I am glad to say the practice continues to achieve excellent results. I have seen several patients recently who have managed to lose all of their excess weight and have regained their normal weight. A recent report from Spain suggests that patients with a BMI in the 40 to 45 range have a reasonably good chance of obtaining their goal weight within 2 years following a sleeve gastrectomy.
We continue to have a good attendance at the Patient Support Group and this month Dr Paul Belt, Consultant Plastic Surgeon gave a presentation on the developing techniques of body contour surgery. He demonstrated that good results can be achieved after a significant weight loss, provided patient’s expectations are realistic and careful consideration is given to planning the exact nature of the surgery.
From the world of research, there have been a number of interesting publications over the last few months. It has been suggested that weight bias is the last acceptable form of discrimination. A recent study from New South Wales has demonstrated that obese people were rated as more disgusting than other social groups such as the mentally ill, homeless, politicians, and welfare recipients with only drug addicts and smokers being viewed more poorly. This may be one of the reasons why politicians seem so reluctant to invest public money in bariatric treatment, as obesity is felt to be just a lack of self-control. It is interesting that politicians do not seem to feel the same way about diseases and illnesses caused by smoking or alcohol. From the world of cancer research it has been known for sometime that obese patients are more at risk of colon cancer and a recent study from the Mayo Clinic demonstrated that obese patients did not survive as long following colon cancer surgery as thinner patients. This affect was particularly marked in men.
In Australia obesity has overtaken smoking as a leading cause of premature death and illness. Recent figures from Western Australia have shown that excessive weight causing ill health has doubled in the last six years and in 2006 accounted for 8.7% of all illness, whereas tobacco’s contribution to ill health has steadily decreased and now causes 6.5% of illness and early death. In 2008 the cost of obesity in New South Wales alone was calculated at $19 billion.
A study from Scotland has demonstrated that obesity enhances the harmful affects of heavy drinking on the liver. Men of a normal weight who consumed 15 or more drinks per week had three times the risk of liver disease than men who did not drink. However, overweight men who drank the same amount were seven times more likely to have liver disease than non-drinkers. For heavy drinkers, who were obese, the risk increased to nineteen times that of non-drinkers. This suggests that safe alcohol limits need to be adjusted to take into consideration a person’s weight.
There have been a number of interesting research publications from the area of obesity prevention. It has always been argued that prevention and treatment of obesity is simply a case of diet and exercise. In terms of exercise, a study from Boston, looking at women, has demonstrated that middle-aged women may have to partake in up to sixty minutes of exercise per day to prevent weight gain. This study showed exercise to be only beneficial in weight control in women who were normal weight to begin with. However, it was emphasized by the researchers that if you could not partake in 60 minutes of exercise per day you should not give up altogether, as clearly some form of regular exercise is beneficial to your overall health.
A study from the American Journal of Clinical Nutrition suggests that for men not getting a goodnight’s sleep may make them prone to obesity. In this study a group of men were either given 8 hours sleep a night or 4 hours sleep a night and their food intake was observed. Those with the shorter sleep pattern tended to consume more calories. They also suggest that this may be a reflection of the body’s perception of daylight, in that longer days were associated with summer time and plentiful food and the individual is consuming more calories with the aim of storing fat for the upcoming cold winter with it’s shorter days.
From the world of pharmaceuticals, researchers from Newcastle University in the UK have demonstrated that alginate made from sea kelp can help prevent absorption of fat. This study suggested that natural fibre added to commonly eaten foods such as bread, biscuits or yoghurt prevented up to ¾ of the fat contained in these meals from being absorbed. The next step will be to see whether they could reproduce the laboratory results in human trials. In terms of diet, a study in the International Journal of Obesity, suggests that the traditional cooked breakfast of bacon, eggs and sausage may in fact be beneficial in controlling weight! In an experimental study on mice, results indicated that having a large fatty breakfast followed by a smaller lunch and an even smaller evening meal resulted in some weight loss, whereas eating fatty foods later in the day led to weight gain. In addition, mice fed high carbohydrate breakfast, such as cereals, tended to gain weight and have difficulty metabolising sugar increasing the risk of diabetes. It should be emphasized that in this study the lunch meal and the evening meal were small. Obviously, having a fatty breakfast following by a large lunch and an even larger evening meal will not result in weight loss!
Finally, a study from researchers in the USA and Sweden has demonstrated that the extra padding of obesity does not act as an additional airbag in motor vehicle accidents. In this study, cadavers were used as obese crash dummies do not exist. The car was crashed at 50 km/h crash with the passenger wearing a seatbelt but not having an airbag. Obese passengers whilst being at less risk of a head injury were more at risk of injuries to ribs and lungs and also significantly more at risk of lower limb injuries. In addition, another study analysing real world data from 11000 drivers reported that obese drivers are more likely to sustain upper body injury in crashes.
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
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
