Short-term intensive weight loss program works for four years: Valid option seen to bariatric surgery

ScienceDaily (June 12, 2012) — A study by a team of clinicians and researchers at the Joslin Diabetes Center in Boston has shown for the first time that patients with diabetes who enrolled in a short-term intensive weight management program were able to lose weight and keep it off on their own for four years. The findings suggest an alternative course to bariatric surgery in the fight against type 2 diabetes.

See Also:Health & MedicineDiet and Weight LossObesityFitnessDiabetesWounds and HealingDiseases and ConditionsReferenceDiabetes mellitus type 2HyperglycemiaDiabetic dietDiabetes mellitus type 1

The study, presented recently as a late-breaking abstract at the American Diabetes Association's 72nd Scientific Sessions, strongly counters the popular view that people generally cannot maintain long-term the weight loss achieved during lifestyle intervention programs.

"The notion that most people in the medical field have is that when you apply intensive lifestyle interventions, the majority of patients gain all or most of the weight back in a year," said Osama Hamdy, M.D., Ph.D., Medical Director of the Obesity Clinical Program and Director of Inpatient Diabetes Management at Joslin and lead author of the paper.

"People have been pessimistic," he added. "They think they may need bariatric surgery. But we are sending an optimistic message. Think again. There is something else that can work effectively in real-world clinical practice and save money too. This is a very important observation."

The study showed that around 50 percent of the 120 patients who enrolled in the Weight Achievement and Intensive Treatment (Why WAIT) program for 12 weeks were able to maintain an average of 9.5 percent weight loss at four years, while the total group maintained 6.3 percent at four years.

Why WAIT is a multidisciplinary diabetes weight management program designed for clinical practice. The program included a change in diabetes medications to enhance weight reduction, structured dietary intervention with lower carbohydrates and higher protein and meal replacement, an exercise program, with emphasis on strength training and weekly educational and support sessions.

Although subjects in this study were followed for four years, they were on their own after the initial 12-week program. The study found that about half of the subjects did not regain the weight -- on average 24 pounds -- after four years. This group also maintained a significant improvement in their metabolic control as measured by hemoglobin A1c and the improvement in other vascular risk factors like blood pressure and lipids.

It also found that those who maintained at least seven percent of their weight loss at one year were most likely to continue the weight reduction over the long term.

"This is very important information," Dr. Hamdy said. "It tells us not everyone gains the weight back. In reality, these are similar numbers to the weight loss gained by some bariatric surgeries at that time frame."

Those who had lost at least seven percent of their body weight after one year lost an average of 29 pounds -- or 11.9 percent of their body weight -- at 12 weeks and maintained an average loss of 31.5 pounds -- or 12.6 percent -- at one year.

A second group included those who lost an average of 19.6 pounds -- or eight percent -- at 12 weeks but was down to a loss of just 5.6 pounds -- or 2.3 percent -- at one year.

Those in the first group maintained weight losses of 23.9 pounds at two years, 23.5 pounds at three years and 24.1 pounds at four years. Those in the second group only maintained losses of 6.9 pounds at two years, 6.3 pounds at three years and 8 pounds at four years.

Blood sugar levels in the first group dropped over the four year period, but levels in the second group rebounded after dropping initially. However, there were no differences in the groups when reductions in blood pressure, HDL cholesterol and triglyceride levels were compared at the end of the four years.

"Those who gained the weight back still got some benefits," Dr. Hamdy said.

He said the findings of this study are more robust than the four-year results initially reported from the National Institutes of Health's Look Ahead (Action for Health and Diabetes) study, designed to assess the long-term health consequences of intentional weight loss in overweight and obese individuals with type 2 diabetes.

He said this probably due to the fact that patients in the Why WAIT study received an optimal intensive lifestyle intervention, which included close evaluation at the outset, and that all interventions were in group format. In addition, diabetes medications were also adjusted by diabetologists at the start and during the follow-up, and patients were fed less carbohydrates and exercised more -- up to 300 minutes per week, he said.

Subjects in Why WAIT were able to cut their diabetes medications by half on average at the end of the 12 week program. It saved them $561 a year on diabetes medications alone, he said. Based on other valid cost-effective analysis, patients in the program saved $2,000 per year or 27 percent on overall health care costs and around $1,000 or 44 percent on diabetes-related costs, he added.

Dr. Hamdy said the study proves that intensive lifestyle intervention is at least as effective as some common bariatric surgeries in helping people lose weight and deal with their diabetes issues, with less cost and fewer short and long-term side effects.

"Surgery carries a lot of long-term risks," he said. "And a significant number of surgical patients gain their weight back after one or two years."

He also said that bariatric surgery costs in the range of $20,000 while the optimal intensive lifestyle intervention through the Why WAIT model cost just $2,700. After those results, "we are ready to debate them on the long-term value," he added.

He concluded: "So many physicians have been telling the governmental authorities that weight loss in clinical practice is a waste of money and that they will never keep the weight off. We now have a message for them. It is very effective in at least half of people in terms of weight loss and cost savings. Intensive lifestyle intervention can be a very valid option."

Dr. Hamdy said a new study involving Joslin and Brigham and Women's Hospital in Boston is underway that aims to compare the Why WAIT model directly to bariatric surgery.

Co-authors included Amy Rossi, MD; Adham Abdel Mottalib, MD; Nuha El Sayed, MD; Ann Goebel-Fabbri, Gillian Arathuzik, Jacqueline Shahan, Joan Beaton, Pamela Needle, Amanda Kirpitch, John Zrebiec, Michael Seem Catherine Carver, Jo-Anne Rizzotto and Martin Abrahamson, M.D..

The study was internally funded by Joslin Diabetes Center.

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Experimental bariatric surgery controls blood sugar in rodents with diabetes via novel sensing signals in gut

ScienceDaily (May 20, 2012) — For the first time, scientists at the Toronto General Hospital Research Institute have shown that an experimental bariatric surgery can lower blood sugar levels in rats with type 1 diabetes.

See Also:Health & MedicineDiabetesDiet and Weight LossWounds and HealingHypertensionObesityHormone DisordersReferenceBlood sugarHyperglycemiaGlycemic indexDiabetic diet

A team led by Dr. Tony Lam and Dr. Danna Breen, a post- doctoral fellow in the lab of Dr. Lam, used a rat model to study novel nutrient-sensing signals in the jejunum, located in the middle of the intestine. Dr. Lam and his team demonstrate that duodenal-jejunal bypass surgery activates novel nutrient-sensing signals in the jejunum and rapidly lowers blood sugar levels in non-obese rats with uncontrolled diabetes. DJB surgery is a type of bariatric surgery which excludes the duodenum and proximal jejunum, the first section of the small intestine, and instead redirects food into the distal jejunum, the middle to last section of the intestine. This latter section of the intestine, as demonstrated by Dr. Lam and his team, can sense glucose and signal to the brain to let the liver know that it must lower glucose production, leading to better control of blood sugar in the diabetic rats.

The study showed for the first time that a surgical intervention induces a rapid glucose-lowering effect in non-obese type 1 uncontrolled diabetic rats, independent of a reduction in food intake and body weight as well as changes in blood insulin levels.

The research was published in a paper entitled, "Jejunal nutrient sensing is required for duodenal-proximal jejunal bypass surgery to lower glucose levels in uncontrolled diabetes," in the May 20, 2012 on-line edition of the international journal Nature Medicine.

"We report that shortly after a meal, the influx of nutrients into the jejunum of DJB surgical diabetic rats activates novel sensing mechanisms to lower blood sugar levels. Importantly, this occurs in the presence of insulin-deficiency and is independent of weight loss," says Dr. Lam, who holds The John Kitson McIvor (1915 -- 1942) Endowed Chair in Diabetes Research and the Canada Research Chair in Obesity at the Toronto General Research Institute and the University of Toronto. He is also Associate Director of Research at the Banting and Best Diabetes Centre at the University of Toronto.

Currently, patients with Type 1 diabetes lower their glucose through insulin injections (usually several times a day) and must regularly monitor blood glucose levels. High or uncontrolled glucose levels can result in damage to eyes, nerves and kidneys and increase the risk of heart attack, stroke, blindness, erectile dysfunction, foot problems and amputations. Many laboratories around the world are in a race to find alternative and effective ways in which to lower and better control glucose levels because of the severe complications which can result from high sugar levels.

Dr. Lam's laboratory is a world pioneer in exploring the role of the gut in regulating blood sugar. "The gut is an easier and therefore more promising therapeutic target in regulating blood sugar than the brain or liver, due to their potential side effects, " says Dr. Danna Breen, who is the lead author in the study. Dr. Breen adds that this type of surgery may potentially have therapeutic value in lowering glucose (sugar) levels in non-obese individuals with type 2 or 1 diabetes, but that many more years of future studies are required to determine whether this approach is effective and safe in humans who have diabetes.

In healthy individuals, insulin is a hormone whose primary role is to regulate blood sugar. It is produced by cells located on the pancreas in response to sugar intake, and it acts to bring blood sugar to appropriate levels, allowing the body to have the energy it needs to function properly. In persons with type 1 diabetes, the pancreas does not produce insulin, resulting in elevated blood sugar levels due to lack of insulin which cannot signal to the liver to reduce sugar production. People with type 1 diabetes need to take daily insulin shots and carefully monitor their blood sugar levels.

"If new medicines or surgical interventions can be developed that stimulate this sensing mechanism in the gut, we may have an effective and alternative way of slowing down the body's production of sugar, thereby lowering blood sugar levels in diabetes," says Dr. Lam, who is also an Associate Professor of Medicine and Physiology at the University of Toronto. Other ongoing studies of Dr. Lam's lab reveal novel molecular targets in the gut that effectively lower blood sugar in obesity and type 2 diabetes.

Studies reported in the New England Journal of Medicine this year have challenged medical therapy as the prevailing method of treating patients with type 2 diabetes. Two studies reported that bariatric surgery induced remission in severely obese patients with type 2 diabetes, and was associated with significant improvement in metabolic control over and above medical therapy, both conventional and intensive. An accompanying April 26, 2012 editorial by Drs. Zimmet and Alberti, states that "surgeons may now be able to claim greater success in achieving metabolic control," in these patients, although long-term studies with greater numbers of patients still need to be completed. No studies have yet reported on surgical interventions as treatments for patients with type 1 diabetes.

"More than two million Canadians have diabetes. Diabetes is an epidemic in Canada and around the world that is growing at an alarming rate," says Dr. Philip M. Sherman, Scientific Director of the Institute of Nutrition, Metabolism and Diabetes at the Canadian Institutes of Health Research. "Since many people are undergoing bariatric surgery in an attempt to manage morbid obesity and the associated health problems, such as diabetes, it is critical that we understand how it works. The Canadian Institutes of Health Research is pleased to support Dr. Lam's work which increases our understanding and may offer a new approach to managing morbidity and premature mortality resulting from this illness."

Working with rats, Drs. Lam, Breen and colleagues designed and performed a series of elegant experiments on two different groups of rats: rats whose insulin-producing pancreatic islet cells were destroyed by toxins; and genetically-altered rats which experienced spontaneous autoimmune destruction of islet cells -- similar to what happens in humans with type 1 diabetes.

Non-obese rats induced with uncontrolled diabetes or autoimmune type 1 diabetes had an experimental DJB surgery, a variation of the Roux-en-Y gastric bypass, the most common surgical method currently used to treat obese patients. Two days after DJB surgery, blood sugars were normal in the insulin-deficient diabetic rats.

Dr. Breen emphasized that further studies need to be undertaken to determine the long-term effects of this intervention in rodents, as well as to ensure the safety and efficacy of this procedure in humans.

Other researchers involved in the study include Brittany A. Rasmussen, Andrea Kokorovic and Grace W.C. Cheung from the Toronto General Research Institute and the Department of Physiology, University of Toronto; and Dr. Rennian Wang, from the Departments of Physiology and Pharmacology, University of Western Ontario.

The work was funded by the Canadian Institutes of Health Research, as well as a fellowship from the University Health Network and the Banting and Best Diabetes Centre, University of Toronto.

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Try Quality Bariatric Protein Bars For Change

April 13, 2012 by adminWhen you are coping with the postoperative bariatric diet plans, you need to provide additional proteins, vitamins and minerals to your body that most often deficit due to reduced absorbing capacity of reduced stomach size and entirely new digestive system. Bariatric protein bars is one of the most convenient protein snack for such patients to recover most of the deficit proteins in the body. There are numerous supermarkets, health stores and consumer stores provide bariatric protein bars having different brands and different contents.  However, most of the high quality protein bars are targeted to provide high protein and low carbohydrate nutritional boost essentially required by the bariatric patients.

Typically, you find that all these commercial Bariatric protein bars contain whey, or soy protein along with some natural ingredients like peanuts, oats, milk, eggs and allowed organic colors and sweeteners. In addition, many of the protein bars manufacturers coat them in chocolate or yogurt to taste good and convenience to eat them on go. Most often the nutritional value of such protein bars depend on their contents and ingredients but most of them provide almost 10-25 grams of proteins in each bar. It should be noted that when they are providing protein rich content they are prepared in such manner that they are low in carbohydrates and total calorie count.

Eating Bariatric Protein Bars is often one of the most convenient ways to recover the deficient protein rather than using alternate methods of eating protein powder, liquid or tables. In addition they not only taste good but it provides mental satisfaction of having a chocolate or candy bar rather than having your regular protein meals. One thing that is important to understand about bariatric protein bars is they have high levels of refined sugars and saturated fats therefore it is better to avoid them as a definitive substitute to your regular meal.

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Bariatric Surgery May Offer A Cure For Diabetes

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2011New York weight loss surgeon Dr. Mitchell Roslin and Northern Westchester Hospital see sharp decline in diabetes symptoms of post-surgery bariatric patients.

(1888PressRelease) November 03, 2011 - New York City, NY - With over 25 million Americans currently suffering from diabetes and two million more being diagnosed every year, the New York weight loss surgery specialist at Northern Westchester Hospital found a proven treatment method for at least some instances of the disease. New York weight loss surgeon, Dr. Mitchell Roslin, is the Chief Bariatric Surgeon at Northern Westchester Hospital and has seen dramatic reductions in the symptoms of Type 2 diabetes among his patients who have undergone bariatric procedures, such as gastric bypass or lap band surgery.

In New York City, gastric bypass surgery is gaining an increasingly impressive reputation for not only helping overweight individuals shed pounds, but for relieving them of the more severe complications which arise from obesity, especially Type 2 diabetes. "At Northern Westchester Hospital, we're seeing excellent results with these procedures. Not only do they offer a solution to obesity, but they also address the serious effects of obesity on the body, such as high blood pressure, sleep apnea and diabetes," Dr. Roslin says. After closely observing his patients before and after their surgeries, he has seen multiple cases in which patients have been able to greatly reduce or cut out their diabetes medications altogether.

Also garnering attention in New York, lap band surgery is an alternative to gastric bypass where the stomach is restricted using a band. Northern Westchester Hospital sees its bariatric center as a leader in these laparoscopic, or minimally invasive, procedures and hopes that new studies regarding bariatric surgery and Type 2 diabetes symptoms will encourage more overweight patients to consider their weight loss options.

With the numerous minimally invasive surgeries available today, Dr. Roslin is hopeful that more people will begin to look at the striking statistics regarding weight loss and the cure for Type 2 Diabetes. Dr. Roslin said, "Physicians need to know that these surgical options are available to their overweight patients."

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Bariatric surgery dramatically outperforms standard treatment for type 2 diabetes

ScienceDaily (Mar. 26, 2012) — In the first published study of its kind, researchers from the Catholic University/Policlinico Gemelli in Rome, Italy, and NewYork-Presbyterian/Weill Cornell Medical Center found that bariatric surgery dramatically outperforms standard medical treatment of severe type 2 diabetes.

See Also:Health & MedicineDiabetesWounds and HealingObesityDiet and Weight LossToday's HealthcarePersonalized MedicineReferenceDiabetes mellitus type 2Blood sugarHyperglycemiaRefractive surgery

These findings were published March 27 in an advanced online edition of the New England Journal Medicine (NEJM).

The study's authors report that most bariatric surgery patients were able to discontinue all diabetes medications and maintain disease remission for the two-year study period, while none of those randomly assigned to receive standard medical treatment did.

"Although bariatric surgery was initially conceived as a treatment for weight loss, it is now clear that surgery is an excellent approach for the treatment of diabetes and metabolic disease," says senior author Dr. Francesco Rubino, chief of Gastrointestinal Metabolic Surgery and director of the Metabolic and Diabetes Surgery Center at NewYork-Presbyterian/Weill Cornell and associate professor of surgery at Weill Cornell Medical College.

It is particularly challenging to treat obese patients who have type 2 diabetes, because insulin therapy and other hypoglycemic medications often cause additional weight gain. In this study, most surgery patients experienced improvements in blood sugar levels, decreased total cholesterol and triglycerides, and improved HDL-cholesterol concentrations. This suggests that bariatric surgery for the treatment of diabetes may reduce a patient's cardiovascular risk.

"The unique ability of surgery to improve blood sugar levels and cholesterol levels as well as reduce weight makes it an ideal approach for obese patients with type 2 diabetes," says lead author Dr. Geltrude Mingrone, chief of the Division of Obesity and Metabolic Diseases and professor of medicine at Catholic University in Rome.

This was a randomized, controlled trial of patients aged 30 to 60.

This study evaluated remission of diabetes in 60 severely obese patients (those with a body mass index

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