weight loss and food intake to be adapted to the individual patient's need. Eighty percent to 90% of these patients can expect to lose 55-70% of their excess weight........

The death rate in centres with experienced staff is less than 0.3%.

Surgical treatment for obesity has proved that it is the best and most effective means of preventing the life-threatening complications and serious degenerative problems associated with morbid obesity. There is no one operation that is effective for all patients.

Major improvements occurred in arthritis, asthma, depression, diabetes, gastro-esophageal reflux disease, hyperlipidemia, hypertension, joint and back pain, sleep apnea and stress incontinence. Medication usage declined remarkably. Quality of life (QoL) by the SF-36 showed highly significant improvements. CONCLUSIONS: At 1 year after Laparoscopic Adjustable Gastric Banding, patients had experienced significant weight loss, resolution of comorbidities, decreases in medication usage, and improvements in Quality of Life.

New strains of superbug hit hospitals Source: The Times Date: 23/06/2005 Most papers detail a Public Accounts Committee report which has warned that NHS patients are regularly hit by Hospital Acquired Infections - 300,000 at least last year. The Times reports that only figures for MRSA are now published after mandatory surveillance and the committee pointed out that this accounted for less than 6% of all hospital acquired infections. The government has been heavily criticised for doing little to tackle the problem over the last four years. The report comes as the Royal Devon and Exeter Hospital yesterday confirmed that a virulent strain of C. difficile, the same infection which killed 12 people who were treated at Stoke Mandeville Hospital, was a factor in the deaths of 13 patients since the beginning of the year.

Astra's fatbuster pill attacked in US Source: Daily Mail Date: 11/03/2005 The final story of interest today is a very brief snippet featured in the Daily Mail, concerning new claims in the US over AstraZeneca's cholesterol pill Crestor. The US pressure group Public Citizen is now calling for the ban on the drug to be renewed, as the organisation believes that Crestor is more likely than other rival treatments to cause rhabdomyolysis.

The Mail and others report today on a new study conducted by Dr David Ludwig of the Children's Hospital in Boston on the links between fast-food consumption and diabetes. Studies found that eating in a fast-food restaurant more than two times a week dramatically increases the risk of diabetes because the enormous weight gain that accompanied junk food consumption increased insulin resistance. In the study, 3,000 adults between 18 and 30 were analysed, and those who ate in a fast-food outlet more than twice a week gained an extra 10lb over the period, as compared with those eating at outlets on fewer occasions.

A study by the Fred Hutchison Cancer Research Centre in Seattle has found that women who are clinically overweight or obese face a higher risk of becoming pregnant whilst on the contraceptive pill. The study, led by Dr Victoria Holt, has found that an obese or overweight woman was 60% to 70% more likely to become pregnant whilst taking the Pill because of the way the treatment was processed by people with a larger metabolism and excess body fat, amongst other factors. Dr Holt stated that "this higher risk of pregnancy also translates into a higher number of obesity-related complications of pregnancy".

Obese children often suffer from undetected sleep disorders which could be affecting their performance at school, researchers have warned.
Researchers from the Royal London Hospital studied 63 children diagnosed as very obese.
They told a British Thoracic Society conference that 54 had a condition called obstructive sleep apnoea (OSA) - a severe form of snoring.
The researchers say all obese children should be checked for the condition.
It is worrying for their future, not just for their health, but also for their social and educational achievements Dr Ian Campbell, National Obesity Forum
Most of the OSA cases were mild, but 14 had a moderate or severe form of the condition.
In OSA, airflow is restricted during sleep, leading to a fall in oxygen levels in the blood.
Obesity nearly doubled among youngsters aged two to four between 1989 and 1998 from 5% to 9%.
Amongst children aged six to 15, obesity rates trebled from 5% in 1990 to 16% in 2001.
'Chronic lack' of specialists
One of the Royal London researcher team said: "Obesity and obstructive sleep apnoea is an area which is under studied, particularly among children.
"Awareness of OSA is limited and often undiagnosed.
"Left untreated, these children may suffer daytime sleepiness resulting in poor concentration and leading to poor performance at school."
He added: "Currently, resources in district general hospitals are insufficient to diagnose and treat obstructive sleep apnoea but we need to be able to establish the best way to investigate and treat obese children with OSA if they can't lose weight, which many can't."
Melissa Hack, of the British Thoracic Society, said: "Sleep apnoea is a debilitating condition and left undiagnosed this can seriously affect the day-to-day lives of children.
"There is a chronic lack of lung specialists and 'diagnostic sleep centres' in the UK, which is hampering fast referrals for diagnosis and treatment.
"As a first step to tackling this problem we strongly urge the Government to carry out a national review of sleep services in the UK."
'Patchy treatment'
Figures published by the Liberal Democrats also showed that the number of children receiving hospital treatment for obesity-related sleep apnoea had increased 15-fold since 1997.
Data presented in response to a parliamentary question showed that in 1997/98 there were just three cases of paediatric treatment for the condition in England.
But in 2002/03, 48 youngsters received hospital treatment for sleep apnoea.
Liberal Democrat health spokesman Paul Burstow said the rise was "deeply worrying".
"Cases of children with obesity related sleep apnoea are on the rise but treatment for the condition on the NHS is patchy.
"The solution is to tackle the causes of the disease, and combat childhood obesity."
Dr Ian Campbell, chief executive of the National Obesity Forum, said: "Sleep apnoea is a disease that often goes undiagnosed.
"This reminder that it affects overweight and obese children is concerning."
He added: "Children who are overweight or obese have a hard enough time at school.
"But if they are unable to perform to their maximum potential, it is worrying for their future, not just for their health, but also for their social and educational achievements."
Story from BBC NEWS:http://news.bbc.co.uk/go/pr/fr/-/1/hi/health/4059357.stmPublished: 2004/12/02 00:31:24 GMT© BBC MMIV

Medicines watchdog warning after second fake drug find Source: The Guardian Date: 03/09/2004 The Medicines and Healthcare Products Regulatory Agency has warned patients to check they are taking genuine medicines following the discovery of a counterfeit batch of anti-obesity tablets claiming to be Reductil. The fake blue-and-white capsules were sold as part of a batch numbered 65542, while genuine medicines made by Abbott Laboratories always had a number with a one-letter suffix. There is no indication that the counterfeit poses an immediate risk to health, however patients are advised to consult their doctor if they are unsure.