Stampede III: Standing the Test of Time

From Moondancefilmfestival.com

Readers of this Blog are quite familiar with the ongoing results of the Stampede trial.  This is a trial following 150 obese patients with uncontrolled DM2 who were randomized to either have Intensive Medical Therapy (IMT) alone, or IMT and either Roux-en-Y Gastric Bypass or Sleeve Gastrectomy.

Previously published data, inclusive of 2 years of data,  demonstrated substantial improvement in DM2 in the IMT plus bariatric surgery group.

Great, but will it stand the test of time?

Now that the study is 3 years old, new data is available.

Exciting as the results are for improved blood sugar control and secondary end points (weight, antidiabetic med usage, quality of life measures), they more represent a continuation in effect than anything new.

Some highlights of the study to review and update the data:

1.  Mean age of the group was 48 y/o, 68% were women

2.  Mean baseline A1C was 9.3

3.  Mean baseline BMI was 36

4.  At 3 years:
 
     *Endpoint of A1C of 6.0% or less was achieved in 5% of the IMT group, as opposed to 38% of the Bypass + IMT group, and 24% of the Sleeve group

     *Use of meds for DM2, including insulin, was lower in the surgical groups than the IMT group alone

     *Patients in the surgical groups had a greater mean percentage reduction in their baseline weight- with 24% reduction in the Bypass group, and 21% in the Sleeve group, vs. only 4% in the medically treated group

     *Quality of life measures were greater for the surgical groups than the medical group

     *No major late surgical complications were reported

Now how does this new "boring" clinical trial update compare with your non-surgical obese diabetic patients' experiences and quality of life lately?

Probably boring is not the word to describe that...

What's worse for your Liver: Fat or Acohol?

from Leanbodylaunchpad.com

Fat?

Or Alcohol?

Which is more hepatotoxic?

Kind of a trick question.

In an article entitled "Obesity Trumps Alcohol in Liver Damage" (Oops, gave it away), in terms of liver-related morbidity and mortality, it seems that obesity was even more dangerous than alcohol consumption.

The study involved 100,000 women in London. The author and his team studied the interaction between BMI and alcohol consumption for 'liver related events', in women middle aged and older.

'Liver-related events' (illness or death related to alcoholic liver disease, NASH, cirrhosis, or decompensation of cirrhosis) were measured, and calibrated for those who were both heavy drinkers or not, and those with a BMI of less than or greater than 30.

Clearly, as expected, for those that drank heavily, the risk of liver events increased irrespective of BMI.

The other findings were a little more surprising, when obesity gets into the mix.

In heavy drinkers that were overweight (BMI <30), the event rate was notably higher than those who drank heavily but were not overweight.

Events were also higher in patients who were overweight, but did not drink heavily. The combined risk was additive.

An effect described as "super additive" was noted with obesity and heavy drinking.

There was a difference between overweight drinkers and obese drinkers, in that more damage was demonstrated with increasing weight. More event were tallied in the obese group (BMI >30) that drank heavily, vs. the dame rate of alcohol ingestion and "just" overweight status.

Interestingly, this study has more public health implications than you might think for the UK and Europe.

Europe has the heaviest alcohol consumption in the world, and consequently alcohol consumption is the third leading cause of death and illness there, only after tobacco and hypertension.

Men and Women are Different...

From Inclusionmagazine.com

Quite a lead title for this post, don't you think?

This could go a number of very interesting ways, but for the purpose of this Blog post, I am going to center on their differences in terms of their participation and results of efforts and treatments for obesity.

I think I have stated before that women far outnumber men in our bariatric surgical practice, by at least a 3:1 margin if not more; it may in fact we may be closer to 80% for female patients in our practice.

I recently saw a post in Fairfield County's (Connecticut) bariatric surgery blog that highlighted a few of the reasons.  Good post.

We all know men and women are different animals, and the same is true in respect to their proclivity to seek treatment, and what kind of treatment for obesity.

Why are our bariatric surgical practices so female-dominant?

While being overweight is not a female or male predominant situation (or disease as recently noted by the AMA), however, according to 2012 US data, it does favor males at nearly 70% of their adult group, vs. females at nearly 60% of their group.  That's a huge group of people that are overweight and obese in the US, and while both sexes have this affliction, how they react to their illness / poor health (female description?) or their challenge (male description?) is  markedly different.  And that, in a nutshell, is probably the main contributor to whether or not a male or female seeks out surgical care for their obesity.

As far as medical treatment as a whole, it is well known that females are much more likely to seek care for health-related matters, whereas men tend to under utilize the health care system more commonly.  Studies have shown that men tend to put off a surgical option for weight loss until they had a significant weight-related health problem that effected their daily functioning. The writer of the blog post from Fairfield correlates this with the parallel of not asking for directions until it's very late in the journey, and how that has always been a stereotype of men from women (before the advent of GPS assistance) :) .

Studies also reveal that men often have a bit more success with weight loss efforts on their own, in terms of utilizing diet and exercise to get to a weight goal.  Men do have more lean body mass (Testosterone = muscle mass),  and can build muscle easier to aid in more 'rapid' metabolic changes, with a similar level of exercise vs. what women experience from their efforts.

So, I guess if you have had a degree of success with lifestyle changes in the past, you can probably justify not considering that definitive surgical option, and delay it until you can just buckle down and give it another shot.

Not as easy as it sounds, but if it works (this time), go for it, for sure.  If you don't need / want the surgical option, and you are successful losing weight and improving health and reducing your comorbidities, admittedly that is the best way.  Waiting years to start this process, or letting your medical issues slowly get out of hand, with irreversible damage from them, can border on irresponsible. Spoken like a true procrastinating male.

And back to those women that make up the majority of our surgical weight loss practice, and likely the vast majority of clients of non-surgical weight loss businesses in the country, persistence does have its rewards.  According to the ASMBS, their data shows that in the battle of the sexes for weight loss averages after bariatric surgery, women tend to lose more weight than their male counterparts, by 10% more.

"So there..." I can hear a female voice saying those words right now...