Surgical Management of Obesity

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Surgical Managementof Obesity
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Obesity is the great epidemic of the 21st century
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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

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There are Degrees of Obesity
MORBIDLY OBESEBMI 35 39.9
NORMAL BMI 18.5 24.9
OVERWEIGHTBMI 25 29.9
OBESEBMI 30 34.9
Super OBESE BMI ? 50
BMI 50
BMI 30-35
BMI 35-40
BMI 20-25
BMI 25-30
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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 obese BMI 35
• Average Australian weight increasing by
  0.5Kg / 5yrs

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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

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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

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Societal implications of obesity
gt Low self esteem and depression. gt Impaired
employment prospects. gt Increased industrial
accidents. gt Restricted access to public
facilities. gt Relationship difficulties. gt
Societal prejudice.
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Body Mass Index vs. Mortality
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!
Source NIH, NEJM, 1995.
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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 !

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Genetic predisposition
Excess Caloric Intake
Morbid Obesity
Failed diets Failed Medical Rx
Reduced Caloric expenditure
Depression Low self esteem
Obesity illness syndrome
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Australians spend millions of dollars each year
on diets

• For the majority of morbidly obese
• Diets just dont 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.
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Tried and abandoned
gt Jaw wiring gt Hypnosis gt
Acupuncture gt Psychotherapy gt VLC
diets gt Intragastric balloon
And then there is always
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Most medical authoritiesnow agree

• The most effective treatment of Morbid obesity
  is surgery
• It is safe, effective and durable!

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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

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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

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Bariatric Surgeon
Bariatric Assessor
Surgical Assistant
Obese Patient
Dietician
Anaesthetist
Office staff
Exercise Physiologist
Physician
Psychologist
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Who is a candidatefor surgery?

• BMI gt 35
• BMI gt 30 -35 Obesity Co-morbidity
• Age 12- 75
• Reasonable attempts at weight loss gt2yrs
• Ability to comprehend implications ofSurgery
• No Alcohol or Drug Dependency

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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.

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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 lt 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
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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
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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.
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Our patients tell the story
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Lap Band 100.7kg BMI 39.7
Post op 12months 79kg BMI 30.5
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Pre op Lap Band Wt 105kg
Post op 2 years Wt 64kg
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Preop Abdo lipoplasty and Lap band Wt 160kg BMI
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18 Months Post op 107kg BMI 35-53kg / 59 EWL
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Laparoscopic tube Gastrectomy
Preop Jan 2004 144kg BMI 45
Jan 2005 87kg / BMI 27
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Tube Gastrectomy
Pre op 152kg
Post op 1 year 92kg
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Preop BPD 174kg BMI 58
24months 74kg BMI 24 - 100kg 96EWL
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Biliopancreatic Diversion
Post op 84 weeks 82kg BMI 27
Preop 127kg BMI 43
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Preop BPD Oct 2001 Wt 146kg BMI 56
Post op BPD Jan 2003 Wt 85kg BMI 31
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Biliopancreatic Bypass
Preop 189kg
2 yrs / Post op 109kg
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Preop 118kg
Post op / 18 months / 65kg
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Preop Lap BPD Sept 2003 Wt 122Kg BMI 40
Postop Jan 2005 Wt 72Kg (-50Kg 92 EWL) BMI 24
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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

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