UNC-Chapel Hill will test new device aimed at diabetes and obesity

— UNC-Chapel Hill researchers are testing a promising device that fights two of the most common health problems that Americans face – obesity and diabetes.

The EndoBarrier is a thin sleeve made of a plastic-like material that lines part of the upper digestive tract so that food simply passes through that section rather than undergoing full digestion.

A team led by Dr. Laura Young of the UNC Diabetes Care Center is part of a nationwide, 500-patient, 20-site study of the device. It has begun seeking local volunteers to participate.

The EndoBarrier has been approved for use in Europe and various countries elsewhere, including Australia, Chile and Israel. It must undergo a large-scale test here, though, before the U.S. Food and Drug Administration will allow it to be marketed in this country.

Diabetes, which is characterized by problems controlling high glucose levels in the blood and often closely tied to obesity, is a big cause of heart disease, stroke and complications that include loss of eyesight and kidney failure.

In patients elsewhere, the EndoBarrier has substantially reduced patients’ weight and lessened and even reversed the symptoms of Type 2 diabetes, by far the most common type.

The device’s effects are similar to those triggered by gastric bypass surgery. One advantage, though, is that it doesn’t require surgery. Instead, it is put in place via the mouth and throat by a relatively simple procedure involving a flexible instrument .

The procedure usually takes about 15 minutes, Young said. And unlike surgery, it’s easily reversible if it causes problems.

If it is effective, she said, the device could also reduce a patient’s need to use various medications for diabetes.

More than 650,000 people in North Carolina have been diagnosed with diabetes, according to the U.S. Centers for Disease Control and Prevention. Nationwide, the number of new cases has been climbing since 1992 and has nearly tripled since then.

The study is focused on the device’s effect on Type 2 diabetes, Young said, with weight loss a secondary interest.

Once the EndoBarrier is installed, improvements in patients’ diabetes symptoms often come within days, before the gradual weight loss that the device causes even kicks in, according to earlier studies and results with patients in other countries.

The effects on diabetes appear to come by not just blocking the body from digested food but also altering hormonal signals that part of the digestive tract sends to other parts of the body, Young said.

“We think it’s a way to help the body respond to the food that comes through it in a different way,” she said.

In earlier, smaller studies, it was effective helping patients controlling blood glucose levels and effective in reducing weight by often double-digit percentages.

It also caused various problems for some patients, including abdominal pain, bleeding and obstructions by the device.

The EndoBarrier was developed by GI Dynamics, Inc., a 10-year-old company based in Lexington, Mass.

Dr. David Maggs, the chief medical officer for the company, said that both the device and the technique of putting it in place have been improved since the early studies. Those changes have significantly reduced the complications, he said.

Another issue with the device is whether its effects last. The EndoBarrier will remain in study participants only for 12 months, the standard period for use in patients elsewhere in the world.

Researchers will continue to follow patients’ conditions for several weeks after the device is removed, Young said, in hopes of learning more about what happens after it is out.

At this point, more than 1,000 patients have had the device implanted, Maggs said. After it is taken out, there seems to be a “legacy effect” that keeps blood glucose at improved levels and weight down, but there is only limited data so far on that.

If the trial proves that the device works and is safe, it is expected to be widely available by 2017.

Price: 919-829-4526

Childhood obesity: A problem of will and money

The American Heart Association recently published a sobering “scientific statement” on severe obesity among children and adolescents in the U.S. in their flagship journal, Circulation. The report, predictably spawning widespread attention in the popular press, suggests that by reasonable criteria, between 4 percent and 6 percent of our kids between the ages of 2 and 19 have severe obesity.

Those percentages probably don’t fully convey how common that makes this ominous condition. Consider that if a typical classroom held roughly 20 kids, there would be one “severely” obese child, on average, in every such classroom in the country. That is stunning, and extremely alarming — particularly given the current trends. Those trends, also noted in the report, indicate that severe obesity is “the fastest growing subcategory of obesity in youth.” Even where overall rates of obesity are leveling off, rates of severe obesity are rising briskly.

Our problems begin with our apparent inability to keep our eye on this ball. All too often, and at our collective peril, we treat scientific research like a Ping-Pong ball, diverting our attention first this way, then that. Media uptake of any given study often gives the impression that it represents the new, final word — replacing all we thought we knew before. But, of course, science is incremental; studies don’t replace one another, they contribute to the gradually accumulating weight of evidence. When we learn that rates of childhood obesity may be dipping slightly in some places, or leveling off among adults, it does not refute everything we knew about the outrageously high prevalence, the grave metabolic consequences, or the run-away increases in the most severe forms.

If virtually all of those vulnerable to obesity — adults and children alike — are already there, we can count on rates stabilizing. But if we are failing to help those who are already there from succumbing ever more fully,we can count on weights rising. It may no longer characterize the toll of epidemic obesity adequately to determine how many of us are overweight; that number may be relatively fixed now. We may need to ask: How overweight are the many of us? The American Heart Association gives us this answer about our kids: very.

This may explain why diabetes rates are rising on a truly ominous trajectory, even as overall obesity rates level off. More severe degrees of obesity are more predictive of metabolic complications and chronic disease, the details of just such associations occupying much of the new report’s verbiage.

But with the pages devoted to the new solutions we need, welcome and appropriate as this attention is, the AHA authors were far too conventional in my view. One of Albert Einstein’s famous witticisms is brought to mind: “We cannot solve our problems with the same thinking we used when we created them.”

We created the problem of epidemic obesity in children, and now hyper-endemic obesity in adults, over the past half century while propagating its causes in our culture and seeking its remedies in our clinics. But scalpels may be a very sorry substitute for the good that might be done in schools; pharmacotherapy may compare quite unfavorably to empowering better use of feet and forks.

Imagine looking at us from without, and assessing causes and cures of severe obesity informed by a dispassionate view from altitude. There would be a role for clinicians, clearly, but much of the relevant medicine would be cultural. Is it symptomatic of our inability to see outside the donut box that there is no mention in the new report, for instance, of aggressive food marketing to children?

The causes of obesity are not so much within us, as all around us. We and our kids are put together much the same ways we ever were, of course; yet the epidemiology of severe obesity is as it never was before. It takes change to produce change, and while our genes and physiologies are fairly constant, our culture is awash in obesigenic changes. Our plight is the predictable consequence.

There is a correspondingly predictable emphasis on drugs and surgery in the new report, and on models of clinical counseling. These are, indeed, appropriate for severe obesity — but they have severe liabilities.Drugs don’t tend to work very well. Surgery does, at least in the short term. But the costs are high; recidivism may be high as well. And surgery is something of a “deus ex machina” approach to obesity, doing nothing to address the factors that caused it in the first place. Surgery requires the skills of a surgeon but imparts no skills to the patient. Benefits we acquire under general anesthesia, whatever their duration, cannot be paid forward.

As for clinical counseling, consider its challenges. A child who is severely obese is generally caught up in a difficult dynamic at the family level. For a clinician to provide family counseling, appointments need to be scheduled for the whole family — a logistical challenge. If these appointments are during business hours, they pull adults away from work (assuming they are employed), and kids away from school. At best, the frequency of such encounters will be modest compared to the scope of the problem, and ill-suited to address some very practical concerns — such as no one in the home having the time, or skills, to prepare a meal.

Such challenges are further compounded by something we likely all know from personal experience, if not from the abundant research literature on the topic: Severely-obese kids are severely persecuted by their peers. When we were young, the “chubby” kid was the object of schoolyard bullying, to the regret of those of us victimized by it, and the shame of those of us who perpetrated it. Now, among kids who are chubbier in general than we were, it’s the severely “fat” kid who gets that daily dose of derision. That addition of insult to injury can lead to depression and despair, putting the behavior change needed for a remedy hopelessly out of reach. Can we really expect a doctor visit, even as often as once a month, to fix all of this?

There is something that can. We can embed solutions to severe obesity into the existing infrastructure of our lives and routines.

So, for instance, just as we have boarding schools to cultivate the talents of the academically gifted, or remediate the difficulties of the behaviorally challenged, so, too, could we have boarding schools for the severely obese, that blend academic rigor with comprehensive weight management. The appeal of such a concept, nowhere mentioned in the AHA report, is that severely-obese kids could get the intensity of treatment they need without stepping out of their lives to do so.

That treatment would almost certainly include behavioral, and psychological counseling. Depression and despair would need to be recognized and addressed by qualified professionals.

It would also include an emphasis on the relevant skills, such as identifying nutritious foods, learning how to choose and prefer them, and learning how to cook. It would include physical education and training, with an emphasis on strategies to fit fitness into every kind of daily routine. And by providing this and more in an environment where all the kids have run the same gauntlet, such a program could offer the therapeutic benefits of community, and compassion, and understanding.

And finally, if we could “fix” severe obesity in kids by empowering them with skills for healthy living, the kids could pay such benefits forward — to family members, and peers. Imagine re-integrating such kids into their public schools of origin, where their success at not just losing weight, but finding health — could inspire hope in others. Imagine such kids acting as peer mentors with a unique fund of knowledge and experience on which to draw.

And then stop imagining, because at least one such program exists. I have been privileged to serve as senior medical advisor to Mindstream Academy, which is the very model I’m describing. The results to date are stunning — with kids losing an average of nearly 50 pounds per semester, and some losing closer to 100. More important still is what the kids find: hope, self-esteem, and a renewed capacity to believe in themselves, and dream. And all of this is achieved by teaching a set of sustainable skills, not with any quick-fix gimmickry.

Why is the Mindstream model not more widely known, not mentioned in Circulation, and not accessible to the hundreds of thousands of kids who need it? In a word: money.

The families of severely-obese children tend to be the very families least able to afford treatment of any kind. Third-party payers can fix this, but they are accustomed to looking only at “medical” treatments. We tend to be rather blind to the possibility of lifestyle, or culture, as the medicine we need. But these are, in fact, the best medicines we’ve got – and with the potential to save us dollars along with lives.

Admittedly, we need to prove it. The Mindstream experience to date, for instance, needs to be published in the peer-reviewed literature; that’s in the works. We need to know more about the overall cost-effectiveness of such an approach, its sustainability, and how the program might be modified and still work. But we have routinely reimbursed for “medical” treatments before having such data. Even now, we know little about the long-term effects of bariatric surgery in tweens and teens. We might at the very least give school the same benefit of doubt we give scalpels.

There are many reasons why a problem that is hard but not truly complex, and amenable to remedies involving better use of feet and forks, has defied us for so long. We are inclined to medicalize obesity to legitimize it. But obesity as a “disease” implies a need for treatments of a clinical nature, drugs and surgery in particular. There are many good reasons why we do not have, and are unlikely to have, good drugs for obesity treatment. Surgery works, although just how long and how well for children, we really don’t know. But even if it worked well and sustainably, would we really want to sanction sending our sons and daughters through the operating room doors, to reorganize their gastrointestinal tracts, because we couldn’t manage to find ways to keep them from passing under the Golden Arches quite so often?

Even as we tear our proverbial beards, and gnash our teeth, we manage to turn a blind eye. Obesity is a cultural problem and requires a cultural solution we have the knowledge and means to administer. That we fail to apply those means — that we can watch television shows telling us of this threat to our kids, while our kids watching television are bombarded with intensive marketing of the very products that propagate the problem — bespeaks our ambivalence at best, our profit-driven hypocrisies at worst. Are we truly willing to mortgage the health of our children to fortify the corporate bottom line?

This is largely a problem of will, and money. Money, too, figures in the new report. The authors note that access to effective treatments for severe obesity is limited by lack of insurance coverage. In fact, the closing line of the article closes with a focus on dollars: “The task ahead will be arduous and complicated, but the high prevalence and serious consequences of severe obesity require us to commit time, intellectual capital, and financial resources to address it.”

Given the dire consequences of severe obesity left unaddressed, pecuniary neglect is at best penny-wise and pound-foolish. But given the prospects for losing far more than pennies as the pounds accumulate to rob our vulnerable daughters and sons of both years of life, and life in years, it is far worse than that. It is a colossal, collective cultural failure of the first order.

The new report speaks to the grave threat of severe obesity among our children and hints at the solutions we need. The solutions exist; the will to cultivate them seems to be in question. So, the words in this report are just a start. The question now is this: Will we put the needed money where these erudite mouths are?

David L. Katz is the founding director, Yale-Griffin Prevention Research Center.

Deep Brain Stimulation Studied as Last-Ditch Obesity Treatment …

Deep Brain Stimulation Studied as Last-Ditch Obesity Treatment

By Amy Norton

HealthDay Reporter

THURSDAY, June 13 (HealthDay News) — For the first time, researchers have shown that implanting electrodes in the brain’s “feeding center” can be safely done — in a bid to develop a new treatment option for severely obese people who fail to shed pounds even after weight-loss surgery.

In a preliminary study with three patients, researchers found that they could safely use the therapy, known as deep brain stimulation (DBS). Over almost three years, none of the patients had any serious side effects, and two even lost some weight — but it was temporary.

“The first thing we needed to do was to see if this is safe,” said lead researcher Dr. Donald Whiting, vice chairman of neurosurgery at Allegheny General Hospital in Pittsburgh. “We’re at the point now where it looks like it is.”

The study, reported in the Journal of Neurosurgery and at a meeting this week of the International Neuromodulation Society in Berlin, Germany, was not meant to test effectiveness.

So the big remaining question is, can deep brain stimulation actually promote lasting weight loss?

“Nobody should get the idea that this has been shown to be effective,” Whiting said. “This is not something you can go ask your doctor about.”

Right now, deep brain stimulation is sometimes used for tough-to-treat cases of Parkinson’s disease, a movement disorder that causes tremors, stiff muscles, and balance and coordination problems. A surgeon implants electrodes into specific movement-related areas of the brain, then attaches those electrodes to a neurostimulator placed under the skin near the collarbone.

The neurostimulator continually sends tiny electrical pulses to the brain, which in turn interferes with the abnormal activity that causes tremors and other symptoms.

What does that have to do with obesity? In theory, Whiting explained, deep brain stimulation might be able to “override” brain signaling involved in eating, metabolism or feelings of fullness. Research in animals has shown that electrical stimulation of a particular area of the brain — the lateral hypothalamic area — can spur weight loss even if calorie intake stays the same.

The new study marks the first time that deep brain stimulation has been tried in that brain region. And it’s an important first step to show that not only could these three severely obese people get through the surgery, but they also seemed to have no serious effects from the brain stimulation, said Dr. Casey Halpern, a neurosurgeon at the University of Pennsylvania who was not involved in the research.

“That shows us this is a therapy that should be studied further in a larger trial,” said Halpern, who has done animal research exploring the idea of using deep brain stimulation for obesity.

“Obesity is a major problem,” Halpern said, “and current therapies, even gastric bypass surgery, don’t always work. There is a medical need for new therapies.”

Obesity surgery-diabetes study shows pros and cons

CHICAGO (AP) — Obesity surgery worked much better at reducing and even reversing diabetes than medication and lifestyle changes in one of the most rigorous studies of its kind. But the researchers and others warn that possible serious complications need to be considered.

The yearlong study indicates that the most common weight-loss surgery, gastric bypass, can effectively treat diabetes in patients with mild to moderate obesity — about 50 to 70 pounds overweight, the researchers reported Tuesday in the Journal of the American Medical Association.

Other studies have shown the operation can reverse diabetes in severely obese patients, although sometimes the disease comes back.

About a third of the 60 adults who got bypass surgery in the new study developed serious problems within a year of the operation, though some cases were not clearly linked with the surgery. That rate is similar to what’s been seen in previous studies.

But for the most serious complications — infections, intestinal blockages and bleeding — the rate was 6 percent, slightly higher than in earlier research.

The most dangerous complication occurred in one patient when stomach contents leaked from the surgery site, leading to an overwhelming infection, leg amputation and brain injury. Lead author Dr. Sayeed Ikramuddin, an obesity surgeon at the University of Minnesota, called that case “a fluke.”

A journal editorial says such devastating complications are rare, but that “the frequency and severity of complications … is problematic” in the study and that the best way to treat patients with both obesity and diabetes “remains unknown.”

A research review in the journal said more long-term evidence on risks and benefits is needed to determine if obesity surgery is an appropriate way to treat diabetes in patients who aren’t severely obese — at least 100 pounds overweight.

More than 20 million Americans have Type 2 diabetes; most are overweight or obese. Diabetics face increased risks for heart disease and strokes, and poorly controlled diabetes can damage the kidneys, eyes and blood vessels.

About 160,000 people nationwide undergo various types of obesity surgery each year. Bypass surgery, the type studied, involves stapling the stomach to create a small pouch and attaching it to a lower part of the intestines.

The American Society for Metabolic Bariatric Surgery says obesity surgery is safe and that the death rate is less than 1 percent, lower than for gallbladder and hip replacement surgery.

The study involved 120 patients at five hospitals in New York, Minnesota and Taiwan. All patients got medicines for diabetes, obesity, cholesterol and/or high blood pressure. They all were advised to cut calories and increase physical activity.

Sixty patients also had surgery, and the two groups were compared after one year.

The surgery group lost on average nearly 60 pounds and 75 percent lowered blood sugar levels to normal or near normal levels. The non-surgery group lost an average 17 pounds and just 30 percent reached the blood-sugar goal. The surgery group also needed less medication after the operation.

The researchers say the diabetes changes were likely due to the weight loss but that hormonal changes affecting blood sugar may have contributed.

The surgery group showed a trend toward having less high blood pressure and elevated cholesterol — both major risk factors for heart disease, although those between-group differences could have been due to chance.

Ikramuddin, the lead author, said the study results don’t mean that all mildly obese diabetics should have obesity surgery, but that “in the correct patient, surgery might be an important thing to consider.”

___

Online:

JAMA: http://www.jama.com

Surgeons group: http://www.asmbs.org

___

AP Medical Writer Lindsey Tanner can be reached at http://www.twitter.com/LindseyTanner

Weight Loss Surgery Can Break Obesity Cycle

baby in a crib

Flickr/djs1021

WASHINGTON (AP) — Obese mothers tend to have kids who become obese. Now provocative research suggests weight-loss surgery may help break that unhealthy cycle in an unexpected way — by affecting how their children’s genes behave.

In a first-of-a-kind study, Canadian researchers tested children born to obese women, plus their brothers and sisters who were conceived after the mother had obesity surgery. Youngsters born after mom lost lots of weight were slimmer than their siblings. They also had fewer risk factors for diabetes or heart disease later in life.

More intriguing, the researchers discovered that numerous genes linked to obesity-related health problems worked differently in the younger siblings than in their older brothers and sisters.

Clearly diet and exercise play a huge role in how fit the younger siblings will continue to be, and it’s a small study. But the findings suggest the children born after mom’s surgery might have an advantage.

“The impact on the genes, you will see the impact for the rest of your life,” predicted Dr. Marie-Claude Vohl of Laval University in Quebec City. She helped lead the work reported Monday in the journal Proceedings of the National Academy of Sciences.

Why would there be a difference? It’s not that mom passed on different genes, but how those genes operate in her child’s body. The idea: Factors inside the womb seem to affect the dimmer switches that develop on a fetus’ genes — chemical changes that make genes speed up or slow down or switch on and off. That in turn can greatly influence health.

The sibling study is “a very clever way of looking at this,” said Dr. Susan Murphy of Duke University. She wasn’t involved in the Canadian research but studies uterine effects on later health. She says it makes biological sense that the earliest nutritional environment could affect a developing metabolism, although she cautions that healthier family habits after mom’s surgery may play a role, too.

It’s the latest evidence that the environment — in this case the womb — can alter how our genes work.

And the research has implications far beyond the relatively few women who take the drastic step of gastric bypass surgery before having a baby. Increasingly, scientists are hunting other ways to tackle obesity before or during pregnancy in hopes of a lasting benefit for both mother and baby.

What’s clear is that obesity is “not just impacting your life, it’s impacting your child,” Duke’s Murphy said.

More than half of pregnant women are overweight or obese, according to the American College of Obstetricians and Gynecologists. But it’s not just a matter of how much moms weigh when they conceive — doctors also are trying to stamp out the idea of eating for two. Gaining too much weight during pregnancy increases the child’s risk of eventually developing obesity and diabetes, too.

What’s too much? Women who are normal weight at the start of pregnancy are supposed to gain 25 to 35 pounds. Those who already are obese should gain no more than 11 to 20 pounds. Overweight mothers-to-be fall in the middle.

Sticking to those guidelines can be tough. The National Institutes of Health just began a five-year, $30 million project to help overweight or obese pregnant women do so, and track how their babies fare in the first year of life.

Called the LIFE-Moms Consortium, researchers are recruiting about 2,000 expectant mothers for seven studies around the country that are testing different approaches to a healthy weight gain and better nutritional quality. They range from putting pregnant women on meal plans and exercise programs, to weekly monitoring, to peer pressure from fellow parents trained to bring nutrition advice into the homes of low-income mothers-to-be.

It’s best to get to a healthy weight before conceiving, noted Dr. Mary Evans of the National Institute of Diabetes and Digestive and Kidney Diseases, who oversees the project.

Just how much mom has to lose for a healthier baby is “obviously a research gap,” she said.

Monday’s research findings from Canada may shed some new light. Consider: Overweight mothers have higher levels of sugar and fat in the bloodstream, which in turn makes it to the womb.

Fetuses are “marinated, and they’re differently marinated” depending on mom’s weight and health, said Dr. John Kral of New York’s SUNY Downstate Medical Center, who co-authored the Canadian study.

That may do more than overstimulate fetal growth. Scientists know that certain molecules regulate gene activity, attaching like chemical tags. That’s what Laval University lead researcher Dr. Frederic Guenard was looking for in blood tests. He took samples from children born to 20 women before and after complex surgery that shrank their stomachs and rerouted digestion so they absorb less fat and calories. On average, they lost about 100 pounds.

Guenard compared differences in those chemical tags in more than 5,600 genes between the younger and older siblings. He found significant differences in the activity of certain genes clustered in pathways known to affect blood sugar metabolism and heart disease risk.

Only time will tell if these youngsters born after mom’s surgery really get lasting benefits, whatever the reason. Meanwhile, specialists urge women planning a pregnancy to talk with their doctors about their weight ahead of time. Besides having potential long-term consequences, extra pounds can lead to a variety of immediate complications such as an increased risk of premature birth and cesarean sections.

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Diet 'just as good as op' for diabetes

It has long been known that patients who undergo gastric operations to curb eating see a dramatic improvement in their diabetes.

But patients with Type 2 diabetes who simply follow the same strict diet as that after surgery are just as likely to see a reduction in their blood glucose levels.

The report was released by researchers at UT Southwestern Medical Centre in Dallas.

Bariatric Surgery Restores Pancreatic Function In Diabetes Patients

In a two-year sub-study of the STAMPEDE (Surgical Therapy And Medications Potentially Eradicate Diabetes Efficiently) trial, researchers  evaluated the effects of bariatric surgery and intensive medical therapy on blood sugar levels, body composition, and pancreatic beta-cell function
and found that gastric bypass surgery reverses diabetes by uniquely restoring pancreatic function in moderately obese patients with uncontrolled type 2 diabetes.

Striking metabolic changes were observed in patients who underwent bariatric surgery compared with intensive medical therapy, particularly in the gastric bypass treatment group.

The cells of the pancreas that produce insulin, a hormone that helps the body store and use sugar, are called beta cells. Malfunctioning pancreatic beta cells can cause the pancreas to not release enough insulin; they can also produce insulin that the body does not recognize. When the body can’t use insulin properly, it can’t regulate the amount of glucose in its bloodstream. 

The prospective, randomized, controlled sub-study followed 60 patients from the original STAMPEDE trial to determine the durability of the initial results and examine the metabolic changes observed with bariatric surgery. The patients were divided into three groups of 20: those who received intensive medical therapy of their diabetes, those who received intensive medical therapy plus gastric bypass surgery, and those who received intensive medical therapy plus sleeve gastrectomy. The researchers measured metabolic parameters at baseline, and at 12 and 24 months. 

After two years, 41 percent of the patients who underwent gastric bypass saw their blood sugar levels back to normal. Only 10 percent of the patients who underwent sleeve gastrectomy and 6 percent who received intensive medical therapy achieved the same results.

At 12 and 24 months, patients who underwent gastric bypass achieved near normal blood sugar levels following a mixed meal test. These results were associated with a remarkable 5.8-fold increase in overall pancreatic cell function. Patients who received intensive medical therapy or underwent sleeve gastrectomy saw a 2-fold increase.

 “Gastric bypass surgery seems to uniquely restore pancreatic beta-cell function, presumably by targeting belly fat and modifying the hormones in the gastrointestinal tract,”   said lead investigator Sangeeta Kashyap, M.D., an endocrinologist at Cleveland Clinic’s EndocrinologyMetabolism Institute. “Furthermore, we observed that gastric bypass can resurrect a failing pancreas. Gastric bypass remarkably targets belly fat where hormones that are toxic to the body develop.”

Researchers observed that patients who underwent gastric bypass saw a greater reduction in belly fat compared to the patients who underwent sleeve gastrectomy. The sub-study results indicate a correlation between a decrease in belly fat and the ability of the pancreas to start working again.

The substudy results show that gastric bypass surgery is a viable therapeutic option for the treatment of uncontrolled type 2 diabetes in moderately obese patients. The authors will continue to follow these patients for three years as further studies examining hormonal effects are warranted.

Published in Diabetes Care.

Robin Gibb not Stayin' Alive

Amongst the glut of celebrity deaths that seem to be filling the news currently is Robin Gibb who died aged 62 after a long running battle with cancer. The most frail and camp looking member of the Brothers Gibb, Bee Gees awoke fr

om a coma about a month ago and was given a 10% chance of survival by doctors.

Fans had been hopeful that Gibb would recover from cancer and intestinal surgery when his awakening from the coma confounded doctors who had all but written him off.

A statement has been released saying, “The family of Robin Gibb, of the Bee Gees, announce with great sadness that Robin passed away today following his long battle with cancer and intestinal surgery. The family have asked that their privacy is respected at this very difficult time.”

Robin Gibb photographed not long before his death.

Robin Gibb photographed not long before his death.

As recently as early February Robin was still taking part in interviews during which time he told a BBC reporter, “I was diagnosed with a growth in my colon, it was removed. And I’ve been treated for that by a brilliant doctor, and in their words ‘the results have been spectacular.'”

Of the cancer growth, he said, “[it] is almost gone and I feel fantastic. Really from now on, it’s just what they could describe as a ‘mopping-up’ operation. I am very active and my sense of well-being is good.”

His career stretches back to the 1970s when the disco era really kicked in. The Bee Gees enjoyed massive success with their camp breed of disco and climbed to greater heights when they penned and performed the soundtrack to Saturday Night Fever which starred John Travolta as a funky sex muppet who wore far too much white.

They will be remembered for their falsetto voices, whiter than white teeth and soft focus videos which accompanied their catchy chart topping hits and drew sniggers from other sections of society.

The Bee Gees; hair, teeth and tight pants.

Robin Gibb (right) with the Bee Gees; tight pants, squeaky voices, shiny teeth, excessive hair and a glut of top ten hits.

Robin Gibb’s death follows his twin brother Maurice’s back in 2009 which ultimately put an end to any possible Bee Gees reunion plans (the group was ‘retired’ in 2003), despite Robins hopes to resurrect the band as a duo.

Barry Gibb, the oldest of the founding members, survives his three brothers and is unlikely to continue as the ‘Bee Gee’.

A very cool looking Robin Gibb in his younger days

A very cool looking Robin Gibb in his younger days.

Robin Gibb’s passing comes just three days after the death of Donna Summer, another disco queen who also died following a battle with cancer (read about that here).

Fans have been paying tribute to the Bee Gees and Robin Gibb on Twitter and Facebook as they mourn the loss of one of the country’s greatest entertainers; a man who started his band as a joke.

Rest in peace Robin Gibb, you will no doubt be Stayin’ Alive in the hearts of millions of fans.

Read about Beastie Boys MCA who died of cancer related illness.

Images: stereogum.com, justfashion.ca, unrealitytv.co.uk, thisislondon.co.uk

Madonna’s Lies About Surgery and Aging.

Back in the eighties when Madonna’s image was based around being super slutty, she released Papa Don’t Preach an innocuous pappy pop ditty about a young tart up the duff who wanted to keep the kid, everyone said what a great role model she was for giving young girls choices and that keeping their baby was another option besides abortion. A great message for 13-year-old girls who have none of the resources that Madonna has/had to bring up a baby without support. Arguably, she could have also been telling girls that it is ok to sleep around at an early age without using some form of protection. Cos that’s positive. But anyway.

Madonna nearly naked

Madonna does what she does best.

Ever since then her message to her fanbase of mostly young women and gay men seems to have been based around obsessions regarding image, valuing output over quality, arrogance over humility, and making a killing from being tediously overtly sexual.

Strangely some women see another woman writhing around barely clad in provocative clothing singing silly pseudo-erotic songs as empowering – apparently it makes them want to behave like a slut too.

Madonna Before and After

Madonna: Before and after something that made her look ten years younger than she did ten years ago.

But according to the media Madonna could do no wrong. They coveted the fact that she occasionally dyed her hair and changed image, exalting her for her chameleon like ability to change, as if hair dye wasn’t available at Walmart for five bucks. But she’s an amazing business woman. Apparently. I bet she doesn’t have a board of directors and an entourage of people far more talented than she is to help her decide what she does next.

Madonna’s latest attack on the communal psyche of the female population is to impress on them that aging is bad. Aging must be avoided at all costs. Over and over she lied about having surgery and still remains committed to the lie that she hasn’t had any work done, but her youthful looks are purely down to her faith in the Kabbalah – the fashionable religion for bored rich folk with no soul, having not yet had it returned by the devil after selling it to him in return for inexplicable fame exponentially greater than any talent that they have warrants. Judging by photos of her recently she seems to have bought shares in Photoshop.

Madonna before and after Photoshop

Madonna before and after Photoshop

Madonna is a dreadful role model. She spreads the message that aging is wrong and she spreads it to a fanbase that mostly can’t afford to spend a zillion bucks on surgery or facials or injections or whatever she uses. Whilst it is natural for people to want to look their best, the trend these days is to look the best someone else can make you. Images of Madonnna extruded through Photoshop produce more than just aspiration in young women keen to emulate the star, they produce unrealistic goals that can never actually be achieved because no one in their mid-fifties really looks 21. It’s a sad fact.

Madonna is good at self promotion, but it’s a brand of self promotion akin to a bull in a china shop. She will stop at nothing to ‘push buttons’ as she calls it. Her pseudo sexual Sex book was risible and only enjoyed by teenage boys who couldn’t find someone their own age to masturbate over; gay men who will adore anything wearing too much make-up that costume changes every 17 seconds; and a few old men who will masturbate over anything, be it man or beast.

Then there is the matter of her adopting from third-world countries when she could be supporting the child in its own habitat. Good role model? Nah.

Stars of Madonna’s ilk eg image-driven pop stars (Lady Gaga, Katy Perry etc) who would rather sell records to everyone rather than have an elite fanbase should take responsibility for their fans, generally young people who like their music unchallenging, and should behave accordingly.

Madonna for Louis Vuitton Shoot before and after Photoshop

Madonna for Louis Vuitton: unrecognizable after Photoshop.

If you must have surgery or if you are Photoshopped beyond recognition, be open about it. Or even better, age naturally. What better example is that to young women already obsessed about their bodies and who can’t afford personal trainers, surgery and Photoshop.

To those that are not taken in by her paltry waffling pop fodder and see her as merely as a jumped up strumpet masquerading as an artiste, she epitomises everything that is wrong and ghastly about the music industry. And now it seems she has produced progeny in the form of Lady Gaga. A woman so intent on fame and attention that she will wear bacon.

And that video of Madonna in her fifties when she wore a child’s pink high-legged leotard is the female equivalent of an old bald man driving around in a Porsche.

Madonna

No.

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Aretha Franklin all smiles at basketball game 2 months after surgery

The star of hits such as Respect and Think looked healthy  and in good spirits when she  watched the Detroit Pistons play Miami Heat with the Reverend Jesse Jackson in what is believed to be one of her first public appearances since undergoing surgery two months ago.

During a break a big screen showed Franklin waving to the crowd and laughing, while some of her songs played over the sound system. “I’m feeling great. Loving the game, loving the game,” Franklin said, going on to add that she hopes to resume her public schedule in May.

In November last year the Queen of Soul was ordered by doctors to cancel all her concerts and personal appearances until May 2011 after she spent a week in hospital for a “serious illness”, which has since been confirmed as incurable pancreatic cancer.

The National Enquirer says the prognosis for the Say a Little Prayer singer, 68, is poor, with the survival rate at 5%-10%. Her age and being overweight lower her chances of recovery further.

In December, however, the 68 year old  — who also broke two ribs in a fall last summer — underwent surgery and she told fans that the procedure was “highly successful”.

Things certainly seem to be looking up for the star: according to Showbiz, Aretha is next planning to soak up some rays and relax on holiday  at a “fabulous beach”.

Read here about Patrick Swayze, who lost his life to pancreatic cancer last year.

Images: Wikimedia Commons