In today’s Guardian – Latest study of long-term impact of bariatric surgery lends support to experts who say more operations should be carried out in UK

Obese patients undergoing stomach-shrinking surgery have half the risk of death in the years that follow compared with those tackling their weight through diet and behaviour alone, new research suggests.

Experts say obesity surgery is cost-effective, leads to substantial weight loss and can help tackle type 2 diabetes. But surgeons say not enough of the stomach-shrinking surgeries are carried out in the UK, with figures currently lagging behind other European countries, including France and Belgium – despite the latter having a smaller population.

In the new study, one of several on obesity surgery published in the Journal of the American Medical Association, researchers sought to explore whether stomach-shrinking operations, known as bariatric surgery, had a long-term impact on the risk of death among obese individuals, compared with non-surgical approaches to weight loss.

In total, more than 33,500 participants were involved in the study – 8,385 of whom had one of three types of bariatric surgery between 2005 and 2014. The majority of participants had a BMI greater than 35; obesity is defined as a BMI of 30 or higher.

The researchers followed up the participants over the years that followed their surgery until death, or the end of the follow-up period in December 2015, comparing the number of deaths and other metrics with those for obese patients who had not had surgery but were given dietary and behavioural help. Each surgery patient was compared to three who did not have surgery, but had similar characteristics such as age and sex, and were also followed until they too had surgery, died or the study ended.

The results reveal that the death rate during the study was 1.3% for those who had any form of bariatric surgery, while among those who had not had surgery it was 2.3%, although the length of follow-up period varied considerably from patient to patient.

Once other factors including age, sex and related diseases were taken into account, the team found those who did not have stomach-shrinking surgery had just over twice the risk of death compared to those who had, with all three types of surgery linked to lower mortality.

What’s more, the group which had surgery showed a greater reduction in BMI, lower rates of new diabetes diagnoses, improved blood pressure, and a greater proportion of diabetic individuals going into remission.

But the team add that a small proportion of surgery patients required further surgery, while they note the study was observational so cannot prove bariatric surgery itself reduced the risk of death since patients were not randomised, meaning it is possible that those who did not have surgery were in poorer health.

A second, smaller study in the same journal also highlighted benefits of bariatric surgery, comparing diabetes-related markers in obese adults who had lived with a diagnosis of type 2 diabetes for an average of nine years. Participants either received two years of intensive diet, exercise and medical management or, in addition, had bariatric surgery.

The results from 113 participants reveal that complications were more common among those who had had bariatric surgery, but that one year after the study began they had lost more weight on average, with a greater proportion having reached the combined targets for cholesterol, systolic blood pressure and a marker of glucose.

While this proportion fell for both groups after five years – at which point 98 patients were still providing data – those who had had bariatric surgery maintained the edge, with 23% reaching the combined targets, compared to just 4% of those offered lifestyle and medical interventions alone.

Francesco Rubino, professor of metabolic and bariatric surgery at King’s College London, who was not involved in the studies, said misunderstandings and stigma were holding back greater use of such operations in the UK. While Rubino noted that surgery is not for everyone, he added “This is a conversation GPs and doctors should have with patients more often.”

A report on sugar’s ruinous health effects that was controversially delayed by Jeremy Hunt has urged ministers to impose a sugar tax. It also pushes for a crackdown on the marketing of unhealthy products to children and two-for-one deals in supermarkets in an effort to tackle childhood obesity.

The report, compiled by Public Health England (PHE), the government’s advisory group, sets out a range of tough policies that it says need to be implemented to reduce the consumption of sugary foods and drinks that are fuelling the obesity crisis and costing the NHS £5.1bn a year. The report was published on Thursday afternoon; the Guardian had obtained an advance copy.

Its recommendations – which include the stripping-out of high amounts of sugar from many everyday food products – pose a serious challenge for ministers, including the prime minister, David Cameron, who have consistently ruled out bringing in any sort of sugar tax, as advocated by Jamie Oliver along with many medical groups and health charities.

No 10 confirmed on Thursday that Cameron did not even read the report before dismissing the idea: “The prime minister’s view remains that he doesn’t see a need for a tax on sugar.” The Food and Drink Federation also vowed to fight any sugar tax.

The report, called Sugar Reduction: the Evidence for Action, was originally meant to be published in July but was delayed by the Department of Health, which PHE is part of, so its findings could be used to “inform” the government’s forthcoming strategy to combat childhood obesity.

Warning that the average sugar intake is 12%-15% of people’s energy intake instead of the recommended 5%, it makes the case for a tax of 10%-20% on sugary foods and drinks: “Research studies and impact data from countries that have already taken action suggest that price increases, such as by taxation, can influence purchasing of sugar-sweetened drinks and other high-sugar products, at least in the short term, with the effect being larger at higher levels of taxation.”

The report, a review of the international evidence on how to tackle rising sugar consumption, is clear and urgent from its very first line – “We are eating too much sugar and it is bad for our health” – that radical action is needed if that trend is to be reversed.

It goes on: “Consuming too many foods and drinks high in sugar can lead to weight gain and related health problems, as well as tooth decay. Almost 25% of adults, 10% of four- to five-year-olds and 19% of 10- to 11-year-olds in England are obese, with significant numbers also being overweight. Treating obesity and its consequences alone currently costs the NHS £5.1bn every year.”

Pointing out that the scientific advisory committee on nutrition, a panel of experts that advises ministers, recommends that sugar make up no more than 5% of an average Briton’s daily energy intake, the report warns that current levels of consumption are far beyond that. “Sugar intakes of all population groups are above the recommendations, contributing between 12% and 15% of energy. Consumption of sugar and sugar-sweetened drinks is particularly high in school-age children. It also tends to be highest among the most disadvantaged, who also experience a higher prevalence of tooth decay and obesity and its health consequences.”

 

Source: The Guardian

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She suggested a series of measures including banning Topshop from selling confectionary, “screen free” days at home and persuading new mothers to wean their children with fresh fruit and vegetables rather than sugary snacks.

Jeremy Hunt, the health secretary, has said that he will make tackling the “great scandal” of childhood obesity one of his main priorities in this Parliament. The latest figures reveal that one in 10 children are obese when they start primary school and one in five is by the time they leave.

Sir Bruce told MPs that the government’s obesity strategy, which is expected in September, should focus on education.

He said: “I think from our point of view the obesity strategy needs to span a number of government departments. It needs to start with education which is very powerful because it gets to kids who in turn get to their parents and their siblings.

“It needs to start with sugar and other additives, which relate to the formulation of other commercially available products. It needs to relate to issues around transport and exercise.”

Professor Jebb went significantly further.

“There will be a backlash against many of the ideas, but people have got to understand the threat that obesity poses to the NHS,” she said. “We need to look at why what might feel like quite intrusive measures are possibly justified.”

She said that new mothers should wean their children with fresh fruit and vegetables instead of high sugar foods like yoghurts and rusks stop them developing a “sugary palate”.

She said: “Fromage frais and little dairy deserts have so much added sugar. You are acclimatising them [children] to a sugary taste. They should appreciate the natural flavours.”

Parents should have “screen free days” to encourage children to play outside more, and that they should set an example by eating more healthy food themselves.

She criticised the government’s “partial” ban on adverts for fatty and sugary foods during children’s shows, suggesting it needs to be extended to all programmes before a 9pm watershed if it is to be successful.

Professor Jebb suggested that ministers could ban two for one deals on fatty and sugary foods, highlighting the success of a decision by the Scottish government to bar multi-buy deals on alcohol.

She also criticised Topshop, the clothes retailer, for selling a large range of confectionary. “Food and sweets are appearing in shops that have nothing to do with food,” she said. “This is pushing food into areas where it should not be. When people are eating constantly your body loses track of what it had. It prompts people into eating when otherwise they wouldn’t.”

Simon Stevens, the chief executive of NHS England, has previously said that parents are getting it “terribly wrong” because of the number of children who are obese.

“And we know what that will mean – that will mean a rising tide of avoidable type 2 diabetes, and cardiovascular disease and cancer, because we now know that one in five cancers are caused by obesity, not to mention blindness and amputations,” he said.

“So the question for all of us is, are we going to, as the National Health Service, stand by and get ready to treat that burden of illness, or are we going to rattle the cage and advocate for something different?”

Source: The Telegraph

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The study involved over 230,000 Swedish males, who were conscripted into the military aged 16 to 20 years old. Those who were in the upper ranges of overweight and those who were obese at that time were about twice as likely to develop bowel cancer over the next 35 years as those who were a normal weight.

This study has a number of strengths, including its size, the fact that body mass index (BMI) was objectively measured by a nurse and that the national cancer registry in Sweden captures virtually all cancer diagnoses. However, it was not able to take into account the boys’ diets or smoking habits – both of which affect bowel cancer risk.

Obesity in adulthood is already known to be a risk factor for bowel cancer, therefore the possibility that a person being obese from an early age also increases risk seems plausible. Maintaining a healthy weight at all ages will have a range of health benefits, such as reducing your risk of developing conditions including heart disease and type 2 diabetes, as well as a number of cancers.

Source: NHS Choices

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Butter isn’t bad for you after all: Major study says 80s advice on dairy fats was flawed, as a new study argues dietary fat guidelines introduced in the 1980s lacked a rigorous evidence base.

The study in question looked at guideline advice on saturated fat published in 1983 in the UK and in 1977 in the US. The researchers wanted to see if the evidence available at the time – specifically, the results of randomised controlled trials (RCTs) – supported the recommendations made.

The researchers identified six RCTs available at the time. The pooled results showed that specific advice to control saturated fat intake did not have a significant effect on deaths from heart disease or other causes.

But it is very important that these findings are interpreted in the correct context – this means we cannot conclude the recommendations were “incorrect”.

We do not know what evidence was used to back up the official guidelines in the late 70s and early 80s. They could have looked at studies other than RCTs, such as observational studies (where health outcomes are studied over time).

This new review considered just six RCTs published before 1983, and all of them were conducted in men, most of whom already had heart disease.

Current dietary advice is not stuck in the 1980s, wearing shoulder pads and sporting a bubble perm. It has evolved as new evidence has emerged. In fact, a small amount of saturated fat is recommended as part of a balanced, Mediterranean-style diet.

But it would be a mistake to conclude from this evidence that you can eat as much saturated fat as you like without damaging your health.

Source: Daily Mail

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Close to 30% of children in Puerto Rico are classified as obese but critics have spoken out against the measure as draconian and unfair.

Legislators in Puerto Rico are debating a bill that would fine parents of obese children up to $800 if they don’t lose weight.

The bill aims to improve children’s wellbeing and help parents make healthier choices, senator Gilberto Rodriguez said in a statement.

If approved, public school teachers would flag potential obesity cases and refer them to a counselor or social worker, depending on the severity of the case. Health department officials would then meet with the parents and determine whether the obesity is a result of bad eating habits or a medical condition. They also would create a diet-and-exercise program combined with monthly visits to ensure it’s being followed.

After six months, officials would evaluate the child again, with parents possibly facing between $500 and $800 in fines if the situation does not improve within another six months to a year.
The US Centers for Disease Control defines childhood obesity as having a body mass index or above the 95th percentile for children of the same age and sex.

Several doctors including the president of Puerto Rico’s chapter of the American Academy of Pediatrics have spoken out against the measure, saying it is unfair.

More than 28% of children in Puerto Rico are considered obese, compared with some 18% in the US mainland.

Source: The Guardian

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Papers published in the Lancet medical journal insist politicians must press WHO to bring in code to prevent children being encouraged to make poor dietary choices.

Tough new controls must be introduced worldwide to stop commercial companies marketing unhealthy foods and drinks which make children overweight and stunt their growth, say some of the world’s leading obesity experts.

No country has yet reversed its obesity epidemic, they point out in a major new series of six papers in the Lancet medical journal. The best that has been achieved is a flattening of childhood obesity rates in countries like the US and UK, but not among poorer families. The levels are still very high, which means that many thousands of overweight children will have health problems as adults. In England, a third of 10- to 11-year-olds and more than a fifth of four- to five-year-olds are overweight or obese.

Tim Lobstein and colleagues, in one of the papers, call for governments to press the World Health Organisation to take radical action so that children do not develop a taste for sweet drinks and unhealthy food. They say it should bring in a code of marketing, similar to that which prevents babymilk companies promoting their products to women in a way that deters them from breastfeeding.

“The food industry has a special interest in targeting children,” they write. “Not only can the companies influence children’s immediate dietary preferences, but they can also benefit from building taste preferences and brand loyalty early in life, which last into adulthood.”

Lobstein and colleagues calculate the money to be made by food companies from overweight children. “Fat children are an investment in future sales,” said Lobstein, from the London-based World Obesity Federation. They use data from the USA, where children are on average 5kg heavier than those of 30 years ago, and so consume an extra 200 kcal a day more than a child from the 1970s would have – or 73,000 kcal more per year

The average cost of food energy is about 56 cents per 100kcal, they say – so 200kcal a day implies spending an extra $1.12 a day per child, or more than $400 a year. “With about 50 million school-age children in the USA, the combined value of their excess food consumption each year approaches $20bn. A high proportion of these children will continue over-consuming through adulthood, creating a market for the US food and beverage industry, which we estimate to be worth considerably more than $60bn each year.”

With such high sums at stake, says the paper, the food industry is likely to resist controls in the same way that the tobacco and alcohol industries have.

Children’s poor nutrition worldwide – including in the UK– leads to stunting as well as obesity. It is not only in poor countries that stunting – poor growth in children eating food without sufficient nutrients – exists side by side with obesity. The authors point out that the national school measurement programme in England shows children in poor households are not only likely to be fatter but also shorter than children in affluent families.

To protect the health of children, there must be “substantial change in the governance of food supplies, controls on commercial competition and measures to promote and protect healthy food supplies,” they say.

“Food supply targets cannot be left to the whim of multinational food companies, commodity markets and speculative financiers, but will need to be kept under tight supervision and regulation.”

Source: The Guardian

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