Scientists discover powerful biomarker panel for the early detection of breast cancer

December 15, 2010 by admin

In the war on cancer, perhaps there is nothing more powerful in a physician’s arsenal than early detection. Despite recent advances in early detection and treatment, breast cancer remains a common and significant health problem in the United States and worldwide. Approximately one in ten women will get breast cancer in their lifetime and more than half of women with late stage cancer (II and III) have no cure or effective therapeutic available.

Using a new, powerful method for rapidly screening molecules associated with disease, proteomics expert Joshua LaBaer and colleagues from the Biodesign Institute at Arizona State University have identified a broad panel of 28 early predictors, or biomarkers, that may one day aid in the early diagnosis of breast cancer.

“We do not have any available blood markers for breast cancer,” said LaBaer, a Virginia G. Piper Chair in Personalized Medicine at ASU who directs the Center for Personalized Diagnostics at the Biodesign Institute. “Our hope is to combine a new type of blood test with mammography screening to aid in the early detection of breast cancer.”

The findings represent the first demonstration of a custom protein array technology deployed to find biomarkers in breast cancer patients before they were clinically diagnosed for cancer. These biomarkers were specific for breast cancer patients and not in healthy women or women with a benign form of breast disease.

Their findings appear in the American Chemistry Society’s Journal of Proteome Research.

The LaBaer lab is involved in a quest for biomarkers that detect early disease and distinguish benign breast disease from invasive cancers to guide patient and doctor decisions. LaBaer is an expert in a burgeoning field that strives to understand the global role of protein function, called proteomics, that plays a powerful and relevant role in the discovery of biomarkersA—unique molecular fingerprints of disease—that is part of a large scale Biodesign Institute effort to identify biosignatures that can provide early warning for those at risk of major illnesses, including cancer and diabetes.

To develop new biomarkers for the early detection of breast cancer, LaBaer’s team explored the intersection between cancer and our bodies’ primary defense mechanism against invaders, the immune system. Previous studies have shown that proteins produced by cancers can trigger the body to produce antibodies that are not found in healthy individuals. These “autoantibodies” can be measured in the blood and used to betray the presence of a hidden cancer.

The challenge faced by researchers is to determine which antibodies among millions are specific for breast cancer. To accomplish this, the team used a novel protein microarray technology, called Nucleic Acid Protein Programmable Array (NAPPA), which was invented in LaBaer’s Harvard Institute of Proteomics lab in 2004.

Protein microarrays display thousands of different candidate proteins lined up in rows and columns on a single microscopic slide. A tiny drop of blood was added to the microarray to look for proteins that are recognized by the antibodies from the cancer patients but not from the healthy women.

To narrow down the list of candidates, several successive screens were performed that compared the immune responses in women with early-stage breast cancer, those without cancer, and those with benign abnormalities in their breasts. The patients and controls were also matched for age and location.

Three phases of screens were performed, using increasingly rigorous statistical selection standards that narrowed down the number of potential biomarkers candidates from 5,000 to 761, which showed any measurable difference between healthy and disease populations, to 119, which showed a clear statistical difference. Finally, these were then tested in a blinded study (where the researchers did not know which samples were from breast cancer patients and which ones were from controls) to find the final 28 biomarkers. The group not only looked at how each individual biomarker fared during the screening, but also how the entire panel of biomarkers worked together.

This was the first time the group has utilized NAPPA technology to identify the parts of the immune response that are activated during cancer, and the first serum biomarker panel developed for the discrimination of benign breast disease from invasive breast cancers. The group was pleased to confirm that many of the candidate biomarkers have also been described as important in breast cancer tumor biology and pathology.

“We were surprised at how hard it is to find biomarkers like this,” said LaBaer. “The changes are subtle and rare, which is a real warning shot to those investigating breast cancer research. The key is a team approach that combines many different types of scientific expertise to tackle the problem.”

In addition, LaBaer’s team has a broad interest in identifying autoantibody biomarkers in patients that can be readily used for the detection of many other cancers, such as ovarian cancer, prostate cancer, and lung cancer as well as autoimmune diseases such as diabetes and arthritis.

Samples used in these analyses were obtained from Fox Chase Cancer Center (FCCC), the Duke University Medical Center (DUMC), and the Dana-Farber Cancer Institute (DFCI) with support from the National Cancer Institute (NCI) Early Detection Research Network and the NCI Breast SPORE program. LaBaer’s research is supported by grants from the NCI branch of the National Institutes of Health and a $35 million philanthropic gift from the Virginia G. Piper Charitable Trust.

Healthy weight or healthy mind? Psych drugs can pile on pounds)

Atypical antipsychotic medication may help with psychosis, but taking the drug often comes with a price.

STORY HIGHLIGHTS

• 30 percent of patients who take atypical antipsychotics experience dramatic weight gain
• The drugs appear to contribute to other risk factors for heart disease and diabetes
• Some patients don't feel hungrier yet still gain weight; making metabolic changes possible
• Still, the drugs do help people with serious mental illnesses to function

RELATED TOPICS

• Body Weight
• Bipolar Disorder Medication
• Mental Health
• Mental Health Treatments
• Diabetes

(Health.com) -- Katie's temper tantrums and emotional outbursts became uncontrollable when she was 5 years old. After diagnosing her with Asperger's syndrome and attention deficit hyperactivity disorder (ADHD), doctors placed her on risperidone, an antipsychotic drug used to treat irritability and aggression in autistic children.

The medication "took the edge off," according to her mother, Janet, but it also made Katie ravenously hungry -- a side effect that Janet says she was never warned about. "It was like she had a constant, insatiable hunger and was almost gorging her food," she recalls. "Like when you haven't been able to eat, are starving, and forget your manners."

In less than a month, the slim, 40-pound kindergartner gained 5.5 pounds -- about 14 percent of her body weight. (That's comparable to a 120-pound woman gaining 17 pounds.) Within a year Katie weighed 60 pounds.

Risperidone (sold under the brand name Risperdal) belongs to a class of drugs, known as atypical antipsychotics, that also includes Seroquel, Zyprexa, Abilify, and Geodon, among others. When they first appeared on the market in the 1990s, these drugs -- sometimes called "second-generation" antipsychotics, to distinguish them from older antipsychotics such as thorazine -- were used primarily to treat bipolar disorder and schizophrenia.

Health.com: 10 subtle signs of bipolar disorder

That was just a start. In recent years, the Food and Drug Administration (FDA) has approved several of the drugs as an add-on medication for depression and autism, and research shows that doctors commonly prescribe them "off-label" (i.e., without the FDA's official blessing) for a wide range of conditions, including anxiety, ADHD, post-traumatic stress disorder (PTSD), and even insomnia.

The use of atypical antipsychotics has soared as a result, and they are now the best-selling class of prescription drugs in the U.S. Roughly 5.5 million people in the U.S. received a prescription for an atypical antipsychotic in 2008, an increase of more than 20 percent from 2004. The increase has been especially dramatic among children, adolescents, and older people.

As the number of prescriptions has risen, so too have concerns about the dramatic weight gain that occurs in as many as 30 percent of patients who take atypical antipsychotics.

In some cases, the drugs also appear to contribute to elevated blood-sugar levels, high blood pressure, and other risk factors for heart disease and diabetes. (Whether the drugs do in fact cause dangerous metabolic changes, including diabetes, is currently being debated in class-action lawsuits involving thousands of patients and several law firms around the U.S.)

Health.com: Getting rid of belly fat may lower type 2 diabetes risk

Patients such as Katie (or their parents) may find themselves in a dilemma: The drug that keeps their debilitating mental illness at bay might cause their weight to balloon, potentially leading to emotional distress and serious medical problems that have little to do with their original diagnosis.

It's not entirely clear how widespread or serious antipsychotic-related weight gain is. But it's common enough -- and potentially damaging enough -- that it's an important factor to consider when deciding whether to take these drugs.

The anatomy of weight gain

Michael, an outgoing and physically fit 19-year-old college student, experienced his first psychotic episode earlier this year. While at a relative's house on Memorial Day weekend, he began acting oddly, typing frantically into a friend's iPhone and yelling at someone who was not there. "It was like a light switch changed from on to off," his mother, Alisa, recalls.

He was taken to the hospital and put on risperidone and anti-anxiety medication. Although he experienced a handful of mostly minor side effects, such as feeling lethargic, the most notable one was a voracious appetite, just like Katie's. He began eating constantly and gained 25 pounds in six months.

Health.com: How the pros curb food cravings

Researchers aren't certain what's behind the dramatic weight gain experienced by some patients taking antipsychotics, but the revved-up appetite that visited Katie and Michael is almost certainly partly to blame.

In a 2007 study involving mice, researchers at John Hopkins University and the University of Vermont found that Zyprexa and another antipsychotic, clozapine (Clozaril), quadrupled the levels of a brain enzyme that spurs appetite. And a study in humans published in the journal Obesity earlier this year found that men who took Zyprexa for just two weeks increased their food intake by 18 percent, on average.

Appetite may not be the whole story, however. Some patients on atypical antipsychotics don't feel hungrier yet still gain weight; in these cases, metabolic changes -- such as a rise in insulin resistance -- may be responsible, says Dr. James Phelps, M.D., a psychiatrist at Samaritan Health Services, in Corvallis, Oregon.

As with anyone who's overweight (or on their way there), people on antipsychotics who follow an intensive regimen of diet and exercise can slow and even reverse weight gain stemming from the drugs. But as some experts have pointed out, a program like that may be too much to ask from people who are depressed, mentally ill, or feeling sedated, a familiar side effect of antipsychotics.

Health.com: How exercise may boost your mood

How common is it?

Studies have found that between 7 percent and 30 percent of people taking atypical antipsychotics experience "clinically significant" weight gain, which is defined as gaining 7 percent or more of your body weight. In those studies, the percentage of people on an atypical antipsychotic who gained a clinically significant amount of weight was between 2 and 10 times greater than the comparable rate among people taking placebo.

Psychiatrists say these ranges are in line with what they see in practice. Dr. Merrill Herman, M.D., an associate clinical professor of psychiatry at the Albert Einstein College of Medicine, in New York City, says that about one-fifth of his patients who take atypical antipsychotics gain weight.

Phelps says that he, too, sees the problem often. "Glucose numbers go up quickly with a lot of my patients," he says, referring to blood-sugar levels. "Most people who take Zyprexa get a profound weight gain, even though the studies don't seem to come out like that."

Dropout rates are one reason weight gain may be understated in studies. The percentage of study participants who, for a variety of reasons, stopped taking antipsychotics (both first- and second-generation) has been as high as 82 percent. Weight gain is a common reason for discontinuing treatment, so the people who stay with a drug until the end of a study may be less prone to its metabolic side effects.

Health.com: Signs you should stop, adjust, or switch antidepressants

In addition, the manufacturers of some atypical antipsychotics have been accused of suppressing data. In a now-notorious internal email from 1999 that came to light during the recent lawsuits, a manager at AstraZeneca described the company as having "buried" (i.e., declined to publish or publicize) at least three clinical trials involving Seroquel.

In one of those studies, 45 percent of the patients who took the drug experienced substantial weight gain -- 11 pounds in one year, on average. (A spokesperson for AstraZeneca, which has agreed to pay hundreds of millions to settle lawsuits related to Seroquel, has said that the company disclosed this study to the FDA, and that Seroquel's side effects, including weight gain, are listed in the prescribing information.)

The study populations may also explain in part why weight gain appears to be less common in studies than in the real world, says Dr. Stephen Grcevich, M.D., a child and adolescent psychiatrist in Chagrin Falls, Ohio, and a professor of psychiatry at Case Western University.

Many of the children who enroll in studies that drug companies conduct for FDA approval have already tried other antipsychotics, and thus may have already experienced some weight gain, Grcevich says.

A 2005 study in the Journal of the American Medical Association that did look at children and teenagers who were taking an atypical antipsychotic for the first time found that 10 percent to 36 percent became overweight or obese after just 11 weeks on the drugs.

Health.com: Is it baby fat -- or obesity?

Risk versus reward

Janet voiced her concerns about Katie's weight gain to numerous physicians, but most said, "If the symptoms are better, a little weight gain isn't a big deal."

As it turns out, it was a big deal. After being on the medication for nearly six years, Katie's cholesterol, triglycerides (fat in the blood), and other metabolic measures began to rise to unhealthy levels.

Grcevich, who began seeing Katie about three years after she started taking risperidone (and is not currently her doctor), recommended weaning her from the medication, but she became violent and suicidal. Her parents placed Katie -- who has since been diagnosed with a number of developmental, neurological, and emotional conditions -- in a residential treatment facility, where she is now receiving care to be successfully removed from risperidone.

If weight gain is a potentially serious problem with atypical antipsychotics, why do so many psychiatrists still prescribe them? The answer's simple: For many patients, the drugs are effective. They reduce the risk of violence and suicide, and they help people with serious mental illnesses to function.

Health.com: How to spot the warning signs of suicide

"I think the evidence is compelling that if a child or teenager clearly has bipolar disorder these are the best medicines to treat that condition," Grcevich says. The same goes for children with schizophrenia and autism with aggressive behavior, he adds.

Every doctor and patient needs to carefully weigh the risks of the mental illness versus the potential weight gain. "In the last year or two, there's been a growing awareness among physicians of the risks, especially of the weight gain issue," says Grcevich. Often, after he informs patients and their parents about the possible side effects of atypical antipsychotics, "families choose not to pursue that as a treatment option," he says.

There are other options for adults with bipolar disorder or schizophrenia, but they don't always do the trick. For example, some bipolar patients can be treated with mood stabilizers such as lamotrigine, but, unlike atypical antipsychotics, they do not help with symptoms during the manic phase of the disorder, Phelps points out.

In the end, it's up to the doctor and patient to work together to figure out a plan. Except in emergencies and other special cases, Phelps generally discusses four principles with his patients prior to beginning any drug therapy: why he is suggesting the treatment, what the alternatives are, what the risks are, and any questions they may have.

"Weight gain does play a role in decision making," he says. "The problem is, it is endless working your way through the trade-offs."

For now, Michael has decided that the weight gain is a reasonable price to pay for the benefits of the medication, which helps soothe his anxiety. "He's come to terms with having to take it and accepting the risks and side effects," Alisa says.

Copyright Health Magazine 2010

Confession: My Sugar Addiction has Returned

Back in May, I wrote a blog titled "Confession: I'm Breaking My Sugar Addiction". At that point I had significantly cut back on the amount of candy, cookies, cake, etc. that I was consuming. I felt better (both physically and mentally) and had more energy. I thought I had finally changed my eating habits, only eating treats now and then (instead of daily.) But since then, things haven't exactly gone as planned�.

Basically, I fell off the "less sugar" wagon. Back in September I suffered a running injury and had a few other things happen in my life that threw me for a loop. Instead of staying focused on my goals, I started to get off track. It wasn't until a few months later that I realized I had fallen back into my old habits: I craved sweets after lunch and dinner, and instead of being satisfied with something small, I wanted bigger things- like a giant piece of my son's birthday cake instead of a reasonable slice. I've gained a few pounds back, but I try not to stress about that too much. What has disappointed me more than anything is that I know exactly what I need to do to get back on track. But so far, I haven't done it.

Every day I wake up saying "Today is the day where I will feel good instead of guilty about my food choices." But every day I find one reason or another why I need that extra handful of M&M's. I know that my body can quickly get used to cutting back on the dessert and I won't crave it so much. So what is it going to take to get my mind onboard? I felt like writing this blog is making me put it out there, and publicly say that enough is enough. My diet is generally very healthy, but sweets are my downfall. I'm tired of feeling guilty, so it's time to make the changes necessary for me to feel better about my food choices. It's time for me to get back on the wagon and start practicing what I preach.

So here we go��.

What do you think? Have you recently fallen off-track with your goals? What are you doing to get things moving in the right direction again?

Advice on Coping with the Holidays, from an Obesity Expert

Editor's Note: This summer we interviewed renowned obesity expert Dr. Martin Binks, and, due to the overwhelming popularity of that post, he has agreed to contribute regular guest posts to the dailySpark. We're thrilled to have him!

NEW: Dr. Binks shared a video on this same subject!

By Dr. Martin Binks

So the holidays have arrived with all the promise of Norman Rockwell-like family celebrations, joy, good cheer, gift giving and spectacular feasts and festivities � maybe. At this time of celebration our expectations are often quite high and our responsibilities and schedules seem to grow exponentially. On top of all the normal day-to-day things like going to work (or in light of our current economy, looking for a job), getting the kids to school and extracurricular activities, and basically living our already full lives, we find ourselves juggling budgets to buy gifts, attending extra family and work-related social events, decorating, cooking--and the list goes on and on. Then if we do all this successfully, we are blessed with the actual holiday, where people you may only socialize with or even see once a year come and judge your party-giving skills, your cooking and the quality of the crystal ball reading you were required to do to find the "perfect gift." In all of this commotion it�s often too easy to forget that self-care is still important. In fact "me time" is often last on the list and frequently postponed until January.

Now don�t get me wrong, I love the holiday season and truly believe it can be a wonderful, rewarding and fun time provided we approach it in the right way and don�t get overwhelmed. Through my work with patients and families I have come to understand some ways that this stressful time of year can remain joyous. I would like to share some general perspectives that seem to have helped folks with whom I work. I will also be reminding you of some core skills that can make coping with and even enjoying this season a little easier by allowing you to focus on realistic self-care goals during this busy season.

1. Holidays are not a season; they are a series of discrete events of varied duration interspersed with periods of preparation/aftermath but also with periods of holiday-free time. What do I mean by that? All too often, in terms of self-care things like diet, exercise, stress management and finding time to take care of ourselves are relegated to "after the holidays." The result being a period of about 2 months (from before Thanksgiving until after New Years) where we let ourselves go and backslide on our health goals. Instead of doing this, consider containing the individual events to a reasonable and accurate timeframe. Whether it's a holiday party, a visit with friends, shopping, or the holiday event itself, each needs to have a clear beginning and end (a few hours, a half day, or a couple days) after which you return "to normal" so that during the hours or days in between you do what�s best for you and your health.
   
   
2. Don�t make a single holiday event into an all-day healthy eating and exercise hiatus. So let�s say you have a holiday party tonight. All too often on holidays folks forget that if you eat a little less (but don�t starve yourself) during the day and be sure to get your exercise, you will benefit both in terms of overall calorie balance for the day but also psychologically you will feel more in control and better prepared to stay with your plan in the days that follow. So the extra calories you might take in at that one event don�t to build to being several days of feeling "off your plan." Do this for each "discrete event" throughout the holidays and you won�t have a 10 pound mountain to overcome in January.
   
3. It�s OK to be frustrated. So many times I hear people beating themselves (or friends and family members) up over the fact that every minute of every event was not perfect, joyous and without disagreement. Think about it, at the height of one of the busiest times of the year, with all the pressure to make things perfect, we then throw groups of people together and expect them to get along perfectly. Not going to happen. Families and friends sometimes disagree, often we all act in ways that might get on people�s nerves � why would the holidays be any different? So think about how to minimize conflict by maximizing your acceptance of other people. More often than not if you try not to take things too personally you will be happier and your friends and family will too.
   
   
4. Take time for yourself. Face it, we all do better if we have some quiet time just for ourselves but that is usually the first thing to go when we are busy. Interestingly if you do take that time to recharge, other things seem to be handled more easily, day to day challenges seem less stressful and life seems a little less overwhelming. This is true every day including during the holiday season. So whether it�s taking an hour for a relaxing bath, reading or fitting in some exercise, down time rejuvenates and makes life easier to handle.

In addition to the tips and strategies above, there are a couple core self-care skills that you can apply during the holidays to improve the quality of your life.

Fight negative thinking.

We all have an �internal dialogue� that can be either positive or negative. Negative thinking often distorts facts and influences other thoughts, can interfere with our comfort level and our goals, and may impact emotions, self-esteem, and self-confidence. In thinking about the holidays, consider all the times that your internal dialogue gets triggered whether it's at a social event, when preparing for a family gathering, or even when looking in the mirror. I am sure you can think of times your thoughts got in your way or upset you. You may recall times that you realized afterwards that your thoughts got you all worked up even beyond the true "facts" of the situation. This holiday season take time to pause and monitor your thinking especially when you are upset. Understand how your thoughts may be making matters worse then take action to 1) Identify the thoughts that are not helping, 2) Stop those thoughts by simply saying stop, and 3) If possible replace the thoughts with something more calming. For example if you are fretting over a party you have planned, tell yourself �I know I have not thought of EVERYTHING but overall I have planned well for the party and its time to relax and have fun!� This process can work to improve your state of mind in almost every situation.

Set aside time to manage your stress and practice some relaxation strategies.

Managing stress effectively involves fighting the negative thinking that adds to daily stress, not taking on more than you can handle, asking for help when needed, and just keeping the holidays in perspective.

However, even when you are able to do this successfully stress does creep in and over time it does build up unless you practice letting it go on a regular basis.

The body�s natural relaxation response is a powerful antidote to stress. This physiologic state of calm allows our body and mind to rejuvenate. Physiologically, we cannot be both stressed and relaxed simultaneously so if you can learn to elicit the body�s relaxation response, the stress response can be effectively blocked or reduced. When our minds become focused through meditation, visualization, or relaxation, the body responds with physical changes, including decrease in heart rate, blood pressure, respiration, muscle tension, and oxygen consumption. Once you learn how to practice the relaxation response regularly you will notice feeling more relaxed throughout the day even when not actually doing a relaxation exercise. Practice makes perfect when it comes to relaxation.

Here is a quick and simple relaxation breathing exercise to get you started.

Make yourself comfortable. Lie on your back or sit in a chair in a comfortable position.

Close your eyes and begin focusing on your breathing. Notice how the breath feels as it flows into your body and then flows back out again. Take a few deep breaths�

Now place your hand on your stomach. Make sure you allow your stomach to rise as you breathe in followed by the air flowing up into your chest� make the breath last for a count of 3 or 4�as your lungs fill with wonderful, energizing air �Pause for just a moment

�then as you breathe out�allow your stomach and chest to fall as you quietly say the word relax under your breath. Repeat this as you continue to gently breathe in 2, 3, 4� and out 2, 3, 4 �

Continue this exercise for as long as you wish, 5, 10 or even 20 minutes. You will find the more you practice the better you become and the easier it is to feel relaxed. Then, when you don�t have time to stop to do this in a formal way, the practice will have "trained" your body�s relaxation response so that just a few deep breaths and perhaps saying the word relax will trigger a calm feeling at any point during your day.

Some people find it easier to use a relaxation CD or audio file; there are many good ones available. Just try some out and see which ones you like the best � you can usually sample these CDs at your local bookstore or on the internet.

So remember, take some time to care for yourself this busy season and above all enjoy a happy and healthy holiday!

Dr. Martin Binks is Clinical Director and CEO of Binks Behavioral Health PLLC. He is also Assistant Consulting Professor, Division of Medical Psychology, Department of Psychiatry & Behavioral Sciences, Duke University Medical Center. His professional activities include direct patient care, research, consultation services and the development of evidence-based obesity and health promotion programs for healthcare, research and corporate wellness environments.

Dr. Binks received his Ph.D. in clinical psychology from Fairleigh Dickenson University, trained at the Bronx VA Medical Center and completed pre and postdoctoral training in behavioral medicine at the Medical University of South Carolina. He is the former Director of Behavioral Health, Research, and New Business and Strategic Alliances at the Duke Diet & Fitness Center. Dr Binks has worked extensively in the areas of obesity, health & wellness promotion, neuropsychology, substance abuse treatment, post-traumatic stress disorder and spinal cord injury.

Dr. Binks has authored and co-authored multiple research publications and the book The Duke Diet and has appeared on MSNBC Countdown with Keith Olberman, ABC news "On Call�, NPR, Lifetime Television, WGN, 700 Club and is a featured contributor on EverydayHealth.com. He is regularly called upon for commentary on a wide range of health and psychological topics in a variety of national publications and websites including USA Today, Washington Post, LA Times, Oprah Magazine, GX Magazine, AOL Health, Fitness, Men�s and Women�s Health Magazines Reuters and the Associated Press. Dr. Binks has been a contributor with the Army National Guard Decade of Health and Wounded Warriors Programs and is a member of several corporate advisory boards.

His research interests include technology-based healthcare delivery, obesity treatment, non alcoholic fatty liver disease, and overall health promotion. He serves as a reviewer on several scientific journals Dr. Binks contributes to healthcare provider education through his work with students and trainees and by lecturing nationally in the areas of obesity management, health promotion and behavioral medicine. Dr. Binks is currently active in several leadership positions at the national scientific organization The Obesity Society.

Dr. Binks works directly with health coaching clients from around the world through in-person, telephone and web-based technology and also offers individual psychotherapy at the Durham, N.C., location. He can be reached through www.DrBinks.com.

Which tactics do you use to get through the holidays?

Obesity surgery and teenagers

Obesity surgery and teenagers

TThis is becoming an option for overweight or obese teenagers. We are seeing an increase in the number of obese young people and unless action is taken to address this, we could be storing up some serious long term problems.

The teenage years can be difficult in that many young people are struggling to find their identity. They are heavily influenced by their peer group and have a strong desire to fit in with that group. Another aspect is that of body image: most teenagers are very self-conscious about their appearance and go to extraordinary lengths to achieve a certain ‘look’. One aspect of this is the desire to emulate celebrities and models are seen in advertising and the media. The models depicted in various magazines and on the television are young, super skinny and attractive which particularly appeals to young girls.

It is perfectly normal for teenagers, especially girls to put on a bit of weight during adolescence which is mainly due to the physical effects of puberty. However, this can get out of control. Teenagers, particularly young girls are less likely to participate in sports or other physical activities than boys which can cause them to put on weight. Add to this a diet of junk food or too much high fat, sugary food and the problem worsens.

Apart from the physical issues of obesity, there are psychological ones as well. A teenager who is very overweight or obese will experience social isolation, feelings of worthlessness, anxiety and depression. They will find it difficult to form relationships with the opposite sex. Buying clothes can be difficult and embarrassing and in general their confidence and self-esteem. This is a time when they are on a roller coaster with their emotions as well as lacking in confidence. So, to have chronic weight problems as well only makes things worse.

As with children, the answer is to help the teenager to undertake a weight loss programme. This will include advice about healthy eating, exercise and dietary supplements if required. Many teenage girls dislike sports and/or exercise so it is important to encourage them to find an activity they do like. Dance, yoga, Pilates or another type of non-competitive activity are good choices.

If however, diet and exercise has failed to achieve weight loss then surgery is an option. The same criteria apply here as with children and adults: the teenager’s suitability for surgery must be assessed against these criteria.
Should teenagers have obesity surgery?

Providing they are fully aware of the risks as well as the benefits and are able to make an informed, mature decision then there is no reason why they shouldn’t have surgery.

The teenage patient will require the services of specialists in other branches of medicine as well as obesity. This is because the teenager is undergoing puberty and as such there will be other factors to take into account. So, the services of an expert in the field of adolescent medicine will be needed.

Ideally, the teenage patient will have completed their skeletal development (skeleton is fully grown) at around the age of 13 for girls and 15 for boys. Girls tend to mature at a quicker rate than boys (two years ahead) but this is an average figure.

They will have tried a weight management programme for at least six months beforehand. This is exactly the same as it is for adults. Diet and exercise must have been tried first along with weight loss medication if necessary. Only when this has been tried but has failed to work can surgery be then considered.

Research findings do indicate that obesity surgery for teenagers is successful and in many cases has also resolved certain obesity related conditions such as Type 2 diabetes. It also improves their ‘heart health’ as well.

In terms of what type of surgery there are two procedures available for teenagers:

    * Gastric bypass
    * Gastric band

If a teenager has taken abused drugs/alcohol now or in the past, is
unwilling to make lifestyle changes or commit to an aftercare plan then this is likely to exclude them from surgery. For teenage girls, if they are pregnant or have recently given birth then this too is an exclusion.

NICE guidelines recommend a minimum age of 18 for but, if there are exceptional circumstances then surgery is appropriate. Again, this is something which needs to be discussed very carefully with you and your surgeon (or if you are a parent, between you, your teenage son/daughter and your surgeon).

There is no evidence in place to show the long term effects of obesity surgery on teenagers. But, we do know that if their obesity isn’t treated then an obese teenager becomes an obese adult. This can mean long term health risks and, in the extreme cases, a reduced lifespan.
Arguments for obesity surgery for teenagers

Obesity surgery can be very effective at treating chronic weight gain. As well as weight loss it can lower blood pressure and heart rate and, in many cases has also eased or even cured Type 2 diabetes.

However, it does need to form part of an overall package designed to tackle the problem of obesity. For the teenager this means a sensible eating plan, exercise and advice about good and bad food choices. If the teenager has gastric bypass surgery then he/she will have to take a nutritional supplement – to prevent vitamin deficiencies, on a daily basis for the rest of their life.

It has to form part of a long term plan and means a complete change in behaviour and lifestyle for it to succeed.
Arguments against obesity surgery for teenagers

One of main objections to surgery is that of age: some experts consider teenagers to be too young for surgery and cite the potential risks of doing so. However, evidence shows that the risks are in fact, no greater than for adults. All surgery is risky but complications are rare and many of these risks can be reduced. For example, taking a daily nutritional supplement can prevent any vitamin/mineral deficiencies.

If your teenage son or daughter has a medical condition which is directly linked to their weight problems or are suffering from poor health due to excessive weight then surgery may just be the answer.

It is not however, a ‘lifestyle’ choice: many teenagers are keen to have cosmetic surgery and may view this in the same light. But, they need to be aware of the seriousness of this decision and what it entails, both now and in the long term.

What happens next?

If you are still looking to go ahead with surgery then the first step is to talk to your GP. He/she can advise you about this option as well as being able to refer you to an obesity surgery. We would recommend that you obtain as much information as you can beforehand and talk to other people in a similar situation at a local support group. There will be other young people who are facing the same decision and it can help to discuss this with them.

What is OBESITY

OBESITY

Obesity is one of the biggest threats facing the human race.  It is a major problem here in the UK and the West in general.  In fact, obesity is now becoming a problem in parts of the world we would never have imagined such as China, Japan and the Middle East.  Even parts of Africa are reporting cases of obesity.

This may sound overly dramatic but consider these facts:

• By 2010 nearly 1 in 4 adults in the UK will be classed as obese.
• By 2050 nine out of ten adults will be classed as obese.
• By 2050 nearly two thirds of children will be classified as obese.

At present 17% of men and 21% of women are classed as obese. And by 2010 around 33% of men and 28% of women will be classed as obese.

It has been suggested that this current generation of children is likely to be outlived by its parents.  We are seeing increasing levels of obesity amongst children and teenagers which is not only blighting their lives but can even reduce their life expectancy levels.  Being obese can mean losing as much as 9 years off your life expectancy.

Medical experts are seeing an increasing number of children and teenagers with Type 2 diabetes and other obesity-related conditions which they would normally expect to see in people who are middle aged or older.  These are chronic conditions which are also potentially life threatening as well.

Obesity is never out of the media and is one of the most critical issues facing our government.  Yesterday’s newspapers (26th February 2009) reported that the numbers of people undergoing obesity surgery had risen by 40%.  The number of obesity related conditions which required admission to hospital has risen by 30% and 1.2 million people in the UK are on weight loss medication.   

Experts state that the UK, especially the NHS if facing an obesity epidemic and unless steps are taken to tackle this problem then the country as a whole is storing up serious, long term health problems. This will impact upon not only the NHS but our very lives. 

This problem is not just confined to the UK: in the US they have reported that 72 million Americans are clinically obese.  And, the WHO (World Health Organisation) states that globally, there are at least 300 million adults who are classed as obese.  These figures are for levels of obesity: they do not include the number of overweight people, here in the UK and around the world.

So, as we can see levels of obesity are rising everywhere and unless measures are taken will carry on doing so.

What is obesity?

This is the name given to the condition of chronic or excessive weight gain.  It means that you are carrying excess amounts of body fat which can cause long term health problems.

How is obesity defined? Obesity can be defined as:

“An excess of body fat that frequently results in a significant impairment of health”.

(Ref: Weight.com
 Michael D. Myers MD)

There are numerous definitions of obesity but they all deal with the same thing; namely that of very high levels of body fat.

There are different levels of obesity which along with being overweight are measured using a BMI (Body Mass Index) calculator.  This tool performs a series of calculations based upon a person’s height, sex and weight.  For example, weight in kilograms x height in metres.  This enables your doctor or healthcare professional to assess whether you fall into one of the following categories:

• Below 18.5 - classed as underweight
• 18.5 to 24.9 - classed as a healthy weight (normal)
• 25 to 29.9 - classed as overweight
• 30 to 34.9 - classed as obese
• 35 to 45 - classed as severely obese
• 45 to 50 - classed as morbidly obese
• 50 to 60 - classed as super obese
• 60 upwards - classed as super-super obese

It is important to remember that BMI is a guide only.  These definitions apply to many people but are not suitable for the very young, very old and sportspeople.

There are also a great many people who are overweight.  Whilst this is not an ideal state it is not as serious as being obese and is easier to address.  Being overweight can mean carrying a few extra pounds, namely around the abdomen for men and the hips and thighs for women.  It can be more of an irritant than a health problem, for example, when clothes shopping but if left unchecked it can develop into obesity.

It is all too easy to think that obesity is something that only happens to a certain group of people.  That it is due to a lack of self-control, education or is simply ignorance.  It does appear to be the case that it is more likely to be found in lower socio-economic groups who for a variety of reasons end up making poor lifestyle choices.  And one of the side effects of that is obesity.    

Why has obesity become such a problem?

There is no easy answer to that question: there are a wide variety of factors which have all contributed to the worrying levels we are now seeing.  The most obvious one is that of lifestyle: we have become much more sedentary than we used to be and this coupled with a greater amount and choice of food has meant that people are generally bigger and heavier than they used to be.

Other factors include genetic predisposition, family traits, our metabolisms, lack of sleep even the type of bacteria we carry in our gut can all contribute to this problem.

Weight loss surgery your guide to obesity Surgery + Weight Loss Surgery Guide

Weight loss surgery your guide to obesity Surgery

Many people with excessive weight problems are turning to obesity surgery or weight loss surgery. It is fast becoming a popular option when other weight loss methods, such as diet, exercise and supplementation has failed. Failure of these methods means that a person is unable to maintain a healthy weight and in many cases, the weight is regained. And, excessive weight, if not dealt with can lead to long term health problems such as cancer, heart disease or strokes.

This can be a source of distress as well as frustration but weight loss surgery may be able to help. Also known as bariatric surgery it can, in combination with a sensible diet and exercise plan help you to lose excessive weight.

Is weight loss surgery safe? Yes, it is a safe and effective form of treatment for excessive weight problems as many satisfied patients will testify. However, it is not something that you go into lightly. We have put together a comprehensive guide to obesity surgery which is designed to help and advise you. This is a serious decision and one that will permanently change your life so it is important that you have all the information you need before making that decision.

This easy to understand guide is Your complete guide to weight loss surgery: what it is, the different types of obesity surgery, benefits and risks of surgery, life after surgery and so on…

As this is a medical subject technical terms have been used but they are fully explained.

We hope that this site will enable you to make a balanced and informed decision which will lead to a new and improved way of life.

Obesity Surgery a quick overview of procedures for weight loss:

Also known as weight loss surgery or bariatric surgery: it is a highly specialised branch of medicine which deals with the causes, symptoms and treatment of obesity. The table below highlights some of the most common procedures that we will be discussing in this guide to weight loss.

Obesity Procedures: Comparison Table

Procedure	Hospital Stay	Recovery	Benefits	Risks	Weight Loss
Gastric Bypass (Roux-en-Y)	2 to 4 nights (keyhole or open surgery)	2 to 3 weeks	Dramatic weight loss. Can resolve or cure co-morbidities.	Complications (1 in 20 cases) ‘Dumping syndrome’ Lifetime nutritional supplements.	60 to 70%
Sleeve Gastrectomy (with or without duodenal switch)	2 to 4 nights (keyhole or open surgery)	2 to 3 weeks	Dramatic weight loss. Can resolve or cure co-morbidities.	Complications (1 in 10/20 cases) Lifetime nutritional supplements.	60% without a DS 70% with a DS
Biliopancreatic Diversion (with or without duodenal switch)	2 to 4 nights (keyhole or open surgery)	3 weeks	Dramatic weight loss. Can resolve or cure co-morbidities.	Complications (1 in 10/20 cases) Lifetime nutritional supplements.	70 to 80%
Gastric Band	Day case or 1 night stay (keyhole surgery)	1 to 2 weeks	Dramatic weight loss. Can resolve or cure co-morbidities.	Band slippage (1 in 50 cases) Erosion (1 in 50 cases) Failure (1 in 20)	50%
Gastric Balloon	Day case (keyhole surgery)	1 day (may take a week to adjust to the balloon)	Can contribute to weight loss. Short term measure.	Weight is regained.	35 to 45%

Weight loss surgery is major medical procedure and is not "Cosmetic"

We cannot stress enough that it is MAJOR surgery. And, like any other form of surgery it does carry risks although these are fairly uncommon. However, you need to be aware of these before considering whether or not to undertake this type of surgery.Many people see it as a form of cosmetic surgery: but the main difference here is that it is designed to treat a medical condition - that of obesity, whereas cosmetic surgery is usually undertaken for reasons of physical enhancement.

It is carried out by well trained and experienced surgeons who will have performed these procedures many times. There is a high success rate and complications tend to be rare.

Obesity Surgery has its risks....

However, nothing in life is risk free and the risks are even greater for those people who are obese so you need to take this into account. It is not a ‘miracle cure’ and you will be required to stick to a prescribed diet and exercise plan. This plan may include nutritional supplementation (daily vitamin and mineral medication). It will also include follow up sessions with your surgeon and his/her team.

This is all designed to check on your progress and to ensure that you achieve your desired weight loss. And, you can get extra help via a local patient support group. Meeting with other people who have undergone the same experience can help and if fact you will find that your surgeon and team will recommend that you do so. Sometimes, just talking to someone when things are not going so well can make a big difference.

The British Obesity Surgery Patient Association (BOSPA) is a very good source of information and advice. They also provide information about local support groups and are there to help you at every step, from finding a surgeon right through to the surgery itself and afterwards.

Weight Loss surgery is not the easy way out..

We are all human and it is very easy to give in to temptation but remember that for the weight to stay off you have to stick to your new healthy lifestyle. The surgery is just one part of this new lifestyle but it is worth it. Consider this: being obese puts you at greater risk of developing one of the many obesity related conditions also known as ‘co-morbidities’. These are long term, chronic conditions which can also take a few years off your life. And, you may have also found that it has affected your confidence, self-esteem and relationships. You are likely to be constantly tired and unable to move around as much as you would like. Plus, if you have a family then there will probably be a range of activities that you are unable to join in due to your excessive weight. 

Weight Loss Surgery Guide

• Types of weight loss surgery
• Benefits of weight loss surgery
• Risks of Weight loss surgery
• Suitability for weight loss surgery
• Weight loss surgery criteria guidelines
• Exclusion Criteria for weight loss surgery
• Finding a obesity surgeon
• Weight loss surgery abroad
• Gastric Bypass Surgery
• Gastric band surgery
• Biliopancreatic Diversion
• Sleeve Gastrectomy
• Gastric Balloon
• Gastric Stimulation
• Revision weight loss Surgery
• Obesity surgery and children
• Obesity surgery and teenagers
• Obesity surgery and older people
• Obesity Surgery and pregnancy
• Costs of weight loss surgery
• Weight loss surgery on the NHS
• Paying for weight loss surgery privately
• Cosmetic Surgery After obesity surgery
• Anti obesity medication
• Duodenal Switch