Reduction in Cancer Risk Following Bariatric Surgery

Dr. Rustgi

WeightControl.com Interview with:
Vinod K Rustgi, MD, MBA
Professor of Medicine
Clinical Director of Hepatology
Director, Center for Liver Diseases and Liver Masses
Professor of Epidemiology
Professor of Pathology and Laboratory Medicine
New Brunswick, NJ 08901

WeightControl.com:  What is the background for this study?  What are the main findings?

Response: ​Obesity is a burgeoning problem in the USA and globally. It is estimated that over $100 billion are spent in healthcare expenditures each year on those patients with fatty liver disease related to obesity-induced problems.

Lifestyle modification is very difficult to achieve on a sustained basis. Insurance companies have strict criteria for bariatric surgery. Our study of a database of over 100 million lives spanning the years of 2007 to 2017 showed a marked reduction in all malignancies after bariatric surgery and particularly in obesity-related cancers such as colorectal, esophageal, pancreatic, ovarian, uterine, postmenopausal breast and kidney cancers.

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Successful Weight Loss Counseling with Both In-Clinic and Remote Primary Care Visits

Primary healthcare, even in under-resources rural settings, has the capacity to offer effective weight loss counseling through different types of patient visits

WeightControl.com Interview with:
Christie A. Befort, Ph.D., Professor

Associate Director, Cancer Prevention and Control
Co-Leader, Cancer Control and Population Health Program
KU Cancer Center

WeightControl.com:  What is the background for this study?

Response: Primary care clinics are an important place for patients to get help with weight loss, especially for those who are at risk from obesity-related health complications or who have other medical conditions that may make weight loss more difficult.  This is especially true in remote rural areas where obesity prevalence is higher and there is less access to effective programs.

WeightControl.com: What are the main findings?

Response: Rural primary care clinics are able to offer weight loss counseling to their patients with clinically meaningful long-term weight loss after 2 years for approximately 2 out of 5 patients.  In-clinic group visits have a small advantage over in-clinic individual visits for weight loss outcomes.

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Mediterranean Diet Linked to Liver Fat Reduction

The main finding from this study is that the green Mediterranean diet, the enhanced version of the Mediterranean diet, rich in walnuts, green tea, and Mankai aquatic plant and low in red/processed meat, was the most successful in liver fat reduction.

WeightControl.com Interview with:
Anat Yaskolka Meir RD Ph.D.
Post-doctoral fellow
Department of Epidemiology
Faculty of Health Sciences
Ben-Gurion University, Beer-Sheva, Israel

WeightControl.com:  What is the background for this study?  What are the main findings?

Response: In the past 15 years, Prof. Shai’s group at the Ben Gurion University of the Negev has conducted several large-scale, long-term clinical trials among over 1000 participants. Results from our previous DIRECT, CASCADE, and CENTRAL trials indicated that the Mediterranean diet is superior to other diets in terms of reducing cardiometabolic risk (e.g., by achieving lower blood lipids levels). Moreover, specific plant components named “polyphenols” (secondary metabolites of plants with antioxidant properties) might associate with this beneficial effect observed. Following the conclusions from these trials, we designed the DIRECT PLUS trial, aimed to examine whether we can enhance the observed and known effect of the Mediterranean diet by adding specific polyphenol-rich food items. Specifically, we enriched the Mediterranean diet, naturally rich in polyphenols, by adding specific components: Mankai aquatic plant (as green shake), walnuts, and green tea, which provided additional 1240 mg polyphenols a day. We also instructed the participants to avoid red and processed meat. 

The main finding from this study is that the green Mediterranean diet, the enhanced version of the Mediterranean diet, rich in walnuts, green tea, and Mankai aquatic plant and low in red/processed meat, was the most successful in liver fat reduction. This group showed the greatest reduction of hepatic fat (-39%), as compared to the traditional Mediterranean diet (-20%) and the healthy dietary guidelines (-12%). The results were significant after adjusting for weight loss (currently, the primary treatment for fatty liver). Moreover, the prevalence of non-alcoholic fatty liver diseases was reduced in the green group by 50%.

Intellihealth: Population Health Guidelines + Online Support Improves Weight Loss

Even small amounts of weight loss, even 3%-5% of body weight, can provide significant health benefits to individuals with overweight and obesity.

WeightControl.com Interview with:
Dr. Louis Aronne, MD, FACP
Chief Medical Officer, Intellihealth
Medical Director, Comprehensive Weight Control Center,
Weill Cornell Medicine

Dr. Louis Aronne

WeightControl.com:  What is the background for the study “Effect of an Online Weight Management Program Integrated With Population Health Management on Weight Change: A Randomized Clinical Trial”?

Response: More than 70% of U.S. adults have overweight or obesity. Online programs promoting lifestyle change have had some success in helping people achieve and maintain weight loss, but study results have been variable, and these programs have not been widely implemented in primary care. We studied the effectiveness of an online program we have developed (Intellihealth, formerly known as BMIQ) in routine primary care practices, both alone and integrated with population health management (with participants receiving additional support and outreach from nonclinical staff). The study’s objective was to determine whether a combined intervention integrating online weight management with population health management would increase weight loss at 12 months among primary care patients compared with the online program only and usual care.

The study, funded through an award from the Patient-Centered Outcomes Research Institute (PCORI), was carried out as a cluster randomized trial with 840 patients within the Brigham and Women’s Hospital Primary Care Center of Excellence, a group of 15 primary care practices, between 2016 and 2019. Eligible participants had a scheduled primary care visit and were aged 20 to 70 years, had a body mass index between 27 and less than 40, and had a diagnosis of hypertension or type 2 diabetes.

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Study of Childhood Obesity Finds “Patients Are Not Doomed by their Genes”

The readers should take away that lifestyle factors are most important regarding successful weight-loss strategies.

WeightControl.com Interview with:
Melanie Heitkamp, PhD
Department of Prevention and Sports Medicine
Centre for Sports Cardiology, University Hospital
Technical University of Munich
Munich, Germany

WeightControl.com:  What is the background for this study?

Response: There are genetic loci influencing obesity risk in children, which have been identified by large genome-wide association studies. However, the current knowledge about associations between these obesity related genes and obesity treatment success is scarce and the results of previous studies are inconsistent. However, it is an important question as there is a wide inter-individual response to obesity treatment. 

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Weight Loss in Low Income Patients in Primary Care Settings

Clinically significant weight loss is possible in underserved, low-income patients in primary care settings.

WeightControl.com Interview with:
Peter Katzmarzyk, Ph.D., FACSM, FAHA, FTOS
Professor and Marie Edana Corcoran Endowed Chair
Pediatric Obesity and Diabetes
Assoc Exec Dir for Population and Public Health Sciences
Pennington Biomedical Research Center
Baton Rouge, LA

WeightControl.com:  What is the background for this study?

Response: Obesity remains one of the greatest public health threats, and there is good evidence that intensive lifestyle interventions should be a primary approach to obesity management and treatment. However, there has been minimal uptake of obesity treatment approaches in primary care, which is the cornerstone of medicine in the US.

WeightControl.com: What are the main findings?

Response: We developed an intervention to reduce calorie intake and increase physical activity that was delivered by health coaches embedded in primary care clinics. The sample was diverse with a large percentage of low-income and African American patients. The results demonstrated that patients in the intensive lifestyle intervention lost approximately 5% of their initial body weight, compared to patients in usual care who lost about 0.5% of their body weight. These weight loss differences between the two groups were maintained out to 2 years, which demonstrates the durability of the intervention.    

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Same Health Benefits with Fast or Slow Weight Loss

WeightControl.com Interview with:

Jennifer L. Kuk, PhD
Associate Professor
York University
School of Kinesiology and Health Science
Sherman Health Science Research Centre, Rm 2002
Toronto, Ontario 

WeightControl.com:  What is the background for this study?  What are the main findings?

Response: Traditionally, weight loss is prescribed at the rate of 1 to 2 pounds per week.  However, this is largely based on the observation that weight losses faster than 2 pounds per week put patients at an increased risk for gallstones.  It is unclear whether this is the optimal rate of weight loss for CVD or diabetes outcomes. Furthermore, fast weight loss has historically thought to be associated with poorer long term weight loss.  However, this was largely based on research using liquid diets.  Recent evidence suggests that faster weight loss may be similar to slower weight loss when more sensible lifestyle interventions are used.  Thus, if there are additional benefits of faster weight loss for CVD or diabetes outcomes, then there may a rationale for prescribing faster weight loss as the overall rate of gallstones is fairly low.

We observed that those who lose weight faster than 2lb/wk tend to lose more weight overall, but for the same overall weight loss, there is no difference in terms of health benefits with fast or slow weight loss.

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