Recent findings indicate that weight loss surgery (WLS) may not be the fix-all cure diabetics hope for to lose excess weight. Surgery alone cannot be relied upon as the sole solution to obesity. A commitment to permanent lifestyle change is required.

Many Kimkins members have undergone weight loss surgery procedures prior to joining. Our low fat low carb approach is very similar to the typical low carb diet prescribed after WLS.

MONDAY, Sept. 15 (HealthDay News) -- People with diabetes and those with larger stomach pouches are less likely than others to have good weight loss after gastric bypass surgery, according to University of California, San Francisco, researchers.

In this procedure, surgeons restrict food intake by creating a smaller stomach pouch that bypasses large sections of the digestive system.

"When performed in high-volume centers and with a low rate of complications, gastric bypass provides sustained and meaningful weight loss, significant improvements in quality of life, improvement or resolution of obesity-associated co-morbidities and extended life span. However, 5-15% of patients do not lose weight successfully, despite perceived precise surgical technique and regular follow-up," the researchers wrote.

The researchers, who analyzed data from more than 300 gastric bypass patients, defined poor weight loss as losing 40% or less of excess body weight after one year and good weight loss as losing more than 40% of excess body weight.

Before gastric bypass surgery, the 310 patients had an average body mass index (BMI) of 52. One year after surgery, the patients had an average BMI of 34 and had lost an average of 60% of excess body weight. However, 38 patients (12.3%) had poor weight loss.

After they adjusted for different factors, the researchers concluded that diabetes and having a larger size of stomach pouch after surgery were independently associated with poor weight loss.

The study authors noted that people with diabetes take insulin or other drugs that stimulate the production of fat and cholesterol.

"Other factors that may lead to weight gain in patients with diabetes include a 'protective' increase in caloric intake to treat episodes of hypoglycemia (low blood sugar), reduction of urinary glucose losses, and sodium and water retention that are a direct effect of insulin on the distal tubule in the kidney," they wrote.

The researchers added that proper stomach pouch size is a critical part of gastric bypass surgery, but many surgeons estimate pouch size using anatomical landmarks rather than using a sizing balloon.

"As the use of gastric bypass continues to grow, we believe it is critical to stress the importance of, and to teach the creation of, the small gastric pouch and to better understand the technique used for pouch creation," the study authors wrote.

"Changes in the use of diabetes medications may reduce the risk of poor weight loss among diabetics undergoing gastric bypass. Detailed attention to the creation of a small gastric pouch is essential for achieving the best results," they concluded.

The study was published in the September [2008] issue of the journal Archives of Surgery.

TUESDAY, Sept. 9 (HealthDay News) -- The fatter you are, the more likely you are to have a heart attack earlier in life, a new study shows.

"Basically, it is showing that as people got progressively more obese, the rate at which they had heart attacks early went up dramatically," said Dr. Eric D. Peterson, a professor of medicine at Duke University Medical Center's Division of Cardiology and a member of the group reporting the findings.

Cardiologists at several institutions studied data on more than 111,000 people who had heart attacks, looking specifically at body mass index (BMI), a measure of obesity. Someone with a BMI of 30 or above is regarded as obese; a person 5 feet, 7 inches tall who weighs 192 pounds has a BMI of 30.

The average age of a first heart attack for people with a BMI of 18.5 or under was 74.6 years. For people with a BMI of 40 or over, it was 58.7 years. The age at which a first heart attack occurred went up steadily with increasing BMI -- 3.5 years earlier for a BMI of 25 to 30; 6.8 years earlier for a BMI 30 to 35; 9.4 years for a BMI of 35 to 40; and 12 years earlier for a BMI 40 or higher.

"That is a pretty profound difference," Peterson said.

One reason for the difference is that obese people are more likely to have other risk factors for heart disease, such as diabetes, high cholesterol and high blood pressure. "But even after adjusting for those factors, just being heavy added considerable risk," Peterson said.

The findings are published in the Sept. 16 issue of the Journal of the American College of Cardiology.

Another study in the same issue of the journal provided evidence for a mechanism by which obesity increases cardiac risk. Researchers at Leiden University in the Netherlands had obese people with diabetes practice "prolonged calorie restriction," or dieting in layman's terms.

BMI went down. But sophisticated tests such as magnetic resonance imaging and biochemical studies also showed that their bodies were better able to manage blood sugar levels and that there were beneficial effects on heart muscle cells.

"The news here is that heart muscle in obese diabetic individuals can be mobilized by eating less," said Dr. Heinrich Taegtmeyer, professor of medicine in cardiology at the University of Texas Health Sciences Center in Houston and co-author of an accompanying editorial comment.

To be sure, the mechanism by which dieting helps heart cells "is only vaguely understood," Taegtmeyer said. "It gets very biochemical and very molecular." A simple explanation is that caloric restriction activates an enzyme that prevents fat from being deposited in heart cells, he said.

Whatever the mechanism, the new research provides "one more reason not to be fat," Peterson said. Some obese people have taken comfort from studies indicating that they're more likely to survive a heart attack than thinner people, he noted. The new study indicates that the reason for that better survival is the heart attack in fat people occurs earlier in life, when people are otherwise sturdier, he said.

"If you had your choice, you would choose not to have a heart attack in the first place," Peterson said.

Both Peterson and Taegtmeyer cited animal studies showing that strict caloric restriction lengthens life.

"It has been shown in virtually every organism, from yeast to flies to worms to mammals, that caloric restriction heightens life expectancy," Taegtmeyer said. "The heart functions better with caloric restriction."