Drop In Body Mass Index Research Articles

Obesity Prevention and Treatment

Obesity Prevention and Treatment

Large-Volume Liposuction and Prevention of Type 2 Diabetes: A Preliminary Report

This report presents a preliminary study investigating the effects of large-volume liposuction on the parameters that determine type 2 diabetes. The study enrolled 31 patients with a body mass index (BMI) exceeding 30kg/m(2) over a 1-year period. All the liposuction procedures were performed with the patient under local anesthesia using ketamine/valium sedation. Pre- and postoperative blood pressure, fasting glucose, glycosylated hemoglobin (HbA1C), weight, and BMI were evaluated for 16 of the 30 patients who returned for a follow-up visit 3 to 12months postoperatively. The average aspirate was 8,455ml without dermolipectomy and 5,795ml with dermolipectomy. The data reveal a trend of improvement in blood sugar levels associated with weight loss that helps the patients. The average blood sugar level dropped 18% in our return patients, and the average weight loss was 9.2%. The average drop in BMI was 6.2%, and HbA1C showed a decrease of 2.3%. The patients with the best weight loss had the best reduction in blood sugar level and blood pressure. No transfers to the hospital and no thromboebolism occurred for any of the 31 patients. One dehiscence, two wound infections, and three seromas were reported. The authors hypothesize that large-volume liposuction in their series may have motivated some to diet, which could be explored in a larger series with control groups. Liposuction alone did not improve obesity but helped to motivate some of the patients to lose weight. These patients had the best results.

Revision to Malabsorptive Roux-En-Y Gastric Bypass (MRNYGBP) Provides Long-Term (10 Years) Durable Weight Loss in Patients with Failed Anatomically Intact Gastric Restrictive Operations

Twenty percent of gastric restrictive operations require revision. Conversion to Proximal Roux-en-Y gastric bypass (PRNYGBP) is associated with weight regain. Forty-one percent of these fail to achieve a body mass index (BMI) < 35. Few report follow-up (F/U) or quality of life (QOL) beyond 5 years. We report the long-term effectiveness of MRNYGBP as a revision. Retrospective chart review of patients (1993-2005) with a failed gastric restrictive operation (S1) at least a year out from revision (S2) to a MRNYGBP: small lesser curve 22 ± 10 (11-55) cm(3) pouch, long biliopancreatic limb, 150 cm alimentary limb, 141 ± 24 (102-190) cm common channel. Staple-line disruptions were excluded. Thirty-eight (37 F, 1 M) patients aged 46 ± 8 (17-56) years underwent conversion to a MRYGBP 8 ± 5 (2-23) years after: gastroplasty 25, adjustable gastric band 13 for weight regain (79%), gastroesophageal reflux disease (GERD; 29%), and band problems (24%). S1 provided only 24 ± 25% excess weight loss (EWL; 5.9 ± 6.3 BMI drop) and caused GERD in 32% of patients (p = 0.0124). There were no deaths or leaks. BMI dropped from 41.4 ± 7.8 to 27.3 ± 5.6 (down 20.5 ± 8.3 from S1), 80.1 ± 23.3% EWL (n = 32) at year 1 (p < 0.0001). This was maintained for 10 years. BMI was 28 ± 4 (21.5-31.9), 75.6 ± 21.1% EWL (57.3-109.6) (n = 5) at 10 years. Super obese patients had better 9.95% EWL after S2 (p = 0.0359). QOL (5 = excellent): 4.5 ± 0.5 (3-5). F/U: 5.1 ± 3.3 (1-13) years with 83.3% F/U 10-year rate. Labs at 3 years (n = 10): Alb 3.8 ± 0.4, Prot 6.8 ± 0.6, Iron 47.6 ± 33.3, VitD 15.1 ± 7.43, PTH 54.5 ± 27.2, B12 620.1 ± 676.5, Hct 34 ± 4.3. Revision MRNYGBP provides excellent durable long-term weight loss after failed gastric restrictive operations. Non-compliant patients are at a higher risk for malnutrition, anemia, and osteoporosis.

Plasma brain-derived neurotrophic factor in women after bariatric surgery: a pilot study

Eighteen morbidly obese women had plasma brain-derived neurotrophic factor (BDNF) measured before bariatric surgery and 3 months postoperatively. We analyzed plasma BDNF levels in all the participants then subdivided according to menopausal status and type of surgery. Brain-derived neurotrophic factor decreased significantly in all the participants and in the premenopausal group when looked at in isolation.

Roux-en-Y gastric bypass as a re-do procedure for failed restricive gastric surgery

Gastric restrictive procedures such as laparoscopic gastric banding or vertical banded gastroplasty show, at longer follow up, more and more failures and complications. This study focuses on the results of Roux-en-Y gastric bypass procedure (RYGBP) done as a re-do procedure, both after a technically failed restrictive procedure or when the restrictive procedure failed to obtain substantial weight loss. We reviewed data concerning the postoperative complications and weight loss of 36 patients undergoing re-do surgery for failed restrictive procedures. Over a period of two years, 36 patients with a mean age of 40.9 years were converted to a RYGBP. Median time to conversion was 4.9 years, median follow up after conversion was 6.6 months. Early postoperative complications (less than 30 days postoperatively) were noted in 11 patients (30%). A greater number of early complications were noticed in group A (technical complications) compared to group B (insufficient weight loss) (39% vs. 22%). Late postoperative complications were seen in six patients (16%). In this relatively short follow up period we noticed a drop in body mass index (BMI) from a mean of 38.8kg/m(2) to 30.9 kg/m(2) with a mean excess body weight loss (EBWL) of 33.1% after the re-do procedure. Body mass index decreased from a mean preoperative value of 37.6kg/m(2) to 28.9 kg/m(2) in group A patients with an EBWL 36%, while group B patients had a change in BMI from 40.1kg/m(2) to 32.9 kg/m(2) with a mean EBWL of 30%. Based on the literature, we can presume that restrictive surgery for morbidly obese patients will require many reoperations in the future. The standard operation of choice is RYGBP. In our study this procedure showed a higher, but not significantly early morbidity rate when the indication for re-do surgery was a technical complication of the initial procedure.

Augmentation With Open-Label Atomoxetine for Partial or Nonresponse to Antidepressants

Atomoxetine is a selective nor-epinephrine reuptake inhibitor currently approved for the treatment of attention-deficit/hyperactivity disorder. Other compounds that enhance synaptic norepinephrine have shown efficacy as antidepressant monotherapies and as augmentation agents. This case series study examined the role of atomoxetine in antidepressant augmentation. Fifteen adult outpatients with primary DSM-IV Axis I depressive disorders received open-label atomoxetine augmentation following partial response or nonresponse to at least 8 weeks of standard antidepressant pharmacotherapy. Atomoxetine 40 mg/day was added to ongoing medication regimens and titrated according to clinical response. Atomoxetine was systematically offered to patients from July through October 2003. Eleven patients (73%) completed at least 6 weeks of atomoxetine augmentation. Mean endpoint dose was approximately 80 mg/day. Nine patients (60%) met criteria for positive categorical response. Inventory of Depressive Symptomatology-Self-Report scores decreased significantly from baseline to endpoint, and clinician ratings of social and occupational functioning increased. There were no significant changes in heart rate or blood pressure, and the most common side effect was activation. A modest but significant drop in body mass index was observed (p = .025), and a subset (6/15; 40%) of patients reported improved sexual function. More studies are warranted to evaluate the potential utility of atomoxetine for antidepressant augmentation.

The impact of the AIDS epidemic on older persons.

The impact of the AIDS epidemic on older persons.