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Highlights for January 16, 2018

Mar, 16/01/2018 - 01:00

What Is the Appropriate Response to Evolving Norms of Obesity?

Mar, 16/01/2018 - 01:00
This Viewpoint discusses shifts in social norms toward acceptance of obesity as normal and proposes harnessing the same peer effects that have destigmatized obesity to promote and spread healthy behaviors.

Toward Precision Approaches for the Prevention and Treatment of Obesity

Mar, 16/01/2018 - 01:00
This Viewpoint discusses the prospects for treatment of obesity through identification of genetic, metabolic, behavioral, and environmental risk factors and an understanding of factors that account for variability in the success of treatment.

Counting Calories as an Approach to Achieve Weight Control

Mar, 16/01/2018 - 01:00
This Viewpoint discusses approaches that clinicians can take when advising overweight or obese patients to achieve weight control via calorie reduction.

Can the Government Require Health Warnings on Sugar-Sweetened Beverage Ads?

Mar, 16/01/2018 - 01:00
This Viewpoint uses the 2017 Ninth Circuit ruling enjoining San Francisco from requiring a health warning statement on sugar-sweetened beverages to discuss modifications that would make the warnings legally justifiable.

Taxes and Sugar-Sweetened Beverages

Mar, 16/01/2018 - 01:00
This Viewpoint discusses the merits and challenges to implementing taxes on sugar-sweetened beverages aimed at reducing their consumption in an effort to curb US obesity rates.

Which Is More Important for Health: Fitness or Fatness?

Mar, 16/01/2018 - 01:00
This Viewpoint reviews evidence comparing the relative importance of cardiorespiratory fitness and obesity with all-cause and cardiovascular disease–related mortality, and calls for accurate measures of physical activity and fitness in future studies investigating associations between obesity and mortality.

Starting Discussions With Patients About Health Policy Changes That Will Affect Their Care

Mar, 16/01/2018 - 01:00
In this essay, Jerry Avorn considers physicians’ social responsibility to initiate discussions with their patients about changes in health policy proposed by politicians that will affect patients' quality and continuity of care.

Comparing the Outcomes of Sleeve Gastrectomy and Roux-en-Y Gastric Bypass for Severe Obesity

Mar, 16/01/2018 - 01:00
Over the past decade there has been a rapid shift in bariatric procedure use worldwide, with the sleeve gastrectomy replacing the Roux-en-Y gastric bypass as the procedure of choice in most patients with severe obesity. The sleeve gastrectomy is less technically complex than the bypass procedure, and involves a 70% vertical gastric resection with no intestinal bypass. The use of the sleeve gastrectomy was spurred by short-term evidence suggesting that weight loss was nearly equivalent to bypass, while conferring a lower risk of perioperative complications. However, the popularity of sleeve gastrectomy has outpaced data from rigorous comparative effectiveness research studies, and the durability and long-term safety of sleeve gastrectomy vs bypass remain topics of debate.

Reimagining Obesity in 2018 A JAMA Theme Issue on Obesity

Mar, 16/01/2018 - 01:00
Six years ago, when JAMA last published a theme issue on obesity, there was optimism that progress was being made in preventing and treating obesity. As time has passed, so too has the optimism, as reports continued to show that the prevalence of obesity was increasing and, most important, rapidly increasing in children. A year and a half ago, there was a call to reconsider obesity and view it in new ways with the hope of better managing this very consequential clinical problem. In response, JAMA has revisited obesity in the form of a theme issue.

Five-Year Outcomes of Laparoscopic Sleeve Gastrectomy vs Gastric Bypass for Morbid Obesity

Mar, 16/01/2018 - 01:00
This study reports 5-year weight loss outcomes for participants in the SLEEVEPASS equivalence trial with morbid obesity managed with laparoscopic sleeve gastrectomy vs laparoscopic Roux-en-Y gastric bypass.

Effect of Sleeve Gastrectomy vs Roux-en-Y Gastric Bypass on Morbid Obesity

Mar, 16/01/2018 - 01:00
This randomized clinical trial compares the effects of laparoscopic sleeve gastrectomy vs laparoscopic Roux-en-Y gastric bypass on 5-year excess weight loss in patients with morbid obesity.

Control of Cardiovascular Disease Risk Factors 5 Years After Gastric Bypass for Type 2 Diabetes

Mar, 16/01/2018 - 01:00
This report describes 5-year blood pressure, Hemoglobin A1c, and lipid levels among participants previously randomized to Roux-en-Y gastric bypass surgery vs no surgery for management of obesity and type 2 diabetes.

Association Between Bariatric Surgery vs Usual Care Obesity Management and All-Cause Mortality

Mar, 16/01/2018 - 01:00
This cohort study uses Israeli electronic health record data to compare mortality of obese adult patients who underwent bariatric surgery (laparoscopic banding, Roux-en-Y gastric bypass, or laparoscopic sleeve gastrectomy) vs obese adults receiving nonsurgical usual care management.

Complications After Bariatric Surgery vs Medical Obesity Treatment

Mar, 16/01/2018 - 01:00
This cohort study uses Norwegian registry data to compare long-term changes in hypertension, diabetes, depression, and opioid use among patients with severe obesity treated with bariatric surgery or specialized medical treatment.

Long-term Outcomes Following Bariatric Surgery

Mar, 16/01/2018 - 01:00
This commentary discusses a study published in JAMA Surgery reporting 7-year weight and health outcomes for patients in the Longitudinal Assessment of Bariatric Surgery (LABS) Study who underwent Roux-en-Y gastric bypass or laparoscopic adjustable gastric banding.

Cost to Consumers of a Sugar-Sweetened Beverage Tax at the Philadelphia Airport

Mar, 16/01/2018 - 01:00
This study estimates how much the 1.5¢-per-ounce tax on sugar-sweetened beverages in Philadelphia raised retail prices of soft drinks at the Philadelphia International Airport 1 month after implementation.

Axillary vs Sentinel Lymph Node Dissection in Women With Invasive Breast Cancer

Mar, 16/01/2018 - 01:00
To the Editor Dr Giuliano and colleagues analyzed 10-year survival and disease-free survival data for women with breast cancer who had breast-conserving surgery followed either by sentinel lymph node dissection (SLND) alone or axillary lymph node dissection (ALND). The study was designed to assess whether SLND was noninferior to ALND with a noninferiority hazard ratio margin of 1.3. How such a large margin for assessing noninferiority can be justified is not clear.

Axillary vs Sentinel Lymph Node Dissection in Women With Invasive Breast Cancer—Reply

Mar, 16/01/2018 - 01:00
In Reply In principle, we agree with Dr Uno and colleagues that restricted mean survival time has the potential for being a more clinically interpretable summary. At this time, few people, especially clinicians, know what this measure is and would need to be educated with respect to its meaning before it would be considered more interpretable.

Trends in Carotid Revascularization Procedures

Mar, 16/01/2018 - 01:00
To the Editor Dr Lichtman and colleagues examined national trends in performance and outcomes of carotid endarterectomy and stenting in the US Medicare population. In a recent time-series analysis examining performance of carotid revascularization in Ontario, Canada, similar trends were noted. Much as in the US Medicare population, a significant decline in carotid endarterectomy and a significant increase in carotid stenting were observed between 2004 and 2006.

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