outlook: OBESITY epidemic

DECEMBER 01, 2006
Susan Farley

Side Effects of Obesity

Diverticulitis Affecting Younger, Obese Adults

Obesity is causing acute diverticulitis in younger adults, according to a new study from the University of Maryland Medical Center. The condition, diverticulosis, caused by the effects of a low-fiber diet, occurs when pressure on the colon causes pouches to develop in the bowel wall. Diverticulitis is when these pouches become infected and inflamed, possibly resulting in perforations in the intestinal wall.

The study divided 104 patients into 2 age groups: < 50 years and >50. Abdominal obesity was found in 85.7% of younger patients and 77% of older patients. At around age 20, obese adults are at risk for diverticulitis and the possibility of recurring attacks of inflamed diverticula. Researcher Barry Daly, MD, noted that physicians should be aware that when young, obese patients present with acute abdominal pain, it may be caused by diverticulitis. Dr. Daly said, "Over the past 10 years, I've noted that many patients coming into the emergency room with CT [computed tomography] findings of acute diverticulitis seemed younger than traditional teaching suggested, and often they were obese." Results of the study were published in the September 2006 issue of the American Journal of Roentgenology.

High BMI Connected to Poor Cognition

A recent French study examined the possible connection between being overweight and having a poor memory. Cognitive tests measured memory, attention, and speed of learning in 2223 healthy French adults between ages 32 and 62 in 1996. Participants took the tests again 5 years later. The researchers found that participants with a high body mass index (BMI) scored lower on the tests than those with a lower BMI. People with a high BMI also showed greater cognitive decline in the 5-year period.

The researchers suggest that overweight people may have a higher risk for developing dementia later in life. Their results, published in an October 2006 issue of Neurology, suggest that cardiovascular disease or diabetes?both associated with obesity?may be the link. Study author Maxime Cournot, MD, from Toulouse University, notes that the thickening and hardening of blood vessels to the brain can contribute to dementia. Also, the effects of insulin on brain cells may affect cognition. Another theory posits that leptin, produced by fat cells, may directly affect the brain. Other studies have suggested that leptin, the "hunger hormone," has an effect on learning and memory.

Obesity May Increase Surgery Complications

In addition to increasing the risks for heart disease and diabetes, obesity may increase the risk for complications during spinal surgery, according to an extensive case review. Orthopedic surgeon John Ratliff, MD, now with the Jefferson Medical College in Philadelphia, reviewed 332 cases of thoracic and lumbar surgery that he performed between 2002 and 2005 while at the Rush University Medical Center and the Neurological and Orthopedic Institute in Chicago. Within that group of patients, 71% were overweight and 39% were obese.

Dr. Ratliff noted a higher number of surgery- related complications, such as blood clots, wound infections, heart problems, and deep vein thrombosis, among the extremely overweight and obese patients. Among patients who were not obese, there was about a 14% chance of complication; that rate was 20% for those with a BMI higher than 30 and 36% for those with a BMI of 40 or more. Dr. Ratliff advises patients who are extremely overweight to put off surgery and lose weight in an effort to reduce the risk of complication. The findings were presented at the 2006 Congress of Neurological Surgeons Annual Meeting in Chicago in October.

Weight-loss Surgery May Hinder Absorption of Drugs, Nutrients

A literature review suggests that patients who undergo obesity surgery may experience difficulty absorbing medication formulations that are delayed-or timed-release. The researchers from the University of Kentucky College of Pharmacy who originated the review note that nutrients from vitamins, minerals, and supplements also may be difficult to absorb. They advise patients who have had weight-loss surgery to inform their pharmacists and physicians that they have undergone bariatric stomach surgery, as that may affect medication and vitamin intake.

The literature review focused on the stomach surgery known as Roux-en-Y gastric bypass, where the bypass of a portion of the small intestine may cause malabsorption of nutrients. If drug absorption is a concern, the researchers suggest alternative medications or dosage forms, such as a patch or liquid form. Study author April D. Miller, PharmD, added, "After bariatric surgery, all patients should take a daily multivitamin and calcium supplementation?preferably in a powder or liquid form to enhance absorption." Dr. Miller further suggests monthly B12 injections as well as bone density testing. The study was published in the October 2006 issue of the American Journal of Health-System Pharmacy.

Ms. Farley is a freelance medical writer based in Wakefield, RI.