metabolic syndrome

208 Million Americans are Obese or Overweight

Robert Cucin MD JD MBA metabolic syndrome, obesity

In a study published in Lancet on November 14, 2024, conducted by the GBD 2021 Forecasting Collaborators using 132 data sources, nearly half of adolescents and three-quarters of adults in the U.S. were classified as being clinically overweight or obese.

The authors forecast that by 2050, 1 in 4 children and 1 in 3 adolescents will be obese.

While clinical research has brought us new pharmacologic agents such as the GLP-1 receptor and GIP dual agonists with both central and peripheral sites of action, none of these drugs are either universally effective or without significant side effects. Further most need to be injected.

The U.S. already has one of the highest rates of obesity and the trend seems to be accelerating. The economic impact on the economy and its exacerbation of racial inequalities is burdensome and unacceptable. We can only hope that as research continues oral medications and solutions that we anticipate will be permanent such as Endoscopic Visceral Lipectomy will brighten the horizon.

We welcome the new Administration’s move to Make America Healthy again. Let’s take a step backwards into less processed foods, more exercise, and un-supersized portions. The most effective drug or operation will fail without suitable patient motivation and participation. And the failure of one generation has a cascading effect on the next with the offspring of obese mothers and fathers being born with more visceral fat and destined to earlier obesity and type 2 diabetes.

Obesity Surgery Benefits May Be Greater For Teens Than Adults

Robert Cucin MD JD MBA bariatric surgery, Diabetes, metabolic syndrome, obesity , , ,
obese kids
 

Most obese teens remain obese as adults, and adults who were obese as teens are unhealthier than those who become obese later in life. 

A new study presented at the Combating Childhood Obesity Conference in Houston (Weight Loss and Health Status 3 Years after Bariatric Surgery in Adolescents. Inge TH, Courcoulas AP, Jenkins TM, et al. N Engl J Med 2016; 374:113-123) suggests that teens may benefit more from early surgery than adults.  

The researchers compared results from two studies of gastric bypass surgery in 161 teens and 396 adults who had been obese since they were teens. Three years after their operations, both groups had lost between 26% to 29% of their weigh and Diabetes went into remission in 86% of teens and 53% of adults diagnosed with the disease before surgery. High blood pressure was also normalized in 68% of teens and 41% of adults.

Although a 2% mortality accompanied surgery in both groups, two of the teens died from drug overdoses, suggesting substance abuse and self harm may accompany teen obesity.

The researchers documented the durability of clinically meaningful weight loss and metabolic improvements and weight-related quality of life among adolescents who underwent gastric bypass surgery or sleeve gastrectomy. The benefits of these current bariatric surgical alternatives must be viewed in the context of the risks of nutritional deficiencies and the possibility that future surgical procedures will be needed in some patients.

It is this author’s hope that Endoscopic Visceral Lipectomy, which does not expose the patient to the nutritional and surgical risks inherent in bypass surgery or sleeve gastrectomy, may prove equally effective and a safer minimally invasive intervention for this younger population (Uncoiling the Tightening Obesity Spiral. Cucin RL Clin Res Diab Endocrinol:1(2):1-5 (2018)).

Bariatric Surgery May Lower Danger of Heart Attack in Diabetics

Robert Cucin MD JD MBA bariatric surgery, Diabetes, metabolic syndrome, obesity

A recent study tracked 20,000 severely obese patients with Type 2 Diabetes and found that those who had weight loss surgery had a 40% lower chance of developing a heart attack or stroke in the five years following surgery compared to those who were managed medically.  They patients who had surgery had gastric sleeve, gastric band or gastric bypass.  These surgeries cost $20,000 to $25,000 and are generally covered by insurance.   Surgery is thought to help by affecting hormones, gut bacteria and other substances that affect how the body handles insulin and blood sugar.

The improved lipid profile, the decrease in inflammatory cytokines and the resistin which antagonizes insulin secreted by visceral fat are likely behind the improvement.  The new findings suggest insurance coverage be expanded for the right patients to result in substantial cost savings and improved patient outcomes.