From Medical News Today:

The causes of obesity are complex and individual, but it is clear that chronic overeating plays a fundamental role. But when this behaviour becomes compulsive and out of control, it is often classified as “food addiction” – a label that has generated considerable controversy, according to a McMaster University psychiatrist and obesity researcher.

In a commentary appearing in the Dec. 21, 2009, issue of the Canadian Medical Association Journal (CMAJ), Dr. Valerie Taylor, an assistant professor of psychiatry and behavioural neurosciences at McMaster and director of the Bariatric Surgery Psychiatry Program at St. Joseph’s Healthcare Hamilton, and her co-authors argue that food addiction in some individuals may be a reality and needs to be considered in the management of weight problems.

“The concept of addiction is complex, and the delineation of its defining characteristics has fostered considerable debate,” Taylor and her co-authors write. “Despite a lack of consensus, researchers nevertheless agree that the process involves a compulsive pattern of use, even in the face of negative health and social consequences.”

Food addiction can be compared to other addictive behaviours, as both food and drugs can cause tolerance, or an increase in the amount required to achieve intoxication or satiety. Withdrawal symptoms such as mood changes can occur after discontinuing drugs or during dieting. As well, after gastric surgery for obesity, a subset of patients exhibit other addictive behaviours.

“The concept of addiction does not negate the role of free will and personal choice,” Taylor and co-authors write. “It may, however, provide insight into why a some individuals with obesity continue to struggle.”

The authors conclude that therapies traditionally applied to the area of addiction may be helpful in managing weight problems, which are often viewed through the same lens.

“The current ‘blame’ mentality that is often applied to individuals with obesity needs to be re-examined,” the authors write. “Although medicine may not yet accept compulsive overeating as an addiction, we cannot ignore evidence highlighting the role played by biologic vulnerability and environmental triggers.”

Source: Veronica McGuire
McMaster University

Metabolic Surgery Statistics — 2008

On November 29, 2009, in Uncategorized, by Andrea

This morning, I came across this article by Buchwald and Oien (thanks Bonamy) outlining worldwide WLS statistics for 2008.  According to the authors, the last evaluation was done in 2003 and this evaluation was done by sending a survey to 39 nations or national groupings (of which 36 responded).  Given this was a survey, it will be somewhat biased based on the person answering the survey, as well as the fact that the numbers are worldwide — some procedures are done in other parts of the world that are not performed in the US routinely (such as Vertical Banded Gastroplasty {VBG}) or the Scopinaro Biliopancreatic procedure.  Of course, I am a numbers girl and wish that all numbers are exact figures, but let’s face it — it’s not realitySo given that, I have to concede that these are not going to be 100% exact.

Some direct quotes and figures from the report:

  • In 2008, 344, 221 bariatric surgery operations were performed by 4,680 bariatric surgeons, 220,000 of these operations were performed in USA/Canada by 1,625 surgeons
  • Seven other countries or national groupings with more than 100 bariatric surgeons: Australia/New Zealand (118), Brazil (700), Chile (100), France (310), Italy (300), Mexico (150), and Spain (400)
  • 91.4% of world bariatric surgery was performed laparoscopically
  • Considering all gastric bypasses together (distal and prox, open and lap), number of RNY exceeds AGB’s.
  • In Europe, relative percent of AGB decreased from 63.7% to 43.2% from 2003 to 2008, while RYGB increased from 11.1% to 39%.  In USA, AGB increased from 9% to 44% and RYGB decreased from 85% to 51%.  In both Europe and USA, VSG went from 0% in 2003 to 4%.
  • Most common type of procedures were purely restrictive (AGB, VSG, VBG) (48.6%), restrictive/malabsorptive (RNY) (49.0%), and primarily malabsorptive (BPD/DS) (2%).

Surgical types by breakdown (Lap and Open combined)

  1. Proximal RNY – 45.4%
  2. AGB – 42.4%
  3. VSG – 5.4%
  4. VBG – 1.1%
  5. BPD and DS procedures combined – 1.1%
  6. Other – 0.1%

The authors make a few conclusions about the numbers they received in this survey — some of which bother me.  There is quite a disenchantment of AGB in Europe, where there is quite a long history of it’s use there, and a growing trend towards VSG and RYGB there.  USA and Canada, where we want newer and better (and have marketing via TV commercials?  WTF?) is moving away RYGB (which we have a longer history) and are moving towards AGB and VSG.  In no cases are we moving closer to DS — which in many ways to ME seems to be an excellent choice and not given any credit or opportunity to shine.  The authors also clearly bring up the fact that many people would presumably want metabolic surgery if they could get their paws on it — would even, I dunnow, self-pay for it, or change jobs for it, or go work part-time at the Buxx for it?  For those of us in the community, we’ve seen and heard this time and time again so nice to see the professionals recognize it in a published article.  Additionally — patients are getting smarter, using the interwebz and understanding a bit more about what we are doing to our guts when we go and get chopped up — and it’s all for the betterment:

Further involved factors may be the predictable craving for something regionally newer, the imposition of payer mandates, media-derived prejudices and and biases, advertisement campaigns by the bariatric surgery industry, increased patient sophistication and use of websites, and, of course, relative regional economic advantages for bariatric surgeons.

I have to say the thing I’m most concerned about is the complete lack of yeast in the DS numbers.  This is a wonderful surgery — doesn’t have many of the RNY pitfalls (and let me tell you, I know several of them first hand), doesn’t require all that much more work than far-out RNY patients (despite what some may tell you — it’s not all roses and rainbows and unicorns) and just isn’t getting the recognition or the opportunity to shine and show it’s stuff.  I wish more surgeons would learn how to perform it.  I wish more people would learn the stats.  I wish more people would stop spreading misinformation crap about it in hopes of making their own surgery look better.  And I wish many of the surgeons that don’t perform it would also stop this practice — it’s unprofessional as all hell and only perpetuates the problems as their patients then do the exact same thing and continues to spread the misinformation, fear, and, eventually, hatred, around.

Europe at least is performing the DS a bit more than we are -0-  they had a 58.7% increase of surgeries from 03 to 08 — but still that increase only comprised 4.9% of the total surgery population in 08 which is an actual decrease from 6.1% surgical population in 03.  Comparatively, the US went from 4.5% surgical population in 03 to 1%?!? in 08?  with a 52.5% decrease.  WHY? I don’t get it.  There is too much good in the DS for this statistic.  At least the US wasn’t as abysmal as Asia and the Pacific.. those numbers were too depressing to even type out.

So what does all of this mean?  WLS is on the rise, but not as much as it was in 03.  Considering how quickly the rate of obesity is climbing, this isn’t quite proportionate as some critics claim (including many private payers who don’t want to cover WLS as it would “cost too much”) — and given how diabetes costs are going to triple by 2023? This is a way to go to help avoid these ballooning costs.  Some surgeries are growing by leaps and bounds regionally — some are growing regardless (VSG, anyone?)  and some are still performed in areas while considered completely antiquated in others (VBG in the US).

Very interesting.  Somewhat sad.  But very interesting.

Bariatric surgery IS an ANSWER…

On November 18, 2009, in General Nutrition, by Andrea

So there’s a new report out yesterday that projects 103 million Americans will be obese by 2018 — that’s 43%  — up from 31% in 2008.  That’s quite an increase, and imagine the costs associated with the co-morbidities that are associated with obesity..

Mr. Thorpe concluded that the prevalence of obesity is growing faster than that of any other public health condition in the country’s history. Health care costs related to obesity — which is associated with conditions like hypertension and diabetes — would total $344 billion in 2018, or more than one in five dollars spent on health care, if the trends continue. If the obesity rate were held to its current level, the country would save nearly $200 billion a year by 2018, according to the study.

So while reading this little article — and thanks Eggface for linking it up — I remembered an article I read last year – this one right here that called Bariatric surgery “cost effective” !!  Heya, this might be an answer!

The cost of the most common type of weight-loss surgery, which typically runs between $17,000 and $26,000, is offset within two to four years by medical cost savings, according to a new study.

The findings, published in the September issue of the American Journal of Managed Care, may increase pressure on health-insurance companies to cover gastric bypass surgery. Some insurance plans specifically exclude weight-loss surgery, despite medical evidence of its effectiveness as a treatment not just for obesity, but also for related conditions including diabetes, high blood pressure and sleep apnea.

“The most cost-effective treatment for obesity is bariatric surgery. If you do that, within two to four years, you will get your money back,” said the study’s lead author, Pierre-Yves Crémieux, a health economist and principal at Analysis Group Inc., an economic consulting firm in Boston. “We have identified the break-even point for insurers,” he added.

So maybe, just maybe we can get people to listen?  Fixing obesity with a gut-rerouting can be a cost-effective solution.  I don’t advocate it for everyone — those who won’t take care of themselves, follow the vitamin regimen, etc. shouldn’t get sliced and diced.  I know, hard to weed out the crazies.  But here, here is a way to help cut health care costs that people are bitching about in the country.  Rather than tell those of us who have the surgery that we shouldn’t do this, doctors should help us and learn more about it, and hey, maybe even educate more patients about it to help save lives.

Well, a girl can dream, right?

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