Hundreds of obese young need surgery

Nearly 40% of under-25s who have weight-loss surgery in the UK are classified as super-obese, according to new figures.

Surgeons say this is evidence of “a clear failure of strategies to prevent weight gain in young people”.

Overall, more patients are having weight-loss surgery and, on average, they are getting more obese and more ill by the time of surgery.

A leading bariatric surgeon said severe obesity threatens to bankrupt the NHS.

The figures are contained in a report, from the National Bariatric Surgery Registry, which includes information on more than 18,000 weight-loss operations in 137 UK hospitals between 2010 and 2013.

The operations were made up of 9,526 gastric bypass procedures, 4,705 gastric band operations and 3,797 sleeve gastrectomy operations.

The aim of bariatric surgery is to improve the overall health of very obese patients, for whom dieting and lifestyle changes have not made any difference.

The report concludes that bariatric surgery is both safe and effective.

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As in all branches of medicine, prevention is better than cure but this report clearly demonstrates that when required, bariatric surgery is effective and safe”

Sir Bruce KeoghNHS medical director

‘Super-obese’ young

It says there are too many young people reaching levels of severe obesity who need weight-loss surgery.

Between 2010 and 2013, 550 young people under the age of 25 had bariatric surgery of some kind, 62 of whom were under 18.

Nearly 40% of these young men and women were already classified as super-obese (with a BMI of 50 or more), the report says, adding: “It is a reflection on society’s failings that these patients had already gained sufficient weight to be broadly comparable to patients who are much older.”

After analysing procedures for all age groups, the report found more men were being treated with bariatric surgery – up from 16% of all weight-loss operations in 2006 to 26% in 2013.

At the time of surgery, male and female patients were – on average – nearly twice the weight they should be for their height, with an averageBMI of 48.8.

Chart showing obese adult population of England 1993-2012

About three-quarters of the men and women treated could not climb three flights of stairs without resting and, on average, patients had more health complications and were more ill at the time of their operation than in previous years.

Excess weight loss

But the good news, surgeons say, is that after surgery, more than half of patients (56%) could manage three flights without resting and the amount of time they spent recovering in hospital decreased, despite the rise in more complex weight-loss operations.

Diabetes: A Surgical Solution?

BBC Radio 4’s The Report asks if increasing access to weight-loss surgery could help the battle against type 2 diabetes.

Mr Richard Welbourn, consultant surgeon and chairman of the National Bariatric Surgery Registry, said severe and complex obesity was a condition “which threatened to bankrupt the NHS”.

He said the data showed there were great benefits to be gained from bariatric surgery.

“In particular, the effect on diabetes has important implications for the NHS. Bariatric surgery cost-effectively improves the health of obese patients.”

In the report, Sir Bruce Keogh, medical director of the NHS, said: “Obesity and bariatric surgery are rapidly rising up the NHS agenda as a consequence of social and lifestyle choices.

“As in all branches of medicine, prevention is better than cure, but this report clearly demonstrates that when required, bariatric surgery is effective and safe.”

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What is bariatric surgery?

Gastric band

Bariatric surgery, also known as weight-loss surgery, is used as a last resort to treat people who are dangerously obese and carrying an excessive amount of body fat.

This type of surgery is available on the NHS only to treat people with potentially life-threatening obesity when other treatments have not worked.

Around 8,000 people a year currently receive the treatment.

The two most common types of weight loss surgery are:

  • Gastric band, where a band is used to reduce the size of the stomach so a smaller amount of food is required to make someone feel full
  • Gastric bypass, where the digestive system is re-routed past most of the stomach so less food is digested to make someone feel full

First e-cig ‘vaping’ ad airing on TV

The first UK TV adverts featuring the use of an electronic cigarette – vaping – are being shown.

While e-cigarette adverts have been on television for some time, showing the device itself was banned until a change in advertising rules which came into force on Monday.

The Committee of Advertising Practice has ruled that adverts must not show tobacco “in a positive light”.

Critics warn showing e-cigarette use could normalise the imagery of smoking.

The British government banned cigarette advertising on television in 1965.

Graphic: What's inside an e-cigarette?

1. On some e-cigarettes, inhalation activates the battery-poweredatomiser. Other types are manually switched on.

2. A heating coil inside the atomiser heats liquid nicotine contained in a cartridge.

3. Liquid nicotine becomes vapour and is inhaled. The “smoke” produced is largely water vapour. Many e-cigarettes have an LED light as a cosmetic feature to simulate traditional cigarette glow.



The new rules, put in place by the Committee of Advertising Practice (CAP) state that adverts must not:

  • be “likely to appeal particularly to people under 18, especially by reflecting or being associated with youth culture”
  • encourage non-smokers to use e-cigarettes
  • claim e-cigarettes are “safer” or “healthier” than smoking tobacco
  • make any health claims without approval from the Medicines and Healthcare Products Regulatory Agency

One advert, featuring a group “vaping” while having a meal, was shown in the morning on Channel 5.

Sandy Chadha, the chief executive of e-cigarette producers KiK, said: “The new advertising rules are a positive step to show people how vaping can help them move away from tobacco products and we are delighted to make history.

“Vaping is a new way of life for past smokers and the advert highlights friends talking about the impact making the change has had for them. We hope it is well received and gives smokers some food for thought.”

Another advert, showing a woman exhaling vapour from an e-cigarette, will be shown in the evening.

Dave Levin of VIP, the Bury-based company behind the advert, says: “E-cigarettes have attracted a lot of controversy recently, which has largely been due to concerns over safety, so it will be interesting to see how people respond to our advert’s debut.”

Prof Martin McKee, of the London School of Hygiene and Tropical Medicine, opposed the change to advertising rules.

He told the BBC: “This is a very daft idea, as many of us said during the consultation.

“A lot of questions need to be answered about e-cigarettes before adverts are even considered.

“First we need to get an agreement on whether they aid people to quit smoking or whether they become a lifestyle choice that people are going to use for 40 years – this hasn’t been resolved yet.

“And there are still huge questions about their safety,” Prof McKee added.

“Experts are also particularly concerned the adverts may lead to the renormalisation of images of smoking again. A number of e-cigarette companies are owned by the tobacco industry.”

Serious concerns

Deborah Arnott, chief executive of health charity Ash, commented: “There is growing evidence that people are using electronic cigarettes as a way of cutting down or quitting smoking and very little evidence of people who have never smoked using them.

“Vaping is safer than smoking, but e-cigarettes should only be promoted to smokers.

“The VIP adverts sexualise e-cigarette use and encourage their use by everyone, not just smokers,” she said.

“Ash doesn’t see how these adverts conform to the guidelines and if they do then we are seriously concerned that the advertising guidelines are not fit for purpose.”

“There is a place for responsible advertising of e-cigarettes but this isn’t it.”

The BMA said it was encouraged that the decision will be reviewed after 12 months “as advertising regulation must match changes in the market.”

Bats jam rivals’ senses in food race

A species of bat can interfere with the sound signals of competitors to “steal” their food.

A flying Mexican free-tailed batMexican free-tailed bats emit specialised signals which scramble the echolocation of competitors

Bats were “jammed” the moment they were about to home in on their insect prey, making them miss their target.

The rival that emitted the call was then able to capture and eat the insect for itself.

This is the first time scientists have witnessed this behaviour in one species – the Mexican free-tailed bat – a team reports in Science journal.

When bats swoop in darkness to catch prey, they emit high-pitched sound waves – a process called echolocation – which speeds up as they get closer to their target. This well-known skill is vital for them to hunt for food and to navigate their environment. This new research shows that others can effectively push them off their tracks mid-hunt.

Lead author of the work, Aaron Corcoran from Wake Forest University in North Carolina, was initially studying moths when he heard these bat calls.

“One bat was trying to capture an insect using its echolocation. The second bat was making another sound that looked to me like it might be trying to jam or disrupt the echolocation of the other bat,” said Dr Corcoran.

“Most of the time when another bat was making this jamming call, the bat trying to capture the moth would miss”, he added.

Cloud of Mexican Free-tailed Bats

In order to study this initial observation further, Dr Corcoran had to illuminate the night sky with a spotlight. On it, he attached a camera with which to record bats capturing insects.

He then reconstructed bats’ flight paths to determine their precise position as they emitted sounds. This was done by placing microphones at various locations to measure the time differences between the sounds.

“We can stitch together all of the sounds that each bat makes and produce a map of their flight trajectories,” explained Dr Corcoran.

When these recorded sounds were manually played back to the bats as they were about to catch a moth, it sabotaged their hunt in the same way. Other recorded bat sounds had no impact.

The finding was really unexpected, Dr Corcoran told the BBC.

“Nobody has seen anything like this in any other animals which echolocate. It’s not necessarily surprising that they’re competing with each other [for food] but the fact that they’ve evolved this jamming signal is quite new.

“When a bat is just about to capture a moth we know they are susceptible to jamming at that point. When we look at it from an acoustics or physics point of view, the jamming sounds are produced at the right time and made at the right frequency that match the frequency the other bats are using.”

The researchers will now look to establish whether this skill is unique to this one species, the Mexican free-tailed bat.

Foraging bats were attracted to this field location with the ultraviolet light tower seen in the right of the image, and the bat sounds were recorded on two microphone arrays placed below the lightForaging bats were attracted to this field location with the ultraviolet light tower seen in the right of the image, and the bat sounds were recorded on microphones

Prof Kate Jones at University College London, who was not involved with the study, said that it was fascinating that bats “are doing all kinds of crazy things that we don’t know about”.

They operate in the world using sonar sound and it takes new technology to access this entirely different world, she added.

“Technology is opening up our understanding of these deeply cryptic creatures,” the UCL researcher explained.

Prof Jones, who also studies echolocation in bats, said that there was still much to learn about the social calls bats make, and this new study advanced the field.

Head of monitoring at the Bat Conservation Trust, Dr Kate Barlow, also commented that social interaction between bats was difficult to study because of their small size and nocturnal habits.

“This study reveals another way in which bats have learnt to take advantage of their competitors by listening out for their feeding buzzes… presumably with the intention of then sneaking in and catching [an] insect for themselves. Very sneaky!”

Need Some Sleep? Here’s How You Can Cope With Hot Flashes at Night .

Hot flashes are a signature of menopause that can really interfere with a woman’s sleep. When they happen during the day, often women can muscle through them – remove a sweater, turn on a fan. But when they heat up at 3 a.m., they can wake women up and leave them sweaty, restless and tired.

Holly L. Thacker, MD, Director of Cleveland Clinic Center for Specialized Women’s Health says that chronic sleep disruptions like hot flashes shouldn’t be waved away. Menopause may not even be the culprit, she says.

Weight gain and resulting sleep apnea, iron deficiency, thyroid problems, depression, restless leg syndrome and anxiety that can result from work-related stress or caring for children and aging parents can all disrupt a woman’s sleep.

“People have to be evaluated,” Dr. Thacker says. “A lot of people need more sleep than they think.”

Dr. Thacker cites research that shows women with disruptive hot flashes suffered professionally because they were unable to concentrate. But, she says, “Usually people with really disruptive symptoms have something going on in addition to menopause.”

How menopause can complicate sleep patterns

Obstructive sleep apnea can develop in postmenopausal women related to changes in hormonal control of the upper airway (i.e namely the loss of estrogen and progesterone in menopause), says sleep specialist Sally Ibrahim, MD.

When post-menopausal women are compared with pre-menopausal women and men, studies show that the post-menopausal women have apnea rates closer to those of men, she says.

Also, many women with disturbed sleep and night sweats (from apnea) will confuse this with being menopausal with hot flashes, she adds.

“Premenopausal women have lower rates of obstructive sleep apnea compared with menopausal women. This is likely related to the protective effects of hormones, which are lost with menopause,” Dr. Ibrahim says.

But sleep in menopausal women is complex. There can be natural changes to sleep related to age. Then, there are also changes related to menopause itself related to an increased risk of depression and insomnia.

If sleep apnea is to blame, it may not be the obvious cause. It’s important to note that some women do not have the typical symptoms, such as snoring or gasping for air. Rather, they may just feel depressed or anxious, have trouble staying asleep, or they may just get up and feel tired, unrefreshed and fatigued during the day.

This is why a comprehensive sleep evaluation is sometimes needed to decipher the causes, Dr. Ibrahim says.

Hormone therapy and hot flashes

For those whose sleep disruption does seem mainly due to menopause and hot flashes, the primary treatment is hormone therapy, Dr. Thacker says, although it’s not the only treatment.

“Women who take hormone therapy feel much better,” she says. “If you didn’t have sleep disruptions before, definitely take hormone therapy. For the vast majority of people, the benefits outweigh the risks.”

The main risk of hormone therapy is a very rare incidence of blood clots, Dr. Thacker says. Many women remember past studies that branded hormone therapy as risky and dangerous, but that is not so.

Another common misconception is that there’s a time limit on how long women should take estrogen and progesterone combined in hormone therapy, Dr. Thacker says.

Typically you know within three months whether hormone therapy is effective, and “one of the reasons I see women who stay on it the longest, are people with trouble sleeping” when they go off the hormones, she says. Doctors re-evaluate symptoms periodically and try to keep the hormones to the lowest effective dose, she adds.

CPAP better bet to control apnea

The risks of hormone replacement therapy generally outweigh the benefits for patients suffering from sleep apnea, Dr. Ibrahim says.

Doctors usually prescribe continuous positive airway pressure (CPAP), as a first line therapy for anyone with obstructive sleep apnea.

“When tolerated, it is very effective,” she says. “CPAP has minimal side effects,” Dr. Ibrahim says.

People sometimes struggle initially with tolerating the mask as it can be hard to get used to wearing it. However, there have been many improvements of the masks and interfaces so with some effort, people can generally find something that works.

“Spending time finding a good mask fit is a good first step. There are other ways to make it comfortable too,” she says. Additionally, there are other therapies for obstructive sleep apnea outside of CPAP, such as dental appliances, she says.