Diabetes

Food for Thought

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

Why is it so hard to lose weight and keep it off? The GLP-1 agonists and new drugs under development with multiple actions can help. But for the vast majority of patients who can afford them and stay on them without suffering annoying side effects or complications, they are not a permanent solution. They are a lifetime of drug-taking with nasty backtracking upon cessation. This video explains why this fat is so hard to take off permanently and a new, promising and permanent approach to the problem,

Obesity Surgery Benefits May Be Greater For Teens Than Adults

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

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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)).

Type 2 Diabetes in Youth is a Disease of Poverty

Robert Cucin MD JD MBA Diabetes, metabolic syndrome , ,

An article published in the Lancet points out that factors that typically co-exist with poverty, such as food insecurity, disparities in access to care, and related mental health challenges, make the adoption of behavioural lifestyle changes, a cornerstone in clinical management of type 2 Diabetes, challenging. The authors Jonathan McGavock, Brandy Wickow and Allison B Dart recommend that clinicians and scientists should actively engage adolescents with type 2 diabetes and their family members in the design of novel approaches to care.

It is clear that the family must be involved in the treatment of the patient.  But, it is only by recognizing, openly discussing and addressing the underlying conditions responsible for these financial, racial and ethnic disparities in our society that we can make meaningful incursion upon this growing scourge on the future of our youth.