Some insurance companies require that you go through a Center of Excellence for them to cover bariatric procedures. Why is that? Well, we assume it is because they are the best of the best and really know their stuff, right?? And, by that way of thinking, you'd also expect much lower rates for complications and deaths as a postop. BUT, according to a recent study by Dr. Edward Livingston of the University of Texas Southwestern School of Medicine, that is NOT the case! He writes, "Designation as a bariatric surgery center of excellence does not ensure better outcomes."
Livingston's study, which appears in The Archives of Surgery, analyzed data from patients who had surgery in 2005--19363 total patients and 5420 who utilized a center of excellence. Of those people, the patients who had surgery at a bariatric center of excellence had a death rate of 0.17% and a complication rate of 6.3%. Of the patients who did NOT use a bariatric center of excellence, the rates were a death rate of .09% and a complication rate of 6.4%. So, despite the fact that centers of excellence are usually better staffed and more costly to run, their outcomes are not better! The extra cost is apparently not warranted.
This information is quoted in a Reuters news article.
Did you have to use a bariatric center of excellence? Was it your insurance company's stipulation? or was it the only choice in your area? When you compare your experience with that of others, do you think things were better or went more smoothly? Do you think it made a difference?
Showing posts with label in the news. Show all posts
Showing posts with label in the news. Show all posts
Wednesday, April 22, 2009
Wednesday, January 21, 2009
Gut Microbes Shift with Obesity, Upended by Gastric Bypass
http://www.genomeweb.com/sequencing/gut-microbes-shift-obesity-upended-gastric-bypass
Gut Microbes Shift with Obesity, Upended by Gastric Bypass
January 20, 2009
NEW YORK (GenomeWeb News) – The microbes living in our guts are linked — and could potentially contribute — to our weight. And these microbial communities are overhauled following gastric bypass surgery-assisted weight loss, according to a new study scheduled to appear online this week in the Proceedings of the National Academy of Sciences.
Using a combination of Sanger and Roche 454 sequencing technology, a team of researchers from Arizona State University, Arizona's Mayo Clinic, and the University of Arizona assessed the gut microbes of nine individuals who were either normal weight, obese, or had lost weight following Roux-en-Y gastric bypass surgery.
The team found that gastric bypass surgery was linked to a dramatic shift in individuals' gut microbes. They also detected an intriguing pattern in the microbial community within obese subjects: these individuals harbored a combination of hydrogen-producing and -consuming microbes that researchers say may ramp up the amount of energy harvested from their food.
By understanding such shifts, the team hopes to come up with new obesity treatments as well as markers to predict who is at risk of becoming obese.
Roughly four million Americans are affected by obesity and about 300,000 die from obesity-related conditions annually. Although increased food energy intake and a lack of physical activity are partly to blame, the authors noted, systems governing the body's energy balance could also be a factor.
Roux-en-Y and other bariatric surgeries are the most effective obesity treatments available to date. By bypassing part of the stomach and small intestine, the surgery limits the amount and type of food an individual can eat.
Such procedures are associated with a certain degree of nutrient malabsorption, changes in stomach acid exposure, and other gastrointestinal changes that could potentially alter the gut microbial community.
In an effort to understand these changes, the researchers used a combination of Sanger and Roche 454 sequencing to amplify and sequence microbial 16S sequences from stool samples taken from nine adults: three who were normal weight, three who were classified as morbidly obese, and three who had undergone gastric bypass surgery between eight and 15 months prior to the study.
Using massively parallel sequencing on the V6 hypervariable region of the 16S rRNA gene, the team generated 184,094 high-quality reads — an average of 20,455 reads per individual tested. These reads represented sequence from between 419 and 575 phylotypes.
Despite the diverse microbial communities and inter-personal differences within each trio of individuals, the researchers found groups of microbes that clustered together depending on weight or bypass surgery.
Whereas Firmicutes were the most common type of bacteria in normal weight and morbidly obese individuals, Gammaproteobacteria were dominant in the guts of those who'd had gastric bypass. These individuals also had more Enterobacteriaceae and Fusobacteriaceae and fewer bacteria from the order Clostridia.
"The large bacterial population shift seen in the post-gastric-bypass individuals may reflect the double impact of the gut alteration caused by the surgical procedure and the consequent changes in food ingestion and digestion," the authors wrote.
Because patients who've had gastric bypass surgery have a shorter gastrointestinal tract, lead author Husen Zhang, a post-doctoral researcher at ASU's Biodesign Institute, told GenomeWeb Daily News, they also have a higher concentration of oxygen in their gut. Not surprisingly then, he said the team found more facultative anaerobes — microbes that are capable of using oxygen — in that the guts of those who'd had the surgery.
Still, the researchers cautioned, more research is needed to determine the implications of this new microbial consortium. "The drastic change may or may not reflect a deficiency in beneficial microbes," Zhang said. "Maybe these patients need some kind of supplement."
The team also detected differences in the microbes found in the guts of the morbidly obese. While individuals from the normal weight and gastric bypass groups carried hordes of bacteria from the Verrucomicrobia phylum, for example, obese individuals did not. Instead, obese individuals often carried bacteria from the Prevotellaceae, a type of Bacteroidetes.
Both sequencing and quantitative real-time PCR indicated that the three obese subjects tested also carried microbes that produce or use hydrogen — including hydrogen-producing bacteria from the Prevotellaceae family and hydrogen-consuming Archaea.
Based on these results, the researchers speculated that there is teamwork taking place between the bacteria and archaea living in the guts of the obese. And, Zhang said, he and his team suspect that this cooperation may increase the amount of energy that obese individuals extract from food.
The researchers don't know yet whether this microbial community causes — or is a consequence of — obesity, senior author Rosa Krajmalnik-Brown, a researcher at ASU's Biodesign Institute, told GenomeWeb. But if the team can verify that gut microbes contribute to weight problems, she said, it may be possible to develop new microbe-based obesity treatments.
And although physicians and researchers don't need a marker for morbid obesity itself, Krajmalnik-Brown added, the archaeal-bacterial community associated with obesity may eventually help to distinguish individuals who are at increased risk of becoming obese.
Next, the team plans to do similar studies in larger groups of individuals over time, to determine, for example, how gut microbes vary during weight-loss programs or before and after bypass surgery.
Is there a basketball hoop at the White House? There may be soon!
According to a WebMD article, the Obamas are very big on fitness and exercise. And, apparently the Commander in Chief's favorite workout is basketball...
The Obamas: First Couple of Fitness
Will the exercise program of Barack and Michelle Obama inspire Americans?
Reviewed by Louise Chang, MD
The Obamas are making history, not just as the first African-American president and first lady, but perhaps also as the fittest first couple ever.
That role model, in turn, may inspire millions of sedentary Americans to get moving, exercise and preventive health experts hope.
Both the new president and first lady are regular exercisers, managing to squeeze in workouts despite their hectic schedules. It's difficult not to admire their dedication. When in Chicago, the new first lady was said to begin her day with a 4:30 a.m. gym workout.
Instead of kicking back and getting some extra sleep the day after he won the election, Obama showed up at his gym at 7 a.m. for a workout. The new president's washboard abs -- snapped by photographers during his Hawaii vacation -- rival that of a 30-something leading man in Hollywood.
Comparisons aside, it's clear that exercise is serious business for the Obamas -- and more about maintaining health and mental acuity than looking good.
"Barack is almost religious about getting in his workouts," says Alan S. King, a close friend of Obama's and an attorney at Drinker Biddle & Reath in Chicago. "He values his workout time as time to think and relieve stress. I'd say he's also driven by the fact that he wants to be fit and healthy to be around for Michelle and the girls [daughters Malia, 10, and Sasha, 7]."
Obama Exercise Program: The Routine
The new president's workout program would put many men half his age to shame. Obama, 47, combines his love of basketball with treadmill workouts and weight training, say those who have observed his workouts or played hoops with him.
Obama told Men's Health magazine in its November issue that his typical routine includes working out for 45 minutes, six days a week, including cardiac-strengthening routines and weight lifting. That's in addition to his famous basketball games -- played whenever possible and always on election days.
"He alternates days between strength and cardio training and gets in as much basketball as his schedule permits,'' King tells WebMD.
Irene Trantas, a master trainer at the Philadelphia Sports Club at Rodin, observed Obama work out on three different occasions when he stopped in while on the road. "You could definitely tell he has a routine, he works out, and he is familiar with the routine," she tells WebMD. During his stops there, he combined a treadmill run and elliptical trainer with weight training, including the chest press, overhead press, leg press and other conditioning exercises, she says. "He is strong."
Obama Exercise Program: What Keeps Them Moving?
By now, workouts have become an ingrained habit for both Barack and Michelle Obama, says Jim Cauley, a political consultant in Louisville, Ky., who managed Obama's 2004 U.S. Senate campaign.
During that campaign, Cauley says, "Everybody fought for his time. [But] he was adamant he got his workout time."
Even when the schedule was jam-packed. "His logic was always, 'The rest of my time will be more productive if you give me my workout time,'" Cauley tells WebMD. "I never worked out with him, but I can speak to his need for it."
The workout time got penned in, more often than not. "When he had a big moment in the campaign -- like a debate -- we always gave him time," Cauley says. "It was almost part of the debate preparation."
He kept up that same routine during his presidential bid and after he won the election. Last month, it was reported that he had gone to the gym for 90 minutes a day for at least 48 days straight.
Besides using fitness to stay in shape and help clear his head, Cauley thinks Obama saw it as valuable "alone" time, especially after he gave up driving himself to campaign events. "He had less time to himself," he says of those days after he had a driver. He thinks that made the workouts, especially the solo ones, even more precious.
The same seems true for the new first lady, Cauley says. "She used to get up early" to work out, he says. "The two of them are pretty methodical and very into working out." According to press reports, she gets in 90-minute workouts three times a week.
Obama Exercise Program: Obsessive or Not?
While some may wonder if the new president is a bit obsessive about his fitness, exercise experts say he's anything but, noting that he is following exercise guidelines.
Under current guidelines issued by the U.S. Department of Health and Human Services, adult Americans should strive for two and a half hours a week of moderate aerobic physical activity, and kids should get an hour or more of physical activity a day. The workouts should include not only cardio strengthening routines such as running, hiking, or brisk walking but also strength training for adults (such as weight lifting) and muscle strengthening for kids (such as rope climbing).
Less than 65% of adult Americans met those guidelines in 2007, according to a report published in December 2008 in the CDC's Morbidity & Mortality Weekly Report.
Calling the Obamas' exercise program excessive is incorrect, says Angela Smith, MD, an orthopaedic surgeon at Children's Hospital, Philadelphia, and past president of the American College of Sports Medicine. She points out they both do a mix of activities. They not only follow the recommendations for the suggested time, but have well-rounded routines including cardio and strength training.
"If someone is doing push-ups for 90 minutes a day, that's excessive," she says.
"I think he has a really good exercise program, one we should all be on," says William O. Roberts, MD, professor of family medicine at the University of Minnesota, Minneapolis, of the new president's routine. Roberts, a member of the American College of Sports Medicine, considers exercise as medicine in his practice.
"It's the cheapest, easiest thing to do [to improve health]," he says.
Following the exercise guidelines produces not only health benefits but other advantages, especially for high-powered people, says Gregg Miele, a Beverly Hills, Calif., personal trainer who has worked for singer Mary J. Blige and numerous other entertainment industry people. "I've worked with an artist who wrote his music in his head when he ran," Miele says. He suspects that Obama uses his workout time to problem-solve as well.
Obama Exercise Program: Will Their Fitness Habit Rub Off?
Colleagues who work out with Obama say his enthusiasm helps get them revved up about exercise, too.
"His dedication to it has inspired me," says King, the Chicago lawyer who often shoots hoops with Obama, "and hopefully his example will inspire many Americans to pay great attention to their health and fitness."
Exercise experts are hopeful that will be the case, too.
"Like it or not, they are going to be role models," says Angela Smith. "The Obamas have an incredible opportunity to influence fitness among adults and children." A good thing, she says, given the obesity epidemic among U.S. youths.
At the very least, observing the first couple's fitness routine may put the time crunch dilemma into perspective for the rest of us, others say. That Obama kept up the exercise routine throughout the grueling campaign is impressive, says Jeannie Moloo, RD, a Sacramento, Calif., dietitian and spokeswoman for the American Dietetic Association.
Seeing the first couple manage to squeeze in exercise will be a wake-up call, she predicts. "It will make the rest of us wake up and say we don't have much room for excuses as far as the time factor goes."
Miele agrees. People may look at the ability of the Obamas to fit in workouts, consider how much less stressful their life is in comparison to the leader of the free world and his wife, and conclude: "Maybe I could find the time, too."
Obama Exercise Program: No Role Model Is Perfect
Part of the Obama appeal, say the experts, may be that they are not perfect role models. The new president has been known to sneak a cigarette or two, a bad habit he says he will give up.
"He's got to get that cigarette out of his mouth," says Roberts.
He's been seen eating a cheeseburger or two, although his post-workout snack has been described as trail mix washed down by organic tea.
If Moloo were counseling Obama, she would suggest he eat plenty of antioxidant-rich foods to counteract the tobacco use.
As for the cheeseburgers? In moderation, they're fine, she says.
Hunger Control: Women the Weaker Sex?
From WebMD
Hunger Control: Women the Weaker Sex?
Women Less Able to Suppress Food Desire, Study Suggests
Reviewed by Louise Chang, MD
Jan. 20, 2009 -- Hungry women can't control their desire for food as well as hungry men can, a brain imaging study suggests.
The finding may explain why women are more prone to emotional eating and why women are less likely than men to lose weight while dieting.
"Women have a much stronger reaction to food, such that whether they try to inhibit their desire or not, they have stronger signal [in the part of the brain that controls hunger perception and desire to eat]," study leader Gene-Jack Wang, MD, tells WebMD.
Wang, chairman of the medical department of Brookhaven National Laboratory, Upton in N.Y., and colleagues have been using state-of-the-art brain imaging to learn which parts of the brain are involved in eating behaviors.
They have previously shown that obese people are less able than others to sense when their stomachs are full. Recently, they have looked at what happens in the brain when a hungry person gets to see, smell, and taste -- but not eat -- favorite foods.
In some of these studies, they saw very strong signals in parts of the brain involved in emotional regulation and motivation. But in other studies, the signals weren't so strong. Wang suspected this might be because of differences between how men and women react to food.
So they tested 13 women and 10 men with PET brain scans. To make sure they were hungry, study participants fasted for 18 hours before scanning. And to make sure they were tempted, the researchers made the participants' favorite foods: bacon/egg/cheese sandwiches, cinnamon buns, pizza, cheeseburgers, fried chicken, lasagna, barbecued ribs, ice cream, brownies, and chocolate cake.
During scanning, participants were able to see and smell the food. They even got tastes, applied to their tongues with a cotton swab. To make sure they stayed tempted, researchers brought them new hot food every four minutes.
But subjects didn't get to eat until the 30-minute scans were completed, and only after they completed a quiz on their feelings of hunger, desire for food, and alertness.
Before their second round of scans, participants were asked to practice ignoring the food or shifting their thoughts away from it. During this phase of scanning, they were asked "to inhibit their desire for food and suppress their feelings of hunger."
That worked pretty well for the men. Their brain scans showed much less hunger-related activity when they tried to suppress their desire for food.
That didn't happen for the women, at least not as a group. Although some women were better than some men at suppressing food desire, overall the women's brains showed just as much hunger-related activity when they tried to hold down their desire.
Are the findings plausible? WebMD asked Rexford S. Ahima, MD, PhD, director of the obesity center at the University of Pennsylvania's Institute for Diabetes, Obesity, and Metabolism. Ahima is an expert in the brain circuits responsible for feeding behavior and body weight regulation.
"More and more we see there is a structural basis for why we eat the way we do. Maybe our brains are hardwired to predetermine the way we eat," Ahima says. "The interesting thing about the Wang study is that when they present food to people and ask them to consciously inhibit the urge to eat, men are better able to do it than women."
Ahima notes that the study only shows men to be better at inhibiting their brains' response to food. But can men really resist emotional eating better than women can? That, he says, will have to be tested directly.
Sex Hormones May Affect Hunger
Why do men's and women's brains respond differently? Wang and Ahima suspect that female sex hormones play a major role.
"There is a link between female hormones tending to promote weight gain and overeating," Ahima says. "There are some women who tend to binge eat in synch with their menstrual cycles. And look at pregnancy -- it makes some women overeat, but some do not. So while there may be overall differences in terms of gender, this may differ for individuals."
Wang suggests that women may have evolved to seek food more avidly than men do.
"There could be evolutionary needs for that, because women have a very important mission: They have to carry the baby," Wang says. "And for most of human history, you could never get enough food to eat. Now that's no longer a problem in developed countries -- but now this brain circuit is a problem when we are surrounded by attractive, high-calorie foods."
The solution, Wang says, is for people who find themselves unable to control their eating to keep filling, low-calorie foods close at hand.
"Our lifestyle now is so much different from that of our grandparents," Wang says. "Our jobs and our living status is very stressful. So when we see food we eat it, because we want to do something to compensate for our problems. Inhibition control is very important -- but if you can't have it, surround yourself with nutritious foods."
Wang's study appears in the Jan. 15 early online edition of the Proceedings of the National Academy of Sciences.
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