Does treating obesity stabilize chronic kidney disease?
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BACKGROUND: Obesity is a growing health issue in the Western world. Obesity, as part of the metabolic syndrome adds to the morbidity and mortality. The incidence of diabetes and hypertension, two primary etiological factors for chronic renal failure, is significantly higher with obesity. We report a case with morbid obesity whose renal function was stabilized with aggressive management of his obesity. CASE REPORT: A 43-year old morbidly obese Caucasian male was referred for evaluation of his chronic renal failure. He had been hypertensive with well controlled blood pressure with a body mass index of 46 and a baseline serum creatinine of 4.3 mg/dl (estimated glomerular filtration rate of 16 ml/min). He had failed all conservative attempts at weight reduction and hence was referred for a gastric by-pass surgery. Following the bariatric surgery he had approximately 90 lbs. weight loss over 8-months and his serum creatinine stabilized to 4.0 mg/dl. CONCLUSION: Obesity appears to be an independent risk factor for renal failure. Targeting obesity is beneficial not only for better control of hypertension and diabetes, but also possibly helps stabilization of chronic kidney failure. (+info)
Use and costs of bariatric surgery and prescription weight-loss medications.
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The extent of use of bariatric surgery and weight-loss medications is unknown. Using the Nationwide Inpatient Sample, we estimate that the number of bariatric surgeries grew 400 percent between 1998 and 2002; such surgeries were performed on 0.6 percent of the 11.5 million adults clinically eligible in 2002. Hospital costs for bariatric surgery grew sixfold to $948 million in 2002. The inpatient death rate declined 64 percent. Among employers that covered weight-loss drugs in 2002, less than 2.4 percent of adults clinically eligible for these drugs used them, with average annual spending of $304 per user. (+info)
The role of price, sociodemographic factors, and health in the demand for bariatric surgery.
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OBJECTIVES: To estimate the effect of price, sociodemographic factors, and health on the demand for bariatric surgery among eligible individuals with private health insurance, in order to enable policy makers and insurers to make more informed decisions concerning access to care for bariatric surgery. STUDY DESIGN: We conducted an Internet-based contingent valuation survey of 1802 obese persons eligible for bariatric surgery but who had not undergone the procedure. METHODS: We used multivariate regression analysis to separately estimate the likelihood of having gastric bypass and gastric banding surgery at different out-of-pocket costs. We combined the results with estimates of the privately insured bariatric surgery-eligible population from the National Health and Nutrition Examination Survey, 1999-2002, to estimate aggregate demand. RESULTS: Out-of-pocket cost was negatively and highly significantly related to the self-reported likelihood of having surgery. Persons with higher incomes and younger persons also reported a significantly higher likelihood of surgery. No effect was found for body mass index or for most comorbidities. We estimate that about 150 000 bariatric operations per year would be demanded by those with private health insurance at an out-of-pocket cost of USD 25 000. At USD 5000, we estimate a demand of 250 000 bariatric operations per year. CONCLUSIONS: Price is significantly and negatively related to the demand for bariatric surgery. At an out-of-pocket cost of USD 5000, about 2.2% of the bariatric surgery-eligible population would strongly consider surgery. (+info)
A cost-benefit simulation model of coverage for bariatric surgery among full-time employees.
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OBJECTIVE: To use a simulation model to estimate the costs and benefits of bariatric surgery among full-time employees. STUDY DESIGN: Multivariate regression analysis of nationally representative survey data sets to estimate the costs of obesity and a simulation model of the number of years until breakeven under alternate assumptions about the costs and benefits of bariatric surgery. METHODS: We used a 2-part model to estimate medical costs of obesity based on the 2000-2001 Medical Expenditure Panel Survey. We estimated work loss with a negative binomial regression based on the 2002 National Health Interview Survey. Using these results, we simulated the expected number of years required for a bariatric surgery procedure to become cost saving. RESULTS: Nine percent of the full-time US workforce, or 29% of the obese workforce, is eligible for bariatric surgery. Obese workers eligible for bariatric surgery have 5.1 (P < .01) additional days of work loss and USD 2230 (in 2004 dollars) (P < .01) higher annual medical costs than persons of normal weight. CONCLUSION: Although the cost implications of bariatric surgery among full-time employees depend on many factors, the simulations reveal that 5 or more years of follow-up are most likely required for these operations to become cost saving unless the employee bears a significant fraction of the total costs of the surgery. (+info)
The progress in bariatric surgery.
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Morbid obesity, caused by fat tissue accumulation, is a serial multi-factorial chronic disease, with rapidly increasing prevalence in most countries in the world including Poland. Conservative treatment of morbid obesity is almost always unsatisfactory and that is why several surgical methods have been developed. There are four kind of methods: malabsorbtive procedures; restrictive procedures; malabsorbtive/restrictive procedures and experimental procedures. The development of bariatric surgery goes back to 1952 and since that time it has been evolving dynamically. All the surgical methods have benefits and disadvantages. Presently the introduction of minimally invasive surgical techniques seems to be very safe, efficient and cost-effective in treatment for morbid obesity. New methods are also being evaluated, such as gastric myo-electrical stimulation. Bariatric surgery will still be developing until we understand all the factors responsible for it is origin. (+info)
Bariatric surgery in Poland from 1993 to 2003.
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Morbid obesity affects about 300, 000 patients in Poland. The number and type of bariatric procedures performed between 1993 and 2003 has been based on data collected from Polish surgeons active in this field. During the years 1993 - 2003, 1285 primary bariatric procedures were performed in total. Amongst these 79.1% were, commonly done as restrictive ones, including vertical banded gastroplasty-76.3%, laparoscopic adjustable gastric banding-17.7% and silastic ring vertical gastroplasty-5.5% and at last non-adjustable gastric band with 0.5%. Less popular are malabsorptive procedures - 20.9%, with Roux-en-Y gastric bypass - 79.1% and biliopancreatic diversion 20.9%. During last year 2003: malabsorptive procedures represented one third of all primary procedures and the laparoscopic approach was utilised in 18 % of operations. 61 revisions were reported. There are only three centres with experience in treating more than 100 patients (one of them treated over 600). Two centres have experience in carrying out bariatric surgery for longer than five years. During 1993 - 1997 216 operations were performed. Between 1998 - 2002: 724 procedures, and during last year 345. Patients were treated during last year in ten surgical departments. The number of morbidly obese patients treated surgically in Poland is increasing, but it is still inadequate to meet the growing demand. (+info)
Gut hormone profiles following bariatric surgery favor an anorectic state, facilitate weight loss, and improve metabolic parameters.
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OBJECTIVE: To study the effect of bariatric surgery on the entero-hypothalamic endocrine axis of humans and rodents. BACKGROUND: Bariatric surgery is the most effective obesity treatment as it achieves substantial and sustained weight loss. Glycemic control and enhanced satiation improve before substantial weight loss occurs. Gut peptides, acting both peripherally and centrally, contribute to glycemic control and regulate food intake. METHODS: We examined meal-stimulated responses of insulin, ghrelin, peptide YY (PYY), glucagon-like-peptide-1 (GLP-1), and pancreatic polypeptide (PP) in humans and rodents following different bariatric surgical techniques. RESULTS: Compared with lean and obese controls, patients following Roux-en-Y gastric bypass (RYGB) had increased postprandial plasma PYY and GLP-1 favoring enhanced satiety. Furthermore, RYGB patients had early and exaggerated insulin responses, potentially mediating improved glycemic control. None of these effects were observed in patients losing equivalent weight through gastric banding. Leptin, ghrelin, and PP were similar in both the surgical groups. Using a rodent model of jejuno-intestinal bypass (JIB), we showed elevated PYY and GLP-1 in JIB rats compared with sham-operated rats. Moreover, exogenous PYY reduced food intake and blockade of endogenous PYY increased food intake. Thus, higher plasma PYY following JIB may contribute to reduced food intake and contribute to weight loss. CONCLUSIONS: Following RYGB and JIB, a pleiotropic endocrine response may contribute to the improved glycemic control, appetite reduction, and long-term changes in body weight. (+info)
Health-related quality of life and depressive symptoms in adolescents with extreme obesity presenting for bariatric surgery.
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OBJECTIVE: We sought to document health-related quality of life (HRQoL) impairment and depressive symptomatology in adolescents with extreme obesity considering surgical weight loss. STUDY DESIGN: A retrospective review of clinical data was conducted for 33 consecutive extremely obese adolescents presenting for evaluation at a bariatric surgery program for adolescents. Adolescents completed the PedsQL and the Beck Depression Inventory. Mothers completed the parent-proxy PedsQL and the Child Behavior Checklist. RESULTS: HRQoL scores from both informants were markedly impaired relative to published norms on healthy youth. Moderate agreement was found for self-reported and parent-proxy HRQoL. Approximately 30% of youth met criteria for clinically significant depressive symptoms when based on self-report and 45% of youth when based on mother report. Only 21% of youth were currently engaged in some form of psychological treatment (eg, medication or therapy). CONCLUSIONS: The day-to-day life of adolescents with extreme obesity seeking bariatric surgery is globally and severely impaired. However, only some of these adolescents demonstrate clinically significant levels of depressive symptomatology. These data will be critical to the development of more informed patient selection criteria and more efficacious treatment paradigms for this vulnerable pediatric subgroup. (+info)