Lesser curvature Roux-en-Y gastric bypass as an alternative procedure to failed vertical banded gastroplasty: surgical technique and short-term results.

PURPOSE: The incidence of revisional surgery for failed vertical banded gastroplasty has increased markedly over the last years. Conversion to gastric bypass is considered as a good alternative with satisfactory long term weight loss without further revisional surgery. Nevertheless, significant morbidity and mortality is still associated with this procedure. New technical aspects make it safer and more effective. The aim of the work is to expose a surgical bypass technique to attempt to reduce morbidity. PATIENTS AND METHODS: Thirty patients have undergone conversions from failed vertical banded gastroplasty to a lesser curvature Roux-en-Y Gastric Bypass. Surgical technique is described in detail and early complications and initial weight loss were analyzed (mean follow-up: 12 months). RESULTS: The key points of the operation were the small vertical pouch, the complete transection of the distal bypassed stomach, the interposition of a jejunal limb between the two gastric shares and the latero-lateral gastrojejunal anastomosis without proximal ring interposition. For the entire series, we noticed one major complication, an acute pancreatitis causing anastomotic fistula and four mild complications, one bleeding on the excluded stomach, one bronchopneumonia, one pleural effusion and one wound dehiscence. The percentage of excess weight loss attained 56.1% at one year follow-up. CONCLUSIONS: There have been tremendous improvements in the safety of gastric bypass over the years. One year follow-up indicates that our surgical bypass procedure is secure with a low complication rate.

Health risks, past usage, and intention to use weight loss products in normal weight women with high and low body dysphoria.

OBJECTIVE: There are many health risks involved with the use of weight loss products by normal weight women. The mass media may compound this problem through the promotion of weight loss products and a thin body size. This study tested women's perceptions of different weight loss product ads to determine if body dysphoria (i.e., an over concern with body size and shape in normal weight people) was associated with risk beliefs, past behaviors, and intention toward using weight loss products. METHOD: Normal weight women (age range = 18-41 yr), who were classified as either high (n=45) or low (n=43) on a measure of body dysphoria, rated different weight loss products according to their perception of health risks, past behavior, and their intention to consume the products. These products were a dietary fat substitute (olestra), a prescription obesity medication (Sibutramine ( Meridia )), and an over-the-counter appetite suppressant (phenylpropanolamine). RESULTS: High body dysphoric women reported higher intentions to use the products as well as increased prior use of two of the three weight loss products. High body dysphoric women did not believe that these weight loss products were harmless. They recognized potential health risks associated with using such products, but nonetheless, expressed intention to use these weight loss products at a higher frequency. Also, several variables related to body image were found to effectively discriminate normal weight women at risk for abusing weight loss products. DISCUSSION: This study found that women who do not need to lose weight but have significant body image concerns were willing to use potentially harmful weight loss products despite the knowledge that such products might pose significant health risks. Techniques utilized by advertising regulatory agencies such as warning labels did not have a strong deterrent effect for stated intentions to use the products. Implications of these findings for public health policy issues were discussed.

Ultrasound parameters of calcaneal bone density in girls with anorexia nervosa.

Osteoporosis is common in patients with anorexia nervosa (AN), but ultrasound has so far been scarcely used to detect it We measured calcaneal broadband ultrasound attenuation (BUA) and velocity of sound (VOS) in 26 AN girls (mean age 15.1+/- 1.5 years) using a Cuba Clinical device (McCue Ultrasonics, UK). Basic anthropometric (body weight, height and body mass index--BMI) and clinical data (mean duration of AN, number of absent cycles, weight loss) were collected. All of the girls reported that they did at least one hour's vigorous exercise a day. BUA was significantly lower (p<0.004) and VOS significantly higher (p<0.0001) in comparison with reference data. Body weight and BMI at the time of the measurements were significantly lower than the reference data (p<0.0001). There were no correlations between body weight or height and BUA or VOS, but there was a slight correlation between BUA and BMI (r=0.4, p<0.05) and a slight inverse correlation between VOS, body weight and BMI (r=-0.48 and r=-0.43, p<0.01). VOS slightly correlated with weight loss (r=0.4, p<0.05), significantly with the weekly number of exercise hours (r=0.48, p<0.01). The duration of AN, the number of missed cycles and the percentage of weight loss did not correlate with BUA, and neither the duration of AN nor the number of missed cycles correlated with VOS. The low BUA value could be attributed to poor nutrition, and substantial physical activity may lead to the increase in VOS. In conclusion, girls with AN have low BUA and high VOS values, neither of which correlate with the duration of AN or the number of missed cycles.

Depression in association with severe obesity: changes with weight loss.

BACKGROUND: The relationship between depression and severe obesity is unclear. We examined depression before and after surgically induced weight loss. METHODS: Beck Depression Inventory (BDI) questionnaires were completed before and at yearly intervals after gastric-restrictive weight-loss surgery. We used the BDI scores of 487 consecutive patients to identify predictors of depression. Scores from all completed questionnaires were used to follow changes with time. Paired preoperative and 1-year postoperative scores (n = 262) were used to identify predictors of change in BDI score. RESULTS: For the 487 subjects, the mean +/- SD preoperative BDI score was 17.7 +/- 9.5. Higher scores, indicating increased symptoms of depression, were found in younger subjects, women, and those with poorer body image. These factors had independent effects. We found no association between BDI and waist circumference or insulin concentrations. High BDI scores correlated with poorer physical and mental quality-of-life measures. weight loss was associated with a significant and sustained fall in BDI scores, with a mean +/- SD score of 7.8 +/- 6.5 at 1 year and 9.6 +/- 7.7 at 4 years after surgery. Greater falls in BDI score at 1 year were seen in women, younger subjects, and those with greater excess weight loss (combined r2 = 0.10; P<.001). Fall in BDI score correlated with improvement in appearance evaluation (r = -0.31; P<.001). CONCLUSIONS: Severely obese subjects, especially younger women with poor body image, are at high risk for depression. We found sustained improvement with weight loss. These findings also support the hypothesis that severe obesity causes or aggravates depression.

Dieting and weight loss do not affect on the platelet serotonin 5-HT2A receptor.

Alterations related to the serotonin 5-HT(2A) receptor have been reported in various psychiatric disorders, and the 5-HT(2A) receptor is also one of the receptors mediating the effects of serotonin on feeding and satiety. The present study was carried out in order to investigate the association between the serotonin 5-HT(2A) receptor and weight loss during dieting in overweight subjects. In nine women studied before, during and after a 6-month period of dieting, body weight loss was not found to affect the platelet 5-HT(2A) receptor status. This finding implies that although body weight decrease is a common feature in many psychiatric disorders, the reported alterations in serotonin 5-HT(2A) receptor status in these disorders do not seem to be caused by the weight loss per se.

Ephedrine is a sympathicomimetic agent that stimulates the central nervous and cardiovascular systems and causes bronchodilatation. It is one of the alkaloids in the herb Ephedra which is the basis of several over-the-counter herbal products, among which a number of popular weight-loss products. The Dutch Inspectorate for Health Care has received reports of adverse reactions presumably associated with Ephedra-containing weight-loss products. These adverse reactions comprised mainly palpitations, stress, headache and insomnia. The Ministry of Health in Canada has recently requested a market recall of some ephedrine-containing herbal products in response to a large number of adverse reactions reported in association with these products. The adverse reactions included stroke, heart attacks, cardiac arrhythmias, seizures and psychotic disorders. The voluntary recall concerns especially products that were marketed without approval and contain Ephedra in combination with caffeine or other stimulants. In the Netherlands, the status of Ephedra-containing products is currently reconsidered.

Effect of an energy reduced high protein red meat diet on weight loss and metabolic parameters in obese women.

Aim - To determine the effects on weight loss, fat and lean body mass, metabolic parameters and markers of bone turnover of reduced energy intake with increased protein from red meat in overweight and obese women (BMI 27-40). Methods - Twelve week randomised parallel design of two 5600KJ diets: High meat (HM) 34% protein 46% carbohydrate 20% fat or low meat (LM) 17% protein 64% carbohydrate 20% fat. Results - One hundred women with a mean BMI of 32.6 and mean age of 49.3 years completed the study. weight loss (Mean +/- SD): -7.6 +/- 3.3 (HM) and -6.9 +/- 3.5 kg (LM) and fat (-5.7 +/- 4.0, -4.6+/- 3.7) and lean mass (-1.6 +/- 1.9, -1.8 +/- 1.8) changes were different from baseline but not between diets. There was a significant interaction between diet and baseline triglyceride (P<0.05). Subjects with high TG (>1.5mmol/L) had greater loss of weight on the HM diet 7.9 +/- 0.7 versus 5.9 +/- 0.4kg (P=0.02). TG fell by 8% in the LM diet and 22% in the HM diet (ns). HDL cholesterol fell 5-8% and LDL cholesterol and glucose fell by 7% and 4% respectively with no differences between diets. Fasting insulin fell by 16-27% with no significant differences between diets. Vitamin B12 increased by 9% on HM and fell by 13% on LM (P<0.01) but fasting plasma homocysteine did not change. Plasma folate was unchanged. Urine markers of bone turnover increased by 8-12% and calcium excretion decreased by 1mmol/day with no differences between diets. Bone density did not change. Conclusions - A low energy diet high in red meat seems to provide a weight loss advantage to subjects with some features of the metabolic syndrome with no adverse effects on bone metabolism.

Stages of change and weight loss among rural African American women.

OBJECTIVE: obesity is a prevalent public health problem in the United States, especially for rural African American women, and causes increased morbidity and mortality. The purpose of this analysis was to determine whether the transtheoretical stages of change model was generalizable to weight loss intention among overweight and obese rural African American women and to identify important predictors of the stages of change. RESEARCH METHODS AND PROCEDURES: The study was conducted in two rural counties in central Virginia. A population-based sample of 200 women under the age of 40 completed questionnaires concerning weight loss behavior and beliefs about weight. Ordinal logistic regression was used to predict stage of change. RESULTS: A total of 142 of the 200 women (71%) were overweight or obese (body mass index of > or =25) and were classified into a stage of change. Overall, 30% of respondents were in the precontemplation stage, 15% in the contemplation stage, 48% in the preparation stage, 4% in the action stage, and 3% in the maintenance stage. Education, what friends think about weight, body mass index, and a scale of the positive aspects of weight loss were significant predictors of the stage of change (p < 0.05). CONCLUSIONS: Several predictors of stage were the same as those found in studies of other health behaviors, and this research provides support for applying a stages of change model for weight loss intention among rural African American women. Two predictors in particular, significance of what friends think about weight and a scale of the positive aspects of weight loss, have implications for health education initiatives and social support in weight loss interventions.