surgical management of obesity
TRANSCRIPT
Surgical Managementof Obesity
Obesity is the great epidemic
of the 21st century
How do we Grade obesity?The most useful measure is BMI : Wt (Kilograms) / Height (Metres) 2
>This is a measure of both weight and height
>It takes into account that the taller you are:
>The more weight you can safely carry
There are Degrees of Obesity
NORMAL
BMI 18.5 – 24.9
OVERWEIGHT
BMI 25 – 29.9
OBESE
BMI 30 – 34.9
MORBIDLY OBESE
BMI 35 – 39.9
Super OBESE
BMI 50
BMI 20-25 BMI 25-30 BMI 30-35 BMI 35-40 BMI 50+
Australia is the second most obese nation in the world
> 50% Australians are overweight BMI 25-30
> 8% Australians are obese BMI 30-35
> 2-4% Australians are Morbidly obeseBMI 35 +
“ Average “ Australian weight increasing by 0.5Kg / 5yrs
Obesity is a major cause of these obesity related illness> Type 11 Diabetes> Hypertension> Sleep apnoea> Asthma> Infertility> Arthritis> Fatty liver
>The good news is… All of these conditions will resolve or improve with significant weight loss
For the first time this century>Our children will live less long than us
>Diabetes rates are skyrocketing
>Children as young as 12 are taking the same tablets for diabetes as their Grandmothers
…all because of Obesity
> Low self esteem and depression.
> Impaired employment prospects.
> Increased industrial accidents.
> Restricted access to public facilities.
> Relationship difficulties.
> Societal prejudice.
Societal implications of obesity
Body Mass Index vs. Mortality
16 19 22 25 28 31 34 37 40 45
0
50
100
150
200
250
300
350
400
High riskMedium riskLow risk
Rela
tive M
ort
ality
R
ate
BMI (kg/m2)
Source: NIH, NEJM, 1995.
Exponential Increase in Risk
If you have a BMI of 40, at age 40 and your weight remains
the same you will have lost on average 15years of life!
Obesity is not just an eating disorder!
>It is a complex relationship between
>Genetic predisposition
>Increased caloric intake
>Reduced caloric expenditure
>We all live in a “Toxic Obesogenic” environment !
Excess Caloric Intake
Morbid Obesity
Genetic predisposition
Reduced Caloric expenditure
DepressionLow self esteem
Failed dietsFailed Medical Rx
Obesity illnesssyndrome
Australians spend millions of dollars each year on dietsFor the majority of morbidly obese ……Diets just don’t work
“The best average weight loss
achieved by the majority of diet interventions is 10kg all of which is regained within 6 months.”
NIH consensus statement.
Tried…and abandoned
> Jaw wiring > Hypnosis > Acupuncture > Psychotherapy > VLC diets > Intragastric balloon
And then there is always
Most medical authoritiesnow agree
>The most effective treatment of
Morbid obesity… is surgery
>It is safe, effective and durable!
Bariatric surgery is not just about the surgery!
>The best results are achievedwith a Multidisciplinary team
>Surgery is an aid to weight loss
> It still requires effort andcommitment by the patient
At Mercy Bariatrics we have developed:
>A dedicated Bariatric team of health professionals
>Diet and exercise programmes to compliment the surgical procedures
>Educational and support services to guide you through the surgical programme
Obese Patient
BariatricSurgeon
BariatricAssessor
SurgicalAssistant
Office staff Exercise Physiologist
Physician
DieticianAnaesthetist
Psychologist
Who is a candidatefor surgery?
> BMI > 35> BMI > 30 -35 + Obesity Co-morbidity
> Age 12- 75> Reasonable attempts at weight loss >2yrs> Ability to comprehend implications of
Surgery> No Alcohol or Drug Dependency
Surgical Choices
> There are many different operations for obesity.
> There is no single operation which is right for all
people
> Each operation has advantages and disadvantages
> Choosing the right operation is the most important
step towards successful outcomes.
> At Mercy Bariatrics we have focussed on three main
types of surgery.
Lap band>A reductive and restrictive operation
>Adjustable silicone band
>Placed around top part of stomach by keyhole surgery
>Decreases intake to an entrée portion
>Prolongs satiety and decreases appetite
>2 days in hospital back at work in < 1 week
>Safe, reliable, effective
>Over 20, 000 procedures throughout Australia
Usual weight loss: 50-60% of excess weight lost over 1-2yrs
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Laparoscopic Tube Gastrectomy
> A purely reductive operation
> Reduces stomach to a 150-200mls tube
> Normal emptying so you can eat a wider range of food
> A set and forget operation> No adjustments required> No malabsorption> No long term side effects> Bypass can be added later
for extra weight loss
Predicted weight loss: 50-70 % EWL over 1-2 years
Biliopancreatic Bypass - DS
> A reductive and Fat malabsorbtion operation
> Profound and rapid improvement in diabetes and high cholesterol
> Open surgery so requires longer to recover
> Best weight loss of all procedures
> Good revisional option> Lifelong mineral and vitamin
supplements required
Predicted weight loss: 70-90% EWL over 1-2 years
Results from surgery…>Type 11 diabetes resolved in 70-90%
>Hypertension resolved in 70-80%
>Sleep apnoea resolved in 80-90%
>Asthma improved in 70%
>Significant improvement in Depression and quality of life scores
80% of our patients achieve more than 50% of excess weight loss over 2years.
Our patients tell the story…
Lap Band 100.7kgBMI 39.7
Post op 12months
79kgBMI 30.5
Pre op Lap Band Wt 105kg
Post op 2 yearsWt 64kg
Preop Abdo lipoplasty and Lap bandWt 160kg BMI 52
18 Months Post op 107kgBMI 35-53kg / 59% EWL
Laparoscopic tube Gastrectomy
Preop Jan 2004144kgBMI 45
Jan 200587kg / BMI 27
Pre op 152kg Post op 1 year 92kg
Tube Gastrectomy
Preop BPD 174kgBMI 58
24months
74kgBMI 24 - 100kg
96%EWL
Preop 127kgBMI 43
Post op 84 weeks82kgBMI 27
Biliopancreatic Diversion
Preop BPDOct 2001Wt 146kg
BMI 56
Post op BPDJan 2003Wt 85kgBMI 31
Preop 189kg 2 yrs / Post op 109kg
Biliopancreatic Bypass
Preop 118kg Post op / 18 months / 65kg
Preop Lap BPDSept 2003Wt 122KgBMI 40
Postop Jan 2005Wt 72Kg (-50Kg 92% EWL)BMI 24
How do I get started?
>Talk to your G.P. about the surgical options>Attend one of our free information evenings>Visit us at Mercy Bariatrics>Check out our website
>www.mercybariatrics.com.au