Fight obesity with effective and guaranteed tools

t

Haitham Al-Khayat, MDConsultant general and bariatric

surgeon

New Dar Al-Shifa hospital

Obesity

Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health, leading to reduced life expectancy and/or increased health problems.

Obesity is the 2nd most common cause of death from a modifiable behavioral risk factor

Obesity related comorbidity• Type II DM• Hypertension• Cardiac diseases• Strokes• Hyperlipidemia• Respiratory

diseases• Degenerative

osteorthritis

• Depression• GERD• Nephrotic

syndrome• Infertility• Venous stasis

ulcers• Pseudotumor

cerebri

Causes of obesity

Genetics Behavior

Environment

Environment portion size

Nonoperative treatment how does it add up??

Nonoperative treatment how does it add up??

DietExerciseBehavioral therapy

+ Drug therapy .

??????

Why Surgery?

• Diet and exercise are not effective long term in the morbidly obese

• Surgery is an accepted and effective approach

• Surgical risk is acceptable vs. risk of long-term obesity

Surgery is effective

Pre-operative Medications Post-operative Medications

Surgery is effective

Surgical treatment of obesityIndication of surgical options

Patient selection

BMI ≥ 40 kg/m2 ORBMI 35 - 40 kg/m2 with significant

comorbidityHigh risk health problems Ineffective documented dietary attempt

The Gastrointestinal system

Operative approaches

Restrictive Procedures Adjustable silastic gastric banding (ASGB) Sleeve gastrectomy Gastric plication

Combined Procedures Roux-en-Y gastric bypass ( GBP )

Lap Band

• Restrictive• Reversible• 40-55% EBW

loss

Lap sleeve gastrectomy

• Restrictive• Very popular in

Kuwait• 60-70% EBW

loss• Relatively new

with unknown long term consequences

Roux En Y gastric bypass

• First done in 1967

• 60-70% EBW 14 year followup

Results of bariatric surgery

• Weight loss• Resolution or improvement in

comorbidity• Increased longevity• Improved QOL

Health Social Personal Work

General Complications of Weight-Loss Surgery

• Post-operative depression• Food issues• Changes in relationships

• Hair loss• Usually temporary• Cause: protein, vitamin A, mineral

• Excess skin

Weight loss program team

• Surgeon• Nurse practitioner• Dietitian• Anesthesiologist• Nurses• Cardiologist

SAFETY and RESULTS

Final words

* Surgery is only a tool

* Patients must commit to lifelong changes in diet and behavior

* Think seriously about options

* We are here to help

Defining the Problem

The Problem• Prevalence of obesity in U.S. increased from 12%

to 21% between 1991 and 2001 = 15 million people

• Obesity is the 2nd most common cause of death from a modifiable behavioral risk factor• 111,909 excess deaths annually

Mokdad AH et al. JAMA. 2003;289:76-79Flegal KM et al. JAMA 2005;293:1861-1919

Excess U.S. Medical Costs Related to Abnormal Body Weight

Int J Obesity 2005;29:334-339

Diabetes Gall bladder diseaseHypertensionDyslipidemiaInsulin resistanceBreathlessnessSleep apnea

Greatly increased(relative risk >>3)

Coronary heart diseaseOsteoarthritis (knees)Hyperuricemia and gout

Cancer (breast cancer in postmenopausal women, endometrial cancer, colon cancer)Reproductive hormone abnormalitiesPolycystic ovary syndromeImpaired fertilityLow back painIncreased anesthetic riskFetal defects arising from maternal obesity

Moderately increased(relative risk 2-3)

Slightly increased(relative risk 1-2)

Relative risk of health problems associated with obesity

1Chan JM et al. Diabetes Care 1994;17:961-969; 2Colditz G et al. Ann Intern Med 1995;122:481-486.

Age-adjusted relative risk of type 2 diabetes

The Effect of Obesity on the Development of Health Risks

0

10

20

30

40

50

1.02.2

12

42

0

25

50

75

100

1.08.1

40

93

<23 25 31 35 <22 25 31 35

Men1 Women2

BMI

Fed up with how her diet is going Charlene takes a more serious aim at her target weight

Weight Maintenance after Bariatric Surgery

Sjöström L, Lindroos AK, Peltonen M et al. N Engl J Med. 2004;351:26

Conclusions• Bariatric surgery is an effective means to

achieve clinically significant, permanent weight loss with low rates of complications.

• Bariatric surgery results in significant improvement in health risks associated with obesity.

• Surgical weight loss increases life-span.• Surgical therapy is cost-effective.