Bariatric surgery can lead to brain disorder
Weight loss surgery can lead to a neurological disorder called Wernicke encephalopathy that affects the brain and nervous system causing memory loss and confusion, inability to coordinate movement, vision impairment and other problems. The syndrome is linked to a deficiency of vitamin B1, or thiamine, and occurs most often in patients who have frequent vomiting after surgery, according to a study published in the March issue of Neurology. Most patients developed the disorder between 4 and 12 weeks after the surgery, but some occurred as early as 2 weeks following surgery.
“The number of people getting this surgery has risen dramatically, and I was seeing a lot of these neurological problems emerging after surgery,” said Sonal Singh, lead author of the study. “What was surprising is that some of these cases occurred among people who were taking their vitamins.” (Dunham W. Neurological condition linked to obesity surgery. Reuters: Washington 3/12/07; Singh S. Neurology 3/13/2007.)
Weight concerns may lead to smoking
Girls who dieted were more likely to smoke, in a Massachusetts study that looked at 932 students in 6th and 7th grade. About 3 percent of both girls and boys were smoking, and 4 to 5 percent were dieting. However, two years later 16 percent of girls and 12 percent of boys reported smoking, and 21 percent of girls and 18 percent of boys said they were dieting at least once a week. Girls who dieted weekly were nearly four times more likely to become smokers than were nondieters, and girls who dieted monthly were twice as likely to become smokers as nondieters. However, obese girls were less likely to report being smokers, either initially or during follow-up. Over one-third of the smoking initiation by girls was attributed to dieting. The researchers say that weight concerns underlie both smoking and dieting behaviors. They advise that to prevent smoking among girls, attention needs to be given to the widespread problems of dieting and unhealthy weight concerns. (Huggins CE, Girls who diet often may be more likely to smoke. Reuters Health. New York, 3/1/01.)
Dieters' nightmare comes true
People who diet and try to lose weight are more likely to experience major weight gain than nondieters. In a large Finnish study, risk was greatest among younger men and women. Over a period of 15 years, 36 percent of the dieting younger men had gained over 10 kg (22.5 pounds), compared with 29 percent of nondieting men in that age group. In 15 years, 24 percent of dieting women in their middle years gained over 10 kg, versus 13 percent of nondieters. Initial weight made no difference. Neither did other potential confounders including smoking, alcohol use, education level, or marital status. The study was based on a twin population of 3,536 men and 4,193 women. In comparing twins, the tendency to gain weight following weight loss was found to have a family component.
The authors cite two US studies with similar results: the Healthy Worker Project, in which a dieting history at baseline predicted weight gain in 3,553 men and women over 2 years, and the Health Professionals Follow-Up Study of 19,478 men, in which frequent dieting was related to weight gain. (Healthy Weight Journal 2000:14:4;51/ Korkeila M, Rissanen A, Kaprio J, et al. Weight-loss attempts and risk of major weight gain. Am J Clin Nutr 1999;70:965-973)
Youth smoke to control weight
Children who worry about their weight are smoking likely to contemplate and experiment with smoking at ages 9 to 14. At this age 10 percent had used cigarettes and 7 percent of girls and 5 percent of boys were contemplating smoking in the next year, in a recent study of over 15,000 children. Concerns about weight and weight control behaviors, including dieting, purging, and exercising to lose weight, were higher among these youth and the few regular smokers than among those who had never smoked and did not plan to try cigarettes in the next year. Of the girls, 15 percent of contemplators and 14 percent of experimenters and users misperceived themselves as overweight, compared with 10 percent of those who did not contemplate smoking.
The researchers say it is important for programs directed at youth to address healthy methods of weight maintenance and dispel the notiion of smoking as a method of weight control. Smoking among high school students increased from 27.5 percent in 1991 to 36.4 percent in 1997. (Tomeo CA, Field AE, Berkey CS, et al. Weight concerns, weight control behaviors, and smoking initiation. Pediatrics 1999;104:918-924, Website: www.pediatrics.org)
Is weight loss after 50 inadvisable?
Instead of urging older people to lose weight, a better public health emphasis might be to inform them that substantial weight loss after age 50 is a potential indicator for poor survival, says a major new study.
Supported by the National Heart, Lung, and Blood Institute, the long-term heart study involves instituions including the National Institute on Aging, at several locations, with a coordinating center at the University of Washington, Seattle. It looked at 4,317 nonsmoking adults over age 65 in four counties in the United States, who recalled their weight at age 50.
The data show that for these adults there is little relation between weight and mortality, except for those with a very low weight (BMI of 20 or below), who have higher death rates. A low BMI was associated with mortality even after control for a wide variety of measures, including short-term unintended weight loss. A high BMI showed no association with mortality, and the variables considered had little effect except that long-term weight loss had a profound effect on results. People who lost 10 percent of their obdy weight after age 50 had a relatively high death rate. When that group was excluded, there was no remaining relationship between body mass index and mortality. During the 5-year study, 12.5 percent of the participants had died (about twice as many men as women).
The researchers conclude that this finding of no excess risk for a BMI above 27 would seem to support advising higher weights for older adults. (Diehr P, Bild D, Harris T, et al. Body mass index and mortality in nonsmoking older adults. Am J Public Health 1998;88:623-629)
Gastric surgery riskier for older adults
Weight loss surgery may be riskier than thought, especially for older patients, according to a study that analyzed the risks at one year for the Medicare patients who underwent surgery between 1997 and 2002. Some previous studies found death rates well under 1 percent. But in the study of 16,155 Medicare patients who underwent obesity surgery, more than 5 percent of men and nearly 3 percent of women aged 35 to 44 had died within one year of surgery. Among patients 65 to 74, nearly 13 percent of men and about 6 percent of women died in that time. For patients age 75 and older, half the men and 40 percent of the women died in the first year. Medicare covers obesity surgery if recommended to treat related conditions such as diabetes and heart problems, and for younger Americans with disabilities. The researchers suggest that obesity surgery may not be right for an older person who has been obese for many years. (Flum DR, Salem L, et al. Early mortality among Medicare beneficiaries undergoing bariatric surgical procedures. JAMA 2005;294:1903-1908.)
Diet drugs require low-calorie diet
A recent review reports that a reduced-calorie diet is essential for orlistat and sibutramine to work effectively (the two antiobesity drugs approved in the US). With this combination of diet and medication, weight loss peaks in 6 months. In 1 year, 30 to 40 percent of obese patients without diabetes can be expected to lose in the range of 10 percent of body weight when receiving orlistat 120 mg 3 times daily, compared with 10 to 25 percent of control patients. Less weight is regained with the combination of diet and orlistat than with a control group on diet and placebo in a 2-year trial. For sibutramine, only 1-year treatment data are available. The effect is dose dependent, and patients with type 2 diabetes lose less weight. Weight is regained when either drug is discontinued.
Orlistat, which acts locally, may be associated with localized adverse effects, whereas sibutramine acts centrally, inhibiting serotonin and noradrenaline reuptake, and can use cause systemic effects. during orlistat therapy, gastrointestinal effects (most commonly, oily stools, flatus, and fecal urgency) may result from fat excretion, arising during the first week of therapy and less commonly in the second year of treatment. Sibutramine can increase blood pressure and heart rate; its most common adverse effects are headache, dry mouth, and anorexia. (Better than slim chances for orlistat and sibutramine to promote weight loss. Drug Ther Perspect 2000;15(12):1-6; www.medscape.com/adis/DTP)
Weight cycling increases risk
Women who have dieted their way through repeated cycles of weight gain and loss tend to have lower levels of high-density lipoprotein cholesterol (HDL, the "good cholesterol"), associated with increased risk of cardiovascular disease. This report comes from the Women's Ischemic Syndrome Evaluation (WISE) multicenter study of 485 women who had coronary risk factors, funded by the National Heart, Lung, and Blood Institute. Overall, 27 percent of the women reported weight cycling, defined as intentionally losing at least 10 pounds at least three times during one's life. Among these women, regardless of their weight, HDL levels were 7 percent lower than in women with no history of weight cycling. Total cholesterol levels were also 8 percent higher. HDL was directly associated with the amount of weight lost and gained, independent of other known factors such as smoking or lack of exercise. Women who lost and gained 50 pounds or more during cycling had HDL levels 27 percent below those of noncyclers.
The researchers urge an end to dieting and more attention to exercise and sound nutritional practices . (Weight cycling appears to lower levels of HDL-C in women. Westport, CT, Reuters Health 11/1/00; J Am Coll Cardiol 2000;36:1565-1571)
Weight loss brings risk, unlike fat loss
Most large studies show an increased risk of death with weight loss. Yet fat loss seems beneficial. Perhaps the harm of losing lean body mass during weight loss overrides any benefits that might come from fat loss. Testing this theory, researchers at the Obesity Research Center in New York analyzed two large longitudinal cohort studies, the Framingham Heart Study, and the Tecumseh Community Health Study.
Results were remarkably similar in both samples. Weight loss was associated with higher death rates, but fat loss with lower death rates. In the Framingham sample, weight loss of 1 standard deviation or 6.7 kg resulted in a 39 percent increase in mortality risk, and fat loss of 1 standard deviation or 4.8 mm resulted in a 17 percent decrease in risk. In the Tecumseh sample weight loss of 1 sd (4.6 kg) resulted in a 29 percent increase in mortality risk, and fat loss of 1 sd (10 mm) resulted in a 15 percent decrease in risk. Controlling for smoking, baseline values of weight and fat, and using different analyses, basically reached the same outcome and confirmed these results. Whether male or female made little difference, nor did age. Essentially weight loss was revealing a loss of lean body mass, said the researchers.
They suggested this may also imply the opposite: that weight gain is associated with lower death rates and fat gain with higher death rates, but this needs further study.
Implications of the study are clear and profound. Whether weight loss is healthy or not may depend on the amount of fat that is lost and lean that is preserved. The optimal percentage is not clear. It may make a difference how much body fat the person has. It is important to begin measuring fat loss in weight loss programs, they said. (Allison DB, Zannolli R, Faith MS, et al. Weight loss increases and fat loss decreases all-cause mortality rate: results from two independent cohort studies. I J Obesity 1999;23:603-611.)
Teen dieting leads to weight gain
At every weight, girls who tried to lose weight were more likely to gain weight over time and were at greater risk for obesity, according to a northern California study. The 692 9th-grade girls from three high schools were studied over a period of 3 years, using actual measurements and behavioral questionnaires. Those who reported more strenuous dieting and radical weight loss efforts such as use of laxatives, diet pills, vomiting, and fasting gained more weight, as did those who reported exercise for weight control purposes. The study also found that initial binge eating was high among those who subsequently gained more weight.
Their initial weight made no difference: overweight girls were no more susceptible to weight gain than those who were underweight or normal weight at baseline. Among girls who dieted, the hazard for obesity onset was 3.24 times greater than for nondieters.
The researchers suggest that girls who strive to lose weight are more likely to progress to binge eating and subsequent weight gain. Further, if they have a family history of obesity, they may try harder. The investigators conclude that weight-reduction efforts can lead to the "dysregulation of the normal appetite system," resulting in weight gain from erratic eating behaviors. (Healthy Weight Journal 2000:14:6;82 / Stice E, Cameron RP, Hayward C, et al. Naturalistic weight-reduction efforts prospectively predict growth in relative weight and onset of obesity among female adolescents. J Consult Clin Psychol 1999;67:967-974)
Deaths reveal liposuction risks
Three liposuction deaths being investigated in California may be just the tip of the iceberg, experts say, in a burgeoning, unmonitored field driven by advertising and quests for the perfect body.
Judy Fernandez, 47, of Irvine, underwent 12 hours of surgery at a cost of $20,000 and died March 17 from what the Medical Board of California called an overdose of anesthesia, fluid overload and a fatal dilution of the blood. Rosemarie Mondeck, 39, of San Diego, died June 21, 1994, from cardiac arrest after stomach liposuction at a La Jolla dermatologist's office. Tammaria Cotton, a 43-year-old court clerk from Los Angeles, suffered massive blood loss and died of cardiac arrest on June 22, 1996, after having fat removed from her stomach, bottom and thighs. Liposuction incidents are not tracked. But Richard Ruffalo, MD, past chair of the department of anesthesia at Hoag Memorial Hospital in Newport Beach, says that for every death there are "at least 15 to 20 cases where severe injury has occurred."
Tumescent liposuction may seem routine. The area is made taut by a combination injection of saline solution, a local anesthetic like lidocaine, and epinephrine to reduce bleeding. Then the doctor makes a small incision and inserts a tubelike device called a cannula to suction out fat. The problem is that more doctors in a variety of specialties are offering the procedures, some pushing the margins of safety, often in private, outpatient surgical suites hidden from scrutiny.
Frederick Grazer, MD, a Newport Beach plastic surgeon, says the money is drawing more untrained doctors to liposuction. "Many doctors who were never interested in plastic surgery... take a weekend course and become interested in things they can bill upfront without insurance." (Healthy Weight Journal 1997:11:6;106 / AP, Los Angeles, Bismarck Tribune 8-25-97)
Brain damage from diet pills
Users of widely prescribed diet pills may suffer irreversible loss of brain serotonin nerve terminals, possibly resulting in symptoms of anxiety, depression, cognitive, memory and sleep problems, say National Institute of Mental Health researchers. Their review of 90 animal studies on serotonin neurotoxicity and primary pulmonary hypertension from fenfluramine and its chemical cousin dexfenfluramine was reported in the August 27, 1997 issue of the Journal of the American Medical Association.
They report an estimated 50 million people have taken the drugs worldwide, often in combination with phentermine, an amphetamine-like diet drug that counteracts the fendluramines' tendency to induce drowsiness. The study cautions that if the animal findings apply to humans, the brain damage "would be expected to occur in almost everyone taking a dose sufficient to achieve weight loss."
In one study cited monkey's brains continued to show signs of damage 17 months after taking the drug. Fenfluramines damage serotonin-secreting neurons by pruning their extensions called axons, which do not grow back in monkeys, although studies show they do in rodents. And since human brains are more like those of monkeys, any such damage in humans would also likely be permanent, said Una McCann, MD, chief of anxiety disorders research in the NIMH Biological Psychiatry Branch, Bethesda, MD. "A dose comparable to that prescribed to reduce weight in humans causes neurotoxicity in monkeys."
McCann cites case reports that some users have experienced psychiatric disorders, which tend to be under-diagnosed in clinical practice. She says we won't know the long-term risks of these drugs until controlled studies are completed in humans. Meanwhile, doctors are advised to be vigilant for both behavioral and cardiopulmonary side effects. (Psychiatric symptoms may signal brain damage from diet pills. National Institutes of Health News Release, USDHHS. 9/26/97. Ref: Jules Asher, Public Affairs tel 301-443-4536; fax 301-443-0008)
Mortality risk rises with weight loss for older women
Older women who are underweight or who lose weight may be at greater risk of dying than women who maintain an average weight or gain a few pounds. In a University of Maryland study, 648 women, age 65 to 99, were interviewed and weighed once a year for 3 years, then followed for an additional 3 years. Women with a low body mass index (BMI) were most likely to die. Of these, 22 percent of women died, compared with 18 percent of women with a high BMI and 13 percent of women with an average weight. Losing weight, regardless of initial BMI, also increased the risk of dying. For example, in women with an average weight, those who lost weight were almost four times as likely to die as women who either maintained that weight or gained a few pounds. The researchers caution that extra medical attention should be paid to older women who lose weight. (Healthy Weight Journal 2000:14:2;18 / McKinney M. Weight loss hikes elderly women's risk of dying. Reuters Health, NY, 12/3/99; J Am Geriatrics Soc 1999; 47:1409-1414.)