Many Overweight Kids Not Getting a Good Night's Sleep

WEDNESDAY, June 3 (HealthDay News) � Children with chubby
bellies are more likely to have sleep-disordered breathing, a condition
that's associated with behavioral problems, hyperactivity and difficulty
staying awake at school, new research shows.

In the study, researchers examined 700 children between the ages of 5
and 12 randomly chosen from 18 public elementary schools in Pennsylvania.
Each child had a physical exam and was monitored for nine hours at a sleep
laboratory using polysomnography, which measures brain electrical
activity, heart activity, airflow, respiration and oxygen saturation
during sleep.

About 25 percent of children had mild sleep-disordered breathing and
1.2 percent had moderate sleep-disordered breathing, defined as five or
more breathing pauses per hour. More than 15 percent had primary snoring,
the researchers found.

Those with sleep-disordered breathing tended to have a larger body-mass
index and a higher waist circumference relative to their peers. Unlike in
adults, a large neck circumference was not a predictor of sleep-disordered
breathing in children, the study authors note in their report in the June
issue of SLEEP.

Until recently, enlarged tonsils or adenoids were believed to cause
most sleep-disordered breathing in children, but the study found no link
between tonsil size and disordered breathing, according to a news release
from the American Academy of Sleep Medicine (AASM).

Instead, obesity may be playing the greater role, said study author
Edward O. Bixler, of Penn State University College of Medicine.

"Risk factors for sleep-disordered breathing in children are complex
and include metabolic, inflammatory and anatomic factors," Bixler said in
the news release. "Because sleep-disordered breathing in children is not
just the outcome of anatomical abnormalities, treatment strategies should
consider alternative options, such as weight loss and correction of nasal
problems."

Sleep-disordered breathing can range from mild to severe, according to
information from the AASM. Mild cases might be marked by persistent
snoring due to nasal anatomic features such as chronic sinusitis, rhinitis
and nasal drain. Severe cases may include obstructive sleep apnea, a
potentially dangerous condition in which breathing repeatedly starts and
stops throughout the night. Each pause typically lasts from 10 to 20
seconds and can occur 20 to 30 times per hour.

While children tend to have milder forms of sleep-disordered breathing
than adults, they can suffer from obstructive sleep apnea.

Older children were more likely to have moderately disordered
breathing. Two percent of children between the ages of 9 and 12 years had
moderate sleep-disordered breathing, compared with only 0.2 percent of
children between 5 and 8, the news release notes.

Obstructive sleep apnea occurs when soft tissue in the back of the
throat collapses and blocks the airway during sleep. In children, loud
snoring, obvious pauses in breathing and gasping for breath are warning
signs. Parents often notice that the child seems to be working hard to
breathe during sleep, according to the AASM.

More information

Find out more about obstructive sleep apnea and sleep breathing
disorders in children at the American Academy of Sleep Medicine.

Weight-Loss Surgery Options Compared in Super-Obese

TUESDAY, June 2 (HealthDay News) � A technique called duodenal
switch surgery may be more effective than gastric bypass surgery for
patients with obesity-related medical problems such as high cholesterol,
diabetes and high blood pressure, according to a U.S. study that included
350 super-obese patients who were more than 200 pounds heavier than their
ideal body weight.

The findings were presented Monday at Digestive Disease Week 2009 in
Chicago.

In gastric bypass surgery, surgeons create a small gastric pouch that's
separate from the rest of the stomach, but with duodenal switch surgery,
the stomach is reshaped into a long narrow tube and the small intestine is
reconfigured to reduce calorie absorption, according to a Digestive
Disease Week news release.

In their new study, Dr. Vivek N. Prachand, an assistant professor of
surgery at the University of Chicago, and colleagues looked at the rates
of resolution of obesity-related diseases (whether patients were able to
stop taking medications to treat their conditions) three years after
either duodenal switch or gastric bypass surgery.

The rates of resolution for duodenal switch and gastric bypass were:
diabetes, 100 percent vs. 60 percent; high blood pressure, 68 percent vs.
38.6 percent; high cholesterol, 72 percent vs. 26 percent; acid reflux;
48.5 percent vs. 76.9 percent, the study authors found.

In previous research, Prachand's team showed that super-obese patients
who underwent duodenal switch surgery had better weight loss than those
who had gastric bypass surgery. They believed that the greater weight loss
among duodenal switch patients may explain why they had higher rates of
resolution of obesity-related diseases. But this new study didn't find a
link between amount of weight loss and resolution of obesity-related
conditions, which suggests that other mechanisms besides weight loss may
be at work.

The researchers also noted that reduced absorption of calories in
duodenal switch surgery patients can lead to vitamin/nutrition
deficiencies and, possibly, malnutrition.

"The effort to better manage the potential vitamin and nutritional
deficiencies associated with duodenal switch surgery is worthwhile because
it appears that the duodenal switch surgery is more successful in terms of
weight loss and resolution of significant obesity-related disease for
super-obese patients," Prachand said in the news release.

More information

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

Australia mulls public funds for obesity surgery

SYDNEY (AFP) -
An Australian parliamentary committee has recommended boosting public funding for obesity surgery to tackle a growing problem which has left nearly two-thirds of the country overweight.

The committee said operations such as lap band surgery � a reversible procedure to reduce the stomach's capacity � should be made more widely available to help people with extreme cases of weight gain.

"It's hard to access and we know that there is immediate improvement in obesity when surgery is performed," committee chair Labor MP Steve Georganas said, according to ABC News.

"We're not saying that this is for everyone � this is only for people who are morbidly obese."

The recommendation was among 20 made by the House of Representatives Health Committee. Georganas said obesity cost the economy eight billion Australian dollars (6.48 billion US) last year.

Better food labelling and public health campaigns were also suggested as ways to trim the Australian waistline.

Official figures last month showed one-quarter of Australians are obese with another 37 percent classified as overweight.

International studies consistently rank Australia among the fattest countries in the world, with the nation's Baker Heart Institute in 2008 suggesting it faced a "fat bomb" outranking even that of the United States.

With weight-loss surgery, type of insurance counts

CHICAGO (Reuters) -
People with private health insurance lose more weight after having weight-loss surgery than those covered by the Medicare health insurance program for the elderly and disabled, U.S. researchers said Monday.

Medicare patients tend to weigh more before having gastric bypass surgery, they said, and are more likely to be depressed, have high blood pressure, heart disease, diabetes, cholesterol and sleep apnea.

For them to succeed, they may need extra exercise and nutrition support, they said.

"Gastric bypass surgery is very successful so we should work to ensure that everyone has the same chance at success," said Dr. John Morton of Stanford University School of Medicine in California, who presented his findings at the Digestive Disease Week meeting in Chicago.

Gastric bypass 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.

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.

For the study, Morton and colleagues collected data on 750 gastric bypass patients with private insurance, Medicare or Medicaid, a state-federal insurance program for the poor.

A year after surgery, all patients had significant weight loss, but the private insurance patients lost more, Morton said in a telephone briefing.

"The Medicare group lost 57 percent of its excess weight, but in comparison with the private insurance group, this was much less, with the private insurance group losing about 82 percent of their extra weight," he said.

The Medicare group had slightly higher complication rates, but there were no deaths from any of the operations.

Morton said patients in the Medicare group had the biggest reductions in levels of low-density lipoprotein, or LDL, the so-called bad cholesterol that causes heart disease.

They also had bigger improvements in fasting insulin, a measure of diabetes severity.

Morton said patients in the Medicare group started out much heavier than other patients, with average body mass index scores of nearly 50, putting them in the so-called super-obese category.

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. People with a BMI of 40 to 49 are considered morbidly obese, while those with a BMI of 50 or higher are considered super obese.

Morton said the study shows that some Medicare patients are starting with more profound disadvantages, and may need more support.

He said morbid obesity is the leading public health crisis in the United States, and bariatric surgery is the only effective treatment for many patients.

(Editing by Maggie Fox)