ARTICLE - NEW CLUES TO HOW GASTRIC BYPAS SURGERY COMBATS DIABETES

New Clues to How Gastric Bypass Surgery Combats Diabetes

By Kathleen DohenyHealthDay Reporter April 27 3,519 8 5

WEDNESDAY, April 27 (HealthDay News) — Gastric bypass surgery has been known to improve blood sugar control, often sending people with type 2 diabetes into remission, but experts have long wondered exactly how that happens.
Now, a new study provides some clues.
Circulating amino acids linked with insulin resistance decline dramatically in those who have the bypass surgery, the researchers discovered. They compared 10 obese people with diabetes who had the surgery with 11 who lost weight through dieting.
"Something happens after gastric bypass that does not happen as much after the diet-induced weight loss," said Dr. Blandine Laferrere, an associate professor of medicine at St. Luke's Roosevelt Hospital Center and Columbia University, both in New York City.
The study is published in the April 27 issue of Science Translational Medicine.
The surgery, which reduces the stomach to the size of a small pouch, also modifies the junction between the stomach and small intestine. It leads to a dramatic reduction in the level of circulating amino acids that have been linked with diabetes.
"The fact that gastric bypass results in the remission of diabetes in the majority of patients is not new," said Laferrere. According to background information in the study, 50 percent to 80 percent of diabetes cases go into remission after the surgery.
What doctors have been trying to figure out, she said, is why the bypass surgery is so good at making the diabetes disappear. "The diabetes improves almost immediately, before a significant amount of weight loss occurs," she said. "That points out it is something other than the weight loss."
In the new study, the researchers evaluated biochemical compounds involved in metabolic reactions in the participants. Each group had lost about 20 pounds.
The investigators found that the bypass patients had much lower levels of amino acids known as branched-chain amino acids, and the amino acids phenylalanine and tyrosine.
"Those changes in the amino acids could be implicated in the mechanism of diabetes remission after gastric bypass," Laferrere said.
Experts know the amino acids are linked with insulin resistance partly due to animal studies, she said. "If you supplement the diet of rats with branched-chain amino acids, you can induce more insulin resistance," she explained.
However, Laferrere said, the finding does not mean all obese people with diabetes should pick surgery over dieting. The surgery is highly invasive, she noted, and not everyone is a candidate.
While the findings are intriguing, she said, it's too early to apply them to diabetes treatment. Eventually, she added, after experts understand more about how the surgery affects the amino acids, it may be possible to apply the findings to develop better diabetes treatments or a less invasive surgery.
The new study adds weight to other research finding a link between the
decline in branched-chain amino acids and the decline in insulin resistance,
said Dr. Thomas J. Wang, associate professor of medicine at Harvard
Medical School, and a coauthor of the perspective accompanying the
study.
"It's known that gastric bypass rapidly reverses insulin resistance,
which is one of the principal biochemical abnormalities that precedes
diabetes," Wang said.
"This study really does help to confirm that hypothesis that
branched-chain amino acids do go down more in people who have weight loss
surgery," he said. While it lends support to the idea that there is a link
between the reduction in the amino acids and the decline in insulin
resistance, it does not yet prove cause and effect, Wang added.
"It shows people who get weight loss surgery have a bigger drop in their
branched-chain amino acids. What is not yet proven is whether that reduction
in branched-chain amino acids is the reason their insulin resistance
declines," he pointed out.
Wang and his coauthor, Dr. Robert Gerszten, are co-inventors on patent
applications related to metabolite predictors of diabetes.
Wang and Gerszten also pointed out that the number of obese people with type 2 diabetes was 171 million worldwide in 2000. By 2030, that number is expected to double. Therefore, they wrote, a detailed understanding of the role of the amino acids in diabetes would be valuable.
More information
To learn more about gastric bypass surgery, visit the U.S. National Library of Medicine.

ARTICLE -INCREASED ALCHOHOLISM RATES SEEN AFTER GASTRIC SURGERY

Increased Alcoholism Rates Seen After Gastric Bypass Surgery

 

Gastric Bypass Associated With Higher Alcohol-related Diagnoses Compared With Banding

by David Wild

Chicago—European researchers have found that gastric bypass patients have an increased risk for postoperative alcohol dependence, according to data presented at the 2011 Digestive Disease Week (DDW) meeting (abstract 266). Based on the findings of a retrospective cohort analysis of more than 12,000 bariatric surgery patients, the investigators are calling for clinicians to examine gastric bypass patients for alcohol-related diagnoses.
“The results of this study clearly indicate the need for physicians to screen for alcohol abuse as part of the workup prior to bariatric surgery and to follow patients who undergo this operation carefully for signs of alcohol abuse,” said Craig Fisher, MD, MPH, associate professor in the Department of Surgery, Weill Cornell Medical College of Cornell University, New York City, who was not involved in the study.
According to primary investigator Magdalena Östlund, MD, a researcher in the Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, patients’ increased risk for acute alcohol intoxication and dependence after gastric bypass surgery may stem from greater alcohol absorption in the small intestine and a more immediate spike in blood alcohol levels. Because of this, she said, gastric bypass patients can experience significant impairment after consuming even a single glass of wine, and dependence can lead to weight gain.
Dr. Östlund and colleagues in Sweden and England examined data from 12,277 Swedish gastric bypass and restrictive surgery patients treated between 1980 and 2006 and followed for a mean of 8.9 years postoperatively. They compared data between these patients and 122,770 age- and gender-matched controls who did not undergo bariatric surgery; the researchers did not control for obesity in the matched group.
Compared with controls, bariatric surgery patients had significantly higher rates of psychosis, depression, attempted suicide and alcohol-related diagnoses, such as acute alcohol intoxication and alcohol dependence before surgery. Preoperative rates of these illnesses were similar among patients undergoing restrictive and gastric bypass procedures; however, patients undergoing gastric bypass were 2.3 times more likely than those receiving banding procedures to get inpatient treatment for alcohol-related diagnoses postoperatively (odds ratio, 2.3; 95% confidence interval, 1.7-3.0 for bypass vs. banding). The only other diagnosis that changed in frequency after surgery was psychosis, which decreased in both groups.
“Patients need to be warned of the risks of alcohol consumption following gastric bypass,” Dr. Östlund told DDW attendees.
Dr. Fisher, who moderated the press conference where the data were presented, said the strengths of the study’s design make the findings exceptionally reliable.
“These data are unique in that they capture a population with very complete follow-up information,” said Dr. Fisher. “In the United States, researchers often find it difficult to follow patients continuously, since they sometimes receive initial treatment at one center but go somewhere else for follow-up care. As there are a limited number of bariatric surgery centers in Sweden, the researchers here were able to track all of the patients who underwent surgery in Sweden.”

ARTICLE -BARIATRIC SURGERY EFFECTIVE IN METOBOLIC SYNDROME

Bariatric Surgery Effective in Metabolic Syndrome

By: ALICIA AULT, Family Practice News Digital Network

HOT SPRINGS, VA. – An analysis of a large database of bariatric surgery patients has found that those with metabolic syndrome had dramatic improvements in comorbidities but a slightly higher rate of adverse events after 90 days.

Overall, patients with metabolic syndrome tend to be sicker and to have a greater incidence of adverse outcomes and higher mortality than do obese patients who don’t have the syndrome, said Dr. William B. Inabnet III, professor of surgery at Mount Sinai School of Medicine in New York.

He and his colleagues at Mount Sinai also determined that the reduction in weight was procedure dependent. "A careful assessment of risk-benefit ratio is warranted to develop the optimal clinical pathway for treating these patients," said Dr. Inabnet at the annual meeting of the Southern Surgical Association.

The researchers examined BOLD (Bariatric Outcomes Longitudinal Database) to identify patients who had undergone bariatric surgery from June 2007 to November 2010 and had metabolic syndrome.

BOLD is maintained by the American Society for Metabolic and Bariatric Surgery Center of Excellence program, and includes 1,157 surgeons at 884 hospitals. The data are self-reported, but some data are verified by on-site inspections. The surgical interventions covered in the registry include gastric banding, Roux-en-Y gastric bypass, sleeve gastrectomy, and biliopancreatic diversion with duodenal switch.

A modified scoring system (0-5) was used to assess comorbidities. For the purposes of the study, metabolic syndrome was defined as a hypertension score greater than 3, a diabetes score greater than 2, a dyslipidemia score greater than 2, and a sleep apnea score greater than 3. (Sleep apnea is not usually included in the definition of metabolic syndrome, but the researchers were interested in the condition as a comorbidity, said Dr. Inabnet.)

Overall, there were 186,567 patients in BOLD, including 23,106 patients who had metabolic syndrome. Those with metabolic syndrome were more likely than other obese patients to be male, older, and white, and to have sleep apnea and an ASA (American Society of Anesthesiologists) classification of 3 or greater. Body mass index was similar for both groups at 47 kg/m².

Gastric bypass was the most commonly performed procedure, and was the preferred method in patients with metabolic syndrome, followed by gastric banding, sleeve gastrectomy, and duodenal switch. And, said Dr. Inabnet, the researchers "were truly amazed to see that the vast majority of these cases were performed with laparoscopic approaches."

At 30 days, those with metabolic syndrome had increases in mortality, serious complications, readmissions, and reoperations, compared with other obese patients. The increases continued as time went on, and became more pronounced at 90 days post surgery, said Dr. Inabnet.

Overall mortality was very low (0.1%) for the entire cohort of 186,567 patients.

Mortality rates differed by procedure, however. The gastric band patients had the lowest rate (0.1%), followed by 1.2% for duodenal switch, 0.3% for sleeve gastrectomy, and 0.4% for gastric bypass. The serious complications, readmissions, and reoperations at 90 days were also lowest for gastric band patients, followed by duodenal switch, sleeve gastrectomy, and gastric bypass patients.

 

Metabolic syndrome was associated with the greatest risk for serious complications, according to the authors’ regression model. Those who received the gastric band had a 2.79-fold increase in risk at 90 days, compared with bypass patients, who had a 1.34-fold increased risk.

Follow-up data at 1 year were available for a little more than half of those with metabolic syndrome (12,144 patients). The data show that the decrease in BMI was procedure dependent. The greatest decrease in mean BMI (from 51 to 32) was seen in those who had a biliopancreatic diversion. Mean BMI dropped from 46 to 39 in gastric band patients, from 49 to 36 in those who had a sleeve gastrectomy, and from 48 to 32 in those who had the bypass.

Reduction of comorbidities was also greatest in the duodenal switch group, followed by the bypass, sleeve, and gastric band procedures. For instance, diabetes resolved in 74% of patients who had the duodenal switch, compared with only 28% of those who received the band. There were big reductions in hyperlipidemia and sleep apnea for all the procedures.

The data are limited in that they are self-reported, noted Dr. Inabnet. Even so, the "study confirms the previously held hypothesis that metabolic syndrome confers increased morbidity," said Dr. Bruce Schirmer, vice-chair of the department of surgery at the University of Virginia, Charlottesville. In discussing the paper, Dr. Schirmer noted that BOLD also seemed to show lower overall weight loss and resolution of comorbidities than was previously reported by individual institutions.

The database, however, has its advantages, said another discussant, Dr. William O. Richards, chair of the department of surgery and director of the surgical weight loss center at the University of South Alabama, Mobile. "This paper is important because it’s another one of the studies emanating from prospective [collections of data across the United States] from hundreds of surgeons, and convinces me we are ever more confident in reporting results not just from a single surgeon but from actual practice," said Dr. Richards.

He questioned whether the low mortality rate was a reflection of surgeons’ opting to avoid procedures in high-risk, older obese patients, or whether it was a reflection of the success of the centers of excellence system.

Dr. Inabnet said that there were 200 patients older than age 75, and although the data are currently too young to allow the measurement of any trends, it doesn’t seem that older patients are being operated on less often than are younger patients.

"What is the best operation? That really is the million dollar question," he said. The data show that the Roux-en-Y procedure provides the best overall risk profile, but he added that the sleeve gastrectomy is increasing in prevalence and may eventually prove to be a good choice.

Dr. Inabnet, Dr. Schirmer, and Dr. Richards reported no conflicts.

ARTICLE -IRON DIFICIENCY ANEMIA 'UNINTENDED CONSEQUENCE'OF GASTRIC SURGERY

Iron Deficiency Anemia 'Unintended Consequence' of Gastric Bypass

By: DOUG BRUNK, Family Practice News Digital Network

SAN DIEGO – About one-quarter of patients referred to a private hematology practice had iron deficiency associated with gastric bypass surgery.

In addition, 57% demonstrated symptoms of pica syndrome – a craving for and compulsive eating of non-food substances such as ice and starch.

"As morbid obesity has become a large problem in this country and more and more people are undergoing gastric bypass surgery, iron deficiency anemia is an unintended consequence," Dr. Thomas A. Bensinger said at the annual meeting of the American Society of Hematology. "Some of these patients get very severely anemic."

Dr. Bensinger and his associates at Maryland Oncology Hematology in Greenbelt reviewed the medical records of 300 adults referred to the practice between March and November of 2010 with a diagnosis of anemia. Of the total, 130 demonstrated iron deficiency anemia after undergoing laboratory studies that included complete blood count, ferritin, iron/total iron-binding capacity, reticulocyte count and review of the peripheral blood film.

Of the 130 patients, 122 (94%) were women, 4 of whom were pregnant. Heavy menstrual bleeding was the most common cause of iron deficiency anemia (62%), followed by gastric bypass surgery (24%), gastrointestinal abnormalities (6%), and heavy menstrual bleeding associated with the presence of uterine fibroid (5%). In addition, 12% of patients had both heavy menstrual bleeding and had undergone gastric bypass surgery. The remaining 3% of patients were male.

More than half of patients (57%) demonstrated symptoms of pica syndrome, primarily the urge to eat ice. Two patients reported an urge to eat toilet paper while one patient reported eating leaves that were stripped from a plant in her garden. Such symptoms "were often not reported by the patient unless the patient was questioned in detail with the exception of a small subset of patients who had performed an internet search and found pica for ice to be associated with iron deficiency anemia," Dr. Bensinger said.

Pica syndrome symptoms typically resolved within 7-21 days of intravenous iron administration. "I speculate that the craving for ice is related to enzymes that are in the oral cavity in the mucosa," he said. "They get iron depleted and somehow the ice makes them feel better. When you give them the iron, those enzymes get repleted. It’s a very interesting phenomenon. Some of our patients know when they start to get iron deficient again because they realize they’re eating ice."

The study’s overall findings underscore the importance of paying close attention to key indicators of iron deficiency anemia, including low mean corpuscular volume and various forms of pica syndrome.

"You have to keep paying attention to the causes of anemia," he said.

Dr. Bensinger reported having no relevant financial disclosures.

GLP-1 PALYS A ROLE IN GLUCOSE CONTROL AFTER GASTRIC BYPASS

GLP-1 Plays Role in Glucose Control After Gastric Bypass

Last Updated: January 03, 2012.

 There is a positive association between glucagon-like peptide-1 (GLP-1) concentrations and insulin concentrations following gastric bypass surgery in patients with type 2 diabetes, suggesting a role for GLP-1 in glucose control, according to a study published in the January issue of Diabetes Care.
TUESDAY, Jan. 3 (HealthDay News) -- There is a positive association between glucagon-like peptide-1 (GLP-1) concentrations and insulin concentrations following gastric bypass (GBP) surgery in patients with type 2 diabetes, suggesting a role for GLP-1 in glucose control, according to a study published in the January issue of Diabetes Care.
Bart J. Van Der Schueren, Ph.D., of St. Luke's Roosevelt Hospital Center in New York City, and colleagues studied 15 obese patients with type 2 diabetes (one man, 14 women) before GBP surgery and one, 12, and 24 months following surgery. Glucose and GLP-1 concentrations were measured during an oral glucose challenge.
The researchers found that weight, glucose area under the curve from 0 to 180 min (AUC_0-180), insulin sensitivity index, and the homeostasis model assessment of insulin resistance all decreased significantly up to one year following GBP, but did not decrease any further at the two-year marker. The decrease in insulin AUC_0-180 became significant at the two-year point. GLP-1 AUC_0-180 was positively associated with insulin AUC_0-180. Glucose AUC_0-180 started decreasing in magnitude one month after surgery, while the GLP-1 AUC_0-180 increased in magnitude one month after GBP, but did not achieve increased variance until the one-year follow-up point.
"The association between GLP-1 and insulin concentrations supports the idea that the incretins are involved in glucose control after GBP," the authors write.

ARTICLE _ GASTRIC BYPASS SLASHES LEVEL OF DISEASE-PROMOTING PROTEINS WITHIN SIX MONTHS

Gastric Bypass Slashes Levels of Disease-Promoting Proteins within Six Months

Released: 6/21/2011
Source: Wake Forest University

Newswise — Winston-Salem, N.C. – New research shows that gastric bypass significantly reduces the inflammation associated with diseases including cancer and diabetes – more proof of the overall health benefits of such surgery beyond weight loss.
The study appears online in advance of print publication in the peer-reviewed journal Surgery for Obesity and Related Diseases.
“We’re amassing evidence that weight loss is a very important part of changing the way the body’s systems work in people with high-risk diseases like diabetes and heart disease,” said Gary D. Miller, an associate professor at Wake Forest University and chief investigator on the study. “It can be encouraging for people who have these diseases and need to lose weight. We’re proving that the benefits of dropping the weight are excellent.”
This study is part of a series of research the team at Wake Forest has conducted to show how weight loss after gastric bypass transforms the body to fight high-risk diseases. Previous research showed that:

•Surgery followed by diet and exercise targeted fat loss inside the abdominal cavity. Increased levels of this abdominal fat, also called visceral fat, is known to boost the risk of developing diseases including cancer. This is the first study to compare levels of visceral vs. subcutaneous fat after gastric bypass.

•Younger people undergoing gastric bypass increased their mobility and improved performance of daily activities within about three weeks, compared with about seven months in older patients. This study seems to dispel the myth that rapid weight loss leads to loss of muscle mass and physical function.

•In the most recent study, based on data collected from 15 gastric bypass patients at Wake Forest University Baptist Medical Center, researchers found that, by six months after surgery, proteins that caused inflammation had decreased, and proteins that reduced inflammation had increased. Such inflammation has been connected to the development of type 2 diabetes and cardiovascular disease.

“I’m hoping this research will help us show people that weight loss is not just about dropping the pounds or about looking different,” Miller said. “It’s about changing your body’s disease-fighting power, too.”
Miller and his team currently are recruiting gastric bypass patients to study how supervised diet and exercise might increase and sustain weight loss after surgery.

NEWS - GASTRIC BAND? HEARTACHE? DIET? OR JUST A BAN ON CHIPS? THE TRUTH ABOUT THE LIGHT NEW DAWN FRENCH

Gastric band, heartache diet or just a ban on chips? The truth about the light new Dawn
By Alison Boshoff
11th June 2011

Berkeley Square Gardens, that small shred of green in the grey heart of old Mayfair, was in quite a hubbub when Glamour magazine held its Women Of The Year awards on Tuesday night.

There were knots of photographers outside the marquee and within huddles of the famous and nearly famous, drinking champagne and gossiping beneath the chandeliers with glowing lavender lights.

One figure, though, attracted all the attention.

It was Dawn French, dressed as usual in black from head to toe, a diminutive 5ft in a room full of towering supermodels and slender actresses.

Everyone did a double take. Gone was the heavy double chin beneath her heart-shaped face.

Instead, her cheekbones were in evidence. Her hair had been freshly coiffed by hairdresser Errol Douglas in Belgravia and was decidedly glossy.

It was clear that a substantial portion of the weight she had carried — proudly — for years was gone.

She glowed with a tan, which she explained had been picked up by sitting in the early summer sunshine in her garden in Cornwall.

Complimented on her weight loss, she smiled and said simply that she had been ‘trying to be a little healthier’ recently.

Some friends say that she has lost five stone; others insist the total is nearer to three. I’m told she is now a size 18 or ‘a 16 on a good day’.

Before, she was at least a size 24. But how has she done it? And why?

Of course, some women do lose dramatic amounts of weight on the back of a divorce — and Dawn was divorced only last year from her husband of 25 years, Lenny Henry.

But the actual separation came long ago, at the close of 2009 — they had already been leading separate lives by the time it was announced in April 2010.

And in that period, as she and Lenny formalised the dismantling of their romantic partnership, she was the heaviest she had ever been.

Fuelled apparently by the misery of the break-up, her already considerable weight went up and up, rather than down.

Gossips on the internet suggest this new dramatic weight loss has happened the Fern Britton way — in other words, with the aid of a gastric band.

But Dawn’s spokesman, Neil Reading, sternly denies that this is the case.

‘That’s utter rubbish,’ he snorts. ‘It’s just healthy eating.’

Mr Reading, who says his client has not been following any of the diets like Atkins or Dukan, insists that Dawn has lost the weight for no other reason than a desire to become fitter.

‘It’s nothing to do with her and Lenny,’ he said, ‘nor is it because she has a new man, because she hasn’t. And it’s not on doctor’s orders or anything like that.’

How curious. Something, though, has persuaded Dawn to totally change the way she eats. And it would seem that fears over her health have played a part.

It is no secret in the showbusiness world that Dawn was huffing and puffing, even when walking relatively short distances.

Whereas once she would tuck into platefuls of salty chips and cook huge meals for herself and Lenny, washed down with gin and tonics, followed by wine, now she dines simply on an omelette and green salad.

In the old days, she had a particular weakness for eating chocolates on the sofa while watching TV. Indeed, Lenny used to regard bringing the chocolate to his wife as his spousal duty. ‘I never do television without chocolate,’ she declared. ‘That’s my motto and I live by it.’

She doesn’t keep a supply of chocolate in the house any more — and, of course, there is no Lenny to bring it to her anyway. Staff have noticed that she barely visits the catering truck on the set of the second series of BBC sitcom Roger And Val Have Just Got In.

People who know Dawn say that she is in a defiant phase. She believes that reaching 50 has been a major watershed in her life and now feels ‘more powerful’ and ‘wiser’ than ever before. And so, after a lifetime of earnestly explaining why being overweight was her choice — and the right one, too — she has changed her mind.

As for her fear of mortality, Dawn now talks about feeling like she is a ‘stayer’ like her mother, who is in her 80s, and her grandmother who lived to be 100.But if she is to live to a long age, Dawn reasons that she had better get into shape.
Dawn French from Spotlight, the actors directory in 1983

Young: Dawn from Spotlight, the actors directory in 1983

Diet and fitness expert Laura Williams says: ‘There is a difference between being morbidly obese and being curvy — and Dawn French was morbidly obese.

‘When you get that big you are living with daily pain in your joints and putting your cardiovascular system under great strain.’

That much must have been obvious to a woman as intelligent as Dawn. So who can blame her for wanting to lose weight?

For now, in her daily life, she is mostly alone, a single woman living in a magnificent 40-room house in Fowey, Cornwall, overlooking the sea. She sits and writes pretty much every day. They almost never see her in the village.

Her silver Range Rover sits behind the high gates of her clifftop house day in, day out, and locals mutter that she is ‘very private’ and likes to ‘keep herself to herself’.

Largely, her only company is her housekeeper, who lives in self-contained quarters in the house, although she is very close to her mother, Roma, and her brother, Gary, who both live locally.

She is working on a second novel, the follow up to her successful A Tiny Bit Marvellous.

Meanwhile, her 19-year-old daughter, Billie, is living in the old marital home in Reading, Berkshire, with Lenny Henry. I’m told she has a job in the area — something connected to horses — and so it suits her to live with her father. He is studying screenwriting and preparing to appear in Shakespeare’s Comedy Of Errors at the Olivier Theatre in London this autumn.

It’s all rather sad. The whole family moved to Cornwall in 2008 and put the Reading home up for sale, first for £3 million and then for £2.3 million.

They only had a single Christmas together there before the marriage ended the following year. Lenny took various paintings and bits of furniture out of storage and quietly moved back into their former home in Reading.

The word is that Dawn cut the cord of the relationship after some indiscretion on Lenny’s part, which was judged to be beyond the pale.
Dawn with ex-husband Lenny Henry as he clutches his Evening Standard award for outstanding newcomer for his debut as Othello

Dawn with ex-husband Lenny Henry as he clutches his Evening Standard award for outstanding newcomer for his debut as Othello

He was, famously, caught out having late-night conversations with hotel receptionist Merri Cheyne in 1999, which caused ructions in their marriage.

In her 2008 autobiography, Dear Fatty, Dawn hinted at infidelities on both sides, writing that they were both ‘flawed and weak’ and had been ‘tempted often’.

She revealed in an interview that year that the Cheyne affair had been something so minor that they would not normally have felt it necessary to discuss it.

It seems the marriage worked on a ‘don’t ask, don’t tell’ basis when it came to infidelity.

In public, they have both declined to discuss why the marriage ended.

Dawn says that she is proud to have made the union last for 25 years. Lenny concludes, rather more morosely: ‘It’s just the way it is. We are still good friends.’

And now, trailing more than a year behind, comes her reinvention.

Her weight — and issues around it — have been significant since she was a teenager.

She vividly recalls her father, Denys, telling her how beautiful she was at 13 — this was the ‘armour’ of body confidence she says she always wore since.

Dawn says that her natural body shape is ‘teeny and wide, like a Weeble’. She briefly slimmed to a size 12 before her 1984 wedding, using diet pills, but said she felt ill and Lenny didn’t even like her that way, so she went straight back up to an 18 and beyond.

‘I can honestly say it doesn’t bother me, though I do worry that I’ll get so uncomfortably fat that I won’t be able to walk any more,’ she said.

An old friend tells me: ‘They were a very sociable couple and loved to entertain and there was always just so much food about. I have seen Dawn match Lenny mouthful for mouthful.’

Not any more.

The new Dawn, as everyone who met her on Tuesday night will attest, is a very happy one indeed.
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i found out about Dawn French as a result of being hard pressed for something to watch, and flipping on PBS..and seeing the comedy show: THE VICAR OF DIBLEY

because shes plus size, i adored her, naturally, and found allot of her comedy to be truthful, and heart felt..

it makes me very pleased to know shes going the healthy route, and if it be naturally, then kudos to her! shes a great comedian/actress, and i want her around alot longer than allot less...

MICHELLE