THURSDAY, July 29 (HealthDay News) — Weight loss has been noted among patients who’ve had a knee or hip replacement, a new study says.

The research focused on 196 patients, mean age 67 years, who had knee or hip replacement surgery (arthroplasty) at the Mount Sinai Medical Center in New York City between 2005 and 2007.

The researchers found that, after their surgery, nearly 20 percent of the patients had significant weight loss (5 percent or more of body weight) and decreased body mass index (BMI), which is a measurement that takes into account a person’s height and weight. The mean weight of the patients decreased from 175.5 pounds to 172.2 pounds, they noted.

Knee replacement patients were more likely than hip replacement patients to experience a significant decrease in BMI (21.5 percent and 16.9 percent, respectively). Patients with a BMI score greater than 30 before their surgery, and therefore considered obese, were most likely to have significant post-surgery weight loss.

“Total joint arthroplasties are performed with the intent of relieving a patient’s pain and disability. Both total knee patients and total hip patients experienced a statistically significant and clinically significant corrected weight loss following surgery, which indicates a healthier overall lifestyle,” lead author Dr. Michael Bronson, chief of joint replacement surgery at Mount Sinai School of Medicine, said in a Mount Sinai news release.

Further studies of knee and hip replacement patients that also include diet counseling and long-term fitness goals may show even more encouraging weight loss results, the researchers noted.

The study was published in the June issue of the journal Orthopedics.

More information

The U.S. National Institute of Arthritis and Musculoskeletal and Skin Diseases has more about joint replacement.

THURSDAY, July 29 (HealthDay News) — Weight loss has been noted among patients who’ve had a knee or hip replacement, a new study says.

The research focused on 196 patients, mean age 67 years, who had knee or hip replacement surgery (arthroplasty) at the Mount Sinai Medical Center in New York City between 2005 and 2007.

The researchers found that, after their surgery, nearly 20 percent of the patients had significant weight loss (5 percent or more of body weight) and decreased body mass index (BMI), which is a measurement that takes into account a person’s height and weight. The mean weight of the patients decreased from 175.5 pounds to 172.2 pounds, they noted.

Knee replacement patients were more likely than hip replacement patients to experience a significant decrease in BMI (21.5 percent and 16.9 percent, respectively). Patients with a BMI score greater than 30 before their surgery, and therefore considered obese, were most likely to have significant post-surgery weight loss.

“Total joint arthroplasties are performed with the intent of relieving a patient’s pain and disability. Both total knee patients and total hip patients experienced a statistically significant and clinically significant corrected weight loss following surgery, which indicates a healthier overall lifestyle,” lead author Dr. Michael Bronson, chief of joint replacement surgery at Mount Sinai School of Medicine, said in a Mount Sinai news release.

Further studies of knee and hip replacement patients that also include diet counseling and long-term fitness goals may show even more encouraging weight loss results, the researchers noted.

The study was published in the June issue of the journal Orthopedics.

More information

The U.S. National Institute of Arthritis and Musculoskeletal and Skin Diseases has more about joint replacement.

THURSDAY, July 29 (HealthDay News) — Weight loss has been noted among patients who’ve had a knee or hip replacement, a new study says.

The research focused on 196 patients, mean age 67 years, who had knee or hip replacement surgery (arthroplasty) at the Mount Sinai Medical Center in New York City between 2005 and 2007.

The researchers found that, after their surgery, nearly 20 percent of the patients had significant weight loss (5 percent or more of body weight) and decreased body mass index (BMI), which is a measurement that takes into account a person’s height and weight. The mean weight of the patients decreased from 175.5 pounds to 172.2 pounds, they noted.

Knee replacement patients were more likely than hip replacement patients to experience a significant decrease in BMI (21.5 percent and 16.9 percent, respectively). Patients with a BMI score greater than 30 before their surgery, and therefore considered obese, were most likely to have significant post-surgery weight loss.

“Total joint arthroplasties are performed with the intent of relieving a patient’s pain and disability. Both total knee patients and total hip patients experienced a statistically significant and clinically significant corrected weight loss following surgery, which indicates a healthier overall lifestyle,” lead author Dr. Michael Bronson, chief of joint replacement surgery at Mount Sinai School of Medicine, said in a Mount Sinai news release.

Further studies of knee and hip replacement patients that also include diet counseling and long-term fitness goals may show even more encouraging weight loss results, the researchers noted.

The study was published in the June issue of the journal Orthopedics.

More information

The U.S. National Institute of Arthritis and Musculoskeletal and Skin Diseases has more about joint replacement.

WASHINGTON (Reuters) – Overweight volunteers who took Orexigen’s experimental drug Contrave, designed to reduce cravings, lost about 13 pounds (6 kg) over a year, U.S. researchers reported on Thursday.

Those who got the drug said they felt less desire for sweet or starchy foods; felt fuller and had fewer cravings, the researchers said.

Their study, published in the Lancet medical journal, also suggested that feared side-effects from the drug were mild and went away over time.

But one expert said more studies are needed before regulators can assume the drug is safe.

Data from the company-sponsored study has already been presented to the U.S. Food and Drug Administration, which has a panel of advisers scheduled to consider approval in December.

The Lancet submitted it for review by experts before publishing it, said Frank Greenway of the Pennington Biomedical Research Center at Louisiana State University, who led the trial.

Contrave is a combination of the antidepressant bupropion, a generic version of GlaxoSmithKline’s Wellbutrin, and naltrexone, used to treat alcoholism and other addictions.

Greenway and colleagues tested two formulations of Contrave against a placebo in 1,700 overweight or obese volunteers.

Only half the volunteers finished the trial, dropping out for various reasons.

“It is something that seems to be characteristic of obesity studies,” Greenway said in a telephone interview.

“The people in the placebo group seemed to drop out more frequently because they were dissatisfied with the lack of weight loss. People in the drug arm seemed to drop out more because of side-effects. Overall, the groups seemed to be equal.”

But of those who finished the trial and also got the highest dose of the drug, mean weight loss was 13 pounds (6 kg) compared to 3 pounds (1.4 kg) for those who got the placebo.

The drug did raise blood pressure slightly at first, a known side-effect of bupropion and a big worry for a drug being taken by overweight people. But this increase leveled off after a short time, Greenway reported.

“The safety is really nothing different from what we would expect from the components,” Greenway said.

One expert said more study is needed to show if the drug is safe. The drugs have been linked to anxiety, insomnia and to raised blood pressure, as well as to thoughts of suicide.

But the trial showed no increase in any of these, said Arne Astrup of the University of Copenhagen in Denmark.

“These findings suggest that the combination might have fewer adverse psychiatric effects than its components given separately, but a meta-analysis of all continuing or completed phase 3 studies of this combination treatment is needed to assess this effect more accurately,” Astrup wrote in a commentary in the Lancet.

Three U.S. companies are competing to get new weight loss drugs approved by the FDA.

FDA advisers voted against Vivus Inc’s Qnexa earlier this month, expressing concerns that it could cause depression, memory loss and potential birth defects.

Arena Pharmaceuticals Inc has a drug called lorcaserin up for consideration in September.

(Reporting by Maggie Fox; Editing by Tim Dobbyn)

WEDNESDAY, July 28 (HealthDay News) — Obesity is associated with early puberty in young girls, according to a researcher who analyzed more than 100 reports on the issue.

Some experts have concluded that early puberty increases the risk for metabolic syndrome and diabetes, but these diseases are linked to obesity, not early puberty, according to review author and pediatric endocrinologist Dr. Emily Walvoord, of the Indiana University School of Medicine.

“Early puberty is one of the many outcomes of obesity. There are clearly other factors we don’t understand that have affected the timing,” she said in a news release from the Center for the Advancement of Health.

These other factors may include an increase in hormone-disrupting chemicals in the environment and more chronic stress in children’s homes, she noted.

Early onset of puberty puts girls at increased risk for negative body image, depression and other mental health issues. But these problems are also closely linked with obesity, so it’s difficult to untangle cause and effect, Walvoord said.

The review appears online in the Journal of Adolescent Health.

Girls who reach puberty early can also end up in social situations they aren’t psychologically prepared to handle, which may lead to mental health problems, said Jane Mandle, a psychology professor at the University of Oregon.

More information

The Nemours Foundation has more about early puberty.

NEW YORK (Reuters Health) – For weight-loss surgery, “Centers of Excellence” may not be any safer than their undistinguished peers, a study of 25 Michigan hospitals suggests.

Yet the overall rate of serious complications — less than three percent — was “relatively low,” the new report said.

The findings, which appear in the Journal of the American Medical Association, come in the wake of widespread safety concerns over weight-loss procedures. (See Reuters Health story of July 26, 2010.)

“Our results show that, at least in the state of Michigan, bariatric surgery is now remarkably safe,” Nancy J. O. Birkmeyer, of the University of Michigan in Ann Arbor, told Reuters Health in an e-mail.

But she added that Centers of Excellence, designated by two surgery societies and intended to point people toward safer hospitals, were not necessarily those with the best outcomes for weight-loss surgery.

“In the absence of reliable outcomes data, patients considering undergoing bariatric surgery should look for a high volume surgeon at a high volume center,” said Birkmeyer, whose study was funded in part by the Blue Cross and Blue Shield of Michigan, a not-for-profit health insurer.

Although centers need to do at least 125 bariatric surgeries per year to be considered for accreditation, that number would still land them in the lower range among the Michigan hospitals.

The researchers tracked more than 15,000 obese people up to one month after they had surgery. The surgeries included gastric bypass, which reduces the stomach to the size of a golf ball, and gastric banding, in which a silicone band is placed around the top portion of the stomach to restrict food intake.

About seven percent experienced complications, but most were minor wound problems.

Serious complications — such as massive bleeding or kidney failure — occurred in 2.6 percent of patients. They were most common in bypass surgery, during which 13 patients (0.14 percent) died; two died during gastric banding (0.04%).

Birkmeyer said a number of studies had shown the benefits of surgery outweighed the risks, with an increase in life expectancy of up to three years.

In 2009, more than 220,000 Americans had bariatric surgery, at a price of about $20,000 per patient, according to the American Society for Metabolic and Bariatric Surgery.

The society, along with the American College of Surgeons, confers the designation of Center of Excellence.

But some of these centers may fall short of excellence when it comes to safety, the new results hint. At first glance, the centers even had a higher rate of complications than did other hospitals. That difference all but vanished after accounting for the type of surgery performed and whether patients had other illnesses, however.

There could be several reasons why the label might not point to safer hospitals, the researchers speculate.

“Given the highly competitive marketplace for bariatric surgery,” they write, “(Center of Excellence) accreditation programs may be attracting hospitals motivated as much by marketing advantage as by the desire to demonstrate and improve their quality.”

Dr. John Baker, immediate past president of the American Society for Metabolic and Bariatric Surgery, had a different explanation.

He said the hospitals in the study might not compare to other hospitals across the country. As part of the Michigan Bariatric Surgery Collaborative, they all track their outcomes, Baker said, meaning it’s likely they’re doing the best they can to improve their quality of care, Centers of Excellence or not.

“Outside of this collaborative group you may see a greater variation,” he told Reuters Health, adding that large studies hadn’t been done.

SOURCE: http://link.reuters.com/vec89m

JAMA/Journal of the American Medical Association, online July 27, 2010.

TUESDAY, July 27 (HealthDay News) — Weight-loss surgery, also known as bariatric surgery, in the state of Michigan has a relatively low rate of serious complications, a new study suggests.

The lowest rates of complications are associated with surgeons and hospitals that do the highest number of bariatric surgeries, according to the report published in the July 28 issue of the Journal of the American Medical Association.

Rates of bariatric surgery have risen over the past decade and it is now the second most common abdominal operation in the country. Despite declining death rates for the procedures, some groups remain concerned about the risks of the surgery and uneven levels of quality among hospitals, researchers at the University of Michigan pointed out in a news release from the journal’s publisher.

In the new study, Nancy Birkmeyer of the University of Michigan, Ann Arbor, and colleagues analyzed data from 15,275 patients who underwent one of three common bariatric procedures between 2006 and 2009. The operations were performed by 62 surgeons at 25 hospitals in Michigan.

Overall, 7.3 percent of patients experienced one or more complications during surgery, most of which were wound problems and other minor complications. Serious complications were most common after gastric bypass (3.6 percent), sleeve gastrectomy (2.2 percent), and laparoscopic adjustable gastric band (0.9 percent) procedures, the investigators found. Rates of serious complications at hospitals varied from 1.6 percent to 3.5 percent.

Infection was the most common type of surgical site complication (3.2 percent) and occurred most often among patients undergoing gastric bypass (4.4 percent) and sleeve gastrectomy (2.5 percent) procedures, the study authors noted.

The findings also revealed that fatal complications occurred in two patients undergoing laparoscopic adjustable gastric band (0.04 percent), 13 patients undergoing gastric bypass (0.14 percent) and zero patients receiving sleeve gastrectomy.

“Risk of serious complications was inversely associated with average annual bariatric procedure volume,” the researchers wrote in their report. “Serious complication rates were about twice as high (4 percent) for low-volume surgeons at low-volume hospitals than for high-volume surgeons at high-volume hospitals (1.9 percent),” they added.

The overall rates of serious complications were similar among patients who had bariatric surgery at centers of excellence (COE) hospitals (2.7 percent) and those who had surgery at non-COE hospitals (2 percent), according to the report.

“In terms of outcome by procedure, the data presented does not show which is safer or more preferable long term. While early serious complications are less with banding, this data does not answer what the long term results are of the various procedures, or the need for other procedures,” Dr. Mitchell Roslin, chief of obesity surgery at Lenox Hill Hospital in New York City, commented in a news release about the new report.

“In terms of volume, once again we see the importance of frequency and repetition for the best outcomes,” Roslin added.

The researchers wrote that their results might not apply outside of the state of Michigan or to surgeries performed in community settings, but said they represented “useful safety performance benchmarks for hospitals performing bariatric surgery.”

More information

The U.S. National Institute of Diabetes and Digestive and Kidney Diseases has more about bariatric surgery.