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    How Coke Comported Itself Last Year

    February 5th, 2016

    coca-cola-truck
    This picture shows the “Holidays Are Coming” truck, which yearly visits more than 40 locations in the United Kingdom. Last year, 2015, saw more pushback than ever, including harsh words from Parliament member Keith Vaz who said:

    The Coca-Cola truck is not welcome in Leicester, and this national tour to promote sugar-laden drinks is ill-judged and unwise at a time of record diabetes and obesity levels.

    Meanwhile in India, where Coke operates 57 facilities that produce sugar-sweetened beverages, the government is trying to pass a hefty 40% tax on that very commodity. The corporation was quick to point out that higher tax leads to falling sales, and then to factory closings and job loss for some of India’s 25,000 Coca-Cola employees. It’s not a threat, just economic reality.

    In the U.S., football star Tom Brady of the New England Patriots said unkind things about Coca-Cola when it was not even the main topic of conversation. It was recently revealed that Brady’s personal trainer Alex Guerrero had trouble with the law in the past, for selling a health product. Defending him to an interviewer, Brady said:

    You’ll probably go out and drink Coca-Cola and think, ‘Oh yeah, that’s no problem.’ Why? Because they pay lots of money for advertisements to think that you should drink Coca-Cola for a living? No, I totally disagree with that. And when people do that, I think that’s quackery. And the fact that they can sell that to kids? I mean, that’s poison for kids.

    The athlete was making the point that the pot shouldn’t call the kettle black, and people in glass houses shouldn’t throw stones. When discussing the guru responsible for Brady’s health and phenomenal performance, people who eat and drink junk are not entitled to an opinion.

    Coca-Cola exercised restraint, releasing a bland statement. But that wasn’t all. Brady also called out Kellogg’s cereal as one of the parties contributing to the “incredible rates of disease in our country.”

    I think we’ve been lied to by a lot of food companies over the years, by a lot of beverage companies over the years… We believe that Frosted Flakes is a food.

    Strong words! In return, Kellogg also issued a mild statement. Brady is, after all, one of the most famous athletes in history. But other kinds of people are voicing their objections, too, such as children’s doctors.

    Regrettable liaisons

    The American Academy of Pediatrics (AAP) has enjoyed a tie with Coca-Cola that included the chair of the AAP’s Committee on Nutrition defending the corporation in terms that could most kindly be described as uncomprehending. Indeed, the coziness of the relationship drew much criticism from both insiders and spectators.

    Then, the Coke PR machine laid down a double whammy that could simply no longer be tolerated. First, they’ve been funding research scientists whose results mysteriously conclude that childhood obesity is in no way connected with a crummy diet, especially a crummy diet built around Coke products.

    Second, the tame scientists also found that exercise is the only factor that makes a difference, and consequently the company has been “using sports to sell soda the way Virginia Slims used tennis to sell cigarettes,” as journalist Casey Hinds put it. This was more than the AAP could stomach.

    Or maybe the breakup was caused by mounting criticism from a public offended by pediatricians at their national conference, carrying around swag bags emblazoned with gigantic, garish Coca-Cola logos.

    A photo of that atrocity appears in an article by Dr. Andreas Eenfeldt. He mentions the end of Coke’s problematic relationship with the Academy of Nutrition and Dietetics, which has been accepting Coke money for eight years, and goes on to say:

    There’s some talk about Coke being the one who ended it, but that may just be spin, an attempt at damage control from Coke.

    Your responses and feedback are welcome!

    Source: “Coca-Cola Christmas truck tour,” independent.co.uk, 11/05/15
    Source: “Coca-Cola India warns of factory closures if ‘sin tax’ is implemented,” IrishExaminer.com, 12/12/15
    Source: “Coca-Cola on Tom Brady’s ‘poison’ remark: ‘All our drinks are safe’ ,” CBSSports.com, 10/13/15
    Source: “How McTeacher’s Nights and Coke Science Betray Us,” beyondchron.org, 10/14/15
    Source: “The Coca-Cola Problem is Getting Uncomfortable,” dietdoctor.com, 09/29/16
    Photo credit: Marnie Pix via Visualhunt

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    Specialized Types of Fatlogic

    February 4th, 2016

    tell-a-smoker

    Twenty-two thousand is a pretty decent-size subject pool for a study, but the result given by this one could have been arrived at through mere common sense. The University of Illinois found that…

    […] diet-beverage consumers may compensate for the absence of calories in their drinks by noshing on extra food that is loaded with sugar, sodium, fat and cholesterol.

    Dr. Ruopeng An, professor of kinesiology and community health, wanted to do something different. Past research on the beverage-to-food relationship had centered around snacks between meals, but An wanted to document “the nutritional quality of the food participants consumed, rather than when it was eaten.”

    It turns out that although drinkers of coffee and diet sodas consume fewer daily calories than those who prefer other beverages, the coffee and diet soda drinkers obtained a greater percentage of their calories from “discretionary” foods, which usually means calorie-laden junk.

    The ethnicity of the subjects provided some minor variations, but it was shown that, universally, obese consumers of diet beverages took in more calories worth of discretionary noshes. The professor makes it plain:

    “If people simply substitute diet beverages for sugar-sweetened beverages, it may not have the intended effect because they may just eat those calories rather than drink them,” An said […]

    In exploring associations between beverage type and dietary quality, An found that people who consumed sugar-sweetened beverages or coffee had the worst nutrition profiles.

    Ouch! It hurts to have this kind of disordered thought pattern exposed. In a similar vein, a very long article by Melissa A. Fabello and Linda Bacon contains good points intermingled with ideas that could be characterized as crypto-fatlogic.

    Let’s take a look.

    The authors are upset by “concern trolling,” said to be a form of online communication in which a forum participant pretends to care about the people affected by an issue, but really wants to insult them. This can be seen from another perspective.

    A common troll strategy is to imply that one is not entitled to participate in conversation about a certain group of humans — women, Asians, obese people, artists, whatever — unless one is a member of that group. Input from outsiders is deprecated or denigrated by the label “concern trolling.”

    Specifically, the authors are bothered by fatphobic concern trolling, especially when it is performed by feminists who allegedly “rush to quote sketchy research and throw oppressive ideologies around all in the name of, supposedly, ‘health.'”

    There are 11 discrete points of contention, which will not all be mentioned here. The first addresses stereotyped and unchallenged assumptions, which are oppressive. Okay, but they go on to quote fat pride activist Marilyn Wann:

    The only thing anyone can accurately diagnose when looking at a fat person is their own level of weight prejudice.

    Not really. Several professions are filled with highly trained people who can, at a glance, assess the probability that an individual experiences shortness of breath, suffers from diabetes, and will not live as long as they otherwise might have, if not for their obesity.

    Next, building on the laudable premise that correlation does not equal causation, come explanations of why obesity is not really America’s second leading cause of preventable death, or even an agent of disease. Obesity, in short, has not been proven to bring about either co-morbidities or premature demise. Viewed from this mindset, what’s really going on is that both dieting and weight cycling cause inflammation, which causes the illnesses erroneously blamed on obesity.

    Number four reminds us that being the target of fatphobia is stressful, and stress contributes to health problems. Granted, no one should be mean to overweight people. But this might be going too far:

    The way that you feel about your body […] has a much more significant impact on your overall wellness than the actual shape and size of your body itself.

    From there, the authors go on to ask, “[…] And is it even really appropriate to value health?” — and make the claim that weight loss does not really improve health, so that’s another myth to be gotten rid of.

    At some point, we arrive at what can only be called crazy talk:

    A liposuction study that controlled for behavioral change found absolutely no improvement in obesity-associated metabolic abnormalities, despite the weight loss that occurred.

    Many of the remaining discussion points seem to say the same things in different ways, and it might be fitting to issue a jargon alert, because the reader will encounter such constructions as,

    Because One-Size-Fits-All Definitions of ‘Health’ Are Ableist and Perpetuate Healthism.

    Your responses and feedback are welcome!

    Source: “Diet beverage drinkers compensate by eating unhealthy food,” Eurekalert.org, 09/11/15
    Source: “11 Reasons Your ‘Concern’ for Fat People’s Health Isn’t Helping Anyone,” EverydayFeminism.com, 01/24/16
    Image: Internet meme found at Chris Ward on Twitter

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    Jamie Oliver vs. Sugar

    February 3rd, 2016

    Flood_January06

    In Jamie Oliver’s world, sugar is “the next tobacco” in the sense that it should be shamed, educated, taxed, and hounded out of existence wherever and whenever possible.

    Last autumn, Oliver’s production company released the documentary film Sugar Rush whose creation took him to a London hospital where a six year old devotee of fizzy drinks was having six teeth extracted. In the 5-to-9 year age group, 26,000 kids in the United Kingdom are admitted to hospitals with severely deteriorated teeth every year.

    Oliver quotes a statistic which is probably reliable, given that he is a very public figure with many critics eager to point out his smallest mis-speak. Regarding the United Kingdom’s National Health Service, he says “68 per cent of every case that goes through the NHS is diet-related.” But his concern doesn’t end at the national borders. He is outraged at how “parts of South America have been raped” by low-quality, nutrition-less products.

    In Mexico he filmed a woman feeding her baby “alternating between breast milk and Coke,” and visited a village where every inhabitant quaffs two liters of Coca-Cola on a daily basis. Mexico reportedly also has 3-year-olds who lack teeth because the world’s favorite SSB has already rotted them, and multitudes of dentists who furnish their patios with branded chairs and umbrellas that are gifts from the corporation. Oh and by the way, type 2 diabetes is the country’s leading cause of death.

    The Opposition

    A rebuttal was written by a fellow named Rob Lyons who calls Oliver’s anti-sugar campaign “simple-minded” and who offers some flabby arguments. For instance, in regard to the £30 million ($43 million) the NHS spends each year to pull teeth, and the fact that dental caries are biggest single reason why children are hospitalized, Lyons says,

    As it happens, infant tooth extraction would have happened in dental surgeries in the past. It’s just that it is now compulsory to bring children into hospital when they need to go under anaesthetic. So pulling kids’ teeth isn’t new – the hospital figures reflect changing medical practice as much as the state of our children’s teeth.

    To this, the only possible reply is, “So what?” Whether it occurs in a hospital or a dentist’s office, it’s still a heap of misery inflicted on children, and because the NHS would be paying either way, it still costs a ton of money that the country can’t afford. That silly excuse does nothing to change the fact that sugar is a plague and a scourge.

    In reply to complaints of massive amounts of sugar being present in processed commercial foodstuffs, Lyons disingenuously points out that “There is an easy way to find out the sugar content… read the label.” This remark totally ignores the years of grueling conflict it took for activists to gain something as elementary as a label that discloses the sugar content – a victory achieved only after fighting every step of the way with sugar apologists like Lyons.

    Coincidentally, just after the Sugar Rush movie came out, Coca-Cola released a new ad campaign to familiarize the populace with its sugar-free and low-calorie products.

    Jamie Oliver has successfully swayed public opinion and government activity before. Years ago, his “Feed Me Better” campaign and petition drive stimulated the British government to invest the equivalent of a billion dollars to improve school lunches. In a New York Times article, Alex Witchel included a couple of typical Jamie Oliver quotations:

    It’s harsh to say, but these parents, when they’ve been to the doctor and keep feeding their kids inappropriate food, that is child abuse. Same as a cigarette burn or a bruise.

    Every child should be taught to cook in school, not just talk about nutrition all day. Good food can be made in 15 minutes. This could be the first generation where the kids teach the parents.

    Your responses and feedback are welcome!

    Source: “As he approaches 40, Jamie Oliver,” DailyMail.co.uk, 01/02/15
    Source: “Don’t Rush to Join Jamie’s Sugar Crusade,” spiked-online.com, 09/04/15
    Source: “Putting America’s diet on a diet,” jamieoliver.com, 09/10/09
    Image: Amor Ministries via Visual hunt / CC BY-ND

     

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    Coke Again

    February 2nd, 2016

    what happens

    Childhood Obesity News salutes two pieces of web journalism that were first published six years ago. Wade Meredith’s classic “What Happens to Your Body if You Drink a Coke Right Now?” describes the effects of the first hour. Then, Briana Rognlin’s “What Happens to Your Body After You Drink a Soda Every Day, For a Long Time?” looks into the future.

    Not to give away the entire plot of this story, because the original post is worth reading, we will reveal a couple of highlights. For instance, the author says the phosphoric acid is in Coca-Cola to keep a person from vomiting when the system is attacked by a sudden onslaught of sugar. Next, the blood sugar goes up and the insulin appears, and the liver gets to work turning sugar into fat. Soon dopamine is produced, and the brain gets involved, and Meredith makes the inevitable heroin comparison.

    Mineral molecules from other foods are inside a person, trying to get to the bones and teeth to make them stronger. But the phosphoric acid in the beverage captures these elemental nutrients and flushes them out of the body. Plus, the person gets to feel irritable and/or mentally sluggish. The infographic at the top of this post, created by Wade Meredith and Niraj Naik, has been widely circulated on the Internet.

    Over the long term, of course, results are even more troublesome: obesity, diabetes, heart disease… and never mind trying to cheat with diet soda. Rognlin says,

    We know you don’t like us to compare drinking caffeine and sugar to substance abuse, but when it comes to your lifestyle, some think that soda is just like a gateway drug.

    People who write and read about such topics as nutrition and obesity would probably enjoy an occasional vacation from thinking about Coke but alas, the gigantic corporation stays busy providing new material on a regular basis. Of course it can’t take all the blame. There are other corporations that sell sugar-sweetened beverages (SSBs) by the millions. Together, they are responsible for 184,000 deaths per year in the world (25,000 in the USA), according to a study from Tufts University. That is pretty much the same number of fatalities as are caused by flu, which is a well-known scourge.

    The data represents deaths from diabetes, heart disease and cancer, but arriving at the final figures was not cut-and-dried. SSBs are not the only factor working against people’s health, so quite a lot of fancy math went into obtaining the results. Journalist Christopher Wanjek wrote:

    The study is based on a complex statistical analysis of country-specific dietary habits and causes of death in more than 50 countries, coupled with information on the availability of sugar on the world market…

    The researchers could not prove a direct cause and effect — for example, they cannot say that sugary beverages are the actual, primary cause of these 184,000 deaths on an individual level. Rather, they based their conclusions on national beverage consumption trends, death rates and sugar availability.

    In August of last year Muhtar Kent, Coca-Cola’s chairman and CEO, wrote an article expressing his disappointment at how the corporation’s latest public relations efforts had only led to more misunderstanding, confusion, and mistrust. He admitted that:

    Our company has been accused of shifting the debate to suggest that physical activity is the only solution to the obesity crisis. There also have been reports accusing us of deceiving the public about our support of scientific research.

    Kent listed the steps he had directed the president of Coca-Cola North America to take, and promised that in the future, the company would “act with even more transparency.” Childhood Obesity News will look at how that has been working out.

    Your responses and feedback are welcome!

    Source: “Updated Post: What Happens to Your Body If You Drink a Coke Right Now?,” Blisstree.com, 06/23/10
    Source: “What Happens to Your Body After You Drink a Soda Every Day, For a Long Time,” blisstree.com, 06/23/10
    Source: “Sugary Drinks Kill 184,000 People Every Year,” livescience.com, 06/29/15
    Source: “Coca-Cola: We’ll Do Better,” WSJ.com, 08/19/15
    Image by Niraj Naik/Wade Meredith

     

     

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    More on Teen Bariatric Surgery Dangers

    February 1st, 2016

    fat bottomed girls

    While not much progress has been made in preventing childhood obesity, it is known that early is better – early as in pre-conception, if possible. It is more than clear that the younger a child starts being overweight, the longer that child will probably remain overweight, and the longer the overweight state lasts, the greater the chance that it it will ripen into adolescent obesity and solidify as adult obesity. “Early intervention”  is the name of the winning game – which is fine, when discussing nutritious food rather than junk, the formation of sane eating habits, and the promotion of an active lifestyle.

    When it comes to obese teens, however, early intervention has taken on a new meaning – namely, bariatric surgery. When Dr. Thomas Inge talks about his successes and those of others in his field, it is difficult to be unexcited about the “gratifying changes” he describes. As Childhood Obesity News mentioned last time, the Teen-LABS project has published a three-year followup study showing that teen bariatric surgery can stop diabetes in its tracks, alleviate hypertension, normalize body chemistry, save kidneys from destruction, and improve quality-of-life scores. What’s not to like?

    Dr. Samer Mattar, MD, chief of the bariatric services program at Oregon Health & Science University, would very much like to receive more referrals from primary care physicians. He says,

    We have 4.5 million severely obese children in the United States. When severe obesity affects people at such a young age, comorbidities latch on and set in so that by the time they are adults, they are experiencing the full ravages of chronic disease… We should be operating on more of these adolescents before they become severely compromised young adults.

    Dr. Anita Courcoulas, who is chief of minimally invasive bariatric and general surgery for the University of Pittsburgh Medical Center, acknowledges that once an adolescent is 80 or 100 pounds overweight, diet and exercise won’t really do the trick. But she more conservatively recommends reserving bariatric surgery for the severely obese with co-morbidities.

    As time goes on, the negative metabolic effects of obesity become more entrenched – so why not nip them in the bud? The main reason is because, apparently, they don’t stay nipped. Teenagers are notorious for being unwilling and unable to comply with a strict program in the long term. The benefits of weight loss show up, but then are lost over time as weight is regained. Of course, for these patients, the W8Loss2Go smartphone application could be a tremendous help. Dr. Pretlow advises pediatricians against using surgery as a bogeyman, quoting a girl of 13, carrying 254 pounds on a 5’6” frame, who said,

    I am really scared about one thing my doctor told me … if i gain anymore weight I might have to have surgery … thats been giving me nightmares and stress … and as I said before stress makes me eat more …

    If surgery itself is frightening, the things that can go wrong are even more so. YouTube.com hosts large array of short video presentations with titles like “Duodenal Switch Issues,” “Disordered Eating Post-Op,” and “Long-Term Post-Op Complications.” Surgery can lead to malnutrition. For example, reports about the Teen-LABS study noted that three years after gastric bypass or sleeve gastrectomy, about half the teenage patients were iron deficient, and some lacked in sufficient amounts of vitamins B12 and A. Of course nutrients can be supplemented, but monitoring is an ongoing responsibility. More serious was the need, in 13% of the patients, to have their gallbladders removed.

    Reproduction

    Pregnant obese women face extra problems, like increased risks for diabetes and hypertension, preeclampsia, and cesarean delivery. There is also more likelihood of excessive blood loss and wound infection, and anesthetic complications

    In adolescent candidates for bariatric surgery, pregnancy will hopefully not be a factor. But just in case it is, the American Congress of Obstetricians and Gynecologists issued some guidelines:

    Researchers have recently determined that complications of gestational diabetes, hypertension, macrosomia, and cesarean delivery are less likely in pregnancies after bariatric surgery than pregnancies of obese women who have not had the surgery. ..
    Patients with adjustable gastric banding should be advised that they are at risk of becoming pregnant unexpectedly after weight loss following surgery…
    All patients are advised to delay pregnancy for 12–18 months after surgery during the rapid weight-loss phase.

    Your responses and feedback are welcome!

    Source: “Teens Gain Big Benefits From Bariatric Surgery,” GeneralSurgeryNews,com, 12/07/15
    Source: “Bariatric surgery in teens shows promise in study,” Triblive.com, 11/21/15
    Source: “Adolescent Bariatric Surgery Reverses Type 2 Diabetes in 95 Percent of Teens, Achieves Major Weight Loss and Improves Quality of Life,” PRNewswire.com, 11/06/15
    Source: “Counseling and treating obese patients during pregnancy,” ACOG.org, September 2005
    Image by Ian Bertram

     

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    Teen Bariatric Surgery – Successes and an Unrelated Failure

    January 29th, 2016

    La plus grosse femmeThe Teen-Longitudinal Assessment of Bariatric Surgery, which is known as Teen-LABS for short, aims to document “the efficacy and complications of bariatric surgery in the adolescent surgical patient and its role in the overall management of obesity prior to and through the emerging years of adulthood.” The literature says,

    The goal of Teen-LABS is to facilitate coordinated clinical, epidemiological and behavioral research in the field of adolescent bariatric surgery, through the cooperative development of common clinical protocols and a bariatric surgery database that will collect information from participating clinical centers performing bariatric surgery on teenagers.

    In addition to investigating surgical outcomes, another broader goal of Teen-LABS is to better understand the etiology, pathophysiology and behavioral aspects of severe obesity in youth and how this condition affects human beings over time.

    The basic question is whether adolescence is the optimal window for surgical intervention, and in order to answer it, a very large number of patients need to be followed up over an extended period of time.

    One problem with the popular meta-study format is that the various sources of data are not grounded with comparable roots. Just to make up an example, from the combination of a 2010 study of European children ages 12-15, a 2012 study of Hispanic children ages 10-15, and a 2013 study of an ethnically mixed children ages 9-14, it is difficult to draw meaningful and useful conclusions.

    The methodology behind Teen-LABS is to use standardized definitions and clinical protocols, measured by the same data-collection instruments. The same tools are used to evaluate, select and follow the patients, eliminating the confusing differences the arise from attempts to cobble together the results of many independent studies.

    The extent

    Founded in 2006, the Teen-LABS effort involves 5 major medical centers. There are 8 primary investigators, including chairperson Dr. Thomas Inge MD, PhD, (surgical director of the Surgical Weight Loss Program for Teens at Cincinnati Children’s Hospital Medical Center) and 8 other team members who coordinate the research data. The guidelines for abstracts, presentations and publications are strictly controlled. During 2015, 3 Teen-LABS publications appeared, along with 4 ancillary publications.

    Meanwhile, other related work goes on. Dr. Inge was principal investigator and lead author of a study whose results were published in the New England Journal of Medicine. The subjects were 242 adolescents (13-19) who were all 3 years past their bariatric surgery. 325 pounds was the average weight of the patients before surgery. Because Caucasian females are the main group seeking surgery at the participating medical centers, they made up most of the subjects in this particular case. Dr. Inge wrote,

    At three years, almost 90 percent experienced clinically meaningful weight loss, and participants were in better health, with improved quality of life scores.

    Also true after 3 years: the average weight loss was 27%, or around 90 pounds. More importantly, 95% of the participants experienced reversal of type 2 diabetes, and 86% showed normalized kidney function. In 74%, high blood pressure disappeared, and there was reversal of lipid abnormalities in 66%.

    A short case history

    Not all kids fare so well, and this story is for the purpose of contrast. In 2012, young Shani Gofman allowed New York Times reporter Anemona Hartocollis to shadow her for her first post-op year.  The history was that Gofman had been fat-shamed at school starting in 4th grade. When she was 17, her pediatrician brought up the idea of surgery, but the girl resisted, announcing her intention to diet. Instead, she gained 30 pounds over the next 8 months. When surgery was decided upon, she was supposed to prepare by limiting herself to a liquid diet, but splurged instead, reasoning that soon enough, she would be unable to.

    On her 19th birthday, Gofman weighed 271 pounds with a body mass index, which quite exceeded the recommended BMI. A state insurance plan for low-income families covered the more than $20,000 cost of lap-band surgery, Hartocollis meticulously documented the various circumstances and tribulation of Gofman’s life that led to her backsliding. Just after her 20th birthday, she had gained back almost half of the weight lost in the first halcyon months. A mere year later, she was back for additional surgery to tighten the band, “so it now took an hour and a half to force down two scrambled eggs.”

    The journalist points out that health plans of every kind are often more willing to pay for a surgical procedure than for more conservative treatment plans, and also that…

    …the long-term effectiveness of weight-loss surgery, particularly stomach banding, the procedure Ms. Gofman had, is still in question.

    Your responses and feedback are welcome!

    Source: “Adolescent Bariatrics: Assessing Health Benefits and Risks,” Undated
    Source: “Adolescent Bariatric Surgery Reverses Type 2 Diabetes in 95 Percent of Teens, Achieves Major Weight Loss and Improves Quality of Life,” PRNewswire.com, 11/06/15
    Source: “Young, Obese and in Surgery,” NYTimes.com, 01/07/12
    Image by Stefan

     

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    Teen Surgery – the Prophylactic Argument

    January 28th, 2016

    Fat Cynthia
    Is disease prevention a sufficient justification for performing surgery? Opponents of neonatal circumcision would say no; on the other hand, women with the genetic predisposition to breast cancer want the choice of bilateral mastectomy just in case. It is a thorny problem. More specifically, is it a good idea to operate on an overweight child or teenager as a precaution?

    In 2012, of all bariatric surgeries, between one and two percent were performed on patients under 21 years of age. There would be a lot more if people could afford it, but apparently insurers are reluctant to spring for it until a person is at least 18. For the New York Times, Anemona Hartocollis wrote,

    The push toward surgery on the young has brought some resistance from doctors who say it is too drastic to operate on patients whose bodies might still be developing and who have not been given much time to lose pounds on their own.

    Some worry that surgery, which is a pretty big deal and certainly an expensive one, would be undertaken purely for reasons of vanity. Some feel that surgery should be a last resort that would not even be suggested except in an immediately life-threatening situation.

    But surgery proponents see the youth of these patients as the big selling point, because earlier intervention can prevent the obesity from spawning a host of related health problems. If someone could avoid developing high blood pressure or type 2 diabetes, that would be much preferable to treating it later. Opinion seems to be swinging from the “last resort” school to a more permissive effort to change the future by curbing the metabolic syndrome before it has a chance to take hold.

    The New England Journal of Medicine published news of a study that concerned itself with 242 adolescents from 5 different American locations. Going in, the kids were between 13 and 19, and their average weight was 328 pounds. They all underwent one of two popular procedures. On three-year followup, the Roux-en-Y gastric bypass group had a mean weight loss of 28% and the sleeve gastrectomy group had declined by 26%. Not bad, but it gets better. Blood pressure had normalized in 74% of the participants, and a whopping 95% experienced remission of type 2 diabetes.

    Adults with the same surgeries top out at a 60% remission rate. That is a persuasive, but not yet definitive, argument for endorsing weight-loss procedures at increasingly earlier ages. The great thing about this study is that it will also publish the follow-up results at 5, 7, and 10 years post-up.

    A hard-nosed, heart-felt plea

    According to a brand-new study,

    Intense research efforts in humans and rodent models are underway to identify the critical mechanisms underlying the beneficial effects with a view towards non-surgical treatment options.
    Although a number of changes in food choice, taste functions, hedonic evaluation, motivation and self-control have been documented in both humans and rodents after surgery, their importance and relative contribution to diminished appetite has not yet been demonstrated.
    The mechanisms responsible for suppression of appetite, particularly in the face of the large weight loss, are not well understood.

    In other words, a lot of observation has been going on, but no one is yet able to pull it all together in a comprehensible manner. It is apparent that surgery does promote weight loss and weight loss is followed by improvements in glycemic control, but the reason is not clear. The research emphasis tends toward pinpointing the origins of appetite and manipulating them. However,

    None of the major candidate mechanisms postulated in mediating surgery-induced changes from the gut and other organs to the brain, such as gut hormones and sensory neuronal pathways, have been confirmed yet.

    That was an ornate way of saying, we don’t know how to get the good stuff without taking a trip to the OR. The report also suggests that future research should concentrate on “interventional rather than descriptive approaches,” which is a politically correct way of saying “Stop telling us about the problem and tell us what to do.”

    Your responses and feedback are welcome!

    Source: “Young, Obese and in Surgery,” NYTimes.com, 01/07/12
    Source: “Bariatric surgery in teens shows promise in study,” Triblive.com, 11/21/15
    Source: “Appetite and body weight regulation after bariatric surgery,” Wiley.com, 01/22/15
    Image by Eurritimia

     

     

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    After Teen Surgery

    January 27th, 2016
    Gastric sleeve-themed items by Etsy craftspersons

    Gastric sleeve-themed items by Etsy craftspersons

    A piece in GeneralSurgeryNews.com makes an excellent point –

    Although bariatric surgery is performed on unprecedented numbers of teenagers today, the number of procedures performed—and the availability of insurance coverage—barely registers compared with the size of the obese population of young Americans.

    The demand far outstrips the supply. If more patients could afford it, no doubt the supply of available bariatric clinics and doctors would increase. Part of the expense is in the ongoing nature of these procedures. It’s not just a one-and-done. There are preparatory stages, the testing and history taking and counseling.

    Costliness is also affected by the fact that sometimes, there is more than one surgery, either by design or because something went wrong the first time. Christina Frangou’s article was published only last month, but the latest available statistics are from 2009, when 1,600 kids under 18 had some form of digestive tract-altering surgery.

    Of the study participants, 13% required at least one additional abdominal procedure during the three-year period, most commonly gallbladder removal. In all, 30 patients required a total of 47 additional procedures.

    She notes that before surgery, only 5% of the subjects were iron-deficient, a number that rose to more than half, after surgery. Their ability to squeeze the goodness out of other nutrients is also affected. Lab work is needed to stabilize the levels of everything. For these and other reasons, bariatric surgery is a long-term commitment that includes continuing interface with the medical profession, and it’s not the kind of commitment just anyone can make.

    The usual post-op course (after for instance an appendectomy or a knee replacement) is for a wound to close, infection to be avoided, and all the customary care to be taken so the patient will emerge in a better state than she or he previously endured. After a certain point, it’s over, and the patient many not see a doctor about that body part for years, or ever.

    After bariatric surgery, however, follow-up is vital and and perpetual. There is no return to normalcy. Life is not like it was before, and not like most other people’s lives. It requires deliberate maintenance under a stringent set of rules, and who wants that? Young people, especially, find it difficult to adhere to such discipline.

    Basic principles

    An underlying assumption is that bariatric surgery on the young should only be undertaken when other methods have failed. The paradox is, sometimes the patient has to lose weight first, or else the operation will be unacceptably dangerous. But if they can do that, doesn’t it indicate that other methods actually do work? A question naturally comes to mind: why then resort to surgery at all? Why not continue with traditional methods like, for instance, eating less and exercising more?

    Overeating and slothfulness are not the only causes of childhood obesity. Ideally, children and teens who contemplate surgery would sign up with W8Loss2Go, and put the big decision on hold for a while. The long-range outcome for bariatric surgery is not overwhelmingly impressive. Sure, a lot of patients get better for a year or even a few years. Also, a lot of patients eventually return to their former sizes. W8Loss2Go, on the other hand, advocates and teaches a relearning that lasts a lifetime.

    Your responses and feedback are welcome!

    Source: “Teens Gain Big Benefits From Bariatric Surgery,” GeneralSurgeryNews.com, 12/07/15
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    Bariatric Surgery for Teens – Risks and Complications

    January 26th, 2016

    Fat Anna Grace Pink Hair

    Weight loss saves lives and reduces the likelihood of numerous co-morbidities. Alas, the effects rarely last. Without surgical intervention, it is said that “only 2% of severely obese teenagers can lose weight and keep it off.” So a case can be made that for many morbidly obese young people, bariatric surgery is their only hope. The New England Journal of Medicine published an editorial by Elias S. Siraj, M.D., and Kevin Jon Williams, M.D. that recognized these unfortunate facts and added:

    Bariatric surgery results in the most weight loss and the highest rates of remission of type 2 diabetes, but the potential side effects are of concern. Furthermore, performing bariatric surgery in approximately 400 million obese persons worldwide is not feasible.

    Absolutely correct. 400 million people are not about to hop onto operating tables any time soon. But how does it work out for the very small fraction who can afford it, and who are near an appropriate medical facility, and are physically and psychologically qualified? The National Institutes of Health set the recommended criterion for surgical intervention as a BMI of at least 40, or at least 35 if there are significant comorbidities present that are related to the obesity. In 2006, there were complications in 7.6% of cases. As recently as 2012, the New York Times said that studies had placed the death rate for open (not laparoscopic) surgeries, as high as 2% within 30 days. A more recent source says,

    Along with the increased volume of surgical procedures, a dramatic decrease in mortality and complications related to surgical intervention has been achieved, as demonstrated in a recent meta-analysis showing a mortality rate of 0.08% within 30 days and 0.31% after 30 days.

    As surgeons gained experience and the proportion of laparoscopic surgeries increased, risk declined across the board, and the number of complications decreased. But the Times suggested it was also because bariatric surgery became less of a last-resort rescue mission, and more of an elective option for patients who were thinner and healthier to begin with.

    The varieties

    The type of surgery makes a difference. Laparoscopic adjustable gastric banding (LAGB) and vertical sleeve gastrectomy are both restrictive procedures in that they leave less available stomach, in the first instance by blocking part of it off, and in the other, by removing part of it. Biliopancreatic diversion is a malabsorptive procedure that skips much of the small intestine, and the Roux-en-Y gastric bypass (abbreviated as RNYGBP) is a combination of both restrictive and malabsorptive types.

    As in many areas of life, sometimes a do-over is necessary. The conditions that might indicate the need for a revisional procedure include the inability to tolerate solid food; nausea and vomiting,; strictures; nonhealing ulcers; and severe dumping syndrome. The revisional procedures come under the headings of conversion, correction, or reversal. With them, the mortality goes up to 1.65%. The need for a reversal is counted as a treatment failure. In addition, some of these surgical interventions are designed from the start to occur in stages, which guarantees the need for additional surgery.

    Also deemed a treatment failure is a 6-year post-op patient’s BMI of 35 or higher. Sadly, in an increasing number of cases, inadequate weight loss is deemed to be sufficient reason for revisional surgery. How is it that lifestyle changes can’t pick up the slack? Could primary procedures be successful more often if the patients adopted the W8Loss2Go program? With that kind of help, could some patients be spared the need for revisional procedures?

    Your responses and feedback are welcome!

    Source: “Adolescent Bariatric Surgery Reverses Type 2 Diabetes in 95 Percent of Teens, Achieves Major Weight Loss and Improves Quality of Life,” PRNewswire.com, 11/06/15
    Source: “Another Agent for Obesity — Will This Time Be Different?,” NEJM.org, 07/02/15
    Source: “Young, Obese and in Surgery,” NYTimes.com, 01/07/12
    Source: “Gastrointestinal Complications After Bariatric Surgery,” gastroenterologyandhepatology.net, August 2015
    Source: “Bypass Beats Band for Weight Loss,” WSJ.com, 01/17/12

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    Two Very Obese Little Boys

    January 25th, 2016

    Fatboy neon

     

    For a time, a Chinese youngster named Lu Hao was one of the most photographed children in the world, because he was billed as the fattest boy in the world. In March of 2011, he was 3 years old and weighed 132 pounds, the equivalent of 5 normal-weight children his age. Because of the danger he might pose to the others, Lu Hao couldn’t be enrolled in nursery school, so his parents were stuck with him full-time. Weirdly, his birth weight was skimpy – a mere 5.7 pounds. At around three months, he inexplicably began to expand, and nobody knew why. Isabel Jensen reported,

    He is getting so big his family are frightened of him — and have given up trying to stop the youngster from gorging on huge plates of ribs and rice. His parents claim he throws vicious tantrums if he doesn’t get third or fourth helpings of dinner.

    Another news piece, also published in March of 2011, said Lu Hao was four, and had started kindergarten. Chris Parsons wrote that Lu Hao hated walking to school, and was often given a ride on his mother’s motorbike. He still cried if not given all the food he wanted. His parents made a heartfelt effort to get him swimming, playing basketball and so on – but the exercise made him hungry and he demanded more food than ever. They took him to three different hospitals.

    Experts examined Lu Hao, but his hormones tested out as normal. One institution suspected a brain tumor, but the other two ruled it out. Guangdong Children’s Hospital suggested that hormone treatment might be an option, but there is no mention of anyone thinking bariatric surgery, and for good reason. The risks would be horrific.

    The real mystery is how the child managed to see at all. In every photo, his eyes are squeezed tightly closed by the fat of his cheeks and eyelids. Sadly, Lu Hao does not seem to have appeared in the news during the subsequent five years.

    A first

    News of it apparently didn’t come out for quite some time, but in 2010 irreversible bariatric surgery was performed in Riyadh, Saudi Arabia, on a two-year-old boy, who at the time was the youngest person ever to undergo a laparoscopic sleeve gastrectomy (LSG). The child weighed 73 pounds, and traditional weight-loss methods had been tried to no avail. He suffered from sleep apnea, and his legs were noticeably bowed.

    The case attracted unfavorable attention from obesity experts, one of whom described the surgical decision as shocking, and who raised concerns about future vitamin deficiencies that could arise from only having a tiny bit of stomach. Another confirmed that LSG should be considered only as a last resort. Of course it also gave the “Fat Can be Fit” people a chance to weigh in and express disapproval.

    At any rate, two years after his surgery, the Saudi boy was reported to weigh around 50 pounds.

    Your responses and feedback are welcome!

    Source: “Tragic toddler weight nine stone,” thesun.co.uk, 03/23/11
    Source: “’We just don’t know why our son is so big’:,” DailyMail.co.uk, 03/31/11
    Source: “Saudi Boy Is Youngest Patient To Ever Undergo Weight Loss Surgery Procedure,” huffingtonpost.com, 09/20/13
    Source: “Two-year-old becomes youngest person ever to have weight loss surgery,” Examiner.com, 09/22/13
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Childhood Obesity News | OVERWEIGHT: What Kids Say | Dr. Robert A. Pretlow
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