Editorial Message—Research Shows that Starting Children with Breastfeeding Alone during the Early Months Prevents Obesity Later in Life

| January 21, 2011

Dear Readers:
Happy New Year! I hope you all are having a good start to 2011.

Our first issue of 2011 discusses several important subjects related to the pre- and postoperative care of bariatric patients.

I congratulate Drs. Youdim and Mathur who contributed two excellent articles based on sessions presented at the “Comprehensive Approach to the Treatment of Obesity,” by Cedars Sinai Medical Center on October 22, 2010.
First, Dr. Youdim discusses risk reduction in bariatric patients. Despite the fact that the literature has well documented that weight loss is important for risk reduction, I personally do not expect patients to loose a certain amount of weight preoperatively. However, I do start them on a high-protein liquid diet two weeks preoperatively, which results invariably in a smaller left liver lobe and better visualization of the gastroesophageal junction. I also found Dr. Mathur’s article on the use of metformin as a weight loss medication interesting.

We continue our new column “Nutritional Considerations in the Bariatric Patient.” In this month’s issue, Dr. Frank presents an important article on beriberi or thiamin deficiency. Previous publications[1] have reported that 13 percent of our patients are already deficient in vitamin B1 preoperatively. This is most likely due to poor dietary habits since obesity is indeed a form of malnutrition. A common symptom in the postoperative period after bariatric surgery, regardless of which procedure the patient undergoes, is nausea and vomiting. While many, if not most, of these symptoms are the result of the small pouch, narrow anastomosis, ulcers, dumping syndrome, and the patient’s poor eating habits (they need to learn how to eat with a small pouch), in some cases, the reason for these symptoms is the lack of vitamin B1, which causes palsy of the hypoglossal/glossopharingeal nucleus (Wernicke Korsakoff’s encephalopathy).

The “home recipe” for differentiating clinically between all of the previously mentioned reasons for vomiting and thiamin deficiency is that the patient with thiamin deficiency will report to vomit shortly after food is in his or her mouth. A patient suffering from any of the previously mentioned problems will report to vomit hours after food is in his or her mouth. Patients with beriberi also will tell you that they cannot swallow. This problem can be resolved in a matter of days by giving the patient an intravenous administration of thiamin. So, always remember to administer B1 to your patients who are not improving their nausea and vomiting.

Next, we have a symposium synopsis of Dr. Michel Murr’s Eleventh Annual Conference on Obesity. I personally attended this meeting and very much enjoyed the presentations. I also got to shake hands with the George W. Bush impersonator, who was greeting attendees between sessions.

As it has become a tradition, we present in this issue an interview with Dr. Wolfe, the current president of the American Society of Metabolic and Bariatric Surgery. Thank you, Dr. Wolfe, for a job well done.

I would like to comment on an interesting article I read on www.Livescience.com.[2] The article highlighted the research done by Brian Moss, a sociologist at Wayne State University in Detroit, Michigan. The study results showed that children who were overweight in their first few years of life faced a higher risk of developing obesity as adults. Moss states the importance of trying to get children on a healthy track at a very early age. In fact, another study[3] has shown that exclusive breastfeeding—breastfeeding alone, not breastfeeding combined with bottle-feeding—prevents obesity.

These findings continue to teach us how important it is to start with natural and healthy eating habits as babies.

Finally, on happy note, I enjoyed reading the article on single-incision laparoscopic surgery (SILS) by Pfluke et al[4] published in the Journal of the American College of Surgeons. To summarize, out of 219 publications on PubMed, there are only 14 papers in the field of bariatric surgery—10 on gastric bands and four on gastric bypass. Only five percent of the papers mention that there is an improvement in pain control, 77 percent of papers do not even mention that there is a cosmetic advantage with SILS when compared to conventional  laparoscopy (probably because they are embarrassed to write about it as general surgeons ), and one percent of the manuscripts saw a cost advantage when using  SILS. So, are the previously mentioned numbers good enough to conclude that SILS offers a cosmetic advantage, is less painful, and cost effective? Thank God Dan Smith wrote this paper.
I hope you enjoy this issue of Bariatric Times!

Sincerely,

Raul J. Rosenthal, MD, FACS
Editor, Bariatric Times

References
1.    Carrodeguas L, Kaidar-Person O, Szomstein S, et al. Preoperative thiamine deficiency in obese population undergoing laparoscopic bariatric surgery. Surg Obes Relat Dis. 2005;1(6):517–522; discussion 522.
2.    Pappas S. A third of 9-month-olds already obese or overweight. Livescience. December 31, 2010. http://www.livescience.com/health/third-of-babies-overweight-obese-101231.html Accessed January 13, 2011.
3.     McCormick DP, Sarpong K, Jordan L, et al. Infant obesity: are we ready to make this diagnosis? J Pediatr. 2010;157(1):15–19. Epub 2010 Mar 24.
4.     Pfluke JM, Parker M, Stauffer JA, et al. Laparoscopic surgery performed through a single incision: a systematic review of the current literature. J Am Coll Surg. 2011;212(1):113–118. Epub 2010 Oct 30.

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