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Obesity and the Microbiome
Abstracts / Can J Diabetes 39 (2015) S1eS7
recommended level of physical activity. Weight loss is an important outcome for obese patients. However, physical activity is associated with no or moderate weight loss, and there is a large weight loss variability between individuals. More and more evidence confirms that physical activity interventions are feasible and effective to maintain weight loss and improve health of individuals with severe obesity beyond weight loss. Thus, to avoid frustration and disappointment, no focus on weight loss should be done during physical activity intervention. Overall, more high quality studies are now required to improve the level of evidence and provide information on the optimal physical activity support, modes of delivery, timing and dose in individuals with severe obesity. In addition, the assessment of implementation outcomes (compliance, adverse outcomes and satisfaction) and cost-effectiveness analyses are required to support that physical activity intervention is a worthwhile option in the medical and surgical treatment of severe obesity.
Saturday, May 2: Plenaries p.m. PL29 Bariatric Tourism DANIEL W. BIRCH* Center for the Advancement of Minimally Invasive Surgery (CAMIS), Edmonton, AB, Canada Abstract not available at time of print. PL30 Infectiobesity: Obesity of Infectious Origin NIKHIL DHURANDHAR* Department of Nutritional Sciences, Texas Tech University, Lubbock, TX, USA Obesity is a complex disease with a multifactorial etiology. The putative contributors of obesity range from genetics to fetal environment and sleep hygiene to assortative mating. In addition, certain infections may play a role in promoting obesity, termed infectobesity. In the past 30 years, about a dozen separate microbes have been linked with obesity, including viruses, bacteria, scrapie agents and even parasites. Human adenovirus 36 (Ad36) is the most studied adipogenic pathogen. Experimental infection of Ad36 induces obesity in various animal models, including chickens, ice, rats, and monkeys. Most studies from countries in Europe, North America, and Asia, report that natural infection of Ad36 is cross-sectionally and longitudinally associated with obesity and weight gain in adults and children. Among human twins studied, those naturally infected with Ad36 had greater adiposity compared to their respective co-twins who were uninfected. Ethical considerations preclude experimental infection of humans with Ad36 to demonstrate a cause and effect. Additional research is needed to better
S7
understand the phenomenon. A long term goal of this investigation is to develop a vaccine to prevent Ad36-induced obesity. More importantly, the concept of infectobesity underscores the significance of recognizing multiple contributors of obesity, in order to develop effective cause-specific prevention and treatment strategies.
PL31 Bariatric Revision Surgery: The Cost of Doing Business CHRISTOPHER DE GARA* Center for the Advancement of Minimally Invasive Surgery (CAMIS), Edmonton, AB, Canada Obesity’s global costs are $2 Trillion annually with 30% (rising to 50% in 2030) or 2.1 Billion people obese individuals worldwide (McKinsey Global Institute 2015). Currently, surgery remains the only truly effective and sustainable management of obesity and its comorbidities. Inevitably a proportion (10-20%) will fail after 36 months. A combination of weight regain (recidivism), early complications (bleeding, anastomotic leak, obstruction), and late complications (mechanical pouch problems, obstruction, nutritional deficits). Revision surgery aims to address these. In Alberta a dedicated Revision Bariatric Surgery Clinic has been established to tackle these problems and those of Bariatric Medical Tourism (Medical Tourism in Bariatric Surgery e Birch et al Am J Surg 2010). Only about a third of patients attending the clinic get further surgery, mainly as they have “red flags” to proceeding with successful bariatric surgery (The Anatomy of Weight Recidivism and a Revision Bariatric Surgical Clinic e de Gara & Karmali Gastroenterology Research and Practice 2013). Revision surgery is associated with a 30% short and medium term complication rate. To date (N¼75) have achieved median body mass index (BMI) reduction from 44 to 33 at 1 year with attendant diminishment of comorbidities. Surgical costs (CAD) range from lap band removal $3 900, band removal plus bypass $23.300, bypass or sleeve revision $18 800, and VBG to bypass $18 400. While bariatric surgery is considered to be cost effectiveness at an Incremental Cost-Utility Ratio of $6 500-$12 000 per quality adjusted life year (CADTH report), revision costs have yet to included in Cost-Effectiveness analyses. Revision surge, its complications, reappearance of comorbidities may be $1.1 million per year - facts that policy makers will inevitably have to grapple with.
PL32 Obesity and the Microbiome JOHANE ALLARD* University Health Network, Toronto, ON, Canada Abstract not available at time of print.
recommended level of physical activity. Weight loss is an important outcome for obese patients. However, physical activity is associated with no or moderate weight loss, and there is a large weight loss variability between individuals. More and more evidence confirms that physical activity interventions are feasible and effective to maintain weight loss and improve health of individuals with severe obesity beyond weight loss. Thus, to avoid frustration and disappointment, no focus on weight loss should be done during physical activity intervention. Overall, more high quality studies are now required to improve the level of evidence and provide information on the optimal physical activity support, modes of delivery, timing and dose in individuals with severe obesity. In addition, the assessment of implementation outcomes (compliance, adverse outcomes and satisfaction) and cost-effectiveness analyses are required to support that physical activity intervention is a worthwhile option in the medical and surgical treatment of severe obesity.
Saturday, May 2: Plenaries p.m. PL29 Bariatric Tourism DANIEL W. BIRCH* Center for the Advancement of Minimally Invasive Surgery (CAMIS), Edmonton, AB, Canada Abstract not available at time of print. PL30 Infectiobesity: Obesity of Infectious Origin NIKHIL DHURANDHAR* Department of Nutritional Sciences, Texas Tech University, Lubbock, TX, USA Obesity is a complex disease with a multifactorial etiology. The putative contributors of obesity range from genetics to fetal environment and sleep hygiene to assortative mating. In addition, certain infections may play a role in promoting obesity, termed infectobesity. In the past 30 years, about a dozen separate microbes have been linked with obesity, including viruses, bacteria, scrapie agents and even parasites. Human adenovirus 36 (Ad36) is the most studied adipogenic pathogen. Experimental infection of Ad36 induces obesity in various animal models, including chickens, ice, rats, and monkeys. Most studies from countries in Europe, North America, and Asia, report that natural infection of Ad36 is cross-sectionally and longitudinally associated with obesity and weight gain in adults and children. Among human twins studied, those naturally infected with Ad36 had greater adiposity compared to their respective co-twins who were uninfected. Ethical considerations preclude experimental infection of humans with Ad36 to demonstrate a cause and effect. Additional research is needed to better
S7
understand the phenomenon. A long term goal of this investigation is to develop a vaccine to prevent Ad36-induced obesity. More importantly, the concept of infectobesity underscores the significance of recognizing multiple contributors of obesity, in order to develop effective cause-specific prevention and treatment strategies.
PL31 Bariatric Revision Surgery: The Cost of Doing Business CHRISTOPHER DE GARA* Center for the Advancement of Minimally Invasive Surgery (CAMIS), Edmonton, AB, Canada Obesity’s global costs are $2 Trillion annually with 30% (rising to 50% in 2030) or 2.1 Billion people obese individuals worldwide (McKinsey Global Institute 2015). Currently, surgery remains the only truly effective and sustainable management of obesity and its comorbidities. Inevitably a proportion (10-20%) will fail after 36 months. A combination of weight regain (recidivism), early complications (bleeding, anastomotic leak, obstruction), and late complications (mechanical pouch problems, obstruction, nutritional deficits). Revision surgery aims to address these. In Alberta a dedicated Revision Bariatric Surgery Clinic has been established to tackle these problems and those of Bariatric Medical Tourism (Medical Tourism in Bariatric Surgery e Birch et al Am J Surg 2010). Only about a third of patients attending the clinic get further surgery, mainly as they have “red flags” to proceeding with successful bariatric surgery (The Anatomy of Weight Recidivism and a Revision Bariatric Surgical Clinic e de Gara & Karmali Gastroenterology Research and Practice 2013). Revision surgery is associated with a 30% short and medium term complication rate. To date (N¼75) have achieved median body mass index (BMI) reduction from 44 to 33 at 1 year with attendant diminishment of comorbidities. Surgical costs (CAD) range from lap band removal $3 900, band removal plus bypass $23.300, bypass or sleeve revision $18 800, and VBG to bypass $18 400. While bariatric surgery is considered to be cost effectiveness at an Incremental Cost-Utility Ratio of $6 500-$12 000 per quality adjusted life year (CADTH report), revision costs have yet to included in Cost-Effectiveness analyses. Revision surge, its complications, reappearance of comorbidities may be $1.1 million per year - facts that policy makers will inevitably have to grapple with.
PL32 Obesity and the Microbiome JOHANE ALLARD* University Health Network, Toronto, ON, Canada Abstract not available at time of print.