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A Beginners Guide To Weight Loss Surgery
Overweight and obesity is a growing problem in modern society. Over half of the population is affected and the consequences are impacting on all aspects of life.
There is growing evidence that our weight is determined more by our genes than it is by the environment we live in. Increasingly the medical profession is viewing obesity as a chronic, relapsing condition. This is because our body is designed to consume food when it is available and to store excess food as fat. Unlike in the past, in the modern world food is readily available. This means we are constantly fighting our body’s natural desire to consume more food than we need. Those people with bodies that are unable to resist this urge will experience weight gain and, ultimately, obesity.
The consequences on our health are well understood. Obesity is causing an increase in Type 2 diabetes of near epidemic proportions, as well as being a major risk factor for cancer, sleep apnoea, heart disease and a host of other illnesses. In addition to these physical problems we also know that it impacts on mental health and quality of life.
If you are struggling to manage your weight through diet and exercise alone, and you want to take back control, there are a number of things you can do. In this ebook we give you an overview of the different treatment options and the things that it’s important to consider for each of them.
About Healthier Weight
About Obesity
Eligibility for treatment
Surgical Treatment options• Gastric Sleeve• Gastric Bypass• Gastric Band
Introduction
Contents
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3
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6 - 8
9 - 10
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13
14
Non-surgical Treatment options• Gastric Balloon• ESG ‘non-surgical sleeve’
Things to consider before surgery
More health benefits of surgery
Recovery after surgery
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Over 15 years we have met thousands of people in clinic, all of whom have followed a unique journey that has brought them to the point where they are ready to consider a weight loss procedure. We treat everyone as an individual.
We choose to view obesity as a health issue first and foremost and it’s precisely because we view it in this way that we are named Healthier Weight.
How did we start?
Healthier Weight was founded in 2004 by Dr David Ashton who was ahead of his time when he foresaw the risk obesity posed to the nation’s health. In response to this he began Healthier Weight and the values he instilled in the company survive today. Two of these are described below.
Data Driven
Above all else we pride ourselves on delivering excellence for our patients and ensuring that our decisions are based on the best available data. We don’t follow trends unless there is compelling evidence that they will deliver better outcomes for our patients.
Medical Heritage and Ethos
Due to our medical heritage and ethos, when you entrust your weight loss procedure to us we take that responsibility very seriously.
About Healthier Weight
It’s important to keep in mind that when you achieve your weight loss goals it will be your success. We consider our role to be that of your coach. We’ll provide all of the tools you need for success and help you to use them. Our entire team is committed to your success and to helping you achieve the health and quality of life benefits that weight loss will bring for you.
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Obesity is defined as a body mass index (BMI) above 30. Morbid obesity is a BMI above 40. BMI is a calculation of your weight in KG and your height in meters squared. The easiest way to calculate your BMI is to go to the BMI checker on our website where you only need to enter your height and weight and it does the rest for you.
In the UK there are over 15 million adults who are now classified as obese and nearly 3 million who are morbidly obese, and both numbers are increasing rapidly.
We know that obesity places you at an increased risk from several diseases, including heart disease, some cancers and type 2 diabetes to mention just a few. The effect is that life expectancy is shortened, and the higher your BMI the more your life expectancy is reduced. Indeed, when your BMI gets above 40 the risk to your health ramps up very quickly.
What is Obesity?
3.3 MillionPeople in the UK with Type 2 Diabetes as a result of their weight.
2.6 MillionPeople in the UK eligible for weight loss surgery
5084Number of weight loss procedures done on the NHS in 2016
3rd HighestThe UK has the third highest obesity rate in Europe.
15 Million15 Million adults in the UK are classified as obese. Did you know the NHS only did 5084 weight loss procedures in 2016?*
*Data taken from ‘thebmj.com’, ‘Why the NHS should do more Bariatric Surgery’. Welbourne et al 2016
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Our services are designed for people who have exhausted diet and exercise programmes alone as a way to take back control of their weight. Most of the people we meet have tried multiple diets and often achieved success for short periods before the weight comes back. If this is a cycle that you recognise, and you are ready to try something different to break it, we have a range of solutions available to help you. There are two types of treatment to consider:
Your Treatment Options
Surgical proceduresGastric band, gastric sleeve and gastric bypass.
Non-surgical proceduresESG ‘Non-surgical sleeve’ and gastric balloon.
Your Eligibility Criteria
Generally speaking, you are eligible for the obesity treatments we offer if you meet the following criteria:
Important: The BMI criteria varies by type of procedure. If you are exploring a non-surgical procedure, then the minimum BMI is 27, whereas this increases to 30 for the gastric band and ESG and to 35 for the gastric sleeve and gastric bypass. The ultimate decision on your eligibility will be made by the consulting surgeon based on your own personal circumstances. These BMI criteria must therefore be viewed as guideline only.
You have tried to manage your weight using diet and exercise aloneYour weight is having a negative impact on your day to day life. This impact could be due to a weight related health condition such as Type 2 Diabetes, due to joint pain, low mood or something else.You have a body mass index of 27 or above – see important note below.
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Criteria in the NHS requires a higher BMI. In addition, most NHS Trusts further restrict procedure numbers by adding additional requirements. You would for example, probably need to have a weight related disease.
There is also a requirement to follow an NHS weight loss programme (called Tier 3) for a minimum of 6 months. This can be very difficult to adhere to. In some parts of the country smokers are also ineligible for NHS treatment.
The result is that a very small number of procedures, just a few thousand per year, take place in the NHS. In reality, it is likely that you will need to be morbidly obese (BMI 40+) and suffering from a weight related disease to be eligible for surgery in the NHS. In addition, those few people who are eligible will find that waiting lists are generally very long meaning people often wait more than two years from the date that their GP refers them for treatment.
Eligibility Criteria in the NHS
When you choose a private weight loss procedure you can usually proceed with surgery within a few weeks of contacting us.
There is evidence to show that your life expectancy is reduced when you have a BMI above 30. The risk your weight poses to your health and life expectancy accelerates as your BMI increases.
We will consider surgery for anyone with a BMI above 30 depending on their individual circumstances. Your eligibility for surgery will ultimately reside with the operating surgeon based on your consultation.
Get Seen Sooner With Healthier Weight
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Check your BMI here
Gastric Sleeve
The gastric sleeve is now the most common form of weight loss surgery across the world. It is a powerful procedure that suppresses the appetite and patients can expect to lose most of their excess weight and quickly.
The gastric sleeve works in two ways:
Firstly, by restricting the amount you can eat.
A large part of the stomach is removed during surgery leaving a smaller, narrower stomach that looks like a ‘sleeve’. In total about 80% of the original stomach is removed.
Secondly, by impacting on gut hormones.
Levels of the hormone Ghrelin fall after sleeve surgery, which explains why patients experience a marked change and reduction in appetite. Sleeve patients report major changes in taste and food preferences towards a healthier diet. This also aids weight loss.
How much weight will I lose with the gastric sleeve?
We expect sleeve patients to achieve about 70% excess weight loss over a 2 year period.
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2
BMI:35+
Surgical Treatments
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Gastric BypassThe gastric bypass is generally regarded as the king of weight loss procedures. It is long established and proven to be both safe and effective. Patients can expect to lose about 70% of their excess weight over 2 years and most of this weight loss is maintained for the long term.
The bypass requires division of the stomach and the bowel. Unlike the sleeve, none of the stomach is removed but food is routed differently (more quickly) through a smaller stomach into the bowel. Time in surgery is about 1 hour 15 minutes. Not only does the bypass deliver excellent weight loss results but it is also the most effective procedure for reversing weight related health problems.
The gastric bypass works in two ways:
Reducing the size of the stomach that the food you eat enters, thus restricting your eating capacity.
Changing the balance of gut hormones in the stomach to suppress and change your appetite.
There are two types of gastric bypass. The most common version and the one favoured for the vast majority of patients in the UK is the Roux-en-Y bypass. A variation called the mini-bypass (or loop bypass) is an alternative. The weight loss for both is similar but the eligibility criteria differ as do the complications that can arise after surgery. We have produced a video which explains the bypass in a little more detail. You can watch it here.
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BMI:40+
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The gastric band is the most well known form of weight loss surgery in the UK. The band is a good option for people who want a less invasive procedure that is reversible and can be done as a day case.
How does the gastric band work?
The gastric band works by encouraging a feeling of fullness on a smaller portion when you eat foods of the right texture slowly.
How is the gastric band performed?
A silicone band is placed around the top of the stomach to create a small stomach ‘pouch’ above the band with the larger stomach below. The food you eat passes into the smaller stomach above the band before quickly squeezing ‘through’ the band into the larger stomach. It is this squeezing that encourages an earlier feeling of fullness, but you must eat slowly to recognise this.
How much weight will you loose?
In addition to being the safest form of weight loss surgery it is also very effective. On average we expect patients to lose about half of their excess weight over a 2 year period (most in year one) and for most of that weight loss to be sustained over the long term.
Gastric Band
BMI:30+
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BMI:27+
The gastric balloon is a temporary treatment in which a small balloon is placed into the stomach and filled with saline. It stays in place for 6 or 12 months before being removed.
How is the gastric balloon inserted?
The balloon requires a simple 20 minute, non-surgical day case procedure. Under sedation, a silicone made balloon is placed in the stomach and filled with saline. It typically occupies about half of the stomach, thus reducing your capacity to eat and making you feel full sooner. It is removed after 6 or 12 months (you can choose a 6 or 12 month balloon).
How does the gastric balloon work?
The gastric balloon is designed to be a kick start to weight loss by creating a period during which you can make changes to your diet, eating habits and exercise that will persist after the balloon is removed.
People who follow the diet and exercise recommendations while the balloon is in place can expect to lose 2-3 stone on average. To maintain that weight after the balloon is removed requires that you continue the diet and exercise habits that have been instilled while the balloon was in. If you are unable to do this then weight will be regained.
Non-Surgical Treatments
Gastric Balloon
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ESG ‘Non-surgical Sleeve’
ESG stands for Endoscopic Sleeve Gastroplasty. It’s a non-surgical procedure during which the stomach is stitched, from the inside, along its length. The effect is to create a narrower stomach of a similar shape to that left after surgical sleeve. This has led to the ESG becoming known as the ‘non-surgical sleeve’.
The procedure is relatively new and we did the first ever case in the UK in 2015. Results have been encouraging with weight loss after 2 years similar to that with the gastric band at 50-60% of your excess weight. The early indications are that most of this weight loss is maintained after 5 years.
How is the ESG performed?
Although the ESG is a non-surgical procedure it is done under general anaesthetic. The procedure takes about 1 hour and most patients will stay in hospital for one night after surgery.
How does the ESG work?
BMI:35+
It reduces the speed at which food empties from the stomach. This means you feel satisfied on smaller portions, and
It reduces your stomach capacity (in a similar way to the surgical sleeve).’
If your weight is not yet affecting your health, you want to avoid surgery and you are seeking a low risk procedure with a short recovery period then ESG is a good option.
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Considerations Before Undergoing Weight Loss SurgeryMost of our patients tell us that they had been contemplating surgery for a long time, sometimes years. We fully understand that it is not a decision people take lightly, and we will support you through the decision making process to make the best decision for you. Here are some of the things we consider important for you to think about when deciding on a procedure. The list is not exhaustive but hopefully you’ll find it helpful.
Vitamins and MineralsWe recommend that all patients take vitamin and mineral supplements. Studies show that most of us are vitamin and mineral deficient in some way regardless of our weight.
The requirement for supplements is greater after gastric sleeve and particularly gastric bypass. You will also need to undergo blood tests at regular intervals to monitor your vitamin and mineral well being.
RefluxAcid reflux is a side effect of the gastric sleeve procedure. It can also occur in those gastric bypass patients who have a mini-bypass procedure.(Not Roux)
Patients with gastric band will sometimes experience symptoms similar to reflux but they are more likely to be due to the band being too tight.
Pre-Op dietFor all of the surgical procedures there will be a requirement to follow a pre-operative diet. This makes it easier for your surgeon to access your stomach by shrinking the size of the liver (the left lobe of the liver sits across the stomach). The pre-op diet is a low calorie diet and we’ll give specific advice on what to include.
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Risks and ComplicationsAll surgery brings with it risk. We do everything possible to reduce risk but it cannot be eradicated altogether. It is important to understand what they are and they will be discussed in detail at your weight loss surgery consultation
Health BenefitsWeight loss surgery is linked to a wide range of health and quality of life benefits. You will be contemplating surgery precisely because you want to realise these benefits for your personally.
When we meet you for consultation we’ll explain your options in detail and help you to come to the best decision for you personally.
Weight Loss ExpectationsThe figures below are averages based on multiple published studies.
Gastric Balloon
Gastric Band
Gastric Bypass
Gastric Sleeve
ESG
25-35%Excess weight
40-60%Excess weight
65-75%Excess weight
65-75%Excess weight
50-60%Excess weight
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Other Health Benefits
It is impossible to predict weight loss outcomes for individuals. The figures shown on the previous page are averages based on published data and individual results will vary.
Important Information
Major improvements in health problems related to obesity. Bypass remains the best procedure for resolution of weight related health problems.
Improvement in long-term mortality – Patients live longer
Most cases of Type II diabetes are cured (in remission) (gastric bypass)
Cholesterol improvements (all procedures)
Hypertension (all procedures)
Cancer risk reduced (especially female cancers) (all procedures)
Cases of sleep apnoea resolved or improved (all procedures)
Mobility improves and joint pain decreases (all procedures)
Overall mental health
Here is a longer list of the health benefits that can be expected after weight loss surgery. We have seen transformational changes to our patients lives, to read some of these amazing, life changing stories, download some of our case studies here.
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Check your BMI here
Recovery After Bariatric SurgeryMost people recover quickly after weight loss surgery and feel ready to go back to normal activities after a few days. It is important to remember though that you have had an operation and to take it steady for a few weeks, while you adjust.
Will There be ScarringYou will have a number of small horizontal scars, normally 5, on your abdomen after surgery. They are typically 5-10mm long. We will advise you how to manage your wounds through the healing process.
Will I Need To Exercise?Gentle outdoor exercise is important as well as getting plenty of sleep and keeping your fluids up. You should gradually try to increase your exercise until you are walking for 30 minutes per day. You should aim to walk at a speed that makes you slightly short of breath and sweaty.
Driving - You cannot drive for 72 hours after your general anaesthetic. Once beyond this period you may drive.
Post-Op DietYou will also need to follow a post-operative diet regime in the weeks following your procedure. The length of the diet can vary by procedure and consists of three stages - liquid, puree and solid food.
The diet allows time for your stomach to recover and surrounding tissue to heal and minimises complications e.g. retching and vomiting.
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Get a free quote
Clinics Located across the UK, in:
LondonBirminghamCardiffGatwickGlasgowLeedsMaidstoneManchester
NewcastleNottinghamShrewsburySouthamptonWolverhamptonBelfastThames Valley
Contact Us0800 313 4618
Alternatively, come and see one of our world class surgeons by booking your FREE consultation. Book now and one of our dedicated patient care team will be in touch.
The Importance of Long-term Aftercare and SupportWhen you choose your weight loss surgery provider you are choosing a partner for life. The surgery itself is the first part of a long process but it is aftercare which is the key to your success. Whatever procedure you undergo, your long-term support and commitment from a dedicated weight team is crucial. This cannot be overstated.
We provide access to an emergency helpline and to specialist support from weight loss nurses, dietitians, psychologists, anesthetists and surgeons. We regard our patients as patients for life and expect to be there to help you whenever you need it.
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