Current Trends in Obesity Management

At the conclusion of this presentation the participant will be able to: 1) Discuss current non-surgical weight loss therapies 2) Discuss current surgical weight loss therapies 3) Discuss emerging weight loss procedures 4) Discuss costs and benefits of these treatments Presentation: 44 minute

Circulating testosterone and prostate-specific antigen in nipple aspirate fluid and tissue are associated with breast cancer.

Preliminary evidence has associated testosterone and prostate-specific antigen (PSA) with breast cancer. Our objective was to determine whether a) testosterone levels in nipple aspirate fluid (NAF), serum, or breast tissue are associated with breast cancer; b) testosterone levels in serum are associated with levels in NAF; c) PSA in NAF, serum, or breast tissue is associated with breast cancer; and d) serum PSA is associated with NAF PSA levels. We obtained 342 NAF specimens from 171 women by means of a modified breast pump. Additionally, we collected 201 blood samples from 99 women and 51 tissue samples from 41 subjects who underwent surgical resection for suspected disease. Women currently using birth control pills or hormone replacement therapy were excluded from the study. Controlling for age and menopausal status, serum testosterone was significantly increased in women with breast cancer (p = 0.002). NAF and serum testosterone levels were not associated. Neither NAF nor tissue testosterone was associated with breast cancer. Controlling for menopausal status and age, NAF PSA was significantly decreased in women with breast cancer (p \u3c 0.001). We did not find serum PSA to be associated with breast cancer, although we found an indication that, in postmenopausal women, its levels were lower in women with cancer. Serum PSA was associated with NAF PSA in postmenopausal women (p \u3c 0.001). PSA levels in cancerous tissue were significantly lower than in benign breast specimens from subjects without cancer (p = 0.011), whereas levels of PSA in histologically benign specimens from subjects with cancer were intermediate. Our results suggest that serum testosterone is increased and NAF PSA is decreased in women with breast cancer, with PSA expression being higher in normal than in cancerous breast tissues. NAF and serum PSA levels in postmenopausal women are correlated, suggesting that as laboratory assessment of PSA becomes more sensitive, serum PSA may become useful in identifying women with breast cancer

Laparoscopic adjustable banded roux-en-y gastric bypass as a primary procedure for the super-super-obese (body mass index > 60 kg/m2)

<p>Abstract</p> <p>Background</p> <p>Currently, there is no consensus opinion regarding the optimal procedure of choice in super-super-morbid obesity (Body mass index, BMI > 60 kg/m2). Roux-en-Y gastric bypass (RYGB) is associated with failure to achieve or maintain 50% excess weight loss (EWL) or BMI < 35 in approximately 15% of patients. Also, percent EWL is significantly less after 1-year in the super-super-obese group as compared with the less obese group and many patients are still technically considered to be obese (lowest post-surgical BMI > 35) following RYGB surgery in this group. The addition of adjustable gastric band (AGB) to RYGB has been reported as a revisional procedure but this combined bariatric procedure has not been explored as a primary operation.</p> <p>Methods</p> <p>In a primary laparoscopic RYGB, an AGB is drawn around the gastric pouch through a small opening between the blood vessels on the lesser curve and the gastric pouch. The band is then fixed by suturing the gastric remnant to the gastric pouch both above and below the band to prevent slippage.</p> <p>Results</p> <p>Between November 2009 and March 2010, 6 consecutive super-super-obese patients underwent a primary laparoscopic adjustable banded Roux-en-Y gastric bypass procedure at our institution. One male patient (21 years, BMI 70 kg/m²) developed a pneumonia postoperatively. No other postoperative complications were observed.</p> <p>Conclusion</p> <p>To the best of our knowledge, this is the first series of patients that underwent a laparoscopic adjustable banded RYGB as a primary operation for the super-super obese in the indexed literature. With the combined procedure, a sequential action mechanism for weight loss is to be expected. The restrictive, malabsorptive and hormonal working mechanism of the RYGB will induce weight loss from the start reaching a stabilised plateau of weight after 12 - 18 months. At that time, filling of the band can be started resulting in further gastric pouch restriction and increased weight loss. Moreover, besides improving the results of total weight loss, a gradual filling of the band can as well prevent the RYGB patient from weight regain if restriction would fade away with time.</p

Lost in Interpretation? Outcomes are equivalent between English Speaking and Non-English Speaking Patients following Bariatric Surgery with use of Certified Medical Interpreters

Sigrid Williamson West Reading PA1, Oliver Gibb West Reading PA2, Megan Bradley Wyomissing PA2, John Fam Wyomissing PA1, David Tichansky Los Angeles CA3Reading Hospital1 Drexel University2 David Geffen School of Medicine at UCLA3 Introduction: Differences exist in medical treatment and outcomes of culturally and linguistically diverse patients. Extensive use of certified medical interpreters (CMI) can theoretically reduce these differences. This study compares outcomes following bariatric surgery between English speaking (ES) and non-English speaking (NES) patients who used CMI’s, thus evaluating the contribution of CMI to healthcare equity in bariatric surgery. Methods: Adult patients who underwent Roux-en-Y Gastric Bypass, Sleeve Gastrectomy, or Duodenal Switch over a two-year period were divided into two groups by self-reported primary language, ES and NES. NES patients received all written educational materials in their primary language and were verbally communicated with through CMI’s. Data from pre-operative and follow-up visits up to 2 years were retrospectively collected. Outcomes between groups was compared using Chi-square analysis, group t-tests, and repeated measures 2-factor ANOVA, with p\u3c0.05 indicating statistical significance. Results: Of 783 patients, 705(90.0%) were ES and 78(10.0%) were NES. Mean preoperative BMI was significantly higher in ES patients (46.19kg/m2 vs. 43.06kg/m2, p\u3c0.001). Follow-up to all visits was equivalent between groups. There were no differences in preoperative comorbid conditions except NES had greater prevalence of GERD(58.4% vs. 48.5%,p-0.035). There were no significant differences in weight loss at any two consecutive time points between groups. There was no significant difference between groups in total body weight loss (27.8% vs 27.94%, p =0.93), percent excess weight loss (52.6% vs 55.3%, p=0.38), or comorbidity resolution at 2-years Conclusion: With use of CMI, equivalence and equity in bariatric surgery outcomes can be achieved in NES patients

The inflammatory response seen when human omental adipose tissue explants are incubated in primary culture is not dependent upon albumin and is primarily in the nonfat cells

Abstract Background The present studies were designed to investigate the changes in gene expression during in vitro incubation of human visceral omental adipose tissue explants as well as fat cells and nonfat cells derived from omental fat. Methods Adipose tissue was obtained from extremely obese women undergoing bariatric surgery. Explants of the tissue as well as fat cells and the nonfat cells derived by digestion with collagenase were incubated for 20 minutes to 48 h. The expression of interleukin 1β [IL-1β], tumor necrosis factor α [TNFα], interleukin 8 [IL-8], NFκB1p50 subunit, hypoxia-inducible factor 1α [HIF1α], omentin/intelectin, and 11β-hydroxysteroid dehydrogenase 1 [11β-HSD1] mRNA were measured by qPCR as well as the release of IL-8 and TNFα. Results There was an inflammatory response at 2 h in explants of omental adipose tissue that was reduced but not abolished in the absence of albumin from the incubation buffer for IL-8, IL-1β and TNFα. There was also an inflammatory response with regard to upregulation of HIF1α and NFκB1 gene expression that was unaffected whether albumin was present or absent from the medium. In the nonfat cells derived by a 2 h collagenase digestion of omental fat there was an inflammatory response comparable but not greater than that seen in tissue. The exception was HIF1α where the marked increase in gene expression was primarily seen in intact tissue. The inflammatory response was not seen with respect to omentin/intelectin. Over a subsequent 48 h incubation there was a marked increase in IL-8 mRNA expression and IL-8 release in adipose tissue explants that was also seen to the same extent in the nonfat cells incubated in the absence of fat cells. Conclusion The marked inflammatory response seen when human omental adipose tissue is incubated in vitro is reduced but not abolished in the presence of albumin with respect to IL-1β, TNFα, IL-8, and is primarily in the nonfat cells of adipose tissue.</p