1 March 2010 Michelle Bent- Form Fashion and style (confirmed)
12 April 2010 Dr Paul Belt – Plastic surgeon (awaiting confirmation)
10th May 2010 Dietician- Maximum taste
7 June 2010 EXERCISE -Maximum output
12 July2010 : Patient driven evening-
2 August 2010: Recognising Depression
Support group topics
1 March 2010 Michelle Bent- Form Fashion and style (confirmed)
12 April 2010 Dr Paul Belt – Plastic surgeon (awaiting confirmation)
3 May 2010 Dietician- Maximum taste
7 June 2010 EXERCISE -Maximum output
12 July2010 : Patient driven evening-
2 August 2010: Recognising Depression
The Practice is continuing to develop and I am glad to say we are continuing to see excellent results with our patients. I recently reviewed a patient who had a Laparoscopic Bypass twelve months ago and I am glad to say she is now off all of her diabetic medication and her weight is within the normal range. Towards the end of the year, there were more patients attending the practice for Sleeve Gastrectomy and Gastric Bypass than there were for Gastric Banding. I continue to perform all three operations with the decision on which type of operation a patient has made usually by the patient themselves.
Anyone interested in Weight Loss Surgery is welcome to contact the practice for a free consultation or alternatively can come to the Patient Support Group meetings which are held at Brisbane Private Hospital on the first Monday of the month. I personally think it is beneficial for patients considering Weight Loss Surgery to have the opportunity to discuss the surgery with someone who has been through it as opposed to just relying on what I say or information obtained from the internet. We continue to have a good attendance at the Patient Support Group with normally between 30 to 40 patients in attendance. Throughout 2010 we will endeavour to have a number of guest speakers in addition to the regular sessions hosted by Michele Van Vuuren, Michelle Graham and Dan Jokovich. Due to changes in the Medical Act, I have had to remove my patient videos from the web site, as patient testimonials are not permitted. Before and After photographs will continue to be posted and I hope to post some operative videos early in the New Year.
In 2005 obesity was estimated to be responsible for 1 in 10 deaths in the year, and was the 3rd leading risk factor for adult death after tobacco smoking and high blood pressure. Australia currently ranks 17th in the world for obesity with 20.6% of males obese and 25.5% of females obese. The average BMI of a female over 30yrs in Australia is now 37.7 and this group of females weight has been increasing twice as fast as anywhere else in the world. It is anticipated we will soon pass the USA for obesity in females over the age of 30. A recent study from the United States demonstrated that obese patients spend on average an extra $1,400 a year on their health care compared to a non obese patient. This suggests that losing weight will not only bring medical benefits, as well as improvement in quality of life, but in the long term can have substantial financial benefits as well.
There has been some debate as to whether there is such a thing as the healthy overweight. Certainly, as with many things in life, there is a subgroup of people who remain healthy despite their excessive weight or despite their smoking. A recent Swedish study of 1700 men looked at the association between BMI category, metabolic syndrome (high blood pressure, high cholesterol and diabetes) and the risk of Cardiovascular disease and death. This study ran over a 30 year period and demonstrated that obesity was associated with an increased risk of non Cardiovascular disease and Cancer incidents when compared to normal weight participants without Metabolic Syndrome. This study tends to refute the notion that being overweight or obese without Metabolic Syndrome is a benign condition. (Amlov J. Circulation 2010; 121; 230-236). Also a recent study from Denmark suggested that women who had a BMI of greater than 30 were more likely to be diagnosed with breast cancer in an advanced stage and also had a higher risk of recurrent disease.
As a practice we have started measuring GHERLIN levels, which is a hormone associated with feelings of hunger when your stomach is empty. There is evidence that GHERLIN levels are significantly reduced in Sleeve Gastrectomy patients and certainly our Sleeve patients tend to say that they don’t feel hungry and that they tend to eat because it is lunch time or dinner time rather than due to feelings of hunger. A recent study on mice has demonstrated that mice, given injections of GHERLIN, tended to seek out the chamber where they had been previously supplied with fatty food, as opposed to the chamber where they had been previously supplied with bland food. Researchers who carried out this study have suggested that this may indicate that GHELIN promotes individuals to seek out unhealthy fatty food. If this is shown to be true it would further enhance the merits of a Sleeve Gastrectomy in which GHERLIN levels are greatly reduced and may facilitate patients seeking a healthier dietary options after surgery.
Brain Issues
Recent research by Professor Paul Thompson, Professor of Neurology at UCLA published in the journal “Human Brain Mapping”, found that obese people have 8% less brain tissue than people of normal weight. The study looked at scans of 94 elderly people in their 70s who were otherwise healthy. Obese patients had lost both grey and white matter in the frontal and temporal lobes, which are areas of the brain critical for planning and memory, and in other areas which are used for attention and executive function, long term memory and movement. According to Dr Thompson, the brains of obese patients looked 16 years older than the brains of people who were not overweight. This means that overweight patients may be at greater risk of Alzheimer’s disease and other diseases that attack the brain.
So obviously maintaining control of your weight, exercising and eating well can maintain brain health with ageing and potentially lower the risk of Alzheimer’s and other forms of dementia.
Sexual Function
An article in the journal “obesity and weight management” has suggested that obesity may increase the risk of erectile dysfunction in men. Doctors from the United States described a case of a 48-year-old man who was overweight with a BMI of 32, who suffered from erectile dysfunction. He was unable to achieve an adequate erection despite the use of medication. However, after weight reduction and medication to lower his blood pressure, he was able to achieve an adequate erection with the help of erectile dysfunction medication.
It should be remembered that obesity increases your risk of narrowing in the arteries and these are not only the arteries that supply the heart and brain, increasing the risk of stroke and heart attack, but also the smaller arteries which are important in erectile dysfunction. This study would suggest that men who are looking for reasons to lose weight should also consider the risk of erectile dysfunction as they get older. Up to 40% over the age of 50 may experience erectile dysfunction.
Dr Philip Lockie
Consultant General Surgeon
BMI guidelines for South Asian patients
The BMI guidelines currently used to define overweight and obesity have recently been revised for people of South Asian origin. The limit for being overweight has been decreased from 25 to 23, and the limit for being obese has been decreased from 30 to 25. There have also been corresponding reductions in waist circumference measurements. This is in part due to the fact that South Asian people are more likely to develop heart disease and type 2 diabetes if they are overweight. For example, in the UK, South Asian people make up 4% of the population, but an estimated 8% of people suffering from type 2 diabetes.
Weight loss surgery might protect against cancer in women
A recent large study from Scandinavia published in The Lancet Oncology suggests that weight loss surgery can reduce mortality in women from cancer. The study began in 1987 and followed a total of 4,000 patients, half of whom had surgery and half of whom did not. During the 10-year follow-up, the average weight loss in the surgery group was 20kg vs. a weight gain of 1.3kg in the control group. The number of cancers in women in the surgery group was 79 vs. 130 in the control group, and this was statistically significant. There were some limitations with the study. In particular, it was not set up to specifically look at cancer mortality, but it does suggest that weight loss following bariatric surgery produces health improvements not only in terms of beneficial effects on diabetes and heart disease, but also potentially with a number of cancers.
Obesity in pregnancy
The American College of Obstetrics and Gynaecology has recently issued some practical guidelines regarding the risks for obesity in pregnancy and outcomes of pregnancy after bariatric surgery.
Obesity in itself reduces fertility, primarily due to decreased or absent ovulation. There are increased risks of gestational diabetes, pre-eclampsia and Caesarean section in obese patients. Obese patients are more likely to be admitted earlier in labour, require induction of labour, and have a longer labour.
A number of conclusions and recommendations were made. These include:
To date, in my practice, I have had one patient who has become pregnant after bariatric surgery, and her pregnancy was uneventful.
Long term outcome of gastric bypass surgery in diabetics
A recent study looking at long term follow-up patients who underwent Roux-en-Y gastric bypass surgery was presented at a meeting of the American Society for Metabolic and Bariatric Surgery. A study of 177 patients who had been followed up for at least five years, and some as long as 16 years, was presented. Researchers found complete resolution of type 2 diabetes in 89% of patients after surgery, with a mean excess weight loss of 70%. Eleven per cent of patients lost on average 58% of their excess weight, but did not resolve their diabetes, and in a minority of patients, diabetes reappeared and this was linked to weight regain.
Patients who achieved the best long term results in terms of resolution of the diabetes were those patients who were either on tablets for their diabetes or on diet only. This supports previous studies which have suggested that the earlier a type 2 diabetic patient has surgery, the better their results will be in the long term.
Myself, Shirley and Michelle Van Weren, the practice Psychologist, have recently attended the Obesity Surgical Society of Australia and New Zealand Annual Meeting in Cairns.
Over the next few weeks we will be providing more information regarding some of the interesting topics which were discussed at the meeting.
The meeting offered the opportunity for each of us to meet and discuss various aspects of bariatric surgery with leading experts from the United States and Europe. I am pleased to say that the model of care that we have set up at the Brisbane Institute of Obesity Surgery (BIOS) fits with current world best practice.
There was some interesting discussion as to the natural neurological and hormonal maintenance of weight. The body has a natural weight balance which is controlled by various hormones and brain stimulus in much the same way as breathing is controlled. There are natural variations in our weight that we are not aware of on a day to day basis, in the same way as we are not aware of the natural stimulus to breathe on a minute to minute basis. Interestingly, the body is set up in a hormonal environment to defend against weight loss. In other words, it is naturally more difficult to lose weight than it is to gain weight, and this is felt to reflect an evolutionary bias whereby it is important to put on weight in times of plenty and defend against weight loss in times of famine.
A recent OECD report has identified Australia as one of four OECD countries forecast to the head the global obesity epidemic in 2019. It is predicted that an increasing precentage of the population will move from being in the overweight to the obese category. Currently nearly half of all Australian adults, that is, 7.4 million people, are either overweight or obese and this is predicted to increase to two thirds of Australians within the next ten years. The average weight of Australian adults has increased by between 0.5 kg to 1.0 kg annually over the last 10 years. As a result there have been increasing levels of chronic weight related diseases such as diabetes and high blood pressure, and this is affecting public health budgets and also the productivity levels in business.
Unfortunately, whilst governments are aware of these trends, as yet there has not been any corresponding increase in the amount of funding available for bariatric surgery in the Public Sector.
It has been developed to provide you with valuable information on Obesity Surgery, including a number of other medical operations – Gastric Banding, Gastric Bypass, Sleeve Gastrectomy, Anti-Reflux Surgery, Laparoscopic, Laparoscopic Colectomy, Hernia Repair.
Tags: Anti-Reflux Surgery, Gastric Banding, Gastric Bypass, Hernia Repair, Laparoscopic, Laparoscopic Colectomy, Obesity Surgery, Obesity Surgery Brisbane, Sleeve Gastrectomy