Obesity Week 2016 to Probe Medical, Surgical Weight Loss

Marlene Busko

October 24, 2016

NEW ORLEANS — Obesity Week 2016, this year's joint annual scientific meeting of the American Society for Metabolic and Bariatric Surgery (ASMBS) and the Obesity Society (TOS), will showcase research ranging from the weight-loss expectations of bariatric-surgery patients to how appetite "reset" may explain weight-loss plateaus.

The more than 5000 attendees expected in New Orleans, Louisiana, will be able to choose from more than 1200 research abstracts (in posters and talks) as well as many sessions providing in-depth, broader insight into challenging aspects of treating patients with obesity.

Louisiana has the fourth-highest rate of obesity in the United States, and Governor John Bel Edwards recently passed a proclamation declaring October 30 through November 5, 2016, "Obesity Care Week."

Appetite and Weight Regain, Dietary Fat and Weight Loss

Invited by Medscape Medical News to select a handful of abstracts of special interest, three TOS spokespeople each pointed to a session where five researchers will present leading studies chosen by the editors of Obesity, which will also all be published in the journal's November issue.

The spokespeople are each intrigued by two studies about appetite and dietary fat.

In the first, "How strongly does appetite counter weight loss? Quantification of the homeostatic control of human energy intake," Kevin D Hall, PhD, from the National Institute of Diabetes & Digestive & Kidney Research in Bethesda, Maryland, and colleagues investigated weight loss in 153 patients treated with the type 2 diabetes drug canagliflozin (Invokana, Johnson & Johnson/Janssen), a sodium glucose cotransporter-2 (SGLT2) inhibitor.

This agent "causes some glucose to be spilled in the urine, meaning calories are lost, [and people experience] weight loss not directly caused by dieting," Patrick O'Neil, PhD, professor in the department of psychiatry and behavioral sciences at the Medical University of South Carolina in Charleston and TOS past president, explained to Medscape Medical News.

The researchers found that patients who received this drug consumed more calories to offset the calories lost in the urine and counteract the weight loss, he noted.

The findings promise to shed some light on the "puzzle" of why keeping weight off can be so difficult, said Scott Kahan, MD, director of the National Center for Weight and Wellness at George Washington University in Washington, DC.

In the second study "Effects of canola and high-oleic acid canola oils on abdominal fat mass in individuals with central obesity," Xiaoran Liu, PhD, from Pennsylvania State University, University Park, and colleagues investigate how different dietary fats can affect central obesity and risk of metabolic syndrome.

This is a "hot" research topic, said Caroline Apovian, MD, professor of medicine and pediatrics at Boston University School of Medicine, Massachusetts, vice president of TOS, and writing committee chair of the "Pharmacological Management of Obesity: An Endocrine Society Clinical Practice Guideline" (J Clin Endocrinol Metab. 2015;100:342–362). The study examines whether diets that are high in monounsaturated fatty acid may reduce the risk for central adiposity and improve metabolic risk factors, she noted.

"The newer attitudes about fats are that unsaturated fats may confer health benefits," noted Dr Kahan, adding that "this is a far cry from years past, when all fats were conflated and vilified as unhealthful."

Insurance Coverage, Mindfulness, and More

Dr Kahan next drew attention to an oral presentation that will be given by Ruchi Doshi, MPH, from the Johns Hopkins University School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, who surveyed health professionals about their beliefs about insurance coverage as possible barriers to care. "While [obesity] prevention is essential, we will need to move forward on coverage of appropriate services and treatments for [such] patients," he said.

In another oral presentation, Shana Adise, a graduate student at Pennsylvania State University, will describe how children's food intake is predicted by brain response to anticipation of food and money rewards.

"This is the first study to my knowledge that looks at reward-driven neurobiological differences in children that may predispose to overeating and ultimately obesity. Several studies have shown these reward links in adults," according to Dr Kahan.

He will himself present research that looks at the number of diseases that are linked to obesity. 

And the psychiatrist Dr O'Neil is intrigued by a poster of a randomized pilot trial by Sara Chacko, PhD, from Beth Israel Deaconess Medical Center, Boston, of a mindfulness-based intervention to control weight after bariatric surgery.

"A significant number of bariatric patients either fail to lose as much weight as expected or begin to regain some of what they lost," he noted, adding that it will be interesting to see whether the study finds this could be averted by teaching patients to become more aware of their emotions and eating patterns.

Key Bariatric Surgery Presentations

Meanwhile ASMBS president Raul J Rosenthal, MD, from the Cleveland Clinic Florida, in Weston, drew attention to the top 10 papers from the ASMBS, which are being presented in two sessions at the meeting.

Among the highlights:

  • Oliver A Varban, MD, will present a study entitled "Goals and expectations: What patients and referring physicians should know about who achieves a body mass index (BMI) < 30 kg/m2 after bariatric surgery" (Abstract A106).

  • Alex D Michaels, MD, will describe 30-year findings from a study looking at postbariatric surgery hypoglycemia (Abstract A103).

  • John M Morton, MD, will report results from the Decreasing Readmission Through Opportunities Provided (DROP) study, a national quality-improvement collaborative (Abstract A101).

  • Wendy C King, PhD, will speak about a 7-year study of incident substance use and misuse among adults following Roux-en Y or laparoscopic adjustable gastric banding (Abstract A104).

  • Marie Menke, MD, will discuss a 7-year study of contraception and conception following bariatric surgery (Abstract A107)

    Combined Session With Audience Participation

    Finally, said Dr Apovian, "I would [attend] the panel case joint discussion between TOS and ASMBS" — the keynote discussion on surgery, weight regain, and weight loss.

    "We have basic and clinical scientists, policy people, and behaviorists talking about a case of two people and what treatments should be given to them and why," she explained. "We will discuss pathophysiology of obesity, treatment options, and policy and insurance coverage," and audience members are able and invited to participate in the discussion.

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