A1261858507VXfFv

1
Obesity Surgical and other interventions Step
hen Pollard Consultant Surgeon St Jamess
University Hospital and Leeds Spire
Hospital Cutting Edge Surgery February 2009
2
Classification by Body Mass Index(BMI kg/m2)

• lt18 underweight
• 18-25 desirable
• 27-30 overweight
• 30-35 obese
• 35-40 with med problems or gt40 morbidly obese
• gt50 superobese
• gt60 super-super obese
• gt70 ultra-obese

3
The size of the problem in the UK

• Prevalence of obesity
• 1980 1993 1998 2002 2006
• Male 6 16 21 24 29
• Female 8 13 17 21 24
• Overall, 3 of adults are morbidly obese
• 30-50,000 deaths attributed to obesity per annum
• 1.2 million fulfil NICE criteria for surgery

4
European Charter on Counteracting Obesity (WHO
2006)

• Recognised surgery as the only effective
  treatment for morbidly obese patients
• Reported European data
• 150,000,000 obese adults
• 15,000,000 obese children
• 1,000,000 deaths per annum
• http//www.euro.who.int/Document/E89567.pdf

5
The size of the problem worldwide

• gt1 billion people are overweight
• gtQuarter of a billion are obese
• More people suffer from obesity than from
  malnutrition

6
The cost of obesity

• In the UK
• Estimated healthcare costs of
• 6.6 7.4 billion per year (NICE, Dec 2006)
• US - 75 billion

7
Socio-economic class

• of adult population with BMIgt30
• SE class 1 5
• Male 11 16
• Female 14 28

8

• The future of bariatric surgery
• Predictions are risky, particularly when made
  about the future
• Senator Dan Quayle, Former U.S. Vice President

9
Obesity in Children

• 8.5 of 6 year olds are obese
• 15 of 15 years olds are obese
• 90 of obese children become obese adults
• But
• Average intake of calories per meal has remained
  unchanged since 1945
• So what has changed?
• Snacking on energy dense high calorie foods
  between meals and a more sedentary lifestyle
• 1985 80 of children walked or cycled to school
• 2003 5 of children walked or cycled to school
• Dec 2006 NICE consider children suitable for
  surgery

10
Even our dogs are getting fatter
11

• Weight is regulated with great precision. For
  example, during a lifetime, the average person
  consumes at least 60 million kcal. A gain or loss
  of 10Kg, representing approximately 90,000 kcal,
  involves an error of no more than 0.001.
• The results of adoption and family studies show a
  heritability of obesity of about 33. Genetic
  influences may be more important in determining
  regional fat distribution than total body fat,
  particularly the critical visceral fat depot.
• The converse of finding that genetic factors only
  influence a proportion of the variation in body
  weight means that the environment exerts an
  enormous influence.

12
The issues of obesity

• What has history told us?
• Mixed messages

13
Idolised as a thing of beauty, prosperity and
health
14
A sign of good health
15
Cardiac risk of obesity

• Based on Framingham Heart Study
• Risk of death within study period (26 yrs)
  increases by 1 per pound overweight for 30-42
  year olds
• 2 per pound overweight for 50-62 year olds
• BMI 25-30 equates to 3 years loss of life
• BMI gt30 equates to 7 years loss of life
• BMI gt40 equates to 15 years loss of life
• BMI gt 30 smoking equates to 13 years loss of
  life

16
Risk of type 2 diabetes

• In males increase waist from lt87.5cm to
  gt101.6cm increases risk of type 2 diabetes 12
  fold
• If BMIgt25, risk increases 5 fold
• If BMIgt35, risk increases 93 fold

17
(No Transcript)
18
Obesity Related Comorbidity

• Diabetes mellitus
• Hypertension
• Dyslipidaemia
• Some cancers
• Hypoventilation syndromes (OHS and OSA)
• Asthma
• Gastro-oesophageal Reflux
• Gallstones and NAFLD
• Osteoarthritis
• Abdominal wall herniae
• Neurological disorders
• Androgenisation, polycystic ovaries and
  infertility
• Psoriasis
• Venous stasis and varicose veins
• Affective disorders

19
Pickwickian Syndrome

• Comprises 2 syndromes
• Obesity Hypoventilation Syndrome
• Obstructive Sleep Apneoa
• They often occur together some degree of
  overlap but 2 distinct conditions

20
Obesity Hypoventilation Syndrome

• Restrictive ventilatory failure
• Characterised by daytime hypoxia due to alveolar
  hypoventilation reduced ventilatory excursion
  in the presence of increased requirement
• Progresses to respiratory failure and right heart
  failure
• Diagnosed by arterial blood gas measurement PaO2lt
  or 7.3 kPa (55 mmHg)