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WEDNESDAY, April 29 (HealthDay News) — Obesity surgery-related
complications in the United States declined 21 percent between 2001 and
2006, and payments to hospitals for obesity surgery decreased by as much
as 13 percent, partly because there were fewer patient readmissions due to
complications, a new study reports.

The findings from a study by the U.S. Agency for Healthcare Research
and Quality are based on an analysis of more than 9,500 patients under age
65 who had obesity surgery, also known as bariatric surgery, at 652
hospitals between 2001 and 2002 and between 2005 and 2006.

The researchers found that the complication rate among obesity surgery
patients dropped from 24 percent to about 15 percent. Contributing to that
decrease were declines in post-surgical infection rates (58 percent
lower), abdominal hernias, staple leakage, respiratory failure and
pneumonia (29 percent to 50 percent lower).

There was little change in rates of other complications such as ulcers,
dumping (involuntary vomiting or defecation), hemorrhage, wound
re-opening, deep-vein thrombosis and pulmonary embolism, heart attack and
stroke, the researchers noted.

Between 2001 and 2006, hospital payments for obesity surgery as a whole
fell from $29,563 to $27,905. Payments for patients who experienced
complications declined from $41,807 to $38,175, and from $80,001 to
$69,960 for those who had to be readmitted to hospital because of
complications, according to the study in the May issue of the journal
Medical Care.

Among the other findings:

• Complications fell even though there were more older and sicker
  patients having obesity surgery. During the study period, the proportion
  of patients over age 50 having obesity surgery increased from 28 percent
  to 44 percent, and the average number of underlying illnesses — such as
  diabetes, high blood pressure and sleep apnea — in bariatric surgery
  patients more than doubled.
• The six-month post-surgical death rate remained at about 0.5 percent
  during the study period.
• Hospital readmissions due to complications fell from 10 percent to 7
  percent, and complication-caused, same-day hospital outpatient visits fell
  from 15 percent to 13 percent.

The researchers said three main factors are behind the decline in
complications and costs among obesity surgery patients: increased use of
laparoscopy, which allows surgeons to operate through small incisions;
increased use of banding procedures without gastric bypass, such as
vertical-banded gastroplasty and lap band; and increased surgeon
experience.

More information

The U.S. National Institute of Diabetes and Digestive and Kidney
Diseases has more about bariatric surgery.

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NEW YORK (Reuters Health) –
The results of a literature review suggest that obesity surgery produces greater weight loss than conventional treatment for moderately obese patients as well as those with severe obesity. The best operation, however, remains unclear.

As reported in The Cochrane Library, Dr. Jill L. Colquitt and colleagues, from the University of Southampton, UK, searched various electronic databases and identified 26 studies that compared weight loss surgical procedures (also called bariatric surgery) with each other or with non-surgical treatments for obesity such as drugs, diets and exercise.

The studies included three randomized trials and three prospective studies that compared surgical with non-surgical treatments. The remaining 20 studies were trials that compared various types of bariatric operations.

Overall, the authors found that surgery provided greater weight loss for any degree of obesity compared with non-surgical treatments. Surgery was also associated with reductions in diabetes, hypertension, and other co-existing conditions. Improvements in health-related quality of life were noted after 2 years, but their long-term persistence was unclear.

The bariatric operations were not free from complications, including serious ones such as pulmonary embolism and even postoperative death, the report indicates.

In the studies that compared different bariatric procedures, there was some evidence that gastric bypass provided greater weight loss than did vertical banded gastroplasty or adjustable gastric banding.

Isolated sleeve gastrectomy and banded gastric bypass both produced weight losses comparable to that seen with gastric bypass.

No statistically significant differences in weight loss or quality of life were seen between procedures performed using conventional open surgery and those using laparoscopic bariatric procedures.

Due to limited data, the authors were unable to reach firm conclusions regarding the relative safety of each bariatric operation.

While surgery produces greater weight loss than conventional obesity treatments, and exactly which procedure provides the best mix of effectiveness and safety is unclear, they note.

SOURCE: Cochrane Database System Review 2009.

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NEW YORK (Reuters) –
Kate Harding has spent most of her life on one diet or another, losing weight but always gaining it back. Determined to improve her quality of life, she joined a fast-growing group of anti-dieting activists promoting overweight people’s civil rights.

Launching an anti-dieting blog called Shapely Prose, Harding and other fat-acceptance advocates online — calling themselves the fat-o-sphere — are also educating one another about how to improve overweight people’s health.

She and other bloggers with names like FatChicksRule and Big Liberty say society’s “war on obesity” makes overweight people hate their bodies and suffer from low self-esteem.

“Being fat doesn’t make me lazy or stupid or morally suspect,” said Harding, 34, of Chicago, who also has written a book, “Lessons from the Fat-o-Sphere.”

“The message we’re promoting is health at every size.”

Her blog entries criticize dieting obsessions and ponder coverage of weight issues in the mainstream media.

Since launching her blog, Harding, who says she is 5 foot 2 inches tall and about 195 pounds (88 kg), says her body image has improved. But she admits wearing a bathing suit in public “can still throw me for a bit of a loop.”

Fat-acceptance advocates are starting to organize to promote anti-bias laws, encourage tolerance in health care and the workplace and help retailers recognize the profit potential of catering to plus-size customers.

“People are just beginning to think about being empowered,” said Lynn McAfee, director of medical advocacy at the nonprofit Council on Size and Weight Discrimination.

“The emphasis has just been ‘lose weight and everything will be fine,’ and it’s becoming really clear that people aren’t losing weight,” she said. “So we want to shift the emphasis to making us as healthy as we can be at whatever weight we are.”

Activists say the movement is beginning to amass some victories, from larger seat belts in cars to a decision by the Supreme Court in Canada that obese and disabled people traveling on airplanes can’t be forced to buy a second seat.

The Fox television network is developing a reality show featuring “average looking” people called “More to Love,” billed as a “dating show for the rest of us.”

The National Association for the Advancement of Fat Acceptance, a civil rights group formed in 1969, has found new life as fat-acceptance advocates gain force online.

There are now more than 50 fat-acceptance blogs and more than a dozen books promoting the idea, from Linda Bacon’s “Health at Every Size” to Wendy Shanker’s “The Fat Girl’s Guide to Life.” There are even romance novels featuring plus-sized characters with names like “Dangerous Curves Ahead.”

But the dominant view remains that overweight people should be focused on losing weight.

Some two-thirds of Americans are considered overweight or obese. Cities across the country have declared wars on obesity, calling it a costly public health crisis that increases the risk of heart disease, type two diabetes and certain cancers.

Obesity-related health care cost upward of $100 billion a year, research shows.

PERVASIVE DISCRIMINATION

There are no U.S. laws prohibiting weight discrimination, and only one state, Michigan, has an anti-weight bias law. Legislatures in Massachusetts and Nevada have taken up size-bias bills, but similar efforts have failed in recent years.

Weight discrimination is pervasive, said Rebecca Puhl, director of research at Yale University’s Rudd Center for Food Policy and Obesity.

An “obesity wage penalty” — larger employees getting paid less regardless of job performance — is widespread, and research shows overweight people are less likely to land a job or be promoted than a non-obese worker, she said.

“We do need to fight obesity, but not obese people,” said Puhl. “Individuals … who are discriminated against because of their weight are more likely to engage in unhealthy eating behaviors and avoidance of physical activity.”

Anecdotal evidence also suggests overweight people avoid trips to the doctor out of fear of being mocked.

According to NAAFA, about 70 percent of overweight and obese women have experienced bias from doctors. Others complain of being turned down by health-insurance companies.

Bloggers in the fat-o-sphere track cases of discrimination they say go uncovered in the mainstream media.

Just recently, United Airlines, a unit of UAL Corp, said it will require obese passengers bumped from full flights to purchase two seats on a subsequent flight. That would match the policies of other carriers, including Continental, Delta, JetBlue and Southwest Airlines.

SEXY AT ANY SIZE

Deb Malkin, 39, considers herself a fat-acceptance advocate but leaves the political battles to others.

Instead, in what she describes as a labor of love, Malkin has opened ReDress, a plus-sized vintage clothing boutique in New York’s Brooklyn borough.

Housed in an airy 3,000 square-foot (280 square meter) space, ReDress sells frilly dresses, formal gowns and jeans, all in size 14 and up.

One recent afternoon, shoppers carried armloads of clothing to spacious dressing rooms, while sales assistants compared the comfort of ReDress to the more typical shopping humiliations of plus-sized consumers.

“There’s a whole indy fashion world that we don’t have access to,” said Malkin. “I think women just come in here and are so excited.”

Bevin Branlandingham, who considers herself a fat activist, has worked in Malkin’s store since it opened in November.

Sorting through lingerie, a frock from the 1960s and a colorful size 22 dress by Calvin Klein, Branlandingham said she likes to help women overcome hatred of their bodies.

Branlandingham, who is partial to dresses with plunging neck lines, says she discourages women from buying so-called goal outfits that are too small and instead pick out things that flatter their figures.

“I feel like my life’s mission is to make the world safer for people to love themselves no matter what their differences,” she said.

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WEDNESDAY, April 22 (HealthDay News) — Overweight and obese
women are less likely to receive an accurate reading from ultrasound
screenings aimed at identifying fetal abnormalities, new research
reveals.

Such screenings also seem to be less effective among women who are
diabetic prior to their pregnancy.

“We were asking the question, ‘Are birth defects less likely to be
detectable with prenatal ultrasound in women who are overweight or obese,
compared with women of normal body-mass index,’” explained study author
Dr. Jodi S. Dashe, who works in the department of obstetrics &
gynecology at the University of Texas Southwestern Medical Center in
Dallas.

After analyzing more than 10,000 standard ultrasound exams — the most
common exam for low-risk pregnancies — as well as more than 1,000
specialized ultrasound exams for high-risk pregnancies, Dashe found, “that
the detection of fetuses with major birth defects dropped significantly as
maternal body-mass index [BMI] increased: a difference of at least 20
percent when women of normal body-mass index were compared with obese
women.”

The findings are to be published in the May issue of Obstetrics
& Gynecology.

To explore the degree to which ultrasound results are sensitive to BMI,
the study authors looked at a total of 12,200 ultrasounds previously
performed at the medical center between 2003 and 2007, among women
entering their 18th to 24th week of pregnancy.

The majority of both standard-risk and high-risk pregnant women were
Hispanic (about 87 percent), with about 10 percent participants being
black and 2 percent being white.

Stacking ultrasound results up against both the mother’s BMI and infant
discharge records, the research team noted the 20 percent weight-linked
plunge in ultrasound effectiveness. That translated into a significant
rise in risk that a child would be born with a major birth defect despite
the fetus having appeared normal during an ultrasound.

For example, the specific risk for incorrectly receiving a “normal”
ultrasound reading rose from just one in every 250 women with normal BMI
to one among every 100 obese women.

Apart from the BMI effect, the authors also found that among cases
deemed to face a particularly high risk for fetal abnormalities prior to
undergoing a screening, ultrasound mistakes were more likely to occur
among women who had been diabetic prior to their pregnancy than among
women with other high-risk indications.

In fact, diabetic women were found to experience only a 38 percent
success rate in spotting fetal abnormalities via ultrasound, compared to
the 88 percent success rate experienced among women burdened with other
sorts of high-risk factors.

One expert said that patient obesity is only one of the challenges
obstetricians deal with when reading an ultrasound.

“It isn’t that ultrasounds are unreliable, but that with some types of
patients it is certainly more difficult to visualize fetal anomalies,”
said Dr. Catherine Y. Spong, chief of the pregnancy and perinatology
branch of the Eunice Kennedy Shriver National Institute of Child Health
and Human Development in Bethesda, Md.

“When I’m doing an ultrasound I’m trying to get as much information as
I can about the baby,” she explained. “And some people are easier to do an
ultrasound on than others. For example, if someone has a lot of scarring
inside the tissue is thicker, and that can make the imaging more
difficult. And if people are obese — including women with diabetes, who
are not uncommonly overweight — you’re going to have to look through a
lot more tissue, and that makes it more difficult to image.”

Dashe and her colleagues noted that American women with normal BMI now
constitute a minority of the country’s pregnant population, so these
screening problems could have “broad implications.”

“Based on our findings, we would suggest that counseling be modified to
reflect the limitations of ultrasound in women who are overweight or
obese,” she said. The researchers also advise that more research be
conducted to examine the particular risk for screening problems observed
among diabetic women.

Spong agreed. “This difficulty presents itself while there has been a
dramatic increase across the U.S. in terms of obesity and morbid obesity
among reproductive-age women,” she said. “So this study provides
physicians with some data on what the difficulty truly is.”

More information

For more on ultrasounds during pregnancy, go to the March
of Dimes.

Source

(Corrects death rate in paragraph 8 to 0.17 from from 1.7 percent)

* Bariatric surgery “centers for excellence” not better

* Complication rates comparable with other hospitals

* Separate study looks at benefits for super obese

By Julie Steenhuysen

CHICAGO (Reuters) – Despite the fancy label, hospitals designated bariatric surgery “centers of excellence” have as many deaths and complications from the weight-loss procedure as others, U.S. researchers said on Monday.

The extra cost and effort required by hospitals to earn such a designation might not be worth it, they said.

“Designation as a bariatric surgery center of excellence does not ensure better outcomes,” Dr. Edward Livingston of the University of Texas Southwestern School of Medicine, whose study appears in the Archives of Surgery, said in a statement.

Bariatric surgery is becoming an increasingly popular treatment for obesity. It works by altering the digestive tract to reduce the volume of food that can be eaten and digested.

A separate study in the same journal looked at the benefits of the surgery in severely obese patients.

Large insurance companies and Medicare, the federal health plan for 44 million elderly and disabled Americans, help pay for the surgery — which costs from $15,000 to $35,000 — in severely obese people. And many payers, including Medicare, require the procedures to be done at hospital designated as a bariatric center of excellence.

Livingston wanted to see if patients at these centers actually got better care. He analyzed 2005 data on 19,363 patients who had bariatric surgery, including 5,420 patients whose surgery was performed at a center of excellence.

He found that 0.17 percent of bariatric surgery patients treated at a center of excellence died and 6.3 percent developed complications. That compared with a death rate of 0.09 and a complication rate of 6.4 percent at hospitals without a center of excellence designation.

Because a “center of excellence” designation requires hospitals to hire extra staff, they are costlier to run, yet these “extra expenses associated with center of excellence designation may not be warranted,” Livingston wrote.

A separate study in the same journal looked at the effects of gastric bypass surgery in two groups of severely obese patients: the morbidly obese — those with a body mass index of 40 to 49 — and the super obese — those with a body mass index of 50 or higher.

Body mass index, or BMI, is a formula that takes into account a person’s height and weight. A BMI of 30 is considered obese, while a BMI of 25 to 30 is considered overweight.

Dr. Michel Suter of Hopital du Chablais in Lausanne, Switzerland, and colleagues studied 492 morbidly obese patients and 133 super obese patients treated with gastric bypass between 1999 and 2006.

They found that while the super obese patients lost more weight (37.3 percent of their body weight) than the morbidly obese patients (34.7 percent of their body weight), fewer than half of the super obese got down to being merely overweight six years after the surgery, compared with more than 90 percent of the morbidly obese patients.

Despite these differences, they said improvements in quality of life and other health measures were similar in both groups. Previous studies have found obese people who have weight-loss surgery are less likely to die from heart disease, diabetes and cancer than obese people who do not.

(Editing by Maggie Fox)

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CHICAGO (Reuters) –
Despite the fancy label, hospitals designated bariatric surgery “centers of excellence” have as many deaths and complications from the weight-loss procedure as others, U.S. researchers said on Monday.

The extra cost and effort required by hospitals to earn such a designation might not be worth it, they said.

“Designation as a bariatric surgery center of excellence does not ensure better outcomes,” Dr. Edward Livingston of the University of Texas Southwestern School of Medicine, whose study appears in the Archives of Surgery, said in a statement.

Bariatric surgery is becoming an increasingly popular treatment for obesity. It works by altering the digestive tract to reduce the volume of food that can be eaten and digested.

A separate study in the same journal looked at the benefits of the surgery in severely obese patients.

Large insurance companies and Medicare, the federal health plan for 44 million elderly and disabled Americans, help pay for the surgery — which costs from $15,000 to $35,000 — in severely obese people. And many payers, including Medicare, require the procedures to be done at hospital designated as a bariatric center of excellence.

Livingston wanted to see if patients at these centers actually got better care. He analyzed 2005 data on 19,363 patients who had bariatric surgery, including 5,420 patients whose surgery was performed at a center of excellence.

He found that 1.7 percent of bariatric surgery patients treated at a center of excellence died and 6.3 percent developed complications. That compared with a death rate of .09 and a complication rate of 6.4 percent at hospitals without a center of excellence designation.

Because a “center of excellence” designation requires hospitals to hire extra staff, they are costlier to run, yet these “extra expenses associated with center of excellence designation may not be warranted,” Livingston wrote.

A separate study in the same journal looked at the effects of gastric bypass surgery in two groups of severely obese patients: the morbidly obese — those with a body mass index of 40 to 49 — and the super obese — those with a body mass index of 50 or higher.

Body mass index, or BMI, is a formula that takes into account a person’s height and weight. A BMI of 30 is considered obese, while a BMI of 25 to 30 is considered overweight.

Dr. Michel Suter of Hopital du Chablais in Lausanne, Switzerland, and colleagues studied 492 morbidly obese patients and 133 super obese patients treated with gastric bypass between 1999 and 2006.

They found that while the super obese patients lost more weight (37.3 percent of their body weight) than the morbidly obese patients (34.7 percent of their body weight), fewer than half of the super obese got down to being merely overweight six years after the surgery, compared with more than 90 percent of the morbidly obese patients.

Despite these differences, they said improvements in quality of life and other health measures were similar in both groups. Previous studies have found obese people who have weight-loss surgery are less likely to die from heart disease, diabetes and cancer than obese people who do not.

(Editing by Maggie Fox)

Source

NEW YORK (Reuters Health) –
People who are overweight or obese in young adulthood and middle-age are at elevated risk of being disabled in their later years, a new study suggests.

The study, of more than 2,800 U.S. adults in their 70s, found that those who were overweight or obese at any point in adulthood had an increased risk of developing problems with walking and climbing stairs.

What’s more, the longer a person had been overweight, the greater his or her risk of mobility limitations, the researchers report in the American Journal of Epidemiology.

The findings underscore the importance of preventing excessive weight gain early in life, according to lead researcher Dr. Denise Houston, an assistant professor of gerontology at Wake Forest University School of Medicine in Winston-Salem, North Carolina.

“The data suggest that interventions to prevent overweight and obesity in young and middle-aged adults may be useful in preventing or delaying the onset of mobility limitations later in life,” Houston said in a news release from the university.

Excess pounds can contribute to later-life disability by creating wear-and-tear in the joints or raising the risks of chronic health problems like heart disease and diabetes. People who become overweight at an early age, Houston and her colleagues note, may be habitually sedentary. That, in turn, leads to poorer fitness and weaker muscles, making them more vulnerable to disability later in life.

The findings are based on 2,845 adults in their 70s who were followed over seven years. At the outset, participants were asked to recall their weight at the ages of 25 and 50, and the researchers measured their current weight.

Overall, the study found, women who’d been overweight at all three time points were nearly three times more likely to develop a mobility limitation than their counterparts who’d been normal-weight throughout adulthood. Among men, the risk was increased by 61 percent.

The researchers also found that the risk of disability was elevated among participants who were normal-weight in their 70s but had been overweight earlier in life.

However, Houston explained, this may be because weight loss in older adults is often the result of poor health.

The findings are important, the researcher said, because the elderly population in the U.S. is growing — as is the obesity rate.

“Over the past couple of decades there has been a trend toward declining rates of physical disability in older adults,” Houston said.

“However,” she added, “the dramatic increase in overweight and obesity in the United States may reverse these declines and may lead to an increase in physical disability among future generations of older adults.”

SOURCE: American Journal of Epidemiology, April 15, 2009.

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NEW YORK (Reuters Health) –
An obesity-prevention program tested in several Dutch schools was able to cut down teenagers’ consumption of sugary sodas and curb body-fat gain, according to a new study.

The program, dubbed Dutch Obesity Intervention in Teenagers (DOiT), aimed to boost students’ exercise levels, steer them away from junk food and sugar-sweetened drinks, and lower their odds of excessive weight gain. Students had 11 lessons on the topics, and schools were encouraged to increase gym classes and make cafeteria changes.

The results were at least partially positive, researchers report in the Archives of Pediatrics & Adolescent Medicine.

Over 20 months, students at 10 schools that ran the program reduced their soda intake, compared with their peers at eight “control” schools. Girls at the intervention schools also showed a smaller increase in body fat.

However, those benefits tended to wane over time. And certain other positive effects seen at the eight-month mark — like less weight gain around the waistline in boys — had disappeared by the 20-month point.

The findings suggest that such school-based programs can be effective, but that they need to be kept up, lead researcher Dr. Amika S. Singh, of the VU University Medical Center in Amsterdam, told Reuters Health.

It’s clear that obese adults have a difficult time losing weight and keeping it off, Singh pointed out, so preventing excessive weight gain in children and teenagers is critical.

When it comes to health-education programs, Singh noted, teenagers may benefit even more than younger children do, because they are better able to grasp the benefits of diet and exercise changes — and then make those changes.

Further studies, she and her colleagues say, should look at whether longer-term education efforts help teenagers maintain healthy lifestyle changes over time.

SOURCE: Archives of Pediatrics & Adolescent Medicine, April 2009.

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LOS ANGELES (Reuters) –
United Airlines, a unit of UAL Corp, will require obese passengers bumped from full flights to purchase two seats on a subsequent flight, matching the policy of some other carriers.

The change brings the Chicago-based in line with eight other airlines including Continental, Delta, JetBlue and Southwest, United spokeswoman Robin Urbanski said on Wednesday.

“Last year we had 700 complaints from passengers who had to share their seats,” she said.

Under the new policy, obese passengers — defined as unable to lower the arm rest and buckle a seat belt with one extension belt — will still be reaccommodated, at no extra charge, to two empty seats if there is space available.

If, however, the airplane is full, they will be bumped from the flight and may have to purchase a second ticket, at the same price as the original fare, Urbanski said.

If the bumped passenger chooses to cancel the trip, the ticket will be refunded with no additional charge.

The policy is effective immediately.

(Reporting by Deena Beasley; Editing by Richard Chang)

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