Tweet

Michael "Mike" Albert, MD

27 Jan, 12 tweets, 5 min read

1/ ENOUGH IS ENOUGH!!!

We can and should acknowledge that bariatric (metabolic) surgery is a superior intervention for the treatment of obesity. [thread]

https://twitter.com/MichelleCardel/status/1354097905993355269?s=20

2/ Independent metabolic and CV benefits outside of absolute wt loss...

1⃣ - ⬇️ in ASCVD & mortality at lower wt loss thresholds than non-surgical wt loss: jamanetwork.com/journals/jama/…

2⃣ - normalization of CV risk factors not wholly attributable to wt loss:

https://twitter.com/MichelleCardel/status/1354097905993355269?s=20

https://twitter.com/FRubinoMD/status/1352406712003817477?s=20

3/ More likely to have long-term remission of type 2 diabetes:

https://twitter.com/FRubinoMD/status/1352406712003817477?s=20

4/ Better renal outcomes...
-care.diabetesjournals.org/content/43/6/1…
-pubmed.ncbi.nlm.nih.gov/30054877/

https://twitter.com/EASOobesity/status/1178930300136673281?s=20

5/ Better long-term weight loss results:
-pubmed.ncbi.nlm.nih.gov/30293134/

https://twitter.com/EASOobesity/status/1178930300136673281?s=20

6/ Decreased risk of death and incident Cancer and ASCVD:

[1] pubmed.ncbi.nlm.nih.gov/32805135/
[2] nejm.org/doi/full/10.10…

https://twitter.com/MichaelAlbertMD/status/1234577863820447744?s=20

7/ And COST-EFFECTIVE...

https://twitter.com/MichaelAlbertMD/status/1234577863820447744?s=20

https://twitter.com/MichaelAlbertMD/status/1291835809427894272?s=20

8/ Despite everything I have shown you, people still believe bariatric surgery is less effective than other means of weight loss treatment.

https://twitter.com/MichaelAlbertMD/status/1291835809427894272?s=20

9/ And do not get me started on the "safety" of bariatric surgery.

Mortality is consistently less in individuals who pursue surgery vs non-surgical controls: jamanetwork-com.mlprox.csmc.edu/journals/jama/…

1-yr mortality of laparoscopic bariatric surgery <0.25%

10/ So enough is enough! Our failure to acknowledge and support bariatric surgery as an important and first-line option for patients, particularly those at higher risk of bad health outcomes, is a travesty. Thanks, and please share!

@NeilFlochMD

@NeilFlochMD @Ali_Aminian_MD @AbdTahrani @arghavan_salles @ZaherToumi

Mortality link for Tweet #9: pubmed.ncbi.nlm.nih.gov/32870301/

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More from @MichaelAlbertMD

Michael "Mike" Albert, MD

@MichaelAlbertMD

25 Jan

There is a stronger evidence basis for calorie counting as a core behavioral strategy for reducing food intake than “eating to satiety.”

Eating foods that reduce the risk of overeating and promoting satiety and less hunger is impt but this is an unproven behavioral strategy.

The reality is appetite is complex; regulated by a number of factors acting on two neural circuits. Also, we know people can eat past satiety given higher level neural circuitry involved in the complex regulation of feeding. But, hey, people like oversimplifying things. 🤷🏼‍♂️

People struggle to be healthy in an OB environment, and w/o monitoring, typically overeat without knowing. Calorie counting serves as a way to self-monitor and should not be viewed as an "exact science." People pushing this narrative have no idea what they are talking about.

Read 8 tweets

Michael "Mike" Albert, MD

@MichaelAlbertMD

3 Dec 20

The presumption that all individuals start with the same potential for restraint (i.e., the ability to refuse a cookie) is not evidenced-based.

https://twitter.com/MichaelAlbertMD/status/1287476307849224192?s=20

Ex#1 => obesity and the brain

https://twitter.com/MichaelAlbertMD/status/1287476307849224192?s=20

https://twitter.com/SteveStuWill/status/1303125496062910464?s=20

Ex#2 Self-control is heritable

https://twitter.com/SteveStuWill/status/1303125496062910464?s=20

Read 4 tweets

Michael "Mike" Albert, MD

@MichaelAlbertMD

15 Nov 20

1/ In honor of #WorldDiabetesDay2020, and to directly address two significant public health threats of the 21st century, I want to discuss very-low-energy-diets and low-energy-diets as a potential treatment for obesity and T2DM. [thread]

2/ Total Diet Replacement (TDR) strategies have been extensively studied and found to be an effective dietary intervention to promote a Calorie deficit and reduced food intake.

3/ I originally became interested in TDR interventions reading the many works of Dr. Thomas Wadden, demonstrating clinically significant short-term weight loss with VLEDs. [Tsai & Wadden, 2006]

Read 16 tweets

Michael "Mike" Albert, MD

@MichaelAlbertMD

17 Oct 20

1/ WHY INCREASING PHYSICAL ACTIVITY/EXERCISE SHOULD BE A GREATER FOCUS THAN LOSING WEIGHT:

I still think a weight-centric approach to managing chronic dz is the best approach, but if you are going to focus on ONE change in your life, I hope it is increasing PA.
[thread]

2/ To understand my point you need context. First, losing WT and maintaining it is hard. I could give you any number of obscure stats on this, but I think you all know from experience. The obesogenic environment (sedentary life + modern UPFs food) is unforgiving.

3/And while I think we should cont to manage our Wts the best we can (lifestyle/meds/surgery), THE SYSTEM is rigged against us. Until we address the systemic issues driving OB (food deserts, health inequity, poverty, agricultural subsidies, etc.) major changes will not occur.

Read 13 tweets

Michael "Mike" Albert, MD

@MichaelAlbertMD

17 Oct 20

In Young Adults, certain health factors predict the risk of mod-severe #COVID19:
👉BMI > 30
👉Fatty liver (increases risk 6-fold)
👉Ectopic fat in the kidney, albuminuria

1) academic.oup.com/cid/article/71…
thelancet.com/journals/lance…
2)ncbi.nlm.nih.gov/pmc/articles/P…
3) onlinelibrary.wiley.com/doi/10.1002/ob…

Risk factors for inpatient mortality from #COVID19:

Obesity (OR 1.7, 1.1-2.8)
Male (OR 5.2, 1.6-16.5)
Older age (OR 1.3, 1-1.6)

*After adjusting for age, gender, and comorbid...for every increase from one BMI category to the next, there was a 70% increased odds of mortality."

Read 6 tweets

Michael "Mike" Albert, MD

@MichaelAlbertMD

10 Aug 20

1/ "MASK"ING THE CASE: WHY THERE SHOULD BE A UNIVERSAL MASK MANDATE

I have been fascinated by the discussion around mask use during the pandemic. Suffice it to say, the US' compliance has not been great considering the size of the current outbreak across the US states. [thread]

2/In fact, as recently as July 2020, there was a only ~48% chance everyone would be masked during five random public encounters.

original article: nytimes.com/interactive/20…