News and Trends: May 2017

| May 1, 2017

Mental Health does Not Affect Bariatric Surgery Weight Loss Results
New Study Compares Bariatric Surgery Outcomes According to Preoperative Mental Illness
SILVER SPRING, Maryland—People with pre-existing mental health conditions had nearly identical results in weight loss after bariatric surgery as compared to those with no known mental health conditions. Published in Obesity, the scientific journal of The Obesity Society (TOS), this is the first large scale study of its kind to examine the relationship of preoperative mental illness to weight loss and health care use after bariatric surgery.
“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 TOS spokesperson Scott Kahan, MD, MPH, FTOS, Director of National Center for Weight and Wellness. “No prior research has evaluated this research question in a large and detailed study group. While all potential surgical patients should receive a thorough evaluation prior to considering surgery, this research suggests that there appears to be no outright reason to deny consideration of bariatric surgery in patients with mental illness who otherwise are good surgical candidates.”

Researchers reviewed electronic health record (EHR) data from over 8,000 adults with and without mental illness, from several health care systems across the United States in 2012-2013, to study weight loss and health care use patterns after bariatric surgery including post-surgery emergency department visits and hospitalization days. The study divided patients with mental illness into three groups: (1) mild to moderate depression or anxiety, (2) severe depression or anxiety and (3) bipolar, psychosis or schizophrenia spectrum disorders.

In the study, groups were compared on weight loss by using generalized estimating equations using B-spline bases, and on all-cause emergency department (ED) visits and hospital days using zero-inflated Poisson and negative binomial regression, up to 2 years after surgery. The results concluded that mental illness was not predictive of differential weight loss up to 2 years after bariatric surgery. “Our findings suggest that this powerful weight loss tool can be equally effective for different groups of patients regardless of pre-existing mental health conditions,” said Kristina Henderson Lewis, MD, MPH, SM, Assistant Professor, Department of Epidemiology & Prevention Division of Public Health Sciences at Wake Forest Baptist Medical Center.

Dr. Lewis cautioned that the majority of patients in this study came from systems where patients are psychologically screened prior to surgery, supporting the use of such screening to identify clinically-stable patients. Importantly, patients with pre-operative mental illness were observed to have higher use of the emergency department and hospital after bariatric surgery, a finding that may have clinical implications and requires further study.
In an accompanying editorial published in Obesity, James Mitchell, MD, discussed the impact of pre-surgery mental illness on post-surgery weight loss, as well as post-surgery emergency department visits and hospitalization. He pointed out that while more research is needed on this topic, “The most important finding is that those with mental illness, even in its more severe forms, can experience significant weight loss after bariatric procedures that is similar to the weight loss seen in the non-mentally ill patients. The current findings suggest that health care providers need to strongly consider bariatric surgical procedures for their severely obese mentally ill patients who are in a period of relative stability.”

About The Obesity Society. The Obesity Society (TOS) is the leading professional society dedicated to better understanding, preventing and treating obesity. Through research, education and advocacy, TOS is committed to improving the lives of those affected by the disease. For more information visit: www.Obesity.org.

Heart Attacks, Strokes, and Other Major Health Events Play Key Role in Driving Older Americans with Obesity to Address Their Weight
New Data Show Need for Healthcare Improvements for Older Americans with Obesity
AUSTIN, Texas (PRNewswire)—A statistically significant greater proportion of older people with obesity (PwO) (16%) than younger ones (12%) reported that a specific medical event such as a heart attack or stroke greatly influenced their desire to manage their weight, according to new data from the Awareness, Care and Treatment In Obesity Management (ACTION) Study. These health event motivators may have led to a vigilant weight loss effort among older PwO study participants, who experienced greater success than younger ones (13%:9% respectively). The new data, which compare attitudes and behaviors of obesity management between PwO who are 65+ versus PwO who are 64 and younger, were presented at the 26th Annual Scientific and Clinical Congress of the American Association of Clinical Endocrinologists.[1]

According to study co-author and ACTION steering committee member Angela Golden, DNP, FNP-C, FAANP, the research could be instrumental in helping health care practitioners (HCPs) better understand the need to “flip” this trend, to ensure that PwO get the help they need before a health crisis.

“Obesity is linked to more than 230 other medical conditions, often more prevalent in the older generation,” she said. “We know that even a 5- to 10-percent weight loss may significantly reduce health risks associated with obesity, so there is a pressing need for the health care community to focus on ensuring early and comprehensive access to obesity care. Collaboration between people with obesity and HCPs is a key part of the solution for addressing and treating this chronic, progressive disease and improving health outcomes.”
According to Golden, this will require PwO, especially older ones, and HCPs to shift the dialogue in the medical setting. Study findings show that currently, of those PwO who discussed their weight with HCPs, a lesser proportion (56%) of older PwO report that they “seek support” from their HCP for weight loss as compared with younger PwO (65%).
Additionally, fewer older PwO (50%) reported having received a “formal diagnosis” of obesity as compared with younger PwO (56%).[1]

These findings held true despite older PwO reporting greater prevalence of obesity-related conditions such as high blood pressure, high cholesterol, diabetes and sleep apnea (variable by condition, as much as twice the prevalence as the younger group).[1]

The ACTION Study was a cross-sectional U.S.-based study, conducted through online surveys, included over 3,000 adults with obesity (BMI ≥ 30 kg/m2 based on self-reported height and weight), of which 946 or 31% were 65 or older.

References
1.    Look M, Golden A, Kyle T, et al. Insights and Perceptions of Obesity Management in Older People with Obesity: Results of National Study. Poster presentation presented at: AACE 2017; May 3–7, 2017; Austin, TX.
About ACTION. The “Awareness, Care and Treatment In Obesity Management” (ACTION) study is the first U.S. nationwide study to investigate barriers to obesity management from the perspective of people with obesity, health care professionals and employers. In addition, the study aims to generate insights to guide collaborative action to improve obesity care, education and support. Sponsored by Novo Nordisk, the ACTION study was led by a multi-disciplinary steering committee comprised of representatives from The Obesity Society, the Obesity Action Coalition, and the Integrated Benefits Institute, as well as obesity experts in the fields of primary care, endocrinology, physiology and nursing. The study involved more than 3,000 people with obesity, 600 health care professionals, and 150 employers in the United States. To learn more about the study, please visit www.ACTIONStudy.com.
About Novo Nordisk. Novo Nordisk is a global healthcare company with more than 90 years of innovation and leadership in diabetes care. This heritage has given us experience and capabilities that also enable us to help people with other serious chronic conditions: hemophilia, growth disorders and obesity. With U.S. headquarters in Plainsboro, New Jersey, Novo Nordisk Inc. has nearly 5,000 employees in the United States. For more information, visit novonordisk.us

Childhood Obesity Quadruples Risk of Developing Type 2 Diabetes
Washington, DC—Children with obesity face four times the risk of developing type 2 diabetes compared to children with a body mass index (BMI) in the normal range, according to a study published in the Journal of the Endocrine Society.

Both obesity and diabetes are epidemic health problems. Obesity affects about 12.7 million children and teens in the United States. The SEARCH for Diabetes in Youth study found 3,600 cases of type 2 diabetes were diagnosed in U.S. children and teens each year between 2002 and 2005, according to the Endocrine Society’s Endocrine Facts and Figures report.
The researchers who published the Journal of the Endocrine Society study found a similar trend in a large-scale analysis of diabetes and obesity rates among British children.
“As the prevalence of obesity and being overweight has rapidly risen, an increasing number of children and young adults have been diagnosed with diabetes in the United Kingdom since the early 1990s,” said the one of the study’s authors, Ali Abbasi, M.D., Ph.D., of King’s College London in London, U.K. “A child with obesity faces a four-fold greater risk of being diagnosed with diabetes by age 25 than a counterpart who is normal weight.”

The cohort study used electronic health records from one of the largest primary care databases worldwide, the U.K. Clinical Practice Research Datalink, to pull data from 375 general practices. The researchers examined BMI measurements, diabetes diagnosis records, and other data for 369,362 children between the ages of 2 and 15.
Examining data recorded between 1994 and 2013, the researchers found 654 children and teenagers were diagnosed with type 2 diabetes and 1,318 were diagnosed with type 1 diabetes. Children and teenagers with obesity constituted nearly half of the type 2 diabetes cases—308 in all.

The study found no association between obesity and increased incidence of type 1 diabetes, which is linked to an underlying autoimmune disorder.

“Diabetes imposes a heavy burden on society because the condition is common and costly to treat,” Abbasi said. “Estimates indicate one in 11 adults has type 2 diabetes, or about 415 million people worldwide. Given that diabetes and obesity are preventable from early life, our findings and other research will hopefully motivate the public and policymakers to invest and engage in diabetes prevention efforts.”

Other authors of the study include: Dorota Juszczyk and Martin C. Gulliford of King’s College London; and Cornelia HM van Jaarsveld of Radboud University Medical Center in Nijmegen, the Netherlands.

Gulliford was supported by the NIHR Biomedical Research Centre at Guy’s and St. Thomas’ NHS Foundation Trust and King’s College London.

The study, “Body Mass Index and Incident Type 1 and Type 2 Diabetes in Children and Young Adults: A Retrospective Cohort Study,” will be published online at https://academic.oup.com/jes/article-lookup/doi/10.1210/js.2017-00044.
The Endocrine Society launched the first issue of its Open Access scholarly publication the Journal of the Endocrine Society in January, marking the first time the Society has introduced a new journal under its ownership in nearly 30 years. The online-only format is specifically intended to rapidly publish emerging science on a variety of endocrinology topics.

Bariatric Advantage Releases New Weight Management Probiotic
Aliso Viejo, California—Bariatric Advantage®, a pioneer in science-based patient-focused nutrition for bariatric patients,  announced the launch of FloraVantage® Control, featuring Bifidobacterium lactis B-420™, a promising probiotic for weight maintenance. FloraVantage Control offers healthcare practitioners a unique approach to help patients in their quest to sustain healthy weight following weight loss.*

Bariatric surgery patients who have success losing weight frequently find that maintaining that weight loss can be quite challenging. As part of a multidisciplinary weight management program, FloraVantage Control may help individuals achieve body weight regulation by modifying gut microbiota composition, and promoting the production of beneficial gut metabolites and helping to improve gut integrity.1–5*

“Bariatric patients require lifelong care,” said Bret Petkus, vice president of commercial operations for Bariatric Advantage. “FloraVantage Control is a promising tool that may provide long-term support to help maintain a healthy weight.”*

FloraVantage Control is specially designed to help support body weight regulation by delivering a targeted probiotic: Bifidobacterium lactis B-420. This unique strain clinically showed in a six-month clinical study to reduce body fat mass, body weight, waist circumference, and abdominal fat all compared to placebo.5*

“This probiotic marks a significant step forward for the targeted use of specific probiotic strains in the long-term support of patients,” said Dr. John Morton, chief of bariatric surgery at Stanford University and past president of the American Society for Metabolic and Bariatric Surgery. “I am glad to see Bariatric Advantage continue to bring innovative solutions to support bariatric professionals and the patients they treat.”

Learn more about FloraVantage Control at BariatricAdvantage.com. Read the full release at https://www1.bariatricadvantage.com/news.
*These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any disease.

References
1.    Stenman LK, et al. EBioMedicine. 2016;13:190–200.
2.    Amar J, Chabo C, Waget A, et al. EMBO Mol Med. 2011;3(9):559–572.
3.    Putaala H, Salusjärvi T, Nordström M, et al. Res Microbiol. 2008;159(9-10):692–698.
4.    Stenman LK, Waget A, Garret C, et al. Beneficial Microbes. 2014;5(4):437–445.
5.    Stenman LK, Waget A, Garret C, et al. Diabetol Metab Syndr. 2015;12(7):75.

About Bariatric Advantage. Bariatric Advantage (www.bariatricadvantage.com), part of Metagenics, Inc., is a market-leading provider of targeted nutrition solutions to meet the micronutrient replacement needs of bariatric surgery patients. Founded in 2002, Bariatric Advantage markets and distributes its nutritional products primarily through the medical professional channel under the brand name Bariatric Advantage. In 2010, it was acquired by Metagenics, Inc.—a nutrigenomics and lifestyle medicine company dedicated to helping people live happier, healthier lives by realizing their genetic potential and operates as a strategic business unit of Metagenics. Bariatric Advantage maintains its offices in Aliso Viejo, Calif.

Vitamin A + High-Fat Diet = Increased Risk for Obesity, Diabetes
Study Finds Changes in Gene Expression, Body Mass with Nutrient Intake in High-fat Diet
Chicago, Illinois—Vitamin A is an essential nutrient that the human body needs to function properly. But new research presented today at the Experimental Biology 2017 meeting in Chicago suggests that normal levels of vitamin A within a high-fat diet can negatively affect expression of liver genes associated with glucose and fat metabolism.

Researchers fed two groups of rats a high-fat diet for eight weeks. One group consumed normal amounts of vitamin A (“sufficient”), while the other group ate food that lacked the nutrient (“deficient”). The research team measured the rats’ body mass (an indicator of concentration of body fat) each week. After six weeks, the deficient group had significantly lower body mass than the sufficient group, a trend that continued through the end of the trial. Fat mass in the liver and the duct surrounding the testicles (epididymis) was also decreased in the deficient group.

Expression of a liver protein (Cytochrome P450 26A1) that regulates levels of retinoic acid—a by-product of vitamin A—was higher in the sufficient group. This protein is also involved in the metabolism of fat and cholesterol. The research team also found that expression of genes that control glucose metabolism and insulin signaling pathways were higher in rats that consumed sufficient amounts of vitamin A. These results suggest that vitamin A combined with a high-fat diet may lead to a higher body weight and increased risk of insulin resistance and diabetes.

More research is needed to determine how vitamin A status affects humans. However, these findings may be another reminder about the dangers of consuming a high-fat diet. “Our study [implies] that we should be careful about vitamin A, especially [in] overweight or obese people,” wrote Heqian Kuang, first author of the study.

Heqian Kuang, a graduate student at the University of Tennessee, Knoxville, also presented “Dietary vitamin A intake affects the body mass gain and hepatic gene expression in rats fed a high-fat diet” in a poster session during the meeting.

About Experimental Biology 2017. Experimental Biology is an annual meeting comprised of more than 14,000 scientists and exhibitors from six sponsoring societies and multiple guest societies. With a mission to share the newest scientific concepts and research findings shaping clinical advances, the meeting offers an unparalleled opportunity for exchange among scientists from across the United States and the world who represent dozens of scientific areas, from laboratory to translational to clinical research.

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