Our Bariatric & General Surgery Blog
How Does the VSG and Changes in the Brain Occur?
Obesity not only affects metabolic health but also affects brain function and structure. Changes in the brain activity such as cognitive function (decrease memory capabilities, learning absorption) and brain atrophy have been seen in individuals with obesity. The treatment of obesity with bariatric surgery has been shown to improve obesity-related cognitive impairment and brain function.
Vertical Sleeve Gastrectomy & Changes in the Brain
“The Vertical Sleeve Gastrectomy (VSG) (also known as the Laparoscopic Sleeve Gastrectomy (LSG) has gained popularity as a result of its safety and low complication rate, making it particularly suitable for people with severe obesity and comorbidities”.
The VSG is classified as a mechanical restrictive and metabolic procedure because it involves complex physiological changes. Both restriction and hormonal modulation achieve weight loss through the modification of the gastric fundus. The gastric fundus expresses various hormones associated with hunger and satiety, insulin secretion, and energy balance and is known to induce rates of type 2 diabetes remission comparable to those observed following malabsorptive procedures.
“The biological mediators that support cognitive control and long-term weight loss after the VSG remain unclear. However, VSG helps to reduce cravings for high-calorie meals, ghrelin, insulin, and leptin levels and increased self-reported cognitive-control of eating behavior”.
The effects of the gut-brain axis on the central nervous system result in fluctuating hormone transmission from your GI tract to your brain.
People with obesity have shown functional abnormalities in the frontal-limbic regions of the brain. The frontal lobe, like all brain regions, connects with the limbic lobe, which houses brain structures associated with the limbic system. The limbic system controls automatic and primitive reactions, but these reactions are heavily dependent upon emotion and experience.
VSG significantly decreased BMI, craving for high-calorie food cues, ghrelin, insulin, and leptin levels, and increased self-reported cognitive-control of eating behavior. Leptin and ghrelin are hormones that are known to have a prominent role in the relationship between hunger and satiety.
How the Vertical Sleeve Gastrectomy Works and Benefits
The “hunger” hormone ghrelin regulates food intake and preference for high-calorie (HC) food through modulation of the mesocortico-limbic dopaminergic pathway. Most ghrelin-producing cells are in the fundus. Ghrelin also plays a role in determining how much of what we eat is burned for fuel versus stored as fat.
“Weight loss alone results in an increase in ghrelin, which explains why we tend to feel hungry as soon as we restrict calories and begin to shed pounds”.
Surgically induced weight loss, however, in which a portion of the stomach is removed or bypassed, reduces the production of ghrelin while restricting the volume of food consumed. This unique combination explains, at least in part, why bariatric patients are able to eat less but not feel hungrier as a result.
Ghrelin travels through your bloodstream and to your brain, where it tells your brain to become hungry and seek out food. Ghrelin’s main function is to increase appetite.
VSG-induced reductions in appetite and total ghrelin levels in the blood are associated with reduced prefrontal brain reactivity to food cues. Leptin also plays an important role in telling your body when you are full and how calories are stored.
It is believed that weight loss improves the body’s sensitivity to the messages leptin delivers to the gut and brain. This, in turn may result in greater food satisfaction with smaller quantities and less flavor intensity.
So how does this change in food cues affect weight loss? If you preferred sweets or salty foods before you had surgery and crave them less after surgery, you are more likely to stick to healthier foods in general. That’s the good news.
However, some of our patients still crave unhealthy fatty foods after surgery. That makes it harder to keep off the weight. Reduction in craving for high-calorie food cues has been shown to continue 6 to 12 months after VSG. Additional research has shown evidence that VSG improved functional and structural connectivity in prefrontal regions of the brain, which contribute to enhanced cognitive control and sustained weight loss following surgery.
VSG and Changes in the Brain: Take-Aways
In conclusion, it is likely to experience taste bud changes after undergoing VSG. This is most commonly due to the sensory changes occurring as a result of fluctuating hormones in the gut-brain axis affecting the central nervous system. Basically, your nervous system relays countless transmissions about your hunger, satiety, and cravings each day between your GI tract and your brain.
Because the carriers of these messages are affected by changes in weight and the removal of a portion of the stomach, it is highly likely they have an impact on taste, smell, gratification, and other sensory perceptions. The good news is that patients who have changes in taste buds and food cues tend to lose more weight than those who do not experience this effect.
In addition, studies have shown that increased weight reduction diminishes food cravings and excess hormone storage in fat cells. It’s important to remember that food aversions after VSG are not permanent; therefore, weight loss optimization should be focused on in the first year of surgery.
Author: Dr. Patricia Cherasard is the Chief Physician Assistant for Winthrop Surgical Associates and Bariatric Surgery
This article was published on Obesity Help at https://www.obesityhelp.com/
I’m pleased to announce that this year, NYU Langone Health received two prestigious awards from The Leapfrog Group that speak to our unwavering commitment to improving quality and safety in healthcare, even in the midst of an unprecedented global pandemic. The Leapfrog Group is a leading national nonprofit that assesses the quality and safety of hospitals across the country based on available health data.
We are honored to be nominated and ask for your support and votes!
Voting runs until December 15th
When we first began talking with NYU Langone Hospital—Long Island about joining forces, we knew we had found a likeminded potential partner. We share a commitment to the highest quality patient care, a deeply rooted dedication to serving our communities, and exceptional people who bring those values to life through their work and the care they provide every day. Today I am very pleased to announce that going forward, NYU Winthrop will be known as NYU Langone Hospital—Long Island, solidifying the journey our institutions have taken together in collaborating to bring our communities the best in world-class healthcare.
Staggering Facts of Obesity and Bariatric Surgery
As we progress into the next decade, the prevalence of obesity has reached epidemic levels. Current trends estimate that 35% of adults in the United States are obese. This trend continues is estimated to reach 50% by 2030! Now more than ever, let’s review the facts of obesity and bariatric surgery
With the associated comorbidities, healthcare costs will continue to skyrocket. In the United States, one in seven healthcare dollars is spent treating diabetes and its complications. Furthermore, over 4100 people every day are newly diagnosed with diabetes. This translates to 1.5 million new diagnoses of diabetes each year!
As the leaves on the trees are changing color, and the kids are getting back into the swing of the new and altered school year, there is one thing that remains constant. The risk of contracting the flu remains the same. Corona virus does not change that flu season is upon us and time for immunization is now. We are fortunate to have a vaccine against a disease that is prevalent in the populations most at risk, which are the very young and very old, and those with multiple comorbid conditions like Diabetes, Hypertension, COPD, Morbid Obesity. These also include the immunosuppressed as well. While we are now more aware than ever about hand washing and covering our coughs, not all are wearing masks and maintaining social distancing. The possibility and probability of spreading the influenza virus is still likely unless you are isolating at home.
Covid-19 and influenza often present with similar symptoms, and a diagnosis is difficult without diagnostic testing. The problem is, that with the testing, you must expose others to the virus in order to get tested. Please be mindful that if and when you do experience symptoms of the flu, like fever greater than 100, or body aches, that you are isolating from others in your home to ensure that you do not spread your virus. Similarly, when you do go to the doctor’s office or even to the ER, please make sure that the staff is made aware of your symptoms in advance so that you can be properly isolated to keep the virus from spreading throughout the office or ER.
Remember that patients with COPD, Asthma, Morbid Obesity and Diabetes are at higher risk for complications associated with the Flu and Covid-19. Currently there is no vaccine for Covid, but there is for the flu, so please make time to go out and get the flu shot as soon as you can. Avoid getting a life threatening virus that can be mistaken for Covid-19.
While data and news reports show that Black and Hispanic communities are disproportionately affected by the 2019 coronavirus disease (COVID-19) pandemic, the role that neighborhood income plays in COVID-19 deaths is less clear. New analyses by a team of researchers at NYU Grossman School of Medicine examine the interplay between race and ethnicity and income on COVID-19 cases and related deaths in 10 major U.S. cities. The researchers found that non-white counties had higher cumulative incidences and deaths compared with predominantly white counties—and this was true for both low-income and high-income communities.
The findings—recently published online in JAMA Network Open—suggest that racial disparities in COVID-19 cases and deaths exist beyond what can be explained by differences in poverty rates. The researchers found that even among communities with higher median income, predominantly non-white communities still bore a greater burden of the virus—almost three times the incidence and deaths—compared with neighborhoods that identified as majority white. Yet income also plays an important contributing role. Indeed, the starkest racial and ethnic contrast between majority non-white and predominantly white counties was found when restricted to low-income counties only, where residents from predominantly non-white communities died from COVID-19 at nine times the rate as those living in predominantly white counties.
“While we expected to see greater numbers of COVID-19 cases and deaths in predominantly non-white, low-income communities, we were surprised that this relationship still held even after we accounted for poverty rates,” says Samrachana Adhikari, PhD, assistant professor in the Department of Population Health at NYU Langone Health and lead author of the study. “Given our findings, we believe that structural racism may explain these racial disparities in number of cases and deaths noted in Black counties.”
How the Study Was Conducted
Using publicly available data from the 2018 U.S. Census Small Areas Income and Poverty Estimates program, the Centers for Disease Control, and state health departments, the researchers examined cumulative COVID-19 cases and deaths per 100,000 across 158 urban counties (accounting for 64 percent of confirmed COVID-19 cases) spanning 10 large U.S. cities: New York City, Boston, New Orleans, Detroit, Los Angeles, Atlanta, Miami, Chicago, Philadelphia, and Seattle. Using the census data, the team linked median income and proportion of non-white residents in each county and used statistical analysis to identify differences in cumulative incidents and death, and their association with neighborhood race and ethnicity and poverty levels. All data analyzed included COVID-19 cases and deaths observed through May 10, 2020.
“We have known for decades that racism kills. Racism is a public health issue which has been implicated in the racial gap in mortality and in health outcomes,” says Gbenga Ogedegbe, MD, MPH, the Dr. Adolph and Margaret Berger Professor of Medicine and Population Health at NYU Langone and one of the study’s co-authors.
“Because the differences in COVID-19 cases and mortality cannot be explained by poverty alone, our findings give credence to our hypothesis that structural racism underlies the disproportionately higher rates of COVID-19 infections and alarmingly high rates of deaths in predominantly Black communities. The fact that non-white residents died from the virus at higher rates than white residents in both wealthier and poorer communities should be a major alarm bell to policymakers at the national and local government levels, academic medical centers, and the country at large,” says Dr. Ogedegbe.
One of the study’s limitations, according to Dr. Adhikari, is that it covers only large metropolitan areas and that the data analyzed are aggregated at the county level. More granular data at the individual level, as well as a breakdown of residents by race and ethnicity, would provide greater insight into the drivers of this troubling association, as well as expose most affected neighborhoods in need of more robust public health interventions, says Dr. Adhikari.
In addition to Dr. Adhikari and Dr. Ogedegbe, additional co-authors from NYU Langone Health are senior author Andrea B. Troxel, ScD; Lorna E. Thorpe, PhD, MPH; Justin Feldman, ScD; and Nicholas Pantaleo. Dr. Adhikari is funded by the National Institutes of Health and Johnson & Johnson.
Also Requests Expanded Coverage of Behavioral Therapy
Washington, D.C. — July 9, 2020 U.S. Senators Bill Cassidy (R-La.) and Thomas Carper (D-Del.) are calling on the Centers for Medicare & Medicaid Services (CMS) to lift regulations that deny insurance coverage for obesity drugs and that limit coverage of Intensive Behavioral Therapy (IBT) amid the COVID-19 pandemic.
In a letter sent to CMS Administrator Seema Verma in early July, the senators request the agency use its administrative authority to update a nearly two-decade-old statute in the Medicare Part D prescription drug program that specifically excludes obesity drugs from Medicare coverage.
Two of the most common comorbidities, or obesity related diseases, that we come across in our patients are type 2 diabetes and high blood pressure. Most of our patients will have been managing these conditions using drug therapy for years before considering surgery as a more permanent, curative solution. When we discuss the benefits of bariatric surgery, we often point out the fact that money can be saved in the form of reduced or eliminated drug therapy. And while every patient will experience different improvement and resolution rates, we have some recent research, presented at the ASMBS National Clinical Symposium on Obesity Prevention Treatment and Research in June 2019, that helps quantify the benefit.
NYU NYU Langone Long Island Surgical Associates is proud to welcome Dr. Venkata Kella as our newest bariatric surgeon. Dr. Kella is board certified in general surgery, specializes in bariatric surgery, and brings with him an impressive list of credentials and experience that will undoubtedly build upon our dedication to the most effective bariatric procedures and the very best patient care.