Researchers are taking a closer look at a previously rare disease that is now on the rise as obesity in children increases. Non-Alcoholic Steatohepatitis (NASH), more commonly known as Fatty Liver Disease, occurs in approximately 15% of obese children.

Fatty Liver Disease (FLD) is when excess fat accumulates in the liver.  While not life threatening by itself, it can lead to cirrhosis of the liver over time, sometimes requiring transplantation by adulthood.  Today, the most common causes of cirrhosis requiring transplantation are chronic alcoholism and hepatitis.  Within one generation, FLD secondary to obesity is expected to move to the top of the list, surpassing both alcoholism and hepatitis.

Approximately one third of children and teens in the United States are overweight, and 15% of children and teens are obese.  Estimates indicate that FLD may exist in 15% or more of obese children, or one out of every 40 children.  Children are routinely tested for conditions that have a much lower incidence, such as scoliosis, due to the severe physical and social implications.  Despite its dramatically increasing incidence, and the huge potential impact on society, there are no guidelines to screen for liver disease in children.

The American Liver Foundation currently estimates that 10-20% of Americans have Fatty Liver Disease.  This means that there are currently between 30 to 60 million overweight Americans with ongoing damage to their livers as a result of excess weight.  The huge concern is that many of these people will progress to cirrhosis and eventual liver failure.

Until now, the treatment for Fatty Liver Disease has been to offer dietary and exercise counseling, but this is often not effective.  Only a significant and maintained weight loss can improve, and possibly reverse, this disease process and significant weight loss with these methods is difficult to achieve and harder to maintain.  If caught early enough the liver is the only internal organ that can regenerate after an injury, but once significant scarring or cirrhosis has set in, it’s too late.  Currently, a national multi-center research network is looking at Vitamin E and a diabetes drug called Metformin, as possible therapy for FLD.  But, as of today, the best and only reliable way to prevent the damaging effects of obesity on the liver is to lose the excess body weight.

At The N.E.W. Program we screen all patients for FLD prior to surgery.  A simple, non-invasive ultrasound test of the abdomen can detect excess fat in the liver as well as enlargement of the liver.  If this disease process is discovered by ultrasound, further testing may be required.

Several recent studies have shown the positive benefit of surgical weight loss on Fatty Liver Disease.  In one study, obese patients had liver biopsies taken both before surgery and again 15 months after surgery, when significant weight loss had been accomplished.  Many patients showed dramatic improvement, and some had complete resolution, of the excess liver fat as well as the inflammation and fibrosis that was seen before surgery. These results highlight the important role that obesity plays in liver disease and reinforce the benefits of surgical weight loss in severely obese adolescents.

We all have a huge number of bacteria and other living organisms in our intestines and most of these organisms support the healthy functioning of our bodies. The organisms that live inside our intestines, and the intestinal environment they thrive in, is called our “Gut Microbiome.” This gut microbiome is unique for everyone, and the balance of bacteria within our intestines is different than everyone else.

Several decades ago, doctors recognized that intestinal bacteria played an important role in our immune system and that certain disease processes were affected by our intestine’s ability to maintain a healthy balance of all organisms. Since then, diseases such as arthritis, heart disease and metabolic disorders have been found to be affected by this intestinal community of organisms, and a lot of interest has developed in determining whether certain drugs, foods, and dietary supplements that alter this balance can possibly improve or even cure certain disease.

When it comes to obesity, research has shown that the balance of intestinal bacteria is different for obese people and healthy weight people. However, so far nobody knows the reason for this; does our intestinal balance of organisms cause weight gain, or dos weight gain cause a change in our intestinal balance? In other words, which is the cause, and which is the effect?

Probiotics are living microorganisms that, when eaten in a significant amount, provide us with certain health benefits. Certain types of food are packed with probiotics; examples are yogurt, buttermilk, tempeh, kimchi, sauerkraut, and pickles. The fact that we might be able to benefit from eating foods that have a high concentration of certain types of bacteria has led many people to assume that we can control our gut microbiome, and thereby control our health, by eating certain specific probiotics. Unfortunately, when it comes to excess weight and obesity, there is no evidence that our intestinal balance can be altered in a way that will improve our ability to control our weight.

Despite this lack of evidence, there is no law that restricts companies from defining probiotics any way they want, and from selling them as ways to improve your health. A huge industry has rapidly arisen where “experts” recommend certain probiotic dietary supplements as treatments for everything from Alzheimer’s to asthma and obesity. In fact, a survey in 2012 showed that probiotics were the third most common dietary supplements purchased after vitamins and minerals.

While there is a lot of research underway to determine how we can use probiotics to prevent and possibly treat certain diseases, there is currently no good scientific evidence that any probiotic can prevent or treat obesity.

Four Pounds Can Make a Difference

The numbers are startling.

Nearly four out of 10 Americans will be obese within five years if people keep packing on pounds at the current rate.

Currently, about 31%, or about 59 million people, are obese, which is defined as roughly 30 or more pounds over a healthy weight. Almost 65% are either obese or overweight, according to government statistics.

The average American has gained eight pounds in the past 10 years, in spite of research proving that people could live longer and healthier at an ideal body weight.  And, half this “average American” weight gain, or a mere four pounds, could be enough to significantly increase the risk of heart failure.

Cardiologists will be first to acknowledge that obesity increases the risk of death from heart disease. Doctors have long known that obesity contributes to heart failure — specifically an enlargement and thickening of the left ventricle, the heart’s main pumping chamber. But we were never sure how much of the added risk stems from obesity, or its impact on blood pressure and other risk factors.

Now, a new study shows that being slightly overweight — as little as a few pounds over — can increase that risk. It’s the first major study to probe the progressive relationship between weight gain and heart failure.

In the New England Journal of Medicine, a study involving nearly 6,000 people followed for over 14 years by the Boston University School of Medicine, demonstrated that being even moderately overweight is a causative factor of congestive heart failure in women.  In other words, many cases of heart failure can be attributed to obesity alone.

People in this study were not extremely obese. Even a little excess weight, the study found, can raise the risk of congestive heart failure.

In fact, “after adjustment for established risk factors, the risk of heart failure is increased by 5% for men and 7% for women for each increase of 1 in Body Mass Index (BMI),” says the journal report.

Because patients who qualify for bariatric surgery have a BMI that is at least 15 points above a “healthy weight,” their risk for heart failure is increased by at least 100%.

We are very good at treating all consequences of obesity — high blood pressure, high cholesterol, diabetes. But, when it comes to treating obesity itself, we often throw up our hands.  That just doesn’t make sense.

Minimally invasive weight-loss surgery has proven to be successful with thousands of obese patients. At The N.E.W Program, when we get patient’s weight down, we discover their diabetes improves, their cholesterol is lower, their blood pressure looks better.

Heart failure is yet another bad medical condition to have. And, for people with severe obesity or worse, we know that bariatric surgery is certainly a successful method to eliminate this grim prognosis.

Researchers over the last decade have just begun to understand how seriously the current obesity epidemic affects women’s health. People with increased adipose (fatty) tissue produce significant amounts of estrones and testosterone. Hormone imbalances can challenge a women’s reproductive system in numerous ways. Obesity can result in infertility, complicated pregnancy, and significant gynecological diseases such uterine cancer. Women who are overweight are prone to develop a number of endocrine disorders such as polycystic ovarian syndrome that often results in irregular or heavy menstrual cycles, abnormal hair growth, acne and infertility. Other associated disorders include the development of diabetes, especially during pregnancy.

Obese women have four to five times the risk of normal-weight women of developing pre-eclampsia, a condition marked by high blood pressure and other problems that can lead to the life-threatening disorder eclampsia. Also, compared with normal-weight women, their babies are two to three times more likely to be stillborn or to die soon after birth. They are also two to three times more likely to suffer a stillbirth after the 28th week of pregnancy, and are more than twice as likely to need a cesarean section or to have labor induced. The babies of morbidly obese women are more likely to die shortly after birth, compared with those born to normal-weight women. These infants also have higher rates of fetal distress, high birth weight, and low Apgar scores — a measure of newborn health that includes heart rate, breathing and other factors.

Amazingly, dramatic weight loss often results in a dramatic improvement in obesity related endocrine abnormalities. After weight loss surgery, many female patients experience rapid improvement in their menstrual cycle, a decrease in acne and “man-pattern hair” growth. Women more easily become pregnant as their hormone balances improve and diabetes is often cured.

Weight loss surgery is the only method proven to reliably allow people who are 100 pounds or more to lose weight. Unfortunately, diet and exercise fails in 95% of people in long-term studies. Pregnancy after weight loss surgery has been shown to be safer than pregnancy while overweight. When performed in expert comprehensive centers, weight loss surgery results in minimal to no risk of problems during pregnancy.  Several studies looking at the gastric bypass and the Lap-Band® have documented no increase in complications compared to normal weight individuals

The surgeons at The N.E.W. Program of Orange County have performed nearly one thousand weight loss procedures. To date, 100 percent of patients have had a laparoscopic operation–even patients weighing more than 600 pounds!

Type II Diabetes is a medical condition in which the body cannot effectively use insulin produced by the pancreas.  As the incidence of diabetes has increased dramatically over the last 10 years, a clear cause-and-effect pattern has emerged.   This pattern demonstrates that the epidemic of diabetes correlates most strongly with a single cause–obesity.  As the prevalence of American adults who are obese climbed from 10 percent to 20.9 percent between 1985 and 2001, the prevalence of diabetes increased by 61 percent.  Even children are developing Type II (“adult-onset”) diabetes at an alarming rate–a rare occurrence just twenty years ago.

This combination of obesity and diabetes is deadly.  Every year more than 300,000 people die in the United States as a direct result of obesity-induced illnesses and diabetes alone is the 6^th leading cause of preventable death in America.  Fortunately, this unrelenting progression of disease can be controlled, and even reversed, with weight loss and permanent weight control.

Statistical evaluation of different methods of weight control has clearly demonstrated that non-surgical weight loss programs have minimal success for severely obese individuals.  In contrast, weight loss surgery (Bariatric Surgery) will result in highly significant weight loss and long term weight control in the vast majority of patients who undergo the operation.  In the end, 80% of all diabetics will have their diabetes controlled or cured after gastric bypass, when performed correctly. This cure rate for diabetes, using surgery-induced weight loss, is even higher for those who have had diabetes for a shorter period of time.  In fact, for patients who have been diabetic for less than 5 years, 95% will be cured after gastric bypass surgery.  With these dramatic results and compelling statistics, every effort to prevent the devastating effects of diabetes should be taken; obesity should be treated aggressively, and severely obese patients should consider bariatric surgery as their most successful option.