Surgical Management of Obesity


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Surgical Management of Obesity

  1. 1. Surgical Management of Obesity
  2. 2. Obesity is the great epidemic of the 21 st century
  3. 8. How do we Grade obesity ? <ul><li>The most useful measure is BMI : </li></ul><ul><li>Wt (Kilograms) / Height (Metres) 2 </li></ul><ul><li>This is a measure of both weight and height </li></ul><ul><li>It takes into account that the taller you are: </li></ul><ul><li>The more weight you can safely carry </li></ul>
  4. 9. 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+
  5. 10. Australia is the second most obese nation in the world <ul><li>50% Australians are overweight BMI 25-30 </li></ul><ul><li>8% Australians are obese BMI 30-35 </li></ul><ul><li>2-4% Australians are Morbidly obese BMI 35 + </li></ul><ul><li>“ Average “ Australian weight increasing by 0.5Kg / 5yrs </li></ul>
  6. 11. Obesity is a major cause of these obesity related illness <ul><li>Type 11 Diabetes </li></ul><ul><li>Hypertension </li></ul><ul><li>Sleep apnoea </li></ul><ul><li>Asthma </li></ul><ul><li>Infertility </li></ul><ul><li>Arthritis </li></ul><ul><li>Fatty liver </li></ul><ul><li>The good news is… All of these conditions will resolve or improve with significant weight loss </li></ul>
  7. 12. For the first time this century <ul><li>Our children will live less long than us </li></ul><ul><li>Diabetes rates are skyrocketing </li></ul><ul><li>Children as young as 12 are taking the same tablets for diabetes as their Grandmothers </li></ul><ul><li>… all because of Obesity </li></ul>
  8. 13. > Low self esteem and depression. > Impaired employment prospects. > Increased industrial accidents. > Restricted access to public facilities. > Relationship difficulties. > Societal prejudice. Societal implications of obesity
  9. 14. Body Mass Index vs. Mortality 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! 16 19 22 25 28 31 34 37 40 45 0 50 100 150 200 250 300 350 400 High risk Medium risk Low risk Relative Mortality Rate BMI (kg/m 2 )
  10. 15. Obesity is not just an eating disorder! <ul><li>It is a complex relationship between </li></ul><ul><li>Genetic predisposition </li></ul><ul><li>Increased caloric intake </li></ul><ul><li>Reduced caloric expenditure </li></ul><ul><li>We all live in a “Toxic Obesogenic” environment ! </li></ul>
  11. 16. Excess Caloric Intake Morbid Obesity Genetic predisposition Reduced Caloric expenditure Depression Low self esteem Failed diets Failed Medical Rx Obesity illness syndrome
  12. 17. Australians spend millions of dollars each year on diets <ul><li>For the majority of morbidly obese …… </li></ul><ul><li>Diets just don’t work </li></ul>“ 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.
  13. 18. Tried… and abandoned > Jaw wiring > Hypnosis > Acupuncture > Psychotherapy > VLC diets > Intragastric balloon And then there is always
  14. 19. Most medical authorities now agree <ul><li>The most effective treatment of Morbid obesity… is surgery </li></ul><ul><li>It is safe, effective and durable! </li></ul>
  15. 20. Bariatric surgery is not just about the surgery! <ul><li>The best results are achieved with a Multidisciplinary team </li></ul><ul><li>Surgery is an aid to weight loss </li></ul><ul><li>It still requires effort and commitment by the patient </li></ul>
  16. 21. At Mercy Bariatrics we have developed: <ul><li>A dedicated Bariatric team of health professionals </li></ul><ul><li>Diet and exercise programmes to compliment the surgical procedures </li></ul><ul><li>Educational and support services to guide you through the surgical programme </li></ul>
  17. 22. Obese Patient Bariatric Surgeon Bariatric Assessor Surgical Assistant Office staff Exercise Physiologist Physician Dietician Anaesthetist Psychologist
  18. 23. Who is a candidate for surgery? <ul><li>BMI > 35 </li></ul><ul><li>BMI > 30 -35 + Obesity Co-morbidity </li></ul><ul><li>Age 12- 75 </li></ul><ul><li>Reasonable attempts at weight loss >2yrs </li></ul><ul><li>Ability to comprehend implications of Surgery </li></ul><ul><li>No Alcohol or Drug Dependency </li></ul>
  19. 24. Surgical Choices <ul><li>There are many different operations for obesity. </li></ul><ul><li>There is no single operation which is right for all people </li></ul><ul><li>Each operation has advantages and disadvantages </li></ul><ul><li>Choosing the right operation is the most important step towards successful outcomes. </li></ul><ul><li>At Mercy Bariatrics we have focussed on three main types of surgery. </li></ul>
  20. 25. Lap band <ul><li>A reductive and restrictive operation </li></ul><ul><li>Adjustable silicone band </li></ul><ul><li>Placed around top part of stomach by keyhole surgery </li></ul><ul><li>Decreases intake to an entrée portion </li></ul><ul><li>Prolongs satiety and decreases appetite </li></ul><ul><li>2 days in hospital back at work in < 1 week </li></ul><ul><li>Safe, reliable, effective </li></ul><ul><li>Over 20, 000 procedures throughout Australia </li></ul>Usual weight loss: 50-60% of excess weight lost over 1-2yrs
  21. 27. Laparoscopic Tube Gastrectomy <ul><li>A purely reductive operation </li></ul><ul><li>Reduces stomach to a 150-200mls tube </li></ul><ul><li>Normal emptying so you can eat a wider range of food </li></ul><ul><li>A set and forget operation </li></ul><ul><li>No adjustments required </li></ul><ul><li>No malabsorption </li></ul><ul><li>No long term side effects </li></ul><ul><li>Bypass can be added later for extra weight loss </li></ul>Predicted weight loss: 50-70 % EWL over 1-2 years
  22. 28. Biliopancreatic Bypass - DS <ul><li>A reductive and Fat malabsorbtion operation </li></ul><ul><li>Profound and rapid improvement in diabetes and high cholesterol </li></ul><ul><li>Open surgery so requires longer to recover </li></ul><ul><li>Best weight loss of all procedures </li></ul><ul><li>Good revisional option </li></ul><ul><li>Lifelong mineral and vitamin supplements required </li></ul>Predicted weight loss: 70-90% EWL over 1-2 years
  23. 29. Results from surgery… <ul><li>Type 11 diabetes resolved in 70-90% </li></ul><ul><li>Hypertension resolved in 70-80% </li></ul><ul><li>Sleep apnoea resolved in 80-90% </li></ul><ul><li>Asthma improved in 70% </li></ul><ul><li>Significant improvement in Depression and quality of life scores </li></ul>80% of our patients achieve more than 50% of excess weight loss over 2years.
  24. 30. Our patients tell the story…
  25. 31. Lap Band 100.7kg BMI 39.7 Post op 12 months 79kg BMI 30.5
  26. 32. Pre op Lap Band Wt 105kg Post op 2 years Wt 64kg
  27. 33. Preop Abdo lipoplasty and Lap band Wt 160kg BMI 52
  28. 34. 18 Months Post op 107kg BMI 35-53kg / 59% EWL
  29. 35. Laparoscopic tube Gastrectomy Preop Jan 2004 144kg BMI 45 Jan 2005 87kg / BMI 27
  30. 36. Pre op 152kg Post op 1 year 92kg Tube Gastrectomy
  31. 37. Preop BPD 174kg BMI 58 24 months 74kg BMI 24 - 100kg 96%EWL
  32. 38. Preop 127kg BMI 43 Post op 84 weeks 82kg BMI 27 Biliopancreatic Diversion
  33. 39. Preop BPD Oct 2001 Wt 146kg BMI 56 Post op BPD Jan 2003 Wt 85kg BMI 31
  34. 40. Preop 189kg 2 yrs / Post op 109kg Biliopancreatic Bypass
  35. 41. Preop 118kg Post op / 18 months / 65kg
  36. 42. Preop Lap BPD Sept 2003 Wt 122Kg BMI 40 Postop Jan 2005 Wt 72Kg (-50Kg 92% EWL) BMI 24
  37. 43. How do I get started? <ul><li>Talk to your G.P. about the surgical options </li></ul><ul><li>Attend one of our free information evenings </li></ul><ul><li>Visit us at Mercy Bariatrics </li></ul><ul><li>Check out our website </li></ul><ul><li> </li></ul>