Fight obesity with effective and guaranteed tools

t

Haitham Al-Khayat, MDConsultant general and bariatric

surgeon

New Dar Al-Shifa hospital

Obesity

Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health, leading to reduced life expectancy and/or increased health problems.

Obesity is the 2nd most common cause of death from a modifiable behavioral risk factor

Obesity related comorbidity

• Type II DM

• Hypertension

• Cardiac diseases

• Strokes

• Hyperlipidemia

• Respiratory diseases

• Degenerative osteorthritis

• Depression

• GERD

• Nephrotic syndrome

• Infertility

• Venous stasis ulcers

• Pseudotumor cerebri

Causes of obesity

Genetics Behavior

Environment

Environment portion size

Nonoperative treatment how does it add up??

Nonoperative treatment how does it add up??

Diet

Exercise

Behavioral therapy

+ Drug therapy .

??????

Why Surgery?

• Diet and exercise are not effective long term in the morbidly obese

• Surgery is an accepted and effective approach

• Surgical risk is acceptable vs. risk of long-term obesity

Surgery is effective

Pre-operative Medications Post-operative Medications

Surgery is effective

Surgical treatment of obesityIndication of surgical options

Patient selection

BMI ≥ 40 kg/m2 OR

BMI 35 - 40 kg/m2 with significant comorbidity

High risk health problems

Ineffective documented dietary attempt

The Gastrointestinal system

Operative approaches

Restrictive Procedures

Adjustable silastic gastric banding (ASGB)

Sleeve gastrectomy

Gastric plication

Combined Procedures

Roux-en-Y gastric bypass ( GBP )

Lap Band

• Restrictive

• Reversible

• 40-55% EBW loss

Lap sleeve gastrectomy

• Restrictive

• Very popular in Kuwait

• 60-70% EBW loss

• Relatively new with unknown long term consequences

Roux En Y gastric bypass

• First done in 1967

• 60-70% EBW 14 year followup

Results of bariatric surgery

• Weight loss

• Resolution or improvement in comorbidity

• Increased longevity

• Improved QOL Health Social Personal Work

General Complications of Weight-Loss Surgery

• Post-operative depression• Food issues

• Changes in relationships

• Hair loss• Usually temporary

• Cause: protein, vitamin A, mineral

• Excess skin

Weight loss program team

• Surgeon

• Nurse practitioner

• Dietitian

• Anesthesiologist

• Nurses

• Cardiologist

SAFETY and RESULTS

Final words

* Surgery is only a tool

* Patients must commit to lifelong changes in diet and behavior

* Think seriously about options

* We are here to help

Defining the Problem

The Problem

• Prevalence of obesity in U.S. increased from 12% to 21% between 1991 and 2001 = 15 million people

• Obesity is the 2nd most common cause of death from a modifiable behavioral risk factor• 111,909 excess deaths annually

Mokdad AH et al. JAMA. 2003;289:76-79Flegal KM et al. JAMA 2005;293:1861-1919

Excess U.S. Medical Costs Related to Abnormal Body Weight

Int J Obesity 2005;29:334-339

Diabetes

Gall bladder disease

Hypertension

Dyslipidemia

Insulin resistance

Breathlessness

Sleep apnea

Greatly increased(relative risk >>3)

Coronary heart disease

Osteoarthritis (knees)

Hyperuricemia and gout

Cancer (breast cancer in postmenopausal women, endometrial cancer, colon cancer)

Reproductive hormone abnormalities

Polycystic ovary syndrome

Impaired fertility

Low back pain

Increased anesthetic risk

Fetal defects arising from maternal obesity

Moderately increased(relative risk 2-3)

Slightly increased(relative risk 1-2)

Relative risk of health problems associated with obesity

1Chan JM et al. Diabetes Care 1994;17:961-969; 2Colditz G et al. Ann Intern Med 1995;122:481-486.

Age-adjusted relative risk of type 2 diabetes

The Effect of Obesity on the Development of Health Risks

0

10

20

30

40

50

1.02.2

12

42

0

25

50

75

100

1.08.1

40

93

<23 25 31 35 <22 25 31 35

Men1 Women2

BMI

Fed up with how her diet is going Charlene takes a more serious aim at her target weight

Weight Maintenance after Bariatric Surgery

Sjöström L, Lindroos AK, Peltonen M et al. N Engl J Med. 2004;351:26

Conclusions• Bariatric surgery is an effective means to

achieve clinically significant, permanent weight loss with low rates of complications.

• Bariatric surgery results in significant improvement in health risks associated with obesity.

• Surgical weight loss increases life-span.

• Surgical therapy is cost-effective.