Salt Lake City - Severely obese patients who undergo gastric bypass surgery significantly reduce their risk of death from coronary heart disease, diabetes, and cancer, according to research published in the Aug. 23, 2007, issue of The New England Journal of Medicine. The study was led by a team of researchers from the University of Utah School of Medicine and LDS Hospital.


The 14-year study evaluated 15,850 severely obese patients, half of whom underwent gastric bypass surgery to reduce their weight. The mortality rate from coronary heart disease was 56 percent lower in the surgery group than in the non-surgery (control) group. The surgery group also showed a 60 percent lower death rate from cancer and a 92 percent lower death from diabetes than the non-surgery group, according to Ted D. Adams, Ph.D., M.P.H., the study's lead author,
Adams is a professor in the Division of Cardiovascular Genetics at the University of Utah School of Medicine and co-founder of the Intermountain Health and Fitness Institute at LDS Hospital in Salt Lake City.


While mortality rates for specific diseases were lower in the surgery group, Adams said mortality rates from other causes such as accidents and suicide were 58 percent higher among those who had the weight loss surgery than the control group.


This study helps to further define the effects of gastric bypass surgery on long-term mortality. Reduction in death by any cause, and disease-specific deaths such as coronary heart disease, diabetes, and cancer were significantly reduced in surgery patients compared to the non-surgical control group, he said. However, rates of death not caused by disease were shown to be greater in those who underwent the weight-loss surgery when compared to controls.


The paper suggests at least some of these non-disease deaths in the surgery group may be due to unrecognized pre-surgical mood disorders or post-traumatic stress disorders, which appear to be more common in severely obese patients. Adams said the research shows the need for better methods of evaluating candidates for the surgery, including the possible need for psychological evaluation and psychiatric treatment before surgery, and aggressive follow-up after surgery.


The reduced mortality for any cause of death is likely related to significant health improvements that follow gastric bypass surgery, such as reduced blood pressure, improved or resolved diabetes, and reduced sleep apnea, says Adams.


Women accounted for 84 percent of the patients involved in the study.


The average body mass index (BMI), which is calculated by dividing a person's weight in kilograms by the square of the person's height, for patients in the surgery group was 45.3, and 46.7 for the non-surgery group.

By BELINDA YU
Special to the Journal Sentinel
Posted: Sept. 16, 2007


Dana Brown lay on an operating table at Froedtert Hospital waiting for a surgeon to shrink her stomach from the size of a football to roughly the size of an egg.


At 239 pounds, she had battled type 2 diabetes for the last 10 years. Gastric bypass surgery, she believed, was her best chance of surviving the disease.


A normal body secretes the hormone insulin, used to burn glucose from food for energy. People with type 2 diabetes, however, don't produce enough insulin to properly digest sugar.


The accumulating sugar causes blood vessels to thicken, damaging the body's organs. Left untreated, diabetes can lead to serious health problems like high blood pressure, blindness and heart disease.


By the time of her surgery in December 2006, Brown's blood sugar levels were so high that she needed an insulin pump to deliver constant doses of the hormone.


As she heard the clinking and scraping of the surgical tools on its metal tray, her throat tightened. She said a prayer for herself and her family. Then she fell into a deep, drug-induced sleep.


Earlier that year, Brown, 35, of Milwaukee, had hoped to introduce a newborn daughter to her husband and young son. But Brown's health was rapidly deteriorating. Hormones produced during pregnancy caused her blood sugar levels to surge. She felt thirsty and hungry, and developed a lingering bone-deep fatigue.


A mother's diabetes is dangerous for a developing fetus. Diabetic women are more likely to have babies born with major birth defects and abnormally large birth weights.


Moreover, according to the American Diabetes Association, women with type 2 diabetes are more than twice as likely to have babies who die within a month of birth.


Two days before Brown was scheduled to deliver, she learned that the baby, whom she had named Amari Annette, had died. The doctors blamed diabetes. That day in March, Brown decided to go through with gastric bypass surgery.


Many people think of gastric bypass surgery as obesity surgery. Because the surgery profoundly limits the amount of food that can be consumed at one time, it helps many people lose weight.


A study from the University of Utah School of Medicine found that severely obese people who underwent gastric bypass surgery were 92% less likely to die from diabetes compared with a control group that did not undergo surgery after seven years.


Resolving diabetes The researchers followed up with 7,925 surgical patients and compared their outcomes with 7,925 people of similar age and body weight.


Overall, gastric bypass patients had a reduced mortality rate of 40%. The study was published last month in the New England Journal of Medicine.


But what surgeons like James Wallace, director of Froedtert Hospital and Medical College of Wisconsin's bariatric surgery program, have found is that the surgery also has a positive effect on type 2 diabetes.


An overwhelming majority of Wallace's patients with diabetes - 85% - experience an improvement in the condition after surgery. Many patients, post-surgery, are no longer considered diabetic.


Wallace said he tells his patients if they've had diabetes for less than 10 years, they have a 95% chance that it will resolve.


While Wallace believed the surgery would improve Brown's diabetes, he remained anxious about her operation.


Diabetics are prone to infections and organ damage; she could experience serious complications.


As Brown slept, Wallace carefully made five small incisions in her body into her abdomen.


He created a small, walnut-sized pouch and separated it from the rest of the stomach. Then he cut the intestines and attached it to the newly formed gastric pouch.


Many people have trouble losing weight, Wallace said, because the body defeats even the most well-intentioned dieter.


Everyone produces hormones that regulate hunger. When a person restricts food to lose weight, hunger signals spike. This is the body's way of protecting itself from starvation.


"You can resist . . . for a few days, weeks, months or even years. But eventually that signal will win," Wallace said.


A success


Two days after the operation, Brown no longer needed her daily insulin injections. Her blood sugar levels returned to normal in a matter of weeks. Her surgery was a success.


Gastric bypass helps improve diabetes because people with a gastric pouch can no longer consume vast quantities of carbohydrates and sugar without feeling sick, Wallace said. But it is possible to defeat gastric bypass surgery if someone were to eat continuously.


Brown's commitment to a healthy diet helped her lose 80 pounds and counting. She feels extraordinary. She walks an hour five days a week, and three days a week she does a half-hour aerobics workout.


It hasn't been easy. Instead of cheeseburgers, she opts for ham sandwiches. Instead of pancakes with sticky syrup, she eats toast. And she doesn't go anywhere near soda.


"I don't just believe it saved my life," Brown said. "I know it did."

NEW YORK (Reuters Health) - When weight loss stalls or other problems arise years after gastric bypass, the surgery can be successfully revised with an incisionless, from-the-inside approach, researchers from Ohio State University in Columbus report.


The technique, involves the use of a device called StomaphyX, which has been approved by the US Food and Drug Administration. The device is inserted with an endoscope via the mouth into the stomach, where suction pulls the stomach walls against the device. Staple-like fasteners are then deployed to create pleats in the walls, effectively reducing the size of the stomach.


"The incisionless surgery helps to recreate the patient's smaller stomach, causing early satiety and further weight loss," Dr. Dean Mikami, a surgeon involved in the development of StomaphyX and the first to perform the operation in the US, said in a statement. "This is currently the only endoscopic or nonsurgical way to reduce the size of the stomach after gastric bypass surgery."


Since April, a total of 22 such gastric bypass revisions have been performed at OSU. On average, patients dropped 10 pounds after 1 month, 15 pounds after 2 months, and 20 pounds after 3 months.


According to Mikami, between 10 and 15 percent of patients who undergo gastric bypass surgery will require a revision 2 to 15 years later.


Good candidates for treatment with StomaphyX, Mikami said, include those who have regained some of their weight after gastric bypass surgery and are compliant with their diet, exercise regularly, and do not experience early satiety during meals.

INDEPENDENCE, MO. -- An Independence man claims he was denied adopting a relative's child because he's overweight. Now, Gary Stocklaufer, who had weight loss surgery two weeks ago, has new hope.


Gary and Cynthia Stocklaufer said when the child they consider their son, Max, was put into foster care in July they were denied a re-hearing. Which meant the case was basically closed.


But Wednesday, the couple learned they were granted a new hearing, and another chance to bring baby Max back home.


"Ecstatic. Speechless. I'm overly thankful that the judge has reconsidered," said Gary Stocklaufer.


It's been two and a half months since five-month-old Max was taken away from Gary and Cynthia Stocklaufer.


At the time, a commissioner denied the couple's adoption petition and a re-hearing even though Max is a blood relative given to the Stocklaufer's to adopt.


The Stocklaufer's court appointed guardian said the couple was denied adoption because there was concern that Gary might develop diabetes or sleep apnea because of his size.


When FOX 4 broke the Stocklaufer's story in late July the couple was bombarded with weight loss doctors from around the county offering help.


Gary, who weighed more than 500 pounds, dropped about 10 pants sizes after having gastric bi-pass surgery in Dallas two weeks ago.


"Since surgery, I've lost a considerable amount of weight and even before surgery I've lost weight. My physician in Dallas has stated by this time next year I'll be about 250 ..275," said Gary.


Gary's wife said the judge may have had a change of heart since Gary had the surgery.

"It definitely has shown that he is willing to do whatever it takes. There's no mountain they can put in front of him that he's not willing to climb," said Cynthia.


With the hearing set for November 29, the Stocklaufer's have new hope that Max will be returned home.


"My goal is to walk out of the courthouse with my son and let the media and everybody aware of what's happened and go on with our private life," said Gary.


The hearing is set for a week after Thanksgiving. The Stocklaufer's said they'll hold off on their Thanksgiving celebration until the judge allows Max to come home.


Monica Evans, FOX 4 News

FDA to approve gastric band for adolescents by 2009


By (BI) Sara Feldkamp

Story Created: Oct 1, 2007 at 12:14 PM EDT

Story Updated: Oct 18, 2007 at 11:44 AM EDT


WALTHAM, Mass. -- Millennium Research Group forecasts that the gastric band market, currently valued at over $190 million, will exceed $630 million by 2012.


The expected 2009 FDA approval of the LAP-BAND device for adolescents aged 14 to 18 will significantly expand the potential patient base into one of the most rapidly growing segments of the obese population, according to Millennium Research Group's US Markets for Laparoscopic Devices 2008 report.


The two surgical approaches to obesity, laparoscopic adjustable gastric banding (LAGB) -which uses devices such as Allergan's LAP-BAND-and gastric bypass surgery , primarily involve restricting food intake into the stomach, thereby limiting caloric intake.


A LAGB procedure involves the placement of an adjustable gastric band around the upper part of the stomach, while gastric bypass surgery changes the anatomy of the digestive system to limit the amount of food that can be eaten and digested.


Gastric bypass surgery may currently be performed on adolescents because it does not need FDA approval. Promoters of LAGB point to lower risk of life-threatening complications, adjustability, and reversibility which will encourage further penetration of LAGB procedures among adolescent patients.


"There has been an alarming growth in the number of obese adolescents in the US," says Barbara Prud'homme, Senior Analyst at MRG.


"The approval of the LAP-BAND for adolescents will provide an additional option to treat these younger patients. The FDA stamp of approval of the LAP-BAND will likely make LAGB performed at an increasing rate by doctors."