Post-op malnutrition

The following is an extract from an article in the Bariatric News. We would like to start a Facebook discussion on this topic. The outcome of this discussion is to provide more local vitamin and mineral supplement options to our patients and readers. Please feel free to read and share your opinions and experiences. We encourage you to consult with either Dr Gert du Toit or Dr Ivor Funnell on what supplements are best suited to you and your individual bariatric journies, given the fact that each patient profile is different.

Post-op malnutrition

Vitamin and mineral deficiencies after LSG: A huge challenge

There are several known nutritional deficiencies following bariatric surgery, but the type of deficiency depends on the type of surgery
By identifying patient’s nutritional deficiencies earlier, they are given an opportunity to reduce their deficiencies prior to surgery when their GI tract can absorb multivitamin supplements

Despite the many benefits of bariatric surgery, one of the long-term complications remains underreported and in some cases more worryingly, untreated. Vitamin and mineral deficiencies are one of most common complication after bariatric surgery. These shortages in essential micronutrients can lead to anaemia, hair loss and osteoporosis, as well as profound consequences reducing a patient’s quality of life, and in more severe cases, life expectancy. Although guidelines exist on nutritional deficiencies1, there is still a lack of awareness and education in both patients and doctors. In fact, research has shown that 57% of patients are micronutrient deficient within the first year of surgery.2

Bariatric News spoke with Dr. Edo Aarts, Surgical Resident and Head Bariatric Research, Rijnstate Hospital and Vitalys Clinic in Arnhem, the Netherlands, about vitamin and mineral deficiencies after bariatric surgery and specifically laparoscopic sleeve gastrectomy, and why all healthcare professional involved in bariatric surgery need to be educated about the importance of pre- and post-surgical evaluation of nutritional deficiencies.

Most post-surgical after care is done by surgeons, but post-nutritional care has only come to the forefront in the last ten years. Previously, patients were unlikely to receive post-operative care nutritional deficiency advice, despite the fact that nutritional problems are common and can continue for the duration of a patients’ lifetime after surgery. According to Dr. Aarts, this is why it is very important patients receive lifelong nutritional deficiency assessments.

There are several known nutritional deficiencies following bariatric surgery, but the type of deficiency depends on whether a patient has undergone restrictive surgery, such as the gastric sleeve, or restrictive and malabsorptive procedures such as the biliopancreatic diversion and gastric bypass procedures.

Sleeve gastrectomy

It has long been thought that deficiencies mostly occurred in procedures with a malabsorptive component, like the rouxen-y gastric bypass or the biliopancreatic diversion, only. The risk for developing deficiencies after non-bypass bariatric surgery like the sleeve gastrectomy was considered low and patients were often not even tested for deficiencies.3 However, research shows that in the restrictive types of surgery deficiencies occur almost as much.3,4

Dr. Edo Aarts

“We know that the malabsorptive component of the gastric bypass leads to deficiencies in micronutrients such as iron and vitamin B12. In addition, after a gastric bypass the ‘carrier’ intrinsic factor – which is need for the absorption of vitamin B12 – is no longer released, so there is only passive absorption,” said Dr. Aarts. “After a sleeve gastrectomy, there is usually less intake so a patient cannot eat sufficient amounts of food to obtain the adequate levels of nutrients and minerals, and patients do not have sufficient amounts of gastric acid in the stomach to convert the iron in the food into their digestive system. So even though a patient consumes ample amounts of iron it will not be absorbed and transferred from iron 3+ into iron 2+ sufficiently.”

Research by Capoccia et al. showed that following laparoscopic sleeve gastrectomy a significant proportion of patients developed vitamin B12 and folate deficiency.4 Even though Capoccia did not report any iron deficiency in this patient group, Dr. Aarts and colleagues did report an iron deficiency in 43% of the patients who had received the same procedure. In addition, anaemia was seen in 26% of patients and significantly low B12, folate, iron and vitamin D levels in this group of sleeve gastrectomy patients.3

“There is no doubt that in practice the levels of nutritional deficiencies after sleeve gastrectomy are higher than those reported in the literature. There is an urgent need to increase awareness of this problem by reporting the actual levels of nutritional deficiencies in the published literature,” said Dr. Aarts. “In our series, 28% of patients were anaemic, but the literature states only a few percent of anaemia cases per year. This is incorrect, nutritional deficiency rates after sleeve gastrectomy are grossly underreported. The sleeve gastrectomy is the number one operation in the world at the moment and the most common complications at the moment are due to deficiencies as a result of the procedure. Some patients who have undergone a sleeve gastrectomy are told they do not need supplementation, this is 100% untrue.”

 “There are a lot of things we do not know about nutritional deficiencies after bariatric surgery, and especially the sleeve gastrectomy, so more research needs to be carried out before we can say that the guidelines are sufficient.”

Overall, he said there are two primary causes of nutritional deficiency following bariatric surgery: 1) a lack of food intake and 2) changes to the gastrointestinal tract due to the surgery. The latter results in the difficulty of the absorption of food nutrients into the bloodstream of the patient’s body.

However, following weight loss surgery many patients suffer from nutritional deficiencies, while others do not have this problem. According to Dr. Aarts, there are a number of factors explaining this phenomenon, but in general it is not due to different alterations of the gastro intestinal (GI) tract that restricts the patient’s ability to absorb vitamins and minerals, but rather the patient’s lifestyles and their eating habits after surgery.

For example, those patients who have a diverse diet (fruit, vegetables, cereal, bread etc.) following surgery do have better nutritional intake compared to those patients who have a limited and unbalanced diet. Following surgery, some morbidly obese patients will lose weight, because they are restricted in the amount of food they can eat, however they are not consuming the most healthy types and/or the best variety of foods. As a result, they are not providing their bodies with the (adequate amounts of) essential nutrients required to stay healthy – resulting in the deficiencies seen in many of our patients.

“If you combine a poor diet with a reduction in the malabsorptive capabilities of the GI tract, following surgery, this compounds a patient’s nutritional deficiencies. This combination is why many patients present with nutritional deficiencies within the first year of surgery,” he explained.

He added that there is also a difference between male and female patients – premenopausal female patients do not have the same iron reserves of their male counterparts because many of the female patients are still fertile and lose iron due to their menstrual cycle.

“This is the same as in the general population, but of course this lack of iron is exacerbated after bariatric surgery,” he added.

In his experience, the most common deficiencies are iron, vitamin B12, folic acid and vitamin D. Vitamin D is particularly important for bone density, but this deficiency goes unnoticed by patients as it takes years before it becomes a real problem. For example, osteoporosis is now a significant problem among those bariatric patients who have undergone surgery 15-20 years ago, Dr. Aarts explained.

Pre-operative assessment

By performing pre-operative nutritional assessments at his centre, Dr. Aarts and colleagues have reported that one in four obese patients have nutritional deficiencies and are malnourished due to a lack of diversity in their diet. Furthermore, because these patients rarely leave their house, many present with vitamin D deficiency.

“We must keep in mind that it is much easier to provide multivitamin supplements before surgery, because the GI tract has not been altered, for this reason it is imperative that patients have pre-operative testing to identify which nutritional deficiencies they have, so they can be treated pre-operatively.”

He added that it is much more difficult to supplement patients after surgery. Therefore, by identifying their nutritional deficiencies earlier, patients are given an opportunity to reduce their deficiencies prior to surgery when their GI tract can absorb multivitamin supplements well yet.

“We know that testing for nutritional deficiencies prior to surgery and prescribing supplements before surgery give patients the opportunity to build up the vitamin and mineral levels in the body, which results in a reduction in post-operative complaints such as fatigue. The evidence shows that patients are far less likely to suffer from short- and long-term nutritional deficiencies when provided with adequate pre-operative nutritional supplements.”

For over ten years, Dr. Aarts has been researching vitamin and nutritional deficiencies in bariatric surgical patients. He soon noticed that a large amount of time and expense was spent on nutritional supplements for patients after bariatric surgery. As a result, he has started to develop different multivitamins for gastric bypass patients. In 2008, he started working with the Dutch company, FitForMe (Rotterdam, The Netherlands).

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Delaying bariatric surgery may result in poorer outcomes

Obese patients who underwent bariatric surgery were more like to achieve a BMI of <30 one year after surgery if they had a BMI<40 before surgery, according to a study published by JAMA Surgery. The study authors from University of Michigan Health Systems, Ann Arbor, Wayne State University and Henry Ford Health System, Detroit, Michigan, report that significant predictors for success included a preoperative BMI<40 and undergoing a metabolic procedure such as sleeve gastrectomy, gastric bypass, or duodenal switch.

It is estimated that more than 34 percent of adults in the US are classified as obese, with a BMI>30 or greater. Achieving a BMI of less than 30 is an important goal of bariatric surgery, given the increased risk for weight-related health conditions and death with a BMI above this level.

“Policies and practice patterns that delay bariatric surgery until the BMI is 50 or greater can result in significantly inferior outcomes.”

Dr Oliver A Varban, from the University of Michigan Health Systems, Ann Arbor and colleagues conducted a study to identify predictors for achieving a BMI<30 one year after bariatric surgery. The researchers examined data for a total of 27,320 adults who underwent bariatric surgery in Michigan between June 2006 and May 2015. They used logistic regression to identify the predictors, as well as 30-day postoperative complications and one-year self-reported comorbidity remission.


They found that 9,713 patients (36%; mean [SD] age, 46.9 [11.3] years; 16.6% male) achieved a BMI<30 at one year after bariatric surgery and a significant predictor for achieving this goal was a preoperative BMI<40 (odds ratio [OR], 12.88; 95% CI, 11.71-14.16; p<0.001). In addition, patients who had a sleeve gastrectomy, gastric bypass or duodenal switch were more likely to achieve a BMI<30 compared with those who underwent adjustable gastric banding (OR, 8.37 [95% CI, 7.44-9.43]; OR, 21.43 [95% CI, 18.98-24.19]; and OR, 82.93 [95% CI, 59.78-115.03], respectively; p<0.001).

Interestingly, only 8.5 percent of patients with a BMI>50 achieved a BMI>30 after bariatric surgery. Patients who achieved a BMI<30 had significantly higher reported rates of medication discontinuation for high cholesterol, diabetes, and high blood pressure, as well as a significantly higher rate of sleep apnoea remission, compared with patients who did not (all p<0.001).

The authors acknowledged that a limitation of their study was that the bariatric procedures were performed in a single state.

“Patients should be counselled appropriately with respect to weight loss expectations after bariatric surgery. Furthermore, policies and practice patterns that delay or incentivize patients to pursue bariatric surgery only once the BMI is highly elevated can result in inferior outcomes,” the authors conclude. “Patients with a preoperative BMI of less than 40 are more likely to achieve a BMI of less than 30 after bariatric surgery and are more likely to experience comorbidity remission. Policies and practice patterns that delay bariatric surgery until the BMI is 50 or greater can result in significantly inferior outcomes.”

Diagnosing obesity by mathematically estimating fat

Researchers from ETH Zurich, Switzerland and Yonsei University in Seoul, South Korea, have proposed a new technique to evaluate abdominal obesity by estimating the thickness of subcutaneous fat using electrical impedance tomography (EIT). The paper, ‘Mathematical Framework for Abdominal Electrical Impedance Tomography to Assess Fatness’, was published in the SIAM Journal on Imaging Sciences.

“Recent studies have shown that abdominal obesity is linked with diseases such as congestive heart failure and metabolic syndrome,” said author Jin Keun Seo. “Static electrical impedance tomography, or EIT, could be employed as a non-invasive surrogate of disease progression in these conditions.”

In addition to being noninvasive, EIT provides real-time data without using ionising radiation, which makes it preferable to computed tomography (CT) since it’s less harmful to patients. Another imaging technique commonly used for this purpose, magnetic resonance imaging (MRI) has poorer spatial resolution than EIT.

“Compared to CT, EIT is more advantageous since it is non-ionizing and can hence be used for continuous patient self-monitoring to track body fat status in daily routines,” explained Seo. “Unlike CT and MRI, EIT is a low cost, portable, and easy-to-use bedside technique to image electrical conductivity distribution.”

Since electrical conductivity of biological tissue depends on its cell structure, it can help image different tissues in the body and distinguish them from each other. The cell structure of fat and muscle are quite different; hence, the electrical conductivity values of fat and muscle differ over different frequencies.

This is a simplified abdomen image from CT with 16 electrodes. Red colour represents subcutaneous fat region, blue represents muscle region, white represent bone region, pink represents visceral region, and green represents abdominal organs (Credit: SIAM)

Multi-frequency EIT (MFEIT) reconstructs the image of conductivity inside the human body based on this dependence of tissue conductivity on frequency. And since bone, muscle, and fat conduct electricity differently over various frequencies, MFEIT can use data of the boundary current-voltage relationship at diverse frequencies to estimate the amount of fat. Again, since body fat is less conductive than water and tissues such as muscle, this difference can be used to estimate the thickness of visceral and subcutaneous adipose tissue.

The specific process involves a specially chosen current pattern, which generates a depth-dependent data set that is used to outline the borders between fat and muscle. Current is injected through one pair of electrodes, and the subsequent voltage drop measured at another pair of electrodes. The relation between the injected current and the voltage drop gives the transadmittance – or the ratio of current to voltage, which depends on the positions of the two pairs of electrodes, body geometry, and admittivity distribution, which combines both conductivity and permittivity.

Assuming that the size of the electrodes is very small in comparison to the size of the border between the various tissue regions, the authors use a point electrode model, which provides a good approximation of the solution, while also simplifying the model considerably.

One issue with EIT is that the technique is prone to forward-modelling errors; these errors often include boundary geometry and electrode position uncertainties. In this paper, authors propose a new reconstruction method that compensates for this pitfall of EIT, using prior anatomical information at the expense of spatial resolution, and improving reproducibility. Numerical simulations demonstrate that the result of reconstruction is satisfactory in identifying subcutaneous fat.

“Existing approaches for static conductivity imaging are based on minimizing the difference between the voltage measured and that obtained from numerical simulations,” explained Seo. “Therefore, obtaining reliable conductivity distributions requires both accurate modelling of the domain and the electrode configuration. This new method can obtain accurate imaging distribution by cancelling out modelling errors.”

Further research is needed to take advantage of the frequency dependent behavior of human tissue to estimate the distribution of visceral fat. “Current experimental work has shown promising results in detecting subcutaneous fat thickness as confirmed with ultrasound imaging,” said Seo. “Future work is needed to determine the volume of visceral fat in patients with metabolic and cardiovascular disorders.”

Abnormally high deposition of fat tissue in the abdominal area has been associated with disorders such as metabolic syndrome, cardiovascular disease, and malignancies. Quantitative assessment of visceral fat in the abdominal region using techniques such as the one described above can thus aid in evaluating the potential risk of developing such conditions.


Gut microbes RYGB dramatically alters gut microbes compared to LAGB

A study comparing Roux-en-Y gastric bypass (RYGB) and laparoscopic adjustable gastric banding (LAGB) has reported that bypass produces profound changes in the composition of microbial communities in the gut, with the resulting gut flora distinct from both obese and normal weight patients. The results are likely due to the dramatic re-organisation of the gut caused by RYGB surgery, which increases microbial diversity. The research could highlight new diagnostics and therapies for obesity.

In the study, ‘Distinctive microbiomes and metabolites linked with weight loss after gastric bypass, but not gastric banding ’, published in the  journal International Society for Microbial Ecology (ISME), Drs Zehra Esra Ilhan and Rosa Krajmalnik Brown, and their colleagues at the Biodesign Institute at Arizona State University (ASU), along with researchers from Mayo Clinic, and Pacific Northwest National Laboratory, explored microbial communities in the human gut following RYBG and LAGB surgeries.

“Another positive outcome would be if we can find a microbial biomarker that will identify the best candidates for surgery and sustained weight loss.”

“This is one of the first studies to show that anatomically different surgeries with different success rates have different microbiome and microbiome-related outcomes,” said Ilhan, lead author of the new paper. The results also indicate that correction of obesity tends to improve related metabolic conditions, including diabetes and high cholesterol.

The results confirmed their earlier research with a smaller sample size, showing that in the case of the more aggressive RYGB surgery, microbial communities underwent a profound and permanent shift following weight loss. The resulting post-surgical composition of gut microbes observed for RYGB patients was distinct from both normal weight and obese patients, and displayed the high microbial diversity associated with a healthy gut.

The current study also applied the technique of nuclear magnetic resonance (NMR) to examine the metabolome, a composite of the metabolites produced by the various microbes in the gut. The outcomes showed significant alterations as a result of the RYGB procedure. In the case of the alternate treatment, LAGB, changes in the gut microbiota were mild and accompanying weight loss was less pronounced.

The four images indicate the degree of microbial diversity in the gut in normal patients as well as in obese patients before and after undergoing two types of weight-loss surgery. The normal human gut has a high degree of microbial diversity, considered important for the maintenance of health. Obese patients have lost much of this diversity and while laparascopic band surgery effectively leads to weight loss, the low microbial diversity condition remains. By contrast, gastric bypass surgery results in the restoration of microbial diversity in the gut, though the composition of microbes is distinct from both normal weight and obese patients (Credit: Jason Drees for the Biodesign Institute)

“One of the key findings of the paper confirms what we had already observed in earlier research. RYGP gastric bypass had a huge effect on the microbial community structure,” said Krajmalnik Brown. This fact may have profound implications for both the understanding and management of obesity.

The millions of bacterial microbes in the human gut perform a vast range of critical functions in the body and have even been implicated in mood and behavior. Among their critical responsibilities are the micro-management of nutrients in the food we digest, hence their central place in the regulation of body weight.

Krajmalnik-Brown explained that diversity of gut microbes is essential to good health.  Low microbial diversity in the gut is associated not only with obesity but a range of ailments including inflammatory bowel disease, ulcerative colitis and autism.

The study sought to explore long-term changes in the gut in patients who had undergone either of the two surgeries at least nine months prior, comparing them with normal weight and pre-bariatric obese patients. While the reasons for the sharp disparity of results between RYGB and gastric banding are not entirely clear, the results indicate that simply reducing the size of the stomach through gastric banding is not sufficient to induce the large changes in microbial communities observed for the RYGB group.

One hypothesis the authors put forward is that RYGB alters the physiology of the gut to such a degree that microbes formerly unable to survive conditions in the obese gut are able to flourish in their surgically-modified surroundings.

“One of the things we observe from the literature is that the oral microbiome community composition is very similar to the colon microbiome composition after bariatric surgery,” said Ilhan. “You’re giving new microbes a chance to make it. Most of the species are acid sensitive, which supports the idea that changes in stomach pH levels may permit these microbes to survive and make it to the colon.”

While it seems clear that RYGB surgery produced permanent changes in bacterial communities in the gut, the resulting microbial community may also act to help maintain weight loss over the long term. Experiments have shown that transplantation of beneficial microbes from mice that have undergone RYGB surgery into obese mice induces dramatic weight loss. While these results have yet to be replicated in humans, the findings open the door to the eventual use of healthy microbial communities to treat obesity.

“These new data on microbial community structure and function significantly expand our knowledge on how the microbiome is associated with weight loss following bariatric surgery,” said Dr John DiBaise, a gastroenterologist at Mayo Clinic, Scottsdale and co-author of the new study.

Although the RYGB surgery has been quite successful for many patients suffering from morbid obesity, for some patients surgery is not successful and they regain the weight they have lost post-surgery, perhaps because they lack the favourable microbes necessary for permanent weight loss.

“A probiotic that would replace surgery would be great,” concluded Ilhan. “Another positive outcome would be if we can find a microbial biomarker that will identify the best candidates for surgery and sustained weight loss.”

EndoBreak: Meet ‘Glucoracle’; Mental Health & Bariatric Surgery

News and commentary from the endocrinology world

A new app — Glucoracle — may help people with type 2 diabetes to manage glucose levels. “Our algorithm, integrated into an easy-to-use app, predicts the consequences of eating a specific meal before the food is eaten, allowing individuals to make better nutritional choices during mealtime,” said lead author David Albers, PhD, of Columbia University Medical Center in a press release. (PLoS Computational Biology)

The American Diabetes Association announced their 2017 National Scientific and Health Care Achievement Award recipients this week, recognizing Gregory Steinberg, PhD, of McMaster University, Daryl Granner, MD, of University of Iowa, William Tamborlane, MD, of Yale University, among others. All recipients will be recognized at the ADA’s annual meeting in San Diego this June.

Pre-existing mental health conditions were deemed to have no significant effects on outcomes following bariatric surgery, according to a new study. “Many clinicians are hesitant to consider bariatric surgery in the mentally ill population due to the assumption that they will not fare well. This research counters those assumptions, showing no difference, on average, in weight loss in the mentally ill versus non-mentally ill population,” said Scott Kahan, MD, spokesperson for The Obesity Society, in a press release.

A third paper was recently retracted by Carl Ronald Kahn, MD, chief academic officer at Joslin Diabetes Center. The paper, published in Journal of Biological Chemistry in 2003, was pulled due to omission of some data resulting in “splicing of the figures of several autoradiograms, which led to several duplicated or mislabeled lanes in the Western blots” appearing in the final paper. (Retraction Watch)

Home routines during early childhood, including structured bedtimes, mealtimes, and limited screen time, were linked to lower rates of obesity later in life, researchers reported. It is hypothesized that behavioral structure improves emotional self-regulation, preventing weight gain by mid-childhood. (International Journal of Obesity)

An $11.2-million NIH grant was recently awarded to the University of Kentucky for research into the relationship between metabolism and cancer. Kentucky currently has one of the highest rates of obesity in the U.S., as well as a relatively high prevalence of both metabolic disorders and cancer. (Newswise)

A newly published cross-sectional study reported that low-SES young adults in Japan — including school dropouts and those with irregular or no employment or on public assistance — are at a significantly greater risk of diabetic retinopathy due to type 2 diabetes. (PLoS One)

Mount Sinai Hospital said it’s the first site in New York City to offer Medtronic’s MiniMed 670G system, FDA-approved last September, to type 1 diabetes patients. Mount Sinai is also currently one of the several sites participating in the InControl AP system study.

According to obesity expert Arya M. Sharma, MD, PhD, of the University of Alberta, medical use of BMI is “largely obsolete.” He also called it “largely opinion based and [having] very little to do with actual data showing that you know BMI makes any real difference to outcomes of surgeries in general,” he stated during a radio interview with Anna Maria Tremonti. (The Current)

Compared to normal weight individuals, people with type 2 diabetes who were also overweight or obese had different brains in a recent study. Specifically, brain structures showed increased abnormalities and participants also had decreased cognition. (Diabetologia)


Brown fat: Researchers identify brown fat signalling lipid

Scientists at Joslin Diabetes Center have shown that a lipid called 12,13-diHOME that circulates in the blood signals brown fat cells in mice to fuel up with other lipids. In one experiment, obese mice given low levels of the molecule produced reduced levels of blood triglycerides. Although the Joslin team has not shown that 12,13-diHOME also triggers brown fat activation in humans, the lipid could aid research by acting as a biomarker for the process.

The research, ‘The cold-induced lipokine 12,13-diHOME promotes fatty acid transport into brown adipose tissue’, was published in the journal Nature Medicine, and lead by Dr Matthew Lynes, a Joslin postdoctoral researcher and lead author on a paper. They began with a cohort of nine healthy human volunteers, taking blood samples first at normal room temperatures and then at temperatures cold enough to activate brown fat. Levels of 12,13-diHOME rose significantly among all the volunteers in the cold.

“After we identified this lipid in the human cohort, we used it to treat mice,” said Lynes. “We showed that it indeed can activate fuel uptake into brown fat, and improve brown fat performance.”

In other mice experiments, the Joslin team also demonstrated that 12,13-diHOME increases in the circulation of animals exposed to cold. Mice treated with 12,13-diHOME were able to better tolerate cold exposure. Still other tests demonstrated that the lipid is produced by brown fat cells exposed to cold.

Additionally, knowing that brown fat activity in humans decreases as obesity increases, the Joslin team measured circulating 12,13-diHOME in 55 people with a wide range of ages and body weights. The scientists found a negative correlation of 12,13-diHOME with measures of BMI, insulin resistance, circulating triglycerides and circulating liver enzymes that are related to fatty liver disease.

The researchers now are gathering more details on the molecular mechanisms by which 12,13-diHOME may affect brown fat activation. If the lipid does indeed assist in activating brown fat in humans, it may offer a route toward therapies, and the route may attract particular interest because we produce this substance naturally.

To access this paper, please click here

The Skinny On Bariatric Surgery

Surgeon Dr Du Toit with his team of doctors during a laparoscopic gastric bypass operation with a patient Mrs Gates in St Augustine Hospital theater, Glenwood Duraban.
Picture: Motshwari Mofokeng

Gastric bypass surgery is helping obese people slim and overcome life-threatening illnesses. Bernadette Wolhuter spoke to two surgeons who are changing their patients’ lives

For the past decade, specialist surgeons Dr Gert du Toit and Dr Ivor Funnell have been changing people’s lives.

The pair founded the Durban Bariatric Surgery – KwaZulu Natal’s only accredited centre – at St Augustine’s Hospital, in 2006.

The practice began in earnest and that year, Du Toit and Funnell performed five surgeries. But in recent years, the popularity of the procedure has grown exponentially and last year, they performed 88.

This week, they performed their 300th.

Initially, people did not realise the dramatic results that were achievable with bariatric surgery, Du Toit said, but as more people started having it, it became evident.

“Simply put, people will pay for something if it works,” Du Toit said, “And this works.”

In essence, bariatric surgery refers to weight loss or metabolic surgery and the most commonly performed type is gastric bypass surgery.

Post-surgery, they have to commit to serious lifestyle changes which include taking regular supplements and agreeing to regular follow-up appointments.

It is certainly not a quick fix and, with a price tag of about R130 000, not cheap either but, Du Toit says, the results speak for themselves.

Diabetes sufferers have the most to gain from the surgery.

“But there are so many other improvements we see in patients, post-surgery,” Du Toit goes on.

“They enjoy longer life expectancies and reduced illness profiles and become more productive in the workplace.”

More and more medical aids are starting to pay for the surgery and Du Toit says, from a financial perspective, it proves beneficial for them in the long term because a diabetic patient could cost his or her medical aid up to R5 000 a month.

“A year after surgery, none of those expense are there anymore,” Du Toit says.

But Du Toit is most excited about the impact the surgery has on his patients’ self esteems. “Many of them have been obese their whole lives and it has created a barrier for them, when it comes to dealing with others. People have a psychological bias towards obese people and they often suffer from an inferiority complex,” he says, “You really make a difference with this surgery, it changes people’s lives.”

West Riding’s Tracey-Lee Featherstone made the decision to undergo bariatric surgery in March 2014.

She had always struggled with her weight, she said, but it became more of an issue after she gave birth to her two sons.

“It affects every aspect of your life,” Featherstone says. “And I wanted to be ‘part of life’, I was tired of watching from the sidelines.”

Two years after her surgery, Featherstone has lost 67kg and weighs just 52kg now.

She no longer suffers from the obesity-related conditions she did before – acid reflux, heartburn, battling to breathe and water retention – and says her entire life has changed.

“It’s just amazing, my energy levels have improved, my cholesterol is fantastic and I can do things with my kids.”

Durban North attorney Charmaine Schwenn had struggled with her weight since childhood and opted for the surgery in 2006, when, aged 34, she weighed 137kg.

In the first three months after the surgery, Schwenn lost 35kg.

“It just melted off,” she said. “After that though, I had to work a lot harder.”

In total, Schwenn has now lost 70kg.

She says she no longer suffers with swollen joints or reflux and, in her personal life, she says she has since excelled at work and her relationships have improved.

“Without a doubt, it is the best thing that I ever could have done for myself,” Schwenn says of the surgery, “My only regret is that I didn’t do it ten years earlier.”



ZG16 protein Newly discovered bacteria-binding protein in the intestine

Deficiency in a certain protein in the gastrointestinal tract has been shown to lead to both inflammation and abdominal fat accumulation in mice. The discovery of a bacteria-binding protein provides yet another piece of the puzzle of how humans are affected, or not, by the large quantities of intestinal bacteria we carry with us. Researchers from the Sahlgrenska Academy, Göteborg, Sweden, have addressed the key role of the bacteria-binding protein ZG16 in protecting the body from intestinal bacteria.

“The hope is that eventually, we’ll be able to administer this protein to improve protection against bacteria in patients with a defective barrier,” said Joakim Bergström, postdoctoral researcher at Sahlgrenska Academy, who is part of Professor Gunnar C Hansson’s research group, which, eight years ago, was first to discover that there is a protective mucus layer in the intestine that separates intestinal bacteria from the intestinal surface.

The paper, ‘Gram-positive bacteria are held at a distance in the colon mucus by the lectin-like protein ZG16’, was published in the Proceedings of the National Academy of Sciences.

The thick mucus layer prevents the large quantities of bacteria people typically have in the gastrointestinal tract, one to two kilos, from reaching the body’s tissues and causing inflammation or other harm. Structurally, this protective barrier is made of proteins (mucins) that are formed and secreted by the goblet cells of the gastrointestinal tract.

The discovery has led to a brand new area of research and has been followed by numerous findings about how the mucus layer is created, is maintained, moves, and is damaged.

The new research shows that the protein ZG16 binds and clumps bacteria together and thus works with the protective mucus layer in the intestine to keep bacteria at a safe distance from the intestinal mucosa.

Mice that lack the protein develop a mucus layer that is more permeable to bacteria, allowing more bacteria to cross the intestinal mucosa into the body. The increased quantity of bacteria that reach the body’s various tissues cause low-grade inflammation. The bacteria that slip through from the intestine also led to increased abdominal fat accumulation in the mice that had a defective mucus barrier due to the lack of the protein.

The research group has previously shown that the mucus layer is permeable to bacteria in patients with the gastrointestinal disorder ulcerative colitis and in mouse models of inflammatory bowel disease. The finding of a specific protein that helps prevent bacteria from entering the body is important for the understanding of inflammatory bowel diseases and of the origins of more general diseases such as obesity and inflammation.

“It’s becoming very clear now that a significant amount of bacteria leaks through the intestine into the body, which plays a role in inflammatory diseases, and even obesity, at least in mice. This indicates a principle that is probably quite universally applicable,” said Hansson.

To access thsi paper, please click here

Post-surgical weight loss increases work productivity

Patients who had bariatric surgery that resulted in weight loss, improved physical function or reduction in depressive symptoms also reduced their absenteeism at work, according to a Researcher Letter published in JAMA. It is well-known that obesity is associated with sick leave, disability, and work-place injuries and bariatric surgery is an effective treatment for patients with severe obesity. However, the evidence is limited regarding the relationship between bariatric surgery and work productivity.

In the study, ‘Longitudinal Evaluation of Work Status and Productivity After Bariatric Surgery’, Dr David R Flum of the University of Washington, Seattle, and colleagues assessed working status and change in productivity in the first three years following bariatric surgery for severe obesity.

This study included adults with severe obesity undergoing bariatric surgery who completed a work productivity and activity impairment questionnaire pre-surgery and annually post-surgery. Work status among non-retirees and past-week work absenteeism (missed work due to health) and presenteeism (impaired work due to health) among employed participants were assessed.

Of 2,019 non-retired participants, 89 percent had work factors data at one or more follow-up assessment(s) and were included in the analysis. Baseline median age was 45 years; median body mass index was 46; 80 percent were women. Weight loss was 28 percent at three years. Prevalence of employment or disability did not significantly change throughout follow-up. However, unemployment increased from pre-surgery to year three (3.7 percent for pre-surgery vs 5.6 percent for year three post-surgery).

Of 1,265 employed participants, 86 percent were included in the work productivity sample. Prevalence of absenteeism was lower at year one (10.4 percent) vs pre-surgery (15.2 percent), but did not significantly differ from pre-surgery at year two or three. Prevalence of presenteeism was lower than pre-surgery at all post-surgery times but increased from years one to three.

Improvements in physical function and depressive symptoms were independently associated with lower risks of post-surgery absenteeism and presenteeism, whereas post-surgery initiation or continuation of psychiatric treatment vs no treatment pre-surgery or post-surgery was associated with higher risks. Greater weight loss was independently associated with lower risk of post-surgery presenteeism only.

“In this large cohort of adults who underwent bariatric surgery, patients maintained working status and decreased impairment due to health while working,” the researchers conclude. “The small increase in unemployment by year three may reflect a secular trend in unemployment during the time of the study; the annual average rate of unemployment increased from 4.5 percent in 2007 to 8 percent in 2012. The reduction in presenteeism following surgery may be explained by weight loss, improved physical function, or reduction in depressive symptoms. The increase in presenteeism between years one and three may reflect an adaptation to a new health state or deterioration of initial pre-surgery to post-surgery improvements.”

Post-surgical assessments aid weight loss

Obesity 2

Assessing certain weight control practices and eating behaviours after bariatric surgery can significantly influence the amount of weight loss after surgery, according to a study published by researchers from the Neuropsychiatric Research Institute, Fargo, ND. The paper, ‘Postoperative Behavioral Variables and Weight Change 3 Years After Bariatric Surgery’, published in JAMA Surgery, suggests that the utility of programmes to modify problematic eating behaviours and eating patterns should be addressed in research.

“The results of this study suggest that certain behaviours, many of which are modifiable, are associated with weight loss differences of significant impact in patients undergoing RYGB or LAGB,” the authors write. “The magnitude of this difference is large and clinically meaningful. In particular, the data suggest that developing positive changes in behaviour, including ceasing negative behaviours or increasing positive behaviours, can affect the amount of weight loss.”

Bariatric surgery has been proven to induce weight loss, but the amount can vary. Most research in this area has focused on preoperative factors and post-operative predictors of weight loss have not been adequately examined. Therefore, the researchers led by Dr James E Mitchell and colleagues examined postoperative eating behaviours and weight control, and their effects on change in weight among adults undergoing first-time bariatric surgical procedures.

Data was gathered from the Longitudinal Assessment of Bariatric Surgery-2 (LABS-2) study, a multi-centre observational cohort study at ten US hospitals in six geographically diverse clinical centres. Adults undergoing first-time bariatric surgical procedures as part of routine clinical care were recruited between 2006 and 2009 and followed up until September 2012. Participants completed detailed surveys regarding eating and weight control behaviours prior to surgery and then annually after surgery for three years.

Participants completed detailed surveys regarding eating and weight control behaviours prior to surgery and then annually after surgery for three years. Twenty-five postoperative behaviours related to eating behaviour, eating problems, weight control practices, and the problematic use of alcohol, smoking, and illegal drugs were examined.

Behaviours examined were divided into those that were never present (pre-operatively or post-operatively), those that were always present (pre-operatively and post-operatively), and those that underwent a healthy change after surgery (development of a positive behaviour or omission of a negative behaviour).

The study included a total of 2,022 participants (median age 47 years, range 38-55 years; median BMI 46; 78% women): 1,513 who had undergone Roux-en-Y gastric bypass and 509 who had undergone laparoscopic adjustable gastric banding. The researchers found that the three behaviours that explained most of the variability (16 percent) in three-year percent weight change following RYGB were weekly self-weighing, continuing to eat when feeling full more than once a week, and eating continuously during the day.

A participant who postoperatively started to self-weigh, stopped eating when feeling full, and stopped eating continuously during the day after surgery would be predicted to lose an average of 39 percent of their baseline weight, which is about 14 percent greater weight loss compared with participants who made no positive changes in these variables, and 6% greater weight loss compared with participants who always reported positive on these healthy behaviours.

The outcomes “suggests that structured programmes to modify problematic eating behaviours and eating patterns following bariatric surgery should be evaluated as a method to improve weight outcomes among patients undergoing bariatric surgery. The results also underscore the need for health care professionals to target these behaviours in the postoperative period,” the authors write.

Bariatric surgery can increase risk of preterm birth


Surgery and pregnancy

Babies of women who have undergone bariatric surgery for obesity run a higher risk of preterm birth, according to an update from a study from the Karolinska Institutet and published in the New England Journal of Medicine.

“Since obesity is associated with a higher risk of preterm delivery, we assumed that the weight-loss achieved by surgery would reduce this risk, especially as it also reduced the risk of gestational diabetes,” said research team member Olof Stephansson from Karolinska Institutet’s Department of Medicine, Solna. “Instead, we found that it increased the risk.”

In the correspondence letter to the journal, ‘Bariatric Surgery and Preterm Birth’, the researchers state that they used data from the Scandinavian Obesity Surgery Registry (SOReg) and National Swedish Health Registers, and found almost 2,000 babies born of post-bariatric surgery women between 2006 and 2013 and compared them with the babies of 6,500 women who had not been operated on but who had the same BMI as the first group prior to surgery.

They found that the women who had undergone surgery ran a higher risk of preterm delivery (i.e. before week 37), so that while 6.8 per cent of the control group had premature babies, the corresponding figure in the surgery group was 8.4 per cent.

“Since bariatric surgery followed by pregnancy can increase the risk of preterm birth, such women ought to be considered risk pregnancies and should receive particular care and attention from the maternity care services,” said Stephansson. “This means, for instance, giving them extra ultrasound scans to check foetal growth and detailed dietary advice that includes the supplements they need after bariatric surgery. They should also be checked for any possible nutrient deficiencies other than iron.”

Bariatric surgery can also have positive effects on subsequent pregnancies. In earlier studies, the Stephansson’s group found that surgery reduces the risk of gestational diabetes and was associated with normalised birth size. The earlier study, Outcomes of Pregnancy after Bariatric Surgery’, suggested that bariatric surgery increased the risk of premature birth but the difference was not statistically significant.

Since bariatric surgery has now become so popular, the researchers in the present study were able to follow a much larger group of women and thus confirm this suspected correlation between surgical intervention and preterm birth.

“In contrast to the findings reported in our earlier article, we now report a significant association between a history of bariatric surgery and an increased risk of preterm birth and spontaneous preterm birth in particular,” they write. “Despite careful matching, differences between the surgery group and the control group may have influenced the results.”

To access the article, please click here

Experts push for surgery to tackle Type 2 diabetes

 DIABETES specialists across the world are calling for a radical mind-set shift in treatment for Type 2 diabetes so that doctors can recommend bariatric surgery for patients. They say the surgery is close to the holy grail of a diabetes cure.


Diabetes is a major cause of kidney failure, blindness, nerve damage, amputations, heart attack and stroke. Type 2 diabetes is a global epidemic, with the number of diabetic adults having quadrupled from 108-million in 1980 to 422-million in 2014.

SA is facing the twin epidemics of obesity and Type 2 diabetes — the incidence of both has increased so rapidly that doctors now refer to it as “diabesity”.

In a special issue of Diabetes Care, 45 international organisations have published a joint consensus statement with new guidelines recommending bariatric surgery for Type 2 diabetics even for patients who are only mildly obese.

The groups say extensive clinical trials show the surgery can improve blood-sugar levels more effectively than lifestyle or pharmaceutical intervention methods, and may lead to long-term remission.

The statement follows the second Diabetes Surgery Summit held in September 2015 at King’s College London, organised jointly by Diabetes UK, the American Diabetes Association, International Diabetes Federation, Chinese Diabetes Society and Diabetes India.

THE  authors say most cases of diabetes (about 90%) are Type 2, and fewer than 50% of patients are able to control their blood-sugar levels adequately with diet, exercise, or drugs. This makes bariatric surgery a viable option.

But, other experts say this finding is unscientific, dangerous and a “dark day for patients, possibly a gift for lawyers”.

Bariatric surgery is the umbrella term for metabolic, gastrointestinal procedures that were originally designed to induce weight loss in morbidly obese patients.

It involves the cutting, manipulating or bypassing parts of the stomach or intestines.

It includes Roux-en-Y gastric bypass (RYGB), a common stapling method that reduces the size of the stomach to a small pouch, and biliopancreatic diversion (BPD). Complications of bariatric surgery include pulmonary embolism, internal bleeding, heart attack, stroke and death.

A PRIME proponent of the new recommendation is King’s College London professor of metabolic and bariatric surgery Dr Francesco Rubino, first author of a paper in Diabetes Care investigating the costs and benefits of meeting potential demand for metabolic surgery in the UK and US.

Rubino has been researching the link between gastrointestinal surgery and glucose homeostasis since the late 1990s. He was one of the first to provide experimental evidence that bariatric surgery can improve diabetes independently of weight loss.

In a commentary in Nature, Rubino says the new guidelines come nearly 100 years after the first clinical observations that diabetes could be improved or resolved surgically. He has witnessed “first-hand how getting to this point has required many clinical scientists to put aside long-standing preconceptions”. Future progress will require “more thinking outside the box”, he says.

Prof Jennifer Rubin, from King’s College London Policy Institute, says the case for increasing the uptake of bariatric or metabolic surgery appears “strong enough to engage policy makers and practitioners in a concerted discussion of how best to use surgical resources in conjunction with other interventions in good diabetes practice”.

ENDOCRINOLOGIST  Dr Tessa van der Merwe, honorary clinical professor and researcher at the University of Pretoria, says metabolic surgery is the most cost-effective long-term treatment for obese diabetics.

She says it is “the only means of achieving complete or partial remission of diabetes”.

Surgery can also resolve other comorbidities (coexisting diseases) and improve quality of life drastically, says Van der Merwe, who is also the chairwoman of the South African Society of Surgery for Obesity and Metabolism and CEO of Centres of Excellence for Metabolic Medicine and Surgery in SA.

Metabolic and bariatric surgery is rigorously controlled in SA, Van der Merwe says. The most frequently performed surgery in SA is the laparoscopic RYGB, which remains “the gold standard for metabolic surgery”, she says.

Costs to patients vary, depending on their medical aid. Most large medical aids will contribute “a significant amount towards treatment costs, but at this stage, will only consider patients at a BMI (body mass index) above 35kg/m²”.

As a general rule, the total co-payment for patients on medical aid is about R30,000 for RYGB and R50,000 for BPD, she says.

Worldwide, the criteria for acceptance of a diabetic into a metabolic surgery programme have shifted downwards to include a BMI of 30 and above, says Van der Merwe.

“This is not a radical step”, but rather a “carefully considered move, based on many years of research and outcome data”.

DOCTORS who are overly critical usually have no significant experience or any knowledge of this field, Van der Merwe says.

South African-born Dr Robert Cywes, a bariatric surgeon and researcher in the US, says the data that surgery resolves Type 2 diabetes is “at best currently anecdotal and associative”.

He says doctors must understand the causes of diabetes and how bariatric surgery resolves symptoms. The data does not show that surgery is the reason the diabetes has resolved, nor is it as a result of weight loss. There is currently “no causal pathway that directly links the bariatric surgery to the resolution of Type 2 diabetes”, says Cywes.

There is research to show a 95% resolution in Type 2 diabetes symptoms after RYGB in adolescents, but doctors need to understand the mechanism “far more carefully than simply assigning the correlation between (the) surgery and resolution of Type 2 diabetes as causal”.

TYPE 2 diabetes may be associated with an increase in weight or with obesity, but this relationship is not causal, Cywes says. The duration of any resolution of diabetes “will not be permanent unless the patient understands and maintains the true reason why it resolved transiently after surgery”.

“Chronic excessive total carbohydrate consumption is shown to be causal both to obesity and Type 2 diabetes,” Cywes says.

THE  weight gain will continue until the genetic capability of their pancreas to produce enough insulin to deal with the excessive carbohydrate load peaks.

“When people consume more carbohydrates over time than the pancreas can produce insulin, the gap is called Type 2 diabetes,” Cywes says.

“Once insulin production peaks, weight gain plateaus because there’s not enough insulin to convert all the excess sugar to fat. Blood glucose rises and this leads to Type 2 diabetes.”

Cywes says weight loss after bariatric surgery lasts no more than one to three years, after which few patients lose any further weight — unless there are complications.

If patients don’t change their eating behaviour radically, and in particular tackle their carbohydrate addiction, both the weight and the Type 2 diabetes return over time.

This is especially true of patients who figure out a way to eat through the “dumping syndrome”, also known as “rapid gastric emptying”, which is common following bariatric surgery procedures that bypass or remove some or all of the stomach.

“Only a radical reduction in total carbohydrate consumption can cause Type 2 diabetes to go into remission,” says Cywes.

“The truth is you cannot have Type 2 diabetes if you do not consume carbohydrates.”

US professor of cellular biology at New York State University, Dr Richard Feinman, says the groups that have endorsed bariatric surgery for Type 2 diabetes have given themselves “the privilege to ignore the scientific data on differences in diets and the evidence that low-carb is first choice”.


microRNA breakthrough may protect against obesity

Obese people

Using a pre-clinical model of obesity, researchers at Brigham and Women’s Hospital (BWH) have discovered that a small, non-coding RNA molecule called miR-181b is an important determinant of obesity-induced changes in adipose tissue by controlling the function of the vessels in adipose tissue. The study, ‘MicroRNA-181b Improves Glucose Homeostasis and Insulin Sensitivity by Regulating Endothelial Function in White Adipose TissueNovelty and Significance. Circulation Research’, published in the journal Circulation Research, could point toward new targets for the development of treatment or obesity and diabetes.

The researchers identified that the expression of miR-181b was lower in adipose tissue endothelial cells, but not adipocytes, after just one week of high-fat feeding in mice. The team hypothesised that reconstituting this microRNA in obese mice might improve the development of insulin resistance/diabetes. Indeed, they found that injections of a miR-181b mimic into obese mice markedly improved insulin sensitivity, glucose levels and reduced inflammation in adipose tissue.

The team found that the protein phosphatase PHLPP2 is a direct target of miR-181b, and that suppression of the protein also improved insulin sensitivity, glucose levels and inflammation in mice, providing an additional new target for therapy. They also noted that levels of PHLPP2 were higher in endothelial cells from diabetic patients than healthy patients, suggesting the new findings in mice are relevant to human disease.

“We have discovered a microRNA that functions to dampen the inflammatory response in the vasculature of adipose tissue by targeting endothelial cells that surround adipocytes and a pathway that leads to increased nitric oxide production,” said senior author, Dr Mark W Feinberg, an associate physician at BWH. “The beneficial role of this microRNA in obesity is likely the tip of the iceberg since excessive inflammation is a pervasive finding in a wide-range of chronic inflammatory diseases.”

Funding for this work came from the National Institutes of Health grants, the American Heart Association, the Arthur K Watson Charitable Trust, the Dr Ralph and Marian Falk Medical Research Trust, Jonathan Levy Research Fund, and a State Scholarship Fund of the China Scholarship Council.

Repeated use of antibiotics linked to T2DM risk

download (1)Repeated use of some types of antibiotics may put people at increased risk of developing type-2 diabetes by possibly altering their gut bacteria, according to a large observational study published in the European Journal of Endocrinology. The findings emphasise the need to reduce unnecessary antibiotic prescriptions.

A team from the Departments of Gastroenterology and Medical Oncology at the University of Pennsylvania looked at the number of antibiotic prescriptions given out in the UK to over 200,000 diabetics at least one year before they were diagnosed with the disease, and compared this to the number given to 800,000 non-diabetic patients of the same age and sex.

“Gut bacteria have been suggested to influence the mechanisms behind obesity, insulin resistance and diabetes in both animal and human models,” said lead author of the study, Dr Ben Boursi. “Previous studies have shown that antibiotics can alter the digestive ecosystem.”

Cases were defined as those with incident diagnosis of diabetes. For every case, 4 eligible controls matched on age, sex, practice-site, and duration of follow-up before index-date were selected using incidence-density sampling. Exposure of interest was antibiotic therapy >1 year before index-date. The risk was adjusted for BMI, smoking, last glucose level and number of infections before index-date, as well as past medical history of coronary artery disease and hyperlipidaemia.

They found that exposure to a single antibiotic prescription was not associated with higher adjusted diabetes risk. Treatment with 2-5 antibiotic courses was associated with increase in diabetic risk for penicillin, cephalosporins, macrolides and quinolones with adjusted OR ranging from 1.08 (95%CI 1.05-1.11) for penicillin to 1.15 (95%CI 1.08-1.23) for quinolones. The risk increased with the number of antibiotic courses and reached 1.37 (95%CI 1.19-1.58) for >5 courses of quinolones. There was no association between exposure to anti-virals and anti-fungals and diabetes risk.

This means that patients prescribed 2-5 courses of penicillins increased their risk of diabetes by 8%, while for those with more than five penicillin courses this risk increased by 23%. For quinolones, diabetes risk increased by 15% among patients that were prescribed with 2-5 courses and by 37% for those with more than five courses.

“While our study does not show cause and effect, we think changing levels and diversity of gut bacteria could explain the link between antibiotics and diabetes risk,” said senior author, Dr Yu-Xiao Yang.

There was no increase in risk associated with use of anti-virals or anti-fungal medications and the study found little evidence of a link between antibiotic use and the risk of type-1 diabetes.

“Over-prescription of antibiotics is already a problem around the world as bacteria become increasingly resistant to their effects” said Boursi. “Our findings are important, not only for understanding how diabetes may develop, but as a warning to reduce unnecessary antibiotic treatments that might do more harm than good.”

Mental health conditions common among bariatric surgery patients

January 12, 2016
The JAMA Network Journals
Mental health conditions, such as depression and binge eating disorder, are common among patients seeking and undergoing bariatric surgery, according to a study. Bariatric surgery is an accepted method of promoting weight loss in severely obese individuals. Mental health conditions may be common among patients seeking bariatric surgery; however, the prevalence of these conditions and whether they are associated with postoperative outcomes has not been known.

Mental health conditions, such as depression and binge eating disorder, are common among patients seeking and undergoing bariatric surgery, according to a study in the January 12 issue of JAMA.

Bariatric surgery is an accepted method of promoting weight loss in severely obese individuals. Mental health conditions may be common among patients seeking bariatric surgery; however, the prevalence of these conditions and whether they are associated with postoperative outcomes has not been known.

Aaron J. Dawes, M.D., of the David Geffen School of Medicine at UCLA, Los Angeles, and colleagues conducted a meta-analysis to determine the prevalence of mental health conditions among bariatric surgery candidates and recipients and the association between preoperative mental health conditions and health outcomes following bariatric surgery. The authors identified 68 publications meeting criteria for inclusion in the analysis: 59 reporting the prevalence of preoperative mental health conditions (65,363 patients) and 27 reporting associations between preoperative mental health conditions and postoperative outcomes (50,182 patients).

Results of the meta-analysis estimated that 23 percent of patients undergoing bariatric surgery reported a current mood disorder — most commonly depression (19 percent) — while 17 percent were diagnosed with an eating disorder. “Both estimates are higher than published rates for the general U.S. population, suggesting that special attention should be paid to these conditions among bariatric patients,” the researchers write. Another common mental health condition was anxiety (12 percent).

There was conflicting evidence regarding the association between preoperative mental health conditions and postoperative weight loss. Neither depression nor binge eating disorder was consistently associated with differences in weight outcomes. Bariatric surgery was, however, consistently associated with postoperative decreases in the prevalence of depression (7 studies; 8 percent-74 percent decrease) and the severity of depressive symptoms (6 studies; 40 percent-70 percent decrease).

“Previous reviews have suggested that self-esteem, mental image, cognitive function, temperament, support networks, and socioeconomic stability play major roles in determining outcomes after bariatric surgery,” the authors write. “Future studies would benefit from including these characteristics as well as having clear eligibility criteria, standardized instruments, regular measurement intervals, and transparency with respect to time-specific follow-up rates. By addressing these methodological issues, future work can help to identify the optimal strategy for evaluating patients’ mental health prior to bariatric surgery.”

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The above post is reprinted from materials provided by The JAMA Network Journals. Note: Materials may be edited for content and length.

Can a Drug or Surgery Solve Your Weight Problem?

In a word, no. Can they help? Perhaps…

Last month I wrote an article that spoke somewhat favorably of the new weight loss drug, Saxenda. I said it was perhaps the most important weight loss medication ever developed.

Wow! Did I get lambasted! I got all sorts of email blasting me for going over to the dark side and becoming a drug pusher and lackey of Big Pharma. I even got an email from my favorite professor of counseling at the University of Massachusetts, now friend, Allen Ivey, Ph.D. Besides being a friend, he is a big shot in the counseling field, the father of Microcounseling and developer of “active listening”. He said he was “sad” to see that I seemed to be pushing drugs. He is the last person on earth that I would want to be mistaken about my views on the solution to obesity. We’ve since gotten that misunderstanding corrected, but I want to make sure it is clear with everyone who reads my blogs.

I am still the world’s staunchest advocate of the behavioral therapy I teach to reverse the condition of obesity. It works -like a miracle, some say. But not 100% of the time. For some, it is not enough.

After 30 years successfully helping people to lose weight permanently, I am convinced that a percentage of the population is dealing with a physiological condition that creates more persistent and intense degrees of craving and compulsion than the rest of us have to deal with. My approach teaches people how to overcome the habits and feelings that make them overweight but sometimes those cravings and compulsions are so strong that nothing on God’s natural earth will quiet them.

If you’ve ever had a blister on your foot or a pebble in your shoe, you’ll remember that your brain is getting the message loud and clear that you need to relieve that pressure and you need to relieve it right now. You will feel the drive to relieve it until you do. It won’t go away until you do whatever it takes. There is no “will-powering” it away. Something is going on in the body, physiologically and chemically, that is triggering a response in your brain that will bother you until you satisfy it. It isn’t exactly the same with the food cravings that some have, but it gives you an idea of what some people are dealing with. Hold your breath for as long as you can and see how powerful the urge to breathe becomes. This is the kind of relentless drive that a small percentage of the population is fighting in their attempts to stop eating too much.

For them, some sort of intervention or tool that would make it easier for them to eat less would be a Godsend. Then, perhaps what they learn in a good behavioral approach would be enough. Self-programming and cognitive techniques like I teach work like magic for many people, but they would be so much more productive for these folks with eating hyperdrive if we could reduce that drive, which the pharmaceuticals can do. Or in the case of surgery, an additional tool to use behaviorally.

Make no mistake about it, drugs or surgery will not by themselves solve your weight problem. To solve your weight problem, you need to make a permanent change in your behavior, made possible with behavioral therapy. Success comes with learning how to eat what you like in ways that keep you at your desired weight and it becoming habitual and a new “normal” for you. Now, with these new medical interventions, success may be possible even for those who have suffered from an abnormally intensive eating drive. Weight loss drugs or surgery may now enable them to overcome the obstacles that prevented them from being able to make those behavioral changes.

William Anderson is a Licensed Mental Health Counselor who specializes in weight loss, eating disorders and addictions. He is the author of The Anderson Method.

Jenny de Beer

The story I am about to tell has been a life changing experience.  All my life I have been known as “big Jenny” and have struggled with weight problems for as long as I can remember.  I was overweight even at primary school and was teased and made fun of but would just brush it off on the outside like it did not matter (sometimes even laughing with them) but on the inside the things that people were saying really did hurt.   I tried all the diets you can think of and I would lose some weight but then very soon would pick it all up again with extra weight gain.  I picked up the bulk of my weight while I was pregnant with my daughters because I was eating, I told myself, for two. After that I would try dieting but never lost more than 10kg and after a while would pick it up all over again with the extra weight.  It was a losing battle.

It got so bad that I would not even get on a scale to weigh myself so for a very long time did not even know how much weight I had gained but felt so terrible and the only place I would go would be to work and back.  On the weekends I would stay home and did not want to go out anywhere.  Walking became difficult and when I had to go to the shop I would have to sit down after just walking for about 10 minutes.  My world became a vacuum.

Shopping for clothes was a nightmare and I never got anything to fit me.  I put so much strain on my family as they had to fetch and carry for me and even help me get dressed for work in the morning as I could not even get down to put on my own shoes.

In 2013 because of my overweight I had a slight stroke and landed up in hospital not being able to even walk and could not have a CT scan to determine the severity as I could not fit in the machine. It took me about 6 months to walk again but still I resorted to eating.  The doctor told me about this Bariatric surgery that would help me with my weight problem.  I did some research and wanted to do this operation so badly but was told that medical aid would not pay for it so what did I do – yip gave up and carried on eating.

I was diagnosed with type 2 diabetes, hypertension, arthritis and cholesterol problems and was taking about 10 chronic tablets a day.  I was later diagnosed with sleep apnea and had to sleep with a C-pap machine which I hated.  All this just made me feel worse and I found comfort in food.

During a visit to my family doctor in 2014 he told me about this operation I could have that would assist me to lose weight.  I still thought to myself “Medical aid won’t pay so what’s the use”.  He went and gave my contact number to Dr Du Toit’s office and I got a call the following week asking if I would like to come in to see doctor to discuss my weight problem.  I said thanks but turned the offer down as I could not afford the operation and medical aid would not pay.  I was asked for my medical aid details and they would get back to me.  I got a call back and was told that they would pay a portion of the operation.  I was so excited I wobbled home and told my husband I really wanted to do this. There was a sign of hope.

I made an appointment and went in for a visit and when I got on the scale I nearly had a heart attack.  I weighed 177.9kg.  I just burst into tears and was so emotional as it was the first time weighing myself in a very long time.

A date was scheduled and I attended all my pre-operation appointments and was determined to make this work so I co-operated with their advice and simply latched onto their support.  It was at this point that I made a concise decision to undergo the operation. I was so impressed with all the support that I was getting from the bariatric team I decided then and there that they really cared for me and the least I could do was follow all their advice and instructions. I had the Gastric bypass surgery on the 4th November 2014.

After the surgery the first couple of weeks were the hardest for me.  I was not hungry but because of my bad eating habits throughout my life it took a while for my head to catch up with my stomach. One day I burst into tears because I could not have that burger that the family was having for dinner.  I was however determined to make this work and would strictly follow the diet that was given. When I went back for my check up and saw the weight that I had lost I was over the moon and decided that I can do this and I was no longer making food my obsession.

I have never been one for exercise (I even battled to walk) but my daughter bought me Zumba and I thought I would give it a go because I love to dance.  The first time I tried it I lasted I think about 5 minutes and could do no more but I stuck it out and carried on with it every morning.  The weight just kept on coming off and I was feeling great.

It has been just over a year now that I have had the operation and have lost 70.3 kg.  I am not at my goal weight yet but working hard at getting there.  The support and encouragement I get from my family, friends and work colleagues has been so great.  I can now do my Zumba exercise for 40 minutes and still feel so energetic after that.

I love to go out and spend time with my family and friend and being a new granny I am able to keep up with my granddaughter with ease.   My life has changed so much, I no longer have to take any chronic medication.  I do not have diabetes, cholesterol or hypertension anymore and even the sleep apnea had disappeared so no C-pap machine. My health as improved tremendously.  I can now buy clothes that fit me and get so excited when I go and try on something in a smaller size.   Food is no longer my obsession and I have learnt to eat properly and find it so easy to stick to the foods I can eat and it does not concern me what others are eating.  I am also now in a position to deal with all the causes of my bad eating habits.

I attend the support group every month and it really helps to talk to people who have gone through what I have, share ideas and just see how this surgery has helped so many people. I am excited for the future and would recommend this surgery to anyone who is considering having it. This operation has changed my life and has taught me many lessons.  My approach to life has changed and I see food in a different light.   Even though my journey is not over yet I am more confident and can’t wait to get to my goal weight.



sLR11 protein prevents body losing weigh

Metabolic weighing scales_3

An international team of researchers from the Wellcome Trust-Medical Research Council Institute of Metabolic Sciences at the University of Cambridge, UK, and Toho University, Japan, have shown that a protein found in the body, known as sLR11, inhibits our ability to burn fat. Most of the fat cells in the body act to store excess energy and release it when needed but some types of fat cells, known as brown adipocytes, function primarily for a process known as thermogenesis, which generates heat to keep us warm. However, the fatter we are, the more our body appears to produces sLR11. The study, ‘Soluble LR11/SorLA represses thermogenesis in adipose tissue and correlates with BMI in humans’, published in the journal Nature Communications, may have implications for the treatment of obesity and other metabolic diseases.

Professor Toni Vidal-Puig

“We have found an important mechanism that could be targeted not just to help increase people’s ability to burn fat, but also help people with conditions where saving energy is important such as anorexia nervosa,” said Professor Toni Vidal-Puig, who led the study team.

The researchers investigated why mice that lacked the gene for the production of this protein were far more resistant to weight gain. Mice and humans increase their metabolic rate slightly when switched from a lower calorie diet to a higher calorie diet, but mice lacking the gene responded with a much greater increase, meaning that they were able to burn calories faster.

Further examinations revealed that in these mice, genes normally associated with brown adipose tissue were more active in white adipose tissue (which normally stores fat for energy release). In line with this observation, the mice themselves were indeed more thermogenic and had increased energy expenditure, particularly following high fat diet feeding.

The researchers were able to show that sLR11 binds to specific receptors on fat cells to inhibit their ability to activate thermogenesis. In effect, sLR11 acts as a signal to increase the efficiency of fat to store energy and prevents excessive energy loss through unrestricted thermogenesis.

When the researchers examined levels of sLR11 in humans, they found that levels of the protein circulating in the blood correlated with total fat mass, the greater the levels of the protein, the higher the total fat mass. In addition, when obese patients underwent bariatric surgery, their degree of postoperative weight loss was directly proportional to the reduction in their sLR11 levels, suggesting that sLR11 is produced by fat cells.

In their paper the authors suggest that sLR11 helps fat cells resist burning too much fat during ‘spikes’ in other metabolic signals following large meals or short term drops in temperature. This in turn makes adipose tissue more effective at storing energy over long periods of time.

There is growing interest in targeting thermogenesis with drugs in order to treat obesity, diabetes and other associated conditions such as heart disease. This is because it offers a mechanism for disposing of excess fat in a relatively safe manner. A number of molecules have already been identified that can increase thermogenesis and/or the number of fat cells capable of thermogenesis. However to date there have been very few molecules identified that can decrease thermogenesis.

“Our discovery may help explain why overweight individuals find it incredibly hard to lose weight. Their stored fat is actively fighting against their efforts to burn it off at the molecular level,” said Dr Andrew Whittle, joint first author of the study.

These findings shed light on one of the mechanisms that the body employs to hold onto stored energy, where sLR11 levels increase in line with the amount of stored fat and act to prevent it being ‘wasted’ for thermogenesis.

“This research could stimulate the development of new drugs that either help reduce obesity, by blocking the action of this protein, or control weight loss by mimicking its action. Based on this promising discovery, we look forward to the Cambridge team’s future findings,” said Jeremy Pearson, Associate Medical Director at the British Heart Foundation, which helped fund the research. “But an effective medicine to treat obesity, which safely manages weight loss is still some way off. In the meantime people can find advice on healthy ways to lose weight and boost their heart healthy on the BHF website.”

To access this paper, please click here

Cancer Study finds surgery eliminates precancerous uterine growths

Cancer Study finds surgery eliminates precancerous uterine growths – A study evaluating the effects of bariatric surgery on obese women most at risk for cancer has found that the bariatric surgery eliminated precancerous uterine growths in those that had them.

Other effects included substantial weight loss, improving patients’ physical quality of life (QoL), improving their insulin levels and ability to use glucose, and altering the composition of their gut bacteria.

Women at extreme risk for obesity-related carcinogenesis

The study, Women at extreme risk for obesity-related carcinogenesis ‘ a Baseline endometrial pathology and impact of bariatric surgery on weight, metabolic profiles and quality of life.’, was published in in the journal Gynecologic Oncology.

Dr Susan Modesitt

“If you look at cancers in women, about a fifth of all cancer deaths would be prevented if we had women at normal body weight in the US,” said Dr Susan C Modesitt of the University of Virginia Cancer Center. “When you’re looking at obesity-related cancers, the biggest one is endometrial cancer, but also colon cancer, breast cancer, renal cancer and gall bladder cancer. We think about 40 to 50 percent of all endometrial cancer, which is in the lining of the uterus, is caused by obesity.”

Baseline Endometrial History

In the study researchers sought to determine baseline endometrial histology in morbidly obese women undergoing bariatric surgery and to assess the surgical intervention’s impact on serum metabolic parameters, QOL and weight.

The study included 71 women undergoing bariatric surgery and their demographic and clinicopathologic data, serum, and endometrium (if no prior hysterectomy) were collected preoperatively and serum collected postoperatively. Serum global biochemical data were assessed pre/postoperatively. The mean age of women was 44.2 years and a mean BMI50.9, interestingly a third of women presenting for bariatric surgery did not identify themselves as obese. A total of 68 participants underwent the procedure; two opted out of the surgery, and another died of a heart condition prior to surgery.


Following surgery, the mean weight loss was 45.7kg and the endometrial biopsy results showed that ten percent of study participants who had not had a hysterectomy showed precancerous changes in the lining of the uterus, and all of those resolved with weight loss (proliferative (13/30; 43%), insufficient (8/30; 27%), secretory (6/30; 20%) and hyperplasia (3/30; 10%—1 complex atypical, 2 simple).


In addition, QoL data showed significant improvement in physical component scores (PCS means 33.9 vs. 47.2 before/after surgery; p<0.001). Twenty women underwent metabolic analysis which demonstrated significantly improved glucose homeostasis, improved insulin responsiveness, and free fatty acid levels. Significant perturbations in tryptophan, phenylalanine and heme metabolism suggested decreased inflammation and alterations in the intestinal microbiome. Most steroid hormones were not significantly impacted with the exception of decreased DHEAS and 4-androsten metabolites.

“The study results demonstrate that there is a huge alteration, but I don’t even know what to say about that, except it is really new and intriguing area to look at in the link between obesity and cancer,” said Modesitt. “For example, before ground breaking work by Dr John Marshall at UVA in the past, no one knew that ulcers were from bacteria. Who knows what role the gut bacteria play in promoting obesity, but metabolic parameter/markers of the bacteria definitely changed after [study participants] lost weight.”

Avoid Weight-gain

While the study speaks to the transformative effect bariatric surgery can have, Modesitt urged people to avoid gaining weight in the first place and for those seeking to lose weight to exercise and eat more healthily before turning to surgery.

“We really should be working on diet and exercise from the get-go in our entire society, starting with our children. And exercise does seem to be protective, even if you don’t lose all the weight, it absolutely has beneficial effects,” she said. “There are lots of studies showing if you exercise, it improves your insulin, your glucose, all of those sorts of things that go along with the cancer-causing effect. Almost everybody agrees adding exercise would be wonderful and improve health on many levels. But losing excess weight would also be good.”


Surgery should not be considered as the last option


For diabetic morbidly obese patients, surgery should not be considered as the last option, but as an appropriate treatment, in particular when diabetes is not controlled or when other obesity-related comorbidities are poorly controlled, according to researchers from Università Cattolica del Sacro, Rome, Italy. In their systematic review, ‘Assessing the obese diabetic patient for bariatric surgery: which candidate do I choose? published in the journal Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, they state that bariatric/metabolic procedures are considered as an additional therapeutic option allowing improved diabetes control in most of patients, but surgery can result in the achievable goal of not curing resolving diabetes and this is particularly achievable in patients with a relatively short history of diabetes duration.

The aim of the paper was to review bariatric-metabolic surgery for obese diabetic patients and compare outcomes from numerous procedures and non-surgical programmes. They emphasise the importance of patient risk factors (high perioperative morbidity and mortality, patients’ preference, compliance of the patients to the postoperative follow-up protocol) and surgical factors (expertise and experience in the bariatric surgical procedures, the simplicity and reversibility of the procedure), when choosing the most suitable treatment. Although they add that the current evidence suggests that multiple factors play in concert to achieve the improvements in diabetic control observed after bariatric-metabolic procedures.

It is clear bariatric-metabolic surgery is an effective treatment for type 2 diabetes when compared with conventional nonsurgical medical treatment (Table 1). A meta-analysis supports these findings, showing an overall type 2 diabetes remission rate of 63.5% for the surgical group versus 15.6% for the conventional non-surgical group (p<0.001) at a mean follow-up of 17.3 months. This meta-analysis was based on the results of 16 studies including 6,131 patients. Although they acknowledge that the short follow-up time limits the results with few reporting long-term follow-up, apart from the {Association of bariatric surgery with long-term remission of type 2 diabetes and with microvascular and macrovascular complications.||Swedish Obese Subjects}} study. This study also reported that short diabetes duration at baseline is associated with higher remission rates at ten and 15 years after surgery.

“Given these findings, preoperative metabolic data could be of primary importance to asses which patients may effectively benefit from bariatric-metabolic surgery in diabetes control,” the researchers note.

Table 1: Comparison between bariatric surgery and conventional medical treatment for type 2 diabetes remission rate (%)

The authors state that not only do diabetic patients eligible for bariatric-metabolic procedures remain morbid and obese after they failure of nonsurgical options for weight loss, a patient with BMI<35 suffering from a significant obesity-related comorbidity simply on the basis of the BMI level does not appear to be clinically justified.

“A clinical decision should be based on a more comprehensive evaluation of the patient and on a more reliable prediction of future morbidity and mortality,” they write.  “Nevertheless, ideally a risk stratification (such as detection of early stages of atherosclerotic disease) should be provided to identify pre-diabetes conditions in obese subjects in order to identify high-risk individuals to potentially prevent the occurrence of type 2 diabetes and its related systemic complications.

An assessment of which patients could benefit from bariatric-metabolic surgery should include pre-operative metabolic work-up with an accurate evaluation of the glycaemic status (including fasting glucose, HbA1c, insulin sensitivity after oral glucose tolerance test, fasting insulin, fasting C-peptide).

“Bariatric-metabolic surgery should be proposed after an adequate careful risk–benefit analysis in high-volume centres with multi-disciplinary teams experienced in the management of obesity and diabetes,” they conclude. “Nevertheless, regular postoperative nutritional monitoring is required, with attention to appropriate diet after the procedure, monitoring of micronutrient status, and individualized nutritional supplementation. Further investigations are needed to clarify the duration of the benefit of surgery in diabetes remission, the mechanism of the success of surgery, and the mechanism associated with diabetic recurrence.”

New mechanism controls glucagon secretion in humans

New mechanism controls glucagon secretion in humans
New mechanism controls glucagon secretion in humans

New mechanism controls glucagon secretion in humans; TYPE 2 DIABETICS who are resistant to insulin have an excess blood glucose level, which they are now trying to reduce using a new class of DIABETES drugs known as the gliflozins.

These new drugs lower the sugar level but also produce a paradoxical effect, leading to the secretion of glucagon, a supplementary source of glucose. Joint research units 1190, “Translational Research for DIABETES,” (University of Lille, Inserm and Lille Regional University Hospital), directed by François Pattou, and 1011 “Nuclear Receptors, Cardiovascular Diseases and DIABETES,” directed by Bart Staels, have described a new mechanism that controls glucagon secretion in humans, making it possible to elucidate this phenomenon and suggesting a modification of this new type of treatment.

The outcomes from the study Inhibition of the glucose transporter SGLT2 with dapagliflozin in pancreatic alpha cells triggers glucagon secretion., researched in Lille, France, at the EGID (European Genomic Institute for DIABETES) Laboratory of Excellence, were published in the journal Nature Medicine.

The team directed by François Pattou is developing innovative therapies to control the more severe forms of DIABETES, a disorder characterised by chronic hyperglycaemia.

To treat TYPE 1 DIABETES, the laboratory is conducting projects based on the production of human islets, which are transplanted into patients. Islet transplantation restores production of insulin, the hormone that controls the level of sugar by storing it when its level in the blood is too high. Analysis of human islets destined for transplantation makes it possible to evaluate the cells and thus improve transplantation.

It was in this context that the research team discovered a new mechanism for controlling glucagon secretion in humans, a mechanism that explains a side-effect of a new class of diabetes drugs used to treat TYPE 2 DIABETESassociated with obesity and characterised by insulin resistance.

When the cells detect a low sugar level, an increase in blood sugar level is required to provide the energy needed by the body. This involves another hormone, glucagon, the role of which is to stimulate sugar production by the liver in order to restore the blood glucose levels to normal as quickly as possible. This hormone, secreted by the alpha cells in the islets of Langerhans in the pancreas, has been somewhat forgotten COMPARED to insulin, which is produced by the beta cells to stimulate storage of sugar. It is, however, an essential part of the physiopathology of DIABETES.

In this study, the researchers discovered that a glucose cotransporter, SGLT2, known to reabsorb glucose in the kidney, is present in the alpha cells, and controls glucagon secretion. By measuring the expression of the gene for this transporter in the islets of DIABETIC donors (type 2), they observed a reduction in SGLT2 expression and an increase in glucagon expression compared with the islets of healthy subjects. This result was confirmed in mice with TYPE 2 DIABETES. As they became increasingly obese, expression of the cotransporter declined.

Unexpectedly, by revealing this mechanism, the researchers have explained the paradoxical increase in glucagon level observed in patients using a new class of DIABETES drugs, the gliflozins, marketed in the US and the UK. This class of drugs targets the glucose transporter located in the kidney, preventing the reabsorption of excess glucose in DIABETICS and its partial elimination in the urine.

“The DIABETES TREATMENT dapagliflozin, by blocking the SGLT2 receptor, stimulates the alpha cells and increases glucagon secretion,” explained Pattou.

This unexpected effect might at least partially limit the hypoglycaemic effect of this DIABETES TREATMENT, and, for the researchers, justifies the simultaneous administration of other drugs that limit glucagon secretion, such as the sulfonylureas or GLP-1 analogues.

Before it is marketed in France, which is expected in the next few months, this discovery might enable patients receiving this treatment for TYPE 2 DIABETESto optimise its efficacy.

After Surgery?

After Surgery? Gastric bypass surgery is a major abdominal operation and like all other major surgeries can affect a patient well after the surgery is over. Aside form the physical aspects, patients may have trouble adjusting psychologically to their drastic weight loss after the operation.

For example, the rapid change in weight and eating habits can cause problems in a relationship where the partner is also obese and day time activities had previously been orientated around food. Furthermore, people who had attributed their depression or anxiety to being overweight or obese may find that these problems do not automatically resolve just because they have had surgery and LOST WEIGHT.

People who undergo gastric bypass also need to be dedicated to a rigorous new lifestyle plan that can be quite demanding. THEIR DIET will need to be strictly controlled and they will need to engage in exercise regularly if they are to avoid putting the weight back on or experiencing long-term complications.

One physical aspect that can be problematic for patients after surgery is excess skin. The skin does not revert back to the firmness and shape it was prior to the patient becoming obese. Residual skin folds can be upsetting to live with from a cosmetic angle as well as from a hygiene perspective because the folds can develop rashes or become infected. Cosmetic surgery is sometimes considered to remove the excess skin.

Patients need to follow a strict DIET PLAN after surgery and an example diet is given below:

  • In the first week after surgery, patients can only drink liquids and not even pureed food is allowed.
  • Between weeks two and four, around 100g of pureed food can be eaten four to five times a day.
  • Between weeks four and six, soft foods are allowed.
  • After six weeks, a healthy and BALANCED DIET can start to be adopted.

Patients also need to be aware that they must avoid foods that are high in sugar such as cakes, chocolates and sweets because the bypass affects the way sugar is digested. Consumption of foods that are rich in sugar can lead to increase insulin levels. The raised insulin level can cause a collection of symptoms that are collectively referred to as dumping syndrome. These include nausea, vomiting, diarrhea and ABDOMINAL PAIN.

Patients will also need to take vitamin and mineral supplements, as the operation reduces the intestinal absorption of various important food components. Most people are advised to take a multivitamin along with a calcium supplement and an iron supplement.

Examples of exercises patients can start to engage in on a regular basis include walking, cycling and swimming.


5 Things Not to Say to Someone Who’s Had Weight-Loss Surgery


5 Things Not to Say to Someone Who’s Had Weight-Loss Surgery;Weight-loss surgery has always been a topic of conversation and intrigue. After New Jersey Governor Chris Christie underwent Lap-Band surgery (in which a silicone band is placed around the upper part of the stomach to shrink it) in 2013, the media went crazy, questioning how much weight he’d lost, why he didn’t look even thinner, and whether or not he had failed in his efforts to slim down.

Although many weight-loss patients are open about their experiences, there are still some questions that are simply insensitive or inappropriate to ask, whether or not you realize it. Brian Smith, MD, a bariatric surgeon at University of California Irvine, weighs in on some of the most common (and offensive) remarks, and why you should keep your mouth closed.

Don’t say: “You’re so lucky you can eat anything you want now!”

Surgery doesn’t prevent you from gaining weight—it just limits the amount of food your stomach can hold, helping you fill up faster. It also doesn’t grant you a free pass to eat whatever you’d like. In fact, each procedure often carries its own set of digestive restrictions. “Lap-Band patients can’t eat bread because it’s bulky and can get stuck in the stomach, while gastric bypass patients have to be careful with concentrated sweets, because they immediately travel to the small intestine and cause cramping and diarrhoea,” says Dr. Smith. “Even the sleeve gastrectomy, which is a newer and more preferred method, can come with food intolerances, so you really have no idea what issues a person may be dealing with after surgery,” he explains.

Don’t ask: “Why didn’t you just try dieting and exercising?”

Bariatric surgery is not a lazy person’s way of getting out of going to the gym or eating a few veggies. “Many people who seek out surgery do so because of medical conditions that make it difficult or impossible to lose weight, like hypothyroidism, depression, endocrine disorders, or arthritis,” explains Dr. Smith. Even for people without medical issues, weight-loss surgery is generally a last-ditch attempt and reserved only for those with BMIs 35 and over, which is about 100 pounds overweight. “People who decide to undergo weight-loss surgery aren’t taking the easy road—it’s still incredibly hard,” Dr. Smith says. “It takes discipline and courage to go through an invasive procedure, overcome it, deal with post-op recovery, and then start doing cardio for an hour, five times a week, for the rest of your life to maintain your new weight.”

Don’t ask: “Do you have a lot of extra skin?”

This one should be a no-brainer, but unfortunately, it still gets asked. “This is obviously a very personal question that I would refrain from asking, especially if a patient is struggling with their body image or considering having more work done to remove the skin,” says Dr. Smith. And, contrary to what you see on TV or in movies, excess skin isn’t even the expected norm after weight loss surgeries. “Younger people with lower BMIs tend to have less sag and more elasticity, and the minority of patients end up needing to have any form of body contouring post-surgery,” he adds.

Don’t say: “You don’t look like you’ve lost that much weight.”

Weight-loss surgery isn’t a magical makeover that leaves you 80 pounds lighter right out of the hospital; it’s a slow, difficult process that gradually happens over the course of a year. “You’re not actually having any fat removed during the surgery, so you can’t expect a patient to look radically different within a few weeks afterwards,” says Dr. Smith. “We rate the expected weight loss after one year, so if you’re 100 pounds overweight, you’re expected to lose 40-70 pounds after a year, depending on the surgery.” Hopefully, you wouldn’t tell your friend that her extra hours at the gym aren’t paying off, so you shouldn’t mention a patient’s post-op size, either.


Don’t ask: “So you’ll lose weight without having to do anything?”

It’s important to remember that weight-loss surgery is not a quick, magical fix—it’s just a jump start. “Bariatric surgery essentially handicaps you and thrusts you into weight loss, forcing you to adopt a healthier lifestyle,” says Dr. Smith. “No operation will succeed long-term if a patient doesn’t commit to diet and exercise to keep the weight off. So by chalking up a person’s entire weight loss to their surgery, you’re actually robbing them of everything they’ve put themselves through, which is the fight of surgery, the pain, the courage it took to get there, and all the diet and exercise they’ve completed post-surgery,” notes Dr. Smith.

Nutritional concerns during post-op pregnancy

Trying to conceive

Nutritional concerns during post-op pregnancy;Women who become pregnant after bariatric surgery are at high risk for low micro-nutrient levels, especially for vitamins A and B-1 and albumin, according to research published online at PlusOne.

The researchers from the University Hospitals Leuven, Leuven, Belgium, prospectively evaluated micronutrient levels during pregnancy and the effect of a standardised supplementation strategy in pregnant women who have undergone bariatric surgery.

The multi-centre prospective cohort study was conducted from April 2009 until January 2011 at the antenatal clinics of Obstetrics and Gynecology departments in five hospitals in Belgium. Fifty four patients were recruited into the study of which 20 (37%) underwent a restrictive procedure and 34 (63%) a malabsorptive or mixed procedure. One subject suffered a miscarriage and as a result the final analysis was performed on data from 49 women (91% of the originally recruited population).

All subjects were of West-European origin older than 18 years with a medical history of bariatric surgery presenting at the antenatal clinic before 15 weeks amenorrhea were eligible for recruitment.

During the first antenatal visit, all patients were recommended to use a standard prenatal multivitamin supplement. In case of observed micronutrient deficiencies during the first or second trimester and at delivery, the obstetrician provided a prescription for the required supplementation.

Both groups were comparable for age at inclusion, height, mean preoperative weight and the time interval between the surgery and conception. 39% of the women were nullipara and 25% smoked at inclusion. The postoperative weight loss was significantly different between both groups, with the highest weight loss in the malabsorptive group. This resulted in a significantly lower pre-pregnancy weight and body mass index of the malabsorptive group compared to the restrictive group.


The researchers found that during pregnancy there was a decline in mean vitamin A concentration was observed (p=0.037) and was comparable in both groups, but the concentration in the restrictive group was consistently lower than in the malabsorptive group (p = 0.034).

Another blood marker that declined significantly during pregnancy was vitamin B-1 (p=0.018), without a difference between groups. A significant time by group interaction (p=0.004) was noted for vitamin B-12: in the restrictive group the mean concentration decreased, whereas the mean concentration in the malabsorptive group increased.

Ferritin and hemoglobin levels declined significantly during pregnancy (p=0.001 and p=0.002 respectively). A last blood marker that declined during pregnancy was albumin (p = 0.001). The mean concentration of albumin also differed between groups with the lowest mean concentration in the restrictive group (p=0.004). No significant changes during pregnancy, group difference or time by group interactions were observed for folic acid, alanine aminotransferase levels and for vitamin D and vitamin E levels.

Table 1 summarizes the association between supplement intake and micronutrient deficiency across the different pregnancy trimesters. The majority of women who had a micronutrient deficiency in the first pregnancy trimester reported to already take a supplement at that time (n=37/40, 92.5%, p=0.380).

Table 1: Association between supplement intake and micronutrient deficiency across the different pregnancy trimesters.

Of the 45 women with a micronutrient deficiency in the second pregnancy trimester, and with corresponding data on self-reported supplement intake in the first trimester, 41 women (n=41/45, 91.1%) was taken a supplement in trimester one of pregnancy (p=0.273). No association was found between micronutrient deficiency in trimester two and supplement intake in that same period (p=0.377).

Also no associations were seen between micronutrient deficiencies at birth and self-reported supplement intake during trimester one and two of pregnancy (p=0.668 and p=0.839) and at birth (p=0.545). Again, the majority of women with a micronutrient deficiency at birth reported to take a supplement during trimester one (n=38/43, 88.4%), trimester two (n=38/41, 92.6%) and around the moment of birth itself (n=33/41, 80.5%).

During the first trimester, almost 90% of the pregnant women reported to take a supplement (n=44). A multivitamin was taken by 28 (57.1%) women and an iron supplement by 10 women (20.4%). During the second trimester, multivitamins were taken by 10 (20.4%) women. Fourteen women (29.1%) took a vitamin B-12 supplement and 6 (12.5%) women an iron supplement. At delivery, a multivitamin, an iron supplement and a vitamin B-12 supplement were taken by respectively 4 (8.2%), 24 (50.0%) and 11 (22.9) women.

There was one case of pre-eclampsia and one of woman was diagnosed with gestational diabetes in the malabsorptive group. Two patients were diagnosed with PIH in the restrictive group and three in the malabsorptive group. Mean birth weight was significantly lower in the malabsorptive group (3.06±0.56) compared to the restrictive group (3.43±0.47) (p=0.024). There was one preterm birth (<37 weeks of gestation) in the restrictive group and four in the malabsorptive group (p=0.639). No low birth weight was detected in the restrictive and two in the malabsorptive group (p=0.526). Besides the miscarriage and the termination of pregnancy due to the diagnosis of neural tube defect mentioned earlier, two more relevant adverse events occurred. Two patients of the malabsorptive group were diagnosed with a small bowel obstruction (Table 2).

Table 2: Maternal and neonatal outcomes.

Most micronutrients were depleted and declined significantly during pregnancy.

The proportion of women with low vitamin A and B-1 levels increased to respectively 58 and 17% at delivery (p=0.005 and 0.002). The proportion of women with vitamin D deficiency decreased from 14% at trimester 1 to 6% at delivery (p=0.030).

Mild anaemia was found in respectively 22 and 40% of the women at trimester one and delivery. In the first trimester, most women took a multivitamin (57.1%). In the second and third trimester, the majority took additional supplements (69.4 and 73.5%). No associations were found between supplement intake and micronutrient deficiencies.

“We show that women undertaking pregnancy after bariatric surgery are at high risk for low micronutrient levels, especially for vitamins A and B-1 and albumin,” the authors note. “Our results need to be carefully interpreted in the light of both the physiological pregnancy changes in absorption and metabolism, as well as the specific alternations due to obesity surgery.”


Pearls of Wisdom – Event at The Oyster Box

We recently held a very successful presentation on Bariatric Surgery entitled Pearls of Wisdom on Weight-Loss Surgery at the Oyster Box ( see what we did there- Pearls of Wisdom + Oyster Box…clever don’t you think so too!) Have a look at some photos of this gala event : pearls-of-wisdom-event-at-the-event-at-oyster-box

Weight -Loss Surgery Advice

pearls of wisdom

Article By Karmen Redman

November 2014

Weight -Loss Surgery Advice; My advice to someone considering weight loss surgery is to do the research and talk to other people who have had the surgery; this helped me considerably in making my decision to have bypass surgery done.

The surgery has changed my life forever and in need I will make the same decision in a heartbeat, my health, self confidence, energy levels and love for life has become so much more.

My surgery was done in May 2012; I have lost 45kg and feel great. The most important lesson I have learnt is to make sure I take my supplements!


My ADVICE, it’s your life, it’s your decision…….take it!

Gastric Bypass Family

BETWEEN the three of them they’ve lost 182 kilograms –the equivalent of 18 large sacks of potatoes or the combined weight of three average-size women. For years Charmaine Schwenn,her husband, Barry Todd, and mother, Marie, tried every diet under
the sun but the weight just kept piling on.Fed up and at their wits’ end, one by one
they took the drastic decision to undergo gastric bypass surgery.

Click the link :Gastric bypass family

gastric bypass family

Bariatric-Surgery-for-obesityObese youths have a nearly six fold risk of hypertension, according to research in more than 22 000 young people from the Prevention Education Program (PEP) Family Heart Study presented at European Society of Cardiology Congress by Professor Peter Schwandt from Germany.

“The prevalence of hypertension and obesity in children and adolescents is continuing to rise in most high and middle-income countries,” said Professor Schwandt. “Because adiposity is considered a driving force for cardiovascular disease, we examined whether elevated blood pressure was associated with body fat distribution in young people.”

The current study included 22,051 children and adolescents from the PEP Family Heart Study. In each participant, the researchers measured blood pressure, BMI, waist circumference (WC), waist-to-height ratio (WHtR), skinfold thickness (SFT) and percent body fat (%BF).

Prehypertension was defined as a blood pressure reading between the 90th and 95th percentile of the blood pressure curve for children and adolescents, while hypertension was a blood pressure reading over the 95th percentile. The diagnosis was based on several measurements on separate days and on repeated estimations with the child sitting quietly for five minutes. The researchers used an adequate cuff size for the arm in the correct position.

The researchers found that compared with normal weight children and adolescents, the risk of prehypertension was significantly higher in youths with an elevated BMI. The risk was 1.6 fold higher in overweight and 2.4 fold higher in obese boys, and 1.8 fold higher in overweight and 3.3 fold higher in obese girls.

The significant associations with adverse fat patterning were even stronger for the risk of hypertension. In obese boys the odds ratio (OR) was 5.9 and in obese girls 4.3.

“We found that obese boys had a nearly six fold increased risk of hypertension compared to normal weight boys,” he added. “In obese girls the risk was more than four times greater than their normal weight counterparts.”

The prevalence of elevated blood pressure increased in boys and girls as body weight went up. The prevalence of prehypertension /hypertension in normal weight, overweight and obese youths was 13.2%/5.7%, 18.3/10.4% and 21.9/18.6% in boys and 12.9/5.0% 18.7/9.1% and 24.9/24.4% in girls, respectively.

“Our study clearly shows that the fatter young people are, the greater their risk of prehypertension and hypertension. Any weight loss they can achieve will help reduce their risk,” Professor Schwandt concluded. “General and abdominal adiposity, estimated using simple and inexpensive methods, are already significantly associated with prehypertension and hypertension in children and adolescents. This is of great importance because of the ongoing rise in the prevalence of hypertension and overweight/obesity in young people and the tracking of childhood overweight into adulthood.”

Taking the bypass route

September 25 2013 at 12:50pm

iol lif sep 23 bypass nd barry todd after.jpg


WEIGHTY: Barry Todd has lost 55kg since his bariatric surgery.

Durban – With 10 percent of men and 28 percent of women being classified as morbidly obese, South Africa has a weighty problem on its hands. For those who have notched up countless failed attempts at losing excess kilos, weight loss surgery seems an attractive option.

The Bariatric Centre of Excellence at Netcare St Augustine’s Hospital in Durban has done 111 surgeries since it opened in 2006. It has a high success rate of sustained weight loss as well as an impressive reduction in conditions like diabetes, hypertension, sleep apnoea.

The procedure favoured by surgeons at the centre is the gastric bypass, in which a small pouch is created from the stomach and linked to the small intestine, bypassing the larger part of the stomach and duodenum. The patient feels full after eating small quantities of food, resulting in dramatic weight loss.


As with any surgery, there is a risk of complications, and even death, but for most people who undergo the procedure, the outcome is life-changing.

“It is a very effective method of weight loss and there is an 80 percent cure rate for type 2 diabetes because of its effect on the endocrine system,” says Dr Gert du Toit, one of two surgeons at the centre.

iol lif sep 23 bypass nd barry todd before.jpg (1)

He tipped the scales at 147kg.


“The bypass also affects the ‘hunger hormone’ ghrelin, which is produced when food passes through the stomach and duodenum. When food no longer passes through these areas, patients don’t feel as hungry.”

About 80 percent of bariatric patients have good weight reduction, with an average loss of between 40 percent and 70 percent of excess weight between one and four years. Research findings show that 60 percent of surgery patients continue to maintain the 50 percent level of weight loss over five to 10 years, while many other weight loss methods have higher relapse rates.

Besides improving and even normalising blood glucose levels, hypertension and sleep apnoea, there is also some evidence of improved heart function. Patients report improvements in mobility and stamina as well as mood, self-esteem and quality of life.

“The procedure takes two to four hours and the patient is discharged on about the fourth day,” says Dr Ivor Funnell. “A good patient will lose 10kg a month. Older patients and those with diabetes lose a bit more slowly. The body eventually reaches an ideal weight and does not go beyond that.”

It is possible for the pouch to stretch and the weight can be regained if the patient does not adhere to the maintenance diet instructions so ongoing monitoring is important.

Professor Tess van der Merwe, chief executive of the Centres of Excellence for Metabolic Medicine and Surgery of South Africa and chairwoman of the SA Society for Obesity and Metabolism, warns that this is not a cure-all for obesity – it is also to address a metabolic and endocrine problem.

“Before a patient is accepted for surgery, he or she must be assessed by an endocrinologist and physician,” she says.

“Not all obese patients are suitable surgical candidates and it requires an experienced team of experts qualified in obesity management to assess these patients before and after their surgery.”

Colleen Smith, 54, of Pinetown had a gastric bypass in November after many years of failed dieting attempts and lost 48kg. She is ecstatic with her slim physique, improved self-confidence and energy – but says it is not easy.

“Don’t let anyone tell you it is easy,” she says. “It is hard. For me, the operation was the easy part. I had no pain and I recovered quickly – but the psychological side has been difficult. Your head tells you to eat but your stomach won’t let you.”

Colleen has, however, got used to eating less. Gone are English breakfasts and hearty restaurant meals. These days, breakfast is half a cup of cereal, lunch is three-quarters of a cup of salad and dinner is half a chicken breast.

She, like other bariatric patients, must take multivitamins to compensate for the nutrients she misses out on by not eating a full diet.

Another happy loser is Barry Todd, 38, of Durban, whose wife, Charmaine Schwenn, lost 70kg with a gastric bypass in 2006.

Todd tipped the scales at 147kg, had dangerously high blood pressure and two slipped discs.

“I had gained a lot of weight and had become a bit of a food addict,” he says. “When you are an alcoholic, you can stop drinking alcohol, but as a food addict, you have to eat. We used to go out to dinner up to 10 times a week and I would nibble constantly at home.”

Since his bariatric surgery in April last year, Barry has lost 55kg.

“Our lives have changed for the better. We eat differently now and get full quickly so there is no chance of overeating.

“Before I had the operation I was almost immobile – I was two days away from having an operation to fuse discs in my back. Now I am active, I have no back or knee pain and I have more energy. It really has been worth it.”

Before a patient is accepted for metabolic surgery, strict criteria have to be met. Patients must have tried repeatedly to lose weight by conventional methods, they must have a body mass index (BMI) of greater than 40, or a BMI of greater than 35 with serious co-morbid conditions (such as diabetes, high blood pressure, heart disease risk etc). They must be between 16 and 65 years and be committed to a prolonged lifestyle change that involves long-term follow-up. They are also assessed by a panel that includes a dietitian and a psychologist.

Counselling psychologist Michael Urbasch says patients need to understand that there will be major lifestyle changes.


“They need to be adaptive,” he says. “Whether they have good social support and how the patient’s weight will affect their relationships are all factors that have to be considered. They need to have insight into how they became obese.”

Registered dietitian Mandy Read, who deals with bariatric patients, says patients are on fluids for two weeks after surgery, then purees and gradually progressing to normal foods. Certain items, such as fizzy drinks, popcorn, nuts, are not allowed back into the diet.

Bariatric surgery is available on a limited basis in the state health sector, where only the gastric sleeve procedure is done.

Du Toit and Funnell believe the number of surgeries would be far higher if funding were more easily available. Only a few medical aids fund the full cost, with some paying a portion of it.

Colleen, who weighed 117kg when she went for her first consultation, was prepared to go ahead whatever the cost. After being turned down by her medical aid, she and her husband Roy paid for the operation which cost R127 000, pending an appeal. They were successful and their medical aid refunded 80 percent of the cost. – Daily News

A New Look Website For Us…and perhaps a New You in 2014


If you are a regular visitor to our website no-doubt you would have noticed a fresh new look and some awesome new features we have added:

  1. Read All About the Success Stories of some of the Bariatric Patients of both Dr Gert du Toit and Dr Ivor Funnell Success Stories
  2. We will also be publishing a Monthly Newsletter – Please feel free to subscribe and receive great advice from our team of professionals and Post and Pre-Surgery Patients on what to do before and after having Bariatric Surgery.
  3. Join our Support Group on Facebook and start a conversation about your personal Journey after weight-loss surgery Connect with Us on Facebook
  4. Get involved in helping each other along the journey Join Our Monthly Support Group Meetings
  5. St Augustine Hospital is our Bariatric Center of Excellence – we offer world class facilities and our Netcare Staff are counted among the best in South Africa

Genetic link between carbohydrate digestion and obesit

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Every additional copy of the salivary amylase gene there was approximately a 20% decrease in the odds of becoming obese

Tuesday, April 22, 2014 – 17:26

Owen Haskins – Editor in chief, Bariatric News



Obesity in the general population may be genetically linked to how our bodies digest carbohydrates according to research published in the journal Nature Genetics. The study investigated the relationship between body weight and a gene called AMY1, which is responsible for an enzyme present in saliva known as salivary amylase. This enzyme is the first to be encountered by food when it enters the mouth, and it begins the process of starch digestion that then continues in the gut.

“I think this is an important discovery because it suggests that how we digest starch and how the end products from the digestion of complex carbohydrates behave in the gut could be important factors in the risk of obesity,” said Professor Philippe Froguel, Chair in Genomic Medicine in the School of Public Health at Imperial College London, and one of the lead authors on the study. “Future research is needed to understand whether or not altering the digestion of starchy food might improve someone’s ability to lose weight, or prevent a person from becoming obese. We are also interested in whether there is a link between this genetic variation and people’s risk of other metabolic disorders such as diabetes, as people with a low number of copies of the salivary amylase gene may also be glucose intolerant.”

People usually have two copies of each gene, but in some regions of our DNA there can be variability in the number of copies a person carries, which is known as copy number variation. The number of copies of AMY1 can be highly variable between people, and it is believed that higher numbers of copies of the salivary amylase gene have evolved in response to a shift towards diets containing more starch since prehistoric times.

Researchers from Imperial College London, in collaboration with other international institutions, looked at the number of copies of the gene AMY1 present in the DNA of thousands of people from the UK, France, Sweden and Singapore. They found that people who carried a low number of copies of the salivary amylase gene were at greater risk of obesity.

The chance of being obese for people with less than four copies of the AMY1 gene was approximately eight times higher than in those with more than nine copies of this gene. The researchers estimated that with every additional copy of the salivary amylase gene there was approximately a 20 per cent decrease in the odds of becoming obese.

“Previous genetic studies investigating obesity have tended to identify variations in genes that act in the brain and often result in differences in appetite, whereas our finding is related to how the body physically handles digestion of carbohydrates,” said Dr Mario Falchi, also from Imperial’s School of Public Health and first author of the study. “We are now starting to develop a clearer picture of a combination of genetic factors affecting psychological and metabolic processes that contribute to people’s chances of becoming obese. This should ultimately help us to find better ways of tackling obesity.”

The first step of the study involved the analysis of genetic data from a Swedish family sample of 481 participants, recruited on the basis of sibling-pairs where one was obese and the other non-obese. The researchers used these data to short-list genes whose copy number differences influence BMI, and identified the gene coding for the enzyme salivary amylase (AMY1) as the one with the greatest influence on body weight in their analysis.

They then investigated the relationship between the number of times the AMY1 gene was repeated on chromosome 1 in each individual and their risk of obesity, by studying approximately 5,000 subjects from France and the UK.

The researchers also expanded their study to include approximately 700 obese and normal-weight people from Singapore, and demonstrated that the same relationship between the number of copies of the AMY1 gene and the risk of obesity also existed in non-Europeans.

“Previous studies have found rare genetic variations causing extreme forms of obesity, but because they occur in only a small number of people, they explained very little of the differences in body weight we see in the population,” said Dr Julia El-Sayed Moustafa, another lead author from Imperial’s School of Public Health. “On the other hand, research on more common genetic variations that increase risk of obesity in the general population have so far generally found only a modest effect on obesity risk. This study is novel in that it identifies a genetic variation that is both common and has a relatively large effect on the risk of obesity in the general population. The number of copies of the salivary amylase gene is highly variable between people, and so, given this finding, can potentially have a large impact on our individual risk of obesity.”

Benefits of Weight Loss Surgery

Severe obesity is a chronic condition that is very difficult to treat. For some people, weight loss surgery — or bariatric surgery — helps by restricting food intake or interrupting digestive processes. But keep in mind that weight loss surgery is a serious undertaking. You should clearly understand the pros and cons associated with the procedures before making a decision.

In order to understand how weight loss works, you need to first understand how the normal digestive process functions.bariatric-surgery1

Normally, as food moves along the digestive tract, appropriate digestive juices and enzymes arrive at the right place and at the right time to digest and absorb calories and nutrients. After we chew and swallow our food, it moves down the esophagus to the stomach, where a strong acid continues the digestive process. The stomach can hold about 3 pints of food at one time. When the stomach contents move to the duodenum, the first segment of the small intestine, bile and pancreatic juices speed up digestion. Most of the iron and calcium in the foods we eat is absorbed in the duodenum. The jejunum and ileum, the remaining two segments of the nearly 20 feet of small intestine, complete the absorption of almost all calories and nutrients. The food particles that cannot be digested in the small intestine are stored in the large intestine (made up of the ascending colon, transverse colon, descending colon, sigmoid colon, and rectum) until eliminated.

Obesity surgery involves making changes to the stomach and/or small intestine

Benefits of Weight Loss Surgery

The primary benefit of weight loss surgery is easy to understand: weight loss!

  • Gastric bypass surgery causes an average loss of 61% of excess weight.
  • Gastric banding surgery causes slightly less — an average of 47% of excess weight lost.

Improvements in general health are also common. Obesity-related medical conditions usually improve or even go away after weight loss surgery, including:

  • Diabetes
  • Severe arthritis
  • Obstructive sleep apnea
  • High blood pressure

About 95% of people report improved quality of life after weight loss surgery. Some studies also suggest people live longer after weight loss surgery, compared to equally obese people who do not have surgery

Do you need Bariatric Surgery? Don’t have Medical Aid…


Losing weight isn’t easy — and for many severely overweight people, exercise and diet simply aren’t effective enough to shed significant weight. When all else has failed, many people start thinking about weight loss surgery, also called bariatric surgery.

You likely have questions about financing weight loss surgery — the costs involved, what is covered by insurance, and how to convince your insurance to cover weight loss surgery.

Incred Medi-Finance understand how much an elective medical procedure can change lives for the better but we know that these procedures can be costly and are not always covered by medical aid. That’s why we’re here.

  • We Provide medical loans for a variety of medical and cosmetic surgery procedures
  • Easy repayment terms with competitive interest rates
  • No down payments or early settlement penalties
  • Simple, easy to complete application

Take the next step… to making your life Incredible again!

Incred Medical Finance offers loans between R10,000 and R150,000 at interest rates of between 18% and 28% p.a. Loan terms are between 6 months and 36 months.

All you need to do is complete an application form and send us the following supporting documents:

  1. Most recent 3 months bank statements
  2. Copy of ID document
  3. Most recent salary slip
  4. Proof of residential address (phone account or utility account)

We will assess your application within 48 hours and get back to you.

All the medical or financial information supplied to Incred is treated in the strictest of confidence.

If your medical loan is approved we would pay the doctor/hospital on your behalf and then deduct a monthly debit order from your bank account as a repayment.
You may choose any doctor to perform your procedure, the doctors on our panel are there for your convenience only.

Now you can easily afford that procedure!

Here are some of our most popular procedures. If you can’t find what you’re looking for please browse through our “Procedures” pages.

Remember – we offer finance for ALL medical procedures, not just those listed on the website, so feel free to give us a call if you have any questions.

Gastric bypass is a surgery that helps you lose weight by altering the way your stomach and the small intestine handles the intake of food. Your stomach is made smaller and you become fuller after consuming less. This procedure is performed to ensure maximum weight loss. If you are overweight and would like to consider gastric bypass surgery, consult your doctor or specialist to ensure you are ready for this procedure. Your doctor will look at the several factors of your medical condition to decide if you are suitable for gastric bypass surgery. Gastric bypass surgery can vastly improve your quality of life.

More Information >>

Bariatric Support Group Secrets

Bariatric Support Group Secrets – What I Learned as a Support Group Leader

by Sarah Muntel, RD



relaxation time #2

Every bariatric center has them. Bariatric surgeons talk about them. Patients promise to go. When it is all said and done, there are many more patients that do not attend support group than those who do. Studies show those who attend groups on a regular basis have a better weight-loss. So what goes on in those groups and what makes them special?


I am a registered dietitian and have been a support group leader for more than 12 years. With all the groups I’ve attended and lead, I’m here to tell you exactly what goes on and why you should clear your schedule to make them part of your life.



Let’s first talk about why people don’t go. Even though I’ve distributed hundreds of schedules, calendars and newsletters, there are a large number of patients who don’t attend. Here are the top reasons why people don’t attend:


1. “My schedule is too hectic.”

People have a lot going on in their lives between work, home and social activities. Most of the time, their schedule becomes busier as they lose weight. It’s so important to make your health a priority. Successful patients tell me they decide to let other things in their life slide so they can fully focus on their program. For example, the laundry may sit an extra day, so they can attend an evening support group.


2. “I feel like an outsider.”

It can be intimidating as you walk into a group who seem to all know each other. Everyone seems to be chatting away like they are old friends. Know that the more you come, the more you’ll meet people and get comfortable. The first step is walking in the door. At each group, you will find many other first-timers as well, and the old-timers who love to tell their story to the new people. It’s easy to get comfortable when you go.


3. “I’m doing well, so I don’t need them.”

When you are doing well, it’s easy to say you don’t need it, but you do need to know that there will be bumps in the road. As you hit those bumps in the road, the support you have at group can give you the inspiration to continue. Even if you feel like you don’t need it now, you will need it at some point. Make it a priority to get your support system together in the beginning.



My favorite part of support group is the patient relationships that form. Most people have support at home with family or friends, which is great. There is a difference between that support and the support you get from someone who’s been in the same situation you are in with weight. The bonds people form at group are strong. When you see the same people week after week, you become friends. Many feel so connected they stand and talk in the parking lot for more than an hour when group is over or arrange to get together and walk or shop during the week.


Sometimes relationships change after surgery. New friends can easily be found at support group. There is something to be said about connecting with someone who is in the exact same situation you are.



Support groups offer a “safe place.” Support group is a place where anything goes and you aren’t judged. Patients feel like they can openly talk about what’s going on in their life and what they’re struggling with. Recently at a support group, the topic went to the discussion of being off track. Patients were able to share their struggles. So many people had the same struggles. The ones who weren’t struggling were able to offer support. In a room full of 20 to 30 post-op patients, you can get great ideas and suggestions that have all worked for them in the past.


As a group leader, sometimes I feel like I only need to sit and observe as one person tells another to stop making poor food choices or take their calcium every day. The next time they see each other, they ask how they’ve been doing making the changes they talked about the previous week.



Support groups can offer education. Bariatric surgery can be like a foreign language when you start. There is so much to learn! You can’t possibly soak it all up in your follow-up appointments. Many groups are education-focused where you can learn about food choices, meal plans, vitamins and fluid guidelines. For those patients who think they know all the basics, remember, bariatric surgery is a growing field. As surgeries change and research is found, recommendations change. Patients who attend are aware of the newest up-to-date recommendations. Throughout the years, meal plans and vitamin recommendations change. This information is vital for health, and coming to group assures you get the latest information.


At Support group, you learn the tricks that you don’t learn in the books. There are books about bariatric surgery and health professionals that also help you along the road. All of this is very important information. Support group can offer you ideas not found in the book. Patients share tricks that work for them. For example, at support group, you can learn what the best tasting protein supplement is, where to buy your calcium citrate and how you really feel after surgery. The things you hear at group are things you don’t hear from the professionals but are invaluable.



Support group is a time during the week that you think about your surgery and your progress. Life is busy and people get overwhelmed with work, kids and other commitments. Sometimes your surgery and your program take a backseat. When your surgery takes a backseat, your program can slip. Coming to support group can give you a shot in the arm and you will become refocused. Some patients say support group is like going to church!


Banding patients must adhere to nutritional advice

Gastric banding patients do not meet recommended daily requirements for important nutrients such as protein, vitamin D and calcium, despite receiving nutritional counselling over a three-month period, according to the outcomes of a study by UT Southwestern Medical Center researchers.Gastric Band

“Our study clearly shows that there are issues regarding nutritional intake in gastric banding patients,” said Dr Abhimanyu Garg, Chief of the Division of Nutrition and Metabolic Diseases at UT Southwestern and senior author of the study. “They may need not only supplementation, but also counseling and constant evaluation.”

The study, published in the Journal of Investigative Medicine, assessed whether dietary counselling improves micronutrient and macronutrient intakes for gastric banding patients.

The researchers followed 23 gastric banding patients who received dietary and behavioural counselling for 12 weeks to limit energy intake and improve nutrient intakes. Food intake was assessed by three-day food record at baseline and six and 12 weeks.


At baseline, more than 50% of the subjects reported inadequate dietary intakes of 13 nutrients but overconsumption of sodium and percent energy from saturated and trans–fatty acids.

After 12 weeks, the investigators found that the patients had a significant reduction in energy (Pp=0.0007), absolute protein (p=0.04), cholesterol (p=0.045), and potassium (p=0.01) intake and an increase in vitamin K (p=0.03) intake and percent energy from protein (p=0.005).

In addition, a McNemar test showed a reduction in the proportion of the subjects with an inadequate intake of vitamin K (p=0.008) but an increase in the proportion of the subjects with an inadequate intake of thiamin (p=0.03) at 12 weeks.

Although there were some improvements in nutrition over the test period, the study participants still had nutritional deficiencies. At least 86 percent did not meet recommended requirements for calcium and vitamin D and many were slightly anaemic at 12 weeks.

The authors note that a proportion of the subjects who did not meet the nutrient requirements for the remaining 27 nutrients was ‘generally high and remained unchanged’.

“Over the past 10 years, the popularity of bariatric surgery has escalated. In banding surgery, it’s presumed there aren’t as many nutritional precautions needed as with some more invasive bariatric surgery options,” said Garg. “But what the study showed is that many banding patients are prone to nutritional deficiency post-surgery, despite taking supplements and receiving nutritional counselling.

Garg recommended that patient’s consume more protein-rich foods to meet the body’s daily protein requirement and to increase the intake of vitamins and minerals as well. Tis includes fatty fish in the diet to increase the intake of omega-3 fatty acids, as well as more fruit, vegetables, whole grains, and nuts to boost dietary fibre intake.

He added that the results results indicate that nutritional counselling beyond 12 weeks is warranted in banding patients to improve their dietary nutrient intakes.

Can Adolescents have Bariatric Surgery?

Idownload (2)n the past, weight loss surgery, was typically reserved for individuals who are over 18 years old and sometimes the requirements are much older than that. Now, as the whole world grows fatter, children are taking the blunt force of this trend. Today the rates of children who are obese are growing at an increasing rate, 18.1% of persons aged 12 to 19 are obese, up from 5% 28 years ago. This trend is alarming many in the medical field, as many bariatric surgeons are being inundated with requests from young persons to consider bariatric surgery.

Bariatric physicians  are extremely reluctant to perform bariatric surgery on teens and adolescents as there are numerous risks and side effects from the procedure. Bariatric surgery is reserved, or should be, only for the extreme cases that require lifestyle modification and medical treatment. Typically from the cases that show the greatest sign of strenuous health risks.

Many teens want to jump right into bariatric surgery, but in many cases a referral from their primary care physician is required and most times hard to get. Thus, primary care physicians are an important piece of the puzzle.

In the spring of 2007 the results of a nationally administered survey regarding bariatric surgery and teens was published. Many family physicians and paediatricians responded to a survey regarding bariatric surgery and teens, and nearly half of the doctors (48%) said they would never recommend bariatric surgery for persons under 18. An overwhelming 99% of respondents said that children who are considering bariatric surgery should be enrolled in a monitored weight management program before surgery. The program will help define the extent of the obesity and whether that person is a satisfactory applicant for surgery. The theoretical program will last between three months and over five years, with the average stating that 12 months of monitored treatment was desired.


Options for Overweight and Obese Children


Unless you’re an extreme case, bariatric surgery will not be an option until you grow older, assuming you met all the requirements.   Other options will be the more traditional approaches to obesity, which are exercise programs and dieting.   Since physicians want to see candidates in monitored programs for about a year, their rationale is that with traditional forms of dieting and exercise, obese children will be able to lose weight.  With mentoring, support and monitoring, overweight children should lose weight in the healthiest way possible.

Post-Bariatric Surgery Life Style Changes

Life after Bariatric Surgery
Bariatric surgery is not a quick fix. It’s an ongoing journey toward weight loss through lifestyle changes. After surgery, the difference in your body makes it physically easier to adjust your eating and lifestyle habits. Fortunately, you will not have to go through the process alone. A team of professionals will be there to support your efforts. Positive changes in your body, your weight, and your health will occur, but you will need to be patient through the recovery process.

 Diet After Bariatric Surgery
The changes made to your gastrointestinal tract will require permanent changes in your eating habits that must be followed for successful weight loss in your new life after bariatric surgery. Postsurgery dietary guidelines will vary by bariatric surgeon. You may hear about postsurgery guidelines different from the ones you receive. It is important to remember that these guidelines will be different depending on the surgeon and type of procedure. What is most important is that you follow your surgeon’s guidelines. The following are some of the generally accepted dietary guidelines for a healthy diet after bariatric surgery:2422005

  • When you start eating solid food, it is important to chew your food thoroughly and eat very slowly. It is important to wait two to three minutes after swallowing before putting the next bite of food in your mouth. You will not be able to digest steaks or other chunks of meat if they are not ground or chewed thoroughly.
  • Don’t drink fluids while eating. They will make you feel full before you have eaten enough food. Fluids consumed with meals can cause vomiting and dumping syndrome, and can lead to feeling hungry sooner after a meal.
  • Don’t eat desserts and other items with sugar if they have more than 3 to 5 grams per serving size.
  • Avoid carbonated drinks, high-calorie nutritional supplements, milk shakes, foods high in fat, and foods that have no nutritional value.
  • Avoid alcohol.
  • Limit snacking between meals. Eating after bariatric surgery will be much different than before!

 Going Back to Work After Bariatric Surgery
Your ability to resume pre-surgery levels of activity will vary according to your physical condition, the nature of the activity and the type of weight loss surgery you had. Most patients return to work and are able to exercise within one to three weeks after their laparoscopic gastric bypass. Patients who have had an open procedure do so about six weeks after surgery.

 Birth Control and Pregnancy
It is strongly advised that women of childbearing age use the most effective forms of birth control during the first 16 to 24 months after weight loss surgery. The added demands pregnancy places on your body and the potential for fetal damage make this a most important requirement.

 Long-Term Follow-Up after Bariatric Surgery
Although the short-term effects of weight loss surgery are well understood, there are still questions to be answered about the long-term effects on nutrition and body systems. Nutritional deficiencies that occur over the course of many years will need to be studied, and can depend on your diet after bariatric surgery. Over time, you will need periodic checks for anemia (low red blood cell count) and Vitamin B12, folate and iron levels. Follow-up tests will be conducted at least yearly and more often as indicated.

 Life After Bariatric Surgery; Support Groups
The widespread use of support groups has provided weight loss surgery patients an excellent opportunity to discuss their various personal and professional issues. Most learn, for example, that weight loss surgery will not immediately resolve existing emotional issues or heal the years of damage that morbid obesity might have inflicted on their emotional well-being. Our surgeons have support groups in place to assist you with short-term and long-term questions and needs, including the most effective exercise and diets after bariatric surgery. Most bariatric surgeons who frequently perform weight loss surgery will tell you that ongoing post-surgical support helps produce the greatest level of success for their patients in their life after bariatric surgery.

Obese SA man too fat for New Zealand

tinnitus-s15-photo-of-obese-personWellington – An obese South African man has been told he is too fat to live in New Zealand despite shedding 30kg since he moved to the country six years ago, a report said on Saturday. Albert Buitenhuis – who now weighs 130kg – and his wife, Marthie, said they face deportation after an application to renew their work visas was rejected because of his weight.

Immigration New Zealand (INZ) cited the demands his obesity could place on New Zealand health services and said their medical assessors deemed Albert no longer “had an acceptable standard of health”. The couple said they moved from SA to the main South Island city of Christchurch six years ago when Albert weighed 160kg and their annual work visas were renewed without any problem. “We applied for year after year and there were no issues. They never mentioned Albert’s weight or his health once and he was a lot heavier then,” Marthie said. “The irony is that at the moment he weighs less than when we first arrived in New Zealand and also less than in his first medical, which was accepted by INZ.” An INZ spokesperson said Buitenhuis was rejected because his obesity put him at “significant risk” of complications including diabetes, hypertension, heart disease and obstructive sleep apnoea. “It is important that all migrants have an acceptable standard of health to minimise costs and demands on New Zealand’s health services,” he said.

A recent OECD report listed New Zealand as the third most obese developed nation behind the US and Mexico.


The Durban Bariatric Surgery Support Group

The Durban Bariatric Surgery Support Group is a safe place for the bariatric population or those considering bariatric surgery, to go for support, acceptance, understanding, encouragement, empowerment and information.

The mission of this group also includes having a very active group, forming friendships and gathering for chats on our Face book page: time #2

We strongly desire and encourage participation from our members. That is how we can truly make an impact in others lives & our own…by really being here for each other!

After weight-loss surgery, new gut bacteria keep obesity away

(Reuters) – The logic behind weight-loss surgery seems simple: rearrange the digestive tract so the stomach can hold less food and the food bypasses part of the small intestine, allowing fewer of a meal’s calories to be absorbed. Bye-bye, obesity.

A study of lab mice, published on Wednesday, begs to differ. It concludes that one of the most common and effective forms of bariatric surgery, called Roux-en-Y gastric bypass, melts away pounds not – or not only – by re-routing the digestive tract, as long thought, but by changing the bacteria in the gut.


Or, in non-scientific terms, the surgery somehow replaces fattening microbes with slimming ones.


If that occurs in people, too, then the same bacteria-changing legerdemain achieved by gastric bypass might be accomplished without putting obese patients under the knife in an expensive and risky operation.


“These elegant experiments show that you can mimic the action of surgery with something less invasive,” said Dr. Francesco Rubino of Catholic University in Rome and a pioneer in gastric-bypass surgery. “For instance, you might transfer bacteria or even manipulate the diet” to encourage slimming bacteria and squelch fattening kinds, said Rubino, who was not involved in the study.




For many obese patients, particularly those with type 2 diabetes, gastric bypass has succeeded where nothing else has. Severely obese patients routinely lose 65 to 75 percent of their excess weight and fat after the operation, studies show, and leave their diabetes behind.


Oddly, however, the diabetes remission often occurs before significant weight loss. That has made bypass surgeons and weight-loss experts suspect that Roux-en-Y changes not only anatomy but also metabolism or the endocrine system. In other words, the surgery does something besides re-plumb the gut.


That “something,” according to previous studies, includes altering the mix of trillions of microbes in the digestive tract. Not only are the “gut microbiota” different in lean people and obese people, but the mix of microbes changes after an obese patient undergoes gastric bypass and becomes more like the microbiota in lean people.


Researchers did not know, however, whether the microbial change was the cause or the effect of post-bypass weight loss.


That is what the new study, by researchers at Massachusetts General Hospital and Harvard University, set out to answer.


They first performed Roux-en-Y on obese mice. As expected, the animals quickly slimmed down, losing 29 percent of their weight and keeping it off, the researchers report in the journal Science Translational Medicine.


To make sure there was not something about the general experience of surgery, rather than gastric bypass specifically, that affected the animals, the scientists performed “sham” Roux-en-Y on other obese mice. In this procedure, the researchers made incisions as if they were going to do a gastric bypass, but instead connected everything up as nature had it.


The researchers then transferred gut microbiota from the Roux-en-Y mice to microbe-free obese mice. Result: the recipient mice lost weight and fat – no surgery required. Crucially, obese mice that received gut bugs from mice that had received sham Roux-en-Y, not the real thing, did not slim down.


It is the first experimental evidence that changes in the gut microbiota cause the weight loss after gastric bypass, and that the new, post-bypass mix of microbes can cause weight loss in animals that did not have surgery.


In particular, just a week after surgery the Roux-en-Y mice harbored relatively more of the same types of bacteria that become more abundant in people after gastric bypass and that lean people have naturally.


“The effects of gastric bypass are not just anatomical, as we thought,” said Dr. Lee Kaplan, senior author of the study and associate professor of medicine at Harvard Medical School. “They’re also physiological. Now we need to learn more about how the microbiota exert their effects.”


Slimming bacteria work their magic in either of two ways, studies of gut microbiota show. They seem to raise metabolism, allowing people to burn off a 630-calorie chocolate chip muffin more easily.


They also extract fewer calories from the muffin in the first place. In contrast, fattening bacteria wrest every last calorie from food.


Transferring slimming bacteria into obese people might be one way to give them the benefits of weight-loss surgery without an operation. It might also be possible to devise a menu that encourages the proliferation of slimming bacteria and reduces the population of fattening bacteria.


Another new study found that figuring out whether you have slimming microbiota or fattening ones might be as easy as breathing.


In a study published on Tuesday in the online edition of the Journal of Clinical Endocrinology & Metabolism, researchers at Cedars-Sinai Medical Center in Los Angeles report that people whose breath has high concentrations of both hydrogen and methane gases are more likely to have a higher body mass index and higher percentage of body fat.


Methane is associated with bacteria called Methanobrevibacter smithii, which in overabundance may cause weight gain by extracting calories from food super-efficiently, Cedars’ Ruchi Mathur, who led the study, said: “It could allow a person to harvest more calories from their food.”


The breath test could provide a warning that someone is at risk of obesity because he harbors fattening microbiota.


It could also validate what many overweight people have long suspected: if their slim friends eat two slices of bacon-cheeseburger pizza the 600 calories go through them like celery, but if the overweight person indulges then every calorie seems to turn into more fat. People absorb different quantities of calories from the exact same food, thanks to their gut microbiota.

(Reporting by Sharon Begley)

Life After Bariatric Surgery; Support Groups

Dear Patients

Friends Playing on the BeachWe are considering starting a Bariatric Support Group for our Candidates in Durban.

The widespread use of support groups has provided weight loss surgery patients an excellent opportunity to discuss their various personal and professional issues. Most learn, for example, that weight loss surgery will not immediately resolve existing emotional issues or heal the years of damage that morbid obesity might have inflicted on their emotional well-being. Our surgeons have support groups in place to assist you with short-term and long-term questions and needs, including the most effective exercise and diets after bariatric surgery. Most bariatric surgeons who frequently perform weight loss surgery will tell you that ongoing post-surgical support helps produce the greatest level of success for their patients in their life after bariatric surgery.

If any of our patients or potential candidates for Bariatric Surgery are interested in forming a Support Group please email us at

If we receive enough interest in setting up a Monthly Support Group Meeting we will be more than happy to make the facilities available to our patients to help them succeed with their weight-loss goals…



Invitation to start a Bariatric Surgery Support Group in Durban

April 2013 – Due to the increasing demand for and at the request of our patients we ( Dr Gert du Toit and Dr Ivor Funnell would like to invite our post-operative Bariatric Surgery Patients to establish a Durban based Support Group for all interested parties.
relaxation time #2The aim of this group will be to provide pre-op as well as post op support for our patients, by ourselves our staff and patients as well as to provide all interested parties with the relevant information needed to make the necessary choices to living a healthier lifestyle after having undergone bariatric surgery.
In order for us to establish such a Support Group we will need to do the following:
Establish a Support Group Committee comprising of at least 3 members (2 females and 1 Male). The committee members need to be post-op patients of either Dr Gert Du Toit or Dr Ivor Funnel.
The purpose of the Support Group Committee Members are to:
1. Be mentors to pre-op patients and other interested parties, by sharing their collective experiences both before and after surgery.
2. To Arrange and facilitate monthly Support Group meetings at an agreed upon venue and to inform all support group members of such planned meetings and events such as guest speakers and discussion topics.

We would d therefore like to invite, all our patients and those considering Bariatric Surgery, to contactVastha Thomas, at our offices to establish this Support Group, for the benefit of everyone involved in this life changing experience.
We look forward to building a mutually beneficial Support Group, in which all of us play a role in ensuring each other’s successful on this weight-loss mission.

Best Wishes,

Durban Bariatric Surgery
Drs du Toit, Funnell and Partners
201 Caritas Wing,
St Augustines Hospital
107 JB Marks Road,Glenwood

Tel: 031 268 5663
Fax: 031 201 3516

Women Should Wait at Least 12 Months Before Trying for a Baby Following Weight Loss Surgery, Experts Say

Women should wait at least 12 months before trying for a baby following weight loss surgery and need further Expecting-Momadvice and information on reproductive issues, suggests a new evidence-based literature review published January 11 in The Obstetrician & Gynaecologist (TOG).

The review looks at the safety, advantages and limitations of bariatric surgery and multidisciplinary management of patients before, during and after pregnancy.

With the prevalence of obesity among women of reproductive age expected to rise from 24.2% in 2005 to 28.3% in 2015, the number of women undergoing bariatric surgery is increasing.

Obesity increases the risk of obstetric complications, however, pregnancy after bariatric surgery is safer than pregnancy in morbidly obese women, states the review. A previous study following pregnancies after weight loss surgery concluded that pregnancy is safe with 79.2% of participants having no complications during their pregnancy.

However, there can be surgical complications during pregnancy following bariatric surgery. A previous study found that band slippage and migration can occur, resulting in severe vomiting, and band leakage was reported in 24% of pregnancies.

Furthermore, based on the current evidence available, the authors of the review recommend that patients should not get pregnant for at least 12 months following bariatric surgery. One study found a higher spontaneous miscarriage rate among pregnancies occurring within 18 months of having weight loss surgery compared with those pregnancies occurring more than 18 months after surgery (31% versus 18%).

The review also recommends that women should receive advice and information pre-conception on topics such as contraception, nutrition and weight gain and vitamin supplementation.

Optimising success for a healthy maternal and neonatal outcome requires a multidisciplinary team including obstetricians, surgeons, primary care clinicians, anaesthetists, fertility specialists, nutritionists, psychologists and plastic surgeons as well as patients themselves, before, during and after pregnancy following weight loss surgery, concludes the review.

Rahat Khan, Consultant Obstetrician and Gynaecologist, Princess Alexandra Hospital NHS Trust, Harlow and co- author of the review said:

“An increasing number of women of child-bearing age are undergoing bariatric surgery procedures and need information and guidance regarding reproductive issues. In light of current evidence available, pregnancy after bariatric surgery is safer, with fewer complications, than pregnancy in morbidly obese women. Multidisciplinary input care is the key to a healthy pregnancy for women who have undergone bariatric surgery. However, this group of women should still be considered high risk by both obstetricians and surgeons.

“Increasingly, obstetricians, surgeons and primary care clinicians will be required to address questions posed by their patients regarding the safety of pregnancy after weight loss surgery.”

TOG‘s Editor-in-Chief, Jason Waugh said: “Pregnancy after bariatric surgery is safer than pregnancy in morbidly obese women. Women who have had bariatric surgery generally tolerate pregnancy well. However, there are risks involved and patients must be well informed.

“Optimal education should be encouraged in these individuals so that they can make well informed decisions about planning pregnancy after their surgery.”

Weight-Loss Surgery in Durban

Our aim is to provide information and support to pre and post surgery patients of Dr Gert du Toit and Dr Ivor Funnel regarding Weight-Loss Surgery Solutions. Bariatric Surgery is designed to create lasting weight-loss results through Lifestyle Changes and Surgical intervention.
The partnership of Drs du Toit & Funnell received their accreditation for bariatric weight loss surgery from Professor Linroth from Sweden in January 2007.
In addition to specializing in Bariatric, Digestive and Laparoscopic Surgery we also offer Endocrine, Vascular and Trauma Surgery.

TV, Devices in Kids’ Bedrooms Linked to Poor Sleep, Obesity

Children who bask in the night-time glow of a TV or computer don’t get enough rest and suffer from poor lifestyle habits, new research from the University of Alberta has shown.

A province-wide survey of Grade 5 students in Alberta showed that as little as one hour of additional sleep decreased the odds of being overweight or obese by 28 per cent and 30 per cent, respectively. Children with one or more electronic devices in the bedroom — TVs, computers, video games and cellphones — were also far more likely to be overweight or obese.

“If you want your kids to sleep better and live a healthier lifestyle, get the technology out of the bedroom,” said co-author Paul Veugelers, a professor in the School of Public Health, Canada Research Chair in Population Health and Alberta Innovates — Health Solutions Health Scholar.

Veugelers, director of the Population Health Intervention Research Unit that works with the Alberta Project Promoting active Living and healthy Eating (APPLE Schools), said the research is the first to connect the dots on the relationship between sleep, diet and physical activity among kids.

Nearly 3,400 Grade 5 students were asked about their nighttime sleep habits and access to electronics through the REAL Kids Alberta survey. Half of the students had a TV, DVD player or video game console in their bedroom, 21 per cent had a computer and 17 per cent had a cellphone. Five per cent of students had all three types of devices.

Some 57 per cent of students reported using electronics after they were supposed to be asleep, with watching TV and movies being the most popular activity. Twenty-seven per cent of students engaged in three or more activities after bedtime.

Researchers found that students with access to one electronic device were 1.47 times as likely to be overweight as kids with no devices in the bedroom. That increased to 2.57 times for kids with three devices, with similar results reported among obese children.

More sleep also led to significantly more physical activity and better diet choices, researchers found.

Co-author Christina Fung noted that children today are not sleeping as much as previous generations, with two-thirds not getting the recommended hours of sleep per night. In addition to healthy lifestyle habits, a good night’s sleep has been linked to better academic outcomes, fewer mood disorders and other positive health outcomes, she said.

“It’s important to teach these children at an earlier age and teach them healthy habits when they are younger.”

The research was published in September by the journal Pediatric Obesity, in an early online release. The REAL Kids Alberta evaluation was funded through a contract with Alberta Health.

Halo Effect: Family Members of Gastric-Bypass Patients Also Lose Weight, Study Finds

Family members of patients who have undergone surgery for weight loss may also shed several pounds themselves, as well as eat healthier and exercise more, according to a new study by researchers at Stanford University School of Medicine.

A year after the 35 patients in the study had Roux-en-Y gastric bypass surgery, their obese adult family members weighed on average 8 pounds less, the researchers say.

In addition, many of the children in these families also appeared to benefit through their close association with the patient, exhibiting a lower body mass index than would have been expected given their growth curve.

The study notes that overweight women on a traditional medically supervised diet, such as Atkins or Ornish, lose between 2 and 5 percent of their body weight over 12 months. Over that same period of time, both obese men and women in the families of the surgery patients lost 3 percent of their body weight overall — slimming down, on average, from 234 to 226 pounds.

“Family members were able to lose weight comparable to being part of a medically controlled diet simply by accompanying the bariatric surgery patient to their pre- and post-operative visits,” said senior author John Morton, MD, MPH, associate professor of surgery at Stanford and director of bariatric surgery at Stanford Hospital & Clinics.

The findings will be published Oct. 17 in the Archives of Surgery. The lead author of the study is Gavitt Woodard, MD, a 2011 graduate of the Stanford School of Medicine.

The 50 adults and children who participated in the study did more than just share a house with the bariatric patients; they also, as Morton noted, accompanied the patients to all of their pre- and post-operative clinical visits, where they received dietary and lifestyle counseling. These sessions would emphasize a high-protein, high-fiber, low-fat and low-sugar diet and small, frequent meals. The sessions also set daily goals for exercise and stressed a good night’s sleep, alcohol moderation and less time in front of the television.

After a year, not only did obese adult family members lose several pounds, but their waistlines also decreased on average from 47 inches to 44 inches. Weight loss among non-obese family members, however, was not significant (180 to 176 pounds), and their waist circumference held steady at an average of 39 inches. But the number of alcoholic drinks consumed by the adult family members, regardless of weight, decreased sharply, from 11.4 to 0.8 each month.

In addition, the mean body mass index among obese children in the study was lower than what would have been expected based on projected growth-curve metrics from the Centers for Disease Control and Prevention.

Adult family members made significant changes in their eating habits, with less emotional and uncontrollable eating. Both adults and children made substantial increases in their activity levels. For adult family members, metabolic equivalent task hours, a measure of physical-energy expenditure, more than doubled from 7.8 to 16.8; for children, the increase was from 12.9 to 22.4.

When behavior changes as a result of social-reinforcing conditions, it is sometimes known as a halo effect. For example, studies have found that people are more likely to quit smoking if their spouses quit, or become obese if a friend becomes obese.

Today, 26 percent of American adults and 15 percent of children are considered obese, which increases the risk of mortality related to diabetes, heart disease and cancer, the study says.

Morton noted that Stanford surgeons perform about 300 bariatric surgeries every year, and more than 200,000 are done annually in the United States.

“Can you imagine if every one of these bariatric patients were an ambassador for good health? You would have a huge, grassroots movement with bariatric surgery providing a vehicle for healthy change for patient and family alike,” Morton said. “Obesity is a family disease and bariatric surgery sets the table for future, healthy family meals.”

The authors conclude by saying, “Bariatric surgery programs should encourage family involvement in support groups and education sessions to capitalize on these halo effects.”

Other authors of the study are Tina Hernandez-Boussard, PhD, MPH, assistant professor of surgery; and former Stanford medical students Betsy Encarnacion, MD, and Joe Peraza, MD.

The study was funded by the school’s Medical Scholars Program.


What is the Bariatric Surgery recovery process?

Most people typically stay in the hospital for a few days or less after gastric bypass surgery.
Some may need to stay four to five days. Your doctor will approve your discharge
home once the following is true for you:
You can move without too much discomfort.
You can eat liquid and/or puréed food without vomiting.
You no longer require pain medication given by injection.
You will remain on liquid or puréed food for several weeks after the surgery. Even after
that time, you will feel full very quickly, sometimes only being able to take a few bites of
solid food. This is because the new stomach pouch initially only holds a tablespoonful of
food. The pouch eventually expands. However, it will hold no more than about one cup
of thoroughly chewed food (a normal stomach can hold up to two to 3 cups).
Upon follow up, your doctor will determine if you need replacement of iron, calcium, vitamin
B12, or other nutrients. Supplements, such as a multivitamin with minerals, will be
prescribed to provide any nutrients that you may not be getting from your diet. A lack of
nutrients can occur because you are eating less and because the food moves through
your digestive system more quickly.
Other recommendations you should follow:
Once you are eating solid food, remember to chew each bite very slowly and thoroughly.
Eat small meals frequently throughout the day, rather than large meals that your
stomach cannot accommodate. Your new stomach probably won’t be able to handle
both solid food and fluids at the same time. So, you should separate fluid and food
intake by at least 30 minutes and only sip what you are drinking.
Avoid high fat, high sugar foods and alcohol.
Resume physical activity six weeks after the operation. Once you are fully recovered,
you should strive for daily physical activity in order to maintain weight loss after
the surgery.
Seek social support from others who have undergone weight loss surgery.
The weight loss results of gastric bypass surgery are generally good. Most patients
lose an average of 4-5 kg per month and reach a stable weight between 18 and 24
months after surgery. Often, the greatest rate of weight loss occurs in the very beginning
(that is, just following the surgery when you are still on a liquid diet).

More Exercise, Eating Less Fat and Weight Loss Programs Are In, Popular Diets Are Out, Study Suggests

ScienceDaily (Apr. 10, 2012) — Contrary to popular perception, a large proportion of obese Americans can and do lose weight, say researchers at Beth Israel Deaconess Medical Center. What’s more, they say, the old tried and true methods of eating less fat and exercising are some of the most effective paths to weight loss success. The research results appear in the April 10 online issue of the American Journal of Preventive Medicine. “This is great news because studies have shown that even a 5 percent reduction in weight can lead to improved health,” says lead author Jacinda M. Nicklas, MD, MPH, MA, a clinical research fellow at Beth Israel Deaconess Medical Center and Harvard Medical School. “With more than a third of Americans now obese and fifty to seventy percent of them trying to lose weight, this is important because the health risks associated with carrying that extra weight are substantial.” Nicklas and colleagues analyzed data from more than 4,000 obese individuals culled from the 2001-2006 National Health and Nutrition Examination Survey conducted by the Centers for Disease Control and Prevention to assess the health and nutritional status of adults in the United States. Individuals included in the study were over 20 years of age with a body mass index of 30 or more 12 months prior to the interview. Of those surveyed, 2,523 individuals reported trying to lose weight. Forty percent of these said they experienced weight loss of 5 percent or greater, and another 20 percent lost 10 percent or more. “Those who exercised more and ate less fat were significantly more likely to lose weight,” say the authors. “Additionally we found a correlation between joining weight loss programs and greater reported weight loss, which may speak to the importance of structure in a weight loss regimen” says Nicklas. And while those who used prescription weight loss medications also reported weight loss success, this represented only a small number of study participants. In contrast, the authors found that, “self-reported use of popular diets, liquid diets, nonprescription weight loss pills and diet foods/products were not associated with weight loss.” “It’s very encouraging to find that the most of the weight loss methods associated with success are accessible and inexpensive,” says senior author Christina Wee, MD, MPH who conducts research on obesity and health disparities as the Co-Director of Research in BIDMC’s Division of General Medicine and Primary Care. “There are lots of fad diets out there as well as expensive over-the-counter medications that have not necessarily been proven to be effective, and it is important that Americans discuss product claims with their doctor before trying such products.” This study did not look at the long-term impact of these interventions on an individual’s ability to keep the weight off. The authors suggest that future research is needed to identify and address barriers to maintaining weight loss. Other authors include Karen W. Huskey, MPH and Roger B. Davis, ScD both of Beth Israel Deaconess Medical Center.

Type 2 Diabetes, Cured by Weight Loss Surgery, Returns in One-Fifth of Patients

ScienceDaily (June 25, 2012) — A new study shows that although gastric bypass surgery reverses Type 2 diabetes in a large percentage of obese patients, the disease recurs in about 21 percent of them within three to five years. The study results were presented June 25 at The Endocrine Society’s 94th Annual Meeting in Houston.

“The recurrence rate was mainly influenced by a long-standing history of Type 2 diabetes before the surgery,” said the study’s lead author, Yessica Ramos, MD, an internal medicine resident at Mayo Clinic Arizona in Scottsdale. “This suggests that early surgical intervention in the obese, diabetic population will improve the durability of remission of Type 2 diabetes.”

Ramos and her co-investigators studied the medical records of 72 obese patients with Type 2 diabetes who underwent a Roux-en-Y gastric bypass operation between 2000 and 2007 and had at least three years of follow-up visits. Of these, 66 patients (92 percent) had a reversal of their diabetes at some point, the authors reported.

Within three to five years after surgery, however, 14 (21 percent) of the 66 patients experienced a recurrence of their Type 2 diabetes, as documented by bloodwork or restarting use of diabetes medications. The patients who did not have recurrence of diabetes lost more weight initially and maintained a lower mean weight throughout the five years of follow-up, although both groups regained similar amounts of weight. There was no significant association between higher recurrence rate and body mass index before surgery, the authors found.

They did find that the longer the duration of Type 2 diabetes before surgery, the higher the probability of diabetes recurrence. Study patients with more than a five-year duration of Type 2 diabetes before they had bariatric surgery were 3.8 times more likely to have recurrence of type 2 diabetes compared to patients with less than a 5 year history of diabetes.

“Providers and patients need to be aware of this information, to have a better idea of the expected outcome and be able to make an informed decision about pursuing gastric bypass surgery,” Ramos said.


Diabetes Improved Regardless of Surgical Procedure

ScienceDaily (May 7, 2012) — New research reports that no procedure for weight loss surgery is any better at treating diabetes than another. The study, presented May 7 at the International Congress of Endocrinology/European Congress of Endocrinology in Florence, Italy, uses a large ongoing study to show that improvements to diabetes in patients undergoing such surgery is likely to be due to the degree of weight loss itself rather than the type of procedure.

A number of procedures for weight-loss surgery (termed ‘bariatric surgery’) have been developed which can work by reducing the functional size of the stomach (‘restriction’), reducing the capacity of the gut to absorb calories (‘malabsorption’) or by a combination of the two. The well-documented improvement in diabetes following such surgery has puzzled doctors but the evidence suggests it is due in part to the altered transit of food through the gut. It is therefore possible that different procedures would give different degrees of improvement. This is what Associate Professor Markku Peltonen at the National Institute for Health and Welfare, Finland and colleagues from the University of Gothenburg, Sweden, set out to investigate using data from the large ‘Swedish Obese Subjects’ study.

2010 severely obese patients (with BMI>34 in men and >38 in women) recruited to the study went on to receive bariatric surgery: 376 gastric banding, 265 gastric bypass (GBP), and 1369 vertical banded gastroplasty (VBG — see below for descriptions). They followed 74% of these patients at both 2 and 10 years and measured improvements in diabetes via blood glucose and insulin levels before and after surgery. The degree of weight loss was categorised as more than 30kg, 30-25kg, 25-20kg and 20-15kg. Improvements in blood glucose and insulin were then compared between the three different surgical procedures accounting for the degree of weight loss.

After 10 years, the researchers found there was no significant difference in the changes to insulin and glucose levels between the three surgical groups when the extent of their weight loss was taken into account. This was true for patients with and without diabetes at baseline. The average 10 year weight losses were 18kg, 20kg and 29kg for the banding, GBP and VBG groups respectively (p<0.001). In a further analysis patients that lost the same amount of weight improved their blood glucose and insulin levels to similar degrees, regardless of the type of surgery.

The researchers conclude that the remarkable improvements in diabetes following weight loss surgery are not a direct result of the procedure itself. More research now needs to take place to investigate why bariatric surgery can cure diabetes in these patients, and why some patients respond better than others.

Associate Professor Markku Peltonen, Director of Department at the National Institute for Health and Welfare, Finland, said:

“Bariatric surgery is clearly effective in reducing weight in patients, but the current mystery is why so many patients appear to cure themselves of diabetes shortly after the operation.

“We would expect that some methods of weight loss surgery would be more effective at treating diabetes than others due to the different ways they alter the passage of food through our gut. When we factored in the weight lost following surgery we found that no procedure was any better at treating diabetes than another.

“Perhaps it is simply the act of losing weight that helps.”

Bariatric Surgery

Gastric banding reduces the functional size of the stomach by fitting a belt around the top section, so that it requires very little food to fill and therefore produces ‘satiety’ hormones after less food. The food is allowed to slowly pass into the main chamber of the stomach to continue digestion as normal. Adjustable gastric bands can be tightened or loosened to control this rate.

Gastric bypass surgery staples off the top portion of the stomach and creates a new route for food from this top portion to the small intestine, thus reducing the functional size of the stomach and bypassing much of the digestion and absorption that occurs in the stomach and small intestine. Bypassing more of the small intestine gives more rapid weight loss.

Vertical banded gastroplasty is a similar technique to gastric banding but is more complex.

Other techniques have been developed, although they are not covered as part of this study.


Cost of Gastric Bypass Surgery

The cost of gastric bypass ranges from R130 000 to upwards depending
on the procedure that is best suited for your individual case. The good
news is that, increasingly, medical aid companies are offering gastric
bypass surgery cover for all or part of the gastric bypass cost if your doctor
establishes medical necessity and if you meet the terms and conditions
of your medical aid scheme.
The cost of gastric bypass surgery comprises:
Anesthesia fees
The hospital facility fee
The surgeon’s fee
Pre-op lab and X-ray fees
Some period of time after surgery
for post-operative care
Factors not included in the cost of gastric bypass:
• Post-surgery behaviour,
exercise and diet counselling,
including the cost of vitamins and supplements.
• Additional body contouring surgeries to remove excess skin, lift
sagging body areas, improve loose muscles or treat fat deposits.
Additional procedures may include a facelift, breast augmentation,
breast lift, abdominoplasty, liposuction, gynecomastia surgery or
labiaplasty surgery.
Many factors affect the gastric bypass surgery cost, including:
• Your health plan. If your surgeon or hospital is an in-network
• The length of your hospital stay.
What to Ask Your Bariatric Surgeon and Your Medical Aid about the Cost of Gastric Bypass Surgery:
1. What is the cost of gastric bypass surgery?
2. What does the cost include? Some bariatric surgeons will
quote one all-encompassing price, while others will quote the
cost of surgery only, not taking into account pre-op tests or
hospital charges.
3. Will my insurance cover all or part of the procedure?
4. Will my insurance cover any complications or additional operations
after gastric bypass surgery?
5. Do you offer patient financing plans to help with cost?

Gastric Bypass Surgery Satisfies Long-Term

Gastric bypass surgery gets high marks for patient satisfaction and maintenance of substantial weight loss at 11 years post-operatively, according to long-term results of a study published online March 26, 2012 in Surgery for Obesity and Related Diseases.

The researchers point out that this study is one of the few studies to provide information on a large group of gastric bypass patients over a long period of time, as most other present long-term studies have included few patients at the last time-point.  This study had a mean follow-up time of 11.4 years (range 7 to 17 years) and included results of 384 gastric bypass patients.

It is also important to note that while many studies have reported on the short-term benefits of gastric bypass surgery, such as the dramatic weight loss and nearly immediate improvement in obesity co-morbidities in the first 18 to 24 months after surgery, this study examines whether or not the benefits can remain over time.
For this study, researchers sent a questionnaire regarding post-operative status to all 539 patients who had undergone Roux-en-Y gastric bypass as a primary bariatric procedure between 1993 and 2003 at Uppsala and Orebro University Hospitals in Sweden.  Of these patients, 384 responded (71.2% response rate, mean age 37.9 years, 317 women, 67 men) to the questionnaire.  Follow-up of study participants included blood samples and a review of medical charts.

The following results were reported:

  • BMI reduced to 32.5 (BMI was 44.5 at surgery), representing an excess BMI loss of 63.3%
  • 72% resolution of orally treated diabetes
  • Improvements in sleep apnea and hyperlipidemia
  • 2.1% had undergone revisional bariatric surgery
  • 40.2% had undergone abdominoplasty (tummy tuck)
  • Gastrointestinal symptoms were considered tolerable
  • 79% of patients reported satisfactory overall result
  • 92% of patients would recommend gastric bypass to a friend
  • 37% of patients attended annual checkups
  • 72% of patients were taking B12 supplements
  • 24% of patients were taking multivitamins

Based on their findings, the researchers noted that surprisingly few patients were compliant with the recommendation of lifelong supplements and yearly checkups.  They also mentioned the successful maintenance of substantial weight loss, the rarity of revisional bariatric surgery, and the high patient satisfaction with gastric bypass surgery.

As obesity continues to pose a significant health challenge to people in the United States, it is worth our time and effort to learn more about the various treatments currently available as well as continuing to search for other safe and effective options.  To date, the research shows that Roux-en-Y gastric bypass weight loss surgery continues to offer an acceptable and effective treatment for morbid obesity with satisfactory long-term results.

Source: Article in Press “Long-term results 11 years after primary gastric bypass in 384 patients” published online 26 March 2012 in Surgery for Obesity and Related Diseases (SOARD), the Official Journal of the American Society for Metabolic and Bariatric Surgery (ASMBS)


The Best Free Apps to Help You Lose Weight Your Smartphone

The Best Free Apps to Help You Lose Weight Your Smartphone is a perfect tool for getting and staying in shape. Think about it: It’s always with you, it lets you listen to music during your workout, and it provides you with many powerful (free!) apps at your fingertips. A fitness app can lead you through workouts without paying the high price of a personal trainer, and using a calorie-counter app is as simple as sending a text. Together, they’re a quick and easy way to start getting in shape. Check out the 10 highest-rated free apps to help you lose weight fast, according to research from Click Here To Read More: you-lose-weight.

Introducing BariMate – your Mobile bariatric assistant.

BariMate is the first weight management App written specifically for patients who have had bariatric surgery or are considering it. The fifteen sub apps will help you to make informed choices about bariatric surgery and keep track of your weight changes and parameters like BMI and %EWL. You can also use the I phone camera to keep a record of the way your body is changing too. It has been written by an experienced bariatric surgeon with advice on diet, sleep apnoea and a fill predictor to help you work out if your band needs adjustment. BariMate is available from Itunes US $7.99, AUD $8.49, UK ₤5.49, Euro €5.99 For: iphone, ipod and ipad Click on this Link: to Read More

Social Network For People With Chronic Conditions

We have launched collaboration with a social network for people with chronic conditions (including, but not limited to people with obesity).  The network is at  Registration and use is at no cost to the user.

There are a number of ways that the network can assist people to stay in touch, provide mutual support, share information and so on.  We have been extremely careful with privacy and confidentiality.  So, for example, upon registration people can choose to make themselves discoverable on the network by name and/or diagnosis.  The default is set to non-discoverable and the registrant chooses how (or if) they want to be seen on the network.  Also, once they are a member, everything that they do can be kept private, shared only with people that they have selected to be Links in their Health Chain, shared with anyone with their condition within the network, shared across the entire network, or shared with the world beyond the network.  Once again, the default setting is private, and every time something is done on the network the member makes a choice as to how, and with whom, that is shared.





Diets High in Fiber Won’t Protect Against Diverticulosis, Study Finds

This is an endoscopic picture of a clean colon (large intestine) with diverticula. (Credit: Anne Peery, MD)

ScienceDaily (Jan. 23, 2012) — For more than 40 years, scientists and physicians have thought eating a high-fiber diet lowered a person’s risk of diverticulosis, a disease of the large intestine in which pouches develop in the colon wall. A new study of more than 2,000 people reveals the opposite may be true.

The study, conducted by researchers at the University of North Carolina at Chapel Hill School of Medicine , found that consuming a diet high in fiber raised, rather than lowered, the risk of developing diverticulosis. The findings also counter the commonly-held belief that constipation increases a person’s risk of the disease.

“Despite the significant morbidity and mortality of symptomatic diverticulosis, it looks like we may have been wrong, for decades, about why diverticula actually form,” said Anne Peery, MD, a fellow in the gastroenterology and hepatology division at UNC and the study’s lead researcher. The study appears in the February 2012 issue of the journal Gastroenterology.

“While it is too early to tell patients what to do differently, these results are exciting for researchers,” said Peery. “Figuring out that we don’t know something gives us the opportunity to look at disease processes in new ways.”

Diverticulosis affects about one-third of adults over age 60 in the United States. Although most cases are asymptomatic, when complications develop they can be severe, resulting in infections, bleeding, intestinal perforations and even death. Health care associated with such complications costs an estimated $2.5 billion per year.

Since the late 1960s, doctors have recommended a high-fiber diet to regulate bowel movements and reduce the risk of diverticulosis. This recommendation is based on the idea that a low fiber diet will cause constipation and in turn generate diverticula as a result of increased pressure in the colon. However, few studies have been conducted to back up that assumption. “Our findings dispute commonly-held beliefs because asymptomatic diverticulosis has never been rigorously studied,” said Peery.

The UNC study is based on data from 2,104 patients aged 30-80 years who underwent outpatient colonoscopy at UNC Hospitals from 1998-2010. Participants were interviewed about their diet, bowel movements and level of physical activity.

“We were surprised to find that a low-fiber diet was not associated with a higher prevalence of asymptomatic diverticulosis,” said Peery. In fact, the study found those with the lowest fiber intake were 30 percent less likely to develop diverticula than those with the highest fiber intake.

The study also found constipation was not a risk factor and that having more frequent bowel movements actually increased a person’s risk. Compared to those with fewer than seven bowel movements per week, individuals with more than 15 bowel movements per week were 70 percent more likely to develop diverticulosis.

The study found no association between diverticulosis and physical inactivity, intake of fat, or intake of red meat. The disease’s causes remain unknown, but the researchers believe gut flora may play a role.

Peery said more research is needed before doctors change dietary recommendations, but the study offers valuable insights on diverticulosis risk factors. “At this time, we cannot predict who will develop a complication, but if we can better understand why asymptomatic diverticula form we can potentially reduce the population at risk for symptomatic disease,” said Peery.

UNC co-authors include Patrick Barrett, Doyun Park (currently at Albert Einstein College of Medicine), Albert Rogers, Joseph Galanko, Christopher Martin and Robert Sandler, gastroenterology & hepatology division chair. The research was supported by grants from the National Institutes of Health.


Number of Laparoscopic Bariatric Procedures Continued to Rise Between 2003-2008, U.S. Study Finds

ScienceDaily (Aug. 8, 2011) — According to a study published in the August issue of the Journal of the American College of Surgeons, there was an increase in the number of laparoscopic bariatric procedures, an increase in the number of bariatric surgeons and a decrease of inhospital mortality rates between 2003 and 2008. During the past decade, the field of bariatric surgery has changed dramatically and the authors concluded that these trends are due, in part, to an increase in the use of laparoscopic techniques and a greater acceptance of bariatric surgery by patients.

“We’ve identified a national trend in the use of bariatric surgery that is tied to the rapid expansion of the laparoscopic approach to bariatric surgery and the laparoscopic adjustable gastric banding operation,” said Ninh T. Nguyen, MD, FACS, chief surgeon for the Division of Gastrointestinal Surgery with University of California, Irvine Healthcare and the study’s lead author. “Many reports we looked at documented the long-term survival and metabolic benefits of bariatric surgery and these benefits are having an impact on patients’ willingness to accept bariatric surgery as an option for the treatment of morbid obesity.”

Using data from the Nationwide Inpatient Sample (NIS) from 2003 through 2008, the study authors found that the number of bariatric operations peaked in 2004 at 135,985 cases (63.9 procedures per 100,000 adults) and reached a plateau at 124,838 cases (54.2 procedures per 100,000 adults) in 2008. The proportion of laparoscopic bariatric operations increased from just over 20 percent in 2003 to more than 90 percent in 2008 and the inhospital mortality rate for these procedures decreased from 0.21 percent to 0.10 percent.

The researchers also identified a considerable swell in the number of bariatric surgeons during the six-year study period. Bariatric surgeons with membership in the American Society for Metabolic and Bariatric Surgery (ASMBS) increased from 931 to 1,819 representing a 95 percent increase.

With regard to the procedures hitting a plateau in 2004, Dr. Nguyen concluded it was likely due to a decrease in patient demand or increased difficulty for patients to access bariatric surgery, possibly tied to lack of insurance coverage.

The median age of patients studied who underwent bariatric surgery ranged from 42 to 45 years, with 79.2 percent to 82.6 percent female and the proportion of Caucasians ranged from 71.3 percent to 78.2 percent. The study sample represents approximately 20 percent of U.S. community hospitals and includes public hospitals and academic medical centers.

Accomplish Your Weight-loss Goals and Resolutions

Don’t let your weight loss goals and resolutions for 2012 fall by the wayside.

weightChances are that to achieve your dreams and live a life you love, those goals and resolutions are crucial. Goal setting and goal achievement are easier if you follow these six steps for effective and successful goal setting and resolution accomplishment.

You need to deeply desire the goal or resolution. Napoleon Hill, in his landmark book, Think and Grow Rich, had it right. “The starting point of all achievement is desire. Keep this constantly in mind. Weak desires bring weak results, just as a small amount of fire makes a small amount of heat.” So, your first step in goal setting and achieving your dreams is that you’ve got to really, really want to achieve the goal.

Visualize yourself achieving the goal. Lee Iacocca said, “The greatest discovery of my generation is that human beings can alter their lives by altering their attitudes of mind.” What will your achievement feel like? How will your life unfold differently as a result? If the goal is a thing, some gurus of goal setting recommend that you keep a picture of the item where you see and are reminded of it every day. If you can’t picture yourself achieving the goal, chances are – you won’t.

Make a plan for the path you need to follow to accomplish the goal. Create action steps to follow. Identify a critical path. The critical path defines the key accomplish-ments along the way, the most important steps that must happen for the goal to become a reality. Stephen Covey said, “All things are created twice. There’s a mental or first creation, and a physical or second creation of all things. You have to make sure that the blueprint, the first creation, is really what you want, that you’ve thought everything through. Then you put it into bricks and mortar. Each day you go to the construction shed and pull out the blueprint to get marching orders for the day. You begin with the end in mind.” He’s right.

Commit to achieving the goal by writing down the goal. Lee Iacocca said, “The discipline of writing something down is the first step toward making it happen.” I agree completely. Write down the plan, the action steps and the critical path. Somehow, writing down the goal, the plan and a timeline sets events in motion that may not have happened otherwise. In my own life, it is as if I am making a deeper commitment to goal accomplishment. I can’t fool myself later. The written objective really was the goal.


Establish times for checking your progress in your calendar system, whatever it is: a day planner, a PDA, a PDA phone or a hand written list. If you’re not making progress or feel stymied, don’t let your optimism keep you from accomplishing your goals. No matter how positively you are thinking, you need to assess your lack of progress. Adopt a pessimist’s viewpoint; something will and probably is, going to go wrong. Take a look at all of the factors that are keeping you from accomplishing your goal and develop a plan to overcome them. Add these plan steps to your calendar system as part of your goal achievement plan.

Review your overall progress regularly. Make sure you are making progress. If you are not making progress, hire a coach, tap into the support of loved ones, analyze why the goal is not being met. Don’t allow the goal to just fade away. Figure out what you need to do to accomplish it. Check the prior five steps starting with an assessment of how deeply you actually want to achieve the goal.

This six step goal setting and achieving system seems simple, but it is the most powerful system you will ever find for achieving your goals and living your resolutions. You just need to do it. Best wishes and good luck.



I had a Gastric Bypass…so now what?

You have made the commitment to a lifestyle change. You have had bariatric surgery and now find yourself with a lot more questions than answers. The big-gest question after surgery usually is:
I had a Gastric Bypass…so now what?
No doubt you will need to make some serious lifestyle changes and here are some mi-nor but significant suggestions:


  • Once you can eat vegetables and fruits, toss a colorful salad – Try to add color and add a veggie or a fruit you may not have tried before.
  • Make sure you also take care of yourself by scheduling screenings that you are due for such as colonoscopy, mammogram, dental, dietitians and for the guys check your blood pressure and heart regularly… Practice strength training by doing pushups, squats, and sit ups. Build up lean body mass.
  • Snack smarter by eliminating processed snacks. Sneak more fiber into your food – add lentils to your salad, high fiber cereal to your yogurt, raspberries to your salad.
  • Do something that requires concentration and coordination like hula-hooping, and burn off calories while having fun. Try to learn something new every month to keep your brain active!
  • Aim to set aside 15 minutes every day to deep breath, meditate, pray, or do yoga
  • Joining a Support Group to share your concerns and experiences is vital to your success—try to team up with a friend from the Support Group with whom you can share your journey, such as being exercise buddies and sharing recipes.

Change your relationship with food


  • Reinforce your motivation by rewarding yourself with treats – not food treats but healthy treats. This is really key; you need to change your relationship with food if you are going to be successful. Find other ways to motivate you don’t use food! Also find new mecha-nisms to cope with stress to replace food as your emotional crutch.
  • A visit to a spa, a new exercise outfit, a facial, music on your iPod, a fitness ball, a jump rope, a massage, a new book, a day by yourself, etc…Ask someone to join you with your exercise, or a healthy cooking class, or just a day together. Reflect on all of the things you are doing right, and write them down. Treat yourself to a nice, new, pretty journal and write down your experiences along your journey to health!

Gastric Bypass Surgery Associated With Improved Health Outcomes, Studies Find

ScienceDaily (Feb. 21, 2011) — Gastric bypass surgery appears to lead to better long-term results including greater weight loss, resolution of diabetes and improved quality of life compared with sleeve gastrectomy and “lap-band” surgery, according to two reports in the February issue of Archives of Surgery, one of the JAMA/Archives journals.

“Obesity and type 2 diabetes mellitus are currently two of the most common chronic, debilitating diseases in Western countries,” the authors write as background information in one of the articles. The most common surgical procedure for treating diabetes in theUnited Statesis the laparoscopic Roux-en-Y gastric bypass, more commonly referred to as gastric bypass surgery. In 2001, the laparoscopic adjustable gastric band, also known as lap-band, was introduced as a less invasive alternative to gastric bypass. Sleeve gastrectomy is another surgical weight-loss procedure, which involves surgical removal of a large portion of the stomach.

To evaluate differing outcomes of bariatric surgeries, Guilherme M. Campos, M.D., now of the University of Wisconsin School of Medicine and Public Health, Madison, formerly of the University of California, San Francisco, and colleagues examined 100 morbidly obese patients (having a body mass index greater than 40) who underwent lap-band surgery. These patients were matched by sex, race, age and initial body mass index (BMI) with 100 patients who underwent gastric bypass surgery.

All weight loss outcomes were significantly greater for patients who underwent gastric bypass. Average excess weight loss for this group was 64 percent, compared to 36 percent for lap-band patients. Additionally, 86 patients in the gastric bypass group successfully lost more than 40 percent of their excess weight compared with 29 (31 percent) of lap-band patients.

Each group had 34 patients with type 2 diabetes mellitus. Resolution or improvement of type 2 diabetes was significantly better after gastric bypass (26 patients or 76 percent) compared to lap-band (17 patients or 50 percent). At the one-year follow-up, six of eight gastric bypass patients (75 percent) who were using insulin had discontinued its use, while only one patient of six (17 percent) in the lap-bad group had done so.

The overall rate of complications was similar in both groups, with 11 patients (12 percent) in the lap-band group and 14 patients (15 percent) in the gastric bypass group experiencing complications. Early complications (within the first 30 days post-surgery) were higher in the gastric bypass group (11 patients or 11 percent) than the lap-band group (2 patients or 2 percent), however the rate of re-operation was higher in lap-band patients (12 patients or 13 percent) compared to gastric bypass patients (2 patients or 2 percent). No deaths occurred in either group.

“Our study shows that laparoscopic Roux-en-Y gastric bypass, when performed in high-volume centers by expert surgeons, has a similar rate of overall complications and lower rate of re-operations than laparoscopic adjustable gastric band,” the authors conclude. “Because it achieves greater weight loss, increased resolution of diabetes, and better improvement in quality of life, we conclude that, in the setting we studied, laparoscopic Roux-en-Y gastric bypass has a better risk-benefit profile than laparoscopic adjustable gastric band.”

In a second report, Wei-Jei Lee, M.D., Ph.D., of the Min-Sheng General Hospital, Taiwan, Republic of China, and colleagues conducted a double-blind randomized controlled trial of 60 moderately obese patients (BMI between 25 and 35) between the ages of 30 and 60, who had poorly controlled type 2 diabetes after conventional treatment. Between September 2007 and June 2008, half of the patients were randomized to undergo gastric bypass with duodenum exclusion (bypassing the first 12 inches of the small intestine) and half were randomized to have a sleeve gastrectomy without duodenum exclusion.

Overall, 42 patients (70 percent) had remission of type 2 diabetes 12 months after surgery. However, this resolution was significantly greater for gastric bypass patients (28 patients or 93 percent) than sleeve gastrectomy patients (14 patients or 47 percent). Both groups also had significant weight loss at the one- and three-month post-surgery follow-up, but gastric bypass patients had better weight loss results at the six- and 12-month follow-ups.

In addition to greater weight loss, patients who underwent gastric-bypass achieved a lower waist circumference and had lower glucose HbA1c and blood lipid levels than patients in the sleeve gastrectomy group. Late complications occurred in two patients (3 percent), one patient in each group, and required hospitalization for treatment, but no major adverse events were observed.

“Although more clinical trials are needed, this study and other previous studies have strongly recommended that laparoscopic gastric bypass as a metabolic surgery should be included in the armament of diabetes mellitus treatments in less obese populations (BMI of 25-35) and in the morbidly obese population (BMI greater than 35),” the authors conclude.

Your Consultation Session

 Preparing for weight loss surgery involves evaluations and recommendations by several health care professionals. They may include a bariatric physician, a bariatric surgeon, a nutritionist and a psychologist. This team works together to develop a comprehensive treatment plan.

Let’s assume that you have a good understanding by now of the treatment plan that is best for you. Your bariatric surgeon has reviewed the procedures with you (gastric bypass, Lap-Band and/or gastric sleeve surgery). You havejointly decided on the best surgical procedure for your particular situation, taking into account the risks, the life-changing effects you can expect afterward and whether the procedure will be covered by your Medical Aid, such as Discovery Health’s top line options.

 1. Bring to the appointment a list of prescription pharmaceuticals, over-the counter drugs and herbal or vitamin supplements you are taking.

2. Prepare to review your medical history, providing the names and phone numbers of physicians you are seeing or have seen recently.

3.Dr du Toit and Dr Funnell will provide you with all the information you need during your consultation session with them.

2 in every 3 South Africans are overweight

South Africans are a nation of people in denial when it comes to perceptions of how overweight, unfit and unhealthy they are.

In a recent national health survey measuring the health of the nation, it was found that 74% of South Africans think their fellow citizens are overweight, while only 34% of people considered themselves as overweight or obese.

The national health survey was commissioned by global research-based healthcare company, GlaxoSmithKline (GSK) and conducted by independent marketing insight consultancy, Added Value.

The survey found that 61%, or nearly two in every three South Africans are overweight, obese or morbidly obese. These figures on the growing size of our population are similar to those of the Medical Research Council (MRC), which also conducted a study in 2003 on overweight and obesity in South Africa.

South Africans still think they’re healthy

The MRC report found that 56% of women and 29% of men are overweight. Nearly 10% of men and 24% of women have a Body Mass Index (BMI) of more than 30.

The GSK national health survey also found that South Africans believe they are healthy, even when they are overweight and obese:

  • 78% of obese people think they are somewhat healthy/very healthy;
  • 52% of morbidly obese people think they are somewhat healthy or very healthy;
  • 42% have no health concerns; and
  • Only 47% recognise that exercise/physical fitness is critical.

GSK recently commissioned the national consumer health survey to assess certain facts about our nation as they relate to general health and wellness, lifestyle, family, nutritional understanding, local socio-political impact and psychological barriers to achieving better health.

Misunderstanding about obese vs. overweight

Jonathan Girling, Vice President, Consumer Healthcare at GSK, says the aim of the survey was “to measure how healthy South Africans are as a nation”.

“As a new entrant into the weight loss category in South Africa, the decision to embark on a National Health Survey was essential for us,” says Girling.

“Not only has it given us insight into the attitudes and behaviours of people on health matters, but a broader context to the overweight and obesity epidemic we’re facing as a nation.”

The GSK national health survey also found:

  • 60% of obese (and 62% of morbidly obese) people consider themselves as only being overweight;
  • 49% of South Africans don’t exercise; and
  • 71% of them have never been on diet.

Lifestyle, food, poverty and demographics play a role in the weight of the nation, the survey reveals. Capetonians are the worst affected with 72% of them overweight, followed by people living in Pretoria (68%), Johannesburg (59%) and Durban (52%).

A total of 65% of people interviewed have the perception that healthy food is more expensive than unhealthy food. However, people consider the food they buy as being healthy and most people claim to shop for healthy food 52% of the time.

The “denialism” continues when it comes to food labels: 66% understand food labels but only 33% consult them.

Proactive approach needed

At least 60 South Africans (three people every hour) die from heart attacks and strokes every day, according to the MRC.  In a 2003 WHO report, statistics further confirm that overweight and obesity pose a major risk for chronic diseases, including type 2 diabetes, cardiovascular disease (CVD), hypertension and stroke and certain forms of cancer.

Additional data from the MRC taken from participants in the age group 60-69 years indicates that a normal mid-life BMI has significant health benefits.

Dr Jeff King, a leading Johannesburg-based cardiologist, calls for a proactive approach to leading a healthy life by watching your weight, eating a balanced diet and maintaining a regular exercise programme.

“Obesity is a major factor of cardiovascular disease. Excess weight puts pressure on the heart and increases blood pressure,” King says. He warns that the heavier you become, the lower you drive your life expectancy.

“In five to 15 years an obese person will develop type 2 diabetes. Smoking increases the risk of cardiovascular disease even more because it doesn’t allow protection from blood clotting. Clotting causes blocked arteries that will result in a stroke or heart attack.”

SA kids also obese

But it’s not only adults who are obese. 17% of South Africa’s children aged one to nine years are obese. This is further backed up by research from the GSK national health survey which found that 23% of people don’t know what their children eat during the day.

“Healthy foods, healthy eating habits and exercise should be promoted to children through special education and awareness campaigns in schools,” says registered dietician Celynn Erasmus.

“Unhealthier choices seem more convenient and readily available, especially for people on the run. More ventures to promote healthier food choices should be encouraged and supported by the government and South African business.”

The survey also reveals that in the tough economic climate:

  • 39% of South Africans look at cost when purchasing food;
  • 87% eat a home cooked dinner; and
  • 46% feel obesity will impact South Africa economically.

For years anecdotal evidence has been building up to show that South Africans have serious problems with being overweight, obese and morbidly obese. Now there is hard empirical evidence that proves beyond doubt that we are already facing an epidemic and denying these facts could result in severe economic and social repercussions.

Source: GlaxoSmithKline, Health24, September 2010

Benefits Of Bariatric Surgery May Outweigh Risks For Severely Obese Patients

Bariatric surgery can result in long-term weight loss and significant reductions in cardiacand other risk factors for some severely obese adults, according to a scientific statement from the American Heart Association.

The statement, published in Circulation: Journal of the American Heart Association, is the first by the American Heart Association focused solely on bariatric surgery and cardiac risk factors, according to lead author Paul Poirier, M.D., Ph.D., director of the prevention/rehabilitation program at Quebec Heart and Lung Institute at Laval University Hospital in Canada.

“The statement is not an across-the-board endorsement of bariatric surgery for the severely obese,” Poirier said. “It is a consensus document that provides expert perspective based on the results of recent scientific studies.”

Bariatric surgery encompasses various procedures that decrease appetite while restricting food intake and/or causing food to pass through the gastro-intestinal tract without being fully absorbed or digested. The American Heart Association has long considered bariatric surgery an option to be evaluated carefully based on each patient’s medical profile.

Severe obesity is defined as a body mass index (BMI) of more than 40, according to the statement. For example, a sedentary woman who is 5-feet, 4-inches tall and weighs 235 pounds has a BMI of about 40.3. A 6-foot tall sedentary man who weighs 295 has a BMI of 40.

“Obesity has reached epidemic proportions in the United States, as well as in much of the industrialized world,” Poirier said. “The most rapidly growing segment of the obese population is the severely obese. The health consequences of severe obesity are profound. In comparison with normal-weight individuals, a 25-year-old severely obese man has a 22 percent reduction in his expected lifespan.”

Doctors and patients have been frustrated with the challenges of treating obesity, Poirier said. “Substantial long-term successes from lifestyle modifications and drug therapy have been disappointing, making it important to look at surgical options,” he said.

When reviewing the scientific literature, the statement-writing committee found that, when indicated, bariatric surgery leads to significant weight loss and improvements in the health consequences of being overweight, such as diabetes, high cholesterol, liver disease, high blood pressure, obstructive sleep apnea and cardiovascular dysfunction. Recent studies have suggested that bariatric surgery prolongs life in the severely obese.

There are, however, surgical risks including death and long-term post-surgical lifestyle implications. Patients must make lifelong behavior changes, such as supplement use, and follow up with the surgical team.

“Bariatric procedures are generally safe; however, this is not a benign surgery,” Poirier said. “At the moment, bariatric surgery should be reserved for patients who can undergo surgery safely, have severe obesity and have failed attempts at medical therapy.”

More research on bariatric surgery in adults and youths is needed, Poirier said. The severely obese adolescent population continues to grow with no effective sustainable treatment available.

The value of psychological evaluations and profiles in bariatric surgery cases is uncertain. The statement’s authors suggest psychological evaluations should assess the behavioral and environmental factors that may have contributed to a patient’s obesity, as well as the potential impact on a patient’s ability to make the dietary and behavioral changes needed to achieve the best results from surgery.

Co-authors are Marc-Andre Cornier, M.D.; Theodore Mazzone, M.D.; Sasha Stiles, M.D.; Susan Cummings, Ph.D.; Samuel Klein, M.D.; Peter A. McCullough, M.D., M.P.H.; Christine Ren Fielding, M.D.; and Barry A. Franklin, Ph.D. Author disclosures are on the manuscript.


Source: American Heart Association – adapted from


Durban Bariatric Surgery provides pre and post surgical information and solutions to severely obese patients of Drs. Du Toit, Funnell and Partners. We proudly service Durban and surrounding areas of Kwa-Zulu Natal in South Africa.

Our practice is situated at Suite 201 Caritas Wing L2 St Augustines Hospital, 107 J B Marks Road, Glenwood, 4001