outlook: OBESITY epidemic

Pharmacy Times
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Side Effects of Obesity

Diverticulitis Affecting Younger,Obese Adults

Obesity is causing acute diverticulitis inyounger adults, according to a new studyfrom the University of Maryland MedicalCenter. The condition, diverticulosis, causedby the effects of a low-fiber diet, occurswhen pressure on the colon causes pouchesto develop in the bowel wall. Diverticulitisis when these pouches become infectedand inflamed, possibly resulting in perforationsin the intestinal wall.

The study divided 104 patients into 2age groups: < 50 years and >50.Abdominal obesity was found in 85.7% ofyounger patients and 77% of olderpatients. At around age 20, obese adultsare at risk for diverticulitis and the possibilityof recurring attacks of inflameddiverticula. Researcher Barry Daly, MD,noted that physicians should be awarethat when young, obese patients presentwith acute abdominal pain, it may becaused by diverticulitis. Dr. Daly said,"Over the past 10 years, I've noted thatmany patients coming into the emergencyroom with CT [computed tomography]findings of acute diverticulitisseemed younger than traditional teachingsuggested, and often they wereobese." Results of the study were publishedin the September 2006 issue of theAmerican Journal of Roentgenology.

High BMI Connected to PoorCognition

A recent French study examined thepossible connection between being overweightand having a poor memory.Cognitive tests measured memory, attention,and speed of learning in 2223 healthyFrench adults between ages 32 and 62 in1996. Participants took the tests again 5years later. The researchers found thatparticipants with a high body mass index(BMI) scored lower on the tests than thosewith a lower BMI. People with a high BMIalso showed greater cognitive decline inthe 5-year period.

The researchers suggest that overweightpeople may have a higher risk fordeveloping dementia later in life. Theirresults, published in an October 2006issue of Neurology, suggest that cardiovasculardisease or diabetes?both associatedwith obesity?may be the link.Study author Maxime Cournot, MD, fromToulouse University, notes that the thickeningand hardening of blood vessels tothe brain can contribute to dementia.Also, the effects of insulin on brain cellsmay affect cognition. Another theoryposits that leptin, produced by fat cells,may directly affect the brain. Other studieshave suggested that leptin, the"hunger hormone," has an effect on learningand memory.

Obesity May Increase SurgeryComplications

In addition to increasing the risks forheart disease and diabetes, obesity mayincrease the risk for complications duringspinal surgery, according to an extensivecase review. Orthopedic surgeon JohnRatliff, MD, now with the JeffersonMedical College in Philadelphia, reviewed332 cases of thoracic and lumbar surgerythat he performed between 2002 and2005 while at the Rush University MedicalCenter and the Neurological andOrthopedic Institute in Chicago. Withinthat group of patients, 71% were overweightand 39% were obese.

Dr. Ratliff noted a higher number of surgery-related complications, such as bloodclots, wound infections, heart problems,and deep vein thrombosis, among theextremely overweight and obesepatients. Among patients who were notobese, there was about a 14% chance ofcomplication; that rate was 20% for thosewith a BMI higher than 30 and 36% forthose with a BMI of 40 or more. Dr. Ratliffadvises patients who are extremely overweightto put off surgery and lose weightin an effort to reduce the risk of complication.The findings were presented at the2006 Congress of Neurological SurgeonsAnnual Meeting in Chicago in October.

Weight-loss Surgery May HinderAbsorption of Drugs, Nutrients

A literature review suggests thatpatients who undergo obesity surgerymay experience difficulty absorbing medicationformulations that are delayed-ortimed-release. The researchers from theUniversity of Kentucky College of Pharmacywho originated the review notethat nutrients from vitamins, minerals,and supplements also may be difficult toabsorb. They advise patients who havehad weight-loss surgery to inform theirpharmacists and physicians that theyhave undergone bariatric stomach surgery,as that may affect medication andvitamin intake.

The literature review focused on thestomach surgery known as Roux-en-Ygastric bypass, where the bypass of a portionof the small intestine may cause malabsorptionof nutrients. If drug absorptionis a concern, the researchers suggestalternative medications or dosage forms,such as a patch or liquid form. Studyauthor April D. Miller, PharmD, added,"After bariatric surgery, all patients shouldtake a daily multivitamin and calcium supplementation?preferably in a powder orliquid form to enhance absorption." Dr.Miller further suggests monthly B12 injectionsas well as bone density testing. Thestudy was published in the October 2006issue of the American Journal of Health-System Pharmacy.

Ms. Farley is a freelance medicalwriter based in Wakefield, RI.

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