2004 ASMBS Consensus Conference: Consensus statement Bariatric surgery for morbid obesity: Health implications for patients, health professionals, and third party payers

University of Minesota, Mineapolis, MN 55455, USA.
Surgery for Obesity and Related Diseases (Impact Factor: 4.07). 01/2005; 1(3):371-81. DOI: 10.1016/j.soard.2005.04.002
Source: PubMed
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    • "Despite overt evidence of its remarkable growing prevalence and its precedence to other metabolic diseases, with serious consequences on organs Contents lists available at ScienceDirect International Journal of Surgery and systems, it had yet been seen as a lifestyle problem. Obesity is set under the interaction of genetics and environmental influences [1] [2] and associates to main causes of mortality and disability around the globe [3]. Bariatric surgery has proved to be the most effective therapy available for weight loss in morbid obesity and provides additional benefits on improvement or complete resolution of comorbidities [4]. "
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    ABSTRACT: Purpose: Bone regulation system may be affected after bariatric surgeries, but procedures impact differently to bone mineral density (BMD) and measures restraining bone loss are frequently neglected until clinical consequences become manifest. This is a systematic review aimed to elucidate whether BMD loss is comparable after different bariatric surgeries. Materials and methods: A search of morbid obese adults, undergone to bariatric surgery, with BMD measured by dual-energy X-ray absorptiometry at baseline and after surgery studies was performed in several databases. Studies were assessed using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement and COCHRANE Risk of Bias tool. The random model was selected for meta-analysis; heterogeneity was analyzed with T(2), inconsistency (I(2) > 50%) and Chi(2) (p < 0.10). Level of evidence and strength of recommendations were summarized using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE System). Results: Twelve studies met the selection criteria. After one year, reduction in total BMD in patients with mixed surgical procedures was significant: -0.03 g/cm(2) (CI 95% 0.00 to -0.06, p < 0.05). BMD was reduced by -0.12 g/cm(2) (CI 95% -0.10 to -0.15, p < 0.001) in the hip, -0.07 g/cm(2) (CI 95% -0.03 to -0.11, p < 0.001) in the column, and -0.03 g/cm(2) (IC 95% -0.02 to -0.04, p < 0.001) in the forearm, but not in restrictive surgeries. Studies included showed high heterogeneity and low quality of evidence. Conclusions: Patients undergone to mixed bariatric surgery had significant higher BMD deterioration as demonstrated in this review, suggesting that more attention for preventing fractures is required.
    Full-text · Article · Sep 2014 · International Journal of Surgery
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    • "Obesity is especially prevalent in type 2 diabetes mellitus (T2 DM), a disease characterized by a relative reduction of insulin secretion from the β-cells despite hyperinsulinemia and the development of insulin resistance [1] [2]. As the prevalence of obesity has increased [3] [4] [5] [6], the number of people with T2 DM has increased in a parallel pattern. In 2005, 1.5 million new cases of T2 DM were reported in the United States [7], and the prevalence is projected to increase by 198%, from 16.2 million individuals in 2005 to 48.3 million in 2050 [8]. "
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    ABSTRACT: Background: Bariatric surgery is the most effective treatment for the reduction of weight and resolution of type 2 diabetes mellitus (T2 DM). The objective of this study was to longitudinally assess hormonal and tissue responses after RYGB. Methods: Eight patients (5 with T2 DM) were studied before and after RYGB. A standardized test meal (STM) was administered before and at 1, 3, 6, 9, 12, and 15 months. Separately, a 2-hour hyperinsulinemic-euglycemic clamp (E-clamp) and a 2-hour hyperglycemic clamp (H-clamp) were performed before and at 1, 3, 6, and 12 months. Glucagon-like peptide-1 (GLP-1) was infused during the last hour of the H-clamp. Body composition was assessed with DXA methodology. Results: Enrollment body mass index was 49±3 kg/m(2) (X±SE). STM glucose and insulin responses were normalized by 3 and 6 months. GLP-1 level increased dramatically at 1, 3, and 6 months, normalizing by 12 and 15 months. Insulin sensitivity (M of E-clamp) increased progressively at 3-12 months as fat mass decreased. The insulin response to glucose alone fell progressively over 12 months but the glucose clearance/metabolism (M of H-clamp) did not change significantly until 12 months. In response to GLP-1 infusion, insulin levels fell progressively throughout the 12 months. Conclusion: The early hypersecretion of GLP-1 leads to hyperinsulinemia and early normalization of glucose levels. The GLP-1 response normalizes within 1 year after surgery. Enhanced peripheral tissue sensitivity to insulin starts at 3 months and is associated with fat mass loss. β-cell sensitivity improves at 12 months and after the loss of ≈33% of excess weight. There is a tightly controlled feedback loop between peripheral tissue sensitivity and β-cell and L-cell (GLP-1) responses.
    Full-text · Article · Aug 2014 · Surgery for Obesity and Related Diseases
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    • "It is international consensus that bariatric surgery is the final option when all other attempts at weight loss have failed (Buchwald, 2005), and it is the most rapidly growing treatment for severe obesity. In Norway, the number of bariatric surgery procedures is increasing: 1900 in 2008 (Kristinsson, 2008), and 2000 in 2010 (Hofsøe et al., 2011). "
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    ABSTRACT: This study is grounded in a phenomenological lifeworld perspective. It aims at providing rich descriptions of lived experience of the process of losing weight after obesity surgery. Two women participated in in-depth interviews four times each during the first postoperative year. Based on the women's experiences, a meaning structure-the ambivalence of losing weight after obesity surgery-was identified across the women's processes of change. This consisted of five core themes: movement and activity-freedom but new demands and old restraints; eating habits and digestion-the complexity of change; appearance-smaller, but looser; social relations-stability and change; and being oneself-vulnerability and self-assurance. These core themes changed over time in terms of dominance. The experience of ambivalence is discussed according to a phenomenological perspective of the body as lived experience.
    Full-text · Article · Jan 2014 · International Journal of Qualitative Studies on Health and Well-Being
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