Big Belly May Increase the Risk of Sudden Death

The United States is experiencing an epidemic of obesity.  Baby Boomers were accustomed to discussing weight in terms of ideal body weight and height weight charts.  Susbsequent generations have become used to the Body Mass Index (BMI) and percentage of body fat.

In a study out of the University of Minnesota and the VA Medical Center of Minneapolis, researchers now encourage us to look at the ratio between our waists and our hips as the most accurate predictive tool for sudden cardiac death.  Sudden cardiac death is defined as a death that occurred within one hour of the onset of symptoms when witnessed or within 24 hours of being seen alive when the death was not witnessed.

Their study included 15,156 participants from the Atherosclerosis Risk in Communities Study which enrolled persons between 45 and 64 years old.  For women with a waist to hip ratio of 0.97 or higher and men with a ratio of 1.01 or higher there was 40% greater chance of sudden cardiac death. While all measures of obesity, including body mass index and waist circumference, could be associated with an increased risk of cardiac disease, only elevated waist hip ratio correlated with an increased risk for sudden cardiac death.

Selcuk Adabag, MD a main researcher in the study made it clear that obesity is “a root cause of problems.”  Physicians need to be paying particular attention to weight gain especially in individuals with a big belly and apple shape and they need to actively work to reduce it. Dr. Selcuk was not sure why belly fat led to sudden death but speculated that belly fat may produce unique inflammatory markers which could lead to heart muscle fibrosis and then arrhythmias and sudden death.

In my practice we are weighing individuals as well as checking heights and body mass index at each visit. This is designed to establish risk of developing severe diseases and preventing them.  We continue to work with our patients to reduce their risk factors.

Bariatric Surgery Reverses Diabetes – But What About Seniors?

A recent well written article in the Fort Lauderdale Sun Sentinel discussed how bariatric surgery to treat extreme obesity was also now a formidable weapon against Type II Diabetes Mellitus.   Type II Diabetes Mellitus or adult onset diabetes occurs in older individuals and is closely related to weight gain, high blood pressure, elevated cholesterol, triglycerides and accelerated narrowing of arteries. The accelerated artery-narrowing results in premature and advanced coronary artery disease and peripheral arterial vascular disease.  A study published in the American Journal of Medicine in 2009 looked at 3,188 obese Type 2 diabetics who had bariatric surgery and lost weight.  Amazingly, 78% of them no longer met the criteria to be called diabetics.

Bariatric surgery includes minimally invasive surgery such as laparoscopic adjusted gastric banding to the more invasive re-routing of the intestines and reduction of stomach volume in the classic Roux-en-Y gastric bypass. Other procedures include open duodenal switch and vertical banded gastroplasty.  These types of procedures are only performed in the morbidly obese defined as those with a Body Mass Index (BMI) of 40 or greater.  The results in reversing Type II diabetes have been so impressive that experts are now considering reducing the BMI to 35 for consideration of candidacy to have these procedures.

Why these procedure reverse diabetes is a matter of debate. Weight loss is a traditional successful treatment for Type II diabetes. Some believe that the actual surgery on the gut stimulates hormones that help control the blood sugar. The positive result has led insurance companies to now start approving payment for these procedures because the $18,000- $30,000 cost is cheap compared to the $300,000 lifetime cost of treating a Type II diabetic.

With so many elderly obese patients with Type II Diabetes, and other metabolic and cardiovascular complications of obesity in the health system, is the procedure safe for the elderly?  A recent study by Robert B. Dorman M.D., at the University of Minnesota seemed to indicate that the surgery is safe.  He looked at 48,378 patients with a BMI above 35 who had bariatric surgery between 2005 and 2009.  He found that the mortality rate for seniors over 65 was higher than for younger patients but was still extremely low and rare for a death to occur. Longer hospital stays were noted for the elderly and were related to how heavy the patient was prior to surgery.  This study gives bariatric surgeons excellent figures on the risk of complications when performing bariatric surgery in the elderly.

As a primary care physician working with elderly Type II Diabetics, I will continue to stress lifestyle improvement with dietary improvement, weight reduction, increased exercise and activity as first line therapy.  Medication when necessary will be next. Bariatric surgery, now proven to be safe is a new weapon available to the proper patient.  Finding an experienced surgeon in performing the procedures (more than 200 of that procedure) will be paramount in reducing complications and mortality.