obesity and bariatric surgery by dr. sanjiv haribhakti
TRANSCRIPT
Obesity and
Bariatric Surgery
Dr. Sanjiv HaribhaktiMS,DNB,MCh(G.I surgery)
Chairman
Kaizen Hospital, Ahmedabad
What is Obesity?
Multifactorial disease of excess fat storage with a genetic
basis
Influenced by the environment
Lifelong and progressive
Associated with multiple serious medical problems
Why everyone talks about obesity?
Increasing incidence
Increasing awareness
Improving understanding of the disease path
physiology and course
Introduction of laparoscopic surgery
Good long term results
India 2015 !!
Patient Awareness
Health consciousness
Knowledge of complications
access to internet , reading
Availability of less painful, laparoscopic surgery , with
speedy recovery
How to Decide , Define?
BMI , universal assessment tool
Assesment of obesity
Determined by using weight and height to calculate a number called the “body mass index” (BMI)
BMI = Body weight(kg)---------------------
Height(m2)
overweight
BMI - 25 to 30
obese
BMI - 30 - 40
Morbidly Obese
BMI > 40
Assesment
Risk factors of obesity
Obesity itself is a disease
The health risks of obesity
FRIENDS TOGETHER
Metabolic Syndrome Syndrome X
Abdominal obesity
D M Type II
Dyslipidemia
Hypertension
Type 2 diabetes
Gaining as little as 4-5 kg doubles your chance of developing type 2 diabetes
More than 80% of people with diabetes are classified as overweight or obese
High blood pressure
High blood
pressure is twice
as common in
obese adults
High cholesterol
Overweight people often
have too much
cholesterol in their
blood.
High cholesterol is linked
to angina (a type of chest
pain), heart disease, heart
attack, and stroke
Arthritis
Your risk of arthritis
increases by 9 - 13% for
every 1 kg of weight that
you gain
Breathing problems
Asthma and obstructive
sleep apnea are more
common in obese people.
Mechanical and
inflammatory reasons
Cancer
Obesity may increase the risk of endometrial, breast, prostate, kidney, esophageal, and colon cancers
Women who gain more than 8 kg between the age of 18 and midlife have double the risk of developing breast cancer after menopause
Gallbladder stones
Excess Weight increase
the chances of getting
Gall bladder stones
Gastrointestinal Tract
GERD
Nonalcoholic fatty liver diseases from steatosis ,
fibrosis to cirrhosis –30 to 100% in obese patients
Pregnancy
complications
Infertility
Obesity increases the risk of diabetes during pregnancy,
delivery complications, and birth defects
Obese women have 10 times the risk of high blood
pressure during pregnancy
Prevalence of Significant Morbidities
per Weight
Mokdad AH, et al. JAMA 2003;289:76.Centers for Disease Control, National Center for Health Statistics, National Health and Nutrition Examination Survey* Increase in mortality rate from cancers of all kinds compared to lowest risk group (BMI 25-30). From: Call EE, et al.Overweight, obesity and mortality from cancer in a prospectively studies cohort of US adults. New Engl J Med 2003;348:1625.
4%
10%
18%16%
3%7%
10%
24%28%
0%
15% 14%
32%
41%
15%
26%23%
44%
51% 52%
0%
10%
20%
30%
40%
50%
60%
Diabetes Asthma Arthritis High Blood Pressure
Cancer*
BMI < 25 25 - 30 30 - 40 BMI > 40
Traditional Weight
Loss Therapies
Diet
Exercise
Lifestyle Habits
Key to success
Assesment of obesity
Target with timeline
Comittemnt
Consistency
Under proper guidence
Regular reassesment
??? Difficult
Is there a better option?
Yes ,
Better
Proven
Consistent
Minimal invasive
Surgery for
Weight Loss
Current Bariatric Surgical Procedures
Restrictive
◦ Sleeve Gastrectomy
◦ Laparoscopic Adjustable Gastric Banding
Malabsorptive
◦ Duodenal Switch / Biliopancreatic Diversion
Restrictive and Malabsorptive
◦ Roux-en-Y Gastric Bypass
Who is a candidate for
surgery?
Who Need surgery ?
Age 18 to 60 years
Patients have a Body Mass Index >40 kg/m2
Patients have a Body Mass Index between
35 and 40 kg/m2 with significant risk factors
Patients have failed other medically managed weight-loss
programs
Who don’t need surgery ?
Obesity related to a metabolic or endocrine disorder
History of substance abuse or untreated major psychiatric
disease
Women who want to become pregnant within the next 18
months
Active cancer
Advanced liver disease with PHT
Severe OSA with Pulmonary hypertension
Adjustable Gastric Banding
Laparoscopic
Mean excess weight loss at 1 year
of 42%1
Requires implanted medical device
Lowest rate of complications
1. Buchwald, H. et al., JAMA. 2004; 292:1724-37.
Vertical Sleeve Gastrectomy
Laparoscopic
Mean excess weight loss at
1 year of 60%2
No implanted medical
device
1. ASMBS, Position Statement on Sleeve Gastrectomy as a Bariatric Procedure. June 17, 2007.2. Lee CM, et al. Surg Endosc (2007) 21: 1810–1816
BMI – 61.7 kg/m2
Gastric-Bypass
Started in 1994
Long-term sustained weight loss
65 to 70 % of EWL
No protein-calorie malabsorption
Little vitamin or mineral deficiencies
Technically difficult procedure
A Combination Approach is Most Common
Laparoscopic
Most frequently performed bariatric procedure
Mean excess weight loss at 1 year of 70 %
No implanted medical device
Low rate of complications
Roux-en-Y Gastric Bypass
Resolution of Comorbidities
% Improved % Resolved
Diabetes 18 82
Hypertension 18 70
Osteoarthritis 47 41
High Cholesterol 33 63
Reflux Disease 24 72
Breathing Problems at night 19 74
Asthma 69 13
Average 35.1% 55.7%
90.8%Improved or Resolved
Deaths per 100 People with
Morbid Obesity and Heart Disease
Christou NV, Sampalis JS, Liberman M, et al. Surgery Decreases Long-Term Mortality, Morbidity, and Health Care Use in Morbidly Obese Patients. Annals of Surgery 2004;240(3):416-424.
Dzavik V, Ghali WA, Norris C, et al. Long-Term Survival in 11,661 Patients with Multivessel Coronary Artery Disease in the Era of Stenting: a Report from the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) Investigators. American Heart Journal 2001;142(1):119-126.
Success Rate of Weight Loss Treatments for
Morbid Obesity
Eliosoff 1997; Sjostrom NEJM 2004, Obrien J Laparoendosc Adv Surg Tech A. 2003 Aug;13(4):265-70.
TreatmentAverage Weight Loss (%
Total)% Excess Weight Loss at
Five Years
Placebo 4–6% 0%
Diet / Behavior Modification 8–12%1.6%
(10 Years)
Drug Therapy < 10% 10%
Gastric Bypass Surgery 65–85% Up to 100%
Laparoscopic Adjustable Gastric Banding
45–50% 56%
Sleeve Gastrectomy 50-60% 65%
Only surgery has proven effective over the long
term for most patients with clinically severe
obesity
Myth – surgery for weight loss is new & experimental
Open surgery ~ 50 years
Laparoscopic surgery
~ 15 years
Proven results of > 10 years of Lap. Weight
Loss Surgery
Myth - surgery for weight loss means
liposuction
Surgery Will Not Work Alone…
Commitment to Diet & Exercise
KAIZEN OBESITY CLINIC
Every Friday 4 p.m. to 6 p.m.
Multidisciplinary consultation
Obesity surgery Counseling
Support group meeting
Public awareness program
Take Home Message
• Obesity is a disease
• Needs attention before it brings all friends together
• Metabolic surgery is the ONLY safe and effective
long term solution
Thank You