Bariatric weight loss surgery: patient education, preparation, and follow-up.

Bariatric weight loss surgery is no small undertaking. It requires a lifelong commitment on the part of the patient. Education is the key to helping patients achieve optimal health and a better quality of life as a result of having undergone weight loss surgery.

Glycemic control in diabetic patients after bariatric surgery.

BACKGROUND: Morbid obesity is associated with a high prevalence of diabetes mellitus, and weight loss is fundamental to improve glycemic control. The aim of the present study was to evaluate the impact of weight reduction during the late postoperative period (> or = 12 months) after gastric bypass on the glycemic control of diabetic patients. METHODS: Fasting glycemia (glucose oxidase) and glycohemoglobin A1c (enzymatic fluorescence, reference value: 4-6%) were determined before and after surgery. Results were compared by the Student t-test for paired samples (P <0.05). RESULTS: 23 women and 8 men with diabetes, with a mean follow-up of 27.2 months and a mean age of 42.5 years (30-68), were studied. Before surgery, mean +/- SD weight, BMI, excess weight, glycemia and glycohemoglobin were 135.9+/-11.6 kg, 51.8+/-6.4 kg/m2, 68.3+/-14.5 kg, 173+/-71.2 mg/dl, and 7.4+/-1.9%, respectively. After surgery, mean weight, BMI, excess weight, percent weight loss, percent excess weight loss, glycemia and glycohemoglobin were 89.7+/-8.8 kg, 35+/-4.5 kg/m2, 24.6+/-11.6 kg, 32.6%+/-1.8 (12.6-46.5%), 64.7+/-18.3%, 98+/-17.3 mg/dl (P <0.01), and 5.4+/-1.0% (P <0.05), respectively. Oral anti-diabetic drug and/or insulin treatment was discontinued in 89.2% of the patients. After surgery, 90.3% of the patients maintained glycohemoglobin A1c levels <7.0%. CONCLUSION: weight loss led to a significant and sustained improvement of glycemic control in these patients submitted to bariatric surgery.

Effects of different weight loss protocols on serum leptin levels in obese females.

We comparatively investigated the effects of different weight loss protocols on leptin levels in obese females with the aim of addressing the leptin resistance which have been determined to be an aggravating factor in obesity. Twenty-four obese females enrolled to one of the three 12 week weight loss protocols: Orlistat ( Xenical )-induced weight loss (OWL, n=8), exercise-induced weight loss (EWL, n=8) and Orlistat ( Xenical ) plus exercise-induced weight loss (OEWL, n=8). Serum leptin levels were measured in duplicate by radioimmunoassay. There were significant reductions in body weight and fat mass after the 12 week period in all groups: -11.4+/-0.5 kg (P=0.01) and -9.8+/-0.5 kg (OEWL), -8.3+/-0.8 kg (P=0.01) and -5.7+/-0.9 kg (OWL), -8.9+/-1.2 kg (P=0.01) and -7.4+/-1.2 kg (EWL), respectively. Serum leptin levels were also decreased markedly in all groups: -59.2% (OEWL, P=0.01), -37.8% (OWL, P=0.01) and -48.6% (EWL, P=0.01). In addition, there were marked decreases in leptin levels for each kilogram of fat mass after the 12 week period: -48.2+/-7.2% (OEWL P=0.01), -27.8+/-4.8% (OWL, P=0.01) and -39.3+/-4.3% (EWL, P=0.01). Decreases in serum leptin levels expressed per kilogram of fat mass were significantly higher in OEWL group compared to OWL (P= 0.03). Consequently, in obesity treatment, an exercise training program in adjunct to pharmacotherapy provides higher amount of weight reduction and fat mass loss, and importantly seem to have further beneficial effects on leptin resistance, as indicated by decreases in leptin levels expressed per kilogram of fat mass.

Weight cycling: more questions than answers.

Most men and women who attempt to lose weight will regain any weight that is lost. This cycle of weight loss and regain - referred to as weight cycling is a recurrent phenomenon for many patients. With the increased frequency of obesity and the increased prescriptions for weight-loss practices without an associated increase in the success of weight-loss maintenance, the concerns about weight cycling have grown. Recent literature has focused on the possible physiologic and psychologic hazards of weight cycling. Review of both human and animal studies indicates no conclusive evidence about harmful effects of weight cycling. Most studies show no adverse effects on metabolism. Some observational studies indicate an association between variations in body weight and increased morbidity and mortality but do not distinguish between voluntary and involuntary weight-loss events. The studies of psychologic hazards have been limited, and little convincing information is available. Without more compelling evidence of the risks of weight cycling, warnings overriding safe, effective weight-loss treatments for the obese are unwarranted. Appropriately designed studies are urgently needed to assess the long-term efficacy of procedures and treatments that promote weight-loss maintenance and to provide further analyses of the effects of weight cycling.