Waist circumference rather than BMI best indicator for obesity risk in surgery

Waist circumference rather than BMI is the
best indicator for obesity risk in surgery.
The high risk 'apple belly' profile is best
picked up by measuring the waist.

by Anne Crawford

BMI (body mass index), a widely used measure of “healthy” weight and of obesity, has been the subject of controversy for some years, criticised as a flawed concept that doesn’t distinguish between weight from body fat and weight from muscle or bone, among other matters.

The concept was put to the test – and found inferior – as part of a major clinical study of almost 3000 people led by Central Clinical School’s Professor Paul Myles. Professor Myles is the Director of the Department of Anaesthesiology and Perioperative Medicine, The Alfred and Monash University.

2019 CCS research highlights: Department of Surgery - liver disease in obesity

Dr Geraldine Ooi, recent PhD graduate from

the Department of Surgery

Monash University's Central Clinical School is at the cutting edge of medical research in national and international arenas. We are publishing a series of our research highlights from across 2019.

In this article, we feature a highlight from the Department of Surgery.

• Towards better detection of liver disease in obesity 

The imperative to act on obesity

Source: OECD 2015. How we compare: Australia's obesity levels
The 10 OECD nations with the most overweight and obese people 

by Paul Zimmet
Dana McCauley makes a very important contribution with her analysis of the failure the Federal and State governments to act decisively on obesity ("While politicians refuse to act, Australia becomes more overweight", The Age,18/12/2019) despite numerous reports and strategies produced over the last few decades.

Concerted action is long overdue - the time to start for a positive impact on Australia’s current health was 20 years ago. In 2009, the Preventative Health Task Force of which I was a member, produced the report “Australia: The Healthiest Country by 2020”.

Research heartland to combat diabetes and obesity

Aussies love their sugary drinks, and the Obesity
 Epidemic in Australia report recommends a sugar
 tax be applied to soft drinks. Image: Shutterstock

This week a Commonwealth government Select Committee into the Obesity Epidemic in Australia has published its final report (see 5 Dec SMH news article on same).

A recent international study suggested that obesity has overtaken malnourishment as a leading global health problem, and that Australia is one of the most overweight nations on earth. In fact, more than 63% of Australians are now overweight or obese.

Video of the week: Wendy Brown on obesity and its treatment

Professor Wendy Brown, Head of Central Clinical School (CCS)'s Department of Surgery, gave CCS's annual public lecture on 18 October 2018 on the topic of "Obesity: a serious disease that deserves serious treatment". See more:

• Video: https://youtu.be/QXln6_fQJ4Y 
• Public lecture: www.monash.edu/medicine/ccs/events/2018-CCS-public-lecture
• Wendy Brown: www.monash.edu/medicine/ccs/surgery-alfred/staff/hod-brown

Photo of the Week: Wendy Brown public lecture on obesity

Professor Wendy Brown, Head of Central Clinical School's Department of Surgery, gave CCS's 7th annual public lecture on 'Obesity: a serious disease deserving serious treatment', on Thursday 18 October 2018. The lecture was well attended, and for those of you unable to make it, we'll be publishing a video on our CCS Youtube channel. See playlist for previous public lecture videos.

Landmark study highlights long-term success of weight loss surgery

Gastric banding. Image: Paul O'Brien
video describing lap banding procedure.
Hear Wendy Brown's 3AW interview

A 20-year study by Monash University researchers has demonstrated that lap-band surgery provides substantial weight loss to obese people for at least 20 years.

Obesity is estimated to affect more than a quarter of Australian adults and has now overtaken smoking as the leading cause of preventable deaths.

The study by Monash’s Centre for Obesity Research and Education (CORE) and the Centre for Bariatric Surgery (CBS), demonstrated that patients who had lap-band surgery 20 years ago now weigh an average of 30.1kg less than their initial weight. Lap-band (laparoscopic adjustable gastric band) surgery places an adjustable band around the top of the stomach to reduce appetite.

18 Oct 2018 Public Lecture "Obesity - a serious disease that deserves serious treatment"

Professor Wendy Brown in surgery

Obesity: a serious disease that deserves serious treatment

Obesity is the most prevalent disease in Australia affecting 28% of the adult population and has become our most important health care challenge. Prevention would be the ideal. However, for those already suffering effective treatment options are desperately needed. Bariatric (weight loss) surgery is currently the most predictably effective treatment for obesity.

• Date: Thursday 18 October 2018
• Time: 6.30pm for a 7.00pm start. Lecture will be followed by Q&A session
• Cost: Free
• RSVP: Register at Eventbrite
• Web: www.monash.edu/medicine/ccs/headlines/events-calendar/2018-CCS-public-lecture

Video of the week: Wendy Brown talks about obesity and addiction

Professor Wendy Brown is one of a number of Monash researchers featured in a documentary produced by the Monash Lens team and published this week, on the science of addiction. She says that addiction centres in your brain sit very close to your appetite centres, so there is a real cross-over between addiction and this disease state [of obesity]. "Once you've gained weight, only about 3% of people can lose a substantial amount of weight and keep it off".
See complete video at: https://lens.monash.edu/@a-different-lens/2018/05/28/1350176/science-of-addiction

Lap Band study shows positive outcomes for diabetes patients

Prof Wendy Brown and her team perform
a gastric banding procedure

by Anne Crawford

A Monash University study on the effect of bariatric surgery on obese people with type 2 diabetes has showed that most patients experienced sustained weight loss with nearly a fifth in remission from the disease. Moreover, many patients reported improved quality of life. Obesity is a key risk factor for diabetes.

Taking a lateral approach to curing sleep apnea

Sleeping on your side helps reduce apnea events. Image: Getty

by Anne Crawford

Obstructive sleep apnea (OSA) is a common yet serious disorder in which obstruction of the throat (upper airway) causes breathing to repeatedly stop and start, resulting in fragmented sleep, sleep deprivation, daytime tiredness and leaving OSA patients liable to a number of health risks.

Curiously, although obesity is the strongest risk factor for developing OSA, weight loss – while it can improve the severity of OSA – rarely cures it.

Study highlights best use of innovative gastrointestinal device

Dr Geraldine Ooi, first author on
the EndoVAC study

by Anne Crawford

Gastric and oesophageal perforations and leaks can be very difficult to treat, particularly if   contamination and sepsis have set in, and can be fatal. Central Clinical School PhD student Dr Geraldine Ooi joined researchers in The Alfred Hospital’s Upper Gastrointestinal Surgical Unit to review a recent innovation used to treat the internal leaks. The results of their study have helped inform The Alfred Hospital’s approach to using the therapy and will potentially help clinicians elsewhere.

Researchers call for new standard to measure obesity risks in surgery

“The most important factor is not how much
body fat you have but where it is”. Central
obesity, or the 'apple belly' creates high risk.

by Anne Crawford

Monash University and Alfred Hospital researchers are conducting research that challenges the popular way of measuring obesity – using Body Mass Index (BMI) – as a perioperative risk.

Professor Paul Myles, Director of Anaesthesia and Perioperative Medicine at Alfred Health and Monash University, recently co-wrote an editorial in the leading British Journal of Anaesthesia that questions the use of BMI as a measurement indicating risk and which calls for a better approach. BMI is body weight in kilograms, divided by the square of height in metres.

Recent CCS publications: Week ending 14 October 2016

Dr Be'eri Niego with Mr Felix Lee in Prof
Rob Mecalf's lab. See the recent research
on reducing thrombosis formation

Bumper list this issue of recent publications for Central Clinical School affiliated authors in the departments of ACBD, AIRmed, Gastroenterology, Immunology, Infectious Diseases, MAPrc, Medicine, Surgery, Obesity, Trauma. Read more »

Australian Centre for Blood Diseases (ACBD)

Gaspari T, Brdar M, Lee HW, Spizzo I, Hu Y, Widdop RE, Simpson RW, Dear AE. Molecular and cellular mechanisms of glucagon-like peptide-1 receptor agonist-mediated attenuation of cardiac fibrosis. Diab Vasc Dis Res. 2016 Jan;13(1):56-68. doi: 10.1177/1479164115605000. Epub 2015 Sep 25.

Thinking outside the box pays dividends for research on obesity and immune function

Immune system function is impaired in obese mice.
Image: WIKIMEDIA, SCHUMINWEB

by Anne Crawford

In 2010, the Department of Immunology at Monash University held a competition encouraging post-doctoral researchers to “think outside the square”, challenging them to design a project outside conventional thinking and their usual area of expertise. That competition, with a prize of $10,000, mushroomed into an NHMRC-funded project employing two post-doctoral researchers and two honours students. It culminated in 2016 with a paper reporting on the influence of obesity on allergic asthma – and some unexpected findings.

Ethics process for weight loss surgery data needs slimming

by Anne Crawford

Ethics process for weight loss surgery data needs overhaul, say Monash researchers.

Monash scientists and clinicians setting up an Australia-wide clinical quality registry for bariatric surgery have called for a more streamlined national ethics review process to oversee data collection and retention.

Program transforms pre-surgery weight loss care

by Anne Crawford

An educational program developed by Monash University and Alfred Hospital researchers to better prepare patients for bariatric (weight loss) surgery is revolutionising their care, streamlining its delivery and leading to improved weight loss after surgery.

The program was based on a study overseen by Professor Wendy Brown, director of the Centre for Obesity Research and Education (CORE), and Associate Professor Peter Nottle, director of Upper Gastrointestinal Surgery at the Alfred Hospital.

Reducing cardiac fibrosis

By Dr Jodie Abramovitch

Cardiac fibrosis (scarring) causes the heart to become stiff which affects the ability of the heart to function normally. Cardiac fibrosis can lead to heart failure and is associated with a range of health problems including hypertension, diabetes and obesity.

Dr Anthony Dear

A new class of therapeutics used to treat diabetes, known as glucagon-like peptide-1 receptor (GLP-1R) agonists, help regulate glucose levels in the body. There is evidence that some GLP-1R agonists are able to improve vascular disease in mouse models.

Monash researchers from the Eastern Health Clinical School and the Department of Pharmacology, overseen by Dr Anthony Dear (also associated with the Australian Centre for Blood Diseases) have investigated the effect of a GLP-1R agonist on cardiac fibrosis in a number of different pathological settings.  The recently published work showed that mice with hypertension, obesity, or age induced cardiac fibrosis had reduced evidence of cardiac fibrosis following treatment with a GLP-1R agonist, regardless of diabetic status. Furthermore, reduced levels of inflammatory markers were found within the hearts of treated animals. This reduction in inflammation may be the mechanism behind the observed reduction in cardiac fibrosis.

These results show that GLP-1R agonists may have success in treating cardiac fibrosis, regardless of pathological cause (i.e. hypertension, obesity or age), in humans.

Reference: Gaspari T, Brdar M, Lee HW, Spizzo I, Hu Y, Widdop RE, Simpson RW, Dear AE. Molecular and cellular mechanisms of glucagon-like peptide-1 receptor agonist-mediated attenuation of cardiac fibrosis. Diab Vasc Dis Res. 2016 Jan: 13;56-68.
doi: 10.1177/1479164115605000.