Understant what is obesity and Bariatric Surgery, what are the risk factors and how to overcome on the it. For more information visit at http://gisurgery.info

1. Obesity and
Bariatric Surgery
Dr. Sanjiv Haribhakti
MS,DNB,MCh(G.I surgery)
Chairman
Kaizen Hospital, Ahmedabad

2. 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

3. 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

4. India 2015 !!

5. Patient Awareness
 Health consciousness
 Knowledge of complications
 access to internet , reading
 Availability of less painful, laparoscopic surgery , with
speedy recovery

6. How to Decide , Define?
 BMI , universal assessment tool

7. 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)

8.  overweight
BMI - 25 to 30
 obese
BMI - 30 - 40
 Morbidly Obese
BMI > 40
Assesment

9. Risk factors of obesity
 Obesity itself is a disease

10. The health risks of obesity

11. FRIENDSTOGETHER
Metabolic Syndrome Syndrome X
 Abdominal obesity
 D M Type II
 Dyslipidemia
 Hypertension

12. 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

13. High blood pressure
 High blood
pressure is twice
as common in
obese adults

14. 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

15. Arthritis
 Your risk of arthritis
increases by 9 - 13% for
every 1 kg of weight that
you gain

16. Breathing problems
 Asthma and obstructive
sleep apnea are more
common in obese people.
 Mechanical and
inflammatory reasons

17. 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

18. Gallbladder stones
 ExcessWeight increase
the chances of getting
Gall bladder stones

19. GastrointestinalTract
 GERD
 Nonalcoholic fatty liver diseases from steatosis ,
fibrosis to cirrhosis –30 to 100% in obese patients

20. 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

21. 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

22. TraditionalWeight
LossTherapies

23. Diet

24. Exercise

25. Lifestyle Habits

26. Key to success
 Assesment of obesity
 Target with timeline
 Comittemnt
 Consistency
 Under proper guidence
 Regular reassesment
 ??? Difficult

27. Is there a better option?
 Yes ,
 Better
 Proven
 Consistent
 Minimal invasive

28. Surgery for
Weight Loss

29. Current Bariatric Surgical Procedures
 Restrictive
◦ Sleeve Gastrectomy
◦ Laparoscopic Adjustable Gastric Banding
 Malabsorptive
◦ Duodenal Switch / Biliopancreatic Diversion
 Restrictive and Malabsorptive
◦ Roux-en-Y Gastric Bypass

30. Who is a candidate for
surgery?

31. 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

32. 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

33. 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.

34. 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

35. BMI – 61.7 kg/m2

37. 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

38. 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

39. 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

40. 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.

42. 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.
Treatment
Average 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%

45. Only surgery has proven effective over the long
term for most patients with clinically severe
obesity

46. 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

47. Myth - surgery for weight loss means
liposuction

48. SurgeryWill NotWork Alone…
Commitment to Diet & Exercise

49. KAIZEN OBESITY CLINIC
 Every Friday 4 p.m. to 6 p.m.
 Multidisciplinary consultation
 Obesity surgery Counseling
 Support group meeting
 Public awareness program

50. 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

51. Thank You