Bradley Waggoner, MD

New Study Strengthens Link Between Everyday Stress and Obesity

Stress can take a daily toll on us that has broad physical and psychological implications. Science has long documented the effect of extreme stress, such as war, injury or traumatic grief on humans. Typically, such situations cause victims to decrease their food intake and body weight. Recent studies, however, tend to suggest that social stress--public speaking, tests, job and relationship pressures--may have the opposite effect--over-eating and weight gain. With the rise of obesity rates, science has increasingly focused on its causes and effects--including stress.

A recent study conducted by the Departments of Psychiatry and Biomedical Engineering at the University of Cincinnati College of Medicine, examined the effects of stress on the meal patterns and food intake of animals exposed to the equivalent of everyday stress on humans. The results suggest that, not only does stress have an impact on us in the short term, it can cause metabolic changes in the longer term that contribute to obesity.

The study was conducted by Susan J. Melhorn, Eric G. Krause, Karen A. Scott, Marie Mooney, Jeffrey D. Johnson, Stephen C. Woods and Randall R. Sakai at the University of Cincinnati College of Medicine, Cincinnati, OH. Their study was published in the American Journal of Physiology – Regulatory, Integrative and Comparative Physiology. 

* * *

Source: Reprinted with editorial adaptations from materials provided by The American Physiological Society. http://www.the-aps.org

* * *

If you are considering weight loss surgery, you owe it to yourself to choose a physician who is not only highly skilled, but caring and compassionate as well. Many physicians out there will treat your obesity. Dr. Waggoner will treat you!

To contact us for more information and/or to reserve your seat for the next free seminar, please click here.

* * *

If you are considering weight loss surgery, you owe it to yourself to choose a physician who is not only highly skilled, but caring and compassionate as well. Many physicians out there will treat your obesity. Dr. Waggoner will treat you!

To contact us for more information and/or to reserve your seat for the next free seminar, please click here.

Focusing on Immediate Health Effects May Improve Weight Loss Success

Most weight loss programs try to motivate individuals with warnings of the long-term health consequences of obesity: increased risk for cancer, diabetes, hypertension, heart disease and asthma.  New research suggests the immediate health benefits—such as reduced pain—may be the most effective motivator for helping obese individuals shed extra weight and commit to keeping it off.

 

In a pilot research study, University of Cincinnati (UC) researchers found that 21 percent of participants in a local dietary weight loss program reported significantly less pain in the lower extremities and back after losing an average of 10 pounds. Additionally, study participants reported a 20 to 30 percent reduction in overall bodily pain after weight loss.

 

Researchers say their results indicate that even small weight loss can relieve pain and reduce the burden excessive weight puts on the musculoskeletal system.

 

"By focusing on an immediate benefit that can be felt—like pain reduction—instead of the future health impact of obesity, weight loss programs may be able to inspire overweight individuals to lose weight,” says Susan Kotowski, PhD, study collaborator and director of the Gait and Movement Analysis Laboratory in the UC College of Allied Health Sciences.

 

Kotowski and colleague Kermit DAvis, PhD, report their findings in the August 2010 issue of the journal Work.

 

According to the Centers for Disease Control and Prevention (CDC), 44 million Americans are considered clinically obese. Since 1975, the number of obese Americans has risen from 47 percent to 66.3 percent. Previous studies have estimated obesity-attributable medical expenditures in the United States at $75 billion, with half of these costs financed by Medicare or Medicaid.

 

"Obesity has become a national health crisis, but compliance for weight loss programs is notoriously poor. One potential reason for this is that current programs target long-term diseases, with little direct relevance to the person’s current health status,” adds Davis, senior author of the study and director of the Low Back Biomechanics and Workplace Stress Laboratory at the UC College of Medicine’s environmental health department. "Our study results challenge people to rethink the way they structure weight loss programs.”

 

For this pilot study, UC researchers partnered with a Cincinnati-based weight loss clinic to recruit study volunteers. Thirty two women between the ages of 22 and 76 participated in the study and data was collected over the course of a 12-week dietary weight loss regimen.

 

Researchers collected baseline individual weight and musculoskeletal pain data related to nine body regions: neck, shoulders, elbows, hands and wrists, upper back, lower back, hips, knees and lower legs and feet. Participants were then tracked each week to record any weight loss and asked to rate their pain on a scale of zero to 10 every other week.

 

Significant associations were found between weight loss and overall pain reduction, as well as pain reduction in the elbow, hip region and upper and lower back.

 

Researchers say these preliminary results could have ramifications for companies with a high prevalence of overweight workers with musculoskeletal problems—particularly in industries that require manual or repetitive weight-bearing labor.

 

"From an ergonomics perspective, we can only do so much to alter the work environment to remove body stressors,” explains Kotowski. "Excess weight adds additional stress to the musculoskeletal system and that can only be relieved through weight loss.”

 

* * *

Source: University of Cincinnati . http://www.healthnews.uc.edu/news/

* * *

If you are considering weight loss surgery, you owe it to yourself to choose a physician who is not only highly skilled, but caring and compassionate as well. Many physicians out there will treat your obesity. Dr. Waggoner will treat you!

To contact us for more information and/or to reserve your seat for the next free seminar, please click here.

Bariatric Surgery in Diabetic Adults Improves Insulin Sensitivity Better than Diet

Gastric bypass surgery improves Type 2 diabetes by other mechanisms in addition to weight loss and does so better than a low-calorie diet despite achieving equal weight loss, a new study finds. The results will be presented Monday at The Endocrine Society’s 92nd Annual Meeting in San Diego.

“Our study shows that in the short term, weight loss by diet alone does not achieve the same improvements in diabetes as gastric bypass surgery,” said the presenting author, Judith Korner, MD, PhD, assistant professor of medicine at Columbia University College of Physicians and Surgeons, New York.

Korner and her colleagues found that gastric bypass surgery better improved insulin sensitivity, the body’s ability to successfully clear glucose sugar from the bloodstream into the cells. Insulin sensitivity is impaired in people with Type 2 diabetes, and obesity adds to this problem. The result is a buildup of sugar in the blood.

The study compared the effects on diabetic adults of a low-calorie diet versus Roux-en-Y gastric bypass, the most common gastric bypass procedure. Roux-en-Y gastric bypass decreases the size of the stomach and reroutes the digestive tract to bypass most of the stomach and part of the small intestine. After gastric bypass, many diabetic patients achieve normal blood glucose control or vastly improved control, and some may no longer require diabetes medications.

In the study, seven obese patients with Type 2 diabetes received a daily 800-calorie liquid diet and no surgery, while seven other obese diabetic adults underwent gastric bypass surgery. The study ended when both groups lost the same amount of weight: an average of 8 percent of body weight. However, the surgery-treated patients lost the weight faster: in about 3.5 weeks compared with 8 weeks for the dieters.

Surgical patients were able to discontinue all of their diabetes medications by the study’s end, but the dieters reduced their medication use by 55 percent, Korner reported.

The researchers found significant improvements in the surgery group in measures of insulin sensitivity and function of beta cells, the insulin-producing cells in the pancreas. Improvements in insulin sensitivity in the low-calorie diet group were not statistically significant and beta cell function improved to a lesser extent.

Korner speculated that hormonal changes may be responsible for the improvements resulting from Roux-en-Y surgery in individuals with Type 2 diabetes.

“It will be important to understand how surgery works to produce these results so that we can develop medical therapies of equivalent efficacy,” she said.

The National Institute of Diabetes and Digestive and Kidney Diseases funded this study.

 

* * *

Source: The Endocrine Society . http://www.endo-society.org

* * *

If you are considering weight loss surgery, you owe it to yourself to choose a physician who is not only highly skilled, but caring and compassionate as well. Many physicians out there will treat your obesity. Dr. Waggoner will treat you!

To contact us for more information and/or to reserve your seat for the next free seminar, please click here.

Study Finds Obese Women Who Undergo Bariatric Procedures Before Pregnancy Are Three Times Less Likely to Have Gestational Diabetes

Obese women who have bariatric surgical procedures before pregnancy were three times less likely to develop gestational diabetes (GDM) than women who have bariatric operations after delivery, according to new research findings published in the August issue of the Journal of the American College of Surgeons. The retrospective study also found that delivery after bariatric procedures was associated with reduced odds of cesarean section—an outcome associated with GDM.

Gestational diabetes affects at least seven percent of all pregnancies in the United States, with rates as high as 14 percent among certain populations. Its prevalence is increasing among reproductive-age women, parallel to increasing rates of obesity and type 2 diabetes. Currently, 33 percent of women over 19 years of age meet the criteria for obesity (body mass index [BMI] > 30 kg/m2) and seven percent for extreme obesity (BMI > 40 kg/m2). Bariatric surgical procedures are the only intervention shown to produce sustained weight reduction in the vast majority of subjects.

“The major finding of our study is that women who had bariatric surgery before they delivered reduced odds of gestational diabetes when compared with women had bariatric surgery after they delivered,” said Anne E. Burke, MD, MPH, assistant professor of obstetrics and gynecology at the Johns Hopkins University School of Medicine in Baltimore, Md.

“Despite a growing body of evidence supporting the safety and efficacy of bariatric surgery in reversing obesity-related complications, few candidates for the procedure are referred to a surgeon to discuss their options,” stated Martin Makary, MD, MPH, associate professor of surgery at Johns Hopkins University School of Medicine and senior author of the study.

Researchers performed a retrospective study to compare rates of GDM and related outcomes between a group of women who had bariatric operations before pregnancy (n=346) and a group who had bariatric operations after delivery (n=354) between 2002 and 2006. Women who delivered after bariatric procedures had lower incidences of GDM (8 percent vs. 27 percent, odds ratio (OR) 0.23) and cesarean section (28 percent vs. 43 percent, OR 0.53) than those who delivered before bariatric procedures.

Women who delivered after bariatric operations were slightly older (32.5 years vs. 31.1 years, p < 0.001). The median time from surgical procedure to delivery was 19.6 months, which meant that the majority of women did not adhere to the current recommendation to defer pregnancy for two years after bariatric procedures were performed. Deliveries before bariatric operations  occurred at a median time of 16.5 months, meaning that most women waited more than a year after delivery before having bariatric procedures. The majority of women in each group had a bypass procedure (75 percent in the prebariatric delivery group and 87 percent in the postbariatric delivery group). Women who had a prebariatric delivery were more likely to have an adjustable banding procedure than women with a postbariatric delivery (9 percent vs. 3 percent).

 

* * *

Source: American College of Surgeons . http://www.facs.org

* * *

If you are considering weight loss surgery, you owe it to yourself to choose a physician who is not only highly skilled, but caring and compassionate as well. Many physicians out there will treat your obesity. Dr. Waggoner will treat you!

To contact us for more information and/or to reserve your seat for the next free seminar, please click here.

Patients With Diabetes May Need Fewer Medications After Bariatric Surgery

Bariatric surgery appears to be associated with reduced use of medications and lower health care costs among patients with type 2 diabetes, according to a report in the August issue of Archives of Surgery, one of the JAMA/Archives journals.

"The rapidly growing epidemics of obesity and diabetes threaten to overburden the world's health care systems," the authors write as background information in the article. "From an epidemiological standpoint, once these diseases develop they are rarely reversed. Dietary, pharmaceutical and behavior treatments for obesity are associated with high failure rates, and medical management of diabetes is also often unsuccessful. Despite many efforts to improve the control of glucose levels in diabetes, including clinical guidelines and patient and provider education, less than half of all patients with type 2 diabetes mellitus achieve the American Diabetes Association recommendation of a hemoglobin A1C level of less than 7 percent."

The use of bariatric surgery—that results in long-term weight loss, improved lifestyle and decreased risk of death—has tripled in the past five years, the authors note. Martin A. Makary, M.D., M.P.H., and colleagues at the Johns Hopkins Bloomberg School of Public Health and The Johns Hopkins University School of Medicine, Baltimore, studied 2,235 U.S. adults (average age 48.4) with type 2 diabetes who underwent bariatric surgery during a four-year period, from 2002 to 2005. They used claims data to measure the use of diabetes medications before and after surgery, along with health care costs per year.

Of the 2,235 patients, 1,918 (85.8 percent) were taking at least one diabetes medication before surgery, with an average of 4.4 medications per patient. Six months after surgery, 1,669 of 2,235 patients (74.7 percent) had eliminated their diabetes medications. Of the 1,847 patients with available data one year after surgery, 1,489 (80.6 percent) had eliminated medications; after two years, 906 of 1,072 (84.5 percent) had done so. This reduction was observed in all classes of diabetes medications.

"We observed that independence from diabetes medication was almost immediate within the initial months after surgery and did not correlate with the gradual weight loss expected," the authors write. "This supports the theory that the resolution of diabetes is not due to weight loss alone but is also mediated by gastric hormones, with the three most implicated being peptide YY, glucagonlike peptide and pancreatic polypeptide. As a known mediator of insulin regulation, glucagonlike peptide levels have been noted to increase immediately after bariatric surgery and may explain why surgeons have noted complete resolution of diabetes in some cases within days after surgery."

Health care costs averaged $6,376 per year in the two years before surgery, and the median or midpoint cost of the surgery and hospitalization was $29,959. Total annual health care costs increased by 9.7 percent ($616) in the year following the procedure, but decreased by 34.2 percent ($2,179) in year two and by 70.5 percent ($4,498) in year three.

"Based on these data, we have identified several important implications for health care delivery and public policy," the authors conclude. "Foremost, eligible obese patients should be properly informed of the risks and benefits of bariatric surgery compared with non-surgical health management. Health care providers should consider discussing bariatric surgery in the treatment of obese patients with type 2 diabetes. Health insurers, private and public, should pay for bariatric surgery for appropriate candidates, recognizing a potential annualized cost savings in addition to the benefit to health."

* * *

Source: Reprinted from materials provided by JAMA and Archives Journals. http://pubs.ama-assn.org/media/

Journal Reference: Martin A. Makary; Jeanne M. Clarke; Andrew D. Shore; Thomas H. Magnuson; Thomas Richards; Eric B. Bass; Francesca Dominici; Jonathan P. Weiner; Albert W. Wu; Jodi B. Segal. Medication Utilization and Annual Health Care Costs in Patients With Type 2 Diabetes Mellitus Before and After Bariatric Surgery. Arch Surg, 2010; 145 (8): 726-731

* * *

If you are considering weight loss surgery, you owe it to yourself to choose a physician who is not only highly skilled, but caring and compassionate as well. Many physicians out there will treat your obesity. Dr. Waggoner will treat you!

To contact us for more information and/or to reserve your seat for the next free seminar, please click here.

New Study Shows Bariatric Surgery Resolves Sexual Dysfunction in Women With Morbid Obesity

Bariatric surgery not only helps people lose weight, it can resolve or significantly improve female sexual dysfunction (FSD), a prevalent and complex condition that adversely affects women's health and quality of life, according to a new study presented at the 27th Annual Meeting of the American Society for Metabolic & Bariatric Surgery (ASMBS).¹

Researchers from The Miriam Hospital’s Weight Control and Diabetes Research Center and the Warren
Alpert Medical School of Brown University studied 54 sexually active women before and after having either laparoscopic adjustable gastric banding (LAGB) or Roux-en-Y gastric bypass surgery. Women in the study had an average body mass index (BMI) of 45 before surgery, meaning they were about 100 pounds or more overweight. Before surgery, 63 percent of the women had FSD as measured by the Female Sexual Function Index (FSFI), a standardized test used to assess sexual function. Using the same FSFI measurement, by six months after surgery, 68 percent no longer had FSD. Nearly all women in the study reported significant improvements in all aspects of sexual function, including desire, arousal, lubrication, orgasm, satisfaction and less or no pain during or after intercourse. Gastric bypass surgery patients lost an average of 60 percent of their excess weight while LAGB patients lost an average of almost 35 percent of their excess weight within six months.

“Sexual functioning appears to improve quickly and dramatically after bariatric surgery and it doesn't seem to matter if a patient undergoes gastric bypass or laparoscopic adjustable gastric banding,” said Dale Bond, Ph.D., study co-author and assistant professor of psychiatry and human behavior at The Warren Alpert Medical School of Brown University. “Clearly significant weight loss plays a role, but further research is needed to determine the extent to which improvements in body image, obesity-related diseases, hormonal mechanisms, and emotional health contribute to better sexual functioning.”

It is estimated that up to 43 percent of women are affected by some form of sexual dysfunction with higher rates linked to advancing age, decreasing estrogen levels, and medical conditions including obesity, Type 2 diabetes and high blood pressure. In this prospective study, women with morbid obesity had a 25 percent higher prevalence of sexual dysfunction than the general female population and the level of sexual dysfunction was significantly worse.

People who are morbidly obese are generally 75 to 100 or more pounds overweight, have a BMI of 40 or
more, or a BMI of 35 or more with an obesity-related disease, such as Type 2 diabetes, heart disease or sleep apnea. According to the ASMBS, more than 15 million Americans have morbid obesity and in 2009 an estimated 220,000 people had some form of bariatric surgery. The most common methods of bariatric surgery are laparoscopic gastric bypass and laparoscopic adjustable gastric banding (LAGB).

In addition to Dr. Bond, co-authors of the study were Rena R. Wing, Ph.D. and Sivamainthan
Vithiananthan, MD from The Miriam Hospital and The Warren Alpert Medical School of Brown University;
Harry C. Sax, Esq. from The Warren Alpert Medical School of Brown University; G.D. Roye, MD and Beth A. Ryder from Rhode Island Hospital and The Warren Alpert Medical School of Brown University; and Dieter Pohl and Jeannine Giovanni, MD from Roger Williams Hospital.

* * *

¹Source: American Society for Metabolic & Bariatric Surgery. http://www.asmbs.org/

* * *

If you are considering weight loss surgery, you owe it to yourself to choose a physician who is not only highly skilled, but caring and compassionate as well. Many physicians out there will treat your obesity. Dr. Waggoner will treat you!

To contact us for more information and/or to reserve your seat for the next free seminar, please click here.

The Remarkable Effects of Fat Loss on the Immune System

Australian scientists have shown for the first time that even modest weight loss reverses many of the damaging changes often seen in the immune cells of obese people, particularly those with Type 2 diabetes.

The immune system is made up of many different kinds of cells that protect the body from germs, viruses and other invaders. These cells need to co-exist in a certain balance for good health to be maintained. Many factors, including diet and excess body fat, can tip this balance, creating immune cells that can attack, rather than protect, our bodies.

It has been known for some time that excess body fat, particularly abdominal fat, triggers the production of ‘pro-inflammatory’ immune cells, which circulate in the blood and can damage our bodies. In addition, other inflammatory immune cells, known as macrophages, are also activated within fat tissue.

The recent study¹ looked at obese people with Type 2 diabetes or prediabetes who were limited to a diet of between 1000 and 1600 calories a day for 24 weeks. Gastric banding was performed at 12 weeks to help restrict food intake further. The study determined the effects of weight loss on immune cells.

Undertaken by Dr Alex Viardot and Associate Professor Katherine Samaras from Sydney’s Garvan Institute of Medical Research, the results showed an 80% reduction of pro-inflammatory T-helper cells, as well as reduced activation of other circulating immune cells (T cells, monocytes and neutrophils) and decreased activation of macrophages in fat. They are published in the prestigious Journal of Clinical Endocrinology Metabolism, now online.

“Excess weight disorders now affect 50% of adult Australians, with obesity being the major cause of Type 2 diabetes and some cancers,” said Associate Professor Samaras.

“The situation has reached crisis point, and people must be made aware that excess fat will affect their immune systems and therefore their survival.”

“We have found that a modest weight loss of about 6 kg [approximately 13.23 pounds] is enough to bring the pro-inflammatory nature of circulating immune cells back to that found in lean people.”

“These inflammatory cells are involved in promoting coronary artery disease and other illnesses associated with obesity.”

“This is the first time it has been shown that modest weight reduction reverses some of the very adverse inflammatory changes we see in obese people with diabetes.”

“We also showed that the activation status of immune cells found in fat predicted how much weight people would lose following a calorie restricted diet and bariatric surgery. Those with more activated immune cells lost less weight.”

“It’s the first time this has been described and is important because it helps us understand why some people lose weight more easily than others, and that inflammation is involved in regulating the response to bariatric surgery.”

The Garvan study reinforces a message we hear regularly – to optimise your health, keep your weight and waist in the healthy range.

* * *

¹Garvan Institute. http://www.garvan.org.au/

* * *

If you are considering weight loss surgery, you owe it to yourself to choose a physician who is not only highly skilled, but caring and compassionate as well. Many physicians out there will treat your obesity. Dr. Waggoner will treat you!

To contact us for more information and/or to reserve your seat for the next free seminar, please click here.

Study Shows Exercising Just Got Easier for Busy People

If you’re the type of person who invokes the “not enough time” clause when it comes to exercising, it’s time to find a new excuse. Researchers who have been studying interval training have found that it not only takes less time than what is typically recommended, but the regimen does not have to be “all out” to be effective in helping reduce the risk of such diseases at Type 2 diabetes.

The study appears in the March issue of The Journal of Physiology.

“What we’ve been able to show is that interval training does not have to be ‘all out’ in order to be effective and time-efficient,” says Martin Gibala, professor and chair of the Department of Kinesiology at McMaster University. “While still a very demanding form of training, the exercise might be more achievable by the general public—not just elite athletes—and it certainly doesn’t require the use of specialized laboratory equipment.”

Since Gibala’s first study on interval training was published five years ago, a growing body of research has zeroed in on this particular style of exercise in which you train hard but for less time.

Previous research by the McMaster group involved 30 seconds of maximal pedaling on a special bike followed by four minutes of recovery, and repeated 4-6 times. The new study involves eight to 12 one-minute bouts of exercise on a standard stationary bicycle at a relatively lower intensity with rest intervals of 75 seconds, for a total of 20-25 minutes per session. The workload was still above most people’s comfort zone —about 95% of maximal heart rate — but only about half of what can be achieved when people sprint at an all-out pace.

“That is the trade-off for the relatively lower intensity,” says Gibala. “There is no free lunch; duration must increase as intensity decreases.”

While the total amount of exercise performed was higher than in Gibala’s previous interval training studies, the overall time commitment was still lower than what is typically recommended by public health agencies.

Subjects used in the study performed six training sessions over 14 days. After the two week training period, the subjects showed the same benefits that Gibala’s team has previously observed after traditional, long-duration endurance training: improved exercise performance and muscular adaptations that are linked to reduced risk of diseases such as Type 2 diabetes.

The study was made possible by funding from the Natural Sciences and Engineering Research Council of Canada.

Gibala is currently taking his research a step further by studying the effects of interval training on middle-aged and elderly participants who are non-traditional exercisers.

* * *

¹McMaster University. http://www.mcmaster.ca/opr/html/opr/media/main/NewsReleases/news_releases.html

Medical Advice Disclaimer: The content of this blog entry is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician, or other qualified health provider with any questions you may have regarding a medical condition.

* * *

If you are considering weight loss surgery, you owe it to yourself to choose a physician who is not only highly skilled, but caring and compassionate as well. Many physicians out there will treat your obesity. Dr. Waggoner will treat you!

To contact us for more information and/or to reserve your seat for the next free seminar, please click here.

New Study May Explain How Weight-loss Surgery Reverses Type 2 Diabetes

A team of researchers, led by a UC Davis veterinary endocrinologist, has shown for the first time that a surgical procedure in rats that is similar to bariatric surgery in humans can delay the onset of type 2 diabetes.¹ The researchers also have identified biochemical changes caused by the surgeries that may be responsible for that delay.

Findings from the study, published online in the journal Gastroenterology, should help researchers identify strategies for preventing and treating type 2 diabetes, a chronic condition in which the body is unable to properly metabolize sugar and fat, leading to serious complications including heart disease, blindness and kidney failure.

Type 2 diabetes affects more than 21 million people in the United States, where it results in more than $150 billion in direct and indirect annual costs, according to the National Institutes of Health.

“Bariatric surgery currently is considered to be the most effective long-term treatment for human obesity and often leads to marked improvements in diabetes,” said the study’s lead author Peter Havel, a professor with joint appointments in the School of Veterinary Medicine and Department of Nutrition.

“It has been thought that reduction of blood sugar, which indicates a reversal of type 2 diabetes, in patients following bariatric surgery was due to post-surgery weight loss,” Havel said. “This study, however, supports the observations from a number of earlier clinical studies reporting that diabetes is often improved prior to substantial weight loss. It also suggests that endocrine changes in hormones produced by the gastrointestinal tract may contribute to the early effects of bariatric surgery, in addition to the later effects of weight loss.”

"This study confirms our clinical observations that metabolic regulation -- specifically homeostasis of glucose -- occurs quickly after gastric bypass surgery," said Mohamed Ali, an associate professor of gastrointestinal surgery and a specialist in bariatric surgery at UC Davis Health System. "It's clear from the outcome that something physiologic is at work with controlling diabetes that is not related to weight loss.

“UC Davis has the perfect environment for collaboration between basic and clinical scientists to take this discovery to the next step, which is identifying the molecular signals that set these physiologic changes in motion," said Ali, who was not a participant in this study, but has collaborated with Havel on previous research.

About Bariatric Surgery in Humans
In severe cases of obesity -- usually when the patient is 80 to 100 or more pounds overweight -- bariatric surgery is used to alter or reconstruct the stomach and/or the intestinal tract. In such cases, obesity is not just a weight issue but also a life-threatening health problem that often leads to type 2 diabetes, heart disease and sleep apnea.

There are several types of bariatric surgeries available in the United States. The most commonly performed surgical procedure, known as Roux-en-Y gastric bypass surgery, limits the amount of food the stomach can hold and reroutes the digestive tract, resulting in changes in intestinal function and hormones produced by the gastrointestinal tract.

In 2008, about 220,000 people with severe obesity in the U.S. had bariatric surgery, according to the American Society for Metabolic and Bariatric Surgery.

The New Study
Havel and colleagues set out to test a hypothesis that certain bariatric surgical procedures were successful in improving type 2 diabetes, at least in part, because the procedures increased the flux of unabsorbed nutrients to the far end of the small intestine and, in doing so, triggered increased secretion of two hormones. Those hormones -- glucagon-like peptide-1 (GLP-1) and peptide-YY (PYY) -- are known to have a role in controlling food intake and improving insulin secretion and insulin sensitivity, thereby helping to stabilize blood sugar levels.

To test the hypothesis, the researchers carried out a surgical procedure known as ileal interposition in a line of rats that were predisposed to obesity and type 2 diabetes. The rat model, developed in Havel’s laboratory, was known as the UC Davis Type 2 Diabetes Mellitus (UCD-T2DM) Rat. The pathology of type 2 diabetes in these animals is more similar to type 2 diabetes in humans than other existing rodent models of the disease.

The ileal interposition procedure involves relocating a short portion of the small intestine known as the ileum further forward in the intestinal tract. Then the researchers compared how long it took for the animals to develop diabetes, compared with a control group of rats that had surgery but without rearrangement of the intestines.

They found that the rats receiving the ileal interposition surgery developed type 2 diabetes 120 days later than did the rats in the control group. Furthermore, by the time the rats were one year old, 78 percent of the control group rats were diabetic while only 38 percent of the rats that had received the ileal interposition procedure had developed diabetes.

Havel said the delay in onset of diabetes in the rats would be similar to delaying the age of onset of diabetes by approximately 10 years in a person, which would be expected to significantly decrease the amount of time for diabetic complications to develop, and to reduce the health care costs associated with treating this costly and prevalent disease.

The researchers also found that, when compared with the control group, the rats receiving the ileal interposition surgery had:

• lower fluctuations in blood sugar levels;


• improved insulin production, making them better able to metabolize sugar; and


• decreased levels of lipids (cholesterol and triglyceride) in the bloodstream,which are known to be risk factors for cardiovascular disease in humans.

“In addition, results from the study also demonstrated that the ileal interposition surgery increases production of bile acids, which are involved in fat metabolism and can increase the production of GLP-1, the hormone that improves insulin secretion and insulin sensitivity,” Havel said. “This could contribute to the delay in the onset of type 2 diabetes that we observed in the rats in this study.”

He noted that further studies are needed to better understand how surgically induced improvements of metabolism can be achieved in order to discover new methods for preventing and treating type 2 diabetes. Havel, postdoctoral researcher Bethany Cummings and their colleagues have received funding from a National Institutes of Health Challenge Grant to continue to pursue research on the effects of bariatric surgical procedures in the UCD-T2DM model of diabetes.

Collaborating with Havel on this study were Cummings, Kimber Stanhope, James Graham, Jennifer Lee and Helen Raybould, all at UC Davis; April Strader of Southern Illinois University School of Medicine; and Denis Baskin of the Department of Veterans Affairs Puget Sound Health Care System and the University of Washington, Seattle.

Funding for the study was provided by UC Davis, the National Institutes of Health and the American Diabetes Association.

***

¹University of California/UC Davis. http://www.news.ucdavis.edu/

* * *

If you are considering weight loss surgery, you owe it to yourself to choose a physician who is not only highly skilled, but caring and compassionate as well. Many physicians out there will treat your obesity. Dr. Waggoner will treat you!

Contact Bradley Waggoner, MD:

• If you are ready to set-up an appoint to discuss your weight loss options.
• Reserve your seat at the next free informational seminar outlining your obesity surgery options (including lap-band system procedures) and meet Bradley Waggoner in person.

If you'd like to set-up an appointment to further discuss your weight loss surgical options, please contact us.

Exercise Counters Negative Effects of Weight Regain, MU Researchers Find

With the obesity rate rising for American adults and children, health concerns such as diabetes and cardiovascular disease are a frequent reality. Although obesity itself is a major risk factor for disease, most of the threat may be associated with a cluster of risk factors called the metabolic syndrome (MetS). Losing weight can improve health and reduce these risk factors, but many people have difficulty keeping the weight off. Now, University of Missouri researchers have found that exercising during weight regain can maintain improvements in metabolic health and disease risk.¹

In the study, individuals who didn’t exercise during weight regain experienced significant deterioration in metabolic health, while those who exercised maintained improvements in almost all areas. The MU study, led by Tom R. Thomas, professor in the Department of Nutrition and Exercise Physiology in the College of Human Environmental Sciences, is the first to examine the role of exercise in countering the negative effects of weight regain on MetS and overall health status.

“Although many people are successful at losing weight through diet and exercise, the majority of them will relapse and regain the weight,” Thomas said. “The findings of this study indicate that regaining weight is very detrimental; however, exercise can counter those negative effects. The findings support the recommendation to continue exercising after weight loss, even if weight is regained.”

In the study, overweight men and women with measured characteristics of MetS were given a diet and aerobic exercise plan that included supervised exercise five days a week, for 4-6 months. After losing weight, participants underwent programmed weight regain and were separated into two groups, one that exercised and one that didn’t. The non-exercise group experienced rapid deterioration in weight-loss induced benefits to metabolic health. The exercise group maintained improvements in almost all measures, including LDL and HDL cholesterol, oxygen consumption (VO2max), blood pressure and glucose. Exercise didn’t maintain blood cholesterol and abdominal fat loss.

“It’s clear that the message to lose weight isn’t working because so many people regain weight; a new message is to keep exercising and maintain your weight to reduce disease risk and improve overall health,” Thomas said. “Don’t worry so much about losing weight, but focus on exercising and maintaining your current weight.”

The study will be published in the Journal of Applied Physiology in April. Thomas, adjunct professor in the Department of Cardiovascular Medicine, completed the study in collaboration with MU researchers in the Department of Internal Medicine; the Department of Medical Pharmacology and Physiology; the Harry S. Truman VA Medical Center; and the Department of Educational, School and Counseling Psychology.

***

¹University of Missouri News Bureau. http://munews.missouri.edu/index.php

* * *

If you are considering weight loss surgery, you owe it to yourself to choose a physician who is not only highly skilled, but caring and compassionate as well. Many physicians out there will treat your obesity. Dr. Waggoner will treat you!

Contact Bradley Waggoner, MD:

• If you are ready to set-up an appoint to discuss your weight loss options.
• Reserve your seat at the next free informational seminar outlining your obesity surgery options (including lap-band system procedures) and meet Bradley Waggoner in person.

If you'd like to set-up an appointment to further discuss your weight loss surgical options, please contact us.