Thursday, April 30, 2009

Obesity Surgery Complications on the Decline

WEDNESDAY, April 29 (HealthDay News) � Obesity surgery-related
complications in the United States declined 21 percent between 2001 and
2006, and payments to hospitals for obesity surgery decreased by as much
as 13 percent, partly because there were fewer patient readmissions due to
complications, a new study reports.


The findings from a study by the U.S. Agency for Healthcare Research
and Quality are based on an analysis of more than 9,500 patients under age
65 who had obesity surgery, also known as bariatric surgery, at 652
hospitals between 2001 and 2002 and between 2005 and 2006.


The researchers found that the complication rate among obesity surgery
patients dropped from 24 percent to about 15 percent. Contributing to that
decrease were declines in post-surgical infection rates (58 percent
lower), abdominal hernias, staple leakage, respiratory failure and
pneumonia (29 percent to 50 percent lower).


There was little change in rates of other complications such as ulcers,
dumping (involuntary vomiting or defecation), hemorrhage, wound
re-opening, deep-vein thrombosis and pulmonary embolism, heart attack and
stroke, the researchers noted.


Between 2001 and 2006, hospital payments for obesity surgery as a whole
fell from $29,563 to $27,905. Payments for patients who experienced
complications declined from $41,807 to $38,175, and from $80,001 to
$69,960 for those who had to be readmitted to hospital because of
complications, according to the study in the May issue of the journal
Medical Care.


Among the other findings:

Complications fell even though there were more older and sicker
patients having obesity surgery. During the study period, the proportion
of patients over age 50 having obesity surgery increased from 28 percent
to 44 percent, and the average number of underlying illnesses � such as
diabetes, high blood pressure and sleep apnea � in bariatric surgery
patients more than doubled.

The six-month post-surgical death rate remained at about 0.5 percent
during the study period.

Hospital readmissions due to complications fell from 10 percent to 7
percent, and complication-caused, same-day hospital outpatient visits fell
from 15 percent to 13 percent.


The researchers said three main factors are behind the decline in
complications and costs among obesity surgery patients: increased use of
laparoscopy, which allows surgeons to operate through small incisions;
increased use of banding procedures without gastric bypass, such as
vertical-banded gastroplasty and lap band; and increased surgeon
experience.

More information


The U.S. National Institute of Diabetes and Digestive and Kidney
Diseases has more about bariatric surgery.

Tuesday, April 28, 2009

Obesity becoming U.S. civil rights issue for some

NEW YORK (Reuters) -
Kate Harding has spent most of her life on one diet or another, losing weight but always gaining it back. Determined to improve her quality of life, she joined a fast-growing group of anti-dieting activists promoting overweight people's civil rights.

Launching an anti-dieting blog called Shapely Prose, Harding and other fat-acceptance advocates online � calling themselves the fat-o-sphere � are also educating one another about how to improve overweight people's health.

She and other bloggers with names like FatChicksRule and Big Liberty say society's "war on obesity" makes overweight people hate their bodies and suffer from low self-esteem.

"Being fat doesn't make me lazy or stupid or morally suspect," said Harding, 34, of Chicago, who also has written a book, "Lessons from the Fat-o-Sphere."

"The message we're promoting is health at every size."

Her blog entries criticize dieting obsessions and ponder coverage of weight issues in the mainstream media.

Since launching her blog, Harding, who says she is 5 foot 2 inches tall and about 195 pounds (88 kg), says her body image has improved. But she admits wearing a bathing suit in public "can still throw me for a bit of a loop."

Fat-acceptance advocates are starting to organize to promote anti-bias laws, encourage tolerance in health care and the workplace and help retailers recognize the profit potential of catering to plus-size customers.

"People are just beginning to think about being empowered," said Lynn McAfee, director of medical advocacy at the nonprofit Council on Size and Weight Discrimination.

"The emphasis has just been 'lose weight and everything will be fine,' and it's becoming really clear that people aren't losing weight," she said. "So we want to shift the emphasis to making us as healthy as we can be at whatever weight we are."

Activists say the movement is beginning to amass some victories, from larger seat belts in cars to a decision by the Supreme Court in Canada that obese and disabled people traveling on airplanes can't be forced to buy a second seat.

The Fox television network is developing a reality show featuring "average looking" people called "More to Love," billed as a "dating show for the rest of us."

The National Association for the Advancement of Fat Acceptance, a civil rights group formed in 1969, has found new life as fat-acceptance advocates gain force online.

There are now more than 50 fat-acceptance blogs and more than a dozen books promoting the idea, from Linda Bacon's "Health at Every Size" to Wendy Shanker's "The Fat Girl's Guide to Life." There are even romance novels featuring plus-sized characters with names like "Dangerous Curves Ahead."

But the dominant view remains that overweight people should be focused on losing weight.

Some two-thirds of Americans are considered overweight or obese. Cities across the country have declared wars on obesity, calling it a costly public health crisis that increases the risk of heart disease, type two diabetes and certain cancers.

Obesity-related health care cost upward of $100 billion a year, research shows.

PERVASIVE DISCRIMINATION


There are no U.S. laws prohibiting weight discrimination, and only one state, Michigan, has an anti-weight bias law. Legislatures in Massachusetts and Nevada have taken up size-bias bills, but similar efforts have failed in recent years.


Weight discrimination is pervasive, said Rebecca Puhl, director of research at Yale University's Rudd Center for Food Policy and Obesity.


An "obesity wage penalty" � larger employees getting paid less regardless of job performance � is widespread, and research shows overweight people are less likely to land a job or be promoted than a non-obese worker, she said.


"We do need to fight obesity, but not obese people," said Puhl. "Individuals ... who are discriminated against because of their weight are more likely to engage in unhealthy eating behaviors and avoidance of physical activity."


Anecdotal evidence also suggests overweight people avoid trips to the doctor out of fear of being mocked.


According to NAAFA, about 70 percent of overweight and obese women have experienced bias from doctors. Others complain of being turned down by health-insurance companies.


Bloggers in the fat-o-sphere track cases of discrimination they say go uncovered in the mainstream media.


Just recently, United Airlines, a unit of UAL Corp, said it will require obese passengers bumped from full flights to purchase two seats on a subsequent flight. That would match the policies of other carriers, including Continental, Delta, JetBlue and Southwest Airlines.


SEXY AT ANY SIZE


Deb Malkin, 39, considers herself a fat-acceptance advocate but leaves the political battles to others.


Instead, in what she describes as a labor of love, Malkin has opened ReDress, a plus-sized vintage clothing boutique in New York's Brooklyn borough.


Housed in an airy 3,000 square-foot (280 square meter) space, ReDress sells frilly dresses, formal gowns and jeans, all in size 14 and up.


One recent afternoon, shoppers carried armloads of clothing to spacious dressing rooms, while sales assistants compared the comfort of ReDress to the more typical shopping humiliations of plus-sized consumers.


"There's a whole indy fashion world that we don't have access to," said Malkin. "I think women just come in here and are so excited."


Bevin Branlandingham, who considers herself a fat activist, has worked in Malkin's store since it opened in November.


Sorting through lingerie, a frock from the 1960s and a colorful size 22 dress by Calvin Klein, Branlandingham said she likes to help women overcome hatred of their bodies.


Branlandingham, who is partial to dresses with plunging neck lines, says she discourages women from buying so-called goal outfits that are too small and instead pick out things that flatter their figures.


"I feel like my life's mission is to make the world safer for people to love themselves no matter what their differences," she said.

Thursday, April 23, 2009

Obesity May Hide Fetal Abnormalities on Ultrasounds

WEDNESDAY, April 22 (HealthDay News) � Overweight and obese
women are less likely to receive an accurate reading from ultrasound
screenings aimed at identifying fetal abnormalities, new research
reveals.


Such screenings also seem to be less effective among women who are
diabetic prior to their pregnancy.


"We were asking the question, 'Are birth defects less likely to be
detectable with prenatal ultrasound in women who are overweight or obese,
compared with women of normal body-mass index,'" explained study author
Dr. Jodi S. Dashe, who works in the department of obstetrics &
gynecology at the University of Texas Southwestern Medical Center in
Dallas.


After analyzing more than 10,000 standard ultrasound exams � the most
common exam for low-risk pregnancies � as well as more than 1,000
specialized ultrasound exams for high-risk pregnancies, Dashe found, "that
the detection of fetuses with major birth defects dropped significantly as
maternal body-mass index [BMI] increased: a difference of at least 20
percent when women of normal body-mass index were compared with obese
women."


The findings are to be published in the May issue of Obstetrics
& Gynecology.


To explore the degree to which ultrasound results are sensitive to BMI,
the study authors looked at a total of 12,200 ultrasounds previously
performed at the medical center between 2003 and 2007, among women
entering their 18th to 24th week of pregnancy.


The majority of both standard-risk and high-risk pregnant women were
Hispanic (about 87 percent), with about 10 percent participants being
black and 2 percent being white.


Stacking ultrasound results up against both the mother's BMI and infant
discharge records, the research team noted the 20 percent weight-linked
plunge in ultrasound effectiveness. That translated into a significant
rise in risk that a child would be born with a major birth defect despite
the fetus having appeared normal during an ultrasound.


For example, the specific risk for incorrectly receiving a "normal"
ultrasound reading rose from just one in every 250 women with normal BMI
to one among every 100 obese women.


Apart from the BMI effect, the authors also found that among cases
deemed to face a particularly high risk for fetal abnormalities prior to
undergoing a screening, ultrasound mistakes were more likely to occur
among women who had been diabetic prior to their pregnancy than among
women with other high-risk indications.


In fact, diabetic women were found to experience only a 38 percent
success rate in spotting fetal abnormalities via ultrasound, compared to
the 88 percent success rate experienced among women burdened with other
sorts of high-risk factors.


One expert said that patient obesity is only one of the challenges
obstetricians deal with when reading an ultrasound.


"It isn't that ultrasounds are unreliable, but that with some types of
patients it is certainly more difficult to visualize fetal anomalies,"
said Dr. Catherine Y. Spong, chief of the pregnancy and perinatology
branch of the Eunice Kennedy Shriver National Institute of Child Health
and Human Development in Bethesda, Md.


"When I'm doing an ultrasound I'm trying to get as much information as
I can about the baby," she explained. "And some people are easier to do an
ultrasound on than others. For example, if someone has a lot of scarring
inside the tissue is thicker, and that can make the imaging more
difficult. And if people are obese � including women with diabetes, who
are not uncommonly overweight � you're going to have to look through a
lot more tissue, and that makes it more difficult to image."


Dashe and her colleagues noted that American women with normal BMI now
constitute a minority of the country's pregnant population, so these
screening problems could have "broad implications."


"Based on our findings, we would suggest that counseling be modified to
reflect the limitations of ultrasound in women who are overweight or
obese," she said. The researchers also advise that more research be
conducted to examine the particular risk for screening problems observed
among diabetic women.


Spong agreed. "This difficulty presents itself while there has been a
dramatic increase across the U.S. in terms of obesity and morbid obesity
among reproductive-age women," she said. "So this study provides
physicians with some data on what the difficulty truly is."


More information

For more on ultrasounds during pregnancy, go to the March
of Dimes.

Tuesday, April 21, 2009

CORRECTED: Hospital label no guarantee of better weight surgery

(Corrects death rate in paragraph 8 to 0.17 from from 1.7 percent)

* Bariatric surgery "centers for excellence" not better

* Complication rates comparable with other hospitals

* Separate study looks at benefits for super obese

By Julie Steenhuysen

CHICAGO (Reuters) - Despite the fancy label, hospitals designated bariatric surgery "centers of excellence" have as many deaths and complications from the weight-loss procedure as others, U.S. researchers said on Monday.

The extra cost and effort required by hospitals to earn such a designation might not be worth it, they said.

"Designation as a bariatric surgery center of excellence does not ensure better outcomes," Dr. Edward Livingston of the University of Texas Southwestern School of Medicine, whose study appears in the Archives of Surgery, said in a statement.

Bariatric surgery is becoming an increasingly popular treatment for obesity. It works by altering the digestive tract to reduce the volume of food that can be eaten and digested.

A separate study in the same journal looked at the benefits of the surgery in severely obese patients.

Large insurance companies and Medicare, the federal health plan for 44 million elderly and disabled Americans, help pay for the surgery � which costs from $15,000 to $35,000 � in severely obese people. And many payers, including Medicare, require the procedures to be done at hospital designated as a bariatric center of excellence.

Livingston wanted to see if patients at these centers actually got better care. He analyzed 2005 data on 19,363 patients who had bariatric surgery, including 5,420 patients whose surgery was performed at a center of excellence.

He found that 0.17 percent of bariatric surgery patients treated at a center of excellence died and 6.3 percent developed complications. That compared with a death rate of 0.09 and a complication rate of 6.4 percent at hospitals without a center of excellence designation.

Because a "center of excellence" designation requires hospitals to hire extra staff, they are costlier to run, yet these "extra expenses associated with center of excellence designation may not be warranted," Livingston wrote.

A separate study in the same journal looked at the effects of gastric bypass surgery in two groups of severely obese patients: the morbidly obese � those with a body mass index of 40 to 49 � and the super obese � those with a body mass index of 50 or higher.

Body mass index, or BMI, is a formula that takes into account a person's height and weight. A BMI of 30 is considered obese, while a BMI of 25 to 30 is considered overweight.

Dr. Michel Suter of Hopital du Chablais in Lausanne, Switzerland, and colleagues studied 492 morbidly obese patients and 133 super obese patients treated with gastric bypass between 1999 and 2006.

They found that while the super obese patients lost more weight (37.3 percent of their body weight) than the morbidly obese patients (34.7 percent of their body weight), fewer than half of the super obese got down to being merely overweight six years after the surgery, compared with more than 90 percent of the morbidly obese patients.


Despite these differences, they said improvements in quality of life and other health measures were similar in both groups. Previous studies have found obese people who have weight-loss surgery are less likely to die from heart disease, diabetes and cancer than obese people who do not.


(Editing by Maggie Fox)

Hospital label no guarantee of better weight surgery

CHICAGO (Reuters) -
Despite the fancy label, hospitals designated bariatric surgery "centers of excellence" have as many deaths and complications from the weight-loss procedure as others, U.S. researchers said on Monday.

The extra cost and effort required by hospitals to earn such a designation might not be worth it, they said.

"Designation as a bariatric surgery center of excellence does not ensure better outcomes," Dr. Edward Livingston of the University of Texas Southwestern School of Medicine, whose study appears in the Archives of Surgery, said in a statement.

Bariatric surgery is becoming an increasingly popular treatment for obesity. It works by altering the digestive tract to reduce the volume of food that can be eaten and digested.

A separate study in the same journal looked at the benefits of the surgery in severely obese patients.

Large insurance companies and Medicare, the federal health plan for 44 million elderly and disabled Americans, help pay for the surgery � which costs from $15,000 to $35,000 � in severely obese people. And many payers, including Medicare, require the procedures to be done at hospital designated as a bariatric center of excellence.

Livingston wanted to see if patients at these centers actually got better care. He analyzed 2005 data on 19,363 patients who had bariatric surgery, including 5,420 patients whose surgery was performed at a center of excellence.

He found that 1.7 percent of bariatric surgery patients treated at a center of excellence died and 6.3 percent developed complications. That compared with a death rate of .09 and a complication rate of 6.4 percent at hospitals without a center of excellence designation.

Because a "center of excellence" designation requires hospitals to hire extra staff, they are costlier to run, yet these "extra expenses associated with center of excellence designation may not be warranted," Livingston wrote.

A separate study in the same journal looked at the effects of gastric bypass surgery in two groups of severely obese patients: the morbidly obese � those with a body mass index of 40 to 49 � and the super obese � those with a body mass index of 50 or higher.

Body mass index, or BMI, is a formula that takes into account a person's height and weight. A BMI of 30 is considered obese, while a BMI of 25 to 30 is considered overweight.

Dr. Michel Suter of Hopital du Chablais in Lausanne, Switzerland, and colleagues studied 492 morbidly obese patients and 133 super obese patients treated with gastric bypass between 1999 and 2006.

They found that while the super obese patients lost more weight (37.3 percent of their body weight) than the morbidly obese patients (34.7 percent of their body weight), fewer than half of the super obese got down to being merely overweight six years after the surgery, compared with more than 90 percent of the morbidly obese patients.

Despite these differences, they said improvements in quality of life and other health measures were similar in both groups. Previous studies have found obese people who have weight-loss surgery are less likely to die from heart disease, diabetes and cancer than obese people who do not.

(Editing by Maggie Fox)

Friday, April 17, 2009

Obese young adults risk disability later

NEW YORK (Reuters Health) -
People who are overweight or obese in young adulthood and middle-age are at elevated risk of being disabled in their later years, a new study suggests.

The study, of more than 2,800 U.S. adults in their 70s, found that those who were overweight or obese at any point in adulthood had an increased risk of developing problems with walking and climbing stairs.

What's more, the longer a person had been overweight, the greater his or her risk of mobility limitations, the researchers report in the American Journal of Epidemiology.

The findings underscore the importance of preventing excessive weight gain early in life, according to lead researcher Dr. Denise Houston, an assistant professor of gerontology at Wake Forest University School of Medicine in Winston-Salem, North Carolina.

"The data suggest that interventions to prevent overweight and obesity in young and middle-aged adults may be useful in preventing or delaying the onset of mobility limitations later in life," Houston said in a news release from the university.

Excess pounds can contribute to later-life disability by creating wear-and-tear in the joints or raising the risks of chronic health problems like heart disease and diabetes. People who become overweight at an early age, Houston and her colleagues note, may be habitually sedentary. That, in turn, leads to poorer fitness and weaker muscles, making them more vulnerable to disability later in life.

The findings are based on 2,845 adults in their 70s who were followed over seven years. At the outset, participants were asked to recall their weight at the ages of 25 and 50, and the researchers measured their current weight.

Overall, the study found, women who'd been overweight at all three time points were nearly three times more likely to develop a mobility limitation than their counterparts who'd been normal-weight throughout adulthood. Among men, the risk was increased by 61 percent.

The researchers also found that the risk of disability was elevated among participants who were normal-weight in their 70s but had been overweight earlier in life.

However, Houston explained, this may be because weight loss in older adults is often the result of poor health.

The findings are important, the researcher said, because the elderly population in the U.S. is growing � as is the obesity rate.

"Over the past couple of decades there has been a trend toward declining rates of physical disability in older adults," Houston said.

"However," she added, "the dramatic increase in overweight and obesity in the United States may reverse these declines and may lead to an increase in physical disability among future generations of older adults."

SOURCE: American Journal of Epidemiology, April 15, 2009.

Thursday, April 16, 2009

United Air to charge obese double on full flights

LOS ANGELES (Reuters) -
United Airlines, a unit of UAL Corp, will require obese passengers bumped from full flights to purchase two seats on a subsequent flight, matching the policy of some other carriers.

The change brings the Chicago-based in line with eight other airlines including Continental, Delta, JetBlue and Southwest, United spokeswoman Robin Urbanski said on Wednesday.

"Last year we had 700 complaints from passengers who had to share their seats," she said.

Under the new policy, obese passengers � defined as unable to lower the arm rest and buckle a seat belt with one extension belt � will still be reaccommodated, at no extra charge, to two empty seats if there is space available.

If, however, the airplane is full, they will be bumped from the flight and may have to purchase a second ticket, at the same price as the original fare, Urbanski said.

If the bumped passenger chooses to cancel the trip, the ticket will be refunded with no additional charge.

The policy is effective immediately.

(Reporting by Deena Beasley; Editing by Richard Chang)

Wednesday, April 15, 2009

Cut out soda to fight childhood obesity

NEW YORK (Reuters Health) -
Replacing sugar-laden drinks with water has a dramatic impact on the amount of calories kids consume and may help in the fight against childhood obesity, researchers report.

"The key observation is that when kids substitute sugar-sweetened beverages with water, there is a significant decline in total energy intake without any compensatory increase in the consumption of other beverages or food," Dr. Y. Claire Wang from Columbia Mailman School of Public Health in New York, told Reuters Health.

Since kids consume a large amount of these "empty calories" nowadays (10 to 15 percent of their daily intake), she added, substituting calorie-free beverages "is a simple and effective way of eliminating the excess calories while improving the diet quality."

Sugar-sweetened beverages "should be viewed as treats, not necessities, and water is a perfect substitute for the purpose of thirst-quenching," Wang said.

Wang and colleagues analyzed diet data from the 2003-2004 National Health and Nutrition Survey of 3098 children and adolescents aged 2 to 19 years.

They found that substituting sugar-sweetened beverages with water was associated with significant reductions in total calories consumed. Each 1 percent drop in sugar-sweetened drinks was associated with a 6.6 drop in calories consumed, and this reduction was not filled by increases in other food or beverages.

Wang and colleagues estimate that replacing all sugary drinks with water could cut out an average of 235 calories out of kids' diets each day.

Since the late 1970s, consumption of sugary drinks by children and adolescents has increased "substantially," and is thought to be "an important contributing factor to obesity," the researchers point out in the Archives of Pediatrics and Adolescent Medicine.

"Replacing these liquid calories with calorie-free beverage alternatives therefore represents a key strategy to eliminate excess calories and to prevent obesity in childhood," they conclude.

Friday, April 10, 2009

"Brown fat" may help adults lose weight

BOSTON (Reuters) -
A sparse form of fat that helps keep newborns warm is more common in adults than previously thought and that discovery that could lead to a new way to lose weight, researchers said on Wednesday.

Once activated by cold temperatures, so-called brown fat burns calories faster than regular fat. It is normally so dormant in adults that there has been debate over how much adults have or whether they have it at all.

In three studies in Thursday's New England Journal of Medicine, researchers report finding brown fat in most adults and discovering they can detect it by exposing people to cold. In some cases, adults who had more active areas of brown fat were thinner.

The hope is that if a way can be found to activate this brown fat and get the body to make more of it, people could burn off extra calories without additional exercise.

"Fifty grams of maximally activated brown fat accounts for 20 percent of your resting energy expenditure," Dr. Aaron Cypress of the Joslin Diabetes Center in Boston, who led one of the studies, said in an interview. "If you add that up, that's 400 or 500 calories per day.

"Practically speaking, we have a great potential to have a new treatment in our armamentarium against diabetes and obesity."

Dr. Kirsi Virtanen of the University of Turku in Finland and colleagues used positron emission tomography, known as PET scans, to find active brown fat deposits in five volunteers and also took little plugs of both types of fat. Brown fat became more active when the volunteers were cold, they reported.

"If the brown adipose tissue in this example were fully activated, it would burn an amount of energy equivalent to approximately 4.1 kg (9 pounds) of adipose tissue over the course of a year," researchers wrote.

OBESE PEOPLE HAVE LESS

A team at Maastricht University Medical Center in the Netherlands found obese men had less brown fat than lean men.

"Taken together, these studies point to a potential 'natural' intervention to stimulate energy expenditure: turn down the heat and burn calories (and reduce the carbon footprint in the process)," Dr. Francesco Celi of the National Institute of Diabetes and Digestive and Kidney Disease in Bethesda, Maryland wrote in a commentary.

But Celi cautioned that the vision may be oversimplified.

Cypress said scientists must first find a way to activate brown fat and, perhaps, even persuade the body to make more of it. In addition, the new studies did not directly test whether activating this fat would make people lose weight.

Celi said further research may reveal that even if brown fat is activated, the body may find a way to compensate by getting people to eat more.

"If you think about it, if you eat three donuts, you hit that calorie count right there," Cypress said.

"Using brown fat to treat obesity has been talked about for 30 or 40 years," he said. "But people essentially gave up on it. Many said it didn't exist in adult human beings and many said it didn't have any connection to obesity and weight at all. What these studies show is that virtually every adult human being has functional brown fat in them."

(Editing by Maggie Fox and Bill Trott)